上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2022 , Vol. 42 >Issue 7: 893 - 897

DOI: https://doi.org/10.3969/j.issn.1674-8115.2022.07.007

论著 · 临床研究

预防性拔除下颌第三磨牙牙胚的临床研究

  • 李晨琳 ,
  • 李岩 ,
  • 徐光宙
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  • 1.上海市徐汇区牙病防治所口腔颌面外科，上海 200032
    2.上海交通大学医学院附属第九人民医院口腔外科，上海交通大学口腔医学院，国家口腔医学中心，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海 200011
李晨琳（1993—），女，住院医师，硕士；电子信箱：1342160590@qq.com。
徐光宙，电子信箱：xgzmy@163.com。

收稿日期: 2022-03-19

  录用日期: 2022-07-08

  网络出版日期: 2022-09-04

基金资助

浦东新区卫生和计划生育委员会卫生计生科研项目(PW2018D-08);上海申康医院发展中心临床科技创新项目(SHDC12019X01)

收起

Clinical study of preventive extraction of impacted mandibular third molar germ

  • Chenlin LI ,
  • Yan LI ,
  • Guangzhou XU
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  • 1.Department of Oral Surgery, Shanghai Xuhui District Dental Center, Shanghai 200032, China
    2.Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
XU Guangzhou, E-mail: xgzmy@163.com.

Received date: 2022-03-19

  Accepted date: 2022-07-08

  Online published: 2022-09-04

Supported by

Health and Family Planning Scientific Research Project of the Health and Family Planning Commission of Pudong(PW2018D-08);Clinical Science and Technology Innovation Project of Shanghai Shenkang Hospital Development Center(SHDC12019X01)

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摘要

目的·研究预防性拔除有阻生倾向的下颌第三磨牙（mandibular third molar，M3M）牙胚的短期和远期临床效果。方法·选取2018年9月—2020年4月在上海交通大学医学院附属第九人民医院口腔外科就诊的患者，有阻生倾向的M3M牙胚纳入试验组，共计21例；同时纳入21例完全骨埋伏阻生的牙根发育完全的M3M作为对照组。2组均采用超声骨刀、气动手机进行分牙拔除M3M，分别于术后1 d、3 d、7 d、3个月、6个月随访，比较2组拔牙时间、下颌第二磨牙 （mandibular second molar，M2M）远中骨缺损深度（bone defect depth，BDD）、探诊深度（probing depth，PD）、菌斑指数（plaque index，PLI）、牙龈指数（gingival index，GI）、疼痛程度 （视觉模拟评分法，visual analog score，VAS）、肿胀程度、张口受限程度、不良反应等。采用IBM SPSS Statistics 25软件进行统计分析，定量资料以x±s表示，采用独立样本t检验、Mann-Whitney U检验比较2组的主要结局和次要结局的组间差异；采用Kruskal-Wallis H检验分析主要结局的组内变化，进一步组内两两比较采用Mann-Whitney U检验。P<0.05表示差异有统计学意义。结果·试验组手术时间为（7.62±1.50） min，对照组手术时间为（10.76±2.21）min，2组的手术时间比较差异有统计学意义（P=0.000）。术后6个月，试验组BDD为（0.65±0.33）mm，对照组BDD为（2.49±1.37）mm，2组BDD、PD、PLI、GI比较差异有统计学意义（P=0.000，P=0.012，P=0.011，P=0.042）。2组术后6个月的BDD较术前显著增加，且差异有统计学意义（P=0.009，P=0.000）。2组术后3d的VAS比较差异有统计学意义（P=0.044）。在术后1、3、7 d复诊时段，2组肿胀程度比较差异有统计学意义（P=0.005，P=0.031，P=0.019）。对照组发生1例下牙槽神经损伤，其余患者均未发生出血、神经损伤、干槽症等不良反应。结论·预防性拔除有阻生倾向的M3M牙胚，手术时间缩短，术后局部反应小，术后M2M远中牙周状况佳，能够获得较好的远期临床效果。

关键词： 下颌第三磨牙; 拔牙; 下颌第二磨牙; 骨缺损; 牙周指数

本文引用格式

李晨琳 , 李岩 , 徐光宙 . 预防性拔除下颌第三磨牙牙胚的临床研究[J]. 上海交通大学学报（医学版）, 2022 , 42(7) : 893 -897 . DOI: 10.3969/j.issn.1674-8115.2022.07.007

Abstract

Objective

·To study the short-term and long-term clinical effect of preventive extraction of mandibular third molar (M3M) germ with impaction tendency.

Methods

·From September 2018 to April 2020, 21 cases of M3M germs with impaction tendency were included in the experimental group at the Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. At the same time, 21 adult M3Ms which were completely impacted were included as the control group. M3Ms were extracted by ultrasonic osteotome and turbine drill. The patients were followed up 1 d, 3 d, 7 d, 3 months and 6 months after surgery. The surgery time, bone defect depth (BDD), probing depth (PD), plaque index (PLI), gingival index (GI), pain degree (visual analog score, VAS), degree of swelling, mouth opening restriction degree, and adverse reactions were compared between the two groups. IBM SPSS statistics 25 software was used for statistical analysis, and the quantitative data were expressed in x±s. The independent sample t-test or Mann-Whitney U test was used for the comparison between the two groups in primary and secondary outcomes. Kruskal-Wallis H test was used to analyze the intragroup changes of the primary outcomes, and Mann-Whitney U test was used for further pairwise comparison within the group. Statistical significance was accepted at a value of P<0.05.

Results

·The surgery time of the experimental group was (7.62±1.50) min and that of the control group was (10.76±2.21) min. There was a significant difference in the surgery time between two groups (P=0.000). The BDD of the experimental group was (0.65±0.33) mm and that of the control group was (2.49±1.37) mm at 6 months after surgery. There were significant differences in BDD, PD, PLI and GI between the two groups at 6 months after surgery (P=0.000, P=0.012, P=0.011, P=0.042). The BDD of the two groups at 6 months after surgery was significantly higher than that at baseline, and the difference was statistically significant (P=0.009, P=0.000). There was a significant difference in VAS between the two groups at 3 d after surgery (P=0.044). At each follow-up period after surgery, there was a significant difference in the degree of swelling between the two groups (P=0.005, P=0.031, P=0.019). In the control group, 1 case of inferior alveolar nerve injury occurred, and the other patients did not have adverse reactions such as bleeding, nerve injury, dry socket disease, etc.

Conclusion

·Preventive extraction of M3M germ with impaction tendency can shorten the surgery time, and reduce postoperative reaction, which can obtain better long-term clinical effect compared with adult impacted M3M extraction.

Key words： mandibular third molar; tooth extraction; mandibular second molar; bone defect; periodontal index

参考文献

1 PETSOS H, KORTE J, EICKHOLZ P, et al. Surgical removal of third molars and periodontal tissues of adjacent second molars[J]. J Clin Periodontol, 2016, 43(5): 453-460.
2 KIM J Y. Third molar extraction in middle-aged and elderly patient[J]. J Korean Assoc Oral Maxillofac Surg, 2021, 47(5): 407-408.
3 KIM J Y, YONG H S, PARK K H, et al. Modified difficult index adding extremely difficult for fully impacted mandibular third molar extraction[J]. J Korean Assoc Oral Maxillofac Surg, 2019, 45(6): 309-315.
4 KIM J Y, JEE H G, SONG H C, et al. Clinical and pathologic features related to the impacted third molars in patients of different ages: a retrospective study in the Korean population[J]. J Dent Sci, 2017, 12(4): 354–359.
5 NGUYEN E, GRUBOR D, CHANDU A. Risk factors for permanent injury of inferior alveolar and lingual nerves during third molar surgery[J]. J Oral Maxillofac Surg, 2014, 72(12): 2394-2401.
6 SELVI F, DODSON T B, NATTESTAD A, et al. Factors that are associated with injury to the inferior alveolar nerve in high-risk patients after removal of third molars[J]. Br J Oral Maxillofac Surg, 2013, 51(8): 868-873.
7 LIU D X, WANG L, ZHAO J H, et al. Extraction of impacted mandibular third molar germs and impacted mandibular third molar: a comparative study[J]. J Oral Sci Res, 2015, 31(9): 60-62.
8 GE J, YANG C, ZHENG J, et al. Autogenous bone grafting for treatment of osseous defect after impacted mandibular third molar extraction: A randomized controlled trial[J]. Clin Implant Dent Relat Res, 2017, 19(3): 572-580.
9 HU D Y. Preventive dentistry[M]. 6rd. Beijing: People's Medical Publishing House, 2012: 22-24.
10 SCOTT J, HUSKISSON E C. Graphic representation of pain[J]. Pain, 1976, 2(2): 175-184.
11 MARIA A,MALIK M,VIRANG P. Comparison of primary and secondary closure of the surgical wound after removal of impacted mandibular third molars[J]. J Maxillofac Oral Surg, 2012, 11(3): 276-283.
12 ZHAO J H. New techniques of modern alveolar surgery[M]. Beijing: People's Medical Publishing House, 2015: 115-118.
13 BLAKEY G H, JACKS M T, OFFENBACHER S, et al. Progression of periodontal disease in the second/third molar region in subjects with asymptomatic third molars[J]. J Oral Maxillofac Surg, 2006, 64(2): 189-193.
14 KUGELBERG C F, AHLSTROM U, ERICSON S, et al. Periodontal healing after impacted lower third molar surgery in adolescents and adults. A prospective study[J]. Int J Oral Maxillofac Surg, 1991, 20(1): 18-24.
15 ANIKO-W?ODARCZYK M, JARO? A, PREUSS O, et al. Evaluation of the effect of surgical extraction of an impacted mandibular third molar on the periodontal status of the second molar-prospective study[J]. J Clin Med, 2021, 10(12): 2655.
16 VIGNUDELLI E, MONACO G, GATTO M R, et al. Periodontal healing distally to second mandibular molar after third molar coronectomy[J]. J Oral Maxillofac Surg, 2017, 75(1): 21-27.
17 STELLA P E M, FALCI S G M, OLIVEIRA DE MEDEIROS L E, et al. Impact of mandibular third molar extraction in the second molar periodontal status: a prospective study[J]. J Indian Soc Periodontol, 2017, 21(4): 285-290.
18 PASSARELLI P C, ROMEO A, LOPEZ M A, et al. Evaluation of the periodontal healing of the second mandibular molar distal site following insertion of PRF in the third molar post extraction alveolus[J]. J Biol Regul Homeost Agents, 2020, 4(5 Suppl. 3): 111-118.
19 PASSARELLI P C, LAJOLO C, PASQUANTONIO G, et al. Influence of mandibular third molar surgical extraction on the periodontal status of adjacent second molars[J]. J Periodontol, 2019, 90(8): 847-855.
20 KAN K W, LIU J K, LO E C, et al. Residual periodontal defects distal to the mandibular second molar 6-36 months after impacted third molar extraction[J]. J Clin Periodontol, 2002, 29(11): 1004-1011.
21 Kirtilo?lu T, Bulut E, Sümer M, et al. Comparison of 2 flap designs in the periodontal healing of second molars after fully impacted mandibular third molar extractions[J]. J Oral Maxillofac Surg, 2007, 65(11): 2206-2210.
22 KRAUSZ A A, MACHTEI E E, PELED M. Effects of lower third molar extraction on attachment level and alveolar bone height of the adjacent second molar[J]. Int J Oral Maxillofac Surg, 2005, 34(7): 756-760.
23 SKLAVOS A, DELPACHITRA S, JAUNAY T, et al. Degree of compression of the inferior alveolar canal on cone-beam computed tomography and outcomes of postoperative nerve injury in mandibular third molar surgery[J]. J Oral Maxillofac Surg, 2021, 79(5): 974-980.
24 SUN R, CAI Y, YUAN Y, et al. The characteristics of adjacent anatomy of mandibular third molar germs: a CBCT study to assess the risk of extraction[J]. Sci Rep, 2017, 7(1): 14154.
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