上海口腔医学

上海口腔医学 ›› 2024, Vol. 33 ›› Issue (6): 667-675.doi: 10.19439/j.sjos.2024.06.018

• 论著 • 上一篇    下一篇

牙根先脱位法拔除下颌骨埋伏第三磨牙对邻近第二磨牙的影响

地力胡马尔·库尔班, 迪丽达尔·塔西甫拉提, 古丽, 卡地里亚·吐尔逊江, 王玲   

  1. 新疆医科大学第一附属医院（附属口腔医院） 口腔外科门诊, 新疆维吾尔自治区口腔医学研究所, 新疆 乌鲁木齐 830000
  • 收稿日期:2024-01-31 修回日期:2024-04-12 出版日期:2024-12-25 发布日期:2025-01-07
  • 通讯作者: 王玲,E-mail: crystalWL272@126.com
  • 作者简介:地力胡马尔·库尔班（1995-）,女,硕士研究生,E-mail: huma0509@sina.cn

Clinical research of mandibular embedded third molars extraction by root dislocation first method resulting in external root absorption of adjacent teeth

DILIHUMAER·Kuerban, DILIDAER·Taxipulati, GU Li, KADILIYA Tuerxunjiang, WANG Ling   

  1. Department of Oral Surgery, First Affiliated Hospital(Affiliated Stomatological Hospital) of Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region. Urumqi 830054, Xinjiang Uygur Autonomous Region, China
  • Received:2024-01-31 Revised:2024-04-12 Online:2024-12-25 Published:2025-01-07

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摘要： 目的: 评估牙根先脱位法拔除下颌骨埋伏第三磨牙（impacted lower third molar,ILTM）对邻近第二磨牙（mandibular second molar,M2M）远中成骨效果、牙髓状态和牙根外吸收（external root resorption,ERR）进展的影响。方法: 选择2023年1月—2023年10月于新疆医科大学第一附属医院进行ILTM拔除的患者64例,其中,32例采用牙根先脱位法拔除ILTM（实验组）,32例采用牙冠先脱位法拔除ILTM（对照组）。术前、术后记录M2M松动度、牙髓状态、ERR情况、术后疼痛视觉模拟评分（VAS）,术后3、6个月拍摄CBCT,测量M2M骨缺损深度、M2M骨高度、骨高度百分比和骨灰度等指标。采用SPSS 26.0软件包对数据进行统计学分析。结果: 实验组术后第3天疼痛VAS评分显著低于对照组（P<0.05）,手术时间、M2M牙髓活力和松动度两组均无显著差异（P>0.05）;实验组去骨量显著少于对照组（P<0.05）。实验组术后即刻近中颊侧、远中舌侧PD显著低于对照组（P<0.05）。不同程度的ERR中,实验组术后3个月和6个月骨缺损深度、骨高度、骨高度百分比和骨灰度显著低于对照组（P<0.05）。不同阻生类型的2组术后骨缺损深度、骨高度、骨高度百分比和骨灰度比较,差异有统计学意义（P<0.05）。阻生深度与ERR严重程度比较,差异无统计学意义（P>0.05）。所有患者术后均未出现感染和神经损伤等并发症。结论: 牙根先脱位法拔除ILTM对M2M远中成骨效果具有一定引导作用,对M2M远中牙周健康改善和术后反应均有效果。

关键词: 下颌完全骨埋伏阻生牙, 牙根先脱位法, 下颌第二磨牙, 骨愈合, 牙根外吸收, 牙周袋

Abstract: PURPOSE: To evaluate the impact of impacted lower third molar(ILTM) extraction by root dislocation first method on bone formation in the distal middle of the second molar(M2M), pulp status and external root resorption (ERR). METHODS: A total of 64 patients who underwent ILTM extraction in the First Affiliated Hospital of Xinjiang Medical University from January 2023 to October 2023 were selected. Among them, 32 patients underwent root first removal of ILTM (experimental group), and 32 patients underwent crown first removal of ILTM (control group). Preoperative and postoperative M2M mobility, pulp status, ERR situation, and postoperative visual analog scale for pain were recorded. Cone-beam CT was performed at 3 and 6 months after operation to measure bone defect depth of M2M, bone height of M2M, percentage of bone height, and bone ash degree. SPSS 26.0 software package was used for data analysis. RESULTS: The VAS pain score of the experimental group on the third postoperative day was significantly lower than that of the control group (P<0.05), while there was no significant difference in surgical time, M2M pulp vitality, and mobility between the two groups(P>0.05); the amount of bone resection in the experimental group was significantly less than that in the control group (P<0.05). The immediate postoperative near-midfacial and distal tongue-side probing depth (PD) in the experimental group was significantly lower than that in the control group(P<0.05). At 3 and 6 months postoperatively, the experimental group exhibited significantly lower bone defect depth, bone height, bone height percentage, and bone gray level compared to the control group across different degrees of external root resorption (ERR) (P<0.05). There were statistically significant differences in bone defect depth, bone height, bone height percentage, and bone gray level between the two groups with different types of impaction(P<0.05), while no statistically significant difference was found in impaction depth and ERR severity comparison (P>0.05). None of the patients experienced complications such as infection or nerve injury postoperatively. CONCLUSIONS: The root dislocation method for ILTM extraction has certain guiding effects on the distal bone formation of M2M, and it has an effect on the improvement of periodontal health and postoperative reaction of M2M.

Key words: Mandibular complete bone embedded impacted teeth, Root dislocation first method, Mandibular second molar, Bone healing, Extraradicular absorption, Periodontal pocket

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