三种不同去骨方法在下颌近中低位阻生智齿拔除中的效果评价

doi:10.19439/j.sjos.2026.01.011

摘要/Abstract

摘要： 目的评价Er:YAG激光、超声骨刀、高速涡轮钻去骨在下颌近中低位阻生智齿拔除中的效果。方法选择2021年4月—2023年7月收治的119例下颌近中低位阻生智齿患者,根据去骨方式不同分为A组（n=38）、B组（n=40）和C组（n=41）。A组采用高速涡轮钻去骨,B组采用Er:YAG激光去骨,C组采用超声骨刀去骨。比较三组手术相关指标、术后疼痛、面部肿胀、开口受限、并发症及患者术后满意度。结果 C组术中出血量显著低于A、B组（P<0.05）,B组显著低于A组（P<0.05）。B组拔牙时间显著长于A、C组（P<0.05）,C组显著长于A组（P<0.05）。三组术后第7天疼痛视觉模拟评分（visual analogue score,VAS）显著低于术后第1天（P<0.05）,B、C组VAS评分显著低于A组（P<0.05）,但B、C组相比无显著差异（P>0.05）。三组术后第7天面部肿胀程度显著低于术后第3天（P<0.05）,B、C组显著低于A组（P<0.05）,但B、C组相比无显著差异（P>0.05）。三组术后第7天开口受限程度显著低于术后第3天（P<0.05）,B、C组显著低于A组（P<0.05）,但B、C组相比无显著差异（P>0.05）。三组并发症总发生率相比无显著差异（P>0.05）。C组患者术后满意度显著高于A、B组（P<0.05）,B组显著高于A组（P<0.05）。多因素logistic回归分析发现,手术时间<20 min、术中出血量<5 mL、术中疼痛VAS评分<2是提高患者满意度的独立保护因素（P<0.05）。结论相比于Er:YAG激光,高速涡轮钻、超声骨刀去骨在下颌近中低位阻生智齿拔除中效果更佳,均可减轻患者术后疼痛,减轻术中创伤,改善患者面部肿胀和开口受限程度。相比于高速涡轮钻和Er:YAG激光,超声骨刀去骨可提高患者满意度。

关键词: Er:YAG, 超声骨刀, 高速涡轮钻去骨, 下颌近中低位阻生智齿, 并发症, 满意度

Abstract: PURPOSE: To evaluate the effect of Er:YAG laser, piezosurgery and high-speed turbine drill in the extraction of mesial and low impacted mandibular wisdom teeth. METHODS: A total of 119 patients with mesial and low mandibular impacted wisdom teeth who were admitted from April 2021 to July 2023 were selected and divided into group A(n=38), group B(n=40) and group C(n=41) according to different bone removal methods. Group A was treated with high-speed turbine drilling, group B was treated with Er:YAG laser and group C was treated with piezosurgery. Postoperative indexes, visual analogue score (VAS) of postoperative pain, facial swelling, mouth opening limitation, complications and postoperative satisfaction were compared among the three groups. RESULTS: The intraoperative blood loss in group C was significantly lower than that in groups A and B (P<0.05), and that in group B was significantly lower than that in group A (P<0.05). The tooth extraction time in group B was significantly longer than that in groups A and C(P<0.05), and that in group C was significantly longer than that in group A (P<0.05). Pain VAS of the three groups on the 7th day after surgery was significantly lower than that on the 1st day after surgery (P<0.05), and pain VAS of groups B and C were significantly lower than that of group A (P<0.05), but there was no significant difference between group B and C (P>0.05). The degree of facial swelling on the 7th day after surgery in the three groups was significantly lower than that on the 3rd day after surgery(P<0.05), and groups B and C were significantly lower than group A(P<0.05), but there was no significant difference between groups B and C(P>0.05). The degree of mouth opening limitation on the 7th day after surgery in the three groups was significantly lower than that on the 3rd day after surgery (P<0.05), and groups B and C were significantly lower than group A (P<0.05), but there was no significant difference between groups B and C(P>0.05). There was no significant difference in the total incidence of complications among the three groups(P>0.05). The postoperative satisfaction of group C was significantly higher than group A and group B(P<0.05), and the postoperative satisfaction of group B was significantly higher than group A(P<0.05). Multivariate logistic regression analysis revealed that operation time <20 min, intraoperative blood loss<5 mL and intraoperative pain VAS <2 were independent protective factors for the improvement of patients' satisfaction (P<0.05). CONCLUSIONS: Compared with Er:YAG laser, high-speed turbine drill and piezosurgery have better effects in the extraction of mesial and low mandibular impacted wisdom teeth. Both of them can reduce postoperative pain and intraoperative trauma, improve the degree of facial swelling and mouth opening limitation of patients. Moreover, compared with high-speed turbo drill and Er:YAG laser, piezosurgery can improve patients' satisfaction.

Key words: Er:YAG, Piezosurgery, High-speed turbine drill, Mesial and low mandibular impacted wisdom teeth, Complications, Satisfaction

中图分类号:

R782.1

周谦, 秦廷飞, 秦旭彩. 三种不同去骨方法在下颌近中低位阻生智齿拔除中的效果评价[J]. 上海口腔医学, 2026, 35(1): 66-71.

Zhou Qian, Qin Tingfei, Qin Xucai. Evaluation of the efficacy of three different bone removal methods in the extraction of mesial and low impacted mandibular wisdom teeth[J]. Shanghai Journal of Stomatology, 2026, 35(1): 66-71.

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