下颌阻生第三磨牙拔除同期植骨对第二磨牙远中牙槽骨缺损修复的影响

doi:10.19439/j.sjos.2020.01.011

摘要/Abstract

摘要： 目的：观察下颌阻生第三磨牙拔除时,于拔牙创内同期植入自体骨混合Bio-Oss人工骨粉,对第二磨牙远中牙槽骨缺损修复的影响。方法：术前根据下颌第三磨牙与第二磨牙的位置,预估下颌阻生牙拔除后,第二磨牙发生远中骨组织缺损的风险,分为低、中、高风险3组。在中、高风险组中再根据是否在术中行同期植骨,分为植骨组与不植骨组,术后1、6个月进行复查,剔除术后感染及失访病例后,植骨组（A组）共计36例,不植骨组（B组）共计45例。术后复查指标包括患者主观感觉,第二磨牙远中探诊深度,曲面体层片观察第二磨牙远中牙槽骨高度变化。数据采用SPSS 19.0软件包进行t检验。结果：术后6个月中风险组中,植骨组第二磨牙远中主观感觉冷热刺激不适者0例,不植骨组中为6例,差异有统计学意义（P<0.05）。第二磨牙远中牙周探诊深度植骨组为（2.93±0.34）mm,不植骨组为（2.95±0.50）mm,差异无统计学意义（P=0.931）。X线片检查第二磨牙远中牙槽骨高度增量Δh植骨组为（3.31±1.02）mm,不植骨组为（3.10±1.72）mm,差异有统计学意义（P=0.749）。高风险组中,植骨组第二磨牙远中主观感觉冷热刺激不适者4例,不植骨组为10例,差异有统计学意义（P<0.05）。第二磨牙远中牙周探诊深度植骨组为（3.08±0.37）mm,不植骨组为（3.24±0.41）mm,差异无统计学意义（P=0.162）。X线片检查第二磨牙远中牙槽骨高度增量Δh植骨组为（5.21±1.79）mm,不植骨组为（2.99±2.42）mm,差异有统计学意义（P<0.001）。结论：术前对阻生牙拔除后第二磨牙远中骨组织缺损进行风险分型,有助于判断术中是否需要植骨。在牙槽骨缺损较多的情况下（高风险型）,于拔牙创内同期植入自体骨混合Bio-Oss人工骨粉,对第二磨牙远中牙槽骨高度的恢复促进作用更显著,并且能够减少第二磨牙因远中牙根暴露所致的不适。

关键词: 阻生牙, 植骨, 牙槽骨修复

Abstract: PURPOSE: To observe the effect of bone grafting during the extraction of mandibular third molar on repair of distal alveolar bone defect distal to the second molar. METHODS: The risks of the distal alveolar bone defect in the second molar were estimated after removal of the impacted teeth according to the position of the third molar and second molar before operation. It was divided into three groups: low risk group, medium risk group and high risk group. The medium risk group and high risk group were further divided into bone graft subgroup (group A) and non-bone graft subgroup (group B). There were 36 cases in group A and 45 cases in group B. Postoperative re-examination indicators included subjective perception of the patients, depth of probing and height of alveolar bone in the distal molar of the second molar by X-ray examination. The data were analyzed with SPSS 19.0 software package. RESULTS: Six months after operation, in mediun risk group, 0 cases in group A had subjective feelings of cold and heat stimulation; in group B, the number was 6 cases, the difference was significant (P<; 0.05). Distal periodontal probing depth of the second molar was (2.93±; 0.34) mm in group A and (2.95±; 0.50) mm in group B. There was no significant difference between 2 groups (P=0.931). X-ray examination of the alveolar bone height increment of the second molar Δh: (3.31±; 1.02) mm in group A, (3.10±; 1.72) mm in group B, the difference was not significant (P=0.794). In high risk group, 4 cases in group A had subjective feelings of cold and heat stimulation; in group B, the number was 10 cases,the difference was significant (P<; 0.05). Distal periodontal probing depth of the second molar was (3.08±; 0.37) mm in group A and (3.24±; 0.41) mm in group B. There was no significant difference between 2 groups(P=0.931). X-ray examination of the alveolar bone height increment of the second molar Δh: (5.21±; 1.79) mm in group A, (2.99±; 2.42) mm in group B, the difference was significant (P<; 0.05). CONCLUSIONS: Risk classification of the second molar distal bone defects after extraction of the impacted teeth is essential, which is helpful to determine whether bone grafting is needed during operation. Autologous bone mixed with Bio-Oss artificial bone powder can promote recovery of the alveolar bone height of the second molar, especially in high risk group, and discomfort caused by exposure can be reduced.

Key words: Impacted teeth, Bone graft, Alveolar bone repair

中图分类号:

R782.1

金晓明, 翟财红, 陶海彪, 江银华. 下颌阻生第三磨牙拔除同期植骨对第二磨牙远中牙槽骨缺损修复的影响[J]. 上海口腔医学, 2020, 29(1): 55-59.

JIN Xiao-ming, ZHAI Cai-hong, TAO Hai-biao, JIANG Yin-hua. Effect of bone grafting on the repair of distal alveolar bone defect of the second molar after extraction of mandibular impacted third molar[J]. Shanghai Journal of Stomatology, 2020, 29(1): 55-59.

参考文献

[1] 朱春溪, 邱华. 下颌阻生第三磨牙危害的回顾性研究(附1226例临床分析)[J]. 口腔颌面外科杂志, 2000, 10:(2) 105-106.
[2] Haohueng C, Jangjaer L, Sangheng K, et al.Periodontal healing after mandibular third molar surgery-A comparison of distolingual alveolectomy and tooth division techniques[J]. Int J Oral Maxillofac Surg, 2004, 33(1): 32-37.
[3] Morjaria KR, Wilson R, Palmer RM.Bone healing after tooth extraction with or without an intervention: a systematic review of randomized controlled trials[J]. Clin Implant Dent R, 2014, 16(1): 1-20.
[4] Barbato L, Kalemaj Z, Buti J, et al.Effect of surgical intervention for removal of mandibular third molar on periodontal healing of adjacent mandibular second molar: a systematic review and bayesian network meta-analysis[J]. J Periodontol, 2015, 87(3): 291-302.
[5] 陶安军, 杨细虎, 范广宇, 等. 引导再生术用于下颌第三磨牙拔除后牙槽骨再生的疗效评估[J]. 口腔医学, 2016, 36(11): 1017-1019.
[6] van Vlijmen OJ, Bergé SJ, Bronkhorst EM, et al. A comparison of frontal radiographs obtained from cone beam CT scans and conventional frontal radiographs of human skulls[J]. Int J Oral Maxillofac Surg, 2009, 38(7): 773-778.
[7] Shiller WR.Positional changes in mesio-angular impacted mandibular third molars during a year[J]. J Am Dent Assoc, 1979, 99(3): 460-464.
[8] Pell GJ, Gregory GT.Report on a ten-year study of a tooth division technique for the removal of impacted teeth[J]. Am J Orthod Oral Surg, 1942, 28(11): B660-B666.
[9] Javier M, Giuseppe M.Effect of removing an impacted mandibular third molar on the periodontal status of the mandibular second molar[J]. Int J Oral Maxillofac Surg, 2011, 69(11): 2691-2697.
[10] Lee CT, Hum L, Chen YW. The effect of regenerative periodontal therapy in preventing periodontal defects after the extraction of third molars: A systematic review and meta-analysis[J]. J Am Dent Assoc, 2016, 147(9): 709-719.e4.
[11] 许竞. 下颌阻生第三磨牙拔除术对下颌第二磨牙远中牙周组织的影响[J]. 口腔疾病防治, 2016, 24(1): 11-15.
[12] 戈旌, 杨驰, 郑家伟, 等. 下颌阻生第三磨牙拔除术后第二磨牙远中骨质缺损治疗进展[J]. 中国口腔颌面外科杂志, 2016, 14(1): 76-82.
[13] Branko S, Javier ZG, Motasem AM, et al.Cellular bone matrices: viable stem cell-containing bone graft substitutes[J]. Spine J, 2014, 14(11): 2763-2772.
[14] Pagni G, Kaigler D, Rasperini G, et al.Bone repair cells for craniofacial regeneration[J]. Adv Drug Deliver Rev, 2012, 64(12): 1310-1319.
[15] 王兴, 刘洪臣. 自体骨移植修复种植位点骨缺损的研究进展[J]. 口腔颌面修复学杂志, 2016, 17(1): 49-52.
[16] 戈旌, 杨驰, 郑家伟, 等. 阻生第三磨牙拔除术后自体骨回植第二磨牙远中骨缺损的单中心随机对照临床研究[J]. 中国口腔颌面外科杂志, 2017, 15(4): 334-340.
[17] Eriksson RA, Albrektsson T.The effect of heat on bone regeneration: An experimental study in the rabbit using the bone growth chamber[J]. Int J Oral Maxillofac Surg, 1984, 42(11): 705-711.
[18] 何锦泉, 欧阳可雄, 张清彬, 等. 2种切开翻瓣法拔除下颌智牙的临床效果分析[J]. 上海口腔医学, 2015, 24(2): 224-227.
[19] 王凌霄, 李钧, 单兆臣, 等. 2种翻瓣方式在下颌中低位阻生智齿拔除中的疗效研究[J]. 口腔医学, 2018, 38(6): 518-522.