种植术后下唇麻木恢复的临床观察及处理  

The clinical observation and the treatment of lower lip numbness recovery after implant operation

作　　者：刘世锋[1] 肖巧灵[1] 吴大怡[1] 

机构地区：[1]成都华西牙种植医院.卫生部口腔种植科技中心,成都610041

出　　处：《中国口腔种植学杂志》2009年第2期5-6,共2页Chinese Journal of Oral Implantology

摘　　要：目的:观察种植术后下唇麻木处理后的恢复过程。方法:8例下颌后牙区种植患者均采用CDIC口腔种植技术.有1例为阻滞麻醉+局部浸润麻醉下下颌磨牙区皮质开窗下牙槽神经游离术后植入CDIC柱状组合式种植体2枚,7例于局部浸润麻醉下植入柱状组合式种植体9枚。术后x全景片观察种植体(除游离牙槽神经后植入种植体的患者外)距下牙槽神经管上壁为-1-2mm。术后第2天8例患者感觉相应侧下唇口角及颏,部皮肤麻木,肿胀,相应下前牙咬自觉垫高。临床检查探针刺激颏神经支配区域粘膜,皮肤均无痛感,叩诊支配区域牙齿有麻木感。6例棉签检查皮肤无触觉。安慰患者同时采用营养神经的药物、理疗、微波等治疗。随访观察患者痛觉及触觉恢复,麻木消失过程。结果:8例患者在1-3月后开始恢复痛觉,痛觉逐渐恢复后1月左右开始恢复触觉,恢复过程中麻木区域呈逐渐缩小趋势,恢复过程中4名患者有针刺感。8例患者在5-10月后刺激患侧与刺激健侧无明显区别。讨论:种植手术是一门精细的牙槽外科手术。下颌后牙区种植术以x全景片及CT定位影像分析,术前基本确定种植体长度。术中多采用局部浸润麻醉,预备种植窝时接近下牙槽神经管时患者有疼痛感。麻木可能原因:1,术中直接损伤下牙槽神经。2,术中损伤下牙槽神经管而未损伤下牙槽神经,局部出血水肿压迫下牙槽神经导致下唇麻木。3,种植体旋入过深直接压迫下牙槽神经管。4,预备种植窝时的机械振动,挤压、转动和温度刺激等物理因素。5,游离神经时牵拉下牙槽神经。根据以上可能原因,患者麻木恢复原因:水肿消失,神经纤维再生,对侧神经代偿。结论:根据x全景片及CT定位影像分析,确定种植体长度行下颌后牙区种植术后造成下唇麻木的患者采用营养神经的药物、理疗、微波等治疗下能逐渐恢复。具体恢复条件,恢Purpose:Observe the recovery process of lower lip numbness after implant operation.Method:CDIC Implant technology is used in the 8 cases.2 CDIC Cyinder Shape Screw Implants were placed into the lower molars area after free the inferior alveolar nerve by the Ring Cutting Cortical bone Surgery with blocking anesthesia and aesthesia of alveolar process in 1 case.9 Cylinder Shape Screw Implants were placed into the lower molars area with aesthesia of alveolar process in the 7 cases.The distance between the implants and the mandibular canal is about-1-2mm in the 7 cases.The 8 patients felt numb and Swelling in the corresponding lower lip skin and chin.The patients felt the corresponding teeth were higher than before.No pain with acupuncture in the corresponding lower lip skin and chin.Numbness with Percussion in the corresponding teeth.6 cases of patients with no tactile in the corresponding lower lip skin and chin by cotton checking.Comfort the patients with the use of neurotrophic drugs,physical therapy,microwave therapy etc.Follow-up.Result:8 patients began to recover pain feeling after 1-3 months.6 cases of patients began to recover Tactile after 2-4 months.four patients felt Acupuncture during the recovery process.no significant difference in the side and contralateral in the 8 cases 5-10 months later.Discussion:Implant operation is a delicate alveolar surgery.Identifying implant length base on the analyzation of the x-panoramic view and CT image before operation.The patient feel pain when operation depth is close to the mandibular canal with aesthesia of alveolar process.Possible causes of numbness:1,injury inferior alveolar nerve.2,Local hemorrhage and local edema after injurying the mandibular canal.3,it is too deep to oppress the mandibular canal when we screwed the implant.4,vibration,extrusion,rotation and temperature and other physical factors stimulate inferior alveolar nerve.5,Inferior alveolar nerve traction when free inferior alveolar nerve.The recovery reasons of lower lip numbness based on the causes

关 键 词：组合式种植体 临床观察 患者 术中 全景片 下唇麻木 神经管 牙槽 下颌后牙 

分 类 号：R783.6[医药卫生—口腔医学]