微创拔除上颌前部埋伏阻生牙的临床观察  

Minimally invasive extraction of impacted tooth in anterior maxilla

作　　者：宋铁砾[1] 陈志远[1] 刘静明[1] SONG Tieli;CHEN Zhiyuan;LIU Jingming(Department of Stomatology,Beijing Tongren Hospital Affiliated to Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院口腔科

出　　处：《河北医药》2019年第17期2628-2631,共4页Hebei Medical Journal

摘　　要：目的评价微创拔除上颌前部埋伏阻生牙的临床效果。方法上颌前部单侧完全骨埋伏阻生牙患者11例(男5例,女6例),所有患者拔牙术前均拍摄锥形束CT精确定位阻生牙,拔牙术中使用超声骨刀、微创牙挺等微创器械去除骨阻力、分割牙齿、增隙,比较患者手术前及手术中血压的变化。拔牙术后第1天、第3天以视觉模拟评分法(VAS)评价患者术后疼痛情况,拔牙术后第3天评价患者术区肿胀情况,拔牙术后第7天评价患者伤口愈合情况。结果本组患者阻生牙包括水平阻生6例、垂直阻生3例、倒置阻生2例,所有病例阻生牙拔除术均在局部麻醉下顺利完成,拔牙术前及拔牙术中血压波动不明显,患者收缩压与舒张压变化差异无统计学意义(P>0.05)。术后患者均按时复诊,术后疼痛、肿胀均不明显,拔牙术后第1天及第3天患者疼痛VAS评分均为5分以下(0-5分),拔牙术后第3天术区轻度肿胀者占比72.7%、中度肿胀者占比18.2%。术后第7天所有患者伤口无感染,愈合良好。结论微创拔除上颌前部埋伏阻生牙,创伤轻微,术后反应小,精准的手术设计是成功的关键,超声骨刀在去骨、分牙中优势明显,值得临床推广。Objective To evaluate the clinical effects of minimally invasive impacted tooth extraction in anterior maxilla.Methods A total of 11 patients(5 males and 6 females)were enrolled for extraction of anterior maxillary impacted tooth,whose impacted teeth were unilateral completely bone embedded.The core beam CT examination was used to locate the impacted teeth before the extration.The piezosurgery and the minimally invasive dental elevator were used to remove bone,cut teeth and enlarge periodontal space.The preoperative and intraoperative blood pressure of the patients were observed.Moreover the postoperative pain was assessed at 1d,3d after operation by visual analogue scales(VAS),and the postoperative swelling was observed in 3d after the operation.Inaddition the wound healing status of the patients was evaluated at 7d after the operation.Results There were 6 horizontal impacted teeth,3 vertical impacted teeth and 2 inverted impacted teeth in this study.All the operations were performed successfully under local anesthesia.The changes between preoperative blood pressure and intraoperative blood pressure of patients were not significant.No severe postoperative pain and swelling were observed in all the cases,the VAS scores at1d,3d after operation were not more than 5 points(0~5 points).At 3d after operation,72.7%of patients had postoperative mild swelling,and 18.2%of them had moderate swelling.Moreover all the wounds healed well,without postoperative infection.Conclusion The precise surgical design is the key of successful minimally invasive extraction,which demonstrates that minimally invasive extraction of impacted tooth in anterior maxilla has the advantages of minimal invasive trauma,fewer postoperative reactions,therefor,which is worthy of promotion in clinical practice.

关 键 词：阻生牙 锥形束CT超声 骨刀微创拔牙 

分 类 号：R543.6[医药卫生—心血管疾病]