下颌骨埋伏阻生第三磨牙拔除术后自然转归及对邻近第二磨牙的影响  

Natural course following extraction of impacted mandibular third molars and their effect on mandibular second molars

作　　者：杨清然 徐光宙[1] YANG Qing-ran;XU Guang-zhou(Department of Oral Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,College of Stomatology,Shanghai Jiao Tong University,National Center for Stomatology,National Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology,Shanghai Research Institute of Stomatology,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院口腔外科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海市口腔医学研究所,上海200011

出　　处：《中国口腔颌面外科杂志》2024年第4期365-372,共8页China Journal of Oral and Maxillofacial Surgery

摘　　要：目的:观察下颌阻生第三磨牙(impacted mandibular third molars,IM3Ms)拔除术后的自然转归及对邻近下颌第二磨牙(mandibular second molars,M2Ms)的影响。方法:选择下颌第三磨牙骨埋伏阻生的患者34例(51颗IM3Ms),使用超声骨刀、气动涡轮手机拔除患牙,分别于术前、术后1周及术后6个月随访,观察术后反应及M2Ms远中骨缺损情况。比较手术前后M2Ms远中骨缺损深度,并分析其影响因素。采用SPSS 29.0软件包对数据进行统计学分析。结果:术前M2Ms远中骨高度未见明显缺损,但拔除IM3Ms时,由于去骨拔牙等操作产生骨缺损。术后6个月,骨高度虽有所恢复,骨缺损率减少,但未达到术前水平。IM3Ms埋伏阻生深度是恢复率的主要影响因素。探诊深度较术前显著增加。术后24 h内患者疼痛感较重,术后1周缓解,但仍存在轻度开口受限及面部肿胀。拔除IM3Ms对患者日常生活、情绪、工作、睡眠影响较小。结论:下颌第三磨牙拔除术后,邻近第二磨牙远中骨高度部分恢复,但未达到术前水平。拔牙手术中需采取更加精细的手术技巧,以减少对邻近牙和骨组织的影响。同时,拔除IM3Ms后应给予镇痛药物,加强卫生宣教,提高患者术后舒适度。PURPOSE:To observe the natural course after extraction of impacted mandibular third molars(IM3Ms) and their influence on adjacent mandibular second molars(M2Ms).METHODS:Thirty-four patients(51 IM3Ms) with bone impaction of mandibular third molars were selected.The affected teeth were extracted by piezosurgery and pneumatic tur-bine handpiece.The postoperative reaction and distal bone defect of M2Ms were observed before operation,1 week and 6months after operation.The depth of distal bone defect at M2Ms before and after operation was compared,and the influ-encing factors were analyzed.SPSS 29.0 software package was used for data analysis.RESULTS:Before surgery,no apparent bone defects were observed in the distal mesial bone of M2Ms,but bone defects occurred during IM3Ms extraction due to bone removal and tooth extraction procedures.After 6 months,although some recovery in bone height was observed and the rate of bone defects decreased,it did not reach the preoperative level.The depth of IM3Ms impaction was the main influencing factor for the recovery rate.Probing depth significantly increased compared to preoperative levels.Pa-tients experienced more pain within 24 hours postoperatively,which eased after 1 week,although mild limitation of mouth opening and facial swelling persisted.The extraction of IM3Ms had minimal impact on patients' daily life,emotions,work,and sleep.CONCLUSIONS:After the mandibular third molar extraction,the distal bone height adjacent to the second molar will partially recover,but it doesn't reach the preoperative level.In order to reduce the impact on adjacent teeth and bone tissue,surgeons need to adopt more refined surgical techniques during tooth extraction.At the same time,analgesic drugs should be given after removal of IM3Ms,and health education should be strengthened to improve the comfort of patients.

关 键 词：下颌第三磨牙 下颌第二磨牙 阻生牙拔除术 骨缺损 自然转归 

分 类 号：R782.1[医药卫生—口腔医学]