微创器械与微动力设备在牙拔除术中的应用进展

doi:10.19438/j.cjoms.2023.02.016

摘要/Abstract

摘要： 牙拔除术是将无法再行使口腔功能的患牙予以拔除的一类手术,也是牙槽外科最基本、应用最广泛的手术之一。传统拔牙术使用牙挺、牙钳、骨凿等器械进行各类牙的拔除,对患者造成的生理和心理创伤较大。近年来,微创拔牙的理念在临床上被广泛接受,材料的发展也促使拔牙器械愈加精细,微动力设备的使用更是大大提高拔牙的效率。拔牙技术和工具的进步都旨在最大程度地保存牙槽骨的完整,减少并发症发生,减轻患者痛苦。本文从拔牙器械演变、微动力系统在牙拔除术中的应用两方面阐述微创拔牙技术的发展,为更多的医师了解和使用微创拔牙提供参考。

关键词: 牙拔除术, 微创, 手术器械, 涡轮机, 超声骨刀

Abstract: Tooth extraction is to remove the affected teeth that can no longer provide oral function, and it is also one of the most basic and common procedures in alveolar surgery. Conventional tooth extraction applies elevators, forceps, chisels and other instruments, which may cause severe physical and psychological trauma to the patient. In recent years, the concepts of minimally invasive tooth extraction has been accepted in the clinic, and the development of materials has led to more refined extraction instruments. Meanwhile the use of micro-power devices has greatly improved the efficiency of tooth extraction. Advancements in tooth extraction techniques and equipments are aimed to maximumly preserve the integrity of the alveolar bone, reduce the complications, and relieve the pain. This paper described the development of minimally invasive tooth extraction techniques through the evolution of instruments and the application of micro-power devices, so as to provide reference for more dentists to understand and apply minimally invasive equipments in daily practice.

Key words: Tooth extraction, Minimally invasive, Surgical instruments, Turbine, Piezosurgery

中图分类号:

R782.11

李燕香, 闫利君, 凌小婉, 周文洁, 王跃平. 微创器械与微动力设备在牙拔除术中的应用进展[J]. 中国口腔颌面外科杂志, 2023, 21(2): 191-196.

LI Yan-xiang, YAN Li-jun, LING Xiao-wan, ZHOU Wen-jie, WANG Yue-ping. Application and advancement of minimally invasive instruments and micro-power devices in tooth extraction[J]. China J Oral Maxillofac Surg, 2023, 21(2): 191-196.

参考文献

[1] Bussell MA, Graham RM.The history of commonly used dental elevators[J]. Br Dent J, 2008, 205(9): 505-508.
[2] 胡开进, 王静娟, 薛洋. 国际牙及牙槽外科发展史[J]. 中国口腔颌面外科杂志, 2017, 15(1): 80-85.
Hu KJ, Wang JJ, Xue Y.Development of international dentoalveolar surgery[J].China Journal of Oral and Maxillofacial Surgery, 2017, 15(1): 80-85.
[3] Sambrook PJ,Goss AN.Contemporary exodontia[J]. Aust Dent J, 2018, 63(Suppl 1): S11-S18.
[4] 华成舸. 微创拔牙的刚体力学分析[J]. 华西口腔医学杂志,2017, 35(2): 119-123.
Hua CG.Geostatics in minimally invasive surgical exodontias[J]. West China Journal of Stomatology, 2017, 35(2): 119-123.
[5] El-Kenawy MH, Ahmed WM.Comparison between physics and conventional forceps in simple dental extraction[J]. J Maxillofac Oral Surg, 2015, 14(4): 949-955.
[6] 杨擎天, 胡开进, 薛洋, 等. 阻生下颌第三磨牙2种拔除方法的比较[J]. 实用口腔医学杂志, 2010, 26(1): 71-74.
Yang QT, Hu KJ, Xue Y, et al.A comparison of two methods of extracting impacted mandibular third molars[J]. Journal of Practical Stomatology, 2010, 26(1): 71-74.
[7] Kang F, Xue Z, Zhou X, et al. Coronectomy: a useful approach in minimizing nerve injury compared with traditional extraction of deeply impacted mandibular third molars [J]. J Oral Maxillofac Surg, 2019, 77(11): 2221.e1-2221.e14.
[8] 李丹, 郭传瑸, 刘宇, 等超声骨刀在上颌死髓劈裂磨牙拔除中的应用[J]. 北京大学学报(医学版), 2016, 48(4): 709-713.
Li D, Guo CB, Liu Y, et al.Applicational evaluation of split tooth extractions of upper molars using piezosurgery[J]. Journal of Peking University (Health Sciences), 2016, 48(4): 709-713.
[9] Dym H, Weiss A.Exodontia: tips and techniques for better outcomes[J]. Dent Clin North Am, 2012, 56(1): 245-266.
[10] 胡开进. 微创技术在牙拔除术中的应用[J]. 口腔医学, 2015, 35(2): 81-84.
Hu KJ.The application of minimally invasive technique in the surgery of teeth extraction[J]. Stomatology, 2015, 35(2): 81-84.
[11] Mamoun J.Use of elevator instruments when luxating and extracting teeth in dentistry: clinical techniques[J]. J Korean Assoc Oral Maxillofac Surg, 2017, 43(3): 204-211.
[12] Sharma SD, Vidya B, Alexander M, et al.Periotome as an aid to atraumatic extraction: a comparative double blind randomized controlled trial[J]. J Maxillofac Oral Surg, 2015, 14(3): 611-615.
[13] Kapila S, Kaur T, Bhullar RS, et al.Use of physics forceps in atraumatic orthodontic extractions of bilateral premolars: a randomized control clinical study[J]. J Maxillofac Oral Surg, 2020, 19(3): 347-354.
[14] Alpert B.The evolution of oral and maxillofacial surgery over the past 100+ years-with special emphasis on the role of fluoride and the high-speed handpiece[J]. J Oral Maxillofac Surg, 2018, 76(8): 1611-1615.
[15] Kilpatrick HC.Removal of impacted third molars utilizing speeds up to 200,000 r.p.m[J]. Oral Surg Oral Med Oral Pathol, 1958, 11(4): 364-369.
[16] Tan S, Nikolarakos D.Subcutaneous emphysema secondary to dental extraction: a case report[J]. Aust Dent J, 2017, 62(1): 95-97.
[17] 胡开进, 李永锋, 吴迪. 微动力系统在牙拔除术中的应用[J]. 华西口腔医学杂志, 2015, 33(1): 1-5.
Hu KJ, Li YF, Wu D.Application of micro-power system in the surgery of tooth extraction[J]. West China Journal of Stomatology, 2015, 33(1): 1-5.
[18] 许竞, 肖翼初, 高文峰, 等. 以高速涡轮手机拔除下颌阻生第三磨牙的微创术式设计探讨[J]. 广东医学, 2012, 33(20): 3081-3085.
Xu J, Xiao YC, Gao WF, et al.Design of minimally invasive surgery for extraction of impacted mandibular third molars by high-speed turbine handpieces[J]. Guangdong Medical Journal, 2012, 33(20): 3081-3085.
[19] Szalma J, Klein O, Lovász BV, et al.Recommended drilling parameters of tungsten carbide round drills for the most optimal bone removals in oral surgery[J]. BioMed Res Int, 2018: 3108581.
[20] Chien AT, Stehle NE, Karian BK.The use of chisels in the extraction of mandibular third molars: a technique that may prevent the aerosolization of severe acute respiratory syndrome coronavirus 2[J]. J Oral Maxillofac Surg, 2021, 79(6): 1199-1206.
[21] Isik H, Sapmaz E, Özbey M, et al.A rare cause of pneumomediastinum and subcutaneous emphysema: tooth extraction[J]. Turk Gogus Kalp Damar Cerrahisi Derg, 2019, 28(2): 390-393.
[22] 张善文, 刘林,孙晓红. 智齿拔除术致颜面颈部及胸部皮下气肿1例[J]. 牙体牙髓牙周病学杂志, 2005, 15(1): 5-5.
Zhang SW, Liu L, Sun XH.One case report of subcutaneous emphysema in face, neck and chest after extraction of wisdom tooth[J]. Chinese Journal of Conservative Dentistry, 2005, 15(1): 5-5.
[23] 钱庆慰, 王玫,马宏涛. 2种外科动力钻在微创拔牙中的联合应用[J]. 口腔医学, 2018, 38(12): 1114-1117.
Qian QW, Wang M, Ma HT.Combined application of two kinds of surgical burs in minimally invasive tooth extraction[J]. Stomatology, 2018, 38(12): 1114-1117.
[24] Szalma J, Kiss C, Gurdán Z, et al.Intraosseous heat production and preparation efficiency of surgical tungsten carbide round drills: the effect of coronectomy on drill wear[J]. J Oral Maxillofac Surg, 2016, 74(3): 442-452.
[25] Vernon JJ, Black EVI, Dennis T, et al.Dental mitigation strategies to reduce aerosolization of SARS-CoV-2[J]. J Dent Res, 2021, 100(13): 1461-1467.
[26] Waknis PP, Jadaun A, Mishra T, et al.Use of 2.0 mm drill bit for intraoral removal of ectopically positioned teeth[J]. J Oral Maxillofac Surg, Med, Pathol, 2015, 27(4): 498-499.
[27] Szalma J, Vajta L, Olasz L, et al.Tooth sectioning for coronectomy: how to perform?[J]. Clin Oral Investig, 2019, 23(2): 519-527.
[28] 金绍康. 不同长度裂钻在下颌阻生智齿拔除中的分类应用研究[J]. 全科口腔医学电子杂志, 2016, 3(13): 8-9, 11.
Jin SK.Classification and application of different length split drill in extraction of impacted mandibular wisdom teeth[J]. General Journal of Stomatology, 2016, 3(13): 8-9, 11.
[29] Zheng X, Lin X, Wang Z.Extraction of low horizontally and buccally impacted mandibular third molars by three-piece tooth sectioning[J]. Br J Oral Maxillofac Surg, 2020, 58(7): 829-833.
[30] McGuire C, Boudreau C, Prabhu N, et al. Piezosurgery versus conventional cutting techniques in craniofacial surgery: a systematic review and meta-analysis[J]. Plast Reconstr Surg, 2022, 149(1): 183-195.
[31] Costa DL, Thomé de Azevedo E, Przysiezny PE, et al. Use of lasers and piezoelectric in intraoral surgery[J]. Oral Maxillofac Surg Clin North Am, 2021, 33(2): 275-285.
[32] Spinelli G, Valente D, Mannelli G, et al.Surgical management of ankyloses of the temporomandibular joint by a piezoelectric device[J]. J Craniomaxillofac Surg, 2017, 45(4): 441-448.
[33] Ge J, Yang C, Zheng J, et al.Piezosurgery for the lingual split technique in lingual positioned impacted mandibular third molar removal: a retrospective study[J]. Medicine (Baltimore), 2016, 95(12): e3192.
[34] Otake Y, Nakamura M, Henmi A, et al.Experimental comparison of the performance of cutting bone and soft tissue between piezosurgery and conventional rotary instruments[J]. Sci Rep, 2018, 8(1): 17154.
[35] McKenzie WS. Principles of exodontia[J]. Oral Maxillofac Surg Clin North Am, 2020, 32(4): 511-517.
[36] Chang HH, Lee MS, Hsu YC, et al.Comparison of clinical parameters and environmental noise levels between regular surgery and piezosurgery for extraction of impacted third molars[J]. J Formos Med Assoc, 2015, 114(10): 929-935.
[37] Patil C, Jadhav A, K R, et al. Piezosurgery vs bur in impacted mandibular third molar surgery: evaluation of postoperative sequelae[J]. J Oral Biol Craniofac Res, 2019, 9(3): 259-262.
[38] Arakji H, Shokry M,Aboelsaad N.Comparison of piezosurgery and conventional rotary instruments for removal of impacted mandibular third molars: a randomized controlled clinical and radiographic trial[J]. Int J Dent, 2016: 8169356.
[39] Menziletoglu D, Basturk F, Isik BK, et al.A prospective split-mouth clinical study: comparison of piezosurgery and conventional rotary instruments in impacted third molar surgery[J]. Oral Maxillofac Surg, 2020, 24(1): 51-55.
[40] Gulnahar Y, Alpan AL.Comparison of postoperative morbidity between piezoelectric surgery and conventional rotary instruments in mandibular third molar surgery: a split-mouth clinical study[J]. Med Oral Patol Oral Cir Bucal, 2021, 26(3): e269-e275.
[41] Bassi F, Cicciù M, Di Lenarda R, et al.Piezoelectric bone surgery compared with conventional rotary instruments in oral surgery and implantology: summary and consensus statements of the International Piezoelectric Surgery Academy Consensus Conference 2019[J]. Int J Oral Implantol (Berl), 2020, 13(3): 235-239.
[42] Cai Y, Sun R, Zhao JH.Flapless boning to increase space by piezosurgery: a novel mini-invasive strategy for teeth extraction. A retrospective study[J]. Medicine (Baltimore), 2018, 97(27): e11398.
[43] Keyhan SO, Fallahi HR, Cheshmi B, et al.Use of piezoelectric surgery and Er:YAG laser:which one is more effective during impacted third molar surgery?[J]. Maxillofac Plast Reconstr Surg, 2019, 41(1): 29-39.
[44] Wang Y, He D, Yang C, et al.An easy way to apply orthodontic extraction for impacted lower third molar compressing to the inferior alveolar nerve[J]. J Craniomaxillofac Surg, 2012, 40(3): 234-237.
[45] Wang Z, Liu Z, Shi Y, et al. A Novel orthodontic extraction method for removal of impacted mandibular third molars in close proximity to inferior alveolar nerve[J]. J Oral Maxillofac Surg, 2019, 77(8): 1575.e1-1575.e6.
[46] Emery RW, Korj O,Agarwal R.A Review of in-office dynamic image navigation for extraction of complex mandibular third molars[J]. J Oral Maxillofac Surg, 2017, 75(8): 1591-1600.
[47] Ureel M, Augello M, Holzinger D, et al.Cold ablation robot-guided laser osteotome (CARLO^®): from bench to bedside[J]. J Clin Med, 2021, 10(3):450-464.