冠根二期拔除法对高危下颌第三磨牙拔除后并发症的影响

doi:10.19438/j.cjoms.2025.06.003

中国口腔颌面外科杂志 ›› 2025, Vol. 23 ›› Issue (6): 553-560.doi: 10.19438/j.cjoms.2025.06.003

冠根二期拔除法对高危下颌第三磨牙拔除后并发症的影响

刘湘奇^1#, 罗雪婷^1#, 陈江海¹, 刘育豪², 陈相屹¹, 匡世军¹

1.中山大学附属口腔医院口腔颌面外科,广东省口腔疾病临床医学研究中心,广东广州 510055;
2.滨州医学院口腔医学院,山东烟台 264003

收稿日期:2025-04-02 修回日期:2025-06-16 出版日期:2025-11-20 发布日期:2025-12-04
通讯作者: 匡世军,E-mail: kuangshj@mail.sysu.edu.cn
作者简介:刘湘奇（1989-）,男,博士,主治医师,E-mail: liuxiangqi200@163.com; 罗雪婷（1991-）,女,博士,主治医师,E-mail: luoxt53@mail.sysu.edu.cn。^#并列第一作者
基金资助:
广东省自然科学基金（2024A1515011990）; 广州市科技项目（2023A04J2167）

Effect of two-stage crown-root extraction method on complications after extraction of high-risk mandibular third molars

Liu Xiangqi¹, Luo Xueting¹, Chen Jianghai¹, Liu Yuhao², Chen Xiangyi¹, Kuang Shijun¹

1. Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Sun Yat-sen University; Guangdong Provincial Clinical Research Center of Oral Diseases. Guangzhou 510055, Guangdong Province;
2. Binzhou Medical University School of Stomatology. Yantai 264003, Shandong Province, China

Received:2025-04-02 Revised:2025-06-16 Online:2025-11-20 Published:2025-12-04

摘要/Abstract

摘要： 目的：观察冠根二期拔除法和冠根一期拔除法对高危下颌第三磨牙（mandibular third molar,M3M）拔除后并发症的影响。方法：采用前瞻性非随机对照设计,将145颗高危M3M分为两组。试验组59颗M3M采用冠根二期拔除法,即一期采取截冠术,3~6个月后二期手术拔除余留牙根;对照组86颗M3M采用常规方法一次性拔除M3M冠根。比较两组术后7天内出血、感染、术后反应（疼痛、肿胀和开口受限）及下牙槽神经（inferior alveolar nerve,IAN）损伤等发生情况。结果：两组间拔牙后出血无统计学差异（P>0.05）;试验组一期手术后感染率高于对照组,疼痛、肿胀以及开口受限等术后反应轻于对照组,组间差异有统计学意义（P<0.05）。试验组两次手术均未发生IAN损伤,对照组IAN损伤发生率为13.95% (12/86),组间差异有统计学意义（P<0.05）。结论：尽管一期术后感染发生率较高,但冠根二期拔除法拔除高危M3M可有效降低术后并发症,特别是IAN损伤的风险,为压迫下颌管的高危M3M拔除提供了新的选择。

关键词: 截冠术, 下颌第三磨牙, 下牙槽神经, 术后并发症

Abstract: PURPOSE: To observe the effects of two-stage crown-root extraction and conventional single-stage extraction on the complications after high-risk mandibular third molar (M3M) extraction. METHODS: A prospective non-randomized controlled design was adopted, with 145 high-risk M3Ms divided into two groups. For the experimental group (59 M3Ms), the two-stage crown-root extraction method was used: crown amputation was performed in the first stage, and the remaining tooth roots were extracted in the second stage 3-6 months later. For the control group (86 M3Ms), the conventional one-time extraction method was used to remove both the crown and root of M3M. The conditions of bleeding, infection, postoperative reactions (pain, swelling, and trismus), and inferior alveolar nerve (IAN) injury within 7 days after surgery were compared between the two groups. RESULTS: No statistically significant difference in postoperative hemorrhage was observed between the two groups within 7 days(P>0.05). The experimental group exhibited a higher infection rate after the first stage of surgery, but the postoperative reactions such as pain, swelling and trismus were less than that of the control group, with statistically significant differences between the two groups(P<0.05). Notably, no IAN injuries occurred in the experimental group, whereas the incidence of IAN injuries in the control group was 13.95%(12/86), demonstrating a statistically significant difference (P<0.05). CONCLUSIONS: Although the incidence of infection after the first-stage surgery is relatively high, the two-stage crown-root extraction method for removing high-risk M3M can effectively reduce postoperative complications, especially the risk of IAN injuries, providing a new option for the extraction of high-risk M3M with radiographically confirmed inferior alveolar canal compression.

Key words: Coronectomy, Mandibular third molar, Inferior alveolar nerve, Postoperative complications

中图分类号:

R782.11

刘湘奇, 罗雪婷, 陈江海, 刘育豪, 陈相屹, 匡世军. 冠根二期拔除法对高危下颌第三磨牙拔除后并发症的影响[J]. 中国口腔颌面外科杂志, 2025, 23(6): 553-560.

Liu Xiangqi, Luo Xueting, Chen Jianghai, Liu Yuhao, Chen Xiangyi, Kuang Shijun. Effect of two-stage crown-root extraction method on complications after extraction of high-risk mandibular third molars[J]. China J Oral Maxillofac Surg, 2025, 23(6): 553-560.

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冠根二期拔除法对高危下颌第三磨牙拔除后并发症的影响

Effect of two-stage crown-root extraction method on complications after extraction of high-risk mandibular third molars

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