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

doi:10.19438/j.cjoms.2024.04.008

摘要/Abstract

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。

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

Abstract: 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 turbine handpiece. The postoperative reaction and distal bone defect of M2Ms were observed before operation, 1 week and 6 months after operation. The depth of distal bone defect at M2Ms before and after operation was compared, and the influencing 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. Patients 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.

Key words: Mandibular third molars, Mandibular second molars, Impact teeth extraction, Bone defects, Natural course

中图分类号:

R782.1

杨清然, 徐光宙. 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[J]. 中国口腔颌面外科杂志, 2024, 22(4): 365-372.

YANG Qing-ran, XU Guang-zhou. Natural course following extraction of impacted mandibular third molars and their effect on mandibular second molars[J]. China J Oral Maxillofac Surg, 2024, 22(4): 365-372.

参考文献

[1] Kugelberg CF.Impacted lower third molars and periodontal health. an epidemiological, methodological, retrospective and prospective clinical, study[J]. Swed Dent J Suppl, 1990, 68: 1-52.
[2] Passarelli PC, Pasquantonio G, D'addona A. Management of surgical third lower molar extraction and postoperative progress in patients with factor Ⅶ deficiency: a clinical protocol and focus on this rare pathologic entity[J]. J Oral Maxillofac Surg, 2017, 75(10): 2070.e1-2070.e4.
[3] Glória JCR, Martins CC, Armond ACV, et al.Third molar and their relationship with caries on the distal surface of second molar: a meta-analysis[J]. J Maxillofac Oral Surg, 2018, 17(2): 129-141.
[4] Candotto V, Oberti L, Gabrione F, et al.Complication in third molar extractions[J]. J Biol Regul Homeost Agents, 2019, 33(3 Suppl 1): 169-172.
[5] Leone SA, Edenfield MJ, Cohen ME.Correlation of acute pericoronitis and the position of the mandibular third molar[J]. Oral Surg Oral Med Oral Pathol, 1986, 62(3): 245-250.
[6] Kugelberg CF.Periodontal healing two and four years after impacted lower third molar surgery. a comparative retrospective study[J]. Int J Oral Maxillofac Surg, 1990, 19(6): 341-345.
[7] Karapataki S, Hugoson A, Kugelberg CF.Healing following GTR treatment of bone defects distal to mandibular 2nd molars after surgical removal of impacted 3rd molars[J]. J Clin Periodontol, 2000, 27(5): 325-332.
[8] Peng KY, Tseng YC, Shen EC, et al.Mandibular second molar periodontal status after third molar extraction[J]. J Periodontol, 2001, 72(12): 1647-1651.
[9] Montero J, Mazzaglia G.Effect of removing an impacted mandibular third molar on the periodontal status of the mandibular second molar[J]. J Oral Maxillofac Surg, 2011, 69(11): 2691-2697.
[10] Camps-Font O, Caro-Bonfill C, Sánchez-Garcés M, et al.Periodontal regenerative therapy for preventing bone defects distal to mandibular second molars after surgical removal of impacted third molars: a systematic review and meta-analysis of randomized clinical trials[J]. J Oral Maxillofac Surg, 2018, 76(12): 2482-2514.
[11] Lee CT, Hum L, Chen YW. The effect of regenerative periodontal therapy in preventing periodontal defects after the extraction of third molars: a systematic review and meta-analysis[J]. J Am Dent Assoc, 2016, 147(9): 709-719.e4.
[12] Sherrard JF, Rossouw PE, Benson BW, et al.Accuracy and reliability of tooth and root lengths measured on cone-beam computed tomographs[J]. Am J Orthod Dentofacial Orthop, 2010, 137(4 Suppl): S100-108.
[13] Maria A, Malik M, Virang P.Comparison of primary and secondary closure of the surgical wound after removal of impacted mandibular third molars[J]. J Maxillofac Oral Surg, 2012, 11(3): 276-283.
[14] Ge J, Yang C, Zheng J, et al.Autogenous bone grafting for treatment of osseous defect after impacted mandibular third molar extraction: a randomized controlled trial[J]. Clin Implant Dent Relat Res, 2017, 19(3): 572-580.
[15] Inocêncio Faria A, Gallas-Torreira M, López-Ratón M, et al.Radiological infrabony defects after impacted mandibular third molar extractions in young adults[J]. J Oral Maxillofac Surg, 2013, 71(12): 2020-2028.
[16] Kim E, Eo MY, Nguyen TTH, et al.Spontaneous bone regeneration after surgical extraction of a horizontally impacted mandibular third molar: a retrospective panoramic radiograph analysis[J]. Maxillofac Plast Reconstr Surg, 2019, 41(1): 4-14.
[17] Aloy-Prósper A, García-Mira B, Larrazabal-Morón C, et al.Distal probing depth and attachment level of lower second molars following surgical extraction of lower third molars: a literature review[J]. Med Oral Patol Oral Cir Bucal, 2010, 15(5): e755-e759.
[18] Kumar N, Prasad K, Ramanujam L, et al.Evaluation of treatment outcome after impacted mandibular third molar surgery with the use of autologous platelet-rich fibrin: a randomized controlled clinical study[J]. J Oral Maxillofac Surg, 2015, 73(6): 1042-1049.
[19] 张志愿. 口腔颌面外科学[M]. 8版.北京: 人民卫生出版社, 2020.
Zhang ZY.Oral and maxillofacial surgery[M]. 8th Ed. Beijing: People's Medical Publishing House, 2020.
[20] Leung WK, Corbet EF, Kan KW, et al.A regimen of systematic periodontal care after removal of impacted mandibular third molars manages periodontal pockets associated with the mandibular second molars[J]. J Clin Periodontol, 2005, 32(7): 725-731.
[21] Kugelberg CF, Ahlström U, Ericson S, et al.The influence of anatomical, pathophysiological and other factors on periodontal healing after impacted lower third molar surgery. a multiple regression analysis[J]. J Clin Periodontol, 1991, 18(1): 37-43.
[22] Koo TH, Song YW, Cha JK, et al.Histologic analysis following grafting of damaged extraction sockets using deproteinized bovine or porcine bone mineral: a randomized clinical trial[J]. Clin Oral Implants Res, 2020, 31(1): 93-102.
[23] 张媛. 阻生下颌第三磨牙拔除3种切口设计对毗邻第二磨牙牙周参数的影响[D].太原: 山西医科大学, 2022.
Zhang Y.Effect of three incision designs on periodontal parameters of adjacent second molar for extraction of impacted mandibular third molar[D]. Taiyuan: Shanxi Medical University, 2022.
[24] Hoffmann O, Bartee BK, Beaumont C, et al.Alveolar bone preservation in extraction sockets using non-resorbable dPTFE membranes: a retrospective non-randomized study[J]. J Periodontol, 2008, 79(8): 1355-1369.
[25] Monaco G, Daprile G, Tavernese L, et al.Mandibular third molar removal in young patients: an evaluation of 2 different flap designs[J]. J Oral Maxillofac Surg, 2009, 67(1): 15-21.
[26] Schofield ID, Kogon SL, Donner A.Long-term comparison of two surgical flap designs for third molar surgery on the health of the periodontal tissue of the second molar tooth[J]. J Can Dent Assoc, 1988, 54(9): 689-691.
[27] Chaves AJ, Nascimento LR, Costa ME, et al.Effects of surgical removal of mandibular third molar on the periodontium of the second molar[J]. Int J Dent Hyg, 2008, 6(2): 123-128.
[28] Korkmaz YT, Mollaoglu N, Ozmeriç N.Does laterally rotated flap design influence the short-term periodontal status of second molars and postoperative discomfort after partially impacted third molar surgery?[J]. J Oral Maxillofac Surg, 2015, 73(6): 1031-1041.
[29] Harrison JW.Healing of surgical wounds in oral mucoperiosteal tissues[J]. J Endod, 1991, 17(8): 401-408.
[30] Chong BS, Rhodes JS.Endodontic surgery[J]. Br Dent J, 2014, 216(6): 281-290.
[31] Gutmann J L, Gutmann MS.Historical perspectives on the evolution of surgical procedures in endodontics[J]. J Hist Dent, 2010, 58(1): 1-42.
[32] Dunphy L, Salzano G, Gerber B, et al.Medication-related osteonecrosis (MRONJ) of the mandible and maxilla[J]. BMJ Case Rep, 2020, 13(1): e224455.
[33] Lee DH, Seo JI, Song SI, et al.Radiographic changes of mandibular cortical bone in bisphosphonate drug holiday[J]. J Korean Assoc Oral Maxillofac Surg, 2022, 48(4): 219-224.
[34] Kato H, Uchibori M, Nakanishi Y, et al.A case of osteomyelitis of the mandibular condyle secondary to bisphosphonate-related osteonecrosis of the jaw[J]. Tokai J Exp Clin Med, 2020, 45(3): 126-130.
[35] 林志健. 18例药物相关性颌骨坏死的临床回顾性分析[D]. 沈阳: 中国医科大学, 2022.
Lin ZJ.Clinical retrospective analysis of 18 cases of drug-related necrosis of the jaw[D]. Shenyang: China Medical University, 2022.
[36] 刘中寅, 汤晓雨, 张兴华, 等. 合并糖尿病的上颌骨感染性骨坏死7例临床分析[J]. 中国口腔颌面外科杂志, 2009, 7(6): 556-558.
Liu ZY, Tang XY, Zhang XH, et al.Infective osteonecrosis of the jaw combined with diabetes mellitus: an analysis of 7 cases[J]. China Journal of Oral and Maxillofacial Surgery, 2009, 7(6): 556-558.
[37] Sivolella S, Berengo M, Bressan E, et al.Osteotomy for lower third molar germectomy: randomized prospective crossover clinical study comparing piezosurgery and conventional rotatory osteotomy[J]. J Oral Maxillofac Surg, 2011, 69(6): e15-e23.
[38] Mantovani E, Arduino PG, Schierano G, et al.A split-mouth randomized clinical trial to evaluate the performance of piezosurgery compared with traditional technique in lower wisdom tooth removal[J]. J Oral Maxillofac Surg, 2014, 72(10): 1890-1897.