非阻生第三磨牙对邻牙健康影响的回顾性研究

发布时间：2017-12-26 23:25

本文关键词：非阻生第三磨牙对邻牙健康影响的回顾性研究　出处：《第四军医大学》2016年硕士论文　论文类型：学位论文

【摘要】：第三磨牙是人类最晚发育最晚萌出,同时也是最容易发生阻生的牙齿[1]。第三磨牙的阻生率在世界范围内有很大差异,不同的民族和地区之间不尽相同[2-4]。关于第三磨牙的处理一直存在争议[5,6]。对于第三磨牙的治疗方案的确定需要考虑每位患者的不同的情况同时也要考虑社会经济效益。以往的很多研究表明,阻生第三磨牙的存在可能与多种口腔疾病的发生有关,比如冠周炎、龋病、牙周病、牙根吸收以及颌骨的囊肿或者肿瘤等[7-11]。如果第三磨牙自身患病或者影响了邻牙的健康则会被建议拔除。但是,目前还没有足够的证据支持对没有临床症状的第三磨牙进行预防性拔除[12,13]。随着年龄的增长,阻生第三磨牙被不断拔除,非阻生第三磨牙所占比例相对升高。同时,第三磨牙自身发生疾病的机率逐渐增大,而拔除这些牙齿的风险随着患者年龄的增加也越来越大[7,14]。有研究表明,非阻生的第三磨牙有可能也会对邻牙的健康产生影响[7,15]。但是,目前有关非阻生第三磨牙对邻牙健康的研究还很少。非阻生第三磨牙是否会对邻牙健康产生影响及其影响程度还不明确[7]。这就给临床上确定此类第三磨牙的处理方案造成了困难。为此,我们设计了本研究。目的:通过对影像资料和临床资料的回顾性研究,分析非阻生第三磨牙的存留情况及其对相邻第二磨牙健康状况的影响。方法:1.非阻生第三磨牙存留情况的横断面研究:该研究分析了2015年8月至2015年10月所有在第四军医大学口腔医院就诊并拍摄全景曲面断层片患者的影像及病例信息。按照统一的纳入和排除标准进行纳入。患者的年龄和性别等社会人口学特征从其病例信息中获取。非阻生第三磨牙的存留情况及阻生第三磨牙的阻生情况从全景曲面断层片中获取。分别通过Winter分类和PG分类确定阻生第三磨牙的阻生角度和阻生水平。2.非阻生第三磨牙对邻牙健康影响的回顾性研究:该研究继续实验一的研究,按照新的纳入和排除标准进行纳入。通过比较第三磨牙在缺失、阻生和非阻生情况下第二磨牙远中发生龋病、根吸收和牙槽骨吸收情况的不同,探讨非阻生第三磨牙对邻牙健康状况影响。3.非阻生第三磨牙对邻牙牙周状况影响的回顾性研究:以从2014年9月至2015年6月到第四军医大学口腔医院牙周科就诊的患者为研究对象。按照纳入和排除标准对患者进行纳入。收集所有纳入患者的社会人口学资料和牙周检查指标。通过比较有无非阻生第三磨牙的情况下第二磨牙牙周状况的差异,进一步探索非阻生第三磨牙对第二磨牙牙周状况的影响。4.统计学分析:运用SPSS 18.0统计软件对数据进行描述和分析。使用均数和标准差对计量资料进行描述。使用频数及构成比或率对计数资料和等级资料进行描述。计量资料的比较用t检验或方差分析,计数资料的比较用Pearsonc2检验。应用logistic回归模型对拟分析的影响因素变量进行分析。所有的统计检验均采用双侧检验,组间比较检验水准α=0.05,多重比较检验水准校正为α=0.017。结果:1.通过对2395例病人的筛选,一共对1958人(37.2±17.0岁)进行了非阻生第三磨牙存留情况的分析,其中男性774人,女性1184人。45.1%的患者有非阻生第三磨牙,在保留的第三磨牙中有约44.1%是非阻生的。此外,我们还发现阻生第三磨牙在纳入人群中的患病率为54.3%。最常见的阻生角度和阻生水平分别是近中阻生(37.3%)和C类阻生(47.1%)。2.通过对2395例病人的筛选,对1958人(37.2±17.0岁)的6695颗第二磨牙的患病情况进行了分析。在非阻生第三磨牙存在的情况下,第二磨牙远中发生龋病、根吸收和牙槽骨吸收的比率分别为10.0%,0.8%和40.4%。非阻生第三磨牙的存在不会增加邻牙发生龋病和根吸收的风险,但会使邻牙发生牙槽骨吸收的风险增加到第三磨牙缺失时的1.77倍(95%CI:1.51,2.08;P0.001)。3.共有135名(男性43.7%,平均年龄40.6岁)患者被纳入到本研究,其中105位患者有至少1颗非阻生第三磨牙,30位患者没有第三磨牙。两组之间在年龄、性别、职业和教育程度等人口学资料上没有差异。非阻生第三磨牙的存在使得邻牙的牙龈指数(GI)、菌斑指数(PLI),探诊深度(PPD)、附着水平(CAL)、探诊出血(BOP)以及至少1个位点探诊深度≥5mm(PPD5+)的比例显著增加(P0.05)。均衡了年龄、颌位和教育程度等影响因素之后,非阻生第三磨牙存在使其邻牙牙发生PPD5+的风险是第三磨牙缺失时的6.79倍(95%CI:1.12-41.16)。结论:1:临床上,约有45%的患者有非阻生第三磨牙。2:非阻生第三磨牙的存在使得邻牙发生牙槽骨吸收的风险显著增加。3:非阻生第三磨牙的存在对于相邻第二磨牙的牙周健康有负面影响。
[Abstract]:The third molar is the most late eruption of human development, and it is also the most easily occurring tooth [1]. The resistance rate of the third molar is very different in the world, and the [2-4] is not the same among the different nationalities and regions. There has been a dispute [5,6] about the treatment of third molars. The determination of the treatment plan for the third molar needs to consider the different cases of each patient and also to consider the social and economic benefits. Many previous studies showed that impacted third molar may exist with a variety of oral diseases, such as periodontitis, dental caries, periodontal disease, root resorption and bone cyst or tumor [7-11]. If the third molars are sick themselves or affect the health of the adjacent teeth, it will be suggested to be removed. However, there is not enough evidence to support the prophylactic extraction of [12,13] for third molars without clinical symptoms. With the increase of age, the impacted third molar was continuously removed, and the proportion of the non impacted third molar was relatively higher. At the same time, the probability of the third molars' own disease is gradually increasing, and the risk of removing these teeth is increasing with the increase of the age of the patients with the increase of [7,14]. Studies have shown that the non impacted third molars may also have an impact on the health of the adjacent teeth [7,15]. However, at present, there are few studies on the health of non impacted third molar teeth to the adjacent teeth. The influence of the non impacted third molar on the health of the adjacent teeth and the extent of its influence are not clear [7]. This makes it difficult to determine the treatment of such third molars clinically. To this end, we have designed this study. Objective: to analyze the retention of non impacted third molar and its influence on the health status of second adjacent molars by retrospective study of image data and clinical data. Methods: 1.. A cross-sectional study of third cases of non impacted and third molar retained. This study analyzed the imaging and case information of all patients who received panoramic tomography in The Fourth Military Medical University dental hospital from August 2015 to October 2015. Inclusion in accordance with unified inclusion and exclusion criteria. Social demographic characteristics, such as age and sex, are obtained from the information of their cases. The retention of the non impacted third molar and the impaction of the impacted third molar were obtained from the panoramic surface fault. The impacted angle and the impacted level of the impacted third molar were determined by Winter classification and PG classification. A retrospective study of the effect of 2. non impacted third molar on the health of the adjacent teeth: the study continued in the first study and included in the new inclusion and exclusion criteria. By comparing the difference of caries, root resorption and alveolar bone resorption between the third molars in the absence, impaction and non impacted condition of the two molar, the influence of non impacted third molar on the health of adjacent teeth was discussed. A retrospective study of 3. non influence impacted third molars on the adjacent periodontal condition: from September 2014 to June 2015 at the The Fourth Military Medical University Hospital of stomatology hospital patients as the research object. The patients were included in the inclusion and exclusion criteria. All the social demographic data and periodontal indicators were collected. By comparing the periodontal status of the two molar, the influence of non impacted third molar on the periodontal status of the second molar was further explored through comparing the periodontal status of the two molar. 4. statistical analysis: using SPSS 18 statistical software to describe and analyze the data. The measurement data are described with the use of mean and standard deviation. The number and grade data are described by frequency and composition ratio or rate. The comparison of the measurement data was made by t test or analysis of variance, and the comparison of the count data was tested by Pearsonc2. The logistic regression model was used to analyze the variables of the influence factors of the quasi analysis. All the statistical tests were both tested by bilateral test, the comparison test between groups was alpha =0.05, and the level of multiple comparison test was alpha =0.017. Results: 1.. Through the screening of 2395 patients, a total of 1958 patients (37.2 + 17 years old) were analyzed for the prevalence of non impacted third molar, including 774 men and 1184 women. 45.1% of the patients had non impacted third molars, and about 44.1% of the retained third molars were not impacted. In addition, we also found that the prevalence of impacted third molar in the population was 54.3%. The most common impacted and impacted levels were impacted (37.3%) and C (47.1%), respectively. 2. the prevalence of 6695 second molars in 1958 people (37.2 + 17 years old) was analyzed by screening 2395 patients. In the presence of non impacted third molar, the ratio of caries, root absorption and alveolar bone absorption in the second molars was 10%, 0.8% and 40.4% respectively. The presence of non impacted third molar does not increase the risk of caries and root resorption, but it increases the risk of alveolar bone absorption to 1.77 times of third molar loss (95%CI:1.51,2.08; P0.001). 3. a total of 135 patients (male 43.7%, mean age 40.6 years) were included in this study. 105 patients had at least 1 non impacted third molars and 30 patients did not have third molar teeth. There was no difference in demographic data between the two groups in age, sex, occupation and educational level. There are third non impacted molars makes the adjacent teeth gingival index (GI), plaque index (PLI), probing depth (PPD) and attachment level (CAL), bleeding on probing (BOP) and at least 1 loci probing depth more than 5mm (PPD5+) ratio increased significantly (P0.05). After the balance of age, jaw position and level of education, there is a risk of non impacted third molars of the adjacent teeth of PPD5+ is 6.79 times the third molar (95%CI:1.12-41.16). Conclusion: in 1:, about 45% of the patients have non impacted third molar. The existence of 2: non impacted third molar
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R781.4

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