舌向分牙技术拔除下颌阻生第三磨牙

发布时间：2018-06-23 19:33

本文选题：阻生牙 + 微创　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:随着多种拔牙新技术、尤其是外科专用手机的广泛应用,减少了拔牙手术创伤,但是仍存在切口大,去骨多等缺点,不符合微创外科的原则。本临床研究观察了舌向分牙技术拔除下颌阻生第三磨牙在手术时间、创伤大小、术后反应以及其他并发症上的优劣,为临床操作进一步减少创伤进行了探索。方法:1临床资料选取2015年12月—2016年8月在白求恩国际和平医院口腔科门诊就诊,术前检查为下颌近中及水平位阻生第三磨牙的患者作为研究对象,随机分为两组。共计120例患者,男41例,女79例。累计拔除120颗患牙,其中近中位82颗,水平位38颗。使用阻生下颌第三磨牙拔除难度评分系统对患牙拔除难度进行评分。2拔除方法2.1实验组舌向分牙技术拔除下颌阻生第三磨牙:翻瓣、去骨,暴露患牙合面?,舌向分牙,先去除舌侧牙块,减少去骨尤其是颊侧去骨,创口一般不缝合。2.2对照组口腔外科门诊手术操作规范法拔除下颌阻生第三磨牙:翻瓣、去骨,暴露患牙最大周径,近远中分牙,先去除近中侧牙块,患牙拔除后开放式缝合。3术后处理和记录拔牙术后常规处理。观察并记录患者术后12h疼痛程度、术后3d、7d肿胀、术后3d、7d开口受限程度以及出血、干槽症等其它术中术后并发症。4统计方法:用SPSS21.0进行分析。对于正态分布数据患牙难度评估值、疼痛程度采用俩样本t检验。对于非正态分布数据手术时间、术后肿胀程度采用Wilcoxon秩和检验。等级资料去骨量和张口受限程度采用Wilcoxon秩和检验。计数资料术后出血、干槽症、下唇麻木、气肿以及术中并发症采用四格表X~2检验。结果:1患牙难度评估实验组患牙难度为10.77±1.94,对照组10.97±1.88。两组在拔除患牙拔除难度上无统计学差异(P0.05),具有可比性。2去骨量实验组平均秩次为42.05,秩次之和为2523;对照组平均秩次为78.95,秩次之和为4737,实验组去骨量明显少于对照组(P0.05)。3手术时间实验组拔除时间其中位数为11.5 min,四分位间距为11min;对照组拔除时间其中位数为10min,四分位间距为8min。两组在拔牙手术时间上无统计学差异(P0.05)。4疼痛术后12小时疼痛程度3.87±0.81,对照组6.91±1.21。实验组疼痛程度小于对照组(P0.05)。5张口受限程度术后第三天实验组对患者张口度影响较对照组小(P0.05)。术后第七天两组张口度程度无统计学差异(P0.05)。6肿胀术后第三天肿胀程度:两组无统计学差异(P0.05)。术后第七天肿胀程度无统计学差异(P0.05)。7其它术后出血、干槽症、气肿、下唇麻木以及术中并发症均无统计学差异(P0.05)。结论:1舌向分牙技术拔除下颌阻生第三磨牙不需要暴露患牙最大径,翻瓣范围小,去骨少2通过舌侧分牙,去除舌侧和近中阻力,改善视野,为小切口、小术野拔牙创造了条件。颊侧牙挺用力,牙根不但可以近中合向移动,而且可以近中舌侧合向三个方向运动,减少了脱位的阻力、去骨量和切磨时间。3术后反应小:舌向分牙拔除下颌第三磨牙的方法无需特殊仪器设备要求,但能有效减轻术后反应,提高患者生活质量,值得推广。
[Abstract]:Objective: with the extensive application of a variety of new tooth extraction technology, especially the special surgical mobile phone, it reduces the trauma of tooth extraction operation, but there are still many defects such as large incision and more bone removal, which do not conform to the principle of minimally invasive surgery. This clinical study observed the operation time, trauma size and postoperative reaction of mandibular impacted third molar extraction by tongue splitting technique. And other complications, in order to further reduce the trauma in clinical operation. Methods: 1 clinical data were selected from December 2015 to August 2016 in the Department of Stomatology, Department of Stomatology, Heping Hospital, Bethune international. The preoperative examination was used as the research object in the proximal and horizontal third molar of the lower jaw and the horizontal position, which were randomly divided into two groups. A total of 12 patients were randomly divided into two groups. 0 cases, 41 men and 79 women, 120 teeth were removed, of which 82 were proximal and 38. The difficulty scoring system of impacted mandible third molar extraction was used to remove the difficulty of tooth extraction by.2 extraction method 2.1. First remove the tongue and side teeth, reduce the bone, especially the buccal side of the bone, the wound usually does not suture the.2.2 control group dental surgery outpatient operation standard method to remove the mandibular impacted third molar: flap, bone, exposure to the maximum circumferential diameter of the teeth, near the distal middle teeth, first removal of the proximal part of the teeth, after the extraction of open type.3 after extraction of tooth extraction and extraction of tooth extraction after extraction and extraction of teeth after extraction and extraction of teeth after extraction. Postoperative routine treatment. Observe and record the degree of postoperative 12h pain, postoperative 3D, 7d swelling, postoperative 3D, 7d opening limitation, and other postoperative complications such as hemorrhage, and dry grooves, and other postoperative complications.4 statistical methods: SPSS21.0 analysis. The degree of difficulty assessment for normal distribution data, the degree of pain using the two samples t test. For non normal fractions. Wilcoxon rank sum test was used for the operation time of the data and the degree of postoperative swelling was measured by the rank sum test. Wilcoxon rank and test were used for the bone mass and the degree of opening restriction. Four lattice X~2 tests were used for the postoperative bleeding, dry grooves, lower lip numbness, emphysema and intraoperative complications. Results: the difficulty of the 1 tooth difficulty assessment was 10.77 + 1.94, There was no statistical difference between the 10.97 + 1.88. two groups in the control group (P0.05). The average rank of the experimental group was 42.05, the rank sum was 2523, the average rank of the control group was 78.95, and the rank sum was 4737. The bone mass of the experimental group was significantly less than that of the control group (P0.05) in the.3 operation time group. The number was 11.5 min, the interval of four division was 11min, the number of the extraction time in the control group was 10min, the four division interval was 8min. two, there was no statistical difference in the time of extraction operation (P0.05).4 pain 12 hours pain 3.87 + 0.81, and the pain range of the control group 6.91 + 1.21. group was less than that of the control group (P0.05).5 opening restriction third. The mouth degree of the experimental group was smaller than that of the control group (P0.05). There was no statistical difference between the two groups at seventh days after operation (P0.05) the swelling degree at third days after the operation of.6 swelling: there was no statistical difference between the two groups (P0.05). There was no statistical difference in the swelling degree of the seventh days after the operation (P0.05).7 other postoperative bleeding, dry slots, emphysema, lower lip numbness and operation. There was no statistical difference in the complications (P0.05). Conclusion: the extraction of mandibular impacted third molar by 1 lingual teeth technique does not need to expose the maximum diameter of the mandibular impacted molar, the range of the flap is small, the bone removal is small, and the reduction of the bone is 2 through the lingual side of the tooth. The lateral and proximal resistance can be removed and the visual field is improved. It moves in the middle, and can move near the middle tongue to three directions, reducing the resistance of the dislocation, reducing the bone mass and cutting time after.3. The method of removing the third molar of the mandible is not required by the tongue to remove the mandibular third molars, but it can effectively reduce the postoperative reaction and raise the quality of life of the patients. It is worth popularizing.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.11

【参考文献】