正畸牵引术在下颌第三磨牙低位近中阻生拔除中的应用

doi:10.3969/j.issn.1005-4979.2020.01.008

摘要/Abstract

摘要：

目的：研究正畸牵引拔除下颌近中阻生第三磨牙对改善邻牙牙槽骨缺损的作用。方法：选取2016-07—2018-01期间，我院收治的单侧或双侧有第二磨牙远中牙槽骨缺损的下颌第三磨牙近中阻生患者60例，按照随机数字表法将所有患者分为对照组（30例）和正畸牵引组（30例）。对照组患者常规拔除下颌第三磨牙，正畸牵引组患者经正畸牵引1~6个月后拔除下颌第三磨牙。检测患者正畸牵引治疗前（T₀）、拔牙前（T₁）、拔牙后3个月（T₂）、拔牙后6个月（T₃）这几个时间点，下颌第二磨牙近中及远中牙槽嵴顶至釉牙骨质界高度、下颌第二磨牙近中及远中牙槽骨密度、张口受限情况。结果：正畸牵引组患者在T₁、T₂、T₃节点时，下颌第二磨牙近中牙槽嵴顶至釉牙骨质界高度分别为5.16、3.98、2.12 mm，均低于对照组的7.16、4.57、3.16 mm，差异有统计学意义（t/P=12.250/0.001、8.963/0.001、56.680/0.001）。正畸牵引组患者在T₁、T₂、T₃节点时，下颌第二磨牙远中牙槽嵴顶至釉牙骨质界高度分别为5.24、3.15、2.34 mm，低于对照组的8.12、5.49、3.16 mm，差异有统计学意义（t/P=17.670/0.001、43.280/0.001、15.110/0.001）。正畸牵引组患者在T₁、T₂、T₃节点时，张口受限评分分别为2.10、1.25、0.68 分，均低于对照组的2.56、2.00、1.69 分，差异有统计学意义（t/P=9.690/0.001、30.530/0.001、41.120/0.001）。结论：正畸牵引拔除下颌近中阻生第三磨牙可有效改善邻牙牙槽骨缺损现象，增大牙槽骨密度。

关键词: 下颌第三磨牙, 近中阻生, 正畸牵引, 牙拔除术, 邻牙牙槽骨缺损

Abstract:

Objective: To study the effect of orthodontic traction in the extraction of impacted mandibular third molar especially its effects on the alveolar bone defect of adjacent teeth. Methods: From July 2016 to January 2018, 60 cases of impacted mandibular third molars with unilateral or bilateral distal alveolar bone defect of the second molar were selected. All patients were divided into control group(n=30) and orthodontic traction group (n=30) according to the random number table method. The control group received conventional minimally invasive tooth extraction of mandibular third molars, while the orthodontic traction group received 1-6 months of orthodontic traction, and minimally invasive tooth extraction of mandibular third molars. The height of the alveolar bone from the crest of the proximal and distal mandibular second molars to the enamel bone boundary, the height and density of the alveolar bone around the mandibular second molars, and the limitation of month opening at 4 time points, were recorded. The 4 time pionts including before orthodontic traction treatment(T₀), before tooth extraction(T₁), three months after tooth extraction(T₂) and six months after tooth extraction(T₃). Results: In the orthodontic traction group, the height of the mandibular second molars（from the alveolar crest to the enamel cementum boundary）at time points of T₁, T₂ and T₃ (5.16, 3.98 and 2.12 mm respectively) were lower than those of the control group (7.16, 4.57 and 3.16 mm), with t/P=12.250/0.001, 8.963/0.001, 56.680/0.001. In the orthodontic traction group, the height from the distal alveolar crest to the enamel bone boundary of the mandibular second molars at T₁, T₂ and T₃ time points (5.24, 3.15 and 2.34 mm), were lower than those of the control group (8.12, 5.49 and 3.16 mm), with t/P=17.670/0.001, 43.280/0.001 and 15.110/0.001 respectively. In the orthodontic traction group, the scores of limited mouth opening at T₁, T₂ and T₃ time points, were 2.10, 1.25, 0.68 respectively, which were lower than those in the control group(2.56, 2.00, 1.69), with t/P=9.690/0.001, 30.530/0.001, 41.120/0.001 respectively. Conclusion: The removal of impacted mandibular third molar by orthodontic traction can effectively decrease the alveolar bone defect and increase the alveolar bone density.

Key words: the third molar in the mandible, mesioangular impaction, orthodontic traction, tooth extraction, defect of adjacent alveolar bone

中图分类号:

R782.1

王留宏, 程刚, 娄新田, 杨惠, 王一霖. 正畸牵引术在下颌第三磨牙低位近中阻生拔除中的应用[J]. 《口腔颌面外科杂志》, 2020, 30(1): 36-41.

WANG Liuhong, CHENG Gang, LOU Xintian, YANG Hui, WANG Yilin. Application of Orthodontic Traction in Extraction of Impacted Mandibular Third Molar[J]. 《Journal of Oral and Maxillofacial Surgery》, 2020, 30(1): 36-41.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2020/V30/I1/36

图/表 6

图1 下颌近中阻生第三磨牙治疗前和截冠术后经正畸牵引3个月的CBCT比较注：A. 下颌近中阻生第三磨牙治疗前水平截面CBCT示根尖贴近下牙槽神经管；B.截冠术后牵引3个月的水平截面CBCT示残留牙体组织上可见种植钉，且根尖较前明显远离下牙槽神经管；C. 下颌近中阻生第三磨牙治疗前矢状截面CBCT图像示根尖贴近下颌管，管壁部分不完整；D. 截冠术后牵引3个月的矢状截面CBCT示剩余牙体组织明显抬高接近牙合平面，且根尖较前明显远离下颌神经管。

Figure 1 The comparison of CBCT images before and after orthodontic traction for impacted mandibuiar third molar

图2 正畸牵引拔除下颌近中阻生第三磨牙典型病例注：A. 首次手术截除牙冠去除邻牙阻力后，在残留牙根上放置微种植支抗钉进行正畸牵引；B. 牵引3个月后，牙根已暴露于口腔中；C. 带着微种植支抗钉的残根被拔除。

Figure 2 A case of mesioangular impacted mandibular third molar extracted after orthodontic traction

表1 2组患者不同时间节点下颌第二磨牙近中牙槽嵴顶至釉牙骨质界高度比较（$\bar{x} \pm s$，mm）

Table 1 Comparison of the alveolar bone height from the mesial crest of the mandibular second molars to the enamel bone boundary at different time points between the two groups（$\bar{x} \pm s$，mm）

组别	总例数(例)	T₀	T₁	T₂	T₃
对照组	30	7.16±0.88	7.16±0.88	4.57±0.34	3.16±0.10
正畸牵引组	30	7.13±0.86	5.16±0.16	3.98±0.12	2.12±0.01
t		0.134	12.250	8.963	56.680
P		0.894	0.001	0.001	0.001

表2 2组患者不同时间节点下颌第二磨牙远中牙槽嵴顶至釉牙骨质界高度比较（$\bar{x} \pm s$，mm）

Table 2 The comparison of the alveolar bone height from the distal crest of the mandibular second molars to the enamel bone boundary at different time points between the two groups （$\bar{x} \pm s$，mm）

组别	总例数(例)	T₀	T₁	T₂	T₃
对照组	30	8.12±0.86	8.12±0.86	5.49±0.29	3.16±0.28
正畸牵引组	30	8.13±0.82	5.24±0.24	3.15±0.06	2.34±0.10
t		0.046	17.670	43.280	15.110
P		0.963	0.001	0.001	0.001

表3 2组患者不同时间节点下颌第二磨牙远中、近中牙槽骨密度比较（g/cm³）

Table 3 Comparison of the mesial and distal alveolar bone density of the mandibular second molar at different time points between the two groups（g/cm³)

组别	总例数 (例)	T₀		T₁		T₂		T₃
组别	总例数 (例)	远中	近中	远中	近中	远中	近中	远中	近中
对照组	30	250.36±12.05	246.35±12.13	250.36±12.05	246.35±12.13	271.12±10.64	258.25±16.47	281.25±18.45	271.48±11.14
正畸牵引组	30	251.42±12.13	248.25±12.16	268.59±18.57	258.46±20.56	279.68±19.54	269.68±17.49	296.68±20.12	283.45±19.25
t		0.340	0.606	4.511	2.779	2.107	2.606	3.096	2.948
P		0.735	0.547	0.001	0.001	0.039	0.012	0.003	0.005

表4 2组患者不同时间节点张口受限情况比较[（$\bar{x} \pm s$），分]

Table 4 Comparison of mouth opening limitation between the two groups at different time points[（$\bar{x} \pm s$），score]

组别	总例数 (例)	张口受限评分
组别	总例数 (例)	T₀	T₁	T₂	T₃
对照组	30	2.56±0.24	2.56±0.24	2.00±0.10	1.69±0.09
正畸牵引组	30	2.53±0.23	2.10±0.10	1.25±0.09	0.68±0.10
t		0.494	9.690	30.530	41.120
P		0.623	0.001	0.001	0.001

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