摘要：

目的： 探讨经前庭沟入路拔除下颌第三磨牙（mandibular third molar，M3M）牙胚对邻牙牙周组织和对患者术后恢复情况的影响，为该术式的临床应用提供参考。方法： 本研究选取2023年5月至2024年7月期间于云南省曲靖中心医院口腔颌面外科就诊、需行双侧M3M牙胚拔除的27例患者，采用自身对照设计。通过随机抽签法，将每位患者的一侧选用前庭沟入路（前庭沟入路组），对侧选用经典角形切口入路（角形切口组）。比较2组手术时间，并于术后第1、3、7天评估患者面部肿胀程度、张口受限程度及疼痛视觉模拟评分法（visual analogue scale，VAS）评分，同时记录并发症（出血、神经损伤、干槽症、邻牙损伤和创口裂开）的发生情况。比较2组术前、术后1个月及术后3个月邻牙的探诊深度（pocket depth，PD）与牙龈指数；术后6个月时，通过锥形束CT（cone beam CT，CBCT）比较2组邻牙远颊骨缺损深度（osseous defect depth，ODD）。结果： 共24例患者（48颗牙胚）完成全部随访。术后7 d，2组在面部肿胀程度、疼痛VAS评分及张口受限程度方面，差异均无统计学意义（P>0.05），且所有患者均未发生术后并发症。2组手术时间及术后1、3个月的邻牙牙龈指数比较，差异无统计学意义（P>0.05）。术后1个月时，前庭沟入路组邻牙远颊PD与术前基本一致，且显著小于角形切口组（P<0.01）；术后3个月，2组间该指标差异无统计学意义（P>0.05）。术后6个月，CBCT结果显示，前庭沟入路组邻牙远颊ODD显著小于角形切口组（P<0.001）。结论： 前庭沟入路拔除M3M牙胚更有利于邻牙远中牙周组织的保护，在术后恢复方面与角形切口入路无明显差异。

关键词: 前庭沟入路, 角形切口入路, 下颌第三磨牙牙胚, 牙拔除术

Abstract:

Objective: To investigate the impact of extracting mandibular third molar (M3M) tooth germs via the vestibular sulcus approach on the periodontal tissue of adjacent teeth and on patient postoperative recovery, providing a reference for the clinical application of this technique. Methods: This self-controlled study included 27 patients who required bilateral M3M germ extraction and presented to the Department of Oral and Maxillofacial Surgery, Qujing Central Hospital of Yunnan Province between May 2023 and July 2024. For each patient, one side was randomly assigned (by drawing lots) to the vestibular sulcus approach (vestibular approach group), while the contralateral side was assigned to the classic angular incision approach (angular incision group). Operative time was compared between the two groups. On postoperative days 1, 3, and 7, facial swelling, degree of mouth opening limitation, and pain visual analog scale (VAS) scores were assessed. The occurrence of complications (hemorrhage, nerve injury, dry socket, adjacent tooth injury, and wound dehiscence) was recorded. Probing depth (PD) and gingival index of the adjacent teeth were compared between the two groups preoperatively, and at 1 and 3 months postoperatively. At 6 months postoperatively, cone beam CT (CBCT) was used to compare the distobuccal osseous defect depth (ODD) of the adjacent teeth between the two groups. Results: A total of 24 patients (48 tooth germs) completed all follow-ups. On postoperative day 7, there were no statistically significant differences (P>0.05) between the two groups in facial swelling, pain VAS scores, or degree of mouth opening limitation. No postoperative complications occurred in any patient. There were no statistically significant differences (P>0.05) in operative time or the adjacent teeth gingival index at 1 and 3 months postoperatively between the two groups. At 1 month postoperatively, the distobuccal PD of adjacent teeth in the vestibular approach group was essentially unchanged from the preoperative level and was significantly smaller than that in the angular incision group (P<0.01) ; by 3 months postoperatively, the difference in this indicator between the two groups was not statistically significant (P>0.05). At 6 months postoperatively, CBCT results showed that the distobuccal ODD of adjacent teeth in the vestibular approach group was significantly smaller than that in the angular incision group (P<0.001). Conclusion: The vestibular sulcus approach for extracting M3M tooth germs is more beneficial for preserving the periodontal tissues on the distal aspect of the adjacent teeth, while showing no significant difference in postoperative recovery compared to the angular incision approach.

Key words: vestibular sulcus approach, angular incision approach, mandibular third molar tooth germ, tooth extraction

中图分类号: 

• R782