Abstract:

Objective: To investigate whether the buccal fenestration approach can be effective in extracting impacted wisdom teeth in the lower mandible while preserving alveolar bone height and preventing the formation of the distal periodontal pocket of the second molar. Methods: A total of eighty patients with mandibular impacted lower wisdom teeth were included in the study. Patients were randomly divided into two groups. In the study group (40 patients), wisdom teeth were extracted by buccal fenestration; in the control group (40 patients), the traditional bone removal technique was used. All patients were followed up at 1 week, 12 months and 36 months after the operation. The injury of the inferior alveolar nerve was examined and recorded 1 week after the operation. After 12 and 36 months, the bone in the extraction area was evaluated by cone beam CT(CBCT). The height of the alveolar bone, the probing depth and the mobility of the adjacent second molar were recorded in the two groups respectively, and the statistical analysis was performed. The descending height of alveolar bone, whether the second molars formed deep periodontal pockets and their probing depth, whether second molars loosened and whether the injury of inferior alveolar nerve occurred were statistically analyzed. Results: The height of alveolar bone in the study group decreased by 1 mm on average, while the height of the alveolar bone decreased by 7 mm in the control group, and the difference between the two groups was statistically significant (P<0.05). In the study group, deep periodontal pockets were formed at the distal part of the second molars in 6 patients, and the average probing depth of deep periodontal pockets was 4.5 mm at 12 months after the operation and 5 mm at 36 months after the operation; in the control group, thirty-two patients developed deep periodontal pockets with an average probing depth of 7.5 mm at 12 months after the operation and 8 mm at 36 months after the operation, and the difference between the two groups was statistically significant (P<0.05). No second molar loosening was found in the study group; in the control group, there were 30 patients with second molar loosening about degreeⅠat 12 months after the operation and 32 patients at 36 months after the operation, and the difference between the two groups was statistically significant (P<0.05). Four patients suffered from the injury of inferior alveolar nerve after the operation and recovered within 6 months in the study group; three patients suffered from the injury of inferior alveolar nerve after the operation and recovered within 6 months in the control group, while the difference between the two groups was not significant (P>0.05). Conclusion: Buccal fenestration can effectively preserve the height of alveolar bone in the extraction area and reduce the incidence of distal periodontal pockets of the second molar. At the same time, it doesn't increase the complication such as the injury of inferior alveolar nerve. It's one of the ideal methods to extract the impacted lower wisdom teeth.

Key words: impacted lower wisdom teeth, buccal fenestration, distal periodontal pocket, alveolar bone height

摘要：

目的：探讨颊侧开窗法能否在拔除下颌低位埋伏阻生智齿的同时，有效保留牙槽骨高度，预防第二磨牙远中牙周袋的形成。方法：纳入门诊就诊的下颌低位埋伏阻生智齿患者80例，将患者随机分成2组。研究组40例，采用颊侧开窗法拔除智齿；对照组40例，采用传统去骨法拔除智齿。术后1周、12个月、36个月时复查，术后1周检查并记录下牙槽神经损伤情况；术后12、36个月时，拍摄锥形束CT (cone-beam CT, CBCT）评估拔牙区骨质情况，分别记录2组患者拔牙区牙槽骨高度，邻近第二磨牙探诊深度、松动度。对牙槽骨下降高度、第二磨牙是否形成深牙周袋、形成深牙周袋的第二磨牙探诊深度、是否出现第二磨牙松动及是否出现下牙槽神经损伤症状进行统计学分析。结果：研究组拔牙区牙槽骨高度较术前平均降低1 mm；对照组较术前平均降低7 mm，2组差异有统计学意义（P<0.05）。研究组有6例患者第二磨牙远中形成深牙周袋，术后12个月时6例患者第二磨牙平均探诊深度为4.5 mm，术后36个月时为5 mm；对照组有32例患者第二磨牙远中形成深牙周袋，术后12个月时32例患者第二磨牙平均探诊深度为7.5 mm，术后36个月时为8 mm, 2组差异有统计学意义（P<0.05）。研究组未发现患者出现第二磨牙松动；对照组在术后12个月时有30例患者第二磨牙出现Ⅰ度松动，术后36个月时有32例患者第二磨牙出现Ⅰ度松动，2组差异有统计学意义（P<0.05）。研究组4例患者术后出现下牙槽神经损伤症状，并在术后6个月内恢复；对照组有3例患者出现下牙槽神经损伤症状，并在术后6个月内恢复，2组差异无统计学意义（P>0.05）。结论：颊侧开窗法拔除下颌低位埋伏阻生智齿可有效保留拔牙术区牙槽骨高度，降低下颌第二磨牙远中牙周袋的发生率，同时并未增加下牙槽神经损伤等并发症的发生率，是拔除低位埋伏阻生智齿的一种较为理想的方法。

关键词: 低位埋伏阻生智齿, 颊侧开窗法, 远中牙周袋, 牙槽骨高度

CLC Number: 

• R782