冠周冲洗上药后即刻拔牙对干槽症相关细菌的研究

目的：比较下颌阻生智齿拔除术前冠周冲洗、上药后即刻拔牙与常规拔牙后干槽症相关细菌检出率的差异，寻找一种有效、简便、经济的预防干槽症的方法。方法：选取94例患者随机分为三组，A组冲洗＋上药组（33例），B组冲洗组（31例），C组对照组（30例）。分别采集术前术后冠周龈盲袋或拔牙创内的细菌进行需氧和厌氧培养。结果：A组产墨 素类杆菌检出率术前为33．3％，术后为10．1％；B组产黑素类杆菌的检出率术前为32．3％，术后为16．1％；C组产墨素类杆菌的检出率术前为30．0％，术后为33．3％。三组术前术后链球菌检出率均为100％。结论：下颌阻生智齿拔除术前冠周冲洗，上药后即刻拔牙能有效地减少干槽症的发生。     

冠周局部注射地塞米松预防下颌第三磨牙拔除术后并发症

目的评价拔牙术前或术后行地塞米松冠周局部注射（下颌第三磨牙颊侧组织,磨牙后三角区以及咀嚼肌区）在下颌第三磨牙拔除术后肿胀,疼痛及张口受限的预防效果。 方法对240例患者的下颌第三磨牙依照阻生类型进行三种方法拔除,对三组牙拔除方式的患者分别列为实验组（拔牙术前冠周局部注射地塞米松组和拔牙术后注射地塞米松组）和对照组（拔牙术前术后均未注射地塞米松）,对患者术后第1、3、7天进行随访分析,对患者肿胀指数,疼痛程度和张口受限程度进行统计,并作统计学分析。实验组之间,以及实验组与对照组之间的比较采用卡方检验,以P<0.05为差异有统计学意义。 结果在拔牙术后第1天和第7天,术前或术后冠周局部注射地塞米松组与未注射地塞米松组在肿胀指数,疼痛程度和张口受限程度差异无统计学意义（P>0.05）;术后第3天,术前或术后冠周局部注射地塞米松组较对照组在肿胀反应中具有更好的疗效（P<0.05）,在疼痛和张口受限程度中具有一定的预防、治疗效果（P>0.05）。术前或术后冠周局部注射地塞米松对拔牙后肿痛反应及张口受限程度差异无统计学意义。 结论拔牙术前或术后冠周局部注射地塞米松可有效的预防下颌第三磨牙拔除术后肿胀、疼痛反应以及张口受限的发生。     

不同方式分冠法拔除下颌阻生第三磨牙的临床观察

目的:比较不同分冠法的两种高速涡轮机拔牙方法的临床应用效果,并与传统劈冠法进行比较。方法 :对210颗下颌阻生第三磨牙(186例),进行随机分组,每组70颗牙。A组:"T+V"型涡轮机分牙冠加C型颈部增隙法;B组:T型涡轮机分牙冠法;C组:传统劈冠分牙增隙法。观察拔牙时间、拔牙术中并发症、术后反应。结果 :3组中,A组拔牙时间平均(26.14±0.78)min,B组拔牙时间平均(34.53±0.52)min,C组拔牙时间平均(41.57±0.62)min。3组间比较(P<0.05),差异有统计意义。A组术后疼痛和术后肿胀均较B组、C组低(P<0.05),但术后张口受限以及术后感染在3组间无差异(P>0.05)。A组术中断根、舌侧骨板U折断发生率较B组、C组低(P<0.05)。3组间,术中明显出血、下齿槽神经损伤的发生率,差异无统计意义(P>0.05)。结论:高速涡轮机配专用长裂钻或球钻进行阻生牙拔除术,采用"T+V"型分冠结合C型颈部去骨法,拔牙时间较短,术中断根率、舌侧骨板折断率较低,术后疼痛、肿胀较少。     

高速涡轮钻、超声骨刀和常规方法拔除下颌阻生智牙的比较

目的:通过比较常规拔牙法、高速涡轮钻、超声骨刀拔除邻近神经管下颌阻生智牙并发症的客观数据,寻求拔除此类牙的最佳方法。方法:将300例符合条件的患者随机均分为3组,A组采用骨凿、劈冠、增隙法拔牙,B组用高速涡轮钻,C组用超声骨刀拔牙。观察3组患者手术时间、术后疼痛持续时间、干槽症和下牙槽神经损伤发生情况。采用SPSS13.0软件包对计量资料进行配对t检验,对计数资料进行χ2检验。结果:手术时间A组为(14.12±0.12)min,B组为(7.22±0.15)min,C组为(25.23±0.32)min;3组间两两比较均有显著差异(P<0.05)。术后疼痛持续时间A组为(62.15±1.51)h,B组为(48.23±1.23)h,C组为(14.34±0.80)h;3组间两两比较均有显著差异(P<0.05)。干槽症发生例数A组为9例,B组为2例,C组为1例。下牙槽神经损伤A组6例,B组2例,C组0例。结论:与常规拔牙方法相比,高速涡轮钻拔除复杂阻生牙能缩短手术时间,减少术后并发症,超声骨刀和前2种方法相比虽然手术时间较长,但术后并发症更少。     

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目的微创拔牙法和传统凿骨劈冠法对下颌阻生智齿拔除效果的比较。方法对1999年6月至2011年5月在解放军第359医院口腔科须要拔除单侧下颌阻生齿的患者270例,随机分成A、B两组,每组135例,A组采用微创拔牙法,B组采用凿骨劈冠法,对拔牙时间及术中、术后并发症进行观察和统计分析。结果 A组(微创拔牙法)平均拔牙时间为(20.83±8.07)min,显著短于B组(凿骨劈冠法)平均拔牙时间(24.82±12.29)min(P<0.05),A组术中、术后的并发症显著少于B组。结论微创拔牙法拔除下颌阻生智齿,可以缩短拔牙时间,减轻手术创伤,减少术中、术后并发症的发生,值得临床推广使用。     

超声骨刀结合涡轮钻法在复杂下颌阻生第三磨牙拔除中的应用

目的比较涡轮钻法、超声骨刀法与超声骨刀结合涡轮钻法拔除复杂下颌阻生第三磨牙的临床效果,探讨较佳的拔牙方式。方法 90例患者随机分成3组,每组30例。A组采用涡轮钻法拔牙,B组采用超声骨刀法拔牙,C组采用超声骨刀结合涡轮钻法拔牙。观察3组患者手术时间、术后疼痛、肿胀程度、张口度、干槽症和下牙槽神经损伤情况。采用SPSS 13.0软件包进行统计学分析。结果 A组手术时间为(19.88±1.87)min,B组为(27.41±1.38)min,C组为(14.06±1.49)min;3组间两两比较差异均有统计学意义(P<0.05)。术后并发症发生情况:A组12例,B组4例,C组1例。结论超声骨刀结合涡轮钻法拔除复杂下颌阻生第三磨牙效率高、安全、微创,是较佳的拔牙方式。     

应用“止泰”胶质银止血明胶海绵预防下颌阻生智牙拔除后干槽症

目的:研究“止泰”胶质银止血明胶海绵预防下颌阻生智牙拔除术后干槽症的临床效果.方法:选取需行下颌阻生智牙拔除术的976例患者的1350颗牙作为研究对象,将患者随机分为A组、B组和C组,A组用“止泰”胶质银止血明胶海绵填塞拔牙窝,B组用吸收性止血明胶海绵蘸碘仿粉填塞拔牙窝,C组不填塞任何物质,观察3组患者拔牙术后干槽症发生率的差异,采用SPSS10.0软件包进行统计学分析.结果:拔牙后干槽症的发生率A组为0.44％,B组为2％,C组为4.44％.A组、B组与C组比较,干槽症发生率具有显著差异(P＜0.05),A组与B组比较,差异也有统计学意义(P＜0.05).结论:“止泰”胶质银止血明胶海绵预防下颌阻生智牙拔除后干槽症的疗效良好,值得推广.     

数字纱布预防下颌阻生牙拔除术后出血和干槽症的临床观察

目的通过与明胶海绵比较来评价数字纱布置入下颌阻生牙拔牙创预防拔牙术后出血和干槽症的临床效果。方法将318例拔除下颌阻生牙的患者随机分成3组,A组下颌阻生牙拔除术后拔牙创内不放置任何材料,B组向拔牙创内置入明胶海绵,C组拔牙创内置入数字纱布,观察3组术后出血和干槽症的发生率,进行对比研究和疗效评价。结果拔牙术后0.5 h,经卡方检验,两两比较,数字纱布(C)组出血率(0.9%)明显少于明胶海绵(B)组(3.8%),明胶海绵(B)组出血率明显少于A组(7.5%),组间差异有统计学意义(P<0.05);术后数字纱布组干槽症的发生率(0.94%)明显少于明胶海绵组(2.83%)和明胶海绵组干槽症的发生率明显少于A组(4.72%),差异有统计学意义(P<0.05)。结论数字纱布局部应用能有效地预防下颌阻生牙拔除术后出血和干槽症的发生。     

涡轮机拔牙法和传统拔牙法拔除下颌阻生第三磨牙对照研究

目的　比较传统拔牙法和涡轮机拔牙法在下颌阻生第三磨牙拔除中的利弊。方法　选取需拔除双侧下颌阻生第三磨牙且两侧牙齿阻生类型相似的患者共45例,将同一患者的下颌双侧阻生第三磨牙随机分为2组,分别采用传统拔牙术（A组）和涡轮机拔牙术（B组）予以拔除。传统拔牙法应用劈冠器将牙劈开,敲击骨凿去骨,再用牙挺将敲碎的牙分块挺出;而涡轮机拔牙法采用45°仰角涡轮机进行去骨分牙,再用牙挺将敲碎的牙分块挺出。比较两组拔牙时间,患者的拔牙主观感受,术后第2天面部肿胀、疼痛、张口受限情况和术中、术后并发症。结果　A组拔除下颌阻生第三磨牙耗时5.5~76分,平均26.4分;B组耗时7~39.5分,平均22.4分。A组中,患者在拔牙时感觉明显不适或更严重不适占80%,而B组仅占15.6%,明显减轻。另外,B组拔牙后肿胀、疼痛和张口受限程度均较A组轻,且并发症发生率小。结论　涡轮机拔牙术可有效缩短拔牙时间,并可以使手术医生在拔牙过程中发挥更加稳定,能有效减小创伤和意外情况发生的可能;而且舒适性更好,更容易被广大患者接受。因而有必要在临床推广涡轮机拔牙术,并逐渐取代传统拔牙术。     

超声骨刀法与凿骨劈冠法拔除下颌低位阻生智齿的比较研究

目的：对比超声骨刀法与传统凿骨劈冠法拔除下颌低位阻生智齿的临床效果。方法：下颌低位阻生智齿126例随机分为两组,超声骨刀组采用超声骨刀法拔除智齿63例,68个牙,凿骨劈冠组采用传统凿骨劈冠法拔除智齿63例,79个牙）,比较两组病例的拔牙时间,术中与术后疼痛评分,术后患者面部肿胀、张口受限情况,以及下唇麻木、伤口感染等并发症发生情况。结果：超声骨刀组平均拔牙时间为（33．3±9．4）min,明显短于凿骨劈冠组平均拔牙时间（47．6±11．3）min,差异有统计学意义（P〈0．05）。凿骨劈冠组术中、术后疼痛评分明显高于同期超声骨刀拔除者,各时间点差异均有统计学意义（P〈0．05）。同组各时间点疼痛评分比较,术后第2d评分均高于术中评分（P〈0．05）,术后第7d评分均低于术中评分（P〈0．05）。凿骨劈冠组术后第2d面部肿胀、术后第7d张口受限程度明显高于超声骨刀组（P〈0．05）。两组病例均未出现下唇麻木、伤口感染病例。结论;采用超声骨刀法拔除下颌低位阻生智齿手术时间短,能明显减少患者术中、术后疼痛,减轻术后面部疼痛与肿胀程度,术后并发症发生率大大降低,优于传统的凿骨劈冠法。     

一次根管治疗术与两次根管治疗术术后短期临床疗效的比较

目的比较一次根管治疗术与两次根管治疗术术后短期临床疗效,并分析不同因素对疗效的影响。方法将96例需行根管治疗的患者随机分成2组,分别进行一次根管治疗术（一次治疗组）和两次根管治疗术（两次治疗组）,并在术后的1、3d和1周进行随访,记录其疼痛情况,术后3个月行影像学检查,评估分析其短期疗效。结果一次治疗组和两次治疗组在术后短期疼痛和影像学检查方面的差异均无统计学意义;患者的性别及患牙术前根尖周指数（PAI）对根管治疗的术后疗效有一定影响,而患者年龄、患牙解剖牙位、患牙牙髓情况（未出现根尖周病损）的差异对根管治疗术术后疗效影响意义不大。结论一次性根管治疗在术后短期的疼痛发生率较低,在临床可根据实际情况推广应用;患者性别及术前PAI会影响根管治疗的术后疗效。     

根管超声荡洗对成人根尖诱导成形术治疗效果影响研究

目的    探究根管超声荡洗对成人根尖诱导成形术治疗效果的影响。方法    选取2013年3月至2016年8月在德阳市口腔医院口腔内科接受根尖诱导成形术治疗的成人患者60例,随机分为对照组与观察组,每组30例。两组患者均在根管预备消毒后以Metapex糊剂为诱导材料行根尖诱导成形术,其中对照组采用常规注射器冲洗,观察组采用超声荡洗。术后3 d内观察患者的疼痛发生情况,比较两组患者的临床疗效。结果    术后3 d内对照组患者的疼痛发生率为36.67%,高于观察组的13.33%,差异具有统计学意义（χ2 = 4.356,P = 0.037）。治疗后随访2年,观察组的有效率为93.33%,高于对照组的73.33%,差异具有统计学意义（χ2 = 4.32,P = 0.038）。结论    根管超声荡洗用于成人根尖诱导成形术中能显著减轻患者术后的疼痛感,提升治疗效果,具有很好的临床疗效。     

A double-blind randomised controlled clinical trial of the effect of preoperative ibuprofen, diclofenac, paracetamol with codeine and placebo tablets for relief of postoperative pain after removal of impacted third molars

We conducted a randomised double-blind placebo-controlled single-centre study to compare the effect of preoperative ibuprofen 600 mg, diclofenac 100 mg, paracetamol 1 g with codeine 60 mg or placebo (Vitamin C 50 mg) tablets for relief of postoperative pain in 119 patients who had day case operations under general anaesthesia for removal of impacted third molars. Patients were given the tablets 1 h before operation. Pain was assessed using visual analogue scales and verbal rating scales preoperatively at 15 and 30 min and 1 and 3 h postoperatively. After they had gone home, patients were contacted by telephone at 6 and 24 h postoperatively to find out whether they had any adverse effects from the analgesics. There was no significant difference in the extent of postoperative pain among the four groups, but the placebo group had significantly shorter times before their first request for postoperative analgesics (median 17 min, range 14-90) than the diclofenac group (median 32, range 15-150). Preoperative analgesics at the stated doses are effective in providing immediate postoperative pain control after operations on third molars. There were, however, some side-effects including nausea, vomiting, headaches, and gastrointestinal discomfort, but there were no significant differences among the active analgesic groups with respect to adverse events either shortly after operation or at 6 or 24 h.     

Postoperative pain after 1- and 2-visit root canal therapy

OBJECTIVES: The factors that influence postoperative pain after root canal treatment are not completely understood. The purpose of this prospective clinical study was to evaluate postoperative pain after root canal therapy performed in 1 appointment versus 2 appointments. STUDY DESIGN: Seventy-two patients requiring root canal therapy on permanent molars were included in this study. Patients were randomly assigned to either the 1-appointment or the 2-appointment group. Both vital and nonvital teeth were included. The standardized protocol for all teeth involved local anesthesia, isolation and access, engine-driven rotary nickel-titanium canal instrumentation to a minimum size #5 (.028 mm).04 taper Profile with step-back flaring, and irrigation with 2.5% NaOCl. Teeth in group 1 (n = 39) were obturated at the first appointment by using laterally condensed gutta-percha and Roth 811 sealer. Teeth in group 2 (n = 33) were closed with a sterile dry cotton pellet and Cavit restoration and were obturated at a second appointment 7 to 14 days later. A modified Visual Analogue Scale was used to measure preoperative pain and pain at 6, 12, 24, and 48 hours after the first appointment. Statistical analysis was performed to compare groups at each interval by using an independent-samples t test with Bonferroni adjustment. RESULTS: There was no statistically significant difference between groups at preoperative intervals or at any of the 4 postoperative intervals (P <.01). CONCLUSIONS: There was no difference in postoperative pain between patients treated in 1 appointment and patients treated in 2 appointments. The majority of patients in both groups reported no pain or only minimal pain within 24 to 48 hours of treatment.     

超声冲洗应用于老年人隐裂牙牙髓炎一次性根管充填治疗术的临床评价

目的：对超声冲洗应用于老年人隐裂牙一次性根充治疗术的临床疗效进行评价。方法：对110例老年患者110颗牙按就诊顺序随机分为实验组和对照组。两组均采用手用镍钛Protaper根管预备后,实验组：57颗患牙进行超声根管冲洗,一次法完成根管充填治疗。对照组：53颗患牙进行注射器冲洗,一次法完成根管充填治疗。冲洗液均为0.9%生理盐水。观察根管充填一周后的术后疼痛反应及一年后充填疗效。结果：1周后复诊两组术后疼痛反应有显著性差异（P〈0.05）。术后1年复诊,2组疗效无明显差异（P〉0.05）。结论：超声冲洗对于治疗老年人隐裂牙牙髓炎一次法完成根管充填,短期内可减少患者复诊次数,缩短疗程,同时提高根管充填质量,值得临床推广使用。     

浓缩生长因子在受区伴有炎症的自体牙移植术中应用效果研究

目的    探讨浓缩生长因子（concentrated growth factor,CGF）在受区伴有炎症的自体牙移植术中应用的临床效果。方法    选取2018年6—12月于新疆医科大学第一附属医院颌面外科门诊就诊的需行自体牙移植术且受区伴有炎症患者42例（移植牙42颗）,随机分为CGF组和对照组,每组21例。两组患者术前均拍摄锥形束CT并3D打印移植牙模型。受区牙槽窝刮净炎症组织后,CGF组将CGF置于牙槽窝内后再植入移植牙,对照组则直接植入移植牙。术后定期随访,比较两组患者术后疼痛视觉模拟评分（visual analogue scale,VAS）、移植牙松动度及骨愈合等情况。结果    术后1、3 d,CGF组VAS分值低于对照组,差异均有统计学意义（均P < 0.05）。两组术后即刻及术后1、4周移植牙松动度比较,差异均无统计学意义（均P > 0.05）。术后3个月,CGF组受区牙槽骨愈合率显著高于对照组（χ2 = 14.538,P < 0.05）;术后6个月,两组受区牙槽骨愈合率比较,差异无统计学意义（P > 0.05）。术后24个月,CGF组所有移植牙均达到成功标准,治疗成功率为100%;对照组中有1例发生根外吸收,治疗成功率为95.24%;两组治疗成功率比较,差异无统计学意义（χ2 = 2.100,P > 0.05）。结论    在受区伴有炎症的自体牙移植术中应用CGF可能有助于减轻术后愈合早期的疼痛,促进牙槽骨早期愈合。     

The Effect of a Single Dose Prednisolone With and Without Diclofenac on Pain, Trismus, and Swelling After Removal of Mandibular Third Molars

PURPOSE: The purpose of this study was to evaluate the effect of a single intramuscular dose of prednisolone and the prednisolone-diclofenac combination on postoperative pain, trismus, and edema after the removal of third molars. PATIENTS AND METHODS: Forty-five patients who were to undergo surgical removal of lower third molars were studied. Patients were divided into 3 groups. In the first group, each patient was given 25 mg prednisolone intramuscularly immediately after surgery. In the second group, each patient was given 25 mg prednisolone and diclofenac intramuscularly immediately after surgery, and in the third group, each patient was given sterile saline solution as control group. Postoperative pain was evaluated by visual analogue scale on the day of surgery. Facial swelling and trismus were evaluated on postoperative days 2 and 7. ANOVA was used to analyze these data. RESULTS: Statistical analysis of the data indicated the prednisolone-diclofenac combination suppressed pain intensity in comparison with control (P < .05) at the 6-hour observation. Both the prednisolone and prednisolone-diclofenac combinations suppressed pain at the seventh postoperative hour in comparison with the control (P < .05). The prednisolone-diclofenac combination group also had a smaller loss of opening at postoperative days 2 and 7 in comparison with both the prednisolone and control groups (P < .05). Postoperative swelling was less in both the prednisolone and prednisolone-diclofenac combination groups, as compared with the control group (P < .05) at postoperative day 2. The prednisolone-diclofenac combination group also had a smaller swelling at postoperative day 7 in comparison with both the prednisolone and control groups (P < .05). CONCLUSION: It was determined that the combination of a single dose of prednisolone and diclofenac is well-suited to the treatment of postoperative pain, trismus, and swelling after dental surgical procedures and should be used when extensive postoperative swelling of soft tissue is anticipated.     

根管消毒药物缓解乳磨牙根尖周炎临床症状的疗效分析

目的：对比四种临床常用的根管消毒药物缓解乳磨牙根尖周炎临床症状的效果。方法 选择根尖周炎乳磨牙160颗,随机分为四组,每组40颗,根管预备超声荡洗后,A组封入抗生素糊剂,B组封入Vitapex糊剂,C组封入氢氧化钙糊剂,D组封入樟脑酚棉球,10 d后复诊,对四种根管消毒药物缓解乳牙根尖周炎临床症状的效果进行评价。结果 在10d后脓肿消除方面抗生素糊剂组效果优于其他三组（P=0.005）,Vitapex组与氢氧化钙组效果,均优于樟脑酚组（P＜0.05）。术后24h内疼痛的发生率抗生素糊剂组术后24 h内疼痛发生率低于Vitapex组（P=0.014）和氢氧化钙组（P=0.045）。10 d后疼痛的比例各组之间无统计学差异。结论 抗生素糊剂能够有效缓解乳牙根尖周炎的临床症状。     

Effect of single dose preoperative intramuscular dexamethasone injection on lower impacted third molar surgery

This study aimed to investigate the effects of dexamethasone intramuscular injection 1h preoperatively, in reducing facial swelling, pain and trismus after lower impacted third molar (LITM) surgery. Twenty healthy Thai patients with both LITM surgical extraction were enrolled in the study. The washout period was 1 month after the first operation. Clinical assessment of the facial swelling, pain and trismus were measured before and after operation for 7 days and the patient's total analgesic consumption was recorded. The level of significance used in the statistical decisions was P<0.05. Preoperative intramuscular injection of single-dose 8mg dexamethasone reduced postoperative swelling after LITM surgical extraction significantly on the second postoperative day, but immediately after surgery and on day 7 after the surgical extraction, no significant difference was found between the dexamethasone and control groups. Dexamethasone also reduced postoperative pain after LITM surgical extraction significantly on postoperative days 2 and 7. Additionally, the amount of paracetamol decreased significantly. There were no significant differences in trismus in the study and control groups 7 days after LITM operation. Single-dose intramuscular injection of dexamethasone can reduce postoperative facial swelling and pain, without affecting trismus after LITM surgical extraction.     

舍雷肽酶对预防复杂下颌阻生智齿拔除术后并发症的疗效观察

目的:观察应用舍雷肽酶预防下颌复杂阻生智齿拔除术后并发症的疗效.方法:选取临床需拔除复杂下颌阻生智齿的患者60例,随机分为实验组和对照组,各30例.实验组术后给予舍雷肽酶肠溶片10mg,tid,7d和甲硝唑片0.2,tid,3d,阿莫西林胶囊0.5,tid,3d.对照组仅给予甲硝唑片0.2,tid,3d,阿莫西林胶囊0.5,tid,3d作为预防性抗感染治疗.观察两组术后第1、2、7d的局部肿胀,疼痛及张口受限情况,并作统计学分析.结果:术后第2天实验组的局部肿胀程度为(9.17±4.17)mm,明显低于对照组(13.97±6.10)mm,差异有统计学意义(P＜0.01);实验组的疼痛评分2.32±0.98与对照组3.50±1.26相比差异有统计学意义(P＜0.01).张口受限情况两组间差异无统计学意义(P＞0.05).结论:舍雷肽酶对于减轻下颌阻生智齿拔除术后疼痛与肿胀反应具有明显疗效.