咀嚼肌内注射地塞米松预防下颌阻生智齿拔除术后并发症的疗效观察

目的：观察咀嚼肌内注射地塞米松预防下颌阻生智齿拔除术后面颊部肿胀、张口受限等并发症的疗效。方法：将390例需要翻瓣去骨拔除下颌阻生智齿病例随机分成2组,对照组常规麻醉后拔牙;实验组常规麻醉后,将地塞米松5 mg分3点注射于智齿颊侧深面咬肌前部、磨牙后区下颌支前缘颞肌内、下颌支内侧翼内肌内,观察两组病例拔牙术后局部肿胀、张口受限的差异。结果：两组病例术后肿胀和张口受限发生率均有显著性差异（P≤0．05）。结论：咀嚼肌内注射地塞米松可有效降低翻瓣去骨法拔除下颌阻生智齿术后局部肿胀和张口受限的并发症。     

颊侧附加切口在关闭下颌高位智齿拔牙创中的应用

目的:探讨颊侧切口缝合法在下颌高位智齿拔除术中的临床意义。方法:比较颊侧切口缝合法和简单拉拢缝合法在下颌高位智齿拔除术术后并发症的发生率。结果:颊侧切口缝合法术后出血以及干槽症发生率明显小于简单拉拢缝合法,而面颊肿胀及张口受限发生率无显著差异。结论:颊侧切口缝合法明显减少术后并发症的发生,大大减轻了患者痛苦。     

2种微动力系统应用于下颌低位阻生智齿拔除术的比较研究

目的:比较电动式颌面微动力系统和高速气动外科手机在下颌低位阻生智齿拔除术中的应用效果。方法:将133 例下颌低位阻生智齿随机分成2组,分别使用电动式颌面微动力系统和高速气动外科手机进行手术,比较2组间拔牙时间和术后肿胀、疼痛、张口受限、干槽症、神经损伤、邻牙损伤情况,结果采用SPSS19.0软件包进行统计学分析。结果:电动式颌面微动力组的手术时间明显少于高速气动外科手机组,术后肿胀、疼痛、张口受限程度明显小于高速气动外科手机组(P＜0.05),干槽症、神经损伤发生率低于高速气动外科手机组,但差异无统计学意义。 结论:应用电动式颌面微动力系统拔除下颌低位阻生智齿具有良好的临床效果。     

两种方法拔除下颌阻生智齿的效果比较

目的:对比分析下颌阻生智齿拔除中微创拔牙术与传统拔牙术的应用效果。方法 :将我院收治的108例下颌阻生智齿患者随机分为观察组54例和对照组54例。对照组患者行传统拔牙术,观察组患者行微创拔牙术。评价2组患者术后的疼痛程度及张口受限程度,统计患者术中及术后并发症的发生率。结果:观察组患者术后疼痛程度及张口受限程度的"0度+Ⅰ度"比例均高于对照组(P<0.05)。观察组患者术中出血不止、邻牙松动、牙龈撕裂、根折、舌侧骨板骨折等并发症的总发生率为11.11%,对照组为27.79%,两组比较,差异具有统计学意义(P<0.05)。同时,观察组患者术后感染、面部肿胀、干槽症并发症的总发生率为12.96%,对照组为29.63%,两组比较,差异具有统计学意义(P<0.05)。结论 :下颌阻生智齿拔除中应用微创拔牙术能有效减轻患者术后的疼痛程度及张口受限程度,并降低术中、术后并发症的发生率,相较于传统拔牙术有明显的优势。     

远中分块拔除法在下颌阻生第三磨牙拔除术中的应用

目的:比较远中分块拔除法与远中整体拔除法在下颌低位近中阻生智齿拔除术中及术后并发症,探讨两种手术方法的优缺点。方法:随机选取40例双侧基本对称下颌低位近中阻生第三磨牙男性患者,一侧采用远中分块拔除法(实验组),对侧用远中整体拔除法(对照组),比较两组术中及术后并发症,采用SPSS19.0软件包对数据进行配对t检验。结果:实验组在舌侧骨板损伤、术后吞咽痛、术后24、48h张口受限均较对照组轻,差别有统计学意义(P<0.05)。结论:对下颌低位近中阻生,远中分块拔除术舌侧骨板损伤、术后短期疼痛、张口受限程度轻。     

高速涡轮牙钻去阻力拔除下颌中低位阻生智齿158例临床报告

目的：观察高速涡轮牙钻去阻力在拔除下颌中低位阻生智齿术中、术后的临床效果。方法：应用高速涡轮牙钻去阻力拔除下颌中低位阻生智齿。观察患者术后疼痛程度、张口受限、颞下颌关节功能紊乱的发生情况。结果：应用高速涡轮牙钻去阻力拔除下颌中低位阻生智齿,手术时间短,手术创伤小,术后反应轻,肿胀疼痛轻,中度张口受限37例（23.4%）,重度张口受限5例（3.2%）,颞颌关节功能紊乱18例（11.4%）,干槽症8例（5.1%）无下颌管神经损伤和黏膜下气肿的病例发生。结论：采用高速涡轮牙钻去阻力拔除中低位阻生智齿,临床效果好。     

萘普生钠联合磷酸可待因用于下颌阻生智齿拔除术后镇痛消肿的疗效评价

目的:比较萘普生钠联合磷酸可待因、洛索洛芬和布洛芬对下颌阻生智齿拔除术后镇痛消肿的临床疗效。方法:90例拔除下颌阻生智齿的患者按随机双盲法分为3组。在拔牙前1 h及术后第2~7天分别服用萘普生钠+磷酸可待因、洛索洛芬和布洛芬。对术后疼痛、肿胀和张口度进行观察和统计分析。结果:萘普生钠+磷酸可待因对疼痛、肿胀和张口受限的治疗效果更好(P<0.05);洛索洛芬和布洛芬临床效果相似(P>0.05)。结论:萘普生钠+磷酸可待因可作为治疗下颌阻生智齿拔除术后疼痛、肿胀和张口受限较好的选择。     

微创技术在下颌近中阻生智齿拔除中的应用

目的：观察微创拔牙技术在下颌近中阻生智齿拔除中的临床效果。方法：下颌近中阻生智齿160例,分为实验组（微创组）及对照组,记录两种方法的拔牙时间、术后感染、肿胀、张口受限、干槽症发生情况。结果：实验组与对照组相比,拔牙时间明显缩短,差异具有统计学意义（P〈0．01）。术后感染、干槽症、肿胀、张口受限等发生率的差异具有统计学意义（P〈0．05）。结论：运用微创拔牙技术拔除下颌近中阻生智齿能明显降低拔牙并发症。     

经舌侧骨板切除术拔除下颌低位阻生第三磨牙29例报道

目的:探讨经舌侧骨板切除术拔除下颌低位阻生第三磨牙的可行性及其优势。方法:47例下颌低位阻生第三磨牙患者,半随机分为2组进行手术拔牙。其中29例为实验组,采取经舌侧骨板切除术式拔牙;18例为对照组,采取传统的颊侧去骨术式拔牙。同期标准对照,比较2组手术的时间、伤口愈合及术后组织反应如疼痛、肿胀、开口受限等的差异,对有关数据进行F检验、t检验及χ2检验。结果:全部病例均获一期愈合,无后遗症。2组手术时间、疼痛及开口受限无显著差异。实验组切口小、去骨及拔牙相对容易,但清创及缝合占用的时间相对较多。在颊侧组织肿胀方面,第2天对照组中度以上肿胀比例达61%,远高于实验组的3%,χ2=19.7653,P<0.005,差异有显著性;第7天2组肿胀消退接近正常,且无差异。2组舌侧组织肿胀均不显著,且无差异。结论:以舌侧骨板切除术拔除下颌低位阻生第三磨牙切口小,能轻松消除骨阻力及拔除牙,术后组织反应程度较轻,无不良后遗症。     

反角高速涡轮机拔除低位下颌阻生齿的效果观察

目的 :观察反角高速涡轮机在下颌低位阻生智齿拔除中的临床效果。方法 :将194例下颌阻生智齿患者随机分为涡轮机组(107例)和对照组(87例)。涡轮机组采用反角高速涡轮机拔除低位下颌阻生智齿,对照组采用传统去骨凿以及劈开凿劈冠法拔除。比较两组方法术后情况。结果:涡轮机组的拔牙时间与对照组比较差异无统计学意义(P>0.05),涡轮机组术后肿胀程度、张口受限情况、术后疼痛程度均小于对照组,差异有统计学意义(P<0.05)。结论:使用反角高速手机拔除下颌低位阻生智齿,操作简便,相对于传统劈冠法,术后反应较轻,减轻了患者的痛苦,值得推广。     

Effect of the suture technique on postoperative pain,swelling and trismus after removal of lower third molars: A randomized clinical trial

Background

To evaluate the intensity of pain, swelling and trismus after the removal of impacted lower third molars comparing two different suture techniques of the triangular flap: the complete suture of the distal incision and relieving incision and the partial suture with only one suture knot for closure of the corner of the flap and the closure of the distal incision, without suturing the relieving incision.

Material and Methods

A prospective, randomized, crossover clinical trial was conducted in 40 patients aged from 18 to 45 years who underwent surgical extraction of impacted lower third molars at the Department of Oral Surgery in the Odontological Hospital of the University of Barcelona during the year 2011. Patients were randomly divided in 2 groups. Two different techniques (hermetical closure and partial closure of the wound) were performed separated by a one month washout period in each patient. Postoperative pain, swelling and trismus were evaluated prior to the surgical procedure and also at 2 and 7 days post operatively.

Results

No statistically significant differences were observed for pain (p<0.06), trismus (p<0.71) and swelling (p<0.05) between the test and the control group. However, the values of the three parameters related to the test group were lower than those for the control group.

Conclusions

Partial closure of the flap without suturing the relieving incision after surgical extraction of lower third molars reduces operating time and it does not produce any postoperative complications compared with complete closure of the wound. Key words: Third molar, surgical flaps, suture techniques, postoperative pain, swelling, trismus.     

下颌埋伏阻生牙拔除后创口关闭与否对创口愈合的影响

目的:探讨改良角形瓣切口不同愈合方式对下颌埋伏阻生牙拔除患者恢复及安全性的影响.方法:选择193例单侧下颌埋伏阻生智牙,随机分为创口封闭组(n=96)、创口未封闭组(n=97),所有患者均采用改良角形瓣切口拔除阻生牙.创口封闭组患者拔牙后采用一期缝合,完全关闭创口(TF-P);创口未封闭组患者拔牙后在第二磨牙远中留三角...     

医用胶原蛋白海绵预防下颌阻生第三磨牙拔除术后并发症的临床观察

目的：研究医用胶原蛋白海绵在预防下颌阻生第三磨牙拔除术后并发症的疗效。方法选择100例需拔除双侧埋伏程度相近的下颌阻生第三磨牙患者,采用抽签法将患者两侧患牙随机分成两组,试验组拔牙创内植入医用胶原蛋白海绵,对照组拔牙创内不放任何药物。分别于术后30 min复查,术后第7天随访,记录术后并发症的发生情况。结果试验组100颗患牙拔除后引起的并发症中,出血10颗,肿胀10颗,张口受限3颗,干槽症3颗;对照组100颗患牙拔除后引起出血37颗,肿胀22颗,张口受限12颗,干槽症10颗。结果显示试验组预防拔牙术后出血率、肿胀出现率、张口受限出现情况与干槽症的出现率均明显低于对照组,组间差异具有统计学意义（P＜0.05）。结论医用胶原蛋白海绵可降低下颌阻生第三磨牙拔除术后并发症的发生。     

Comparing primary and secondary wound healing discomfort after mandibular third molar surgery: a randomized, double-blind clinical trial

Extraction of impacted mandibular third molars is one of the most common procedures in the oral cavity and often is followed by pain, swelling, and postextraction alveolitis and trismus. It has been suggested that postoperative discomfort is in relation to the type of surgical wound healing. The aim of this study was to compare pain, swelling, and maximum mouth opening in two groups of patients with primary and secondary wound healing after impacted mandibular third molar surgery. Thirty-two patients were enrolled in this study and randomly divided into two equal groups, quantitatively and by gender. After the surgical procedures, 16 patients received primary wound closure, while the other 16 participants received secondary wound closure. A visual analog scale was used to collect pain data three days after the surgeries. A checklist was used to record data regarding swelling size and maximum mouth opening before, immediately following, three days after, and one week after surgery. Frequency tests and a t-test were used for statistical analysis and a P value of <0.05 was considered to be statistically significant. Patients in the secondary wound healing group showed statistically significant lower discomfort regarding pain, swelling size, and maximal mouth opening compared to the primary wound healing group. The authors suggest the use of secondary wound healing closure to reduce postoperative complications such as pain, maximal mouth opening, and swelling size after impacted mandibular third molar extractions.     

下颌阻生智牙不翻瓣拔除的临床效果观察

目的 探讨中位下颌阻生智牙不翻瓣拔除的疗效。方法 98例拔除下颌阻生智牙的患者,共计112颗患牙纳入研究,分为不翻瓣组和翻瓣组。不翻瓣组采用横断法或T形截断法将牙分割后拔除,翻瓣组采用角形切口翻瓣的方法拔除。对2组患者术后1 d、3 d、1周时的并发症进行观察并记录,采用SPSS 17.0软件包进行统计学分析。结果 不翻瓣组术后1 d、3 d出血、肿胀、疼痛及开口受限、对生活的影响等并发症显著低于翻瓣组(P<0.05),但2组平均手术时间无统计学差异(P>0.05)。结论 对于下颌中位阻生智牙,采用不翻瓣方法拔除,有助于减轻患者术后并发症,提高生活质量。     

The effect of sutureless wound closure on postoperative pain and swelling after impacted mandibular third molar surgery

Our aim was to assess the influence of sutureless and multiple-suture closure of wounds on postoperative complications after extraction of bilateral, impacted, mandibular third molars in 30 patients in a split mouth study. After the teeth had been removed, on one side the flap was replaced but with no suture to hold it in place (study side), and on the other side the wound was closed primarily with three sutures (control side). Recorded complications included pain, swelling, bleeding, and formation of periodontal pockets. The results showed that patients had significantly less postoperative pain and swelling when no sutures were used (p=0.005). There were no signs of excessive bleeding or oozing postoperatively on either side. Six months postoperatively there was no significant difference in the depth of the periodontal pocket around the second molar.     

Effects of tube drain with primary closure technique on postoperative trismus and swelling after removal of fully impacted mandibular third molars.

OBJECTIVE: Surgical removal of impacted mandibular third molars with primary wound closure may result in postoperative edema, facial swelling, pain, and restriction of mouth opening. The type of closure may be a cause of these complications. The aim of this study was to compare the effects of placement of a surgical tube drain before primary closure with the effects of primary closure alone after removal of fully impacted mandibular third molars. METHOD AND MATERIALS: The study group included 13 patients aged 15 to 39 years with bilateral fully impacted mandibular third molars. The insertion of a small surgical tube drain before primary closure (drain group) was compared to a simple primary closure procedure (no drain group) after removal of the impacted third molars in a randomized crossover design. The duration of the operation was recorded. Patients were evaluated 1, 2, 3, and 7 days postoperatively for facial swelling and trismus. RESULTS: The facial swelling experienced by the drain group was significantly less than that experienced by the no drain group. The degree of trismus was greater in the no drain group than in the drain group, but the difference was not statistically significant. CONCLUSION: Use of a surgical drain, especially after removal of fully impacted third molars, will reduce postoperative facial swelling.     

2种拔除阻生下颌第三磨牙手术切口的比较

目的:观察和比较不同手术切口对拔除低位阻生下颌第三磨牙术后效果的影响。方法:选择18～30岁未萌出的双侧低位水平阻生下颌第三磨牙患者35例,随机选取患者的一侧磨牙列,采用信封切口的手术方案(A组),另一侧采用角形切口(B组)。采用同种拔牙方法拔除阻生下颌第三磨牙。观察两组患者术后第2天的反应(局部肿胀、疼痛和术后开口受限)及其他并发症发生情况,采用SPSS11.0软件包对数据进行χ2检验。结果:手术后第2天,B组术后重度肿胀的发生率显著高于A组(P<0.05)。术后开口受限程度及术后疼痛发生率A组与B组比较差异无显著性(P>0.05)。结论:不同手术切口设计与术后肿胀程度相关,信封切口术后肿胀发生程度较轻。     

2种不同方法在下颌中位近中水平阻生智牙拔除术的疗效比较

目的:比较“T”形截断法与单纯锤凿劈冠法拔除下颌中位近中水平阻生智牙的疗效。方法:138例需要拔除单侧下颌中位近中水平阻生智牙的患者,随机分为A、B 2组,A组70例,B组68例。 A组采用“T”形截断法,B组采用传统锤凿冠劈法,去除阻力后拔除。对拔牙术中、术后并发症进行观察,采用SPSS13 .0软件包对数据进行统计学分析。结果:A 组术中、术后并发症显著少于B 组(P< 0.05 )。结论:“T”形截断法在下颌中位近中水平阻生智牙拔除术中创伤小、并发症少,值得临床推广。