引流在下颌阻生第三磨牙拔除后应用效果的系统评价

目的评价各种引流方法控制下颌阻生第三磨牙拔除术后并发症的有效性与安全性。方法明确评价各种引流方法控制下颌阻生第三磨牙拔除术后并发症的有效性与安全性的研究问题后,电子检索MEDLINE、Cochrane 图书馆临床随机对照试验库、荷兰医学文摘、欧洲灰色文献数据库和中国生物医学文献数据库,检索时间截至2011 年8月23日,同时对中文口腔医学杂志进行手工检索,对纳入文献的参考文献进行追索。使用Cochrane协作网推荐的标准对纳入文献进行偏倚风险评价并提取数据。采用Revman 5.1软件进行统计分析。结果最终纳入研究的文献为 9篇,其中7篇为随机对照试验,2篇为半随机对照试验。偏倚风险评价显示,7篇为中度风险,2篇为高度风险。Meta 分析结果显示,引流能够增加患者术后最大张口度4.44 mm（P=0.003）,明显改善患者术后面部肿胀（P<0.05）,减少术后干槽症的发生率（P=0.008）。但是引流并不能够显著降低患者术后疼痛（P=0.09）。结论引流对缓解下颌阻生第三磨牙拔除术后并发症有一定的疗效和安全性,但还需要更多的临床随机对照试验的支持。     

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。     

应用超声骨刀拔除下颌第三磨牙临床效果的Meta分析

目的:采用Meta分析评价应用超声骨刀拔除下颌第三磨牙的临床效果。方法:计算机检索CBM、CNKI、VIP数据库和万方数据库,同时对检索结果的参考文献进行检索,检索时间为建库至2019-03-01,搜集应用超声骨刀与单纯涡轮钻法拔除下颌阻生第三磨牙临床效果的随机对照试验文献,对检索结果进行独立质量评估和数据提取,采用RevMan 5.3软件进行Meta分析。结果:9篇文献纳入研究分析,包括实验组534例,对照组529例。Meta分析表明应用或者联合应用超声骨刀与单纯涡轮钻法拔除下颌阻生第三磨牙相比,手术时间缩短(P<0.01),术后疼痛程度减轻(P<0.01),肿胀和张口受限的发生率降低(P<0.01)。结论:应用或联合应用超声骨刀法拔除下颌阻生第三磨牙的临床效果优于单纯涡轮钻方法。     

引流对下颌阻生智齿术后反应影响的系统评价

目的:系统评价下颌阻生智齿拔出后引流的意义。方法:通过检索Cochrane图书馆(2011年第4期)、MEDLINE(1950-2012)、EMbase(1950-2012)和中国生物医学文献数据库(1979-2012)收集全世界关于下颌阻生智齿拔出后引流与未引流的随机对照试验/临床对照试验(RCT/CCT),并用RevMan 5.0 Tutorial软件进行统计分析。结果:Meta分析结果显示:下颌阻生智齿拔除后引流能减轻术后第3、7 d的面部肿胀度{[MD=-3.56,95%C(I-4.62.12,-2.49)]、[MD=-1.78,95%C(I-3.06,-0.49)]},但并不能减轻术后第1、3、7 d的张口受限程度{[MD=3.57 mm,95%CI(0.08,7.06)]、MD=6.30 mm,95%C(I 5.07,7.53)]、MD=2.01 mm,95%C(I 0.51,3.52)]}。结论:下颌阻生智齿拔除后引流会加重术后张口受限,但能减轻患者的面部肿胀度。     

超声骨刀与凿骨劈冠法拔除下颌阻生智齿的比较

目的 探讨超声骨刀拔除下颌阻生智齿的效果.方法 根据下颌阻生第三磨牙拔除难度判断方案选择拔牙难度判断为较难的228颗下颌阻生智齿,分成实验组和对照组,每组114颗,实验组应用超声骨刀法拔牙,对照组采用凿骨劈冠法拔牙.对2组的拔牙时间、术后疼痛、张口受限、面部肿胀情况进行分析比较.结果 实验组平均拔牙时间为(16+5.2...     

下颌阻生智齿拔除术后应用地塞米松,芬必得的疗效观察

下颌阻生智齿拔除术后应用地塞米松、芬必得的疗效观察广东省江门市口腔医院（５２９０５０）龙文面部肿胀、疼痛、张口受限是下颌阻生智齿拔除术常见的术后反应［１］。本文报道采用拔牙后局部注射地塞米松和术后口服芬必得的方法预防和减轻以上术后反应的发生。资料和方...     

局部应用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：观察局部注射地塞米松预防下颌第三磨牙阻生拔除术后面部肿胀度和疼痛程度的临床疗效。方法：筛选2010年3月至2014年2月102例18-25周岁的、需拔除的下颌阻生第三磨牙患者,分成实验组和对照组,每组51例,实验组在拔牙区软组织内局部注射地塞米松。术后第1天分别对两组患者观察面部肿胀度和测试疼痛程度。结果：实验组患者拔牙术后面部肿胀率明显低于对照组。术后两组的疼痛程度没有显著差异。结论：术前术区局部注射地塞米松,可以有效减少下颌阻生第三磨牙拔除术后的面部肿胀程度,有较好的临床疗效。     

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。     

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。     

富血小板纤维蛋白在下颌第三磨牙拔除术的应用系统评价与Meta分析

目的 通过系统评价及Meta分析的方法评估下颌第三磨牙拔除术中使用富血小板纤维蛋白(PRF)的有效性,为缓解术后并发症提供建议.方法 对Pubmed、EMBASE、Web of Science和中国生物医学文献数据库针对在下颌第三磨牙术中使用PRF的临床随机对照试验进行电子检索,检索时间截至2020年2月.评价者使用C...     

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.     

Efficacy of secondary closure technique after extraction of third molars: a meta-analysis

The purpose of this study was to assess the influence of two suture methods on the postoperative complications of extraction of mandibular third molars (M3M). We searched the MEDLINE (PubMed), Cochrane Library, and Web of Science databases until 18 May 2018 for randomised controlled trials (RCT) that evaluated the influence of any suture techniques on postoperative complications after the removal of impacted M3M. Pain, facial swelling, and trismus were measured for both the early stage (2–3 days) and late stage (5–7 days) after extraction. We identified 655 records, of which five were assessed for eligibility. All trials included had a moderate risk of bias. The analysis showed that the patients whose wounds had been closed primarily had significantly more pain than those whose wounds were closed secondarily (a wedge of mucosa) during the early stage (standardised mean difference (SMD), ?0.49; 95% CI ?0.71 to ?0.27; P < 0.0001) and the late stage (SMD ?0.36; 95% CI ?0.54 to ?0.19; P < 0.0001) after the removal of impacted M3M. Patients whose wounds were closed secondarily had less swelling (mm) at the postoperative early stage (SMD ?1.12; 95% CI ?1.57 to ?0.66; P < 0.00001) and late stage (SMD ?0.51; 95% CI ?0.68 to ?0.33; P < 0.00001). There was more trismus in the primary closure group than in the secondary group during both stages. Our findings suggest that secondary closure causes less pain, facial swelling, and trismus in both early and late stages of surgical removal of impacted M3M, and therefore it improves the quality of life by reducing postoperative discomfort.     

Effect of the local administration of betamethasone on pain,swelling and trismus after impacted lower third molar extraction. A randomized,triple blinded,controlled trial

Objectives: The aim of this study is to compare the analgesic and anti-inflammatory effects of the local postoperative administration of a single 12-mg dose of betamethasone after the surgical removal of impacted lower third molars. Study Design: A split-mouth, triple-blind, randomized, placebo-controlled clinical trial of 25 patients requiring the surgical removal of symmetrical lower third molars was performed. In the experimental side, a 12-mg dose of betamethasone was administered submucosally after the surgical procedure, while in the control side a placebo (sterile saline solution) was injected in the same area. To assess postoperative pain, visual analogue scales and the consumption of rescue analgesic were used. The facial swelling and trismus were evaluated by measuring facial reference distances and maximum mouth opening. Results: There were no significant differences between the two study groups regarding postoperative pain, facial swelling and trismus. Conclusions: The injection of a single dose of betamethasone does not seem to reduce pain, facial swelling and trismus after impacted lower third molar removal when compared to placebo. Key words:Third molar extraction, corticosteroids, betamethasone.     

Efficacy of different dexamethasone routes and doses in reducing the postoperative sequelae of impacted mandibular third-molar extraction: A network meta-analysis of randomized clinical trials

BackgroundThe aim of this network meta-analysis was to assess the comparative effects of different dexamethasone (DXM) routes and doses on reducing postoperative sequelae (pain, swelling, trismus) after surgical extraction of impacted mandibular third molars.MethodsFive databases were searched on September 22, 2021, for randomized controlled trials. Risk of bias (ROB) was assessed using the Cochrane ROB 2 tool. Study heterogeneity, publication bias, and quality of evidence were investigated. Network meta-analyses were conducted (P < .05), and the P-score was used to rank comparisons of DXM doses and routes.ResultsThirty-four eligible studies were included. Eight studies had low ROB, 21 had some concerns, and 5 had high ROB. The certainty of evidence evaluated by the Confidence in Network Meta-Analysis tool indicated low to very low certainty in most comparisons. The results showed that most DXM route and dose combinations were superior to a placebo in reducing the postoperative sequelae 1 day after surgical extraction. The results also showed that a 4-mg DXM submucosal injection substantially reduces pain 3 days after extraction compared with a 4-mg twin-mix or 8-mg intramuscular injection. Overall, it appears that 4 mg DXM submucosal injection or admixed with local anesthetic is effective in reducing postoperative sequelae after surgical extraction.ConclusionsWithin the limitations of this study, the administration of DXM appears to be effective in reducing the postoperative sequelae, especially in the submucosal route. However, no noteworthy differences were found between the investigated DXM route and dose comparisons.Practical ImplicationsSubmucosal DXM injection effectively reduce postoperative sequelae of third-molar extractions.     

Effect of preoperative ibuprofen on pain and swelling after lower third molar removal: a randomized controlled trial

The aim of this study was to compare the analgesic and anti-inflammatory effects of preoperative and postoperative administration of ibuprofen after the surgical removal of impacted lower third molars. A triple-blind, randomized, placebo-controlled clinical trial of 120 patients requiring the surgical removal of lower third molars was performed. The subjects were randomized into the experimental group (patients were administered 600 mg of ibuprofen (p.o.) 1h before the surgical procedure, followed by placebo just after the end of the operation) or into the control group (subjects received the same medication but the administration sequence was reversed). Pain was assessed using visual analogue scales, and consumption of rescue analgesic. The facial swelling and trismus were evaluated by measuring facial reference distances and maximum mouth opening. There were no significant differences between the two study groups regarding postoperative pain, rescue analgesics consumption, facial swelling and trismus. There was a slightly higher need for rescue analgesics in the experimental group. The preoperative intake of ibuprofen does not seem to reduce pain, facial swelling and trismus after impacted lower third molar removal when compared to the postoperative administration of the same drug.     

2种切开翻瓣法拔除下颌智牙的临床效果分析

目的 比较2种不同切开翻瓣法拔除水平阻生下颌第三磨牙的临床效果。方法选取水平阻生下颌第三磨牙患者400 例,随机分为A、B 2组。A组200 例,采用远中切口翻瓣法;B组200 例,采用常规角形切口翻瓣法,观察2组病例拔牙时间、干槽症发生率、术后疼痛、面部肿胀、开口受限等情况,应用SPSS 13.0软件包对数据进行统计学分析。结果A组手术时间比B组长。术后第3天,A组面部肿胀及开口受限均较B组轻,2组患者的疼痛程度无显著差异。术后第7天,2组术后疼痛、面部肿胀及开口受限无显著差异。结论远中切口法翻瓣较角形切口法明显减少患者术后肿胀及开口受限的程度。     

Piezoelectric bone surgery for impacted lower third molar extraction compared with conventional rotary instruments: a systematic review,meta-analysis,and trial sequential analysis

The aim of this study was to evaluate whether piezoelectric bone surgery (PBS) for impacted lower third molar extraction reduces the surgical time and risk of intra- and postoperative complications in comparison with conventional rotary instruments. This meta-analysis followed the PRISMA guidelines and was registered in the PROSPERO database. The PubMed, Embase, Scopus, and OpenGrey databases were screened for articles published from January 1, 1990 to December 31, 2018. Selection criteria included randomized controlled trials (RCTs) comparing PBS with conventional rotary instruments for impacted lower third molar extraction and reporting any of the clinical outcomes (intra- and postoperative complications and duration of surgery) for both groups. A risk of bias assessment was performed using the Cochrane Collaboration tool. A meta-analysis was performed, and the power of the meta-analytic findings was assessed by trial sequential analysis (TSA). Strong evidence suggests that PBS prolongs the duration of surgery and low evidence suggests that PBS reduces postoperative morbidity (pain and trismus) in comparison with rotary instruments. Data were insufficient to determine whether PBS reduces neurological complications and postoperative swelling in comparison with burs.