2种浓度利多卡因对下颌智牙拔除麻醉效果的影响

目的：探讨低浓度利多卡因行下牙槽、舌、颊神经一次阻滞麻醉的效果。方法：采用自身对照研究,前瞻性分析3 mL 1%利多卡因1∶100 000肾上腺素（低浓度组）或3 mL 2%利多卡因1∶100 000肾上腺素（高浓度组）行下牙槽、舌、颊神经阻滞麻醉拔除下颌智牙的差异。患者术后经过21 d的洗脱期,选择对应浓度的利多卡因拔除对侧阻生牙。分析2组间注射时疼痛水平（疼痛评估量表,NRS）、麻醉起效时间、麻醉深度及麻醉持续时间的差异。采用SPSS 17.0 软件包对数据进行统计学分析。结果：21例患者（平均年龄24岁）完成试验,其中62%为女性。低浓度组的疼痛水平（1.09,95% CI,0.77~1.41）显著低于高浓度组（1.66,95%CI,1.33-1.99）（P=0.010）。低浓度组下牙槽、颊、舌神经阻滞麻醉起效时间（52~63 s）显著快于高浓度组（259~335 s）（P=0.000）。下牙槽、舌、颊神经麻醉深度2组之间未见显著差异（P=0.751）。在疼痛NRS值为1~3的患者中,低浓度组,9例（100%）均在分牙时疼痛（下牙槽神经麻醉深度浅）;高浓度组3例（43%）分牙时疼痛,4例(57%)翻瓣时疼痛（颊神经麻醉深度浅）（P=0.019）。高浓度组麻醉持续时间比低浓度组平均长61 min（52~69 min）（P=0.000）。结论：用低浓度利多卡因组行下牙槽、舌、颊神经阻滞麻醉起效快,注射时疼痛水平低,术后下唇麻木不适感消失快。术中轻微疼痛,高浓度组常因颊神经麻醉深度较浅引起,低浓度组因下牙槽神经麻醉深度较浅引起。     

两种局部麻醉方法应用于下颌阻生第三磨牙拔除术的比较

目的 比较下颌高、中位阻生第三磨牙拔除的患者应用无痛口腔局麻仪行牙周膜注射与卡局芯式注射器行下牙槽神经阻滞麻醉注射的麻醉效果.方法 随机选择50例行双侧下颌高、中使阻生第三磨牙拔除术的成人患者,同一患者左右侧随机归入试验组和对照组.试验组应用无痛口腔局麻仪行阻生牙牙周膜局部浸润麻醉,对照组应用卡局芯式注射器行下牙槽神经阻滞麻醉,患者本人对两种麻醉方式的注射疼痛程度及效果进行评价.结果 两组比较,试验组麻醉注射时疼痛的视觉模拟评分法(visual analogue scale,VAS)值为2.48±0.98,对照组为6.12±0.44,差异有统计学意义(=3.501,P＜0.01).麻醉效果试验组患者自评为“优”者44例,对照组为35例,两组差异无统计学意义(H=2.833,P=0.812).结论 应用无痛口腔局麻仪行牙周膜局部浸润麻醉更有利于下颌高、中位阻生牙拔除术中的无痛操作.     

武义县部分城乡干部第三磨牙状态的调查

目的 调查成人中第三磨牙的状态,为研究第三磨牙的萌出提供相关材料。方法 采取整群抽样的方法,对武义县部分城乡干部的第三磨牙进行调查,调查人数共1263人。结果 未萌出智齿共651人,占调查人数的51.54%;智齿阻生341人,占调查人数的27.00%;主要并发症为下颌智齿冠周炎、智齿龋损、下颌第二磨牙龋损。结论 通过对智齿的萌出、阻生的发生、发展、分类及并发症的分析讨论,促进在智齿疾病的诊断、治疗和预防。     

Subacute pericoronitis from an unerupted supernumerary third molar. Report of a case.

Any tooth may be affected by pericoronitis. A case of acute pericoronitis from an unerupted supernumerary third molar tooth is described. The importance of the patient's history and the clinical examination in reaching a diagnosis is stressed.     

微创拔除下颌第三磨牙患者心理干预模式及其效果研究

目的:探讨微创拔除下颌第三磨牙手术患者心理干预模式及具体措施,并验证其效果.方法:208例行微创拔除下颌第三磨牙的患者,随机分为心理干预组108例及常规组100例.常规组行四手操作微创拔牙.干预组根据Gross的情绪调节理论建立干预模式,实施相应的心理干预措施.对患者术中的表现分为:沉稳型、张乱型以及混合型,对疼痛程度进行分级,对两组患者的结果进行统计分析.结果:与对照组比较,干预组中沉稳型患者比例增高(P＜0.01),感知痛苦程度较低(P＜0.01),张乱型患者比例降低(P＜0.05);2组混合型患者数量无明显差异.结论:心理干预模式可缓解患者的负性情绪,降低患者的畏惧程度和疼痛感受,确保微创拔除下颌第三磨牙手术的顺利进行.     

Ectopic third molar in the maxillary sinus. Case Report

Ectopic eruption of teeth can occur in a wide variety of sites. These include the mandibular condyle, coronoid process, palate, nasal cavity and maxillary sinus. While this process is unusual, the detection of a third molar in the maxillary antrum is extremely rare. A case is presented of ectopic eruption of a third molar in the left maxillary sinus of a 35-year-old caucasian male giving rise to local morbidity.     

Lingual access for third molar surgery: a 20-year retrospective audit.

We describe a technique for obtaining lingual access for the insertion of a wide metal retractor to protect the lingual nerve from accidental damage during third molar surgery. We also report an audit of a single practice over a 20-year period using the technique described. The approach involves raising soft tissues on the lingual side of the lower third molar tooth to allow insertion of a broad Hovell's lingual retractor. We conclude that raising lingual tissues to form a wide tension-free flap and inserting a specifically designed retractor does not increase the incidence of lingual nerve morbidity. Indeed, the overall incidence of lingual nerve damage was particularly low compared with those in other published series.     

Inverted and impacted maxillary third molar. Report of two cases.

Two cases of inverted and impacted third molars are described. They were conservatively managed without surgery. Complications that may arise from surgical removal of inverted and impacted teeth must be carefully considered beforehand. These should be weighed against the benefit of surgical removal. The two cases are reported because impaction with inversion of a molar tooth is not common.     

An odontogenic myxofibroma related to an embedded third molar of the mandible. Report of a case

A case of odontogenic myxofibroma involving the angle of the mandible is reported. This case arose in the area closely associated with the pericoronal portion of the embedded third molar. When the mandible resected was histopathologically examined, the tumor mass containing various shapes of epithelial cell nests and amorphous calcified bodies in the myxomatous fibrous tissue was found to be formed in the localized area well-demarcated by the enamel of the embedded tooth. These findings strongly suggest that this lesion is of odontogenic origin.     

Internal resorption of an unerupted third molar

Extensive resorption of an unerupted third molar resulted from progressive periodontal and periapical pathological conditions associated with the adjacent second molar. The subject's failure to seek restorative and periodontal treatment during the 12 years documented led to the findings noted and to eventual tooth loss.     

The migration pathway of an extracted maxillary third molar into the buccal fat pad

The migration of the maxillary third molar is one of the most critical complications that can occur during extraction, and the most frequent site of migration is the maxillary sinus. We herein report an extremely rare case in which the migrated maxillary third molar became displaced into the buccal fat pad. The pathway of migration from the original site of the tooth into the buccal space is therefore considered from the anatomical perspective in this paper.