640例第三磨牙拔除原因分析

1　临床资料收集了本院 1995 - 0 1～ 1999- 12口腔门诊第三磨牙拔除患者 6 40例 ,1382个牙 ,平均每人 2 .2个。下颌 42 0例 ,76 8牙 ;上颌 2 2 0例 ,6 14牙。男性 35 5例 ,女性 2 85例 ;年龄18～ 30岁者 312例 ,31～ 40岁者 2 18例 ,41～ 5 0岁者 83例 ,5 1岁以上 2 7例。现对其拔除原因进行回顾性分析 (表 1)。表 1　 1382个第三磨牙的临床情况　　　 (牙数 )阻生垂直近中远中颊舌 伸长残根残冠其它合计上颌 2 982 4135 12 92 3 2 915 6 5 3下颌 2 5 2 349412 6 19182 472 9表 2　 6 40例第三磨牙拔除原因拔除原因例数 %阻生引起相关疾病 …     

双侧上颌第三磨牙双冠1例

患者女 ,2 8岁 ,因上颌磨牙后区经常胀痛半年余就诊。检查 :18、2 8正常萌出 ,18无龋坏 ,2 8牙合面中度龋 ,38、48缺失 ,因无对牙合牙建议拔除 2 8。局麻下用牙钳拔除时受阻 ,改用牙挺 ,向远中用力将牙挺出。见其远中牙颈线 3ｍｍ以下多生出一桃形副冠 ,两冠之间夹角呈 45° ,摄Ｘ线片 ,可见 18远中有一与 2 8相同的副冠 ,且根髓相通。 3ｄ后局麻下拔除 18,拔出后见 18与 2 8形态完全相同。患者回忆38、48拔除时无此现象。此例双侧同位牙同时有两冠同一根 ,且主冠萌出正常 ,副冠埋伏 ,属少见。拔出后随访 3月 ,患者双侧上颌胀痛症状消失。双…     

正畸拔除下颌前磨牙对第三磨牙萌出影响的测量研究

目的:评价正畸拔除下颌前磨牙对下颌第三磨牙萌出角度和间隙的影响.方法:选取23 例正畸非拔牙矫治病例(男性12 例,女性11 例,平均年龄13.5 岁),23 例拔除下颌第一前磨牙矫治病例(男性12 例,女性11 例,平均年龄13 岁),21 例拔除下颌第二前磨牙矫治病例(男性11 例,女性10 例,平均年龄14.07 岁),在治疗前和治疗后拍摄全颌曲面断层片,测量下颌第三磨牙的轴倾角度和萌出间隙,使用SPSS 17.0软件对3 组病例的数据进行配对t检验.结果:拔除下颌第一前磨牙组患者RS,LS,Rratio,Lratio在治疗后显著增大(P<0.01);拔除下颌第二前磨牙组患者RM3,LM3等指标在治疗后增大(P<0.05),RS,LS,Rratio,Lratio等指标在治疗后显著增大(P<0.01).结论:正畸拔除下颌前磨牙较非拔牙矫治可以增加下颌第三磨牙的萌出间隙;拔除下颌第二前磨牙可以改善第三磨牙的萌出角度.     

不同部位拔牙对第三磨牙牙胚位置的影响

牙颌畸形的病因及临床症状复杂,要求正畸治疗方案具有多样性。随着基础研究的不断深入和临床技能的提高,正畸医师对拔牙部位有了更多的选择。国内外研究表明,拔牙矫治导致的磨牙近中移动及伴随的萌出间隙增加很可能降低第三磨牙的阻生。本文就目前国内外关于不同部位拔牙对第三磨牙牙胚位置的影响进行综述。     

下颌舌向低位水平阻生第三磨牙拔除1例报告

下颌第三磨牙常不能萌至正常功能位置,造成食物嵌塞,使口腔微生物容易大量繁殖生长,引发冠周炎、邻牙龋坏、蜂窝组织炎症等多种并发症。临床上常用局部冲洗上药、切龈助萌或拔除阻生第三磨牙等方法治疗和预防其并发症。下颌阻生第三磨牙拔除术是口腔门诊常见、较复杂的手术。下     

正畸拔除第一前磨牙后第三磨牙倾斜度的变化

目的 探讨正畸拔除第一前磨牙对第三磨牙倾斜度的影响。方法 选择37例拔牙和32例非拔牙患者,分别在治疗前和治疗后的曲面断层片上测量第三磨牙长轴与平面的交角以及第二、第三磨牙长轴的交角。用U检验来比较两组患者第三磨牙倾斜度在治疗前后的变化。结果 拔牙组和非拔牙组间治疗前后下颌第三磨牙长轴与平面和第二磨牙长轴交角的差异均具有统计学意义（P<0.05）;拔牙组和非拔牙组治疗前后上颌第三磨牙长轴与平面和第二磨牙交角的差异没有统计学意义（P>0.05）。在拔牙组,治疗后下颌第三磨牙比上颌第三磨牙更直立。结论 拔除前磨牙的正畸治疗能够改善第三磨牙的倾斜角度。     

正畸拔除第二前磨牙后第三磨牙倾斜度的变化

近年来,正畸的研究在口腔医学界日益受到重视,该文总结了拔牙矫治和非拔牙矫治,拔除前磨牙正畸治疗能够改善第三磨牙倾斜度,期望对相关临床和科研人员有所帮助.     

拔除第三磨牙治疗颞颌关节紊乱综合征

颞颌关节是具有转动和滑动运动的左右联动关节，是人体最复杂的关节之一。它的正常生理功能有赖于中枢神经系统、牙合、颌面肌肉及关节各部分关系的协调，如果某一部位发生改变，均可直接或间接地影响到颞颌关节的功能。本文就第三磨牙错位萌出造成创伤牙合从而引起颞颌关...     

正畸拔除第一前磨牙对第三磨牙萌出角度的影响

目的：研究正畸拔除第一前磨牙对第三磨牙的影响。方法：37例第一前磨牙拔除和33例非拔牙患者作为研究对象,拍摄术前术后的全景片,测量第三磨牙长轴与平面及第三磨牙长轴与第二磨牙长轴的夹角,对治疗前后夹角的变化以U检验进行比较。结果：结果显示,拔除第一前磨牙后,下颌第三磨牙的的萌出角度得到了改善,而对上颌第三磨牙萌出改善并不明显。结论：拔除下颌第一前磨牙后,第三磨牙萌出角度会更加直立,从而可能减少其阻生的可能性。     

牙颌畸形矫治与第三磨牙拔除的临床分析

牙颌畸形矫治与第三磨牙拔除的临床分析第一军医大学珠江医院（５１０２８２）袁荷英梁河清广东省湛江市海军４２２医院梁江在牙颌畸形矫治中（以下称正畸），对第三磨牙的处理是正畸科医师关注和有所争议的问题之一。国内外学者均有提出第三磨牙阻生的萌出与前牙拥挤和正...     

General dental practitioners'' evaluation of the need for extraction of asymptomatic mandibular third molars

Thirty general dental practitioners were asked to evaluate the need for extraction of asymptomatic mandibular third molars. Thirty-six mandibular third molars with equal distribution of angular positions, impaction status, males and females and age groups were selected. To estimate the consistency of the evaluation, the 36 cases were duplicated so that, in all, 72 teeth were evaluated. The number of molars proposed to be extracted by the observers varied from 0 to 26. There was no third molar which all observers agreed should be extracted. The two molars which most observers, 25 and 23 of altogether 30 observers, proposed to be extracted were partially covered by soft tissue. The decision not to extract two molars was unanimous. Both of these were completely covered by bone tissue and positioned vertically. The mean overall intra-observer agreement for the therapeutical decision was 92%, with a range of 69-100%. The length of professional experience of the observer did not influence the evaluation whether or not to extract. We conclude that there is a great variation among general dental practitioners regarding their evaluation on the need for removal of asymptomatic mandibular third molars.     

正畸治疗中磨牙的拔除和保留(二十六)——第三磨牙发生和发育状况的研究

目的:调查第三磨牙的发生和发育情况.方法:对870名8～18岁青少年全牙列曲面断层片进行统计分析.结果:第三磨牙牙胚发生率趋于稳定的时间下颌早于上颌约1年;男14岁,女13岁起第三磨牙的发生率趋于稳定;上颌第三磨牙缺失率约为17%,下颌约为12%;个体缺失4个、3个、2个和1个第三磨牙的比例分别是5.06%、3.86%、8.92%和10.84%;上颌第三磨牙与第二磨牙的牙冠近远中宽度比主要集中在0.9 0.1,而下颌集中在1.0 0.1的范围内;第三磨牙的发育阶段个体年龄差异较大.结论:对第三磨牙的发生、发育及牙冠大小的评估对于口腔各专业学科均有参考价值.     

微创法与锤凿法拔除下颌阻生智齿的临床研究

目的:评估微创拔牙技术在阻生牙拔除术中的应用价值。方法:选择342例需拔除下颌阻生智齿患者,随机分成2组,分别采用微创法和锤凿法拔除患牙,记录两种方法平均拔除时间、术后肿胀、疼痛、张口受限、颞颌关节痛、干槽症等并发症发生情况。结果:实验组与对照组相比,平均拔除时间明显缩短(P<0.001);术后疼痛、肿胀、张口受限、干槽症、颞颌关节痛等并发症发生率较对照组明显降低(P<0.005)。结论:随着微创医学的发展及新型拔牙器械的推出,微创拔牙理念和技术将逐渐取代传统的锤凿法。     

A regimen of systematic periodontal care after removal of impacted mandibular third molars manages periodontal pockets associated with the mandibular second molars

AIM: This randomized, single-blinded control trial investigated the local effects of periodontal care on the mandibular second molar delivered during and after impacted third molar surgical extraction. METHOD: Thirty subjects (50% male, 32.1+/-7.8 years) out of 35 enrolled, with a mesio-angular impacted mandibular third molar, having probing pocket depth (PPD) >5 mm at adjacent second molar distal, and crestal radio-lucency between the two teeth, completed the study. Oral hygiene instruction, scaling and caries stabilization were performed before surgery. Controls (n=16) had their third molar extracted followed by standard socket debridement. Test group subjects (n=14) received the same treatment, except that before wound closure the operator was informed of the group allocation and ultrasonic root debridement on the second molar was performed, followed by a three-visit plaque control programme. RESULTS: Six months post-extraction, statistically significantly (p<0.007) better plaque control and shallower probing depths were observed at test second molars' distal (%plaque=21; PPD=3.2+/-1.2 mm) than at control second molars (%plaque=88; PPD=5.2+/-0.7 mm). CONCLUSIONS: The periodontal interventions investigated prevented residual pockets on periodontally involved second molars 6 months after ipsilateral impacted mandibular third molar removal.     

无痛微创法与凿骨劈冠法拔除下颌阻生智齿的临床观察

目的 观察无痛微创法和凿骨劈冠法拔除下颌阻生智齿的临床疗效。方法 306颗下颌阻生智齿随机分成2组,分别采用无痛微创法（实验组）和凿骨劈冠法（对照组）拔除患牙,记录2组平均拔除时间、术后肿胀、疼痛、张口受限、颞颌关节痛、干槽症等并发症发生情况及对拔牙的畏惧感。结果 实验组与对照组相比,平均拔除时间明显缩短（P<0.01）;术后疼痛、肿胀、张口受限、颞颌关节痛、干槽症等并发症发生率较对照组明显降低（P<0.01）;术前畏惧在术后的消失率和术前不畏惧在术后出现的畏惧率,均表明实验组优于对照组（P<0.001）。结论 随着社会-心理-生物医学模式的不断完善,拔牙手术正由传统的凿骨劈冠法向着无痛、微创、安全、规范、舒适、愉悦等人性化方向发展。     

Dentists' decisions on prophylactic removal of mandibular third molars: a 10-year follow-up study

OBJECTIVES: In recent years, several critical outcome studies concerning the prophylactic removal of mandibular third molars have been published. These would appear to motivate a more restrictive approach today as compared with 10 years ago. The aim of the present study was to examine dentists' decisions on the prophylactic removal of impacted mandibular third molars over a 10-year period. METHODS: Thirty-six cases were selected so as to represent an equal distribution of males and females, ages, angular position and degree of impaction of the molar. Twenty-six general dental practitioners (GDPs) and 10 oral surgeons judged the same cases on two occasions 10 years apart. RESULTS: Calculated for each category of dentists, there was no significant difference in the mean number of molars designated for removal between the two occasions. Two GDPs and three oral surgeons presented a higher removal rate, whereas five GDPs presented a lower removal rate on the second occasion as compared to the first one. The dentists presented a considerable interindividual variation in removal rate, between 0 and 22 molars on the first occasion and between 0 and 25 molars on the second occasion. CONCLUSION: In the decisions on prophylactic removal of mandibular third molars, there has been no change over the last 10 years towards a more noninterventionist attitude. Thus, the dentists seem not to have been influenced by the evidence that this intervention is not cost-effective.     

Patients'' retrospective preference for extraction of asymptomatic third molars

The purpose of this study was to determine the personal utility of asymptomatic third molar removal in military patients. From 1 to 30 days (mean = 7.4) after the extraction of one or more third molars, 100 returning patients (all male, mean age = 20.1) were asked to respond to hypothetical questions concerning the extraction of asymptomatic third molars. If the likelihood of third molars ever having to be removed was given as 10%, 50%, and 100%, then 45%, 61%, and 88% of responses, respectively, showed preference for immediate extraction. When respondents chose to delay treatment until there was a problem, no likelihood group would tolerate more than 2.77 additional days of post-extraction pain before changing their preference to immediate extraction. 87% of respondents preferred extractions prior to a deployment which would make treatment delivery difficult, and 89% prior to becoming a civilian at which time treatment might no longer be free. The results indicate general acceptance of the strategy of prophylactic third molar removal among a sample of military patients who have undergone pre-treatment counseling and the surgical procedure. A question remains as to the personal utility that might be measured prior to surgery.     

Risk factors for root resorption of second molars associated with impacted mandibular third molars

External root resorption (ERR) affecting mandibular second molars (M2) may occur when the adjacent third molar (M3) is impacted in close proximity. This retrospective cohort study aimed to assess the presence, severity, and location of ERR on M2 due to M3 using cone beam computed tomography (CBCT) scans and to identify associated factors. The angle between the axis of M2 and M3 was measured. ERR on M2 was classified as absent, slight, moderate, or severe. The location of contact between M3 and M2, the size of the dental follicle, and patient demographic characteristics were recorded. A total of 433 patients with 640 M3 were included. A male predilection was found with regard to ERR (P = 0.0004). ERR was identified on 31.9% of M2 and was slight in 30.2%, moderate in 1.4%, and severe in 0.3% of cases. The presence of ERR was associated with direct contact between M2 and M3 (P < 0.0001), the angle between M2 and M3 (P < 0.0001), the inclination of M3 (P = 0.001), and the location of contact (P = 0.0005). This study showed ERR to be a frequent finding. ERR is associated with a mesioangular position of M3 in more than one third of cases, and a proximity ≤0.5 mm between M2 and M3 favours ERR.     

下颌第三磨牙拔除术后疼痛的临床分析及预防

目的研究下颌阻生第三磨牙拔除术后疼痛的相关因素,探索其预防和控制方法。方法第一阶段选择450例下颌阻生第三磨牙拔除患者（第1组）,分析术后疼痛的相关因素,建立预先判断牙齿拔除难度的评估模式,在此基础上制定术后疼痛的临床干预模式。第二阶段另外选择450例下颌阻生第三磨牙拔除患者（第2组）,术前判断拔牙难度和引起疼痛的危险因素,并实施术后疼痛的临床干预模式（有选择性和针对性地给予术前用药或牙槽窝局部用药）,观察治疗效果。结果2组患者的年龄、性别、拔牙难度、拔牙时间等相关因素的差异无统计学意义,具有可比性。拔牙难度和拔牙时间是与术后疼痛相关最为紧密的因素,手术后期疼痛还与局部感染因素（牙齿龋坏）以及女性月经周期相关。实施临床干预模式后,第2组患者的术后疼痛程度、重度疼痛发生率和止痛药服用量均明显低于第1组。结论拔除下颌阻生第三磨牙时,实施基于术前拔牙难度判断的围手术期药物的合理控制,可以实现术后疼痛的个体化预防,减轻或避免术后疼痛,有助于避免过量或不当使用药物。     

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。