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.     

Prophylaxis versus pre-emptive treatment for infective and inflammatory complications of surgical third molar removal: a randomized, double-blind, placebo-controlled, clinical trial with sustained release amoxicillin/clavulanic acid (1000/62.5 mg)

The most common complications after surgical extraction of the third mandibular molar are trismus, oedema or swelling, local pain, dysphagia and infection. The aim of this comparative, double-blind, randomized clinical trial was to evaluate the efficacy of two sustained release amoxicillin/clavulanate regimens in the reduction of infection after third molar extractive surgery. A total of 225 patients were randomized into three equal groups: placebo, prophylaxis with single pre-surgical dose of two tablets amoxicillin/clavulanate 1000/62.5 mg, and pre-emptive post-surgery therapy with two tablets amoxicillin/clavulanate 1000/62.5 mg BID for 5 days. A higher rate of infection (P=0.006) was found among patients receiving placebo (16%) than those receiving single-dose prophylaxis (5.3%) or 5-day pre-emptive therapy (2.7%). A relationship between both the duration (13.8% for long versus 7.4% for medium versus 1.6% for short) and difficulty (12.7% with ostectomy versus 3.5% without ostectomy; P=0.011) of surgical procedure and incidence of subsequent infection was also observed. Both prophylactic and therapeutic regimens versus placebo achieved greater reduction of pain after surgery on day 3 (P=0.001). Logistic regression analysis revealed a risk of infection of 24%, 9% and 4% for ostectomy with placebo, prophylaxis and pre-emptive treatment, respectively, whereas it was 7%, 2% and 1% if ostectomy was not performed. Pre-emptive therapy with the oral sustained release amoxicillin/clavulanate formulation reduced the rate of subsequent infection in patients undergoing ostectomy. Prophylaxis was beneficial in simpler procedures and may be indicated in cases where ostectomy is not performed.     

Efficacy of Single Dose Azithromycin as Prophylactic Antibiotic in Surgical Removal of Mandibular Third Molars: A Clinical Study

Objective

To evaluate the efficacy of single dose Azithromycin as prophylactic antibiotic in surgical removal of mandibular third molar.

Materials and Methods

The study was carried out as an open clinical trial on fifty (23 males & 27 females) patients chosen from the ones referred to our Oral & Maxillofacial Surgery Department for surgical removal of mandibular third molar (SRMTM). Pre-surgical evaluation of pain, swelling, lymphadenopathy, fever and purulent discharge from the surgical site were made. All patients were administered oral Azithromycin 500mg, 1 hour prior to the procedure. The patients were followed up clinically for a minimum period of 10 days post operatively. Evaluation for pyrexia, purulent discharge from surgical site, persistent pain &/or swelling & lymphadenopathy was done on 1st, 3rd, 7th and 10th postoperative day to determine SSI (surgical site infection). All patients received same set of post-operative medications (Tab. Diclofenac sodium (50mg) TID, Tab. Ranitidine 150 mg BID for 5 days) and set of instructions.

Results

Surgical site infection was seen in only one patient (2%) out of the total fifty patients included in the study when oral Azithromycin was administered one hour prior to surgical removal of mandibular third molar.

Conclusion

Our study suggests that, giving antibiotics pre-operatively 1 hour before the SRMTM is beneficial to reduce/avoid SSI. The surgeon must consider all potential factors that may contribute to the post-operative complication and decide whether the benefits of antibiotic therapy outweigh its risks.     

臭氧油在下颌阻生第三磨牙拔除术后应用效果研究

目的    观察下颌阻生第三磨牙拔除术后局部涂抹臭氧油的临床效果。方法    选取2019年1-9月就诊于南京大学医学院附属口腔医院并拟拔除双侧下颌阻生第三磨牙患者45例,共计患牙90颗。采用随机自身对照的方法,将所有患牙分为臭氧油组和对照组。所有患者均采用微创牙拔除术,术后连续3 d,臭氧油组在手术创面及创面周围涂抹臭氧油,对照组给予抗生素口服。于术后1、3、7 d评估患者疼痛、肿胀、张口受限程度等舒适度相关指标。结果   术后1、3、7 d,臭氧油组患者的疼痛及肿胀程度明显低于对照组,臭氧油组患者的张口度明显优于对照组,差异均有统计学意义（均P < 0.05）。结论    局部涂抹臭氧油能够有效缓解下颌阻生第三磨牙拔除术后的疼痛、肿胀和张口受限程度。     

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。     

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。     

Foreign-body granuloma occurring in the mandible subsequent to orthognathic surgery: a case report

We report the first case of foreign-body granuloma occurring in the mandible of a patient with a history of orthognathic surgery. A 20-year-old male patient had a hard swelling and pain in the left mandibular angle and the parotid area. Plain radiographs showed a radiolucent lesion extending from the buccal area under the left sigmoid notch of the mandible to the mandibular angle. Computed tomographs showed an expanded osteolytic mass in the same area, with destruction of most of the bone on the buccal side. A microscopic examination revealed filamentous foreign material associated with chronic inflammatory cell infiltration and an aggregation of multinucleated giant cells. Foreign-body granuloma in the mandible, although rare, should be included in the differential diagnosis in cases of postoperative masses.     

The effects of different levels of dietary sucrose on root caries subsequent to gingivectomy in conventional rats infected with Actinomyces viscosus M-100

Three groups of weanling, Sprague-Dawley-derived rats were inoculated with Actinomyces viscosus M-100 and fed powdered diet containing either 67%, 5%, or 0% confectioner's sugar. Two further groups were fed diet containing 5% confectioner's sugar and inoculated with Streptococcus sobrinus 6715 or S. sobrinus 6715 plus A. viscosus M-100. The most coronal 1 mm of gingiva was removed from maxillary and mandibular right molar quadrants (gingivectomy), and the animals re-inoculated following gingivectomy. The animals were killed 64 days following gingivectomy, and the lingual surface of mandibular first molar roots was measured for exposed root-surface area and root caries. In the groups of rats infected with A. viscosus M-100, root caries area was significantly greater in the group fed diet containing 67% confectioner's sugar. Sucrose level did not significantly affect the amount of exposed lingual first molar root area regardless of whether the tooth had been subjected to a gingivectomy. In the groups of rats receiving diet containing 5% confectioner's sugar, there were no significant differences in root caries area or exposed root-surface area, regardless of the infection status of the animals. In the rat model presented here, a high level of dietary sucrose was a necessary condition for the initiation of root caries in the absence of other readily fermentable carbohydrates.     

下颌有阻生倾向智牙胚与阻生智牙拔除术的比较研究

目的:比较下颌有阻生倾向的智牙胚拔除术与下颌阻生智牙拔除术的手术难度及术后并发症。方法:研究组选取有阻生倾向的下颌智牙胚拔除术病例41例,并随机收集成年下颌埋伏阻生智牙拔除病例40例作对照。收集两组拔牙手术操作时间、术后疼痛、局部肿胀、张口度改变情况的数据,并进行对比分析。结果:下颌有阻生倾向的智牙胚拔除术操作时间短,术后的肿胀、疼痛及开口改变情况,均较对照组轻。结论:下颌有阻生倾向的智牙胚拔除术,操作简单,术后不良反应较轻,恢复快。     

地塞米松冠周注射预防下颌阻生第三磨牙拔除后肿胀及张口受限的系统评价

目的 评价地塞米松（DM）冠周注射对下颌阻生第三磨牙拔除术后肿胀及张口受限的预防效果。方法 检索Cochrane图书馆临床随机对照试验库、PUBMED、荷兰医学文摘（EMBASE）和中国生物医学文献数据库;同时手检纳入文献的参考文献及中文口腔医学杂志。偏倚风险评价由2位评价者使用Cochrane系统评价者手册5.0版介绍的偏倚风险评价标准独立完成,同时独立进行数据提取。运用Revman 5.1软件进行Meta分析。结果 共纳入7篇随机对照试验,涉及患者684名,偏倚风险评价显示6个研究为中度偏倚风险,1个研究为高度偏倚风险。Meta分析的结果显示,4～5 mg DM冠周注射能够使患者术后1～2 d内最大张口度大6.77 mm（P=0.02）,同时能够减少51%的中-重度张口受限的发生率（P<0.000 01）,并且在控制面部肿胀方面效果显著（P<0.05）。注射4 mg DM与8 mg DM在各项指标中无显著差别（P>0.05）。结论 选择4～5 mg的DM冠周注射能够较好地控制下颌阻生第三磨牙拔除术后面部肿胀和张口受限,但还需要更多的临床随机对照试验的支持。     

Treatment of Cervicofacial Actinomycosis: A report of 19 cases and review of literature

Objectives: Actinomycosis is a chronic suppurative granulomatous infection caused by the Actinomyces genus. Orocervicofacial actinomycosis is the most common form of the disease, seen in up to 55% of cases. All forms of actinomycosis are treated with high doses of intravenous penicillin G over two to six weeks, followed by oral penicillin V. Large studies on cervicofacial actinomycosis are lacking. Therefore proper guidelines for treatment and treatment duration are difficult to establish. The aim of this study is to establish effective treatment and treatment duration for orocervicofacial actinomycosis. Study design: A Pubmed and Embase search was performed with the focus on treatment and treatment duration for cervicofacial actinomycosis. The hospital records of all patients presenting to our department with head and neck infection from January 2000 to December 2010 were reviewed, retrospectively. The following data were collected: age, gender, clinical presentation, aetiology, duration of symptoms, microbiological findings, treatment, and duration of treatment. The treatment and treatment duration is subsequently compared to the literature. Results: The literature search provided 12 studies meeting the inclusion criteria. All studies were retrospective in nature. Penicillin or amoxicillin/clavulanic acid are the preferred antibiotic regimens found in the literature. Most of our patients were treated with a combination of penicillin G 12 million units/day and metronidazol 500 mg 3/day, most commonly for a duration of 1 – 4 weeks, being shorter than the 3 – 52 weeks reported in the literature. Conclusion: When actinomycosis is suspected, our review has shown that a surgical approach in combination with intravenous penicillin and metronidazol until clinical improvement is seen, followed by oral antibiotics for 2 – 4 weeks is generally efficient. Key words:Actinomycosis, actinomyces, actinomycosis treatment, cervicofacial infection, actinomycosis diagnosis, head and neck infection.     

下颌阻生第三磨牙拔除术后肿胀度评估方法研究进展

近年来，各种微创拔牙方法被越来越多地应用于下颌阻生第三磨牙的拔除，但对其手术创伤的评估缺乏客观量化的指标。牙拔除术后肿胀度能较为客观地反映手术创伤程度。目前常用于评估下颌阻生第三磨牙拔除术后肿胀度的方法包括肿胀视觉模拟评分法、直接测量法及光学3D测量法等，这些方法的评估原理不同，评估精确性也存在一定的差异。文章就以上几种评估方法的研究进展做一综述，并分析其优缺点及临床应用价值。     

Rare lesions of the oral cavity: case report of an actinomycotic lesion limited to the gingiva

Actinomycosis is an infectious disease that frequently has chronic granulomatous and suppurative lesions caused by saprophytic Actinomyces species. Although cervicofacial actinomycosis is known to be the most common type, intraorally and periodontally types occur rarely in a localized fashion. The present case reports on an adult periodontitis patient with a diffuse and atypic actinomycotic lesion which was limited to the gingiva and had an abscess formation, a large desquamation and subsequent exposure of the alveolar bone in the involved region. Diagnosis was based on histopathological examination, the history of the case and clinical nature of the lesion. The patient responded to daily administration of 100 g doxcycycline (first day-bid) for 3 weeks and 0.2% chlorhexidine gluconate irrigation (following tooth brushing) performed with oral hygiene reinforcement and periodontal debridement procedures. Complete improvement of the lesion was observed after 5 weeks. Due to the opportunistic characteristics of the actinomycotic infection, early and adequate differential diagnosis of actinomycosis prior to therapeutic attempts, as well as management steps, are of great importance in the oral cavity to prevent the spread of the disease.     

Effect of preoperative prednisolone on clinical postoperative symptoms after surgical extractions of mandibular third molars

Background: This study compared postoperative symptoms in patients treated preoperatively with a single dose of ≤20 mg oral steroid during third molar surgery. Methods: A total of 450 patients were categorized randomly into three groups containing 150 patients each. Patients were in their second or third decade and had no specific medical history and findings involving infections of the mandibular third molar area. Two groups received preoperative steroids orally one hour before the operation; one group received 10 mg prednisolone and the other received 20 mg. No steroids were administered to the control group. Patients were asked to report by questionnaire any changes in postoperative symptoms, such as pain, facial oedema, or gastrointestinal disorders, and in masticatory disorders, trismus, or swallowing discomfort. They reported daily from days 1 to 6 post‐extraction by evaluating their experience over the preceding 24 hours. Results: A single preoperative oral administration of ≤20 mg prednisolone had no significant effect on postoperative symptoms of pain, facial oedema, or gastrointestinal upset, or on masticatory symptoms, trismus, or swallowing discomfort in mandibular third molar surgery. Conclusions: A single oral dose of ≤20 mg prednisolone before third molar extraction may not be helpful for the relief of postoperative symptoms.     

Eventuality of Dexamethasone Injected Intra-massetrically on Post Operative Sequel Following the Surgical Extraction of Impacted Mandibular Third Molars: A Prospective Study

Objective

The objective of the study was to compare the efficacy of dexamethasone given intra-massetrically via intra buccal approach on postoperative sequele after surgical extraction of impacted mandibular third molars.

Methodology

Twenty patients, each of who required surgical extraction of a single impacted mandibular third molar under local anesthesia, were randomly set apart to one of the two groups of ten each. The experimental group received dexamethasone 8 mg injected to the masseter muscle intra buccally and the control group did not receive any steroid. Facial swelling and maximal inter-incisal distance were measured by an independent examiner preoperatively, and at 4th h, on the day of surgery, 2 and 7 postoperative days. Pain was measured from the patient’s response to a visual analogue scale.

Results

Patients were of the age range 18–40 years. Dexamethasone group showed significant reduction in swelling and pain compared with the control group at all intervals. Dexamethasone injected into the masseter muscle via intra buccal approach resulted in significantly less trismus than control on day one postoperatively.

Conclusion

Dexamethasone 8 mg given intra-massetrically through intra buccal approach is an effective way of minimizing swelling, trismus, and pain following surgical extraction of impacted mandibular third molars. It offers a simple, safe, painless, non-invasive and cost-effective treatment.

     

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...     

Bifid mandibular canal in Japanese

The location and configuration of mandibular canal variations are important in surgical procedures involving the mandible, such as extraction of an impacted third molar, dental implant treatment, and sagittal split ramus osteotomy. We report 3 Japanese patients with bifid mandibular canals using panoramic radiograph and multi-slice helical computed tomography (CT) images. In 2 of the 5 sides, the bifid mandibular canal was suggested on panoramic radiograph. The bifid mandibular canal had a short and narrow upper canal toward the distal area of the second molar in 4 sides, and a short and narrow lower canal toward the distal area of second molar in 1 side, as revealed on reconstructed CT images. Since the location and configuration of mandibular canal variations are important in surgical procedures involving the mandible, they should be carefully observed using reconstructed CT images.     

Sclerosing osteomyelitis of Garré periostitis ossificans

Sclerosing osteomyelitis of Garré is a rare syndrome; the mandible is the most commonly affected bone segment in the cervicofacial region. This chronic disease is characterized by a nonsuppurative ossifying periostitis with subperiosteal bone formation, commonly reactive to a mild infection or irritation. The differential diagnosis must be made with similar clinical conditions with hard mandibular swelling associated with bony sclerosis. Presumptive diagnosis can be achieved by radiology, but such diagnosis must be confirmed by histology. The aim of therapy is to remove the cause when recognized, aided by an adequate antibiotic therapy. Clinical, radiographic, and histologic features are presented in this case report.     

Decadronphosphate in the relief of complaints after third molar surgery. A double-blind, controlled trial with bilateral oral surgery

The purpose of the present double-blind study was to investigate the preventive effect of 4 mg dexamethasone (1 ml Decadronphosphate) on swelling, trismus and pain after removal of impacted mandibular third molars. The population comprised 30 healthy individuals (17 female, 13 male) who needed removal of 2 identical, impacted mandibular third molars. Each patient served as his own control as the teeth were removed in 2 sittings with either steroid or placebo injected into the masseter muscle just before starting the operation. Control visits took place 48 h and 7 days after the operations. The results showed that steroid administration led to about 50% reduction of postoperative swelling and trismus and to about 30% reduction of postoperative pain. No general or local complaints/complications occurred due to the steroid injection. It is concluded that prophylactic steroid treatment is effective in reducing postoperative complaints and that the administration is safe in the absence of contraindications for such administration. Prophylactic steroid treatment is therefore recommended in third molar surgery when pronounced postoperative reaction can be expected.     

高速涡轮机头和微创拔牙刀在下颌阻生牙拔除术中的应用效果评价

目的评价高速涡轮机、微创拔牙刀在下颌阻生智牙拔除中的应用效果。方法选择2011年5月—2014年5月于我科实施下颌阻生智牙拔除治疗的患者83例,依据治疗方式将其分为实验组（n=42）与对照组（n=41）。对照组采用传统拔牙器械进行患牙拔除,实验组采用高速涡轮机、微创拔牙刀进行患牙拔除。观察比较2组牙根折断、牙龈撕裂、邻牙松动、舌侧骨板骨折、颌骨骨折、颞下颌关节脱位等术中并发症的发生情况,2组下唇麻木、干槽症、面颊部肿胀、开口受限等术后并发症的发生情况,以及2组手术时间、拔牙窝的完整性、疼痛VAS评分、满意度评分情况。采用SPSS19.0软件包对数据进行统计学处理。结果实验组牙根折断、牙龈撕裂、邻牙松动、舌侧骨板骨折、颌骨骨折、颞下颌关节脱位等术中并发症发生率均显著低于对照组（P<0.05）。实验组下唇麻木、干槽症、面颊部肿胀、开口受限等术后并发症发生率也显著低于对照组（P<0.05）。实验组手术时间、拔牙窝的完整性、VAS评分、满意度评分情况与对照组相较,均有显著差异（P<0.05）。结论高速涡轮机、微创拔牙刀用于下颌阻生智牙拔除,具有操作简单、手术难度低,创伤小、术中术后并发症少和效率高的特点,可显著降低患者对拔牙产生的恐惧感,值得临床推广。