Efficacy of secondary vs primary closure techniques for the prevention of postoperative complications after impacted mandibular third molar extractions: A systematic review update and meta-analysis

BackgroundThe aim of this systematic review was to determine whether secondary closure (SC) or primary closure (PC) is better at preventing postoperative complications after impacted mandibular third-molar extraction.Types of Studies ReviewedThe authors sought randomized controlled trials comparing the effects of PC and SC on pain, swelling, trismus, infection, and bleeding after impacted mandibular third-molar extraction. Screening, data extraction, and risk of bias assessments were conducted independently and in duplicate. The reviewers pooled results across studies using a random-effects meta-analysis and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.ResultsThis review identified 785 unique citations and included 40 trials. Compared with PC, SC was found to have trivial benefits for pain at day 7 and trismus within 1 week (moderate certainty). The incidence of infection and bleeding did not differ importantly between techniques (moderate certainty). However, SC is probably associated with less swelling on day 1 (standardized mean difference, –0.98; 95% CI, –1.22 to –0.73; moderate certainty) and day 3 (standardized mean difference, –0.87; 95% CI, –1.16 to –0.59; moderate certainty). There was very low certainty evidence for pain on days 1 and 3 and low certainty evidence for swelling on day 7.Conclusions and Practical ImplicationsClinicians choosing between closure techniques should be aware that SC probably imparts an important benefit only for swelling at days 1 and 3. There seems to be a trivial difference between the techniques in other outcomes.     

阻生下颌第三磨牙2种拔除方法的比较

目的:比较拔除下颌阻生第三磨牙时,传统的凿骨劈冠法与改良涡轮机拔除法的优劣.方法: 600 例下颌阻生第三磨牙病例,其中300 例,使用传统的凿骨劈冠法拔除, 另300 例使用改良涡轮机法拔除,对手术时间以及术中、术后并发症进行对比观察和统计分析.结果: 2 种方法的手术时间分别为(22.285±12.025) min和(16.115±12.078) min.与传统的凿骨劈冠法相比,改良涡轮机拔除法拔除下颌阻生第三磨牙的手术时间较短(P<0.05),术中及术后并发症的发生率均明显降低(P<0.05).结论: 改良器械的应用,使阻生下颌第三磨牙的拔除更加方便,值得推广应用.     

高速涡轮牙钻辅助拔除下颌智齿后伤口愈合情况的研究

目的：了解高速牙钻法拔3除下颌智齿后拔牙创的愈合状况。方法：210例下颌需拔除的智齿,随机分成2组,分别用高速牙钻和牙凿辅助去除阻力,观察比较拔牙创愈合情况。结果：牙钻组拔牙后并发症明显少于骨凿组（P＜0．05）,同一个体使用不同方法拔除智齿后牙槽窝伤人微生物状态无明显差异,牙槽窝骨密度恢复早期有差异,但长期无明显差异,结论：高速牙钻法辅助拔除智齿后伤口愈合状况优于骨凿法。     

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。     

Keratocystic odontogenic tumor arising at the mandibular ramus with an impacted tooth: a case report and mimic lesions

Objectives: To consider the biologic behaviors of keratocystic odontogenic tumors (KCOTs) and

ameloblastomas and dentigerous cysts.

Methods: A 63-year-old Japanese man presented with swelling and discomfort in the left cheek during jaw movement. Examination revealed a multilocular lesion within the mandible extending from the left second premolar to the left mandibular ramus and coronoid process; the lesion contained a deviated impacted tooth. The tumor had expanded beyond the bone and was invading the masseter and medial pterygoid muscles. Marginal mandibulectomy with a free iliac bone graft was performed.

Results: No recurrence was observed during a 7-year follow-up.

Discussion: The histopathological diagnosis of the lesion showed it was a KCOT. These tumors usually grow within the bone, causing bone expansion. However, this tumor had expanded beyond the bone and invaded surrounding muscles. Thus, KCOTs can, in rare cases, manifest themselves as described here. Evaluating preoperative images and histopathological findings is important to determine the optimal treatment strategy.     

下颌阻生智齿急性炎症期拔除的临床研究

目的：探讨急性炎症期与炎症后拔牙的临床区别。方法：将１２６例急性冠周炎患者随机分为两组，分别在急性炎症控制后拔除患牙及急性期拔除患牙，同期比较其并发症及疗效。结果；急性炎症期拔牙能够缩短炎症过程，术后反应轻，并发症无明显增加。结论；急性炎症期拔牙为治疗部分急性冠周炎的有效手段之一。     

应用涡轮机钻拔除下颌阻生智齿的临床观察

作者于1987年9月～1988年10月间,应用高速涡轮牙钻为主要器械拔除158例下颌阻生智齿,并对手术当时及术后24小时反应进行观察。对69例进行了五天观察,结果比较满意。对应用涡轮牙钻机拔除下颌阻生智齿的优点,注意事项及并发症等作了讨论     

Efficacy of adjuvant laser therapy in reducing postsurgical complications after the removal of impacted mandibular third molars: A systematic review update and meta-analysis

Background

The authors updated a previously published systematic review to assess the effects of low-level laser therapy (LLLT) on reducing complications after the removal of impacted mandibular third molars.

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。