超声骨刀与涡轮法拔除下颌阻生第三磨牙的效果比较

目的: 比较超声骨刀和涡轮法拔除下颌阻生第三磨牙的手术时间和术后反应等,评价2种方法拔除不同类型下颌阻生第三磨牙的疗效。方法: 2018年1月—2019年1月宿迁市人民医院收治的120例中、低位埋伏阻生牙患者,按照垂直阻生、近中阻生、水平阻生各40例分为3组。每组20例应用超声骨刀,20例应用涡轮钻。记录手术时间、术后疼痛、肿胀、开口度及永久性神经损伤等严重并发症情况。采用SPSS 17.0软件包对数据进行统计学分析。结果: 术后1 d和3 d,超声骨刀法疼痛显著小于涡轮法;7 d时,2组之间疼痛无显著差异。垂直阻生组手术时间、术后肿胀、开口度在2组之间无显著差异。近中阻生牙组2种方法术后肿胀无显著差异,但超声骨刀法手术时间更短、开口度更大。水平阻生牙的手术时间、肿胀、开口度超声骨刀法优于涡轮法。各组均未出现严重并发症。结论: 超声骨刀对组织可选择性切割、截骨精准、术后创伤小、使用安全方便,在一定程度上比涡轮更具优势,真正实现了微创外科。临床上推荐应用超声骨刀拔除中低位近中或水平埋伏阻生牙,以减少术后创伤,提高手术疗效。

Clinical research on therapeutic effect of pulling out the mandibular third impacted molar with piezosurgery and highspeed rotary handpiece

PURPOSE: This research aimed at evaluating the efficacy of different types of impacted mandibular third molars removed by piezosurgery and highspeed rotary handpiece. METHODS: One hundred and twenty low-positioned impacted mandibular third molars were assigned to 3 groups (vertically impacted group, mesially impacted group and horizontally impacted group) and each group included 40 teeth. Twenty teeth in each group were treated with piezosurgery and another 20 teeth with highspeed rotary handpiece. The operation time, degree of postoperative pain and swelling, mouth opening and serious complications (such as permanent nerve injury) were recorded. SPSS 17.0 software package were used for statistical analysis. RESULTS: All cases treated with piezosurgery showed minor postoperative pain at 1 d and 3 d than those with highspeed rotary handpiece, but no significant difference at 7 d. In vertically impacted group, no significance was shown in the operation time, swelling, mouth opening between two methods. In mesially impacted group, piezosurgery had the advantages of reducing operation time and mouth opening limitation than highspeed rotary handpiece, but with the same degree of swelling. In horizontally impacted group, piezosurgery was superior to highspeed rotary handpiece in all postoperative clinical indexes. No serious complication was observed in each group. CONCLUSIONS: Comparing to highspeed rotary handpiece, piezosurgery achieves minimally invasive surgery via selectively cutting bone tissue, accurate osteotomy, less postoperative trauma. It is recommended to use piezosurgery to remove low positioned mesially or horizontally impacted third molars to reduce postoperative trauma and improve surgical outcomes.