口腔疾病防治 ›› 2020, Vol. 28 ›› Issue (3): 169-173.DOI: 10.12016/j.issn.2096-1456.2020.03.006

• 临床研究 • 上一篇    下一篇

埋伏多生牙微创精准拔除85例临床研究

宋治锋(),费菲   

  1. 上海市口腔病防治院口腔综合科,上海(200031
  • 收稿日期:2019-12-11 修回日期:2019-12-22 出版日期:2020-03-20 发布日期:2020-03-20
  • 通讯作者: 宋治锋

Clinical study of the minimally invasive extraction of impacted supernumerary teeth in 85 cases

SONG Zhifeng(),FEI Fei   

  1. Department of Integrated Dentistry, Shanghai Stomatological Hospital, Shanghai 200031, China
  • Received:2019-12-11 Revised:2019-12-22 Online:2020-03-20 Published:2020-03-20
  • Contact: Zhifeng SONG

摘要:

目的 探讨埋伏多生牙微创精准拔除的手术设计与方法,为临床提供参考。方法 对85例患者共87颗埋伏多生牙进行手术拔除,术前行CBCT检查,根据埋伏多生牙距离颊舌(或唇腭)侧皮质骨的距离,就近原则选择手术入路;以CBCT的测量尺测量埋伏多生牙的牙冠颊舌向及近远中向的最大直径,根据牙冠颊舌向的半径,以其上方的牙槽嵴顶或邻牙釉牙骨质界为参照,确定拟去骨的上界、下界;自上下界连线的中点向近远中做水平垂线,水平垂线的长度为埋伏多生牙冠近远中向直径的1/2,即半径,确定拟去骨的水平向起止点;阻滞麻醉+局部浸润麻醉下电刀做梯形或弧形切口,切口保留龈乳头,用骨尺标记去骨的上界点、下界点及近远中点,从上界点与下界点连线的中点区开始向上下及近远中向去骨,去骨的范围略大于牙冠的半径,显露埋伏多生牙牙冠,以45°仰角气动式外科专用切割手机或超声骨刀将埋伏牙的牙冠牙体一分为二,分块取出牙冠及牙体组织,清理冲洗术区,缝合伤口,术后予以抗炎、消肿治疗,嘱术后24 h局部冰敷,流质饮食;备止痛药;术后7 d复诊,检查伤口愈合并询问记录患者止痛药的服用情况。结果 所有患者术后7 d伤口愈合良好,均予以拆线。颌面部无肿胀,开口度基本恢复正常,未发生感染及麻木等并发症,其中58例患者未服用止痛药。结论 以CBCT对骨内埋伏多生牙定位,就近原则选择手术入路,术中使用骨尺精准定点去骨,分块拔除埋伏多生牙,可以达到微创精准的效果。

关键词: 埋伏多生牙, 锥形束计算机断层扫描, 骨尺, 定位, 超声骨刀, 气动式外科专用切割手机, 微创, 拔牙, 精准医学

Abstract:

Objective To explore the surgical design and surgical Methods for the minimally invasive extraction of embedded supernumerary teeth and to provide a reference for clinical practice. Methods A total of 87 embedded supernumerary teeth were removed from 85 patients. CBCT examination was performed before the operation. The nearest surgical approach was selected based on the distance between the embedded supernumerary teeth and the bony plate of the buccal tongue (lip and palate). The CBCT measuring ruler measured the maximum diameter of the impacted dental crown. According to the radius of the buccal and tongue directions of the crown, the upper and lower boundaries (bucco-lingual direction) of the bone to be deboned were determined with reference to the top of the alveolar crest or adjacent enamel cementum. A horizontal vertical line was made from the point to the meridian, and the length of the horizontal line was 1/2 the diameter of the impacted multiple crown. Thus, the radius determined the horizontal starting and ending points of the bone to be boneless. A trapezoidal or arcuate incision was made with an electric knife under block anesthesia and local infiltration anesthesia. The incision retained the gingival papilla. The upper and lower as well as the near and far midpoints of the bone were marked with a bone ruler. Starting from the midpoint area, the upper and lower points were connected. The mesial bone was removed in the mesial direction, and the range of the removed bone was slightly larger than the radius of the crown, showing the crown of the embedded supernumerary teeth. A surgical impact air handpiece with a 45-degree elevation angle or a piezosurgery device was used to divide the crown of the embedded supernumerary teeth into two parts. The crown and dental tissues were removed in pieces, the surgical area was cleaned and rinsed, and the wound was closed. Anti-inflammatory and swelling treatments were administered after the operation, and painkillers were prepared. The patients were revisited 7 days after the operation to check for wound healing. We asked and recorded the amount of painkillers taken by the patients. Results All patients had good wound healing 7 days after the operation, and the wounds were sutured. There was no swelling on the maxillofacial surface, and the degree of opening was basically normal. No other complications such as infection or numbness occurred. Fifty-eight patients did not take painkillers. Conclusion CBCT can be used to locate the embedded supernumerary teeth in bone. The surgical approach can be chosen based on the principle of proximity. During the surgery, the bone ruler is used to accurately locate the bone and remove the embedded supernumerary teeth in pieces, which can achieve a minimally invasive effect.

Key words: embedded supernumerary teeth, cone beam computed tomography, bone ruler, positioning, piezosurgery device, surgical impact air handpiece, minimally invasive technique, teeth extraction, precision medicine

中图分类号: