北京大学学报(医学版) ›› 2020, Vol. 52 ›› Issue (2): 395-403. doi: 10.19723/j.issn.1671-167X.2020.02.033

• 临床经验交流 • 上一篇    

下颌阻生智齿拔除手术的可预期微创化

段登辉(),王恩博,崔念晖,翟新利,刘宇,孟娟红,张伟,张益   

  1. 北京大学口腔医学院 · 口腔医院,口腔颌面外科 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室 口腔数字医学北京市重点实验室,北京 100081
  • 出版日期:2020-04-18 发布日期:2020-04-18
  • 通讯作者: 段登辉 E-mail:18910188808@163.com

  • Online:2020-04-18 Published:2020-04-18

关键词: 下颌智齿, 吸入镇静术, 手术决策树, 微创手术

中图分类号: 

  • R782.11

图1

左下颌阻生智齿拔除术后麻木两年,敲锤增隙时,圆凿直接损伤下牙槽神经,挺松过程中圆凿折断(A);右下颌水平阻生智齿,敲锤增隙过程中,牙齿舌向移位,进入咽旁间隙(B)"

图2

左下颌垂直阻生智齿(A),根尖片显示融合根(B),远中截冠(C),远中冠取出(D),牙挺顺牙根长轴远中牙合向脱位(E, F),近中冠根取出后的拔牙窝(G),远中截冠接近根尖1/2~1/3水平(H)"

图3

右下颌水平阻生智齿,融合牙根与下牙槽神经相贴(A),颊侧角形翻瓣(B),垂直截冠后远中面去骨显露釉牙骨质界(C),釉牙骨质界处斜行制备沟槽(D),牙挺顺牙根长轴近中方向脱位(E),牙齿拔除后的拔牙窝(F)"

图4

右下颌水平阻生智齿,牙根肥大(A), 垂直截冠后牙根断面(B),远中根面釉牙骨质界处斜行打孔(C),三角挺顺牙根长轴挺向近中方向(D),冠根脱位(E),牙齿拔除后的拔牙窝(F)"

图5

右下颌水平阻生智齿(A),根尖片显示双根分叉(B),垂直截冠后釉牙骨质界处斜行截断远中根(C),牙挺顺牙根长轴挺向近中方向(D),截根后的牙根断面(E, F),牙齿拔除后的拔牙窝(G),离体牙显示远中截根的位置(H)"

图6

右下颌舌向阻生智齿(A),颊侧角形翻瓣(B),去骨至釉牙骨质界处显露牙冠颊侧面(C),垂直方向远中截冠(D),顺牙根长轴舌向冲出,舌侧有阻力,牙齿不松动(E),垂直方向舌侧截冠(F),顺牙根长轴舌向冲出,冠根脱位(G),牙根为双根,颊舌向分根(H),牙齿拔除后的拔牙窝(I)"

图7

下颌智齿牙根形态分类:单根锥形(A,E),单根肥大/融合根(B,F),双根分叉(C,G),其他类型(D,H)"

图8

下颌垂直阻生,远中阻生智齿拔除手术决策树"

图9

下颌近中阻生,水平阻生智齿拔除手术决策树"

图10

下颌舌向阻生和其他类型智齿拔除手术决策树"

图11

拔牙窝切口近中放置引流条(A),角形瓣复位,切口不缝合(B)"

[1] Sun Y, Pan B, Fu Y , et al. Development of a novel intelligent laparoscope system for semi-automatic minimally invasive surgery[J]. Int J Med Robo, 2019, 11(2019-11-01)[2019-11-5]. 1002/rcs. 2049.
[2] 中国腹腔镜胃肠外科研究组( CLASS研究组). 中国腹腔镜胃肠外科研究组十年回顾与展望[J]. 中华胃肠外科杂志, 2019,22(10):916-919.
[3] Blanco RT, Ojala R, Kariniemi J , et al. Interventional and intraoperative MRI at low field scanner: A review[J]. Eur J Radiol, 2000,56(2):130-142.
[4] Mathew MS, Oto A . MRI-guided focal therapy of prostate cancer[J]. Future Oncol, 2017,13(6):537-549.
[5] Kim SH, Won KS, Choi BW , et al. Usefulness of F-18 FDG PET/CT in the evaluation of early treatment response after interventional therapy for hepatocellular carcinoma[J]. Nucl Med Mol Imaging, 2012,46(2):102-110.
[6] Donlon WC, Truta MP . Minimally invasive third molar surgery[J]. J Oral Maxillofac Surg, 2007,65(2):359.
[7] Engelke W, Lazzarini M ,Beltrán V. Hard tissue preservation in minimally invasive mandibular third molar surgery using in situ hardening TCP bone filler[J].Biomed Res Int, 2018,11(2018-11-11)[2019-11-01].
[8] Lodi G, Figini L, Sardella A , et al. Antibiotics to prevent complications following tooth extractions[J]. Cochrane Database Syst Rev, 2012,11(2012-11-14)[2019-11-02].
[9] Menon RK, Kar Yan L, Gopinath D , et al. Is there a need for postoperative antibiotics after third molar surgery? A 5-year retrospective study[J]. J Investig Clin Dent, 2019,10(4):e12460.
[10] Hechler BL, Blakey GH . Necrotizing soft tissue infection following routine third molar extraction: Report of two cases and review of the literature[J]. Int J Oral Maxillofac Surg, 2019,48(12):1525-1529.
[11] Ma S, Li X, Zhang A , et al. Efficacy of secondary closure technique after extraction of third molars: A meta-analysis [J]. Br J Oral Maxillofac Surg, 2019, 9(201-09-17)[2019-11-05].
[12] Tojyo I, Nakanishi T, Shintani Y , et al. Risk of lingual nerve injuries in removal of mandibular third molars: A retrospective case-control study[J].Maxillofac Plast Reconstr Surg, 2019, 9(2019-09-10)[201-11-05].
[13] Oliveira MMM, de Franca Acioly R, de Souza DD , et al.Third molar displacement into submandibular space[J].Case Rep Dent, 2019, 9(2019-09-17)[2019-11-02].
[14] Singh YK, Adamo AK, Parikh N , et al. Transcervical removal of an impacted third molar: an uncommon indication[J]. J Oral Maxillofac Surg, 2014,72(3):470-473.
[15] Cai Y, Sun R, Zhao JH . Flapless boning to increase space by piezosurgery: A novel mini-invasive strategy for teeth extraction. A retrospective study[J]. Medicine (Baltimore), 2018,97(27):e11398.
[16] 杨映阳, 杜胜男, 吕宗凯 . 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[J]. 上海口腔医学, 2015,24(4):489-492.
[17] Mantovani E, Arduino PG, Schierano G , et al. A split-mouth randomized clinical trial to evaluate the performance of piezosurgery compared with traditional technique in lower wisdom tooth removal[J]. J Oral Maxillofac Surg, 2014,72(10):1890-1897.
[18] Patil C, Jadhav A, Bhola N , et al. Piezosurgery vs bur in impac-ted mandibular third molar surgery: Evaluation of postoperative sequelae[J]. J Oral Biol Craniofac Res, 2019,9(3):259-262.
[19] Badenoch-Jones EK, David M, Lincoln T . Piezoelectric compared with conventional rotary osteotomy for the prevention of postoperative sequelae and complications after surgical extraction of mandi-bular third molars: a systematic review and meta-analysis[J]. Br J Oral Maxillofac Sur, 2016,54(10):1066-1079.
[20] Mamoun J . Use of elevator instruments when luxating and extracting teeth in dentistry: Clinical techniques[J]. J Korean Assoc Oral Maxillofac Surg, 2017,43(3):204-211.
[21] Yu C, Li S, Deng F , et al. Comparison of dexmedetomidine/fentanyl with midazolam/fentanyl combination for sedation and analgesia during tooth extraction[J]. Int J Oral Maxillofac Surg, 2014,43(9):1148-1153.
[22] Inverso G, Dodson TB, Gonzalez ML , et al. Complications of moderate sedation versus deep sedation/general anesthesia for adolescent patients undergoing third molar extraction[J]. J Oral Maxillofac Surg, 2016,74(3):474-479.
[23] 张昊, 侯亚丽, 李向军 , 等. 靶控输注异丙酚和异丙酚复合瑞芬太尼镇静在小儿埋伏多生牙拔除手术中应用的比较[J]. 华西口腔医学杂志, 2017,35(4):408-412.
[24] 邵云, 王新河, 苏荣祥 , 等. 氧化亚氮/氧吸入镇静在老年高血压患者拔牙术中的应用[J]. 上海口腔医学, 2013,22(3):302-304.
[25] 钟恬, 胡道勇 . 笑气/氧气吸入镇静技术及其在儿童口腔临床中的应用[J]. 华西口腔医学杂志, 2014,32(1):101-104.
[26] 孙玉娟, 戚道一, 张炳熙 , 等. 笑气吸入清醒镇静法用于拔牙术的临床研究[J]. 中华口腔医学杂志, 1998,33(1):24-26.
[27] Bouloux GF, Steed MB, Perciaccante VJ . Complications of third molar surgery[J]. Oral Maxillofac Surg Clin North Am, 2007,19(1):117-128.
[28] Cho H, Lynham AJ, Hsu E . Postoperative interventions to reduce inflammatory complications after third molar surgery: Review of the current evidence[J]. Aust Dent J, 2017,62(4):412-419.
[29] 齐伟, 李健男, 赵静仁 , 等. 角形切口设计和愈合方式与下颌阻生智齿拔除术后并发症[J]. 北京大学学报(医学版), 2019,51(5):949-953.
[30] Liu S, You Z, Ma C , et al, Effectiveness of drainage in mandibular third molar surgery: A systematic review and meta-analysis[J]. J Oral Maxillofac Surg, 2018,76(8):1640-1650.
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