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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (1): 106-112. doi: 10.19723/j.issn.1671-167X.2025.01.016

• 论著 • 上一篇    下一篇

顺牙长轴拔牙法在下颌近中与水平智齿拔除术中的应用及三维有限元分析

王菲1, 张馨月2, 刘木清3, 王恩博1, 段登辉1,*()   

  1. 1. 北京大学口腔医学院·口腔医院, 口腔颌面外科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，北京 100081
    2. 北京大学口腔医学院·口腔医院, 口腔医学数字化研究中心，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，北京 100081
    3. 北京大学口腔医学院·口腔医院, 医学影像科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，北京 100081
  • 收稿日期:2024-10-09 出版日期:2025-02-18 发布日期:2025-01-25
  • 通讯作者: 段登辉 E-mail:18910188808@163.com
  • 作者简介:第一联系人：

    * These authors contributed equally to this work

  • 基金资助:
    北京大学口腔医院临床研究专项(PKUSS-2023CRF202)

Clinical application and three-dimensional finite element analysis of along-axis extraction method in mandibular mesial and horizontally impacted third molar surgery

Fei WANG1, Xinyue ZHANG2, Muqing LIU3, Enbo WANG1, Denghui DUAN1,*()   

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
    2. Center for Digital Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
    3. Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
  • Received:2024-10-09 Online:2025-02-18 Published:2025-01-25
  • Contact: Denghui DUAN E-mail:18910188808@163.com
  • Supported by:
    the Clinical Research Program of Peking University School and Hospital of Stomatology(PKUSS-2023CRF202)

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摘要：

目的: 探讨顺牙根长轴拔牙法在下颌阻生第三磨牙拔除术中的临床应用效果，并通过三维有限元分析比较不同方法的生物力学特性。方法: 纳入68例患者，随机分为两组，试验组采用顺牙长轴取根法，对照组采用传统颊侧去骨后取根法，统计取根手术时长、术中及术后并发症情况。通过构建不同取根方法的三维有限元模型，模拟并分析取根过程中牙根、颌骨、牙周膜及下颌管的受力情况。结果: 对照组的手术取根时长、术后第1天的疼痛评分和术后肿胀度分别为(7.87±3.90) min、(4.62±1.90)分和(11.37±5.12) mm，均显著高于试验组的(5.74±2.37) min、(3.87±1.19)分和(7.22±3.39) mm；对照组的术中牙根折断率和舌侧骨板骨折率也均显著高于试验组。有限元分析结果显示，对照组舌侧牙槽骨的等效应力峰值最高，易出现舌侧骨板骨折；试验组模型牙周膜的等效应力峰值最高，易出现牙周膜撕裂，有利于牙根脱位。牙根在受力时，试验组的牙根瞬时位移量高，而对照组的牙根朝向舌向移位趋势更明显。结论: 顺牙根长轴取根法能有效减少下颌阻生第三磨牙拔除术的创伤，提高手术安全性和患者舒适度。三维有限元分析为不同取根方式下的生物力学特性提供了直观展示，为临床手术方法的选择和优化提供了重要参考，辅助验证了顺牙长轴拔牙法具有更佳的临床效果。

关键词: 下颌骨, 第三磨牙, 拔牙, 牙，阻生, 并发症

Abstract:

Objective: To investigate the clinical application effect of the along-axis extraction method in the extraction of impacted mandibular third molars (IMTM) and to compare the biomechanical characteristics of different root extraction techniques through three-dimensional finite element analysis. Methods: A total of 68 patients requiring IMTM extraction were enrolled and randomly divided into two groups: the experimental group underwent the along-axis extraction method, while the control group underwent the traditional buccal bone removal and root extraction method. The duration of the procedure, intraoperative and postoperative complications were recorded. Three-dimensional finite element analysis further revealed the stress distribution in the tooth root, jawbone, periodontal ligament, and mandibular canal during different root extraction methods. Results: The duration of root extraction, pain score and swelling on the first postoperative day in the control group were (7.87±3.90) min, 4.62±1.90 and (11.37±5.12) mm, respectively, which were significantly higher than those in the experimental group [(5.74±2.37) min, 3.87±1.19 and (7.22±3.39) mm, respectively]. The root fracture rate and lingual bone plate fracture rate in the control group were significantly higher than those in the experimental group (P < 0.05). The results of finite element analysis showed that the control group ' s lingual al-veolar bone had the higher peak equivalent stress, and lingual bone plate fracture was prone to occur. The periodontal ligament of the experimental group had the higher equivalent stress value, making it more likely to rip and more likely to cause root displacement. When subjected to force, the experimental group' s instantaneous root displacement was higher, but the control group ' s root displacement was more pronounced in the lingual direction. Conclusion: This study suggests that the along-axis extraction me-thod can not only effectively shorten the operative time but also reduce postoperative complications after extraction of impacted mandibular third molars, and enhance the safety of the operation and the patient' s comfort. Three-dimensional finite element analysis shows the biomechanical characteristics of various root extraction techniques visually, serves as a valuable guide for choosing and refining clinical surgical techniques, and confirms that extracting a tooth' s root along its long axis yields better clinical results.

Key words: Mandible, Molar, third, Tooth extraction, Tooth, impacted, Complications

中图分类号: 

  • R782.11

图1

试验组(A~F)与对照组(G~L)的不同取根方式"

图2

试验组(A、B)与对照组(C、D)的三维有限元分析模型"

表1

材料及各组成部分的材料属性"

Items Modulus of rupture/MPa Poisson’s ratio
Cortical bone 14 000 0.30
Cancellous bone 1 370 0.30
Dentin 20 000 0.31
Periodontal membrane 0.68 0.49
Inferior alveolar neurovascular bundle 12 0.45

表2

两组患者一般情况比较"

Items Control group Experimental group P
Age/years, ${\bar x}$±s 27.8±8.4 29.6±8.0 0.364
Gender, n 0.627
Female 17 19
Male 17 15
Type of impaction, n (%) 0.347
Horizontal 23/41 (56.1) 18/41 (43.9)
Mesioangular 12/27 (44.4) 15/27 (55.6)
Depth of impaction, n (%) 0.165
Low impaction 14/22 (63.6) 8/22 (36.4)
Median impaction 21/46 (54.3) 25/46 (55.6)

表3

两组患者的术中及术后评价指标比较"

Items Control group Experimental group t/χ2 value P
Operation duration for root extraction/min, ${\bar x}$±s 7.87±3.90 5.74±2.37 2.713 0.012
Pain VAS score of Pod1, ${\bar x}$±s 4.62±1.90 3.87±1.19 1.932 0.009
Pain VAS score of Pod7, ${\bar x}$±s 1.96±1.28 2.02±1.12 -0.163 0.875
Degree of swelling of Pod1/mm, ${\bar x}$±s 11.37±5.12 7.22±3.39 3.931 0.014
Degree of swelling of Pod7/mm, ${\bar x}$±s 3.94±1.79 4.45±2.10 -1.274 0.199
Degree of trismus of Pod1/mm, ${\bar x}$±s 9.41±4.83 9.81±5.35 -0.325 0.313
Degree of trismus of Pod7/mm, ${\bar x}$±s 5.46±3.82 4.48±4.30 1.004 0.553
Dental root fracture 8/34 1/34 6.275 0.027
Lingual bone plate fracture 6/34 0/34 6.681 0.025

表4

三维有限元分析结果"

Items Control group Experimental group
Maximum displacement of root/mm 0.079 0.161
PES of lingual bone plate/MPa 21.658 11.681
PES of periodontal membrane/MPa 1.655 3.978
PES of root/MPa 71.464 32.453
PES of IAN/MPa 0.010 0.034

图3

试验组(A~F)与对照组(G~L)模型的三维有限元力学分析结果"

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ISSN 1671-167X
CN 11-4691/R
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