超声骨刀在上颌死髓劈裂磨牙拔除中的应用

摘要

目的：评价超声骨刀（piezosurgery）在上颌死髓劈裂磨牙拔除术中的应用效果。方法：临床选取需拔除无保留价值的死髓、劈裂的上颌磨牙患者40例，分为试验组和对照组，每组各20例，试验组使用超声骨刀拔牙工作尖切削去骨、扩大牙周间隙后拔除，对照组采用常规峨眉凿去骨、增隙后拔除。比较两组在手术时间、颊侧牙槽嵴顶高度及牙槽窝宽度的改变量、患者术中感觉评价、患者对手术的畏惧率等指标上的差异。结果：试验组手术时间为（629．5±171．0）s，对照组（456．0±337．2）s；试验组颊侧牙槽骨降低（1．07±0．64）mm，对照组降低（1．49±0．61）mm，两者差异均有统计学意义（P ＜0．05）；牙槽窝宽度的改变两组差异无统计学意义（P ＞0．05）；患者术中畏惧率、术中手术不适感 VAS 评分、术后24 h 的 VAS 评分两组差异亦无统计学意义（P ＞0．05）。结论：上颌死髓、劈裂牙拔除术中应用超声骨刀去骨、扩隙与应用凿去骨增隙相比在原理上类似，但可更好地保存牙槽骨骨量，降低骨创伤，同时降低了患者对手术的畏惧率，体现出微创拔牙的特点，具有推广的价值。%Objective:To evaluate the efficacy of Piezosurgery in split teeth extractions.Methods:A single-center,randomized,split-mouth study was performed using a consecutive serious of unrelated healthy patients attending the departing of oral and maxillofacial surgery,Peking University School and Hospital of Stomatology.40 patients were selected for extraction of maxillary molars without reservation value,splitting or nonvital teeth.They were divided into control (20 patients)and test groups (20 pa-tients)randomly.Surgical treatments for both groups were under local anesthesia.Molar teeth of control group were extracted by common equipments like dental elevators,chisels,forceps,etc.While molar teeth of experimental group were extracted by Piezosurgery,aided with the use of common equipments if needed.Then we compared the duration of surgery,frequency of the usage of chisels,expansion of post-operative bony socket surgical discomfort and postoperative pain between two groups.Results:The ave-rage of operation time was (629.5 ±171.0)s in control group and (456.0 ±337.2)s in test group.The buccal alveolar bone reduced (1.07 ±0.64)mm in control group and (1.49 ±0.61)mm in test group. There was a significant difference between the two groups (P <0.05).The duration of surgery for experi-mental group was significantly longer than that of the control group,but the change of buccal alveolar bone was lower than the control group.For visual analogue scale (VAS)value of surgical discomfort,ex-pansion of postoperative bony socket and the operative fear rate,there were no significant difference be-tween the two groups (P >0.05).Conclusion:Piezosugery can be better to preserve alveolar bone,re-duce trauma and patient’s fear.Application of the piezosugery reflect the characteristics of minimally in-vasive extraction,which has the value of promotion.The Piezosurgery technique have the advantage of re-ducing change of buccal alveolar bone during the surgery,but a longer surgical time was required when compared with the conventional technique.VAS value of surgical discomfort,expansion of postoperative bony socket and the operative fear rate,there were no significant difference.Minimally invasive tooth ex-traction technique has good clinical results and high satisfaction.Piezosurgery proved its worth as the in-strument adapted to limiting the destruction of bone tissue.