王雪涛 李璁 李芳凝

[摘要]目的：探討截冠留根法拔除下颌阻生智齿的临床疗效。方法：选取2018年12月-2019年8月在笔者科室就诊要求拔除下颌第三磨牙，且全景片显示智齿牙根尖连结下颌管，并经锥形束CT（CBCT）扫描确认的106例患者为研究对象，按照随机数字表法分为两组，每组53例，分别采用截冠留根法拔除（观察组）和传统拔牙法拔除（对照组）治疗，观察两组手术时间、术后疼痛情况、颌面部肿胀程度、张口受限程度、手术并发症及牙根移位情况。结果：观察组手术时间短于对照组（P<0.05），术后VAS疼痛评分低于对照组（P<0.05）;观察组术后颌面部肿胀程度轻于对照组（P<0.05），术后张口受限程度低于对照组（P<0.05）;观察组下牙槽神经损伤发生率低于对照组（P<0.05），其他并发症发生率与对照组无显著性差异（P>0.05）。观察组术后12个月断根移位（2.28±0.57）mm，前6个月移位较快，后期趋于稳定。结论：截冠留根法拔除下颌阻生智齿能够减轻患者术后疼痛，面部肿胀、张口受限程度轻，且断根可上移萌出，远离下牙槽神经管，降低下牙槽神经损伤的风险。

[关键词]截冠留根法;下颌阻生智齿;疼痛;张口受限;牙根移位;下牙槽神经损伤

Abstract： Objective To analyze clinical curative effect of coronectomy on extracting impacted mandibular third molar. Methods During the period from December 2018 to August 2019， 106 patients who required extracting mandibular third molar and confirmed by cone beam computed tomography （CBCT） scan， whose apex of wisdom teeth were connected to mandibular canal showed by panoramic film in the department were enrolled. According to random number table method， they were divided into two groups， 53 cases in each group. The coronectomy method （observation group） and traditional tooth extraction method （control group） were conducted. The operation time， postoperative pain， maxillofacial swelling degree， degree of mouth opening limitation， surgical complication， and root displacement in both groups were observed. Results  The operation time of observation group was shorter than that of control group （P<0.05）， and postoperative VAS pain score was lower than that of control group （P<0.05）. The postoperative maxillofacial swelling degree in observation group was milder than that in control group （P<0.05）， and degree of postoperative mouth opening limitation was lower than that in control group （P<0.05）. The incidence of inferior alveolar nerve injury in observation group was lower than that in control group （P<0.05）. There was no significant difference in incidence of other complications between the two groups （P>0.05）. In observation group， broken root displacement was （2.28±0.57） mm at 12 months after surgery. The displacement was faster in the first 6 months， stabilized in the later stage. Conclusion The coronectomy on extracting impacted mandibular third molar can alleviate postoperative pain， facial swelling and mouth opening limitation. And broken root can be moved up and eruptive， keep away from inferior alveolar nerve canal， and reduce risk of inferior alveolar nerve injury.

Key words： coronectomy; mandibular impacted mandibular third molar; pain; mouth opening limitation; root displacement; inferior alveolar nerve injury

饮食结构的改变使得口腔牙齿咀嚼摩擦减小，颌骨生长发生改变，阻生智齿发生率提高，尤其是下颌第三磨牙。相关研究指出，下颌第三磨牙阻生率可超过50%[1]。阻生智齿与覆盖在其上面的牙龈之间易藏有食物残渣等，导致多种细菌滋生，继而引起口臭、冠周炎、龋坏等，甚至引发炎症，出现疼痛、脸肿及张口困难等症状，严重影响患者身心健康[2-3]。需拔除潜在隐患的下颌第三磨牙，消除隐患。但对于颌低位阻生智齿，特别是根尖连结下颌管的阻生智齿，采用传统手术拔除后容易引起下牙槽神经损伤，造成下唇麻木[4]。……