下颌第三磨牙拔除中预防下唇麻木和舌麻木的方法探讨

目的:探讨下颌第三磨牙拔除导致下唇和舌麻木的有关因素。方法:按照三种分类标准进行分组。第一种分组:以不同年龄段分成两组。第二种分组:以下颌第三磨牙根尖与下颌神经管的关系分成三组。第三种分组:以不同拔牙方法分为三组。结果:1.下颌第三磨牙拔除后引起下唇麻木和舌麻木与年龄无明显关系。2.460例下颌第三磨牙拔除术后出现下唇麻木31例(占6.74%),其中第二组和第三组占26例(占5.65%),第一组和第二组分别与第三组相比具有统计学意义(P0.05);出现舌神经损伤17例(占3.70%),其中第二组和第三组占14例(占3.04%),第一组和第二组分别与第三组相比具有统计学意义(P0.05)。3.口腔全景片显示的66例下颌第三磨牙根尖与下颌神经管重叠中,CBCT显示根尖多位于下颌神经管舌侧,而跨于下颌神经管最少见。4.拔牙方法越复杂,引起下唇和舌麻木的几率就越大。结论:本组病例的方法评估对拟定合适的治疗方案和安全指导拔牙以降低下唇和舌麻木具有重要的临床意义。     

拔除下颌第三磨牙对下颌角区形态影响的CBCT 研究

目的:探讨下颌第三磨牙的拔除会否造成下颌角区骨骼形态的变化以及这种变化对面型的影响。方法:30例因矫治需要拔除下颌第三磨牙的成人正畸患者,在拔牙前和拔牙后6个月拍摄CBCT片,采用三维测量软件mimics10.01测量下颌第三磨牙所在的下颌角区牙槽骨骨质的宽度、高度和长度,利用SPSS18.0统计软件分析前后数值有无差异。结果:下颌第三磨牙拔除前后下颌角区骨质宽度和高度减小,差异有统计学意义(P<0.05),下颌角区骨质前后向长度未见明显差异。结论:拔除下颌第三磨牙能从一定程度上减小下颌角区骨质高度和宽度,但是前后向长度度基本没有变化。     

单纯上牙槽后神经阻滞麻醉拔除上颌第三磨牙的临床观察

目的:观察单纯上牙槽后神经阻滞麻醉在上颌第三磨牙拔除中的镇痛效果,为临床应用单纯上牙槽后神经阻滞麻醉拔除上颌第三磨牙提供依据.方法:选择463例患者,共拔除500颗上颌第三磨牙,以500例上颌第三磨牙拔除术临床资料为研究对象,将其随机分为试验组(n=300)和对照组(n=200).试验组采用单纯上牙槽后神经阻滞麻醉拔除上颌第三磨牙,对照组加用腭前神经阻滞麻醉和腭侧浸润麻醉.进行视觉模拟量表(VAS)评分,分析并比较两组患者麻醉镇痛效果.结果:试验组与对照组疼痛感觉无显著差异(P0.05);对照组与试验组间VAS评分比较,差异无统计学意义(P0.05).结论:仅用单纯上牙槽后神经阻滞麻醉可满足临床上颌第三磨牙拔除的镇痛要求.     

口腔锥形束CT联合微创拔牙技术对埋伏阻生牙患者牙槽完整度及张口受限度的影响

摘要 目的：探讨口腔锥形束CT联合微创拔牙技术对埋伏阻生牙患者牙槽完整度及张口受限度的影响。方法：选取我院2017年1月到2023年2月收治的50例埋伏阻生牙患者作为研究对象,应用随机数字表法将其分为观察组与对照组,每组25例。对照组应用传统拔牙技术进行治疗,观察组采取口腔锥形束CT联合微创拔牙技术治疗,对比两组患者术后疼痛、面部肿胀、牙槽完整度,术后即刻和术后3 d的炎症因子水平,术后张口受限程度以及菌斑指数（PLI）,龈沟出血指数（SBI）、龈沟探诊深度（SPD）、牙龈指数（GI）等牙周健康指标水平。结果：观察组患者视觉模拟量表（VAS）评分、面部肿胀程度以及牙槽完整度评分明显低于对照组（P＜0.05）;术后即刻两组患者白细胞介素-6（IL-6）、白细胞介素-1（IL-1）、肿瘤坏死因子-α（TNF-α）相关炎症因子水平对比无明显差异（P＞0.05）,术后3 d两组患者IL-6、IL-1、TNF-α相关炎症因子水平均降低,且观察组低于对照组（P＜0.05）;观察组患者开口度正常的比例明显高于对照组,中度、重度张口受限度比例明显低于对照组（P＜0.05）;治疗前两组患者GI、SPD、SBI、PLI水平对无明显差异（P＞0.05）,治疗后两组患者GI、SPD、SBI、PLI水平均降低,观察组低于对照组（P＜0.05）。结论：口腔锥形束CT联合微创拔牙技术针对埋伏阻生牙进行治疗与传统拔牙相比能够改善患者术后疼痛、面部肿胀程度,减轻术后张口受限程度,减轻炎症反应水平,提升牙周健康程度,值得临床应用推广。     

碱性成纤维细胞生长因子对下颌阻生牙手术患者血清IL-6水平及牙槽骨密度的影响

目的:探讨碱性成纤维细胞生长因子对对下颌阻生牙手术患者血清IL-6水平及牙槽骨密度的影响。方法:收集我院就诊的104例行下颌阻生牙手术患者,随机分为实验组和对照组,每组52例。所有患者均行下颌阻生牙手术。对照组患者术后注射生理盐水,实验组患者术后注射碱性成纤维细胞生长因子。观察并比较两组患者血清白介素6(IL-6)、牙槽骨密度水平、临床治疗有效率以及不良反应发生情况。结果:与治疗前相比,两组患者治疗后的骨密度水平均升高,IL-6水平均下降,差异具有统计学意义(P0.05);与对照组相比,实验组患者的牙槽骨密度水平及临床治疗有效率均较高,IL-6水平较低,差异具有统计学意义(P0.05)。实验组患者未出现不良明显反应。结论:碱性成纤维细胞生长因子可显著提高下颌阻生牙术后患者的创口恢复,且有效预防感染的发生。     

阻生牙拔除术的临床进展

阻生牙是指由于各种阻力导致不能正常萌出的牙齿的统称,通常阻生牙牙体大部甚至全部埋伏于骨内。阻生牙可导致各种并发症的发生,因此临床上一般主张预防性拔除阻生牙。阻生牙拔除手术因其难度高、风险大、术后反应重一直是口腔牙槽外科关注的重点。近年来随着手术器械、手术观念等方面的进步,阻生牙拔除术取得了一些临床进展。新型CT扫描设备CBCT可以为手术设计提供精确定位;借助各类微创器械,微创拔牙技术减小了手术创伤,降低了手术风险;新型麻醉方式和新型局麻药物可以极大减轻疼痛反应;心理干预也将成为阻生牙拔除患者围手术期管理的重要步骤。本文对近年来阻生牙拔除术在定位方式、微创技术、团队协作、疼痛控制和心理干预等方面的临床进展做一综述。     

阻生牙拔除术的临床进展

阻生牙是指由于各种阻力导致不能正常萌出的牙齿的统称,通常阻生牙牙体大部甚至全部埋伏于骨内。阻生牙可导致各种并发症的发生,因此临床上一般主张预防性拔除阻生牙。阻生牙拔除手术因其难度高、风险大、术后反应重一直是口腔牙槽外科关注的重点。近年来随着手术器械、手术观念等方面的进步,阻生牙拔除术取得了一些临床进展。新型CT扫描设备CBCT可以为手术设计提供精确定位;借助各类微创器械,微创拔牙技术减小了手术创伤,降低了手术风险;新型麻醉方式和新型局麻药物可以极大减轻疼痛反应;心理干预也将成为阻生牙拔除患者围手术期管理的重要步骤。本文对近年来阻生牙拔除术在定位方式、微创技术、团队协作、疼痛控制和心理干预等方面的临床进展做一综述。     

拔除阻生智齿患者牙科焦虑的调查及分析

目的:了解综合医院口腔科拔除阻生智齿患者牙科焦虑的患病情况并进行相关因素分析。方法:采用牙科焦虑一般因素调查表、改良牙科焦虑量表(MDAS)及状态焦虑量表(S-AI)对300例口腔颌面外科门诊的拔除阻生智齿患者进行调查及评定,同时对引起牙科焦虑的相关因素进行分析。结果:拔除阻生智齿患者牙科焦虑的发生率为56.00%,有6项因素对牙科焦虑症的患病率有影响,差异有统计学意义(P<0.05),其中5项因素对MDAS得分影响较大。结论:牙科焦虑在拔除阻生智齿的患者中较普遍,有多种因素影响患者牙科焦虑的程度。     

拔除阻生智齿患者牙科焦虑的调查及分析

目的：了解综合医院口腔科拔除阻生智齿患者牙科焦虑的患病情况并进行相关因素分析。方法：采用牙科焦虑一般因素调查表、改良牙科焦虑量表（MDAS）及状态焦虑量表（S-AI）对300例口腔颌面外科门诊的拔除阻生智齿患者进行调查及评定,同时对引起牙科焦虑的相关因素进行分析。结果：拔除阻生智齿患者牙科焦虑的发生率为56.00%,有6项因素对牙科焦虑症的患病率有影响,差异有统计学意义（P〈0.05）,其中5项因素对MDAS得分影响较大。结论：牙科焦虑在拔除阻生智齿的患者中较普遍,有多种因素影响患者牙科焦虑的程度。     

安氏Ⅰ类错合拔牙与非拔牙矫治对口唇形态影响的研究

目的：研究安氏Ⅰ类错合拔牙与非拔牙矫治对口唇形态的影响。方法：从直丝弓矫治的AngleⅠ类错合患者治疗前后的X线侧位片中随机选取拔除4个第一前磨牙患者15例（A组）,非拔牙矫治患者15例（B组）,经X线头影软组织测量分析比较矫治前后拔牙组与非拔牙组口唇形态的变化,对所得数据进行统计学处理。结果：拔牙矫治后上下唇的突度有明显改善,平均减少1.42和2.03mm;上下唇的长度也平均增加0.51和1.58mm;非拔牙矫治患者治疗后鼻唇角、下唇突度、上下唇长度均有增加,但矫治前后无统计学差异。结论：拔牙矫治有利于减小上下唇突度从而改善软组织侧貌。     

局部放置三七粉对下颌阻生齿拔出术患者的临床疗效

目的：探讨局部放置三七粉对下颌阻生齿拔出术患者的临床疗效。方法：选取我院收治的180例下颌阻生齿拔出术患者,根 据术后治疗方式不同,将患者分为对照组和实验组。对照组患者采用常规治疗方式,实验组患者在此基础上采用局部放置三七粉 治疗。观察并比较两组患者的临床疗效、疼痛情况以及术后并发症的发生情况等。结果：两组患者的并发症相比较,实验组并发症 发生的人数均明显低于对照组（P＜0.05）。两组患者的疼痛、焦虑、抑郁情况比较,实验组明显低于对照组,差异有统计学意义（P＜ 0.05）。结论：局部放置三七粉能够减轻下颌阻生齿拔出后患者的并发症,减轻疼痛,改善患者的心理状态,提高其疗效,值得临床 推广使用。     

Pain relieve after impacted wisdom teeth extraction dependent on the drug therapy

Purpose of this study was to compare the effects of combined therapy using nonsteroid anti-inflammatory analgetics and corticosteroids, and the effects of the mono-therapy with same drugs for post-operative pain after surgical removal of the impacted mandibular third molar. The study was completed at the Department of Oral Surgery and at the Department of Dental Medicine of the Public Institute Health Center Zenica in Zenica. The research included 60 patients divided into 3 groups using random selection, including both sexes. Age range was between 18 and 45 years. All participants came without any pain or other inflammatory symptoms at the time of oral surgical intervention. Two medicaments were prescribed after the impacted tooth removal: 15 mg of nonsteroid anti-inflammatory analgesic drug (Meloxicam, Bosnalijek, BiH) and 32 mg Methylprednisolone (corticosteroid, Bosnalijek, BiH). Both medicaments were applied per os, according to schedule determined by the research protocol. The level of post-surgical pain was evaluated by the 1-10 visual analog scale (VAS). One way ANOVA was made with Tuckey post-hoc tests. Statistically significant difference (p < 0.05) was found between the group treated with mono therapy and the group treated with combined therapy. Application of monotherapy using only corticosteroids or only nonsteroid anti-inflammatory pain-killers was less effective compared to the combined therapy with both medicaments after surgical removal of the impacted mandibular third molar.     

鼻内窥镜辅助下大型颌骨囊肿开窗减压并拔除埋藏智齿病例报告及文献复习

摘要 目的：分析大型颌骨囊肿开窗减压术联合鼻内窥镜辅助下拔除低位埋藏智齿的临床应用效果。方法：选择9例大型颌骨含牙囊肿患者,自磨牙或磨牙后区或者磨牙后外侧前庭沟处开窗形成引流通道,在鼻内窥镜下联通各个囊腔并拔除因被囊肿挤压而低位埋藏的第三磨牙,术后以阻塞器维持开窗口并保持日常冲洗治疗,观察术后囊肿大小及囊壁周围骨质变化情况。结果：术后随访6-18个月,9例含牙囊肿治疗效果明显,有效率为100%。术后复查对比入院时均有不同程度的骨再生,囊腔皆有明显缩小,局部畸形及损伤也有不同程度恢复,其中3例均未行II期刮治术,无复发。结论：颌骨囊肿的开窗治疗保留了颌骨的形态及功能,对于提升患者的生活质量效果明显;同时,鼻内窥镜在颌骨大型囊肿中引导连通各个囊腔以及拔除因囊肿移位的牙齿发挥了重要作用。     

Dental reductions and dental caries

Although first permanent molar hypoconulid absence, third molar agenesis, and small tooth size are all part of the evolutionary trend of dental reduction, each bears a different relationship to dental caries. Caries prevalence in the maxillary and mandibular permanent first molars of the Burlington Research Centre serial experimental group at age 16 years was less in the children whose first molars were missing the hypoconulid. Conversely, caries prevalence in mandibular first molars was greater in the children who had agenesis of third molars. The extraction of first molars due to caries was more frequent in children with agenesis of third molars, less frequent in those with absence of hypoconulids of the first molars and unrelated to tooth size. Caries prevalence was less in small teeth, and occurred least in the small mandibular first molars with four cusps. Whereas this is in harmony with the hypothesis that evolutionary dental reductions resulted from the pressure of caries, the increased prevalence of caries and extractions coinciding with third molar agenesis does not support this view. In addition, agenesis of hypoconulids and agenesis of third molars were related to changes in structures unrelated to caries.     

An observational study of the effectiveness of practice guideline implementation strategies examined according to physicians' cognitive styles

Background

Routine oral examination (ROE) refers to periodic monitoring of the general and oral health status of patients. In most developed Western countries a decreasing prevalence of oral diseases underpins the need for a more individualised approach in assigning individualised recall intervals for regular attendees instead of systematic fixed intervals. From a quality-of-care perspective, the effectiveness of the widespread prophylactic removal of mandibular impacted asymptomatic third molars (MIM) in adolescents and adults is also questionable. Data on the effectiveness of appropriate interventions to tackle such problems, and for promoting continuing professional development in oral health care are rare.

Methods/design

This study is a cluster randomised controlled trial with groups of GDPs as the unit of randomisation. The aim is to determine the effectiveness and efficiency of small group quality improvement on professional decision-making of general dental practitioners (GDPs) in daily practice. Six peer groups ('IQual-groups') shall be randomised either to the intervention arm I or arm II. Groups of GDPs allocated to either of these arms act as each other's control group. An IQual peer group consists of eight to ten GDPs who meet in monthly structured sessions scheduled for discussion on practice-related topics. GDPs in both trial arms receive recently developed evidence-based clinical practice guidelines (CPG) on ROE or MIM. The implementation strategy consists of one interactive IQual group meeting of two to three hours. In addition, both groups of GDPs receive feedback on personal and group characteristics, and are invited to make use of web-based patient risk vignettes for further individual training on risk assessment policy. Reminders (flow charts) will be sent by mail several weeks after the meeting. The main outcome measure for the ROE intervention arm is the use and appropriateness of individualised risk assessment in assigning recall intervals, and for the MIM-intervention group the use and appropriateness of individualised mandibular impacted third molar risk management. Both groups act as each other's control. Pre-intervention data will be collected in study months one through three. Post-intervention data collection will be performed after nine months.     

Tooth morphology and other aspects of the Teso dentition

The teeth of over 5,000 Teso schoolchildren members of a Nilo-Hamitic tribe in East Africa, were examined for morphological traits. There was a significant difference between the sexes in the number of cusps on the lower first and second molars, in the prevalence of the cusp of Carabelli, and in variability and agenesis of the upper lateral incisor. The results showed that females consistently favoured tooth reduction. There was also a tendency among those possessing extra cusps on one molar to have extra cusps or other molars. Records kept of the prevalence of the tribal custom of extracting lower central incisors indicated that this practise is rapidly dying out. On another group of teeth which had been extracted from adults common variations of root morphology were noted, together with the fissure pattern of the lower molars. Measurements were made of those teeth which were unworn and were not broken down by dental decay, and the lower third molar was found to be the largest tooth of the series. Observations on the pattern of molar tooth wear showed that the buccal as well as the occlusal surface was strongly affected.     

运动康复训练对冠心病多支病变患者运动耐量及血脂的影响

目的:探讨运动康复训练对冠心病多支病变患者活动耐量及血脂的影响。方法:选取冠心病多支病变患者,所有患者均进行不完全血运重建术,分为运动康复训练组及对照组,运动康复训练组自术后第三日起治疗组进行运动康复训练,对照组对运动量无要求。3月后,测量两组患者血脂水平及6分钟步行试验,比较两组患者步行距离、心绞痛发作次数、运动至心绞痛出现时间、6分钟内累积运动时间及血脂水平。结果:经运动康复训练治疗3月后,治疗组6分钟步行距离、运动至心绞痛出现时间及运动累积时间较对照组均明显增加,发生心绞痛次数较对照组明显减少。运动康复训练组治疗后甘油三酯、总胆固醇及低密度脂蛋白水平较治疗前明显降低,对照组仅总胆固醇有所降低,甘油三酯及低密度脂蛋白水平较治疗前无统计学差异。结论:运动康复训练可减少冠心病多支病变患者心绞痛发作次数,增加患者运动耐量并调节血脂代谢。