| Objective:To study the clinical effect of the extraction of mandibular complete impacted teeth by using piezosurgery combined with inverse angle turbine method,to observe the indicators three days after surgery and the angle of the turbine pull out the difference of clinical effect,and the changes of the alveolar bone were observed 6days after the operation,to explore the technical difficulties and treatment methods in the treatment process,and to provide new ideas and methods for minimally invasive extraction of the impacted teeth with complete bone impaction.Materials and methods:A total of 45 patients with mandibular complete impacted third molars who were treated in the Stomatological Hospital of Nanchang University from June 2019 to December 2020 were selected and divided into 2 groups according to the inclusion criteria:experimental group:A total of 25 patients,including 14 males and 11 females,were treated by piezosurgery "lifting the cap method" combined with inverse angle turbine method.The age range was 18-47 years old,with an average age of28.20±7.20 years old.Control group: 20 patients,including 10 males and 10 females,were treated with inverse angle turbine method.Age range: 19-36 years,mean age:26.50±4.48 years.Preoperative Cone Beam Computed Tomography(CBCT)images were taken,postoperative anti-inflammatory treatment was performed for 3 days,postoperative follow-up was performed for 3 days,and the degree of pain,swelling,and mouth opening limitation were recorded.CBCT was performed 6 months after the operation,and the alveolar bone height at the buccal and lingual sides of the tooth extraction fossa and the formation height of bone tissue at the bottom of the alveolar fossa were measured.The same experienced oral surgeon performed all procedures from surgery to follow-up examination,and all measurements and records were made by the same assistant.All CBCT shots were performed by the same technician.Results:There was no statistical difference in age and gender between the experimental group and the control group.Two patients in the experimental group were excluded from infection,of which one patient developed tooth extraction swelling 1 month after the operation.After repeated local irrigation with 3% hydrogen peroxide and0.9% normal saline,no significant improvement was found.After communication with the patient,the second operation was opened and necrosis was found in the graft bone block,and local debridement was performed after its removal,and the swelling subsided.The other one had tooth extraction trauma and swelling 1.5 months after the operation,but the swelling did not subside after anti-inflammatory treatment.Local incision revealed that the bone graft had completely healed,and there was a small amount of food residue in the wound,and the healing was good after debridement.Operation time: the experimental group: 36.68±2.78 min,the control group:26.85±1.81 min,t=13.64,P=0.00<0.05,the difference between the two groups was statistically significant.The VAS score 3 days after surgery: the average score of experimental group was 2.92±1.15 points,and that of control group was 3.75±1.02 points,Z=2.357,P=0.018<0.05,the difference was statistically significant.The pain degree of experimental group was lighter than that of control group Z=2.048,P=0.041<0.05,the difference was statistically significant.The degree of postoperative swelling 3 days after operation: The degree of moderate swelling in experimental group was more than that in control group,while the degree of severe swelling was less than that in control group,Z=1.982,P=0.047<0.05,the difference was statistically significant.The degree of limitation of mouth opening 3 days after operation:The degree of mouth opening limitation was mild and moderate in experimental group,which was less severe than that in control group(Z=5.879,P=0.000<0.05),the difference was statistically significant.Six months after operation,the amount of buccal and lingual alveolar bone absorption in the distal 2mm of the mandibular second molar and the height of alveolar bone formation at the base of the alveolar bone: the mean amount of buccal bone absorption in experimental group was 1.33±0.74 mm,and that in control group was 1.96±0.59 mm,Z=2.787,P=0.005<0.05,the difference was statistically significant.The mean value of lingual bone absorption in experimental group was1.16±0.41 mm,and that in control group was 1.33±0.45 mm,Z=0.788,P=0.430>0.05,the difference was not statistically significant.The mean amount of bone tissue formation in experimental group was 10.27±1.38 mm,and that in control group was9.22±1.58 mm.By rank sum test,Z=2.318,P=0.02<0.05,the difference was statistically significant.Six months after operation,the absorbance of the distal 5mm buccal and lingual alveolar bone of the second molar and the formation height of the base of the alveolar bone were as follows: the average absorbance of the buccal bone of experimental group was 0.49±0.17 mm,and that of control group was 0.93±0.32 mm,Z=4.60,P=0.00<0.05,the difference was statistically significant.The mean value of lingual bone absorption in experimental group was 0.59±0.19 mm,and that in control group was 0.77±0.22 mm,Z=2.72,P=0.007<0.05,the difference was statistically significant.The mean amount of bone tissue formation in experimental group was13.67±1.30 mm,and that in control group was 11.13±1.51 mm,Z=4.523,P=0.000<0.05,the difference was statistically significant.Conclusion:The extraction effect of piezosurgery combined with the inverse angle turbine method is better than that of the inverse angle turbine method.Intraoperative vision clear,easy to operate,less intraoperative and postoperative complications,postoperative 6 crescent groove less bone resorption,nest alveolar bone formation is more,can effectively restore the second molars far alveolar bone height,reduce far in alveolar bone defect and the occurrence of postoperative complications,achieve "minimally invasive,efficient" double effect,is worth popularizing in clinical. |
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