| Purpose and Background:Extraction of teeth is one of the most common operations in the oral surgery clinic,which is prone to complications such as bleeding,pain,swelling and restricted opening of the mouth.In clinic,the treatment of tooth extraction wound can be improved to reduce the occurrence of the above complications.Currently,gelatin sponge is commonly used as a filler to stop bleeding from tooth extraction wounds,but its effect is relatively simple.In recent years,Carboxymethyl chitosan(CMCS),as a new antibacterial filler for hemostasis,can promote hemostasis,reduce inflammation,and promote wound healing.Its application in oral and maxillofacial surgery is increasing gradually.However,the existing reports on the use of carboxymethyl chitosan is not detailed,the clinical effect evaluation is not clear,and even there are mistakes;Moreover,the clinical research on drug delivery of CMCS is still blank.Therefore,the purpose of this study was to: 1.To clarify the correct use of carboxymethyl chitosan for hemostasis of common tooth extraction wounds and its influence on soft tissue healing of tooth extraction wounds.2.To explore the effect of carboxymethyl chitosan on reducing complications after extraction of impacted third molar in lower mandible.3.To explore the effect of carboxymethyl chitosan loaded dexamethasone on reducing complications after extraction of impacted third molar in lower mandible.Method:This study was reviewed and approved by the Ethics Committee of the College.All subjects were informed of the possible risks of tooth extraction and signed the informed consent of tooth extraction.1.A controlled clinical study on the application of carboxymethyl chitosan to hemostasis and soft tissue healing of common tooth extraction wounds(1)Patients were selected to seek medical treatment in our hospital from October 2020 to July 2022,with clear diagnosis and the need for extraction of common teeth.Sixty subjects(healthy patients,32 males and 28 females)met the inclusion criteria,with a total of 71 affected teeth,including 41 in the upper jaw and 30 in the lower jaw.60 cases of common tooth extraction subjects were randomly included in the experimental group and the control group,maxillary experimental group had 20 teeth,control group had 21 teeth,mandibular experimental group had 15 teeth,control group had 15 teeth.The experimental group: carboxymethyl chitosan sponge was placed in the tooth extraction trauma,the placement method: roll placement,fitting the four sides of the bone wall of the tooth extraction fosba was placed(stick method);Control group: Appropriate size of gelatin sponge was put into the tooth extraction wound(implantation method).Experimental group and control group did not bite sterile gauze cotton roll.The hemostatic effect at 3,5,10,15,20 and 30 minutes after surgery and wound healing at 7,14 and 21 days after surgery were recorded,a total of two observation indexes.(2)Patients were selected to seek medical treatment in our hospital from October 2020 to July 2022,with clear diagnosis and the need for extraction of common teeth.Twenty-one patients(10 males and 11 females with bleeding tendency)met the criteria,with a total of 31 teeth,all maxillary premolars,15 in the experimental group and 16 in the control group.In the experimental group,carboxymethyl chitosan sponge was placed in the tooth extraction wound,and the placement method was roll-type placement and fitting to the four sides of the bone wall of the tooth extraction fossa(sticking method).Control group: Gelatin sponge of appropriate size was put into the tooth extraction wound(implantation method).Both the experimental group and the control group clenched the sterile gauze cotton roll(1ml normal saline wetting the surface).The experimental group and the control group were treated with the same anesthesia and traditional extraction method,which was performed by the same experienced doctor.The hemostatic effect at 30 minutes,60 minutes and 24 hours after surgery and wound healing at 7,14 and 21 days after surgery were recorded.There were two observation indexes in total.2.The clinical control study of carboxymethyl chitosan used in the extraction of middle and low mandibular impacted teethPatients who received medical treatment in our hospital from March 2021 to August 2022 with clear diagnosis and need to undergo middle and low mandibular impacted teeth extraction were selected.Thirty subjects met the inclusion criteria,and 30 subjects with impacted teeth extraction had to meet the conditions of the same impacted type and basic symmetry of left and right mandibular impacted wisdom teeth(14 males and 16 females,A total of 60 wisdom teeth),the left and right sides were randomly included in the experimental group and the control group to form their own control,the experimental group and the control group were all using the same anesthesia and extraction method,which was completed by the same experienced doctor.In the experimental group,carboxymethyl chitosan chitosan sponge was placed in the tooth extraction wound.Placement method: roll placement,covering the surface of the bone removal,and fitting 1/2 bone wall of the tooth extraction fossa,i.e.buccal and far middle bone wall(sticking method);Control group: Appropriate size of gelatin sponge was inserted into the tooth extraction wound(implantation method),and intermittent suture was used to stop bleeding.The use of anti-inflammatory drugs and analgesics should be controlled after operation.The operation time was recorded,and six observation indexes including postoperative pain index at 24,48 and 72 hours,cheek swelling and opening degree at 1,3 and 7 days after surgery,gingival index at 3 and 7 days after surgery and dry slot were observed.3.A controlled clinical study of dexamethasone carboxymethyl chitosan sponge used in the extraction of middle and low mandibular impacted teethPatients who received medical treatment in our hospital from May 2021 to November 2022 with clear diagnosis and need to undergo middle and low mandibular impacted teeth extraction were selected.Thirty subjects met the inclusion criteria,and 30 subjects with impacted teeth extraction had to meet the conditions of the same type of impacted mandibular wisdom teeth and basic symmetry(14 males and 16 females,A total of 60 wisdom teeth),the left and right sides were randomly included in the experimental group and the control group to form their own control,the experimental group and the control group were all using the same anesthesia and extraction method,which was completed by the same experienced doctor.Experimental group: carboxymethyl chitosan sponge loaded with dexamethasone was inserted into the tooth extraction wound;Control group: carboxymethyl chitosan sponge was inserted into the tooth extraction wound,and the placement method was as follows: roll placement,covering the surface of the bone removal,and fitting 1/2 bone wall of the tooth extraction fossa,namely buccal side and far middle bone wall(sticking method).Intermittent suture was used to stop bleeding in both cases.The use of anti-inflammatory drugs and analgesics should be controlled after operation.The operation time was recorded,and six observation indexes including postoperative pain index at 24,48 and 72 hours,cheek swelling and opening degree at 1,3 and 7 days after surgery,gingival index at 3 and 7 days after surgery and dry slot were observed.Results: 1.A controlled clinical study on the application of carboxymethyl chitosan to hemostasis and soft tissue healing of common tooth extraction wounds(1)Teeth of healthy patients1)Hemostasis: There were statistical differences in the distribution of hemostasis grades within 30 minutes after operation between the experimental group and the control group of maxillary teeth and mandibular teeth(P<0.05),and statistical differences in average degree(P<0.05).2)Wound healing: 7 and 14 days after maxillary and mandibular tooth extraction,there were statistical differences in the distribution of soft tissue healing index between the two groups(P<0.05),and statistical differences in average degree(P<0.05).At 21 days after surgery,there was no statistical difference in distribution(P>0.05),and no statistical difference in average degree(P>0.05).(2)Teeth of patients with bleeding tendency1)Hemostasis: there were statistical differences in the distribution of hemostasis effect between the experimental group and the control group at 30 minutes and 60 minutes after surgery(P<0.05),but no statistical differences in the distribution of hemostasis effect at 24 hours after surgery(P>0.05).2)Wound healing: There were statistical differences in the distribution and average degree of soft tissue healing index between the two groups at two time points,7 and 14 days after surgery(P<0.05).At 21 days after surgery,there was no statistical difference in distribution(P>0.05),and no statistical difference in average degree(P>0.05).2.The clinical control study of carboxymethyl chitosan used in the extraction of middle and low mandibular impacted teeth(1)Operation time: the operation time of the experimental group was 37.14±0.90,and that of the control group was 37.04±1.01,with no statistical difference between the two groups(P>0.05).(2)Pain index: Postoperative pain index at 24 hours,48 hours,72 hours after surgery,there were statistical differences between the two groups(P < 0.001).(3)Degree of swelling: There were statistical differences in postoperative swelling between the two groups at 1 day,3 days and 7 days after surgery(P < 0.05).(4)Opening degree: the opening degree of the experimental group was 2.84±0.14 on the first day after surgery,3.30±0.16 on the third day after surgery,and 3.87±0.21 on the 7th day after surgery.The opening degree of the control group was 2.55±0.12 on day 1,3.25±0.16 on day 3 and 3.86±0.21 on day 7.There were statistical differences between the two groups at 1 and 3 days after surgery(P < 0.001),but no statistical differences at 7 days after surgery(P>0.05).(5)Gingival index: at 3 and 7 days after surgery,there were statistical differences in the distribution of gingival index between the two groups(P < 0.05),and in the average degree(P < 0.05).(6)Dry groove disease: no dry groove disease appeared in the experimental group and the control group after surgery.3.A controlled clinical study of dexamethasone carboxymethyl chitosan sponge used in the extraction of middle and low mandibular impacted teeth(1)Operation time: 37.02±0.90 in the experimental group and 36.90±1.07 in the control group,there was no statistical difference between the two groups(P>0.05).(2)Pain index: Postoperative pain index at 24 hours,48 hours,72 hours after surgery,there were statistical differences between the two groups(P < 0.001).(3)Degree of swelling: there were statistical differences in postoperative swelling between the two groups at three time points of 1 day,3 days and 7 days in the experimental group(P < 0.05).(4)Opening degree: the opening degree of the experimental group was 3.15±0.17 on the first day after surgery,3.54±0.06 on the third day after surgery and 3.87±0.21 on the seventh day after surgery;The opening degree of the control group was 2.84±0.14 on day 1,3.30±0.16 on day 3 and 3.86±0.21 on day 7.There were statistical differences between the two groups at 1 and 3 days after surgery(P < 0.001),but no statistical differences at 7 days after surgery(P>0.05).(5)Gingival index: There were statistical differences in the distribution and average degree of gingival index between the two groups(P < 0.05)at two time points 3 and 7 days after surgery.(6)Dry groove disease: no dry groove disease appeared in the experimental group and the control group after surgery.Conclusion:1.The application of carboxymethyl chitosan in the extraction of common teeth can reduce the extraction of blood and promote the early healing of wounds.2.The application of carboxymethyl chitosan in the extraction of lower mandibular impacted teeth can effectively relieve postoperative pain,postoperative swelling and restricted mouth opening,etc.3.Carboxymethyl chitosan can be used as a delivery carrier of dexamethasone,and carboxymethyl chitosan sponge loaded with dexamethasone can effectively relieve postoperative pain,postoperative swelling and restriction of mouth opening when used in the extraction of middle and low mandibular impacted teeth. |
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