专家笔谈
ENGLISH ABSTRACT
刚体力学在下颌阻生第三磨牙拔除术中的理论和应用探索
王兴
作者及单位信息
·
DOI: 10.3760/cma.j.cn112144-20240221-00081
Geostatics in impacted mandibular third molar surgury
Wang Xing
Authors Info & Affiliations
Wang Xing
Department of Oral and Maxillofacial Surgery, Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
·
DOI: 10.3760/cma.j.cn112144-20240221-00081
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摘要

如何微创拔除下颌阻生第三磨牙,实现“创伤小、时间短、恢复快”的治疗目标,仍是口腔医师热切关注的焦点。目前,下颌阻生第三磨牙拔除术多使用仰角气动手机、超声骨刀、骨凿或其他动力系统,通过去骨、分牙方法解除牙冠和牙根阻力后分块拔除。然而在不同省市和基层医院,如何在复杂下颌阻生第三磨牙拔除术中避免过量去骨,如何优选分牙的具体位置和角度,存在牙根阻力时如何寻找支点和设计最佳脱位道,仍主要依赖经验的传授,缺乏原理层次上的解析归纳。本文将刚体力学原理引入下颌阻生第三磨牙拔除术,分析如何应用刚体力学原理巧妙地设计牙齿切割,提高分牙效率;研究如何优化牙根脱位的力学设计,分析牙根脱位道;重点关注如何在拔牙过程中减少对阻生牙周围牙槽骨组织的损伤,降低术中、术后的并发症风险,为广大口腔医师微创拔牙的手术设计和技巧提供解读和参考。

拔牙;下颌阻生第三磨牙;牙,阻生;磨牙,第三;微创拔牙;刚体力学
ABSTRACT

Exploring the application of minimally invasive techniques in the extraction of impacted mandibular third molar (IMTM), to achieve the treatment goal of "less trauma, short time, fast recovery", remains the focus of dentists. For now, the IMTM are mostly extracted in pieces after removing the crown and root resistance by bone removal and tooth segmentation, using 45°reverse-angle high speed turbine, piezosurgery, chisel or other dynamic system. However, There is a lack of principle-level parsing in different provinces and primary hospitals, while experience is still the main factor in avoiding excessive bone removal in complex IMTM extraction, as well as optimizing the specific position and angle of the parting teeth, finding the fulcrum and designing the best dislocation path when there is root resistance. In this review, the principle of geostatics was introduced into the extraction of IMTM. According to this principle, we analyzed how to design a clever tooth cutting line cleverly to enhance the efficiency of tooth segmentation, and how to optimize the mechanical design of root dislocation and the root dislocation path. Meanwhile, we will also focus on how to minimize trauma to alveolar bone during tooth extraction, so as to reduce the risk of intraoperative and postoperative complications, and provide interpretation and reference for dentists in surgical design and techniques of minimally invasive tooth extraction.

Tooth extraction;Impacted mandibular third molar;Tooth, impacted;Molar, third;Minimally invasive tooth extraction;Geostatics
Wang Xing, Email: mocdef.3ab61001xwqk, Tel: 0086-351-4690307
引用本文

王兴. 刚体力学在下颌阻生第三磨牙拔除术中的理论和应用探索[J]. 中华口腔医学杂志,2025,60(02):109-115.

DOI:10.3760/cma.j.cn112144-20240221-00081

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下颌阻生第三磨牙(impacted mandibular third molar,IMTM)拔除术是口腔颌面外科经典的手术操作之一,也是牙槽外科医师的专业必备技能 1。IMTM位于下颌牙列的最末端,下颌骨体后部与下颌支交界处的骨组织内,毗邻舌下间隙、下牙槽神经、舌神经等重要解剖结构 2,手术视野狭窄、操作空间有限,术后易出现肿胀、疼痛、感染和神经血管损伤等并发症 3
为缓解患者的术中、术后疼痛,IMTM拔除术的治疗理念持续向规范化、舒适化发展,更加安全微创的手术方案被广泛推广和应用 4。刘川等 5提出牙槽外科诊疗“四化理念”——器械标准化、技术微创化、操作规范化及服务人性化,已经在全国范围内推广应用。Cai等 6提出“超声骨刀增隙、先出牙根策略”,显著减少对牙槽骨和软组织的损伤,降低邻牙牙周和下牙槽神经损伤的风险 7。目前,IMTM拔除多使用仰角气动手机、超声骨刀、骨凿或其他动力系统,通过去骨、分牙方法解除牙冠和牙根阻力后分块拔除 8
口腔医师经过系统的理论学习基本可熟练掌握IMTM的分型分类,基于邻牙阻力、骨阻力和软组织阻力的拔牙难度分析,以及阻生牙需经历牙齿切割改变牙齿运动方向保证脱位 9。IMTM拔除中,传统力学原理在一些复杂场景下难以直接使用。许多IMTM残根由于盲目过量去骨引起出血和术后严重肿痛,而多次无效率分牙不仅延长手术时间,还可能进一步增加手术难度 10。鉴于此,迫切需要将IMTM拔除手术的经验进行解读、概括和提炼,深入探索其理论依据,便于口腔医师对该手术的理解和应用。2017年,华成舸 11提出将刚体力学原理应用于牙拔除术,将牙及牙槽骨视作刚体,从刚体力学原理出发,对牙拔除中的阻力消除进行探讨,为解决如何在消除骨阻力的同时尽量减少对骨组织的损伤的难题提供了思路。本文深入探讨刚体力学在IMTM拔除过程中的理论和应用,分析如何应用刚体力学原理巧妙地设计牙齿切割,提高分牙效率;研究如何优化牙根脱位的力学设计,解读牙根脱位道;同时,重点关注如何在拔牙过程中减少对阻生牙周围骨组织的不必要损伤,降低术中术后的并发症风险,为口腔医师微创拔牙的临床操作提供参考。
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备注信息
A
王兴,Email: mocdef.3ab61001xwqk,电话:0351-4690307
B
王兴. 刚体力学在下颌阻生第三磨牙拔除术中的理论和应用探索[J]. 中华口腔医学杂志, 2025, 60(2): 109-115. DOI: 10.3760/cma.j.cn112144-20240221-00081.
C
山西医科大学口腔医学院·口腔医院王世辉医师绘图并提供病例;山西医科大学口腔医学院·口腔医院程永峰医师提供病例
D
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