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摘 要目的:观察下颌埋伏阻生智齿拔除后的创口作部分开放引流处理能否减轻术后肿胀反应。方法:380例下颌埋伏阻生智齿患者随机分为A、B两组,每组190人。A组拔牙后的创口粘膜瓣缝合后再作三角形切除6mm(毗邻第二磨牙的远中面)形成小窗口开放牙槽窝,B组作传统的疏松缝合,完全关闭牙槽窝。术后第三天复诊评估肿胀。结果:在A组中,有42例无肿胀出现(22.1%),B组全部出现肿胀。肿胀程度的比较,两组的轻度与中度相比均无显著性差异,但两组的重度相比,有显著性差异(P 在B组的病例中,约3%病例在术后第4周因第二磨牙远中邻面的牙周炎而合并牙槽窝的牙槽脓肿,而A组的病例无这种合并症出现。显然,在A组,因第二磨牙远中邻面的龈瓣被部分切除而呈三角形,难于形成牙周袋,即使第二磨牙远中邻面的牙槽骨吸收严重,其形成的牙周袋也较浅而难于形成脓肿;而B组的情况与A组恰好相反,如果第二磨牙远中邻面的牙槽骨吸收严重,则易形成深牙周袋而易诱发该处牙周脓肿,进而扩大至拔牙创的牙槽脓肿。
从本研究结果可知,下颌埋伏阻生智齿拔除后的创口,宜切除小部分粘膜瓣以开放牙槽窝,使引流更加通畅,以更有效减轻术后肿胀。而对于第二磨牙远中邻面的牙槽骨吸收严重者,开放牙槽窝使其延期闭合,还可避免术后牙槽脓肿的发生。
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