三维打印导板辅助超声骨刀颊侧开窗法拔除下颌低位骨埋伏第三磨牙的临床应用

doi:10.13591/j.cnki.kqyx.2026.02.008

摘要/Abstract

摘要：

目的探讨三维打印导板辅助超声骨刀颊侧开窗技术在拔除下颌低位骨埋伏第三磨牙中的应用价值。方法选择2022年9月至2024年9月在安徽医科大学附属口腔医院口腔颌面外科就诊,需要拔除下颌低位骨埋伏阻生第三磨牙的患者20例,随机分为两组,每组各10例。对照组患者使用45°反角牙科高速气涡轮手机和加长硬质合金车针拔除,观察组患者采用三维打印导板辅助超声骨刀经下颌颊侧骨板截骨开窗入路拔除。比较分析两组患者的手术时间及术后24 h疼痛、肿胀及并发症情况。结果观察组手术时长及术后疼痛与对照组无明显差异(P>0.05),术后肿胀程度显著低于对照组(P<0.05)。观察组术后感染1例,无神经损伤;对照组术后感染1例,下唇麻木1例。结论使用三维打印导板辅助超声骨刀经下颌颊侧骨板截骨开窗入路拔除下颌低位骨埋伏第三磨牙,具有明显减轻肿胀程度、减少神经损伤风险等特点,具备临床推广价值。

关键词: 下颌骨, 第三磨牙, 阻生牙, 拔牙, 三维打印导板, 并发症

Abstract:

Objective To investigate the application value of buccal bone osteotomy with a 3D printed guide plate and piezosurgery method in extracting deeply impacted mandibular third molars. Methods A total of 20 patients who were admitted to the Department of Oral and Maxillofacial Surgery of the Affiliated Stomatological Hospital of Anhui Medical University from September 2022 to September 2024 and needed to have their deeply mandibular impacted third molar removed were randomly divided into 2 groups with 10 patients in each group. Mandibular impacted third molars in the control group were extracted using a 45° reverse angle dental high-speed air turbine handpiece and lengthened tungsten carbide fissure burs, while those in the observation group were extracted using buccal bone osteotomy with 3D printed guide plate and piezosurgery method. The operation time and 24-hour postoperative pain and swelling and complications of the two groups were recorded and analyzed comparatively. Results No significant differences in operation duration and postoperative pain between the two groups (P>0.05); the postoperative swelling of the observation group was significantly lower (P<0.05). There was no significant difference between the operation time in the observation group and the control group(P>0.05), and the postoperative pain and swelling in the observation group were significantly lower than those in the control group(P<0.05). There was one case of postoperative infection and no nerve damage in the observation group, and one case of postoperative infection and one case of lower lip numbness in the control group. Conclusion The use of buccal bone osteotomy with 3D printed guide plate and piezosurgery method in extracting deeply impacted mandibular third molars can reduce the degree of swelling and the risk of nerve injury, and is of clinical promotion value.

Key words: mandible, third molar, impacted tooth, tooth extraction, 3D printed surgical guide plate, complications

中图分类号:

R782.11

邵梦慈, 温泽惠, 王元银, 徐文华. 三维打印导板辅助超声骨刀颊侧开窗法拔除下颌低位骨埋伏第三磨牙的临床应用[J]. 口腔医学, 2026, 46(2): 131-135.

SHAO Mengci, WEN Zehui, WANG Yuanyin, XU Wenhua. Application of the buccal bone osteotomy with 3D printed guide plate and piezosurgery in extracting deeply impacted mandibular third molars[J]. Stomatology, 2026, 46(2): 131-135.

图/表 3

参考文献 26

[1]	Carter K, Worthington S. Morphologic anddemographic predictors of third molar agenesis: A systematic review and meta-analysis[J]. J Dent Res, 2015, 94(7): 886-894. doi: 10.1177/0022034515581644 pmid: 25883107
[2]	Ye ZX, Qian WH, Wu YB, et al. Pathologies associated with the mandibular third molar impaction[J]. Sci Prog, 2021, 104(2): 368504211013247.
[3]	梁宇文, 盘小梅, 邱宇婷. 微创拔除下颌中低位阻生齿的效果观察[J]. 医药前沿, 2021(31): 48-49.
[4]	Wang Z, Zhao SY, He WS, et al. Application of digital position-ing guide plates for the surgical extraction of multiple impacted supernumerary teeth: A case report and review of literature[J]. World J Clin Cases, 2022, 10(27): 9886-9896. doi: 10.12998/wjcc.v10.i27.9886 pmid: 36186207
[5]	Tang XP, Lai QG, Xue RQ, et al. Hard tissue preservation and recovery in minimally invasive alveolar surgery using three-dimensional printing guide plate[J]. 2022, 33(5): e476-e481.
[6]	Zhu FY, Hou DQ, Zhou C, et al. Precise extraction of impacted supernumerary tooth in the maxillary anterior region with a digital guide plate: A case report[J]. Medicine (Baltimore), 2022, 101(20): e29275. doi: 10.1097/MD.0000000000029275
[7]	Yan ZY, Xu JY, Zhang JY, et al. Optimal tooth sectioning using a surgical handpiece and elevator: A finite element study of horizontally deeply impacted mandibular third molars[J]. Clin Oral Investig, 2024, 28(8): 439. doi: 10.1007/s00784-024-05834-9
[8]	张志愿. 口腔颌面外科学[M]. 8版. 北京: 人民卫生出版社, 2020.
[9]	赵宏霞. 超声骨刀拔牙法对下颌阻生牙患者术后VAS评分及张口受限度的影响[J]. 临床研究, 2020, 28(11): 83-85.
[10]	Zhao SF, Wang YJ, Yang XY, et al. Extraction of impacted mandibular third molars in close proximity to the inferior alveolar canal with coronectomy-miniscrew traction to avoid nerve injury[J]. Clin Oral Investig, 2023, 27(8): 4279-4288.
[11]	Munhoz EA, Bodanezi A, Junior OF, et al. Bone crestal height and bone density after third-molar extraction and grafting: A long-term follow-up study[J]. Clin Oral Investig, 2011, 15(1): 123-126. doi: 10.1007/s00784-010-0412-z
[12]	周杨一帆, 张雪明, 侯光宇, 等. 超声骨刀颊侧开窗法拔除下颌低位骨埋伏第三磨牙[J]. 口腔颌面外科杂志, 2019, 29(1): 30-33.
[13]	Wang XX, Mu M, Yan JZ, et al. 3D printing materials and 3D printed surgical devices in oral and maxillofacial surgery: Design, workflow and effectiveness[J]. Regen Biomater, 2024, 11: rbae066.
[14]	钟业宏, 徐梁, 林喜凤, 等. 计算机导航技术在眶颧部骨纤维异常增生症治疗中的应用[J]. 中华整形外科杂志, 2021, 37(1): 22-28.
[15]	李明哲, 王晓霞, 李自力, 等. 计算机导航辅助下口内入路髁突切除术精确性分析[J]. 北京大学学报(医学版), 2019, 51(1): 182-186. doi: 10.19723/j.issn.1671-167X.2019.01.031
[16]	陈泉林, 陈琳, 王彬晨, 等. 红外光学定位动态导航技术在口腔种植领域应用的研究进展[J]. 实用口腔医学杂志, 2022, 38(5): 570-577.
[17]	Khorsandi D, Fahimipour A, Abasian P, et al. 3D and 4D printing in dentistry and maxillofacial surgery: Printing techniques, materials, and applications[J]. Acta Biomater, 2021, 122: 26-49. doi: 10.1016/j.actbio.2020.12.044 pmid: 33359299
[18]	Si JW, Zhang CL, Tian M, et al. Intraoral condylectomy with 3D-printed cutting guide versus with surgical navigation: An accuracy and effectiveness comparison[J]. J Clin Med, 2023, 12(11): 3816. doi: 10.3390/jcm12113816
[19]	杨清然, 徐光宙. 下颌骨埋伏阻生第三磨牙拔除术后自然转归及对邻近第二磨牙的影响[J]. 中国口腔颌面外科杂志, 2024, 22(4): 365-372.
[20]	曾素云, 郭凤芹, 王建广. 锥形束CT评估与下颌阻生第三磨牙相关的第二磨牙远中牙槽骨缺损的危险因素[J]. 中华口腔医学研究杂志(电子版), 2021, 15(1): 13-17.
[21]	梁艺, 康非吾. 完全埋伏阻生的下颌第三磨牙拔除术后第二磨牙远中骨缺损的修复[J]. 口腔医学, 2020, 40(1): 78-82.
[22]	张媛. 阻生下颌第三磨牙拔除三种切口设计对毗邻第二磨牙牙周参数的影响[D]. 太原: 山西医科大学, 2022.
[23]	李娟, 张栋, 刘玉东, 等. 年轻人拔除无症状阻生下颌第三磨牙术后下颌第二磨牙远端的牙周变化[J]. 现代口腔医学杂志, 2021, 35(5): 320-323.
[24]	Gupta P, Naik SR, Ashok L, et al. Prevalence of periodontitis and caries on the distal aspect of mandibular second molar adjacent to impacted mandibular third molar: A guide for oral health promotion[J]. J Family Med Prim Care, 2020, 9(5): 2370-2374. doi: 10.4103/jfmpc.jfmpc_37_20 pmid: 32754503
[25]	Toedtling V, Forouzanfar T, Brand HS. Parameters associated with radiographic distal surface caries in the mandibular second molar adjacent to an impacted third molar[J]. BMC Oral Health, 2023, 23(1): 125. doi: 10.1186/s12903-023-02766-w pmid: 36829170
[26]	Ateş Yıldırım E, Türker N, Göller Bulut D, et al. The relationship of the position of mandibular third molar impaction with the development of dental and periodontal lesions in adjacent second molars[J]. J Stomatol Oral Maxillofac Surg, 2024, 125(1): 101610.

组别	例数	肿胀		疼痛
组别	例数	无、轻度	中、重度	无、轻度	中、重度
观察组	10	6	4	6	4
对照组	10	1	9	2	8
χ²		5.495		3.333
P		0.057 3		0.169 8