Clinical Research Of Minimally Invasive Removal Third Molar And Weighted Assessment

Objectives:To investigate the clinical effect of the Piezosurgery combined with turbine drill for removal of the horizontally impacted mandibular third molar by comparing the efficiency, trauma, postoperative complications and prognosis of the traditional turbine-drilling with that of the method combining ultrasonic osteotome with turbo-drill when used for removal of the horizontally impacted mandibular wisdom tooth in low site. Provide experimental basis for clinical selection of appropriate tooth extraction method and aid in the development of minimally invasive treatment of the alveolar surgery. At the same time, we establish a alveolar surgical weighted scale for evaluation and prediction of trauma controlling, with which we can evaluate and predict the trauma levels and compare these to the actual situations thus verifying its reliability, provide theoretical evidence and feasible reference tool for the clinical development of minimally invasive surgery and specifcally selecting trauma-controlling measurement.Materials and Methods:The outpatients was carried out who have visited the apartment of oral and maxillofacial surgery, stomatological hospital of Tianjin Medical University for removal of the horizontally impacted mandibular wisdom tooth in low site from October2009to March2011.Among those patients, we included60patients(28males and32females, aged from20to28years old, average age (23.3±4.4)) who have similar impact type on both sides(120mandibular horizontally impacted wisdom teeth in low site). Randomly grouping and auto-crossover controlled clinical trial was adopted, all60patients were randomly divided into group A and B,30patients in each group. For group A, ultrasonic osteotome with the turbine drill was used for the left side firstly (experimental group), turbo-drill alone (control group) used for the right side. For group B, used the turbine drill(control group) for the left side and the ultrasonic osteotome with the turbine drill (experimental group) for the right side. The operating order was contrary. The two surgical procedures in each group should be separated by at least two months. Record the operation time, bleeding volume, the VAS score of local pain at the second postoperative day, the degree of swelling and limitation of mouth opening while using the ultrasonic osteotome with the turbine drill method in the extraction. Note whether there was postoperative numbness, dry socket, joint pain or wound infection. The datas were entered in the statistical software SPSS15.0for analysis of differences between groups. On the basis of final results, we evaluated whether such tooth extraction method has advantages in controlling of trauma, surgical efficiency and complications. In addition, an epidemiological statistical research method was conducted to collect the surgical trauma related factors and calculate the weighted coefficient scale, make a score according to the scale to predict postoperative trauma reactions and related complications.50clinical cases were selected and got in the process of prediction and evaluation of trauma through the scale as well as a comparative analysis with actual situations, the actual contrast analysis according to scale. Evaluate the postoperative adverse reaction after corresponding trauma controlling measures were undertaken,Results:1. in the surgery of removing the mandibular horizontally impacted wisdom tooth, the experimental group took less time than the control group, the difference was statistically significant (p<0.05); compared to the conventional method, ultrasonic osteotome with the turbo-drill method made significantly less fear and pain feeling in patient’s self-assessment(p<0.05).2. after the surgery using the ultrasonic osteotome with the turbine drill, the duration of remission of the symptoms of pain and local swelling was significantly better than the control group (p<0.05).3. there were3cases of lower lip numbness,2cases of joint pain,1cases of dry socket and2cases of wound infection in control group, whereas none of these were happened in experimental group. Among the complications arisen in control group, lower lip numbness had no been significantly mitigated during the six months follow-up. Experimental group has lower degree of postoperative pain, limitation of mouth opening, swelling and less intra-operative bleeding than control group(P<0.05). The alveolar surgical weighted scale for evaluation and prediction of trauma controlling was proven weighted reasonably, having a high forecast credibility, and could effectively enhance the purposiveness of operations of alveolar surgery and realize prevention and control of postoperative trauma reactions and complications.Conclusions:1. in the surgery of removing the low site mandibular horizontally impacted wisdom tooth, using ultrasonic osteotome combined with the turbine drill can significantly improve the efficiency of surgical procedures than turbine drill alone, thus reducing the patient’s intraoperative discomfort, occurring of postoperative swelling and pain. In addition, because the unique transducer principle of ultrasonic osteotome, postoperative complications such as lower lip numbness caused by injury to the inferior alveolar nerve can be effectively avoided.2. in the surgery of removing the low site mandibular horizontally impacted wisdom tooth, ultrasonic osteotome can remove bone more precisely, achieving the maximum retention of healthy bone.3. Ultrasonic osteotome has its advantage in the extraction of low horizontally impacted wisdom teeth, but is less efficient when used alone especially in tooth-separating, while for the operation of osteotomy, it can achieve the best cost-effective. Using ultrasonic osteotome with a turbo drill for removal of mandibular impacted wisdom teeth can play their respective advantages, reduce postoperative complications more effectively to achieve minimally invasive procedure. For clinical development of minimally invasive surgery, the alveolar surgery should gradually establish a quantifiable prevention and control criterion, try the initial establishment of the alveolar surgical trauma control evaluation weighted scale, predict according to it and achieve the phased implementation of control in the preoperative, intraoperative and postoperative respectively, so that minimally invasive operations can be better achieved.