Jiang Qian, Qiu Yating, Yang Chi, Yang Jingyun, Chen Minjie, Zhang Zhiyuan
From the Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (QJ, YQ, CY, MC, ZZ); Rush Alzheimer's Disease Center (JY); and Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois (JY).
Medicine (Baltimore). 2015 Oct;94(41):e1685. doi: 10.1097/MD.0000000000001685.
Impacted third molars are frequently encountered in clinical work. Surgical removal of impacted third molars is often required to prevent clinical symptoms. Traditional rotary cutting instruments are potentially injurious, and piezosurgery, as a new osteotomy technique, has been introduced in oral and maxillofacial surgery. No consistent conclusion has been reached regarding whether this new technique is associated with fewer or less severe postoperative sequelae after third molar extraction.The aim of this study was to compare piezosurgery with rotary osteotomy techniques, with regard to surgery time and the severity of postoperative sequelae, including pain, swelling, and trismus.We conducted a systematic literature search in the Cochrane Library, PubMed, Embase, and Google Scholar.The eligibility criteria of this study included the following: the patients were clearly diagnosed as having impacted mandibular third molars; the patients underwent piezosurgery osteotomy, and in the control group rotary osteotomy techniques, for removing impacted third molars; the outcomes of interest include surgery time, trismus, swelling or pain; the studies are randomized controlled trials.We used random-effects models to calculate the difference in the outcomes, and the corresponding 95% confidence interval. We calculated the weighted mean difference if the trials used the same measurement, and a standardized mean difference if otherwise.A total of seven studies met the eligibility criteria and were included in our analysis. Compared with rotary osteotomy, patients undergoing piezosurgery experienced longer surgery time (mean difference 4.13 minutes, 95% confidence interval 2.75-5.52, P < 0.0001). Patients receiving the piezoelectric technique had less swelling at postoperative days 1, 3, 5, and 7 (all Ps ≤0.023). Additionally, there was a trend of less postoperative pain and trismus in the piezosurgery groups.The number of included randomized controlled trials and the sample size of each trial were relatively small, double blinding was not possible, and cost analysis was unavailable due to a lack of data.Our meta-analysis indicates that although patients undergoing piezosurgery experienced longer surgery time, they had less postoperative swelling, indicating that piezosurgery is a promising alternative technique for extraction of impacted third molars.
在临床工作中，阻生第三磨牙很常见。通常需要通过手术拔除阻生第三磨牙以预防临床症状。传统的旋转切割器械可能会造成损伤，而压电手术作为一种新的截骨技术，已被引入口腔颌面外科。关于这项新技术在第三磨牙拔除术后是否会导致更少或更轻的术后后遗症，尚未达成一致结论。本研究的目的是比较压电手术和旋转截骨技术在手术时间以及术后后遗症的严重程度（包括疼痛、肿胀和牙关紧闭）方面的差异。我们在考克兰图书馆、PubMed、Embase和谷歌学术上进行了系统的文献检索。本研究的纳入标准如下：患者被明确诊断为下颌阻生第三磨牙；患者接受压电手术截骨，对照组采用旋转截骨技术来拔除阻生第三磨牙；感兴趣的结局包括手术时间、牙关紧闭、肿胀或疼痛；研究为随机对照试验。我们使用随机效应模型计算结局的差异以及相应的95%置信区间。如果试验使用相同的测量方法，我们计算加权平均差；否则，计算标准化平均差。共有七项研究符合纳入标准并被纳入我们的分析。与旋转截骨术相比，接受压电手术的患者手术时间更长（平均差4.13分钟，95%置信区间2.75 - 5.52，P<0.0001）。接受压电技术的患者在术后第1、3、5和7天肿胀较轻（所有P值≤0.023）。此外，压电手术组术后疼痛和牙关紧闭也有减轻的趋势。纳入的随机对照试验数量和每个试验的样本量相对较小，无法进行双盲，且由于缺乏数据无法进行成本分析。我们的荟萃分析表明，虽然接受压电手术的患者手术时间较长，但术后肿胀较轻，这表明压电手术是拔除阻生第三磨牙的一种有前景的替代技术。
