Chen Y-W, Lee C-T, Hum L, Chuang S-K
Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard University, School of Dental Medicine, Boston, MA, USA; Oral and Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General Hospital and School of Dentistry, National Yang-Ming University, Taipei, Taiwan.
Department of Periodontics and Dental Hygiene, University of Texas Health Science Center at Houston, Houston, TX, USA.
Int J Oral Maxillofac Surg. 2017 Mar;46(3):363-372. doi: 10.1016/j.ijom.2016.08.005. Epub 2016 Sep 3.
The extraction of an impacted third molar violates the surrounding soft and bony tissues. The surgeon's access to the tooth, for which there are various surgical approaches, has an important impact on the periodontium of the adjacent second molar. The aim of this review was to analyze the relationships between the different flap techniques and postoperative periodontal outcomes for the mandibular second molars (LM2) adjacent to the impacted mandibular third molars (LM3). An electronic search of MEDLINE and other databases was conducted to identify randomized controlled trials fulfilling the eligibility criteria. To assess the impact of flap design on the periodontal condition, the weighted mean difference of the probing depth reduction (WDPDR) and the weighted mean difference of the clinical attachment level gain (WDCAG) at the distal surface of LM2 were used as the primary outcomes. The results showed that, overall, the different flap techniques had no significant impact on the probing depth reduction (WDPDR -0.14mm, 95% confidence interval -0.44 to 0.17), or on the clinical attachment level gain (WDCAG 0.05mm, 95% confidence interval -0.84 to 0.94). However, a subgroup analysis revealed that the Szmyd and paramarginal flap designs may be the most effective in reducing the probing depth in impacted LM3 extraction, and the envelope flap may be the least effective.
拔除阻生第三磨牙会侵犯周围的软组织和骨组织。外科医生接近该牙齿有多种手术入路，这对相邻第二磨牙的牙周组织有重要影响。本综述的目的是分析不同瓣技术与下颌阻生第三磨牙（LM3）相邻的下颌第二磨牙（LM2）术后牙周结局之间的关系。通过对MEDLINE和其他数据库进行电子检索，以识别符合纳入标准的随机对照试验。为评估瓣设计对牙周状况的影响，将LM2远中面探诊深度减少的加权平均差（WDPDR）和临床附着水平增加的加权平均差（WDCAG）作为主要结局指标。结果显示，总体而言，不同的瓣技术对探诊深度减少（WDPDR -0.14mm，95%置信区间 -0.44至0.17）或临床附着水平增加（WDCAG 0.05mm，95%置信区间 -0.84至0.94）均无显著影响。然而，亚组分析显示，Szmyd瓣和边缘旁瓣设计在减少阻生LM3拔除术中的探诊深度方面可能最有效，而信封瓣可能最无效。
