Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medical; Shanghai Key Laboratory of Stomatology, Shanghai, PRC.
Department of Oral-maxillofacial Head and Neck Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medical; Shanghai Key Laboratory of Stomatology, Shanghai, PRC.
Clin Implant Dent Relat Res. 2017 Jun;19(3):572-580. doi: 10.1111/cid.12466. Epub 2016 Dec 8.
Extraction of impacted mandibular third molar (M3) has been cited as causing osseous defect at the distal aspect of the adjacent second molar (M2).
This randomized controlled trial was aimed to evaluate the effect of autogenous bone grafting in situ for regeneration of periodontal osseous defect distal to the M2 compared with non-grafting after impacted M3 removal.
A total of 60 sites in 51 adult patients were enrolled and randomly assigned to the control group or the test group. In both groups, the M3 was extracted using a piezosurgical device, and the distal root surface of M2 was scaled and root planned. In addition, the removed alveolar bone was grinded to particles and grafted to the distal osseous defect of M2 in the test group. The primary outcome variable was the osseous defect depth (ODD), the secondary outcome variables were probing pocket depth (PD) and clinical attachment level (CAL) on the disto-buccal aspect of the M2 during a 12-month follow-up period. Postoperative symptom at 7-day postoperatively and adverse events were also recorded and analyzed.
The patient characteristics were homogeneous between the 2 groups. Six and 12 months after surgery, there were statistically significant bone fill in both groups (P ＜ .01). Moreover, the ODD and CAL in the test group were significantly lower than the control group at every postoperative re-entry (P ＜ .01). The postoperative symptom was more severe in the test group than the control group, but the difference was not significant (P > .05).
The result of this study demonstrated that scaling and root planning was beneficial to periodontal healing of M2 after impacted M3 extraction. Addition of autogenous bone grafting for the treatment of osseous defects distal to M2 was safe and more effective than periodontal treatment alone. (Registry Number: ChiCTR-IOC-15006561).
下颌第三磨牙（M3）的拔除被认为会导致相邻第二磨牙（M2）远中端的牙槽骨缺损。
本随机对照试验旨在评估与 M3 拔除后非植骨相比，自体骨原位移植对 M2 远中端牙周骨缺损再生的影响。
共纳入 51 名成年患者的 60 个位点，并随机分为对照组和试验组。两组均采用超声骨刀取出 M3，对 M2 的远中端根面进行洁治和根面平整。此外，将取出的牙槽骨磨成颗粒，移植到试验组 M2 的远中端骨缺损处。主要结局变量为牙槽骨缺损深度（ODD），次要结局变量为 M2 远中颊侧的探诊袋深度（PD）和临床附着水平（CAL），随访时间为 12 个月。还记录并分析了术后 7 天的术后症状和不良事件。
两组患者的特征具有同质性。术后 6 个月和 12 个月，两组均有统计学意义的骨填充（P＜0.01）。此外，试验组在每次术后复诊时的 ODD 和 CAL 均明显低于对照组（P＜0.01）。试验组的术后症状比对照组更严重，但差异无统计学意义（P＞0.05）。
本研究结果表明，M3 拔除后洁治和根面平整有利于 M2 的牙周愈合。自体骨移植治疗 M2 远中端骨缺损的效果安全且优于单纯牙周治疗。（注册号：ChiCTR-IOC-15006561）
