Saraiva Amaral Joana, Marto Carlos Miguel, Farias João, Alves Pereira Daniela, Ermida Jorge, Banaco Álvaro, Campos Felino António, Caramelo Francisco, Matos Sérgio
Dentistry Department, Institute of Oral Medicine and Surgery, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal.
Institute of Experimental Pathology, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
Bioengineering (Basel). 2022 Jun 25;9(7):276. doi: 10.3390/bioengineering9070276.
The extraction of impacted mandibular third molars is a frequent dental surgery, interfering with patients' quality of life. Ultrasonic surgery is an alternative to osteotomy with conventional rotary instruments. This study compares postoperative signals and symptoms after extracting impacted mandibular third molars using ultrasonic surgery or conventional rotary osteotomy.
A pilot randomized controlled clinical trial was conducted. Thirty patients were randomly divided into the test group (ultrasonic technique) and a control group (conventional rotatory technique). All surgeries were timed. Swelling parameters, trismus and paraesthesia were evaluated on the day of surgery and the third, fifth and seventh postoperative days. Intraoperative bleeding was evaluated during surgery. Postoperative pain was evaluated daily by the patient through a visual analogue scale and the number of ingested analgesics.
Pain, swelling and trismus present beneficial results with the ultrasonic technique but without statistical significance. Intraoperative bleeding was significantly lower with ultrasonic surgery (t(28) = 3.258; = 0.003). Operating time was significantly higher in extractions involving osteotomy and cutting crown and roots either with the conventional technique ( = 0.020) or ultrasonic technique ( = 0.039). Regardless of the surgical difficulty, no statistically significant results were detected between techniques regarding the procedure duration.
The beneficial postoperative signs and symptoms make ultrasonic surgery a favourable therapeutic option, especially when the integrity of noble anatomical structures is the most important risk factor. Further studies with larger samples are needed to support the use of piezosurgery as a valid option for impacted mandibular third molar extraction.
下颌阻生第三磨牙拔除术是一种常见的牙科手术，会影响患者的生活质量。超声手术是一种替代传统旋转器械截骨术的方法。本研究比较了使用超声手术或传统旋转截骨术拔除下颌阻生第三磨牙后的术后体征和症状。
进行了一项初步随机对照临床试验。30例患者被随机分为试验组（超声技术）和对照组（传统旋转技术）。所有手术均计时。在手术当天以及术后第3、5和7天评估肿胀参数、牙关紧闭和感觉异常情况。术中评估术中出血情况。术后疼痛由患者每天通过视觉模拟量表和摄入的镇痛药数量进行评估。
超声技术在疼痛、肿胀和牙关紧闭方面呈现出有益结果，但无统计学意义。超声手术的术中出血明显较少（t(28) = 3.258；P = 0.003）。无论是采用传统技术（P = 0.020）还是超声技术（P = 0.039），涉及截骨以及切割牙冠和牙根的拔牙手术操作时间均明显更长。无论手术难度如何，两种技术在手术持续时间方面均未检测到统计学上的显著差异。
有益的术后体征和症状使超声手术成为一种有利的治疗选择，尤其是当重要解剖结构的完整性是最重要的风险因素时。需要进行更大样本量的进一步研究来支持使用压电手术作为下颌阻生第三磨牙拔除的有效选择。
