歯の分割方法は下顎骨遠心性第三大臼歯の外科的抜去に影響を与えるか？

Does the Tooth Sectioning Method Impact Surgical Removal of the Distoangular Impacted Mandibular Third Molar?

抄録

目的:

Distoangular Impactedの除去は、その解剖学的位置から困難であると考えられている。適切な歯牙分割を行うことで、最小限の骨量での抜去が可能となる。本研究は、2種類の歯牙分割法の結果を比較することを目的とする。

PURPOSE: Distoangular impacted teeth are considered challenging to remove due to their anatomic position. Proper tooth sectioning ensures the removal with minimal bone removal. This study is aimed to compare the outcome of 2 different tooth sectioning methods.

材料と方法:

この単盲検無作為化比較試験には、遠心性下顎骨第三大臼歯の患者を対象とした。Class IIIの衝撃を受けた患者、総崩壊した歯、ASA III以上の患者は除外した。被験者は，セメントエナメル接合部で歯牙分割を行うグループA従来法と，歯牙分割により歯冠の遠位部のみを除去するグループB修正法に無作為に振り分けられた．主要予測変数は歯の分割方法であった．主要評価項目は手術時間，副次評価項目は術後疼痛，トリスマス，術後3日目と7日目に評価した浮腫であった．手術時間に対する治療の効果はt検定で評価し，カテゴリーデータの比較にはChi-squared検定を用いた．

MATERIALS AND METHODS: Patients with distoangular-impacted mandibular third molar were included in this single-blinded randomized controlled trial. Patients with Class III-impacted, grossly decayed teeth and who were ASA III and above were excluded. The subjects were randomly allocated into Group-A conventional method, where tooth sectioning at the cementoenamel junction, and Group B, the modified method, where tooth sectioning removes only the distal portion of the crown. The primary predictor variable was the tooth sectioning method. The primary outcome variable was the operative time and the secondary outcomes included postoperative pain, trismus, and edema assessed on postoperative days 3 and 7. The effect of treatment on operative time was assessed using a t-test and Chi-squared test was used to compare the categorical data.

結果:

38名の患者が本研究に組み入れられた。1:1の割付比率で、各群18名（50%）の患者が組み入れられた。性別（P=.32），年齢（P=.34），歯種（P=.97），抜歯側（P=.32）は2群間で有意差を認めなかった．平均手術時間はA群31.61±14.13分，B群22.72±10.79分で，95%信頼区間のP値は.04（P<.05）でB群に有利であった．A群3.83±3.06、B群3.88±3.06（P=.95）、顔面浮腫22.79±2.08、22.88±1.32（P=.88）。88）、最大切歯間開口は3日目に33±8.59と31.33±7.42（P=.54）、7日目に36.16±11.62と39.05±6.08（P=.36）であった。しかし，救助鎮痛の必要性の差は2.05±2.15と0.44±0.85（P<.01）であり，従来の切開法の優位性を示唆するものであった．

RESULTS: Thirty eight patients were included in this study. With a 1:1 allocation ratio, 18 (50%) patients were included in each group. No statistically significant differences were observed in the 2 groups for gender allocation (P = .32), age (P = .34), tooth classification (P = .97), and side of extraction (P = .32). The mean operative time was 31.61 ± 14.13 minutes for group A and 22.72 ± 10.79 minutes for group B, at the 95% confidence interval had a P value of .04 (P < .05), favoring group B. Secondary outcomes of pain measured by visual analogue scale 3.83 ± 3.06 for group A and 3.88 ± 3.06 for group B (P = .95), facial edema 22.79 ± 2.08 and 22.88 ± 1.32, respectively (P = .88), and the maximal interincisal opening of 33 ± 8.59 and 31.33 ± 7.42 on day 3 (P = .54) and 36.16 ± 11.62 and 39.05 ± 6.08 on day 7 (P = .36). However, the difference in need for rescue analgesia 2.05 ± 2.15 and 0.44 ± 0.85 (P < .01) was statistically significant, suggesting the superiority of the conventional sectioning method.

結論:

両手法とも良好な結果が得られた．しかし，本グループでは，改良型セクショニングの方が抜歯が早く，救援鎮痛の必要性も少なかったことから，従来法よりも好ましい手技であることが示唆された．

CONCLUSIONS: The results show that both methods of tooth sectioning yield comparably acceptable results. However, the tooth removal was faster by the modified sectioning and the need for rescue analgesia was minimal in this group, suggesting it to be a preferred technique over the conventional method.