Digital design combined with endoscopic minimally invasive extraction of impacted mandibular third molars with roots in contact with the mandibular canal
10.3760/cma.j.cn112144-20240512-00201
- VernacularTitle:数字化设计结合内镜微创拔除牙根与下颌管接触的下颌阻生第三磨牙
- Author:
Yue WANG
1
;
Kenan CHEN
;
Junqi JIANG
;
Junlin WANG
;
Wei ZHANG
;
Xiangliang XU
Author Information
1. 北京大学口腔医学院·口腔医院口腔颌面外科 国家口腔医学中心 国家口腔疾病临床医学研究中心 口腔生物材料和数字诊疗装备国家工程研究中心 口腔数字医学北京市重点实验室，北京 100081
- Keywords:
Tooth, impacted;
Molar, third;
Digital design;
3D printing;
Endoscope;
Inferior alveolar neurovascular bundle
- From:
Chinese Journal of Stomatology
2024;59(12):1221-1227
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the clinical efficacy of digital design combined with three-dimensional (3D) printing model minimally invasive extraction of complex impacted mandibular third molars.Methods:Eight patients who visited the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from April 2023 to March 2024 were included, including 3 males and 5 females, aged from 27 to 57 years old. The impacted mandibular third molars of all patients were closely related to the mandibular canal, and part of the dental tissue entered the mandibular canal. Preoperative digital design was used to simulate the intraoperative tooth segmentation and bone removal operation of the power system and the segmented tooth dislocation path, and analyze the tooth extraction resistance. The mandibular teeth, mandibular canal and mandibular model were three-dimensionally printed using light-curing resin inkjet. During the operation, an endoscope was used combined with the 3D printed model to minimally invasively extract the impacted mandibular third molar. Quantitative sensory testing of the patient′s lower lip skin on the operated side was performed before surgery, 2 days after surgery, and 7 days after surgery. Clinical data such as operation time were collected. A paired sample t test was performed on the 2 and 7 days postoperative data and the preoperative data to compare the data differences.Results:All 8 patients successfully completed preoperative design, model printing and minimally invasive surgery. The number of teeth segmented in the preoperative design was (4.4±1.3), and the number of teeth segmented in the actual operation was (4.0±1.1). The operation time was (33.3±13.0) min. None of the patients had postoperative numbness of the lower lip or other postoperative complication. It was observed endoscopically that the inferior alveolar neurovascular bundle was exposed in the extraction socket during the operation. The patient′s pressure pain threshold 2 days after surgery (0.601±1.170) was significantly lower than before surgery (1.251±1.109) ( t=2.83, P=0.025). Conclusions:For complicated impacted mandibular third molars, digital design combined with 3D printing model can be used to perform minimally invasive extraction with the assistance of an endoscope.
