本文關(guān)鍵詞：非阻生第三磨牙對(duì)鄰牙健康影響的回顧性研究　出處：《第四軍醫(yī)大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 非阻生第三磨牙 第二磨牙 阻生第三磨牙 齲病 根吸收 牙周

【摘要】：第三磨牙是人類最晚發(fā)育最晚萌出,同時(shí)也是最容易發(fā)生阻生的牙齒[1]。第三磨牙的阻生率在世界范圍內(nèi)有很大差異,不同的民族和地區(qū)之間不盡相同[2-4]。關(guān)于第三磨牙的處理一直存在爭議[5,6]。對(duì)于第三磨牙的治療方案的確定需要考慮每位患者的不同的情況同時(shí)也要考慮社會(huì)經(jīng)濟(jì)效益。以往的很多研究表明,阻生第三磨牙的存在可能與多種口腔疾病的發(fā)生有關(guān),比如冠周炎、齲病、牙周病、牙根吸收以及頜骨的囊腫或者腫瘤等[7-11]。如果第三磨牙自身患病或者影響了鄰牙的健康則會(huì)被建議拔除。但是,目前還沒有足夠的證據(jù)支持對(duì)沒有臨床癥狀的第三磨牙進(jìn)行預(yù)防性拔除[12,13]。隨著年齡的增長,阻生第三磨牙被不斷拔除,非阻生第三磨牙所占比例相對(duì)升高。同時(shí),第三磨牙自身發(fā)生疾病的機(jī)率逐漸增大,而拔除這些牙齒的風(fēng)險(xiǎn)隨著患者年齡的增加也越來越大[7,14]。有研究表明,非阻生的第三磨牙有可能也會(huì)對(duì)鄰牙的健康產(chǎn)生影響[7,15]。但是,目前有關(guān)非阻生第三磨牙對(duì)鄰牙健康的研究還很少。非阻生第三磨牙是否會(huì)對(duì)鄰牙健康產(chǎn)生影響及其影響程度還不明確[7]。這就給臨床上確定此類第三磨牙的處理方案造成了困難。為此,我們設(shè)計(jì)了本研究。目的:通過對(duì)影像資料和臨床資料的回顧性研究,分析非阻生第三磨牙的存留情況及其對(duì)相鄰第二磨牙健康狀況的影響。方法:1.非阻生第三磨牙存留情況的橫斷面研究:該研究分析了2015年8月至2015年10月所有在第四軍醫(yī)大學(xué)口腔醫(yī)院就診并拍攝全景曲面斷層片患者的影像及病例信息。按照統(tǒng)一的納入和排除標(biāo)準(zhǔn)進(jìn)行納入。患者的年齡和性別等社會(huì)人口學(xué)特征從其病例信息中獲取。非阻生第三磨牙的存留情況及阻生第三磨牙的阻生情況從全景曲面斷層片中獲取。分別通過Winter分類和PG分類確定阻生第三磨牙的阻生角度和阻生水平。2.非阻生第三磨牙對(duì)鄰牙健康影響的回顧性研究:該研究繼續(xù)實(shí)驗(yàn)一的研究,按照新的納入和排除標(biāo)準(zhǔn)進(jìn)行納入。通過比較第三磨牙在缺失、阻生和非阻生情況下第二磨牙遠(yuǎn)中發(fā)生齲病、根吸收和牙槽骨吸收情況的不同,探討非阻生第三磨牙對(duì)鄰牙健康狀況影響。3.非阻生第三磨牙對(duì)鄰牙牙周狀況影響的回顧性研究:以從2014年9月至2015年6月到第四軍醫(yī)大學(xué)口腔醫(yī)院牙周科就診的患者為研究對(duì)象。按照納入和排除標(biāo)準(zhǔn)對(duì)患者進(jìn)行納入。收集所有納入患者的社會(huì)人口學(xué)資料和牙周檢查指標(biāo)。通過比較有無非阻生第三磨牙的情況下第二磨牙牙周狀況的差異,進(jìn)一步探索非阻生第三磨牙對(duì)第二磨牙牙周狀況的影響。4.統(tǒng)計(jì)學(xué)分析:運(yùn)用SPSS 18.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行描述和分析。使用均數(shù)和標(biāo)準(zhǔn)差對(duì)計(jì)量資料進(jìn)行描述。使用頻數(shù)及構(gòu)成比或率對(duì)計(jì)數(shù)資料和等級(jí)資料進(jìn)行描述。計(jì)量資料的比較用t檢驗(yàn)或方差分析,計(jì)數(shù)資料的比較用Pearsonc2檢驗(yàn)。應(yīng)用logistic回歸模型對(duì)擬分析的影響因素變量進(jìn)行分析。所有的統(tǒng)計(jì)檢驗(yàn)均采用雙側(cè)檢驗(yàn),組間比較檢驗(yàn)水準(zhǔn)α=0.05,多重比較檢驗(yàn)水準(zhǔn)校正為α=0.017。結(jié)果:1.通過對(duì)2395例病人的篩選,一共對(duì)1958人(37.2±17.0歲)進(jìn)行了非阻生第三磨牙存留情況的分析,其中男性774人,女性1184人。45.1%的患者有非阻生第三磨牙,在保留的第三磨牙中有約44.1%是非阻生的。此外,我們還發(fā)現(xiàn)阻生第三磨牙在納入人群中的患病率為54.3%。最常見的阻生角度和阻生水平分別是近中阻生(37.3%)和C類阻生(47.1%)。2.通過對(duì)2395例病人的篩選,對(duì)1958人(37.2±17.0歲)的6695顆第二磨牙的患病情況進(jìn)行了分析。在非阻生第三磨牙存在的情況下,第二磨牙遠(yuǎn)中發(fā)生齲病、根吸收和牙槽骨吸收的比率分別為10.0%,0.8%和40.4%。非阻生第三磨牙的存在不會(huì)增加鄰牙發(fā)生齲病和根吸收的風(fēng)險(xiǎn),但會(huì)使鄰牙發(fā)生牙槽骨吸收的風(fēng)險(xiǎn)增加到第三磨牙缺失時(shí)的1.77倍(95%CI:1.51,2.08;P0.001)。3.共有135名(男性43.7%,平均年齡40.6歲)患者被納入到本研究,其中105位患者有至少1顆非阻生第三磨牙,30位患者沒有第三磨牙。兩組之間在年齡、性別、職業(yè)和教育程度等人口學(xué)資料上沒有差異。非阻生第三磨牙的存在使得鄰牙的牙齦指數(shù)(GI)、菌斑指數(shù)(PLI),探診深度(PPD)、附著水平(CAL)、探診出血(BOP)以及至少1個(gè)位點(diǎn)探診深度≥5mm(PPD5+)的比例顯著增加(P0.05)。均衡了年齡、頜位和教育程度等影響因素之后,非阻生第三磨牙存在使其鄰牙牙發(fā)生PPD5+的風(fēng)險(xiǎn)是第三磨牙缺失時(shí)的6.79倍(95%CI:1.12-41.16)。結(jié)論:1:臨床上,約有45%的患者有非阻生第三磨牙。2:非阻生第三磨牙的存在使得鄰牙發(fā)生牙槽骨吸收的風(fēng)險(xiǎn)顯著增加。3:非阻生第三磨牙的存在對(duì)于相鄰第二磨牙的牙周健康有負(fù)面影響。
[Abstract]:The third molar is the most late eruption of human development, and it is also the most easily occurring tooth [1]. The resistance rate of the third molar is very different in the world, and the [2-4] is not the same among the different nationalities and regions. There has been a dispute [5,6] about the treatment of third molars. The determination of the treatment plan for the third molar needs to consider the different cases of each patient and also to consider the social and economic benefits. Many previous studies showed that impacted third molar may exist with a variety of oral diseases, such as periodontitis, dental caries, periodontal disease, root resorption and bone cyst or tumor [7-11]. If the third molars are sick themselves or affect the health of the adjacent teeth, it will be suggested to be removed. However, there is not enough evidence to support the prophylactic extraction of [12,13] for third molars without clinical symptoms. With the increase of age, the impacted third molar was continuously removed, and the proportion of the non impacted third molar was relatively higher. At the same time, the probability of the third molars' own disease is gradually increasing, and the risk of removing these teeth is increasing with the increase of the age of the patients with the increase of [7,14]. Studies have shown that the non impacted third molars may also have an impact on the health of the adjacent teeth [7,15]. However, at present, there are few studies on the health of non impacted third molar teeth to the adjacent teeth. The influence of the non impacted third molar on the health of the adjacent teeth and the extent of its influence are not clear [7]. This makes it difficult to determine the treatment of such third molars clinically. To this end, we have designed this study. Objective: to analyze the retention of non impacted third molar and its influence on the health status of second adjacent molars by retrospective study of image data and clinical data. Methods: 1.. A cross-sectional study of third cases of non impacted and third molar retained. This study analyzed the imaging and case information of all patients who received panoramic tomography in The Fourth Military Medical University dental hospital from August 2015 to October 2015. Inclusion in accordance with unified inclusion and exclusion criteria. Social demographic characteristics, such as age and sex, are obtained from the information of their cases. The retention of the non impacted third molar and the impaction of the impacted third molar were obtained from the panoramic surface fault. The impacted angle and the impacted level of the impacted third molar were determined by Winter classification and PG classification. A retrospective study of the effect of 2. non impacted third molar on the health of the adjacent teeth: the study continued in the first study and included in the new inclusion and exclusion criteria. By comparing the difference of caries, root resorption and alveolar bone resorption between the third molars in the absence, impaction and non impacted condition of the two molar, the influence of non impacted third molar on the health of adjacent teeth was discussed. A retrospective study of 3. non influence impacted third molars on the adjacent periodontal condition: from September 2014 to June 2015 at the The Fourth Military Medical University Hospital of stomatology hospital patients as the research object. The patients were included in the inclusion and exclusion criteria. All the social demographic data and periodontal indicators were collected. By comparing the periodontal status of the two molar, the influence of non impacted third molar on the periodontal status of the second molar was further explored through comparing the periodontal status of the two molar. 4. statistical analysis: using SPSS 18 statistical software to describe and analyze the data. The measurement data are described with the use of mean and standard deviation. The number and grade data are described by frequency and composition ratio or rate. The comparison of the measurement data was made by t test or analysis of variance, and the comparison of the count data was tested by Pearsonc2. The logistic regression model was used to analyze the variables of the influence factors of the quasi analysis. All the statistical tests were both tested by bilateral test, the comparison test between groups was alpha =0.05, and the level of multiple comparison test was alpha =0.017. Results: 1.. Through the screening of 2395 patients, a total of 1958 patients (37.2 + 17 years old) were analyzed for the prevalence of non impacted third molar, including 774 men and 1184 women. 45.1% of the patients had non impacted third molars, and about 44.1% of the retained third molars were not impacted. In addition, we also found that the prevalence of impacted third molar in the population was 54.3%. The most common impacted and impacted levels were impacted (37.3%) and C (47.1%), respectively. 2. the prevalence of 6695 second molars in 1958 people (37.2 + 17 years old) was analyzed by screening 2395 patients. In the presence of non impacted third molar, the ratio of caries, root absorption and alveolar bone absorption in the second molars was 10%, 0.8% and 40.4% respectively. The presence of non impacted third molar does not increase the risk of caries and root resorption, but it increases the risk of alveolar bone absorption to 1.77 times of third molar loss (95%CI:1.51,2.08; P0.001). 3. a total of 135 patients (male 43.7%, mean age 40.6 years) were included in this study. 105 patients had at least 1 non impacted third molars and 30 patients did not have third molar teeth. There was no difference in demographic data between the two groups in age, sex, occupation and educational level. There are third non impacted molars makes the adjacent teeth gingival index (GI), plaque index (PLI), probing depth (PPD) and attachment level (CAL), bleeding on probing (BOP) and at least 1 loci probing depth more than 5mm (PPD5+) ratio increased significantly (P0.05). After the balance of age, jaw position and level of education, there is a risk of non impacted third molars of the adjacent teeth of PPD5+ is 6.79 times the third molar (95%CI:1.12-41.16). Conclusion: in 1:, about 45% of the patients have non impacted third molar. The existence of 2: non impacted third molar
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R781.4

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