微创拔牙技术与药物辅助减轻下颌阻生第三磨牙拔除术后并发症的研究综述

A Review of Minimally Invasive Tooth Extraction Techniques and Pharmacological Adjuncts for Reducing Postoperative Complications Following Mandibular Third Molar Extraction

摘要: 目的：为进一步综述分析下颌阻生第三磨牙拔除术在微创手术技术以及药物辅助方面的最新研究进展，并探究单用或联用对缓解术后并发症(疼痛、肿胀、张口受限、感染)的作用情况，以期为临床上给予患者更为满意的诊治提供循证依据。方法：梳理根据近15年的国内外相关文献、专家共识等资料，归纳总结微创拔牙技术应用方法、围术期药物辅助的应用策略。结果：微创拔牙技术可有效减少术中组织创伤，明显减轻术后疼痛、肿胀程度、神经损伤发生率；围术期药物辅助可有效控制术后炎症反应、感染及并发症发生。初略研究表明，微创技术和局部药物如超声骨刀、地塞米松黏膜下注射技术联用后可以较好地改善术后疼痛、张口受限情况，但涉及少有高质量临床试验，有待于后续大规模临床试验证实。结论：微创拔牙技术以及围术期药物辅助治疗是减少下颌阻生第三磨牙拔除术后并发症的重要手段，两者联用有一定优势，但对于后续大规模临床研究仍缺乏足够的有力证据支持，有待进一步大样本量、多中心的临床研究加以证实并将其规范化、个体化应用于临床工作中。

Abstract: Objective: To review and analyze the latest research progress in minimally invasive surgical techniques and pharmacologic adjuncts for the extraction of mandibular impacted third molars, and to explore the effects of their individual or combined use on alleviating postoperative complications (pain, swelling, trismus, infection), thereby providing evidence-based references for achieving more satisfactory clinical diagnosis and treatment outcomes. Methods: Relevant domestic and international literature, expert consensus, and other materials from the past 15 years were reviewed to summarize the standardized application of minimally invasive extraction techniques and the strategies for perioperative pharmacologic adjunctive therapy. Results: Minimally invasive extraction techniques effectively reduce intraoperative tissue trauma and significantly alleviate postoperative pain, swelling, and the incidence of nerve injury. Perioperative pharmacologic adjuncts effectively control postoperative inflammatory responses, infections, and complication occurrence. Preliminary studies indicate that combining minimally invasive techniques (e.g., piezoelectric surgery) with local pharmacologic agents (e.g., submucosal injection of dexamethasone) may improve postoperative pain and trismus. However, high-quality clinical trials in this area remain scarce, warranting further validation through large-scale studies. Conclusion: Minimally invasive extraction techniques and perioperative pharmacologic adjunctive therapy are crucial for reducing complications following mandibular impacted third molar extraction. Their combined use shows potential advantages, but sufficient robust evidence from subsequent large-scale clinical research is still lacking. Further large-sample, multicenter clinical studies are needed to confirm these findings and establish standardized, individualized protocols for clinical practice.