下颌阻生智齿拔除切口设计对第二磨牙牙周 状况影响的研究进展

Research Progress on Incision Design for Extraction of Impacted Mandibular Wisdom Teeth and Its Effect on Periodontal Status of the Second Molar

摘要: 下颌阻生第三磨牙拔除术是口腔临床常见手术，但其操作易对相邻第二磨牙牙周状况产生不良影响，切口设计作为手术核心环节，对术后第二磨牙牙周健康及并发症的发生具有关键作用。本文通过梳理国内外相关研究，系统阐述了三角形瓣与改良三角形瓣、信封瓣与改良信封瓣、Szmyd瓣、逗号瓣等常见切口设计的操作特点及对第二磨牙牙周健康的具体影响，同时分析了阻生牙类型、患者年龄、术前牙周基础状况、去骨方式及缝合技术等其他因素对术后第二磨牙远中牙周组织愈合的作用机制。此外，本文还归纳了富血小板纤维蛋白、引导组织再生术、骨移植、胶原蛋白海绵填充等现阶段临床用于保障第二磨牙牙周健康的常用材料与方法。目前关于各类切口设计的适应症及长期临床效果仍缺乏统一结论，未来仍需开展更多高质量的临床研究，为下颌阻生第三磨牙拔除术的切口选择及牙周保护策略提供更多的医学依据。

Abstract: Extraction of impacted mandibular third molars is a common procedure in clinical dentistry, which may easily adversely affect the periodontal status of the adjacent second molars. As a key step in surgery, incision design plays a vital role in the periodontal health of the second molars and the occurrence of postoperative complications. This paper systematically reviews the domestic and international studies, expounds the operational characteristics of common incision designs such as triangular flap, modified triangular flap, envelope flap, modified envelope flap, Szmyd flap and comma flap, and their specific effects on the periodontal health of the second molars. It also analyzes the mechanism of other factors, including impaction type, patient age, preoperative periodontal status, bone removal method and suture technique, on the healing of the distal periodontal tissue of the second molars after surgery. In addition, this paper summarizes the common clinical materials and methods to protect the periodontal health of the second molars, such as platelet-rich fibrin, guided tissue regeneration, bone grafting and collagen sponge filling. At present, there is still no unified conclusion on the indications and long-term clinical effects of various incision designs. More high-quality clinical studies are needed in the future to provide more medical evidence for incision selection and periodontal protection strategies in the extraction of impacted mandibular third molars.