不同翻瓣设计对下颌第三磨牙拔除术后疼痛的影响:系统评价与Meta分析
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摘要
目的评价不同翻瓣设计对下颌第三磨牙拔除术后疼痛的影响。方法对9个常用数据库进行电子检索,检索时间截至2018年6月29日;并对纳入研究参考文献进行手检。研究质量由2位评价者独立使用Cochrane协作网推荐的标准进行评价并提取数据。应用Review Manager 5.3软件进行Meta分析。结果共纳入17项RCT研究,纳入受试者合计1 033人,纳入牙数合计1 421颗。17项研究中,1项高偏倚风险,其他16项偏倚风险不确定。封套瓣的术后疼痛轻于标准三角瓣,差异有统计学意义;封套瓣与Szmyd瓣之间差异无统计学意义。结论Szmyd瓣或封套瓣术后疼痛较标准三角瓣轻,考虑到封套瓣操作的便利性,实际应用中可能优于其他翻瓣设计。
Objective This review aimed to assess the effects of flap design on pain after the extraction of mandibular third molars. Methods Nine databases were searched electronically on 29 June 2018. A manual search of reference lists of included studies was conducted. Two reviewers performed quality assessment independently with tools suggested by Cochrane's handbook, and then, they extracted data. Meta-analysis was performed using Review Manager 5.3. Results Seventeen studies with 1 033 participants and 1 421 teeth were included. Among these studies, one was at high risk of bias, whereas the risk in the other 16 was unclear. The postoperative pain of envelope flap was milder than that of standard triangular flap, and the difference was statistically significant. No significant difference was found in postoperative pain between envelope flap and Szmyd flap. Conclusion Envelope flap and Szmyd flap can be more effective in reducing the postoperative pain of patients than standard triangular flap.
Objective This review aimed to assess the effects of flap design on pain after the extraction of mandibular third molars. Methods Nine databases were searched electronically on 29 June 2018. A manual search of reference lists of included studies was conducted. Two reviewers performed quality assessment independently with tools suggested by Cochrane's handbook, and then, they extracted data. Meta-analysis was performed using Review Manager 5.3. Results Seventeen studies with 1 033 participants and 1 421 teeth were included. Among these studies, one was at high risk of bias, whereas the risk in the other 16 was unclear. The postoperative pain of envelope flap was milder than that of standard triangular flap, and the difference was statistically significant. No significant difference was found in postoperative pain between envelope flap and Szmyd flap. Conclusion Envelope flap and Szmyd flap can be more effective in reducing the postoperative pain of patients than standard triangular flap.
引文
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[2]Karaca I,Sim?ek S,U?ar D,et al.Review of flap design influence on the health of the periodontium after mandibular third molar surgery[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2007,104(1):18-23.
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[6]Abandansari AS,Foroughi R.The effect of releasing incision on the postoperative complications of mandibular third molar surgery[J].Int J Adv Biotechnol Res,2016,7(S3):1144-1151.
[7]Nageshwar.Comma incision for impacted mandibular third molars[J].J Oral Maxillofac Surg,2002,60(12):1506-1509.
[8]Roode GJ,Bütow K.An alternative surgical flap design for impacted third molars:a comparison of two different surgical techniques[J].SADJ,2010,65(6):246,248-251.
[9]Goldsmith SM,De Silva RK,Tong DC,et al.Influence of a pedicle flap design on acute postoperative sequelae after lower third molar removal[J].Int JOral Maxillofac Surg,2012,41(3):371-375.
[10]Mobilio N,Vecchiatini R,Vasquez M,et al.Effect of flap design and duration of surgery on acute postoperative symptoms and signs after extraction of lower third molars:a randomized prospective study[J].J Dent Res Dent Clin Dent Prospects,2017,11(3):156-160.
[11]Baqain ZH,Al-Shafii A,Hamdan AA,et al.Flap design and mandibular third molar surgery:a split mouth randomized clinical study[J].Int J Oral Maxillofac Surg,2012,41(8):1020-1024.
[12]Erdogan O,Tatl?U,Ustün Y,et al.Influence of two different flap designs on the sequelae of mandibular third molar surgery[J].Oral Maxillofac Surg,2011,15(3):147-152.
[13]何锦泉,欧阳可雄,张清彬,等.2种切开翻瓣法拔除下颌智牙的临床效果分析[J].上海口腔医学,2015,24(2):224-227.He JQ,Ouyang KX,Zhang QB,et al.Comparison of two different flap designs in removal of impacted wisdom tooth[J].Shanghai J Stomatol,2015,24(2):224-227.
[14]Kim HR,Choi BH,Engelke W,et al.A comparative study on the extractions of partially impacted mandibular third molars with or without a buccal flap:a prospective study[J].J Oral Maxillofac Surg,2011,69(4):966-970.
[15]Kirk DG,Liston PN,Tong DC,et al.Influence of two different flap designs on incidence of pain,swelling,trismus,and alveolar osteitis in the week following third molar surgery[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2007,104(1):e1-e6.
[16]Korkmaz YT,Mollaoglu N,Ozmeri?N.Does laterally rotated flap design influence the short-term periodontal status of second molars and postoperative discomfort after partially impacted third molar surgery[J].J Oral Maxillofac Surg,2015,73(6):1031-1041.
[17]Koyuncu B?,Cetingül E.Short-term clinical outcomes of two different flap techniques in impacted mandibular third molar surgery[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2013,116(3):e179-e184.
[18]Koyuncu B?,Zeyt?no?lu M,?et?ngül E.Comparison of 2 different flap techniques in the surgical removal of bilateral impacted mandibular third molars[J].Turk J Med Sci,2013,43(6):891-898.
[19]乔峰,朱东望.封套瓣与三角瓣对下颌第三磨牙拔除术后并发症的影响[J].天津医药,2015,43(1):78-81.Qiao F,Zhu DW.The influence of the envelope flap and triangular flap designs on postoperative complications after mandibular third molar removal[J].Tianjin Med J,2015,43(1):78-81.
[20]Tareen MK,Hamad J,Saleem SM,et al.To compare the triangular flap to envelop flap for the removal of impacted mandibular last molar[J].Pakistan J Med Health Sci,2015,9(1):434-436.
[21]Yolcuü,Acar AH.Comparison of a new flap design with the routinely used triangular flap design in third molar surgery[J].Int J Oral Maxillofac Surg,2015,44(11):1390-1397.
[22]Briguglio F,Zenobio EG,Isola G,et al.Complications in surgical removal of impacted mandibular third molars in relation to flap design:clinical and statistical evaluations[J].Quintessence Int,2011,42(6):445-453.
[23]Laskin DM.Indications and contraindications for removal of impacted third molars[J].Dent Clin North Am,1969,13(4):919-928.
[24]Saravana KB,Sarumathi T,Veerabahu M,et al.To compare standard incision and comma shaped incision and its influence on post-operative complications in surgical removal of impacted third molars[J].JClin Diagn Res,2013,7(7):1514-1518.
[25]Szmyd L.Impacted teeth[J].Dent Clin North Am,1971,15(2):299-318.
[26]Rai A,Rai M.Lingual based four cornered flap for third molar surgery[J].J Maxillofac Oral Surg,2017,16(2):258-259.
[27]华成舸.微创拔牙的刚体力学分析[J].华西口腔医学杂志,2017,35(2):119-123.Hua CG.Geostatics in minimally invasive surgical exodontias[J].West Chin J Stomatol,2017,35(2):119-123.
[2]Karaca I,Sim?ek S,U?ar D,et al.Review of flap design influence on the health of the periodontium after mandibular third molar surgery[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2007,104(1):18-23.
[3]Coulthard P,Bailey E,Esposito M,et al.Surgical techniques for the removal of mandibular wisdom teeth[J].Cochrane Database Syst Rev,2014(7):CD004345.
[4]Higgins JPT,Green S.Cochrane handbook for systematic reviews of interventions[EB/OL].http://handbook-5-1.cochrane.org,2011-03-01.
[5]Sandhu A,Sandhu S,Kaur T.Comparison of two different flap designs in the surgical removal of bilateral impacted mandibular third molars[J].Int J Oral Maxillofac Surg,2010,39(11):1091-1096.
[6]Abandansari AS,Foroughi R.The effect of releasing incision on the postoperative complications of mandibular third molar surgery[J].Int J Adv Biotechnol Res,2016,7(S3):1144-1151.
[7]Nageshwar.Comma incision for impacted mandibular third molars[J].J Oral Maxillofac Surg,2002,60(12):1506-1509.
[8]Roode GJ,Bütow K.An alternative surgical flap design for impacted third molars:a comparison of two different surgical techniques[J].SADJ,2010,65(6):246,248-251.
[9]Goldsmith SM,De Silva RK,Tong DC,et al.Influence of a pedicle flap design on acute postoperative sequelae after lower third molar removal[J].Int JOral Maxillofac Surg,2012,41(3):371-375.
[10]Mobilio N,Vecchiatini R,Vasquez M,et al.Effect of flap design and duration of surgery on acute postoperative symptoms and signs after extraction of lower third molars:a randomized prospective study[J].J Dent Res Dent Clin Dent Prospects,2017,11(3):156-160.
[11]Baqain ZH,Al-Shafii A,Hamdan AA,et al.Flap design and mandibular third molar surgery:a split mouth randomized clinical study[J].Int J Oral Maxillofac Surg,2012,41(8):1020-1024.
[12]Erdogan O,Tatl?U,Ustün Y,et al.Influence of two different flap designs on the sequelae of mandibular third molar surgery[J].Oral Maxillofac Surg,2011,15(3):147-152.
[13]何锦泉,欧阳可雄,张清彬,等.2种切开翻瓣法拔除下颌智牙的临床效果分析[J].上海口腔医学,2015,24(2):224-227.He JQ,Ouyang KX,Zhang QB,et al.Comparison of two different flap designs in removal of impacted wisdom tooth[J].Shanghai J Stomatol,2015,24(2):224-227.
[14]Kim HR,Choi BH,Engelke W,et al.A comparative study on the extractions of partially impacted mandibular third molars with or without a buccal flap:a prospective study[J].J Oral Maxillofac Surg,2011,69(4):966-970.
[15]Kirk DG,Liston PN,Tong DC,et al.Influence of two different flap designs on incidence of pain,swelling,trismus,and alveolar osteitis in the week following third molar surgery[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2007,104(1):e1-e6.
[16]Korkmaz YT,Mollaoglu N,Ozmeri?N.Does laterally rotated flap design influence the short-term periodontal status of second molars and postoperative discomfort after partially impacted third molar surgery[J].J Oral Maxillofac Surg,2015,73(6):1031-1041.
[17]Koyuncu B?,Cetingül E.Short-term clinical outcomes of two different flap techniques in impacted mandibular third molar surgery[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2013,116(3):e179-e184.
[18]Koyuncu B?,Zeyt?no?lu M,?et?ngül E.Comparison of 2 different flap techniques in the surgical removal of bilateral impacted mandibular third molars[J].Turk J Med Sci,2013,43(6):891-898.
[19]乔峰,朱东望.封套瓣与三角瓣对下颌第三磨牙拔除术后并发症的影响[J].天津医药,2015,43(1):78-81.Qiao F,Zhu DW.The influence of the envelope flap and triangular flap designs on postoperative complications after mandibular third molar removal[J].Tianjin Med J,2015,43(1):78-81.
[20]Tareen MK,Hamad J,Saleem SM,et al.To compare the triangular flap to envelop flap for the removal of impacted mandibular last molar[J].Pakistan J Med Health Sci,2015,9(1):434-436.
[21]Yolcuü,Acar AH.Comparison of a new flap design with the routinely used triangular flap design in third molar surgery[J].Int J Oral Maxillofac Surg,2015,44(11):1390-1397.
[22]Briguglio F,Zenobio EG,Isola G,et al.Complications in surgical removal of impacted mandibular third molars in relation to flap design:clinical and statistical evaluations[J].Quintessence Int,2011,42(6):445-453.
[23]Laskin DM.Indications and contraindications for removal of impacted third molars[J].Dent Clin North Am,1969,13(4):919-928.
[24]Saravana KB,Sarumathi T,Veerabahu M,et al.To compare standard incision and comma shaped incision and its influence on post-operative complications in surgical removal of impacted third molars[J].JClin Diagn Res,2013,7(7):1514-1518.
[25]Szmyd L.Impacted teeth[J].Dent Clin North Am,1971,15(2):299-318.
[26]Rai A,Rai M.Lingual based four cornered flap for third molar surgery[J].J Maxillofac Oral Surg,2017,16(2):258-259.
[27]华成舸.微创拔牙的刚体力学分析[J].华西口腔医学杂志,2017,35(2):119-123.Hua CG.Geostatics in minimally invasive surgical exodontias[J].West Chin J Stomatol,2017,35(2):119-123.