下顎有咬合第三大臼歯抜歯後、第二大臼歯遠位面の骨形成を促進するための歯槽骨稜保存の修正：予備的研究

Modified alveolar ridge preservation to promote the osteogenesis of the distal surface of second molar after mandibular impacted third molar extraction: a preliminary study.

抄録

目的:

下顎第三大臼歯（M3）抜歯後の第二大臼歯遠位面の骨形成に、修正歯槽骨稜保存法の使用が影響するかどうかを調べることを目的としたレトロスペクティブスタディである。

OBJECTIVES: The objective of the retrospective study was to explore whether the use of a modified alveolar ridge preservation technique impacts osteogenesis on the distal surface of the second molar after mandibular third molar (M3) extraction.

材料と方法:

本研究では、合計54名の患者を登録し、修正歯槽骨隆起保存（MARP）群、伝統的抜歯（TRA）群、古典的ガイド下骨再生（GBR）群の3群に分けた。この研究では、MARPはM3より上側と舌側の歯槽骨の保存に重点を置いてデザインされた。過去に感染症に罹患していた患者や、歯根膜炎を予防するために、患者自身の希望により異なる手術方法を選択し、各群の手術時間と手術費用を記録した。術後経過観察中に同側下顎第二大臼歯（M2）の歯周状態と遠位歯槽骨の高さを測定した。

MATERIALS AND METHODS: A total of 54 patients were enrolled in this study and divided into three different groups, including modified alveolar ridge preservation (MARP) group, traditional tooth extraction (TRA) group, and classical guided bone regeneration (GBR) group. In this study, MARP was designed with the highlights of the preservation of the alveolar bone superior and lingual to M3. These patients chose different surgical methods according to their own wishes for past infection or in order to prevent pericoronitis, and the operation time and surgical cost of each group were recorded. The periodontal conditions of the ipsilateral mandibular second molar (M2) and the height of its distal alveolar bone were measured during the postoperative follow-up.

結果:

MARP群の同側M2遠位面のプロービングデプス、臨床的アタッチメントレベル、骨欠損深さはTRA群に比べ、いずれの時点においても良好であった（いずれもP<0.05）が、術後6ヶ月の時点でGBR群と比較した場合、統計学的な差は認められなかった（いずれもP>0.05）。

RESULTS: The probing depth, clinical attachment level, and osseous defect depth on the distal surface of the ipsilateral M2 in the MARP group were better than those of the TRA group at any time of the follow-up (P < 0.05 for all), but there was no statistical difference in the measurements when compared to the GBR group at 6 months after operation (P > 0.05 for all).

結論:

このように、MARP療法は、M3抜歯後のM2遠位の歯周骨欠損の再生を改善するだけでなく、手術時間および手術費用を削減することができた。

CONCLUSIONS: Thus, MARP therapy not only improves the regeneration of periodontal osseous defects distal to the M2 after M3 extraction but also reduces the operation time and surgical cost.

臨床的意義:

本論文では、経済的かつ効果的にインパクト下顎第3大臼歯を抜歯できるだけでなく、安定した骨造成を得ることができる改良手術法を紹介する。

CLINICAL RELEVANCE: This paper introduces a modified surgical method that can not only economically and effectively remove the impacted mandibular third molar but also obtain stable osteogenesis.