Influence of Two Mucoperiosteal Flap Outlines on Neighbouring-Tooth and Mucosal Microcirculation Following Surgical Removal of Impacted Mandibular Wisdom Teeth: A Laser Doppler Flowmetry Investigation
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 56
- 试验地点
- 1
- 主要终点
- Change in mucosal microcirculation adjacent to the operative field
研究概览
简要总结
Wisdom teeth in the lower jaw are frequently buried in bone and must be taken out surgically. To reach the tooth, the surgeon lifts the gum away from the bone as a flap, and the shape of that flap is left to the surgeon's judgement. Two outlines are in everyday use. The first runs only along the necks of the teeth, so the gum is lifted without any additional cut. The second adds a short downward cut in front, which opens the field more widely but also divides some of the small vessels that run within the gum.
Because the tissues around a wound rely on a rich network of tiny vessels while they repair themselves, it is worth knowing whether these two outlines leave the local circulation in a different state. This project measured that circulation directly. A laser probe was placed against the tooth in front of the extraction site and against three points on the cheek-side gum, and the amount of moving blood beneath the probe was recorded. To make sure the probe returned to exactly the same spots at every visit, a thin clear plastic guide with prepared openings was made for each participant from a plaster model of the mouth.
Measurements were taken before the operation and again on the third and the seventh day afterwards. Facial swelling and how widely the mouth could be opened were recorded on the same occasions. Participants were assigned to one of the two flap outlines in turn, and every operation was carried out by the same surgeon so that the comparison depended on the flap outline alone.
详细描述
Fifty-six systemically healthy adults presenting for surgical removal of a single fully bone-impacted mandibular wisdom tooth were assigned to one of two mucoperiosteal flap outlines by an alternating (non-random) sequence, giving twenty-eight participants per arm. Assignment was stratified by angulation according to Winter's scheme, so that each of the four angulation categories contributed seven cases to each arm.
Microvascular perfusion was quantified in perfusion units using a laser Doppler flowmeter (Perimed, Järfälla, Sweden). One recording site lay on the mid-buccal aspect of the tooth immediately anterior to the extraction site, at the crossing of its mesiodistal and occlusocervical axes, and served as an index of pulp circulation; three further sites were distributed over the adjacent buccal mucosa. Probe position was reproduced across visits by a 2 mm transparent acrylic stent carrying prepared probe housings, constructed individually on a stone model. Each site was sampled for 30 seconds.
Swelling was derived from three facial reference distances (gonion to labial commissure, tragus to labial commissure, and gonion to lateral canthus), averaged to a single value. Mouth opening was taken as the greatest interincisal distance. Every assessment was carried out immediately before surgery and repeated on the third and seventh postoperative days, sutures being removed at the final visit.
All operations were performed by one operator with a standard armamentarium under inferior alveolar, lingual and buccal block anaesthesia, using no more than two cartridges of articaine 40 mg/mL with epinephrine 1:100,000. Bone was removed and the tooth divided with a physiodispenser and steel burs under saline cooling, and the socket was closed with 3/0 silk. All participants received amoxicillin-clavulanate, paracetamol and a benzydamine-chlorhexidine mouthrinse after the procedure. Group means were compared by repeated-measures analysis of variance with Tukey HSD pairwise testing.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 40 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Free of systemic illness and taking no regular medication
- •Aged 18 to 40 years
- •One fully bone-impacted mandibular wisdom tooth for which surgical removal is indicated
- •Ramus relationship of class II or III and depth position A, B or C on the Pell and Gregory scheme
- •Angulation falling into one of four categories on Winter's scheme: vertical, mesioangular, horizontal or distoangular
- •Neighbouring second molar intact, i.e. without extensive caries, endodontic treatment, a large filling or a crown
- •Willing and able to give written consent and to attend both follow-up visits
排除标准
- •Any systemic disorder, or use of medication on a continuing basis
- •Tobacco use
- •Previous irradiation or chemotherapy involving the head and neck
- •Infection within the mouth at the time of surgery, including acute pericoronitis
- •Pregnancy or suspected pregnancy
- •Menstruation at the time of a scheduled measurement
- •Need for more than two anaesthetic cartridges to achieve profound anaesthesia
研究组 & 干预措施
Sulcular (envelope) flap
The mucoperiosteum is raised through an incision confined to the gingival sulcus, carried from the mesial aspect of the first molar back to the distal aspect of the second molar and then along the external oblique ridge. No vertical cut is made.
干预措施: Sulcular flap elevation for wisdom tooth removal (Procedure)
Three-cornered (trapezoidal) flap
The same sulcular and posterior incision is used, with the addition of a vertical relieving cut placed anterior to the second molar and kept clear of the interdental papilla.
干预措施: Three-cornered flap elevation for wisdom tooth removal (Procedure)
结局指标
主要结局
Change in mucosal microcirculation adjacent to the operative field
时间窗: Immediately before surgery, and on postoperative days 3 and 7
Perfusion in perfusion units (PU) at three buccal mucosal sites recorded by laser Doppler flowmetry through the same stabilising stent, 30 seconds per site. The most anterior site lies in the region traversed by the vertical relieving cut of the three-cornered outline.
Change in pulp microcirculation of the tooth adjacent to the extraction site
时间窗: Immediately before surgery, and on postoperative days 3 and 7
Perfusion recorded in perfusion units (PU) by laser Doppler flowmetry over the mid-buccal aspect of the neighbouring second molar, with probe position reproduced by an individually made acrylic stent. Each recording lasts 30 seconds. A higher value indicates greater circulation.
次要结局
- Change in facial swelling(Immediately before surgery, and on postoperative days 3 and 7)
- Change in maximum mouth opening(Immediately before surgery, and on postoperative days 3 and 7)
- Duration of the operation(Day of surgery (day 0), intraoperative)
研究者
Betül Taş Özyurtseven
Associate Professor of Oral and Maxillofacial Surgery, Senior Researcher / Clinician
University of Gaziantep