Yrd. Doç. Dr. M. Emre BENLİDAYI, Öğr. Gör. Dr. Ufuk TATLI, Dt. Fariz SALİMOV

Gömülü üçüncü molar diş operasyonunda piezoelektrik kemik cerrahisi ve geleneksel döner enstrümanların karşılaştırılması

Amaç: Bu çalışmanın amacı, gömülü alt üçüncü molar operasyonunda kullanılan piezoelektrik cerrahisinin ve döner enstrümanların operasyon sonrası enflamatuar yanıt üzerindeki etkilerini değerlendirmek ve karşılaştırmaktır. Bireyler ve Yöntem: Çalışmaya, simetrik olarak gömülü mandibular üçüncü molar dişlere sahip 26 sağlıklı hasta dahil edildi. Birinci operasyonda, bukkal ostetomi rond frez ile gerçekleştirildi (Frez grubu). İkinci operasyonda, kemik kaldırmak için piezoelektrik cerrahi tekniği kullanıldı (Piezo grubu). Cerrahi işlem süresi, ağrı, trismus ve yüzdeki şişlik değerlendirildi. Bulgular: Ortalama cerrahi işlem süresi piezo grubunda anlamlı olarak daha uzun bulundu (p=0,003). Operasyon sonrası ikinci günde, dinlenme (p=0,005) ve çiğneme (p<0,001) anındaki ortalama VAS ağrı skorları ve operasyon sonrası yedinci günde çiğneme anındaki (p<0,001) ortalama VAS ağrı skoru frez grubunda anlamlı olarak daha yüksek tespit edildi. Operasyon sonrası yedinci günde, piezo grubunda alınan analjezik tabletlerin sayısı frez grubundan anlamlı olarak daha az sayıdaydı (p=0,013). Frez grubunda, ortalama yüz şişliği operasyon sonrası ikinci (p<0,001) ve yedinci (p=0,003) günlerde piezo grubundan anlamlı olarak daha fazla tespit edildi. Operasyon sonrası ikinci (p<0,001) ve yedinci (p<0,001) günlerde frez grubunda trismus anlamlı olarak daha yüksek bulundu. Sonuç: Bu çalışmada elde edilen bulgulara göre, piezoelektrik kemik cerrahisi gömülü üçüncü molar diş operasyonu sonrası morbiditeyi azaltmak ve iyileşmeyi hızlandırmak için kullanılabilecek alternatif bir yöntemdir.

Anahtar Kelimeler:

piezoelektrik cerrahi; gömülü üçüncü molar; morbidite; iyileşme

Comparison of piezoelectric bone surgery and traditional rotary instruments in impacted third molar surgery

Purpose: The aim of this study was to evaluate and compare the effects of piezoelectric surgery and rotary instruments on the inflammatory response in the impacted lower third molar surgery. Patients and Methods: Twenty-six healthy patients with symmetrically impacted mandibular third molars were included. In the first operation, buccal osteotomy was performed with a round burr (Rotary group). In the second operation, piezoelectric surgery was used for bone removal (Piezo group). Duration of surgery, pain, trismus and cheek swelling were evaluated. Results: The mean duration of surgery was significantly longer in the piezo group (p=0.003). On the second postoperative day, the mean VAS pain scores during rest (p=0.005) and chewing (p<0.001) and on the seventh postoperative day during chewing (p<0.001) were significantly higher in the rotary group. On the seventh postoperative day, the number of analgesic tablets taken in the piezo group was significantly lower than the rotary group (p=0.013). The mean facial swelling in the rotary group was significantly higher than the piezo group on the second postoperative day (p<0.001) and on the seventh postoperative day (p=0.003). On the second (p<0.001) and seventh postoperative days (p<0.001) trismus was significantly higher in the rotary group. Conclusion: According to the findings of the present study, piezoelectric bone surgery is an alternative method to reduce morbidity and to improve recovery after impacted third molar surgery.

Keywords:

piezoelectric surgery; impacted third molar; morbidity; recovery,

PDF

___

Etöz M, Şekerci AE, Şişman Y. Türk toplumunda üçüncü molar dişlerin retrospektif radyografik analizi. Atatürk Üniv Diş Hek Fak Derg 2011;21:170-4.
Sisk AL, Hammer WB, Shelton DW, Joy ED. Complications following removal of impacted third molars: the role of the experience of the surgeon. J Oral Maxillofac Surg 1986;44:855-9.
Üstün Y, Erdogan O, Esen E, Karsli ED. Comparison of the effects of 2 doses of methylprednisolone on pain, swelling, and trismus after third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:535-9.
Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg 2002;195:694-711.
Barone A, Marconcini S, Giacomelli L, Rispoli L, Calvo JL, Covani U. A randomized clinical evaluation of ultrasound bone surgery versus traditional rotary instruments in lower third molar extraction. J Oral Maxillofac Surg 2010;68:330-6.
Montgomery MT, Hoggs JP, Robers DL, Redding SW. The use of glucocorticosteroids to lessen the inflammatory sequelae following third molar surgery. J Oral Maxillofac Surg 1990;48:179-87.
Yapıcı ET, Keskin M, Yılmaz NT, Öğütcen Toller M. Diflunizal ve tiaprofenik asitin alt gömülü 3. molar dişlerin postoperatif ağrı ve trismus üzerine etkilerinin değerlendirilmesi. Cumhuriyet Üniv Diş Hek Fak Derg 1999;2:33-6.
Satılmış T, Gönül O, Garip H, Altun A, Göker K. Gömülü üçüncü molar diş cerrahisinde submukozal tramadol uygulamasının postoperatif ağrı üzerine etkinliği. Marmara Üniv Sağlık Bil Enst Derg 2012;2:26-30.
Roynesdal AK, Bjornland T, Barkvoll P, Haanaes HR. The effect of soft-laser application on postoperative pain and swelling. A double-blind crossover study. Int J Oral Maxillofac Surg 1993;22:242-5.
Forouzanfar T, Sabelis A, Ausems S, Baart JA, van der Waal I. Effect of ice compression on pain after mandibular third molar surgery: A single- blind, randomized controlled trial. Int J Oral Maxillofac Surg 2008;37:824-30.
Sortino F, Pedullà E, Masoli V. The piezoelectric and rotatory osteotomy technique in impacted third molar surgery: comparison of postoperative recovery. J Oral Maxillofac Surg 2008;66:2444-8.
Labanca M, Azzola F, Vinci R, Rodella LF. Piezoelectric surgery: twenty years of use. Br J Oral Maxillofac Surg 2008;46:265-9.
Vercellotti T, De Paoli S, Nevins M. The piezoelectric bony window osteotomy and sinus membrane elevation: introduction of a new technique for simplification of the sinus augmentation procedure. Int J Periodontics Restorative Dent 2001;21:561–7.
Vercellotti T, Pollack AS. A new bone surgery device: sinus grafting and periodontal surgery. Compend Contin Educ Dent 2006;27:319-25.
Martí-Bowen E, Peñarrocha-Diago M, García-Mira B. Periapical surgery using the ultrasound technique and silver amalgam retrograde filling. A study of 71 teeth with 100 canals. Med Oral Patol Oral Cir Bucal 2005;10:E67-73.
Blus C, Szmukler-Moncler S. Split-crest and immediate implant placement with ultrasonic bone surgery. A 3-year clinical experience with 230 treated sites. Clin Oral Implants Res 2006;17:700
Escoda-Francolí J, Rodríguez-Rodríguez A, BeriniAytés L, Gay-Escoda C. Application of ultrasound in bone surgery: Two case reports. Med Oral Patol Oral Cir Bucal 2010;15:e902-5.
Chiriac G, Herten M, Schwarz F, Rothamel D, Becker J. Autogenous bone chips: influence of a new piezoelectric device (Piezosurgery) on chip morphology, cell viability and differentiation. J Clin Periodontol 2005;32:994-9.
Metzger MC, Bormann KH, Schoen R, Gellrich NC, Schmelzeisen R. Inferior alveolar nerve transposition - an in vitro comparison between piezosurgery and conventional bur use. J Oral Implantol 2006;32:19-25.
Robiony M, Polini F, Costa F, Vercellotti T, Politi M. Piezoelectric bone cutting in multipiece maxillary osteotomies. J Oral Maxillofac Surg 2004;62:75961
Beziat JL, Bera JC, Lavandier B, Gleizal A. Ultrasonic osteotomy as a new technique in craniomaxillofacial surgery. Int J Oral Maxillofac Surg 2007;36:493-500.
Pell GJ, Gregory GT: Report on a ten-year study of a tooth division technique for the removal of impacted teeth, Am J Orthod 28:660, 1942.
Schultze-Mosgau S, Schmelseizen R, Frolich JC, Schmele H. Use of ibuprofen and methylprednisolone for the prevention of pain and swelling after removal of impacted third molars. J Oral Maxillofac Surg 1995;53:2-7.
Gabka J, Matsumura T. Measuring techniques and clinical testing of an anti-inflammatory agent (tantum). Munch Med Wochenschr 1971;113:9820
Gruber RM, Kramer FJ, Merten HA, Schliephake H. Ultrasonic surgery—an alternative way in orthognathic surgery of the mandible. A pilot study. Int J Oral Maxillofac Surg 2005;34:590–3.
Kotrikova B, Wirtz R, Krempien R, Blank J, Eggers G, Samiotis A, Mühling J. Piezosurgery--a new safe technique in cranial osteoplasty? Int J Oral Maxillofac Surg 2006;35:461-5.
Pedersen A. Interrelations of complaints after removal of impacted mandibular third molars. Int J Oral Maxillofac Surg 1985;14:241-4.
Oikarinen K. Postoperative pain after mandibular third molar surgery. Acta Odontol Scand 1991;49:7-13.
Lago-Mendez L, Diniz-Freitas M, Senra-Rivera C, Gude-Sampedro F, Gándara Rey JM, García-García A. Relationship between surgical difficulty and postoperative pain in lower third molar extractions. J Oral Maxillofac Surg 2007;65:979-83.
Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Creminelli L, Santoro F. Assessing postoperative discomfort after third molar surgery: A prospective study. J Oral Maxillofac Surg 2007;65:901-17.
Benediktsdottir IS, Wenzel A, Petersen JK, Hintze H. Mandibular third molar removal: Risk indicators for extended operation time, postoperative pain and complications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:438-46. Yazışma Adresi: Yrd. Doç. Dr. M. Emre BENLİDAYI
Çukurova Üniversitesi Diş Hekimliği Fakültesi, Ağız Diş ve Çene Cerrahisi AD 01330 Balcali / Adana / TURKEY Telefon: + 90 322 338 73 13 Faks: + 90 322 338 73 13
E-posta: ebenlidayi@cu.edu.tr