对比分析功能性拔牙术与微创拔牙术在拔除埋伏下颌阻生第三磨牙（IMTM）的疗效。

前瞻性选择2024年7月至2025年6月于惠州市第一人民医院实施拔除IMTM患者94例，随机数字表法分为对照组（微创拔牙术组）与研究组（功能性拔牙术组）各47例，术后1 d、7 d、3个月随访。比较两组手术情况（手术时间、手术成功率、出血、操作难易程度、拔牙窝完整率、断根率和邻牙损伤），术后1 d出血、肿胀、疼痛视觉模拟评分量表（VAS）评分、下唇麻木和张口度情况，术后7 d疼痛、张口度、肿胀、下唇麻木和干槽症发生情况，以及术后3个月的治疗效果（牙槽骨宽度及高度、下唇麻木和颞下颌关节症状）。

研究组拔牙窝的完整性评分为（3.64 ± 0.28）分，明显优于对照组[（2.47 ± 0.14）分]，差异有统计学意义（t = 25.623，P<0.001）。术后1、7 d，研究组VAS评分分别为（0.83 ± 0.21）、（0.463 ± 0.010）分，低于对照组[（1.56 ± 0.24）、（0.527 ± 0.020）分]，差异均有统计学意义（t_{1 d} = 15.693，t_{7 d} = 19.622，P<0.001）。术后3个月，研究组牙槽骨高度为（14.1 ± 2.3）mm，高于对照组[（12.8 ± 2.6）mm]，差异有统计学意义（t = 2.449，P = 0.016）；研究组牙槽骨宽度为（6.2 ± 1.7）mm，对照组牙槽骨宽度为（5.6 ± 1.1）mm，差异也有统计学意义（t = 2.310，P = 0.023）。

功能性拔牙术拔除IMTM时拔牙窝的完整性更高，有效减轻术后短期疼痛不适，术后出血、肿胀等不良反应发生率更低，且术后3个月牙槽骨宽度与高度保留效果更优，但手术时间更长、术中出血量更多且操作难度更大。因此，功能性拔牙术手术时间长、难度高，但术后恢复效果好，具有一定的临床可行性。

To compare and analyze the efficacy of functional extraction and minimally invasive extraction in the removal of impacted mandibular third molars (IMTM) .

A total of 94 patients who underwent the removal of impacted IMTM in our hospital from July 2024 to June 2025 were prospectively selected and randomly divided into a control group (minimally invasive tooth extraction) and a study group (functional tooth extraction) using a random number table, with 47 cases in each group. Follow-up was conducted at 1 day, 7 days, and 3 months after the operation. The surgical conditions (operation time, operation success rate, bleeding, difficulty of operation, integrity of the extraction socket, root fracture rate, and damage to adjacent teeth), symptoms at 1 day after the operation [bleeding, swelling, pain visual analogue scale (VAS) score, numbness of the lower lip, and mouth opening], symptoms at 7 days after the operation (pain, mouth opening, swelling, numbness of the lower lip, and dry socket), and effects at 3 months after the operation (alveolar bone width and height, numbness of the lower lip, and temporomandibular joint symptoms) were compared between the two groups.

The integrity score of the extraction socket in the study group was (3.64 ± 0.28), which was significantly higher than that in the control group (2.47 ± 0.14), with a statistically significant difference (t = 25.623, P<0.001). At 1 day and 7 days postoperatively, the VAS scores in the study group were (0.83 ± 0.21) and (0.463 ± 0.010), respectively, which were lower than those in the control group (1.56 ± 0.24) and (0.527 ± 0.020), with statistically significant differences (t_{1 d} = 15.693, t_{7 d} = 19.622, P<0.001). At 3 months postoperatively, the alveolar bone height in the study group was (14.1 ± 2.3) mm, which was higher than that in the control group (12.8 ± 2.6) mm, with a statistically significant difference (t = 2.449, P = 0.016). The alveolar bone width in the study group was (6.2 ± 1.7) mm, compared with (5.6 ± 1.1) mm in the control group, and the difference was also statistically significant (t = 2.310, P = 0.023) .

When removing IMTM, functional extraction leads to higher integrity of the extraction socket compared with minimally invasive extraction. It can effectively alleviate short-term postoperative pain and discomfort, reduce the incidence of adverse reactions such as postoperative bleeding and swelling, and achieve better preservation of alveolar bone width and height three months after surgery, but it takes longer and involves more bleeding during the operation, and is more difficult to perform. Therefore, although functional tooth extraction has a long operation time and high difficulty, it offers good postoperative recovery outcomes and has certain clinical feasibility.