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磨牙拔掉可以不补吗？会怎样？｜證據鏈

km 編輯部2026-08-13阅读约 29 分钟
#證據鏈#牙醫KM#植牙#牙橋

本頁是〈磨牙拔掉可以不补吗？会怎样？〉的事實單元帳：每一條主張對應的來源、證據等級、地域與期間、原文引句與限制，逐條攤開。

磨牙拔掉可以不补吗？会怎样？｜證據鏈

F-Units（事实单元账）

  • F1｜confidence: verified｜basis: peer_reviewed（PMID 17559530）｜period: 2007 年发表｜geo: universal｜span: 「The mean supraeruption for subjects was 1.68 mm (SD 0.79, range 0 to 3.99 mm) and for controls, 0.24 mm (SD 0.39, range 0 to 1.46 mm)」「Supraeruption was found in 92% of subjects' unopposed teeth」「The extent of supraeruption was statistically greater in maxillary unopposed teeth than in mandibular unopposed teeth」｜caveat: 100 例加 100 对照的诊断模型研究、就诊人群，非社区普查
  • F2｜confidence: verified｜basis: peer_reviewed（PMID 17672834）｜period: 2007 年发表｜geo: universal｜span: 「A statistical significance in the degree of tipping of teeth both mesial and distal to the extraction site was detected between the subject and control groups」「Teeth mesial to the extraction site had a tendency to tip distally」｜caveat: 同系列第二部分，同一 100 加 100 样本
  • F3｜confidence: verified｜basis: peer_reviewed（PMID 17927736）｜period: 2008 年发表｜geo: universal｜span: 「Unopposed posterior teeth are more likely to be involved in RCP contacts or interferences than their matched controls」「Initial RCP contacts have associations with the extent of supraeruption of the unopposed teeth」「Working side interferences were associated with tipping of the tooth mesial to the extraction site」｜caveat: 同系列第三部分
  • F4｜confidence: verified｜basis: peer_reviewed（PMID 21902708）｜period: 追踪 12 年，2012 年发表｜geo: universal｜span: 「unopposed molars showed 4·9 times higher risk of overeruption of ≥2 mm (95% CI 1·5-15·3)」「The average overeruption for the unopposed molars was 4·5% (s.d. 7·6), which corresponds to approximately 0·9 mm」「The average mesial tipping was 0·8° (s.d. 5·6)」「Molars facing a mesial edentulous space showed a low risk for mesial tipping」｜caveat: 292 名女性的前瞻性人群研究，仅女性样本
  • F5｜confidence: verified｜basis: peer_reviewed（PMID 17371561）｜period: 2007 年发表｜geo: universal｜span: 「Partial tooth contact does not appear to prevent or reduce overeruption」「partial tooth contact should not be relied on clinically to maintain vertical tooth position」｜caveat: 91 名患者的临床研究
  • F6｜confidence: verified｜basis: peer_reviewed（PMID 16671988）｜period: 2006 年发表｜geo: universal｜span: 「when a posterior tooth has remained unopposed for 5 years or more positional changes, which cause deviation from the Broadrick curve, occur」「The extent of the deviation may be extreme, potentially leading to difficulties in restoring a harmonious occlusal scheme」｜caveat: 咬合曲线技术研究，非患者结局研究
  • F7｜confidence: verified｜basis: peer_reviewed（PMID 17002745，文献回顾）｜period: 检索自 1966 年至 2005-11，2006 年发表｜geo: universal｜span: 「no clinically significant differences between subjects with shortened dental arches of three to five occlusal units and complete dental arches regarding variables such as masticatory ability, signs and symptoms of temporomandibular disorders, migration of remaining teeth, periodontal support, and oral comfort」「No systematic clinical study with conflicting results was found」｜caveat: 叙述性回顾（非荟萃分析），主要纳入单一研究群作品
  • F8｜confidence: verified｜basis: peer_reviewed（PMID 29476794，系统综述）｜period: PROSPERO CRD42017064851，2018 年发表｜geo: universal｜span: 「there is currently insufficient evidence to recommend one tooth replacement strategy over another in adult patients with reduced dentitions」｜caveat: 纳入 10 篇；作者明确指出高质量随机对照试验不足
  • F9｜confidence: verified｜basis: peer_reviewed（PMID 28370239，系统综述与荟萃分析）｜period: 检索自 1980 年至 2016-11，2017 年发表｜geo: universal｜span: 「There was no statistically significant difference in OHIP summary scores between SDA and RPDP at 6 (SWMD = 0·24) or 12 (SWMD = 0·40) months post-treatment」「516 participants」｜caveat: 仅 2 篇 RCT 加 1 篇非 RCT，为短期（12 个月）结果
  • F10｜confidence: verified｜basis: peer_reviewed（PMID 24992473，系统综述）｜period: 2014 年发表｜geo: universal｜span: 「The shortened dental arch as a treatment option is encouraging in terms of functioning, patient satisfaction and cost-effectiveness」「some of the included studies had to be downgraded due to methodological errors」｜caveat: 叙述性合成，未做荟萃分析
  • F11｜confidence: verified｜basis: peer_reviewed（PMID 37001792，系统综述）｜period: 检索至 2022-11-06，2023 年发表｜geo: universal｜span: 「No significant difference was recorded in the nutritional status of patients rehabilitated using the SDA concept compared with RPDs」「Higher costs for treatment provision and maintenance for patients in the RPD group was found when compared to SDA treatment」｜caveat: 仅 4 份报告（来自 2 个 RCT），不能荟萃；成本结论不可换算为任何地区价格
  • F12｜confidence: verified｜basis: peer_reviewed（PMID 22733244，多中心 RCT 5 年）｜period: 2013 年发表｜geo: universal｜span: 「the Kaplan-Meier survival rates at 5 years were 0.74 (95% CI 0.64, 0.84) in the PRDP group and 0.74 (95% CI 0.63, 0.85) in the SDA group」「For tooth loss in the study jaw, the survival rates at 5 years were 0.88 … and 0.84 …. The differences were not significant」｜caveat: 152 人接受治疗、132 人完成 5 年追踪；德国多中心
  • F13｜confidence: verified｜basis: peer_reviewed（PMID 29316570，同一 RCT 10 年）｜period: 2018 年发表｜geo: universal｜span: 「the survival rates for tooth loss at 10 years were 0.44 (95% confidence interval [CI]: 0.30 to 0.56) in the PRDP group and 0.52 (95% CI: 0.37 to 0.65) in the SDA group」「The number of teeth lost was higher than expected」「The results suggest an overestimation of the influence of the prosthetic management of the bilateral SDA」「For tooth loss in the study arch, the survival rates were 0.67 (95% CI: 0.52 to 0.78) in the PRDP group and 0.60 (95% CI: 0.45 to 0.73) in the SDA group.」｜caveat: 152 人中 82 人完成 10 年检查，失访率高
  • F14｜confidence: verified｜basis: peer_reviewed（PMID 26066662，系统综述）｜period: 检索自 2003 年至 2014 年，2015 年发表｜geo: universal｜span: 「Subjects with (E)SDA had a 30-40% reduced masticatory performance」「Comminution or mixing ability in subjects with (E)SDA was 28-39% lower compared to that of subjects with complete dentitions」「distal-extension RDPs could compensate this reduction partially (some 50%)」「more artificial teeth in RDPs resulted in better performance」｜caveat: SDA 为 3 至 5 对后牙咬合、ESDA 为 0 至 2 对；纳入研究数少
  • F15｜confidence: verified｜basis: peer_reviewed（PMID 34761421，系统综述）｜period: 检索自 1966 年至 2020 年，2022 年发表｜geo: universal｜span: 「Two retrospective studies indicated that RDPs increased the risk of tooth loss compared to FDPs in patients with a history of periodontitis」「Several studies indicated that RDP increased plaque accumulation」「There is no strong evidence that RDPs per se will cause periodontal destruction including tooth loss」｜caveat: 资料异质，未做荟萃分析；人群限有牙周炎病史者
  • F16｜confidence: verified｜basis: peer_reviewed（PMID 23062124，系统综述与荟萃分析）｜period: 检索自 2006 年至 2011 年，2012 年发表｜geo: universal｜span: 「Based on the meta-analysis, survival of implants supporting SCs at 5 years amounted to 97.2% (95% CI: 96.3-97.9%), and at 10 years amounted to 95.2% (95% CI: 91.8-97.2%).」「The survival of implant-supported SCs was 96.3% (95% CI: 94.2-97.6%) after 5 years and 89.4% (95% CI: 82.8-93.6%) after 10 years.」「8.8% (95% CI: 5.1-15.0%) for screw-loosening, 4.1% (95% CI: 2.2-7.5%) for loss of retention, and 3.5% (95% CI: 2.4-5.2%) for fracture of the veneering material」「technical, biological, and aesthetic complications were frequent」「For biological complications, a 5-year cumulative soft tissue complication rate of 7.1% (95% CI: 4.4-11.3%) and a cumulative complication rate for implants with bone loss >2 mm of 5.2% (95% CI: 3.1-8.6%) were calculated.」「Based on the meta-analysis, survival of implants supporting SCs at 5 years amounted to 97.2% (95% CI: 96.3-97.9%), and at 10 years amounted to 95.2% (95% CI: 91.8-97.2%).」｜caveat: 纳入 46 篇；存留率不是成功率，不能等同个人预期
  • F17｜confidence: verified｜basis: peer_reviewed（PMID 25935732，系统综述与荟萃分析）｜period: 检索自 2006 年至 2013 年，2015 年发表｜geo: universal｜span: 「an estimated 5-year survival rate of metal-ceramic FDPs of 94.4% (95% CI: 91.2-96.5%)」「densely sintered zirconia FDPs was 90.4%」「A significantly higher incidence of caries in abutment teeth was observed for densely sintered zirconia FDPs compared to metal-ceramic FDPs」「framework fractures … reinforced glass ceramic FDPs (8.0%) and glass-infiltrated alumina FDPs (12.9%) compared to metal-ceramic FDPs (0.6%) and densely sintered zirconia FDPs (1.9%)」「The estimated survival rate of reinforced glass ceramic FDPs was 89.1% (95% CI: 80.4-94.0%), the survival rate of glass-infiltrated alumina FDPs was 86.2% (95% CI: 69.3-94.2%) and the survival rate of densely sintered zirconia FDPs was 90.4% (95% CI: 84.8-94.0%) in 5 years of function.」｜caveat: 多单位固定修复体；材料差异大
  • F18｜confidence: verified｜basis: peer_reviewed（PMID 23062127，系统综述）｜period: 2012 年发表｜geo: universal｜span: 「Initial costs for single implant crowns and FDPs on teeth were similar, but varied between tariff systems」「Failure rates reported with single implant crowns and FDPs on teeth were similar」「The utility for the patient to keep healthy adjacent teeth unprepared makes the implant crown more economic」｜caveat: 经济综述，费用制度因地而异；本卡不引用金额
  • F19｜confidence: verified｜basis: peer_reviewed（PMID 35258700，系统综述与荟萃分析）｜period: 2022 年发表｜geo: universal｜span: 「The meta-analytic study of overall survival included a total of 14 studies, yielding an overall survival rate of 97.9%」「the 5- and 10-year survival rates were 95.9% and 96.9%」｜caveat: 限牙根尚未完成发育的移植牙；不适用根尖已闭合者
  • F20｜confidence: verified｜basis: peer_reviewed（PMID 25903060，系统综述与荟萃分析）｜period: 2015 年发表｜geo: universal｜span: 「Teeth with open apex were less likely to be extracted in comparison to teeth with closed apex (3 studies; 413 teeth; relative risk 0.3; 95% confidence interval 0.2-0.6)」「Reported complications included the need for extraction, failure, hypermobility, pulp necrosis, pulp obliteration, and root resorption」「no firm conclusions can be drawn」｜caveat: 作者说明研究数少、方法学受限且异质，不能下确定结论
  • F21｜confidence: verified｜basis: peer_reviewed（PMID 36898857，伞状综述）｜period: 检索至 2022-09-25，2023 年发表｜geo: universal｜span: 「Seventeen SRs met the inclusion criteria」「The 5-year and 10-year survival rates were >95%」「Five SRs were rated as 'low quality' and 12 SRs were rated as 'critically low quality' in the AMSTAR 2 RoB assessment」｜caveat: 纳入综述的质量评级偏低，数字应保守解读
  • F22｜confidence: verified｜basis: peer_reviewed（PMID 26696138，系统综述与荟萃分析）｜period: 追踪至少 6 年的研究，2016 年发表｜geo: universal｜span: 「Survival rates ranged from 75.3% to 91% and the meta-analysis showed an effect size of 81%」「The percentage ankylosis ranged from 4.2% to 18.2% and the effect size was 4.8%」「Root resorption percentages ranged from 3% to 10% and the effect size was equal to 4%」｜caveat: 仅纳入 6 篇；长期追踪数字低于短期研究，本卡并列呈现而不择一
  • F23｜confidence: verified｜basis: peer_reviewed（PMID 16527628，回顾性研究）｜period: 2006 年发表｜geo: universal｜span: 「The subjects were 48 patients who had 128 permanent second molars extracted during or before orthodontic treatment. Their ages at extraction were 11 to 23 years」「The median time of eruption was 3 to 4 years」「A total of 96.2% of the maxillary and 66.2% of the mandibular third molars erupted in good positions」「Unsuccessful third-molar eruptions occurred in older patients who had higher Nolla developmental stages」｜caveat: 人群限正畸中的青少年和年轻成人，不能套用一般成年患者
  • F24｜confidence: verified｜basis: peer_reviewed（PMID 22211303，系统综述）｜period: 2012 年发表，纳入 20 篇｜geo: universal｜span: 「horizontal dimensional reduction (3.79 ± 0.23 mm) was more than vertical reduction (1.24 ± 0.11 mm on buccal, 0.84 ± 0.62 mm on mesial and 0.80 ± 0.71 mm on distal sites) at 6 months」「Percentage vertical dimensional change was 11-22% at 6 months. Percentage horizontal dimensional change was 32% at 3 months, and 29-63% at 6-7 months」「Soft tissue changes demonstrated 0.4-0.5 mm gain of thickness at 6 months」｜caveat: 限未处理的自然愈合拔牙窝；与本站 #28 卡同族锚
  • F25｜confidence: verified（2026-08-05 实测 200 加逐字核对，同 #9 卡锚 C2、#28 卡 F16）｜basis: law｜period: 现行条文｜geo: TW｜span: 《全民健康保險法》第 51 條「下列項目不列入本保險給付範圍：……十一、義齒、義眼、眼鏡、助聽器、輪椅、拐杖及其他非具積極治療性之裝具。」｜caveat: 个别给付以健保署现行公告为准，本卡不作给付判断
  • F26｜confidence: verified（2026-08-05 实测 200 加逐字核对）｜basis: law｜period: 现行条文｜geo: TW｜span: 《醫療法》第 81 條「醫療機構診治病人時，應向病人或其法定代理人、配偶、親屬或關係人告知其病情、治療方針、處置、用藥、預後情形及可能之不良反應。」｜caveat: 条文转述，非法律意见
  • F27｜confidence: verified（2026-08-05 实测 200）｜basis: official_statement｜period: 数据集现况｜geo: TW｜span: 政府資料開放平臺資料集「臺北市醫療收費標準」，提供機關臺北市政府衛生局｜caveat: 单一县市例证；其他县市页面在放量前逐一补验；同 #9 卡锚 C3 家族
  • F28｜confidence: verified（入口可用，2026-08-05 实测 200）｜basis: official_statement｜period: 入口现况｜geo: TW｜span: 健保署醫材比價網入口 info.nhi.gov.tw/INAE2000/INAE2010S01｜caveat: 页面由 JS 动态载入，curl 无法逐字核对；发布前须补验缺牙重建品项是否可查。2026-08-05 OP 实测更正：该网不含牙科品项，不能用来核对缺牙重建相关项目
  • F29｜confidence: verified｜basis: internal_data｜period: 2025-03 至 2026-08 GSC｜geo: TW｜span: backlog #34「第二大臼齒拔掉不補」等 7 詞項合計曝光 107,506，跨 4 站｜caveat: 曝光为资产级数字，非去重流量；
  • F30｜confidence: 结构性整理（编辑框架，非外部事实声明）｜basis: editorial_framework｜period: 2026-08-05｜geo: universal｜span: 「三個問題的拆解」與「短牙弓適用／不適用條件對照」為本站依 F1 至 F24 文獻整理的溝通用架構｜caveat: 非临床判断、非诊断工具，不替代牙医师评估

来源清单

取用日期均为 2026-08-05；完整可点击来源、作者、期刊与 URL 与 zh-Hant 母版 F1–F30 一致，逐条见其对应 F-Unit 的 PMID 或官方链接。

内部引用链

  • 拔牙后牙槽骨变化与植骨处理（KM-DENTAL-28）
  • 种植牙费用怎样问、怎样读报价单（KM-DENTAL-09）
  • “牙套”名称分流（KM-DENTAL-08）
发布闸门提醒：本卡为 draft。四语齐全前不得进入 km_entries；F28 的相关品项收录范围未实测前，仍只能作为查证路径，不得改写成价格陈述。

FAQ

第二磨牙拔掉不补，真的没关系吗？
**有条件下可维持功能，但不能一概而论。** SDA 研究的情境是三至五个咬合单位、前牙与前磨牙咬合完整；同时，研究中的无对颌牙有 92% 过度萌出，咬合对越少咀嚼表现下降越明显 [F1][F7][F14]。须由牙医师评估。
第二大臼歯を抜いて補わなくても、本当に大丈夫ですか？ — **補わずに機能を保てるという文献上の議論はありますが、条件付きです。** SDA 文献の場面は、三から五の咬合単位があり、前歯と小臼歯の咬合が保たれた人です。咀嚼能力、顎関節症状、残存歯の移動、歯周支持には一般に臨床的有意差がないとされます [F7]。一方、研究対象の対合歯のない歯の 92% に挺出があり（量の個人差は大きい）[F1]、残る咬合対が少ないほど咀嚼能率の低下は大きくなります [F14]。大丈夫かは残る咬合状態によるため、歯科医師の評価が必要です。
Is it really okay not to replace an extracted second molar? — **The literature does discuss maintaining function without replacement, but only under conditions.** SDA literature concerns people with three to five occlusal units and intact anterior and premolar occlusion; it generally found no clinically significant difference in masticatory ability, temporomandibular symptoms, migration of remaining teeth, or periodontal support [F7]. At the same time, 92% of unopposed teeth in the study population showed overeruption (with large individual variation in amount) [F1], and masticatory performance declines more as fewer occlusal pairs remain [F14]. Whether it is “okay” depends on your remaining occlusion and requires a dentist’s assessment.
不补多久会开始移位？
**没有统一的“几个月开始”时间点。** 12 年研究记录 4.9 倍风险及约 0.9 毫米；无对颌后牙达 5 年以上可见咬合曲线偏离；牙槽嵴的水平缩减在拔牙后 6 个月已可测量 [F4][F6][F24]。个体速度差异很大。
補わないと、いつから歯が動きますか？ — **文献に「何か月後から」という共通の時点はありませんが、複数の時間尺度があります。** 12 年研究は長期の蓄積を記録し、対合歯のない大臼歯で 2 mm 以上の挺出リスクは 4.9 倍、平均は約 0.9 mm でした [F4]。別研究では後方歯に 5 年以上対合歯がないと咬合曲線の位置逸脱が記録されました [F6]。歯槽骨の変化は抜歯後 6 か月以内にも測定可能で、水平減少は 3.79 ± 0.23 mm でした [F24]。個人差は大きいです。
If I do not replace it, when will teeth start to shift? — **The literature does not give one universal point such as “after a certain number of months,” but it provides several time frames.** The 12-year study records long-term accumulation: unopposed molars had 4.9 times the risk of overeruption of 2 mm or more and a mean of approximately 0.9 mm [F4]. Another study recorded deviation in the occlusal curve after a posterior tooth had been unopposed for 5 years or more [F6]. Alveolar-bone changes can be measured within 6 months after extraction (horizontal reduction 3.79 ± 0.23 mm) [F24]. Individual rates vary greatly.
智齿能替代拔掉的磨牙吗？
**文献有两条路，条件都严格。** 自然萌发数据来自正畸青少年；自体牙移植的数字受根尖发育与追踪时间影响，影像评估不可省略 [F19][F20][F22][F23]。
親知らずで抜いた臼歯を置き換えられますか？ — **文献には二つの道がありますが、どちらも条件は厳格です。** 青年矯正患者で第二大臼歯を抜いた後、第三大臼歯が良好な位置へ自然萌出した割合は上顎 96.2%、下顎 66.2%、萌出期間中央値は 3 から 4 年で、年齢が高いほど成功は少なくなりました [F23]。自家歯牙移植では根尖未閉鎖歯の統合生存率は 97.9%（10 年 96.9%）[F19] ですが、6 年以上追跡したメタ解析では 75.3% から 91%（効果量 81%）、癒着 4.8%、歯根吸収 4% とされ、根尖閉鎖歯は抜去リスクが高いです [F20][F22]。可能性は歯科医師が画像で評価します。
Can a wisdom tooth replace an extracted molar? — **The literature describes two routes, but both have strict conditions.** After second-molar extraction in adolescent orthodontic patients, 96.2% of maxillary and 66.2% of mandibular third molars erupted into a good position, with a median eruption time of 3 to 4 years; success was lower with older age [F23]. For tooth autotransplantation, pooled survival with open apices was 97.9% (96.9% at 10 years) [F19], but a meta-analysis with follow-up of 6 years or more reported survival of 75.3% to 91% (effect size 81%), with ankylosis 4.8% and root resorption 4%; closed-apex teeth had a greater risk of extraction [F20][F22]. Feasibility requires imaging assessment by a dentist.

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km 編輯部・《磨牙拔掉可以不补吗？会怎样？｜證據鏈》・IDAEO 知識庫・2026-08-13・https://km.idaeo.ai/post/reports/dental-molar-extraction-no-replacement-evidence

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