埋伏阻生第三磨牙致第二磨牙牙根外吸收临床处理策略分析及病例报告

目的探讨对于埋伏阻生的第三磨牙导致第二磨牙牙根外吸收的治疗方案选择及预后分析。 方法纳入2019年1月至2021年12月期间于南方医科大学口腔医院因埋伏阻生第三磨牙导致相邻第二磨牙牙根外吸收而就诊的35例病例为观察对象,通过临床及锥形束CT（CBCT）检查,根据Ericson分类将吸收程度分为以下三类予以处理：（1）轻度吸收：16例。拔除阻生第三磨牙并在第二磨牙远中同期行骨移植术;（2）中度吸收：11例。拔除阻生第三磨牙同时保护其近中牙囊;（3）重度吸收：8例。拔除阻生第二磨牙,择期修复或行正畸治疗。于术后7 d、1个月及6个月对病例进行临床及影像学检查,随访术区及第二磨牙预后情况。 结果15例第二磨牙牙根轻度吸收及10例中度吸收病例术后6个月随访,CBCT显示牙根外吸收程度较术前无加重,第二磨牙牙髓活力正常;1例轻度吸收病例失访,1例中度吸收病例出现第二磨牙牙髓坏死;8例重度吸收病例在拔除第二磨牙后进行种植或正畸治疗。 结论通过术前CBCT检查可准确判断埋伏阻生第三磨牙导致第二磨牙牙根外吸收程度。对于牙根外吸收轻度及中度病例采用不同的干预方法可有效地阻断第二磨牙的牙根外吸收进程,且尽可能保留第二磨牙的牙髓活力。

Clinical treatment strategy of the second molars with external root resorption caused by the embedded impacted third molars: A case series

ObjectiveTo analyze the clinical treatment strategy of the second molars with external root resorption (ERR) caused by the embedded impacted third molars. MethodsFrom January 2019 to December 2021, 35 second molars with ERR caused by the impacted third molars in the Department of Oral and Maxillofacial Surgery, Stomatological Hospital of Southern Medical University, were included. Through clinical and cone-beam computed tomography (CBCT) examinations, the situation of the embedded impacted third molars and the degree of ERR of the second molars were determined. In the 16 cases with mild resorption, the impacted third molars were removed and bone grafting was performed simultaneously. In the 11 cases with moderate resorption, the impacted third molars were extracted and mesial follicles were protected. In the eight cases with severe resorption, the second molars were extracted and replaced with the third molars through orthodontic treatment or restored by implants. Clinical and CBCT examinations were taken before and after surgery (7 days, one month, and 6 months) to analyze the prognosis of the surgery sites and second molars in all cases. ResultsAfter the treatment of the 15 cases with mild ERR and 10 cases with moderate ERR, the CBCT results showed that ERR stopped and the pulp vitality was normal in 6 months after operation. The follow-up of one case with mild resorption was lost. Pulp necrosis occurred in one case with moderate ERR during follow-up. A total of eight patients with severe ERR received orthodontic or implant treatment after the extraction of the second molars. ConclusionsBy determining the degree of ERR and selecting the corresponding clinical treatments, the process of ERR can be effectively blocked, and the pulp vitality and occlusal function of the second molars can be likely retained.