冠根分次去除法在疑或累及下牙槽神经的下颌第三阻生磨牙拔除术中的应用

目的 :评价应用截冠法分次拔除紧贴下牙槽神经的下颌阻生第三磨牙的效果。方法 :对10例术前全景片及CT均显示牙根紧贴或接触下牙槽神经的下颌阻生第三磨牙患者采用截冠留根法,于釉-牙骨质界去除阻力牙冠,包埋牙根于牙槽骨内;术后观察,待牙根移动远离下牙槽神经后再行拔除术。结果:10例患者术后反应轻微,均无下牙槽神经损伤,无感染情况出现;仅1例牙根未能上移至远离下牙槽神经的位置,留根于牙槽骨内,牙龈创面愈合,随访1年无不适。结论:根尖紧贴或接触下牙槽神经的下颌阻生第三磨牙,经截冠留根术后,断根有上移萌出趋势,可远离下牙槽神经管,后期拔除断根,可明显降低下牙槽神经损伤的风险。

Clinical evaluation for coronectomy of the impacted mandibular third molars in close proximity to inferior alveolar nerve

PURPOSE: To evaluate the outcome of coronectomy for management of impacted mandibular third molars in close proximity to inferior alveolar nerve (IAN). METHODS: Ten patients with impacted mandibular third molars which approached or was close to the inferior alveolar nerve diagnosed on panoramic film and cone-beam CT (CBCT) scan were included in the study. Coronectomy was conducted at the cemento-enamel junction, leaving the roots below the alveolar crest and primary closure was performed. After the root apex was pushed away from the inferior alveolar nerve, the impacted lower third molar was then removed. RESULTS: Ten patients had little post-operative pain and swelling, none of them had IAN injury or infection. Only 1 patient was failed to move the roots away from IAN and the roots were left in the alveolar socket, but without any symptoms and side effects during 1 year of follow-up. CONCLUSIONS: Coronectomy is effective in controlling inferior alveolar nerve injury following third molar surgery in radiographically evaluated high risk cases and it has very low incidence of complications.