下颌第三磨牙阻生拔除术中失误及并发症防治

目的　通过临床病例分析 ,总结下颌阻生第三磨牙拔除术中失误及术后并发症的防治。方法　对194 5例下颌阻生第三磨牙拔除术中失误的 15 9例回顾总结 ,并对因失误而引起术后并发症 112例归类分析 ,提出减少术中失误及术后并发症的措施。结果　本组病例可见阻生牙拔除术中失误是导致术后并发症的一个重要原因 ,手术失误率为 8% ,而术后并发症占失误病例的 71%。结论　阻生牙拔除发生术中失误的原因 :对第三磨牙阻力估计不足 ;选择拔牙方法不当 ,造成创伤过大 ;术者的手术操作过于粗暴 ,术中保护措施不当。在行下颌阻生第三磨牙拔除术时 ,只要术前认真检查 ,仔细分析阻力情况 ,选择合适的拔牙方法 ,规范操作 ,大部分术中失误可以避免。即使发生失误 ,采取积极补救措施 ,亦可减少术后并发症。     

下颌近中阻生第三磨牙拔除方法与神经损伤危险因素分析

目的: 调查分析下颌近中阻生第三磨牙拔除术后牙槽骨缺损及下牙槽神经（inferior alveolar nerve,IAN）损伤发生的影响因素,为今后制定更具针对性的预防措施提供参考。方法: 回顾性调查分析500例口腔门诊顺利完成下颌近中阻生第三磨牙拔除术患者的临床资料、影像学资料、随访资料等,对比分析发生与未发生牙槽骨缺损及神经损伤患者的资料,明确危险因素。采用SPSS18.0软件包进行Logistic回归分析,研究发生牙槽骨缺损及神经损伤的独立危险因素。结果: 500例患者中,52例 (10.40%)发生IAN损伤。经单因素分析和Logistic回归分析发现,患者年龄、手术切口、拔牙器械、拔牙术方案、术后其他并发症（血肿、感染、干槽症）均为下颌近中阻生第三磨牙拔除术后牙槽骨缺损及神经损伤的危险因素（P<0.05）。结论: 术前充分考虑患者年龄、下颌阻生第三磨牙的阻生形态、解剖结构、牙根和下颌管位置关系,进而评估拔除风险、个性化拟定手术方案并选择最佳的手术器械,可预防术后并发症的发生。     

下颌双侧低位近中阻生第三磨牙微创与传统拔除的对照研究

目的 :通过同体对照方法 ,比较微创法与传统凿骨劈冠法拔除下颌低位近中阻生第三磨牙的临床效果。方法:2012—2015年,在浦东新区人民医院口腔科就诊,需拔除双侧下颌低位近中阻生智齿的患者120例。随机分为2组,第1组一侧第三磨牙首先采用微创拔牙技术拔除(研究组),另一侧采用凿骨劈冠法拔除(对照组),两次操作间隔3个月。第2组拔牙方法的顺序相反,先用凿骨劈冠法拔除一侧第三磨牙(对照组),3月后采用微创拔牙法拔除另一侧(研究组)。对两种拔牙方法患者的拔牙时间、术中并发症、术后并发症、患者满意度、牙科畏惧率等进行比较观测和统计学分析。结果:研究组的拔牙时间、术中并发症、术后并发症、畏惧率明显较对照组低,两组间差距有统计学意义;且研究组患者满意度高,两组间差距有统计学意义。结论:运用微创拔牙技术拔除下颌低位阻生智齿,临床效果优于传统的凿骨劈冠法。     

下颌埋伏第三磨牙拔除中导致断根风险的相关因素分析（英文）

目的:分析总结与下颌埋伏第三磨牙断根有关的影像学或临床表现,分析断根风险的相关因素以指导临床。方法:2013-11—2014-10期间共收集91例下颌埋伏阻生的第三磨牙患者的完整术前、术中相关影像学和临床表现数据并分析。所有患者在同样环境标准流程下治疗,由未提前告知研究目的不同临床医生处理。结果采用卡方检验或t检验。结果 :91例病例中,12例在拔牙术中出现断根(断根率13.1%)。经统计分析,患者年龄、阻生深度、牙根数目、医生资历均与断根发生率有相关(P<0.05)。在多根牙,拔牙方式(是否分根)对断根发生有意义。经统计分析,其他因素与断根发生之间无相关。结论:与下颌阻生第三磨牙拔除时断根相关的高危因素有患者年龄、阻生深度、医生经验、牙根数目和拔除方式。     

下颌第三磨牙阻生两种拔除术的并发症比较

目的:对比两种方法拔除下颌阻生的第三磨牙在术中或术后出现并发症的情况,分析其可能原因及预防方法。方法:回顾分析我科分别用涡轮机钻法和凿劈法拔除的524例下颌第三磨牙阻生病例中,出现术中或术后并发症的131例病例。结果:采用涡轮机钻法拔除的298例病例中,出现术中或术后并发症的有53例,占17.8%;而采用凿劈法拔除的226例病例,出现术中或术后并发症的有78例,占34.5%。手术创伤大、保护措施不到位和术中产热量大,是造成手术并发症的重要原因。结论:涡轮机钻法拔除阻生的下颌第三磨牙可减少拔牙手术并发症,术中并发症的出现会导致和加重术后并发症的发生。     

改良法拔除下颌阻生第三磨牙

目的：下颌完全埋伏阻生第三磨牙的患者运用改良法拔除,研究患者的心理状态、拔牙时间及术后并发症的发生率。方法：对符合标准的患者用传统法先拔除一侧下颌阻生第三磨牙,1个月后用改良法拔除患者对侧下颌阻生的第三磨牙,以自身对比研究2种拔牙方法对患者心理状态的影响及两者拔牙时间、术后并发症发生率。结果：通过实验可知,改良法能减轻患者的紧张、焦虑、疼痛,得到患者认可。在术后并发症中除了干槽症的与传统法无显著性差异外,术后肿胀、疼痛、张口受限等的差异均有显著性。结论：改良法拔除下颌完全埋伏阻生第三磨牙是一种符合现代医学行为模式的方法,值得临床推广应用。     

下颌阻生第三磨牙规范化微创拔除

牙及牙槽外科是口腔颌面外科的重要分支.下颌阻生第三磨牙拔除术是牙及牙槽外科最常见的手术.下颌阻生第三磨牙常见的阻生分类有垂直阻生、水平阻生、近中阻生及远中阻生等.术前通过影像学检查以及口内检查评估下颌阻生第三磨牙的拔除难度,进行阻力分析,可有效提高拔牙效率、缩短手术时间、减少拔牙并发症.本文结合临床病例对下颌阻生第三磨牙的规范化微创拔除进行详细阐述,旨在为临床工作者提供帮助.     

上颌埋伏阻生第三磨牙78例微创拔除的临床总结

目的评价微创拔除较为困难上颌埋伏阻生第三磨牙的临床效果。 方法2012年1月至2017年3月期间就诊广州市海珠区口腔医院口腔颌面外科诊断为上颌埋伏阻生第三磨牙共计78例,排除拔牙禁忌证,锥形束CT（CBCT）检查评估患牙位置与毗邻重要解剖结构的位置关系,利用微创拔牙器械与方法拔除患牙。术后1周评估微创拔牙方法的效果以及其并发症发生率等。 结果78例微创拔牙手术时间为3~ 45 min,平均13 min。手术期间患者感觉无明显不适,微创拔牙术后不良反应较低,78例均未出现严重并发症的情况。 结论微创拔牙在拔除较为困难的上颌埋伏阻生第三磨牙中具有一定优势,值得临床推广使用。     

高速涡轮机应用于齿槽外科的护理配合

目的探讨高速涡轮机应用于齿槽外科的护理配合方法。方法回顾应用高速涡轮机法拔除下颌阻生第三磨牙的468例患者资料,总结临床护理配合要点。结果468例患者第三磨牙均顺利拔除,术中无大出血及周围软组织损伤等严重并发症。结论高速涡轮机法拔除下颌阻生第三磨牙,减轻了患者的焦虑情绪,减少了手术创伤及并发症的发生,临床护理配合时,应保持良好的护患关系,保持术野清晰,注意控制交叉感染,熟练的"四手"操作配合有助于顺利完成拔牙术。     

涡轮机拔牙法和传统拔牙法拔除下颌阻生第三磨牙对照研究

目的　比较传统拔牙法和涡轮机拔牙法在下颌阻生第三磨牙拔除中的利弊。方法　选取需拔除双侧下颌阻生第三磨牙且两侧牙齿阻生类型相似的患者共45例,将同一患者的下颌双侧阻生第三磨牙随机分为2组,分别采用传统拔牙术（A组）和涡轮机拔牙术（B组）予以拔除。传统拔牙法应用劈冠器将牙劈开,敲击骨凿去骨,再用牙挺将敲碎的牙分块挺出;而涡轮机拔牙法采用45°仰角涡轮机进行去骨分牙,再用牙挺将敲碎的牙分块挺出。比较两组拔牙时间,患者的拔牙主观感受,术后第2天面部肿胀、疼痛、张口受限情况和术中、术后并发症。结果　A组拔除下颌阻生第三磨牙耗时5.5~76分,平均26.4分;B组耗时7~39.5分,平均22.4分。A组中,患者在拔牙时感觉明显不适或更严重不适占80%,而B组仅占15.6%,明显减轻。另外,B组拔牙后肿胀、疼痛和张口受限程度均较A组轻,且并发症发生率小。结论　涡轮机拔牙术可有效缩短拔牙时间,并可以使手术医生在拔牙过程中发挥更加稳定,能有效减小创伤和意外情况发生的可能;而且舒适性更好,更容易被广大患者接受。因而有必要在临床推广涡轮机拔牙术,并逐渐取代传统拔牙术。     

Prolonged analgesia following preoperative bupivacaine neural blockade for oral surgery performed under general anesthesia

The effectiveness of prolonged neural blockade following removal of impacted third molars under general anesthesia was evaluated in a controlled clinical study. There was a significant reduction in the amount of postoperative pain experienced, and no complications, either local or systemic, occurred. The technique has advantages, especially when general anesthesia is administered to outpatients.     

Mandibular third molar removal: risk indicators for extended operation time, postoperative pain, and complications

OBJECTIVES: The aim of this study was to identify risk indicators for extended operation time and postoperative complications after removal of mandibular third molars. STUDY DESIGN: There were 388 molars included in the study. The teeth were removed using the buccal approach under local anesthesia. Four hours postoperatively the patient recorded his or her pain perception on a visual analogue scale (VAS). After surgery a surgeon recorded parameters regarding the tooth and if the mandibular nerve had been visible during the operation. One week postoperatively the postoperative pain and complications were recorded. Logistic regression models were made to identify risk indicators for extended operation time, postoperative pain, and complications. RESULTS: Females were at higher risk for postoperative pain and dry socket than males. Older patients were at higher risk for extended operation time than younger patients. Radiographically fully impacted molars increased the risk of postoperative general infection. If the nerve was visible during surgery there was a higher risk of a high VAS score, postoperative pain, and general infection than if the nerve had not been visible. CONCLUSION: Several indicators were found to increase the risk of postoperative complications, but a visible alveolar inferior nerve during the operation was repeatedly found to be the highest single risk indicator.     

Assessment of factors associated with surgical difficulty in impacted mandibular third molar extraction.

PURPOSE: The aim of this prospective study was to investigate radiologic and clinical factors associated with increased difficulty in the removal of impacted mandibular third molars. We also aimed to form an index to measure the difficulty of removal of the impacted molars preoperatively. PATIENTS AND METHODS: A total of 87 patients who required 90 surgical extractions of impacted mandibular third molars from November 2003 to May 2004 were involved in the study. Radiologic and clinical data were taken preoperatively. All extractions were performed under local anesthesia by a single operator. Surgical difficulty was measured by the total intervention time. RESULTS: Increased surgical difficulty was associated with increasing age and body mass index. It was also associated with the curvature of roots of the impacted tooth and the depth from point of elevation (P < .05). CONCLUSION: Both clinical and radiologic variables are important in predicting surgical difficulty in impacted mandibular third molar extractions.     

Risk of osteoradionecrosis after extraction of impacted third molars in irradiated head and neck cancer patients.

PURPOSE: This study was performed to compare the risk of osteoradionecrosis (ORN) in head and neck cancer patients in whom 1 or more impacted third molars were extracted before radiotherapy with patients whose impacted third molars were left intact. PATIENTS AND METHODS: Eighty-one patients were selected from the medical records from 1989 to 1998. Patients had at least 1 impacted third molar and received radiotherapy for a head and neck cancer. These patients were divided into 2 groups on the basis of preirradiation extraction: group 1, patients who had impacted third molars extracted before radiotherapy (n = 55), and group 2, patients whose impacted third molars were left intact before radiotherapy (n = 38). In 12 patients of combined groups 1 and 2, at least 1 but not all of the impacted third molars were extracted before radiotherapy. RESULTS: Before radiotherapy, a total of 99 impacted third molars were extracted from the 55 patients in group 1 and a total of 55 impacted third molars were left intact in the 38 patients in group 2. After radiotherapy, a total of 7 impacted third molars were removed from 5 patients as treatment for infection (5 lower molars) or discomfort (2 upper molars). A total of 4 patients (2 from group 1 and 2 from group 2) developed ORN in the mandible. Of these 4 cases of ORN, 1 from group 1 appeared to be related to a dry socket that developed after preirradiation extraction of a lower impacted third molar, 1 from group 2 seemed to be related to infection of a lower impacted third molar after radiotherapy, and the remaining 2 cases appeared to be unrelated to an impacted third molar. CONCLUSION: Because few patients in this study developed ORN, the study failed to demonstrate whether preirradiation extraction versus retention of impacted third molars affects the risk for ORN.     

Complications of the mandibular sagittal split ramus osteotomy associated with the presence or absence of third molars.

PURPOSE: This study compared the number of unfavorable fractures after sagittal split osteotomies (SSOs) of the mandible when third molars were present or absent. PATIENTS AND METHODS: The treatment records of 262 patients (500 SSOs) were retrospectively evaluated. Group 1 consisted of 250 SSOs and concomitant removal of impacted mandibular third molars and group 2 consisted of 250 SSOs with absence of third molars. A modified SSO technique with inferior border cuts was used on all patients, and the third molars, when present, were removed after separation of the proximal and distal segments. Rigid fixation was applied using bicortical bone screws. Bone plates with monocortical screws were additionally used to secure the free bony segments of the proximal segment in cases with unfavorable fracture. RESULTS: There were 11 (2.2%) unfavorable fractures in 500 SSO procedures. The incidence of unfavorable splits was 3.2% in group 1 and 1.2 % in group 2. In group 1, all fractures occurred in teenagers, with 7 of 8 fractures extending through the extraction socket in the distal segment. Six of the 8 fractures were associated with completely impacted third molars, and 2 involved partially impacted teeth. All 3 fractures in group 2 occurred in the proximal segment. No significant difference was seen in the amount of relapse in patients with unfavorable or favorable splits. CONCLUSIONS: The occurrence of unfavorable splits is uncommon when using a modification of the SSO that includes an inferior border osteotomy. Although more unfavorable fractures occurred in teenage patients with third molars, this had no impact on the stability of the final result.     

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。     

Actuarial life-table analysis of lower impacted wisdom teeth in general dental practice

Fernandes MJ, Ogden GR, Pitts NB, Ogston SA, Ruta DA. Actuarial life‐table analysis of lower impacted wisdom teeth in general dental practice. Community Dent Oral Epidemiol 2010; 38: 58–67. © 2009 John Wiley & Sons A/S Abstract – Background: The appropriateness of extraction of asymptomatic impacted third molars has been much debated and as a result the number of extractions has fallen in the UK in the past few years. As a direct consequence of this decrease more impacted third molars are left in situ and yet, little is known about the natural history of these teeth. Objective: The aim of this study was to create an actuarial life‐table and related survival analysis that would shed light on the natural history of an impacted lower third molar. Methods: Panoramic radiographs taken in 14 different general dental practices in Scotland were analysed and matched with their respective case notes in order to generate a sample of patients with asymptomatic impacted lower third molars. Subjects were assessed to confirm the presence of impaction and absence of symptoms and then re‐assessed 1 year later for the development of symptoms during the study period to relate the incidence of symptoms within 1 year in the sample studied to age. Logistic regression was used to construct a life table based on the survival of symptom‐free teeth (independently of extraction) during the study period. Results: The number of patients included in the study was 583 and 421 for the baseline and follow‐up assessments respectively. The total number of teeth analysed in both appointments was 676; from those 37 (5.47%) were extracted during the study period. About 562 teeth (83.13%) survived the study period symptom‐free. There was a statistically significant inverse association between the development of symptoms studied and age. There was no statistically significant association between extraction and age. Conclusions: The study indicates that older patients are less likely to develop the symptoms studied. In addition the authors believe that there is evidence to suggest that general dental practitioners might not be following current guidelines when deciding whether or not to extract an impacted lower third molar in the centres studied.     

The unerupted maxillary second molar, due to an overlying and malformed upper third molar: treatment and follow-up

This retrospective study presents the treatment and follow-up of 20 young patients with 23 impacted upper second molars, due to overlying, impacted upper third molars. The third molars were removed surgically under local anaesthesia. After removal of these palatally obstructing teeth, radiographic and clinical follow-up was performed. The purpose of this study was to evaluate the eruption progress of the upper second molars after surgery. Radiological and/or clinical follow-up showed complete eruption of 19 (83%) of the upper second molars. For those cases treated before the age of 12 years and 4 months (the mean eruption age), all the upper second molars erupted completely. For those cases where surgical removal was undertaken after the mean eruption age, four (17%) of the upper second molars did not completely erupt. It was concluded that early treatment of impacted upper second molars, due to overlying third molars, may lead to more rapid eruption. Further prospective research is necessary to develop guidelines for the removal of palatally obstructing third molars to avoid eruption problems.