下颌阻生智齿拔除术的护理体会

目的：探讨下颌阻生智齿拔除术的配合及护理。方法：通过对我院5000例下颌阻生智齿拔除术的分析，总结术前准备、术中配合和术后护理的体会。结果：拔牙前护士应了解阻生智齿类型并作好患者的心理护理及拔牙术中劈冠、去骨、增隙时正确击锤的方法和力量是阻生智齿顺利拔除的重要内容。结论：护士拔牙前应做好患者心理护理，拔牙术中主动积极配合医生操作，密切观察病情变化，做好抢救工作和术后护理工作     

全景片对下颌智齿拔除时神经损伤风险的评估

目的:评估全景曲面体层片中哪些影像学标志可用于判断智齿与下牙槽神经的解剖关系,以此预测智齿拔除时神经暴露的风险几率方法:选择5个影像学标志,由一名医生先判定上述5个影像学标志是否存在,再由另一名医生判定在智齿拔除后是否会有下牙槽神经暴露,智齿拔除后经临床检查是否有下牙槽神经暴露确定阳性结果经统计学分析判断哪些影像标志可以用于评估下牙槽神经暴露(P<0.05)。结果:评估210名患者的302颗智齿,智齿拔除后神经暴露19例(6.3%),其中4个影像学标志可用于预测智齿拔除后神经暴露,敏感度和特异度分别为0.57～0.79和0.62～0.91;临床的术前预测神经暴露具有统计学意义,可用于判断结果(P<0.001,敏感度0.79,特异度0.83)。结论:4个影像学标志(智齿牙根根尖1/3密度降低、下牙槽神经管上壁的骨白线中断、下牙槽神经管位置上移或方向改变、牙根变窄),可用于预测智齿拔除后神经暴露;临床的术前预测神经暴露具有统计学意义,可用于判断结果。     

下颌阻生智齿拔除术后合理用药问题探讨

本文通过标准化短程预防用药的观察,对下颌阻生智齿拔除术后使用药物问题进行了探讨。作者认为下颌阻生智齿拔除术后应常规使用止痛药,但如无感染存在,则使用抗生素预防术后并发症无益。作者还认为非类固醇类抗炎药不具预防术后并发症的效用。而糖皮质激素具有较显著的预防术后反应及并发症的作用。     

下颌埋伏阻生智齿拔除术205例的临床观察

目的观察下颌埋伏阻生智齿拔除术的临床效果。方法采用冠周附加切口的方法拔除下颌埋伏阻生齿。结果205例埋伏智齿除4例根尖折断遗留牙槽窝内及1例镇痛不全二次拔除外,其余则均顺利拔除。发生干槽症11例,下牙槽神经损伤5例,舌神经损伤1例。结论此法具有手术视野清晰、操作方便、去骨精确、手术时间短、术后反应轻的优点。     

地塞米松在下颌阻生智齿拔除术中的临床应用

面部肿胀是下颌阻生智齿拔除术后常见的并发症 ,一方面 ,可引起张口受限 ,另一方面也影响患者颜面部的美观 ,增加了患者术后的恐惧心理。我院口腔科自 1 997年 8月～ 2 0 0 1年 3月对下颌阻生智齿拔除患者 ,给予术后加服地塞米松片剂 ,对预防或减少术后面部肿胀取得了良好的疗效。1　临床资料1 .1　病例选择门诊收集双侧智齿均阻生的患者 ,且双侧阻生类型近似和需要同样的手术难易程度 ,术前均消除冠周炎症。共 42例 84个阻生智齿 ,其中男 2 6例 ,女 1 6例 ,年龄 1 9～ 42岁 ,平均年龄 2 7岁。依患者要求及随机的原则 ,一侧拔除术后加服地塞…     

下颌智齿拔除术中根折原因Logistic回归分析

根折（Root fracturc）是下颌智齿拔除术中经常出现的并发症之一,据统计拔除下颌阻生智齿时出现根折的几率为21．7％,根折会明显增加智齿拔除的手术时间,从而会增加患者的痛苦。     

右侧下颌智齿拔除致下颌角骨折1例

患者男, 35岁。因右下颌磨牙疼痛、张口受限就诊,检查及处理:右侧下颌智齿近中阻生,牙周感染,右侧下颌肿胀,张口度一横指。静脉给青霉素、甲硝唑治疗 5d,炎症消除后,于局麻下切开覆盖牙面上的牙龈组织,翻瓣拔除。因牙间隙小,光线不易到达,阻力较大,又缺少支点,用锤敲击牙挺柄,将牙挺插入牙间隙,反复多次,不能挺出。牙钳又不能到达,强行用牙挺,由于用力过猛,牙未挺出,下颌骨纵行骨折,移位 0. 5cm。智齿从骨断端挺出,缝合翻瓣的牙龈组织,止血,拍X线片,见右侧下颌角骨折,经手法复位,在X线下见对位线可,用绷带沿头顶下颌外固定,进流食,抗炎治疗…     

下颌智齿拔除术后并发干槽症61例临床分析

下颌智齿拔除术是口腔科门诊最常见的手术之一 ,而下颌智齿拔除后干槽症的发生率较高。从1996年 1月～ 2 0 0 1年 12月我科门诊共拔除下颌智齿 5 6 8例。本文对所发生的 6 1例干槽症进行了分析。结合文献报道 ,对下颌智齿拔除术后干槽症产生的原因、预防及治疗方法进行了讨论。1　临床资料　本组病例男性 2 95例 ,占 5 2 %,女性 2 73例 ,占4 8%;年龄 18～ 4 2岁 ,平均年龄 2 5 .4岁 ;左侧 2 90例 ,右侧 2 96例。所有病人均采用 2 %利多卡因下齿槽神经阻滞麻醉下常规拔除下颌智齿。对阻生智齿采用劈开拔除法拔除。其中的 5 1例埋伏阻生位的病…     

Orthodontic extraction of mandibular third molar to avoid nerve injury and promote periodontal healing

Aim: Impacted mandibular third molar extraction is a common procedure in oral surgery, not without risk of nerve injury and periodontal defects on the distal aspect of the adjacent second molar. The "orthodontic extraction" is proposed as a method to avoid mandibular nerve injury during the extraction of a deeply embedded third molar and to prevent or limit such periodontal problems.
Material and Methods: A 28-year-old man presented a deeply impacted left mandibular third molar that required extraction. Radiographs revealed a very slight quantity of bone at the distal surface of the adjacent second molar. The third molar was extruded according to the "orthodontic extraction" technique. A 3-month retention phase elapsed to ensure adequate bone maturation and the tooth was finally extracted.
Results: No neurological complications occurred. A minimal residual bone defect at the distal surface of the adjacent second molar was detected radiographically both post-operatively and at the 3-year follow-up.
Conclusions: Orthodontic extraction makes third molar removal easier and has no neurological risk. This procedure, followed by a 3-month retention phase, appears to be effective in preventing or limiting the development of periodontal problems on the distal aspect of the adjacent second molar.     

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。     

Incidence of inferior alveolar nerve injury in mandibular third molar surgery

This paper documents the incidence of inferior alveolar nerve injury and resultant sensory disturbance encountered in the removal of 100 consecutive impacted mandibular third molars. Five cases of anesthesia and/or paresthesia resulted and all but one of these resolved within six months. The lack of direct correlation between surgical exposure of the neurovascular bundle intraoperatively and the proximity of radiographic images of tooth root and mandibular canal, with the occurrence of sensory deficit, is noted. Our findings support the 1979 Recommendations of NIHCDCRTM*, upon which the policy of informed consent regarding nerve injury was based.     

Anatomic relationship between impacted third mandibular molar and the mandibular canal as the risk factor of inferior alveolar nerve injury

Our aim was to explore the relation between the site of the mandibular canal and neurosensory impairment after extraction of impacted mandibular third molars.     

Panoramic radiographic risk factors for inferior alveolar nerve injury after third molar extraction.

PURPOSE: The purpose of this study was to estimate the association between specific panoramic radiographic signs and inferior alveolar nerve (IAN) injury during mandibular third molar removal. PATIENTS AND METHODS: A case-control study design was used; the sample consisted of patients who underwent removal of impacted mandibular third molars. Cases were defined as patients with confirmed IAN injury after third molar extraction, whereas controls were defined as patients without nerve injury. Five surgeons, who were blinded to injury status, independently assessed the preoperative panoramic radiographs for the presence of high-risk radiographic signs. Bivariate analyses were completed to assess the relationship between radiographic findings and IAN injury. The sensitivity, specificity, and positive and negative predictive values were computed for each radiographic sign. RESULTS: The sample was composed of 8 cases and 17 controls. Positive radiographic signs were statistically associated with an IAN injury (P <.0001). The presence of radiographic sign(s) had positive predictive values that ranged from 1.4% to 2.7%, representing a 40% or greater increase over the baseline likelihood of injury (1%) for the individual patient. Absence of these radiographic findings had a strong negative (>99%) predictive value. CONCLUSIONS: This study confirms previous analyses showing that panoramic findings of diversion of the inferior alveolar canal, darkening of the third molar root, and interruption of the cortical white line are statistically associated with IAN injury. Based on the estimated predictive values, the absence of positive radiographic findings was associated with a minimal risk of nerve injury, whereas, the presence of one or more of these findings was associated with an increased risk for nerve injury.     

Immediate cranial nerve paralysis during removal of a mandibular third molar

Cranial nerve palsy is a rare complication of dental extraction. This article presents a report of an incomplete seventh nerve paralysis and branch third nerve palsy occurring during extraction of a mandibular third molar. Diagnostic and treatment considerations are discussed, including a review of pertinent neuroanatomy.     

正畸治疗中磨牙的拔除与保留(十六)——正畸拔除下颌第一磨牙后第三磨牙位置和倾斜度变化

目的：探讨正畸拔除下颌第一磨牙对下颌第三磨牙位置和倾斜度的影响.方法：选择34例拔除下颌第一磨牙正畸治疗和29例非拔除下颌第一磨牙正畸治疗,对两组病例治疗前后头颅侧位片进行测量分析.观察矫治前后下颌第三磨牙在垂直方向、水平方向及倾斜角度的改变,比较两组之间的差异.结果：拔牙组和非拔牙组间治疗前后下颌第三磨牙垂直位置和倾斜度变化的差异没有统计学意义（P＞0.05）;拔牙组和非拔牙组间治疗前后下颌第三磨牙水平位置变化的差异具有统计学意义（P＜0.05）.治疗后,拔牙组下颌第三磨牙比非拔牙组更靠近近中.结论：拔除下颌第一磨牙的正畸治疗加速了下颌第三磨牙向近中迁移.     

Risk factors for lingual plate fracture during mandibular third molar extraction

Objective

The aim of this study was to predict the risk of lingual plate fracture during mandibular third molar (M3) extraction.

Materials and methods

Cone beam computed tomography (CBCT) data from 264 mandibular M3s (erupted and impacted) from 264 patients (104 males and 160 females; age range, 17–75 years) were retrospectively analyzed. Lingual plate thicknesses at the levels of the mid-root and root apex of the M3s were measured and defined as “thicker” (bone thicker than 1 mm), “thinner” (bone thinner than 1 mm), or “perforated” (bone perforated by the M3 root). These measurements were correlated with potential risk factors for thinner and perforated lingual plates: tooth position of the mandibular M3, morphology of the lingual plate, and patient characteristics (age and sex).

Results

The mean thickness of the lingual plate was 1.49 ± 1.38 mm at the mid-root of the M3s, and 2.35 ± 2.03 mm at the root apex. Multivariate regression analyses revealed that mesioangularly and horizontally impacted M3s were significantly associated with thinner and perforated lingual plates at the mid-root (P < 0.001), whereas the M3s in infra-occlusion positions (in infra-occlusion when compared with the adjacent second molar) had thinner lingual bone at the root apex (P = 0.022 and P = 0.027, depending on the level of impaction). Female patients were less likely to have lingual plate perforation (P = 0.036).

Conclusions

Mesioangulation, infra-occlusion, and male sex were risk factors for lingual plate fracture.

Clinical relevance

When the risk of lingual plate fracture is high, a sufficiently large flap, osteotomy, and tooth section by bur or piezosurgery are recommended to create a good operative field and avoid excessive pressure on the lingual plate.