截冠术：下颌第三磨牙保守拔除术

随着治疗观念的不断进步,拔牙术后并发症的预防成为口腔外科医生的重点关注话题。由下颌第三磨牙拔除造成的下牙槽神经永久性损伤而导致的下份面部感觉异常严重影响着患者的生活质量。20世纪末,截冠术从修复领域引入口腔外科领域,经过多年的实践,其在安全性、可操作性、并发症发生率等方面皆有良好的表现。本文通过对截冠术这一术式进行回顾性综述以期为下颌第三磨牙拔除的临床实践操作提供新思路。     

微种植钉牵引水平阻生下颌第三磨牙后拔除1例

水平低位阻生下颌第三磨牙常与下牙槽神经毗邻,直接拔除创伤较大,易出现各种并发症,最严重的就是下牙槽神经损伤.该文报告1例接触下颌神经管的低位水平阻生第三磨牙通过微种植钉牵引,使其远离下颌神经管后顺利拔除.     

CBCT在下颌阻生第三磨牙拔除术前风险评估中的应用

目的：运用CBCT评估下颌阻生第三磨牙拔除术中下牙槽神经损伤的手术风险,并指导拔牙手术径路选择。方法：对曲面体层片显示下颌第三磨牙根端与下颌神经管接触重叠,评估下牙槽神经易损伤病例42例,65侧下颌阻生第三磨牙,进行CBCT检查。两组医师（每组口腔外科医师和颌面影像科医师各1名）分别根据曲面体层片和CBCT图像评估拔除下颌第三磨牙时下牙槽神经损伤的风险程度并进行手术设计,应用x2检验两种影像评测结果之间的差异度。结果：评估拔除下颌阻生第三磨牙时出现下牙槽神经损伤的可能性经曲面体层片和CBCT对比研究差异具有统计学意义（P＜0．001）。与曲面体层片相比,CBCT为临床医师提供了阻生磨牙与下颌神经管之间三维影像的空间距离,有效辅助了牙拔除手术方式的设计（P＜0．001）。结论：拔除下颌阻生第三磨牙可能造成下牙槽神经损伤的评估中,与曲面体层片相比,CBCT可以更好地评估手术风险,能指导术者帮助选择更恰当的术式。     

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.     

微创拔除压迫下牙槽神经的第三磨牙方法分析

目的: 应用牵引拔牙、截冠和超声骨刀微创拔牙技术拔除压迫下牙槽神经的第三磨牙,观察术后产生下唇麻木等并发症的发生情况。方法: 选择60例全景片和锥形束CT（CBCT）显示下颌第三磨牙牙根压迫下牙槽神经的患者,分别采用3种方法拔牙各20例,术后检查下唇麻木情况。结果: 应用牵引拔牙技术和截冠方法拔除压迫下牙槽神经的第三磨牙,术后无人发生下唇麻木,而应用超声骨刀微创拔牙的患者中有1例出现轻微的下唇麻木症状,经用药1个月后好转。结论: 牵引拔牙技术、截冠和超声骨刀3种方法均可有效避免智牙拔除后下唇麻木的并发症。     

微创牵引辅助拔除近中阻生下颌第三磨牙1例报告

近中阻生下颌第三磨牙拔除是口腔外科常见手术。中、低位近中阻生的第三磨牙牙根与牙根位置常与下牙槽神经(inferior alveolar nerve, IAN)关系密切,由于近中邻牙的阻力,拔除时创伤较大,易造成第二磨牙损伤及神经损伤。本文报告1例牙根压迫下牙槽神经的近中阻生下颌第三磨牙患者,采用微创正畸牵引法,直立患牙,牵引完成后顺利拔除。     

正畸牵引法辅助拔除接触下牙槽神经管的埋伏阻生牙1例报告

阻生下颌第三磨牙拔除是口腔颌面外科的一种常见手术.由于低位阻生的下颌第三磨牙牙根位置常与下牙槽神经(inferior alveolar nerve,IAN)关系密切,神经损伤是该手术的严重并发症之一.目前,国际上主要有3种避免IAN损伤的方法:截冠法、部分牙冠切除术和正畸牵引法.本文报告1例下颌第三磨牙近中斜位低位阻生的患者,采用改良正畸牵引法,分两步将牙根牵离神经管,牵引完成后顺利拔除患牙.     

下颌第三磨牙拔除术后并发双侧广泛性皮下气肿及纵隔气肿1例报告

下颌第三磨牙拔除术是口腔颌面外科的重要组成部分,皮下气肿作为牙拔除术后并发症之一,早在1900年,Turnbull即报道了 1例前磨牙拔除术后出现皮下气肿和纵隔气肿的病例,推测与该患者术后即刻吹号角致使口腔内压力增高有关.虽然皮下气肿少见且大多病情局限、具有自限性,但压迫重要组织或发生感染时,将严重威胁患者生命.本文报...     

富血小板纤维蛋白在下颌第三磨牙拔除术的应用系统评价与Meta分析

目的 通过系统评价及Meta分析的方法评估下颌第三磨牙拔除术中使用富血小板纤维蛋白(PRF)的有效性,为缓解术后并发症提供建议.方法 对Pubmed、EMBASE、Web of Science和中国生物医学文献数据库针对在下颌第三磨牙术中使用PRF的临床随机对照试验进行电子检索,检索时间截至2020年2月.评价者使用C...     

Methods of determining the relationship of the mandibular canal and third molars: a survey of Australian oral and maxillofacial surgeons

BACKGROUND: Surgical extraction of third molars is one of the most common oral and maxillofacial surgical procedures performed and may have a number of associated complications. One of these complications is inferior alveolar nerve (IAN) dysaesthesia or impairment of sensory perception (including paraesthesia and/or anaesthesia). Previous studies assume that most clinicians use various combinations of nine radiologic criteria on panoramic radiographs as indicators of the relationship and, therefore, predictors of the risk of postoperative dysaesthesia. Our study assessed both the current radiologic modalities and assessment criteria used by Australian oral and maxillofacial surgeons when determining the proximity of mandibular canal to third molars. METHODS: A survey of all surgeon members of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons (ANZOMS) practising in Australia was undertaken. RESULTS: Of the 105 questionnaires sent to surgeons, 72 responses (68 per cent) were returned. All surgeons reported using the panoramic radiograph but only 25 per cent considered it sufficiently accurate in determining the relationship between the mandibular canal (MC) and the third molar root, while 61 per cent of surgeons use CT for this purpose but the average frequency of use was very low (five per cent). This study also revealed that the nine radiologic criteria on a panoramic radiograph are used to varying extents by Australian surgeons. Nearly all surgeons use 'change in MC direction' and 'MC narrowing' to determine and close relationship. Thirty-one per cent used superimposition of the MC and the root of the third molar alone and 24 per cent used appearance of contact of the root with the MC alone in the absence of any other radiologic criteria to indicate close or intimate relationship. CONCLUSION: Further research is required to determine the accuracy and observer agreement or reliability of using the nine panoramic characteristics, to determine this relationship and whether the presurgical determination of proximity and position (buccal or lingual) of the canal utilizing CT has any usefulness in determining the surgical protocol or affect on postoperative morbidity.     

Current perspectives on the surgical management of mandibular third molars in the United Kingdom: the need for further research

This survey of expert opinion regarding the management of mandibular third molar (M3M) impaction and its clinical sequelae was circulated to all members of the British Association of Oral and Maxillofacial Surgeons (BAOMS). It was completed by 289 clinicians who reported treating 60 003 patients annually. Respondents included 199 (69%) specialists and 58 (20%) primary care clinicians. Most (99%) of the clinicians treated at least one M3M with complete surgical removal (CSR) annually. Only 69% performed one or more coronectomies (COR). Advocates of coronectomy reported lower rates of inferior alveolar nerve (IAN) injury, but IAN, lingual nerve, and adjacent second molar damage were rare, occurring in less than 0.5% of cases, with small differences between the COR and CSR groups. Although these differences are not statistically significant, they are likely to be clinically important. Also, the COR group would have comprised mainly high-risk teeth, while the CSR group would include many teeth at low risk of complications. This might have skewed the results. Those clinicians performing no coronectomies cited three main reasons for being low adopters of COR: the lack of irrefutable evidence to support its benefit, the increased need for a second operation, and more non-IAN complications. Although COR may prevent permanent IAN damage in high-risk cases, this paper highlights clinicians’ views that there is a gap in evidence and knowledge to support COR. As a result, 47% of the clinicians surveyed recommended, and were prepared to participate in, further studies to determine the effectiveness and safety of COR.     

Association between impacted third molars and position of the mandibular canal: a morphological analysis using cone-beam computed tomography

Our aim was to assess the association between the angle of impaction of the third molar and the position of the mandibular canal on cone-beam computed tomography (CT). We designed a retrospective study of 100 cone-beam CT images of 173 mandibular third molars that were obtained between January 2012 and December 2015, and recorded the angle of impaction of the third molar, the position of the mandibular canal in relation to the impacted tooth, and the potential contact between the roots of the tooth and the mandibular canal. Most third molars tilted mesially (n = 33), while the mandibular canal was positioned below the roots of the third molar in most cases (n = 73). Contact between the two was most likely when the mandibular canal was between (RR = 1.49; 95% CI 1.27 to 1.75, p < 0.001), or to the lingual side (RR = 1.49; 95% CI 1.27 to 1.75, p < 0.001) of the roots of the tooth. These outcomes indicate a greater likelihood of contact between the canal and the roots when the canal is between, and to the lingual side, of the roots. We found no association between the angle of impaction and the position of the canal. These findings illustrate the importance of surgical planning using complementary imaging tests such as cone-beam CT.     

Osteomyelitis of the condyle secondary to pericoronitis of a third molar: a case and literature review

In this study, we report a very unusual case of a patient with osteomyelitis of the condyle secondary to pericoronitis of an impacted third molar. The patient was treated by removal of the impacted third molar, opening of the drainage, combined with systemic application of antibiotics for two weeks. This treatment option did not lead to any functional defects or facial asymmetry. The patient fully recovered and the disease did not recur.