微创拔除压迫下牙槽神经的第三磨牙方法分析
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摘要
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。
PURPOSE: Extraction of impacted mandibular third molar compressing inferior alveolar nerve(IAN) is highly related to inferior alveolar nerve injury. The aim of this study was to compare the incidences of IAN injury in orthodontic traction, coronectomy and piezosurgery for the impacted mandibular third molar removal. METHODS: After examination of panoramic radiography and cone-beam computed tomography(CBCT), sixty patients with impacted mandibular third molar compressing the IAN were enrolled in this study. Orthodontic traction, coronectomy and piezosurgery were carried out in 20 patients, respectively. Signs of postoperative neurosensory impairment were recorded. RESULTS: No sign of neurosensory impairment was observed in patients undergoing orthodontic traction or coronectomy. One patient(5%)undergone piezosurgery had postoperative lower lip numbness, and recovered within 1 month after drug treatment.CONCLUSIONS: Orthodontic traction, coronectomy and piezosurgery can reduce the incidence of nerve injury during removal of impacted mandibular third molar compressing IAN.
PURPOSE: Extraction of impacted mandibular third molar compressing inferior alveolar nerve(IAN) is highly related to inferior alveolar nerve injury. The aim of this study was to compare the incidences of IAN injury in orthodontic traction, coronectomy and piezosurgery for the impacted mandibular third molar removal. METHODS: After examination of panoramic radiography and cone-beam computed tomography(CBCT), sixty patients with impacted mandibular third molar compressing the IAN were enrolled in this study. Orthodontic traction, coronectomy and piezosurgery were carried out in 20 patients, respectively. Signs of postoperative neurosensory impairment were recorded. RESULTS: No sign of neurosensory impairment was observed in patients undergoing orthodontic traction or coronectomy. One patient(5%)undergone piezosurgery had postoperative lower lip numbness, and recovered within 1 month after drug treatment.CONCLUSIONS: Orthodontic traction, coronectomy and piezosurgery can reduce the incidence of nerve injury during removal of impacted mandibular third molar compressing IAN.
引文
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[7]Hasegawa T,Ri S,Shigeta T,et al.Risk factors associated with inferior alveolar nerve injury after extraction of the mandibular third molar-a comparative study of preoperative images by panoramic radiography and computed tomography[J].Int J Oral Maxillofac Surg,2013,42(7):843-851.
[8]Park W,Choi JW,Kim JY,et al.Cortical integrity of the inferior alveolar canal as a predictor of paresthesia after third-molar extraction[J].J Am Dent Assoc,2010,141(3):271-278.
[2]Srinivas M,Susarla BS,Bart F.Third molar surgery and associated complications[J].Oral Maxillofac Surg Clin North Am,2003,15(2):177-186.
[3]Wang Y,He D,Yang C,et al.An easy way to apply orthodontic extraction for impacted lower third molar compressing to the inferior alveolar nerve[J].J Craniomaxillofac Surg,2012,40(3):234-237
[4]Bauer SE,Romanos GE.Morphological characteristics of osteotomies using different piezosurgical devices.A scanning electron microscopic evaluation[J].Implant Dent,2014,23(3):334-342.
[5]Jerjes W,Swinson B,Moles D,et al.Permanent sensory nerve impairment following third molar surgery:a prospective study[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2006,102(4):e1-e7.
[6]Gomes A,Vasconcelos EB,Silva OE,et al.Sensitivity and specificity of pantomography to predict inferior alveolar nerve damage during extraction of impacted lower third molars[J].J Oral Maxillofac Surg,2008,66(2):256-259.
[7]Hasegawa T,Ri S,Shigeta T,et al.Risk factors associated with inferior alveolar nerve injury after extraction of the mandibular third molar-a comparative study of preoperative images by panoramic radiography and computed tomography[J].Int J Oral Maxillofac Surg,2013,42(7):843-851.
[8]Park W,Choi JW,Kim JY,et al.Cortical integrity of the inferior alveolar canal as a predictor of paresthesia after third-molar extraction[J].J Am Dent Assoc,2010,141(3):271-278.