Hirsch A, Shteiman S, Boyan B D, Schwartz Z
Department of Periodontics, Hebrew University Hadassah Faculty of Dental Medicine, Jerusalem, Israel.
J Periodontol. 2003 Jun;74(6):887-92. doi: 10.1902/jop.2003.74.6.887.
Impaction of mandibular third molars predisposes to pathological conditions including periodontal disease. Extraction of these teeth also may lead to damage to the nerve and to periodontal involvement of the second molars. This report describes a series of cases in which the third molars were orthodontically induced to erupt to prevent the sequelae associated with extraction.
Impacted mandibular third molars in 18 patients were surgically exposed following placement of an orthodontic appliance. Depending on the individual case, 1 of 3 approaches was used: attachment of a bracket, placement of a post in the root canal, or placement of an orthodontic wire through a bucco-lingual canal. After suturing the mucoperiosteal flap, the orthodontic appliance was activated. After the tooth erupted, it was removed and periodontal parameters were measured on the second molar.
No damage to the inferior alveolar nerve was found. Probing depths on the second molar were reduced from 7.9 +/- 1.6 mm on the buccal and 7.4 +/- 1.0 mm on the lingual to 1.8 +/- 0.7 mm and 1.9 +/- 0. 7 mm, respectively. There was an average gain of 5.0 mm in attachment. Keratinized tissue increased from 2.9 +/- 0.7 to 3.8 +/- 0.6 mm.
The interdisiplinary use of periodontics and orthodontics results in non-surgical removal of impacted mandibular third molars without damage to the inferior alveolar nerve and iatrogenic periodontal sequelae to the second molars.
下颌第三磨牙阻生易引发包括牙周病在内的病理状况。拔除这些牙齿也可能导致神经损伤以及第二磨牙的牙周受累。本报告描述了一系列通过正畸诱导第三磨牙萌出以预防拔牙相关后遗症的病例。
在18例患者中，于放置正畸矫治器后手术暴露阻生的下颌第三磨牙。根据具体病例，采用以下3种方法之一：粘接托槽、在根管内放置桩或通过颊舌向根管放置正畸钢丝。缝合粘骨膜瓣后，激活正畸矫治器。牙齿萌出后将其拔除，并测量第二磨牙的牙周参数。
未发现下牙槽神经损伤。第二磨牙的探诊深度从颊侧的7.9±1.6mm和舌侧的7.4±1.0mm分别降至1.8±0.7mm和1.9±0.7mm。附着平均增加5.0mm。角化组织从2.9±0.7mm增加至3.8±0.6mm。
牙周病学和正畸学的跨学科应用可实现非手术拔除阻生下颌第三磨牙，且不会损伤下牙槽神经以及对第二磨牙造成医源性牙周后遗症。
