Blondeau François, Daniel Nach G
Affiliated medical centre of the Enfant-Jésus Hospital, Quebec City, Quebec, Canada.
J Can Dent Assoc. 2007 May;73(4):325.
The purpose of this prospective study was to evaluate the incidence of various complications, including alveolitis, infection and paresthesia of the inferior alveolar nerve, in association with removal of impacted mandibular third molars. The relation between these 3 complications and several clinical variables (age, sex, degree of impaction, surgical difficulty and use of oral contraceptives) was also examined.
Data were collected prospectively for all patients who underwent extraction of an impacted third molar in a single private dental practice over a 12-month period. A variety of data were collected for each patient, including age, sex, medical status at the time of the procedure and type of procedure performed. Patients were contacted at 2 days and 4 weeks after surgery to establish the occurrence of complications, and those with complications were treated; those with paresthesia were followed for at least 24 months.
A total of 550 impacted mandibular third molars were extracted from 327 patients (136 males and 191 females). The complication rate was 6.9%, consisting of 20 cases of alveolitis, 12 cases of infection and 6 cases of paresthesia of the inferior alveolar nerve. Of the 6 neurosensory deficits, 3 resolved and 3 were permanent. The risk factors associated with permanent neurosensory deficit were female sex, Pell and Gregory IC or IIC classification of impaction, and age greater than 24 years. The risk of postoperative alveolitis and infection was also greater among women. There was no significant relation between the use of oral contraceptives and alveolitis.
Surgical removal of impacted mandibular third molars should be carried out well before the age of 24 years, especially for female patients. Older patients are at greater risk of postoperative complications and permanent sequelae. A surgeon's lack of experience could also be a major factor in the development of postoperative complications.
本前瞻性研究旨在评估与拔除下颌阻生第三磨牙相关的各种并发症的发生率，包括牙槽炎、感染及下牙槽神经感觉异常。同时还研究了这三种并发症与几个临床变量（年龄、性别、阻生程度、手术难度及口服避孕药的使用情况）之间的关系。
前瞻性收集在一家私人牙科诊所接受下颌阻生第三磨牙拔除术的所有患者的数据，为期12个月。收集每位患者的各种数据，包括年龄、性别、手术时的健康状况及所施行手术的类型。术后2天和4周与患者联系以确定并发症的发生情况，有并发症的患者接受治疗；感觉异常的患者随访至少24个月。
共从327例患者（136例男性和191例女性）中拔除了550颗下颌阻生第三磨牙。并发症发生率为6.9%，包括20例牙槽炎、12例感染和6例下牙槽神经感觉异常。6例神经感觉功能缺损中，3例恢复，3例为永久性。与永久性神经感觉功能缺损相关的危险因素为女性、Pell和Gregory IC或IIC类阻生以及年龄大于24岁。女性术后发生牙槽炎和感染的风险也更高。口服避孕药的使用与牙槽炎之间无显著关系。
下颌阻生第三磨牙的手术拔除应在24岁之前进行，尤其是女性患者。年龄较大的患者术后发生并发症和永久性后遗症的风险更高。外科医生经验不足也可能是术后并发症发生的一个主要因素。
