Blakey George H, Parker David W, Hull Donald J, White Raymond P, Offenbacher Steven, Phillips Ceib, Haug Richard H
Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina, Chapel Hill, NC 27599-7450, USA.
J Oral Maxillofac Surg. 2009 Feb;67(2):245-50. doi: 10.1016/j.joms.2008.08.022.
This study assessed the impact of third molar removal on periodontal pathology in subjects with third molars asymptomatic at enrollment.
Subjects in whom at least 2 third molars were removed were a subsample of healthy young subjects enrolled with 4 asymptomatic third molars in an institutional review board-approved longitudinal study. Full-mouth periodontal probing (PD) data, 6 sites per tooth, were obtained as a measure of periodontal status at each of 3 visits: enrollment, before removal of third molars, and after removal of third molars. Data were aggregated to subject and jaw levels. The oral cavity was divided by jaw into segments: the third molar region including the third molar (12 probing sites), distal to the second molar (4 probing sites), and non-third molars (80 probing sites). A PD >or=4 mm was considered an indicator variable for periodontal pathology. The number and percent of sites with a PD >or=4 mm were calculated from the total number of probing sites across all subjects. The frequency of subjects with at least one PD >or=4 mm and all third molars removed were compared with the frequency of subjects retaining at least 1 mandibular third molar using Fisher's exact test, with significance set at 0.05.
Sixty-nine subjects had third molars removed: 57% were female, and 77% were Caucasian. The median age at surgery was 26.3 years (interquartile range, 23.3-31.5 yr). The median interval from enrollment to surgery was 2.4 years (interquartile range, 1.5-4.2 yr). The median follow-up after surgery was 9 months (interquartile range, 6.7-15.4 mo). All third molars were removed in 56 subjects; 13 retained at least 1 mandibular third molar. More subjects had at least 1 PD >or=4 mm around their mandibular third molars before surgery compared with enrollment (52% vs 45%, respectively). Of the total possible mandibular third molar probing sites, 18% had PD >or=4 mm presurgery compared with 12% at enrollment. Significantly fewer subjects who had all third molars removed had a PD >or=4 mm on the distal of their mandibular second molars after surgery, compared with those retaining at least 1 mandibular third molar (20% vs 69%, respectively, P= .001). The number of PDs >or=4 mm in the mandible was less after surgery if all third molars had been removed (1.4% vs 6.6%, respectively).
Removal of the mandibular third molars significantly improved the periodontal status on the distal of second molars, positively affecting overall periodontal health.
本研究评估了拔除第三磨牙对入组时第三磨牙无症状的受试者牙周病理状况的影响。
在一项经机构审查委员会批准的纵向研究中，拔除至少2颗第三磨牙的受试者是从拥有4颗无症状第三磨牙的健康年轻受试者中抽取的子样本。在3次就诊时（入组时、拔除第三磨牙前、拔除第三磨牙后），获取全口牙周探诊（PD）数据（每颗牙6个位点），作为牙周状况的衡量指标。数据汇总至受试者和颌骨水平。口腔按颌骨分为几个部分：第三磨牙区域，包括第三磨牙（12个探诊位点）、第二磨牙远中（4个探诊位点）和非第三磨牙（80个探诊位点）。PD≥4 mm被视为牙周病理状况的指示变量。根据所有受试者探诊位点总数计算PD≥4 mm的位点数量及百分比。使用Fisher精确检验比较所有第三磨牙均被拔除且至少有一个位点PD≥4 mm的受试者频率与保留至少1颗下颌第三磨牙的受试者频率，显著性设定为0.05。
69名受试者拔除了第三磨牙：57%为女性，77%为白种人。手术时的中位年龄为26.3岁（四分位间距为23.3 - 31.岁）。从入组到手术的中位间隔时间为2.4年（四分位间距为1.5 - 4.年）。手术后的中位随访时间为9个月（四分位间距为6.7 - 15.4个月）。56名受试者拔除了所有第三磨牙；13名受试者保留了至少1颗下颌第三磨牙。与入组时相比，更多受试者在手术前下颌第三磨牙周围至少有一个位点PD≥4 mm（分别为52%和45%）。在所有可能的下颌第三磨牙探诊位点中, 术前PD≥4 mm的位点占18%，而入组时为12%。与保留至少1颗下颌第三磨牙的受试者相比，所有第三磨牙均被拔除的受试者在手术后下颌第二磨牙远中位点PD≥4 mm的明显更少（分别为20%和69%，P = 0.001）。如果所有第三磨牙均被拔除，下颌中PD≥4 mm的数量在术后更少（分别为1.4%和6.6%）。
拔除下颌第三磨牙显著改善了第二磨牙远中的牙周状况，对整体牙周健康产生积极影响。
