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下颌前突和小下颌矢状劈开截骨术中的阻生第三磨牙

Impacted third molars in sagittal split osteotomies in mandibular prognathism and micrognathia.

作者信息

Balaji S M

机构信息

Director and Consultant, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India.

出版信息

Ann Maxillofac Surg. 2014 Jan;4(1):39-44. doi: 10.4103/2231-0746.133074.

DOI:10.4103/2231-0746.133074
PMID:24987597
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4073460/
Abstract

BACKGROUND

The timing of removal of mandibular third molars (M3) in Sagittal Split Osteotomy (SSO) has been an issue of contention. The aim of this retrospective study is to identify the incidence of unfavorable fractures during SSO with the presence of M3 and to identify the association between unfavorable fractures with the factors specifically related to the M3.

MATERIALS AND METHODS

Retrospective analysis of consecutive bilateral sagittal split osteotomy (BSSO) patient's treatment records of 208 patients treated by a single surgeon was analyzed. The position of M3, fracture details, and demographics were collected. Descriptive statistics and Chi-square tests were employed in SPSS package. A P ≤ 0.05 was taken as significant.

RESULTS

There were altogether 416 SSO performed. M3 was completely impacted in 88.9% of all instances, and in 85.6% of the instances, the bulk of the M3 was identified to be above the external oblique ridge. In 59.4% of the cases, M3 was positioned in alignment with the arch as observed during surgery. There were about 27 (6.5%) instances of unfavorable splits. A statistically significant relationship was observed with M3 root morphology and axial position of M3.

DISCUSSION

This study for the first time has confirmed the spatial positioning of M3 as one of the several causes of unfavorable splits during SSO. An impacted M3 that lies below the oblique ridge, distoangularly/vertically oriented, with divergent/supernumerary root would cause unfavorable splits when the spreader is not used properly. Potential causes and influencing factors of the unfavorable splits are discussed.

摘要

背景

下颌第三磨牙（M3）在矢状劈开截骨术（SSO）中的拔除时机一直存在争议。本回顾性研究的目的是确定在存在M3的情况下SSO期间不良骨折的发生率，并确定不良骨折与M3的特定相关因素之间的关联。

材料与方法

对由单一外科医生治疗的208例连续双侧矢状劈开截骨术（BSSO）患者的治疗记录进行回顾性分析。收集M3的位置、骨折细节和人口统计学数据。在SPSS软件包中采用描述性统计和卡方检验。P≤0.05被视为具有统计学意义。

结果

共进行了416例SSO。在所有病例中，88.9%的M3完全阻生，在85.6%的病例中，M3的大部分位于外斜线之上。在59.4%的病例中，手术中观察到M3与牙弓对齐。约有27例（6.5%）出现不良劈开。观察到M3牙根形态和M3轴向位置与不良劈开存在统计学显著关系。

讨论

本研究首次证实M3的空间定位是SSO期间不良劈开的几种原因之一。当未正确使用撑开器时，位于斜线下方、远中角向/垂直方向、牙根分叉/多生的阻生M3会导致不良劈开。讨论了不良劈开的潜在原因和影响因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d080/4073460/84ced179fb6e/AMS-4-39-g013.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d080/4073460/d881c65c7958/AMS-4-39-g011.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d080/4073460/e7cc7e74958a/AMS-4-39-g012.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d080/4073460/84ced179fb6e/AMS-4-39-g013.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d080/4073460/ace5f29e794f/AMS-4-39-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d080/4073460/4432fad7c228/AMS-4-39-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d080/4073460/e165b11c2035/AMS-4-39-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d080/4073460/d881c65c7958/AMS-4-39-g011.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d080/4073460/e7cc7e74958a/AMS-4-39-g012.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d080/4073460/84ced179fb6e/AMS-4-39-g013.jpg

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Occurrence of bad splits during sagittal split osteotomy.矢状劈开截骨术中出现不良劈开情况。
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