Badenoch-Jones Emma K, David Michael, Lincoln Trent
General Dentist and Resident, Royal Brisbane and Women's Hospital, The University of Queensland, School of Medicine, Brisbane, QLD, Australia.
Statistical Consultant and Lecturer in Biostatistics, The University of Queensland, School of Public Health, Brisbane, QLD, Australia.
J Oral Maxillofac Surg. 2017 Jul;75(7):1376.e1-1376.e5. doi: 10.1016/j.joms.2017.01.034. Epub 2017 Feb 4.
Conventional teaching regarding palatal injection for the removal of maxillary teeth dictates the administration of buccal and palatal injections. Recently, some investigators have questioned the necessity of the palatal injection, suggesting that contemporary local anesthetics might diffuse sufficiently across the buccopalatal cortical bone distance. It has been suggested that because the buccopalatal cortical bone distance increases anteriorly to posteriorly in the maxilla, the success of maxillary extractions with buccal injection only might be related to the anteroposterior position of the tooth. Evidence from clinical trials has only recently become available. Since 2006, 15 clinical trials that examined outcomes of maxillary tooth extractions performed with buccal injection of local anesthetic only have been published. However, there are limited data available on the clinical practice of surgeons.
An online survey was sent to 276 full members of the Canadian Association of Oral and Maxillofacial Surgeons. Respondents were asked about their use of palatal injection for the removal of maxillary teeth under local anesthesia, including how often they administer a palatal injection for maxillary extractions in each region of the maxilla.
Ninety-two responses were received (33%). Most practitioners deliver a palatal injection for every maxillary tooth extraction under local anesthesia. However, there is a substantial number who do not always administer a palatal injection (ie, they give it "most of the time," "occasionally," or "never"). This number decreased in a linear fashion anteriorly to posteriorly in the maxilla (incisors, 17 of 89; canines, 16 of 88; premolars, 13 of 88; first and second molars, 10 of 89; third molars, 10 of 88).
Some surgeons who do not always administer a palatal injection for extraction of maxillary teeth under local anesthesia. The number is larger for anterior compared with posterior teeth.
关于拔除上颌牙时腭侧注射的传统教学要求进行颊侧和腭侧注射。最近，一些研究者对腭侧注射的必要性提出质疑，认为当代局部麻醉剂可能足以扩散穿过颊腭侧皮质骨间距。有人提出，由于上颌骨中颊腭侧皮质骨间距从前向后增加，仅采用颊侧注射进行上颌牙拔除的成功率可能与牙齿的前后位置有关。临床试验的证据直到最近才可得。自2006年以来，已发表了15项仅采用颊侧注射局部麻醉剂进行上颌牙拔除的临床试验结果。然而，关于外科医生临床实践的数据有限。
向加拿大口腔颌面外科医生协会的276名正式会员发送了一份在线调查问卷。受访者被问及在局部麻醉下拔除上颌牙时使用腭侧注射的情况，包括在上颌每个区域进行上颌牙拔除时进行腭侧注射的频率。
共收到92份回复（33%）。大多数从业者在局部麻醉下拔除每颗上颌牙时都会进行腭侧注射。然而，有相当一部分人并非总是进行腭侧注射（即他们“大多数时候”“偶尔”或“从不”进行腭侧注射）。这个比例在上颌骨中从前向后呈线性下降（切牙，89例中有17例；尖牙，88例中有16例；前磨牙，88例中有13例；第一和第二磨牙，89例中有10例；第三磨牙，88例中有10例）。
一些外科医生在局部麻醉下拔除上颌牙时并非总是进行腭侧注射。与后牙相比，前牙的这种情况更为常见。
