Balaji Preetha, Balaji S M
Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India.
Indian J Dent Res. 2017 May-Jun;28(3):304-308. doi: 10.4103/ijdr.IJDR_272_17.
BACKGROUND/AIMS: Open reduction and internal fixation (ORIF) is a standard surgical procedure in jaw trauma and in orthognathic surgery. Insertion of screws is a significant risk for accidental tooth root injury with varying outcomes. Contrary evidences are found in literature due to a variety of study designs. This study was undertaken to address the lacunae and possibly estimate the difference in occurrence of tooth damage during or after ORIF between trauma and planned osteotomies.
In this retrospective study, the data of ORIF in either trauma or orthognathic surgery fulfilling inclusion and exclusion criteria were collected and analyzed.
There were 1632 patients fulfilling the inclusion and exclusion criteria and formed the study group, of which 663 were in orthognathic surgery, of whom 210 had bimaxillary orthognathic surgery. In the trauma group, 358 patients had fractures involving both jaws whereas 272 had maxilla alone and 339 had mandibular fractures alone. On comparing the outcome, of the 9073 screws studied, 93.40% were not involved in any contact with the teeth, 6.3% were in category of potential hits (near apices or the root surfaces), and only 0.28% had evidence of root damage with the screws. It is observed that molar and premolar had a significant difference in terms of the type of surgery (P ≤ 0.05) whereas canine (P = 0.75) and incisor (P = 0.67) showed no statistical difference.
ORIF when used as mentioned is a safe way for the management of fractures. The incidence of root injury is not uncommon but can be avoided with careful planning and execution.
背景/目的：切开复位内固定术（ORIF）是颌面部创伤和正颌外科手术中的标准外科手术。螺钉植入存在意外损伤牙根的重大风险，且后果各异。由于研究设计的多样性，文献中存在相互矛盾的证据。本研究旨在填补这一空白，并可能估计创伤性手术和计划性截骨手术在ORIF期间或之后牙齿损伤发生率的差异。
在这项回顾性研究中，收集并分析了符合纳入和排除标准的创伤或正颌外科手术中ORIF的数据。
共有1632例患者符合纳入和排除标准，组成了研究组，其中663例接受正颌外科手术，其中210例接受双颌正颌手术。在创伤组中，358例患者双侧颌骨骨折，272例仅上颌骨骨折，339例仅下颌骨骨折。比较结果发现，在所研究的9073枚螺钉中，93.40%未与任何牙齿接触，6.3%属于潜在接触（靠近根尖或牙根表面），仅有0.28%有螺钉导致牙根损伤的证据。观察发现，磨牙和前磨牙在手术类型方面存在显著差异（P≤0.05），而尖牙（P = 0.75）和切牙（P = 0.67）无统计学差异。
按上述方式使用的ORIF是治疗骨折的安全方法。牙根损伤的发生率并不罕见，但通过仔细规划和执行可以避免。
