采用坚固内固定治疗下颌骨骨折时对骨折线上牙齿的评估
Evaluation of Teeth in Line of Mandibular Fractures Treated with Stable Internal Fixation.
作者信息
Bang K O, Pandilwar P K, Shenoi S R, Budhraja N J, Ingole P, Kolte V S, Garg A
机构信息
VSPM's DCRC, Digdoh Hills, Hingna Road, Nagpur, Maharashtra 440019 India.
GDC, Nagpur, India.
出版信息
J Maxillofac Oral Surg. 2018 Jun;17(2):164-168. doi: 10.1007/s12663-016-0993-4. Epub 2016 Dec 19.
PURPOSE
To determine whether retention or removal of teeth in line of mandibular fractures affects the incidence of postoperative complications. To evaluate the fate of teeth retained in mandibular fractures based on location of fracture line in relation to apical foramen and lateral periodontium of retained tooth.
METHOD
51 mandibular fracture sites in 39 patients were treated by open reduction and internal fixation using miniplates. Teeth in line of fracture were removed if showed extensive caries, excessive mobility of tooth, or root fracture. Accordingly patients were divided into two groups, group I tooth removed (15 sites) and group II tooth retained (36 sites). Teeth retained in fracture line were classified based on position of the fracture in relation to apical foramen and the lateral periodontium of involved tooth estimated from preoperative panoramic radiograph into four types. Postoperative periodic follow up done for 1 year and seen for incidence of postoperative complications and fate of tooth in line of fracture.
RESULTS
Out of 36 fracture sites in which teeth were retained 5 (13.89%) showed postoperative complications, and out of 15 fracture sites in which teeth were removed 3 (20%) showed postoperative complications. Out of 36 fracture sites in which tooth was retained we found in 3 cases fracture line passed through 2 adjacent teeth. Thus we had in total 39 teeth in fracture line out of them 26 required no treatment 9 required endodontic treatment and 4 teeth required extraction. Need for extraction and endodontic treatment was found more in type I and type III relation.
CONCLUSION
There is an increased risk for postoperative complications when a tooth is removed, although it is not statistically significant. Evaluation of fate of retained teeth showed better prognosis of teeth in type II cases than type III and type I cases. Results of this study leads to conclusions that teeth associated with mandibular fractures need not be removed on prophylactic basis.
目的
确定下颌骨骨折线上牙齿的保留或拔除是否会影响术后并发症的发生率。根据骨折线相对于保留牙齿根尖孔和牙周膜的位置，评估下颌骨骨折中保留牙齿的转归情况。
方法
对39例患者的51处下颌骨骨折部位采用微型钢板进行切开复位内固定治疗。如果骨折线上的牙齿出现广泛龋坏、牙齿过度松动或牙根骨折，则予以拔除。据此将患者分为两组，I组为拔牙组（15处骨折部位），II组为保留牙齿组（36处骨折部位）。根据术前全景X线片估计骨折线相对于受累牙齿根尖孔和牙周膜的位置，将骨折线上保留的牙齿分为四种类型。术后进行为期1年的定期随访，观察术后并发症的发生率以及骨折线上牙齿的转归情况。
结果
在保留牙齿的36处骨折部位中，有5处（13.89%）出现术后并发症；在拔除牙齿的15处骨折部位中，有3处（20%）出现术后并发症。在保留牙齿的36处骨折部位中，我们发现有3例骨折线穿过相邻的两颗牙齿。因此，骨折线上共有39颗牙齿，其中26颗无需治疗，9颗需要进行根管治疗，4颗需要拔除。I型和III型关系中拔牙和根管治疗的需求更多。
结论
拔牙时术后并发症的风险增加，尽管差异无统计学意义。保留牙齿转归情况的评估显示，II型病例中牙齿的预后优于III型和I型病例。本研究结果得出结论，与下颌骨骨折相关的牙齿无需预防性拔除。
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