Richards J A, Coyle M J, Beech A N
Oral and Maxillofacial Surgery Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN.
Br J Oral Maxillofac Surg. 2019 Sep;57(7):663-665. doi: 10.1016/j.bjoms.2019.06.004. Epub 2019 Jun 21.
In recent years, coronectomy of impacted lower third molar teeth has become an increasingly popular alternative to removal. Traditionally, orthopantomograms of mandibular third molars have been used to indicate features that show that the tooth is in close proximity to, or in an intimate relation with, the inferior dental nerve. Some authors advocate coronectomy as opposed to surgical removal to reduce the risk of damage to the nerve. In our Trust during the last two years, there has been a noticeable increase in the prescription of coronectomy for the management of pericoronitis associated with mandibular third molars. The purpose of this study therefore was to examine the differences among clinicians in their assessment of the need for coronectomy using plain-view radiographs. An online survey was completed by 25 clinicians with different levels of experience from six units across the UK and Republic of Ireland. We found a wide variation in the number of coronectomies prescribed (intraclass correlation 2.67), and when prescribed, a lack of agreement about the radiographic feature that had influenced the decision. These judgments are not straightforward. They are, to some extent, subjective, and in certain cases may benefit from a team-led approach.
近年来，下颌阻生第三磨牙的牙冠切除术已成为一种越来越受欢迎的替代拔牙方法。传统上，下颌第三磨牙的全景片被用于显示牙齿与下牙槽神经紧密相邻或关系密切的特征。一些作者主张采用牙冠切除术而非手术拔除，以降低神经损伤的风险。在我们信托机构过去两年中，用于治疗下颌第三磨牙相关冠周炎的牙冠切除术处方显著增加。因此，本研究的目的是使用平片X线照片检查临床医生在评估牙冠切除术必要性方面的差异。来自英国和爱尔兰共和国六个单位的25名不同经验水平的临床医生完成了一项在线调查。我们发现所开牙冠切除术的数量差异很大（组内相关系数为2.67），并且在开出该手术时，对于影响决策的X线特征缺乏一致性意见。这些判断并不简单直接。它们在某种程度上是主观的，并且在某些情况下可能受益于团队主导的方法。
