Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 South Street Zhong Guan Cun, Haidian District, Beijing, 100081, China.
Department of Medical Statistics, Peking University Clinical Research Institute, Beijing, China.
Clin Oral Investig. 2020 Sep;24(9):3017-3028. doi: 10.1007/s00784-019-03169-4. Epub 2019 Dec 18.
This study aimed to quantitatively compare the somatosensory function changes of inferior alveolar nerve (IAN) after mandibular third molar extraction with a surgery protocol of coronectomy, as opposed to the conventional method.
Patients with a lower third molar directly contacting IAN were recruited and assigned either to a test group (coronectomy group) or a control group (conventional extraction). A standardized quantitative sensory testing (QST) battery was performed for four times: one week before surgery and the second, seventh, and 28th days after surgery. Z-scores and the loss/gain coding system were applied for each participant.
A total of 140 molars (test group: n = 91, control group: n = 49) were enrolled. The sensitivity of the mechanical detection threshold (MDT) and pressure pain threshold (PPT) significantly increased after surgery more than before surgery in both groups (P ≤ 0.001). After the surgery, the sensitivities of the cold detection threshold (CDT), cold pain threshold (CPT), and heat pain threshold (HPT) were significantly higher in the test group than in the control group (P ≤ 0.027). The risk of IANI was significantly larger (P = 0.041) in the test group than in the control group.
QST was a sensitive way to detect somatosensory abnormalities even with no subjective complaint caused by surgery. Coronectomy had less influence on IAN function than conventional total extraction.
The somatosensory function changes after mandibular third molar extraction were quantitatively studied, and coronectomy was proved a reliable alternation to reduce IAN injury rate.
本研究旨在定量比较下颌第三磨牙拔除后使用冠切除术与传统方法治疗下牙槽神经（IAN）的感觉功能变化。
招募了与 IAN 直接接触的下颌第三磨牙患者，并将其分为实验组（冠切除术组）和对照组（传统拔除组）。在术前一周以及术后第 2、7 和 28 天进行了四次标准化的定量感觉测试（QST）。为每位参与者应用 Z 分数和损失/增益编码系统。
共纳入 140 颗磨牙（实验组：n=91，对照组：n=49）。两组患者的机械检测阈值（MDT）和压力疼痛阈值（PPT）的敏感性在术后均明显高于术前（P≤0.001）。术后，实验组的冷觉检测阈值（CDT）、冷痛阈值（CPT）和热痛阈值（HPT）的敏感性明显高于对照组（P≤0.027）。实验组 IANI 的风险明显大于对照组（P=0.041）。
即使手术后没有主观感觉异常，QST 也是检测感觉异常的一种敏感方法。与传统的完全拔除相比，冠切除术对 IAN 功能的影响较小。
本研究定量研究了下颌第三磨牙拔除后感觉功能的变化，并证明了冠切除术是一种降低 IAN 损伤率的可靠替代方法。
