Vranckx Myrthel, Lauwens Lieselotte, Moreno Rabie Catalina, Politis Constantinus, Jacobs Reinhilde
OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.
Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
Clin Oral Investig. 2021 Jul;25(7):4471-4480. doi: 10.1007/s00784-020-03759-7. Epub 2021 Jan 3.
Although panoramic radiographs are extensively studied for diagnosis and preoperative planning in third molar surgery, research on the predictive value of this radiographic information regarding the postoperative recovery of patients remains underexploited. This prospective cohort study aimed to assess the potential relationship between radiologic risk indicators and persistent postoperative morbidity, in 1009 patients undergoing 2825 third molar extractions in context of the M3BE study.
Two observers evaluated ten radiographic parameters: vertical and horizontal eruption status, third molar orientation, surgical difficulty, nerve relation, maxillary sinus relation, presence of periapical and pericoronal radiolucencies, caries, and third or second molar resorption. Patients' postoperative recovery was recorded 3 and 10 days after surgery. Univariate logistic regression was performed to assess potential associations between radiographic risk indicators and persistent postoperative morbidity.
Deep impactions were significantly associated with the persistence of postoperative pain, trismus and swelling until 10 days after surgery, prolonged need for pain medication, and the inability to resume daily activities and work/studies. Pericoronal radiolucencies and resorption were significantly associated with persistent morbidity and a longer recovery time, whereas caries and periapical lesions were linked to a shorter recovery time.
Based on the results of this study, clinicians may better inform patients at risk for persistent postoperative discomfort according to what was preoperatively diagnosed on the panoramic radiograph.
Preoperative panoramic radiographs contain information about patients at risk of prolonged recovery after third molar removal. Several risk indicators for persistent postoperative morbidity were identified.
尽管全景X线片在第三磨牙手术的诊断和术前规划方面得到了广泛研究，但关于这种影像学信息对患者术后恢复的预测价值的研究仍未得到充分利用。这项前瞻性队列研究旨在评估在M3BE研究背景下，1009例接受2825次第三磨牙拔除术的患者中，放射学风险指标与持续性术后发病率之间的潜在关系。
两名观察者评估了十个影像学参数：垂直和水平萌出状态、第三磨牙方向、手术难度、神经关系、上颌窦关系、根尖周和冠周透射影的存在、龋齿以及第三或第二磨牙吸收情况。在术后3天和10天记录患者的术后恢复情况。进行单因素逻辑回归分析，以评估影像学风险指标与持续性术后发病率之间的潜在关联。
深度阻生与术后疼痛、张口受限和肿胀持续至术后10天、对止痛药物的需求延长以及无法恢复日常活动和工作/学习显著相关。冠周透射影和吸收与持续性发病率和更长的恢复时间显著相关，而龋齿和根尖周病变则与较短的恢复时间相关。
根据本研究结果，临床医生可以根据全景X线片术前诊断的情况，更好地告知有持续性术后不适风险的患者。
术前全景X线片包含了第三磨牙拔除后恢复时间延长的风险患者的信息。确定了几个持续性术后发病率的风险指标。
