School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
PLoS One. 2021 Feb 22;16(2):e0246625. doi: 10.1371/journal.pone.0246625. eCollection 2021.
Most of complications after impacted mandibular third molar (iLM3) extraction surgeries are transient and resolved spontaneously within one or two weeks, but some of them are more complicated and required further treatments to alleviate the symptoms. The aim of study is to revisit incidence and predictors of complications after iLM3 surgery by reviewing previous literature and investigating a population-based data. From Taiwan National Health Insurance Research Database, records of 16,609 patients who had received iLM3 extraction under ambulatory settings were retrieved for analysis. Outcomes of interest included dry socket (DS), prolonged temporomandibular joint symptoms (TMD), and surgical site infection (SSI), which necessitated additional appointments to manage. Odds ratios of having those complications between different variables were analyzed. The incidence rates of DS, TMD, and SSI were 3.6%, 0.41%, 0.17%, respectively; while they ranged from 0.33-19.14% (DS), 0-4.17% (TMD), and 0.2-5.17% (SSI) in previous studies. Logistic regression revealed DS significantly correlated with complexity of odontectomy (2.5-fold of risk) and history of gingivitis or pericoronitis (1.3-fold of risk). More TMD was found in female than male patients (0.5% versus 0.3%). However, no factors associated with SSI was found; neither did we find aging as a risk in association with any of above complications. Compared to previous studies, our data supports that surgical intervention should be considered in iLM3 with risk of gingivitis or pericoronitis to reduce the occurrence of DS. The original information in this article, which provides a "real-world" evidence, along with the organizing data we summarized from previous article, can serve as a reference for clinicians in assessing the complication risks before treatment of iLM3.
大多数下颌第三磨牙（iLM3）拔除术后并发症是暂时的，在一到两周内会自行缓解，但有些并发症更为复杂，需要进一步治疗以缓解症状。本研究旨在通过回顾既往文献并调查基于人群的数据，重新评估 iLM3 手术后并发症的发生率和预测因素。从台湾全民健康保险研究数据库中，检索了 16609 例在门诊接受 iLM3 拔牙手术的患者记录进行分析。感兴趣的结局包括干槽症（DS）、颞下颌关节症状持续时间延长（TMD）和手术部位感染（SSI），这些并发症需要额外预约治疗。分析不同变量之间发生这些并发症的优势比。DS、TMD 和 SSI 的发生率分别为 3.6%、0.41%和 0.17%；而在之前的研究中，DS 的发生率范围为 0.33-19.14%，TMD 的发生率范围为 0-4.17%，SSI 的发生率范围为 0.2-5.17%。Logistic 回归显示，DS 与牙切除术的复杂性显著相关（风险增加 2.5 倍），且与牙龈炎或冠周炎病史有关（风险增加 1.3 倍）。女性 TMD 发生率高于男性（0.5%比 0.3%）。然而，没有发现与 SSI 相关的因素，也没有发现年龄与上述任何并发症有关。与既往研究相比，本研究数据支持在 iLM3 存在牙龈炎或冠周炎风险的情况下进行手术干预，以降低 DS 的发生风险。本文提供的原始信息为“真实世界”证据，结合我们从既往文章中总结的数据，可为临床医生在治疗 iLM3 前评估并发症风险提供参考。
