Research Professor, Department of Dental Education, College of Dentistry, Yonsei University, Seoul, South Korea.
Private Practice, Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, South Korea.
J Oral Maxillofac Surg. 2021 Jul;79(7):1422.e1-1422.e8. doi: 10.1016/j.joms.2021.01.036. Epub 2021 Feb 7.
Sensory dysfunction is the most serious complication that occurs after extracting lower third molars in close proximity to the inferior alveolar nerve (IAN). Even experienced surgeons have difficulties in avoiding nerve damage when the root is anatomically adjacent to the nerve canal. A useful method for reducing nerve damage during extraction is to perform orthodontic extrusion, in which the distance between the nerve and the root increased after applying an orthodontic force on the third molar while extruding the tooth. Here, we report the case of a 37-year-old female who presented with a partially erupted left lower third molar and risk of IAN nerve damage because of close anatomical proximity between the nerve and root. She underwent extraction using a miniscrew placed in the maxilla and a routine orthodontic mechanism using a cross-arch elastic band that induced a 3-mm vertical eruption in the impacted third molar without using complex orthodontic devices. In addition, tilting the dental axis to the lingual side resolved the proximity between the IAN and the tooth, thereby allowing extraction to proceed without major complications.
感觉功能障碍是在下颌第三磨牙(智齿)接近下牙槽神经(IAN)时最严重的并发症。即使是经验丰富的外科医生,在牙根与神经管解剖位置接近时,也难以避免神经损伤。在拔牙过程中减少神经损伤的一种有效方法是进行正畸牵引,即通过对第三磨牙施加正畸力,同时将牙齿向外牵引,增加神经和牙根之间的距离。在这里,我们报告了一位 37 岁女性的病例,她的左侧下颌第三磨牙部分萌出,由于神经和牙根之间的解剖位置接近,存在 IAN 神经损伤的风险。我们使用上颌放置的微型螺钉和常规的交叉弓弹性带正畸机制,在不使用复杂正畸装置的情况下,使受影响的第三磨牙垂直萌出 3mm,从而成功地进行了拔牙。此外,将牙轴倾斜到舌侧,解决了 IAN 和牙齿之间的接近问题,从而可以在没有重大并发症的情况下进行拔牙。