基于倾向评分匹配分析的下颌第三磨牙阻生拔牙后根向对下牙槽神经损伤的影响：一项回顾性队列研究。
The effect of root orientation on inferior alveolar nerve injury after extraction of impacted mandibular third molars based on propensity score-matched analysis: a retrospective cohort study.
机构信息
Hospital of Stomatology, Guangdong Provincial Clinical Research Center of Oral Diseases, Guangdong Provincial Key Laboratory of Stomatology, Guangdong Key Laboratory for Dental Disease Prevention and Control, Sun Yat-Sen University, No.56, Lingyuan West Road, Yuexiu District, Guangzhou City, Guangdong Province, 510030, China.
State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, Third Section of Ren Min Nan Road, Chengdu City, Sichuan Province, 610041, China.
出版信息
BMC Oral Health. 2023 Nov 27;23(1):929. doi: 10.1186/s12903-023-03661-0.
BACKGROUND
The injury of the inferior alveolar nerve (IAN) is one of the most serious complications of impacted mandibular third molars (IMTMs) extraction. The influence of the root orientation of IMTMs on IAN injury is still controversial. A deeper understanding of the risk factors of IAN injury conduces to better prevention of IAN injury. This study aims to explore whether root orientation is an independent risk factor of IAN injury during IMTMs extraction using the statistical strategy of propensity score matching (PSM).
METHODS
This retrospective cohort study included 379 patients with 539 cases of high-risk IMTMs screened by panoramic radiography and cone beam computed tomography. The IAN injury incidence after extraction of different groups of IMTMs was analyzed using the chi-square test or Fisher's exact test. The correlation between third molar root orientation and impaction depth/contact degree with IAN was evaluated by the Lambda coefficient. Based on PSM for balancing confounding factors including age, sex, impaction depth, and contact degree, the effect of root orientation on the incidence of IAN injury was further analyzed using Fisher's exact test.
RESULTS
There were significant group differences in IAN injury incidence in impaction depth, root orientation, and contact degree of root-IAC before PSM. Root orientation was correlated with impaction depth and contact degree of root-IAC. After PSM, there were 9 cases with IAN injury and 257 cases without IAN injury. There were significant group differences between the buccal and non-buccal groups after PSM, and the risk of IAN injury was higher when the root was located on the buccal side of IAC (OR = 8.448, RR = 8).
CONCLUSIONS
Root orientation is an independent risk factor of IAN injury, and the risk is higher when the root is located on the buccal side of IAC. These findings could help better evaluate the risk of inferior alveolar nerve injury before the extraction of IMTMs.
背景
下牙槽神经（IAN）损伤是下颌第三磨牙（IMTMs）拔除最严重的并发症之一。IAN 损伤与 IMTMs 牙根方向的关系仍存在争议。深入了解 IAN 损伤的危险因素有助于更好地预防 IAN 损伤。本研究旨在通过倾向评分匹配（PSM）的统计策略，探讨牙根方向是否是 IMTMs 拔除过程中 IAN 损伤的独立危险因素。
方法
本回顾性队列研究纳入了 379 名经全景片和锥形束 CT 筛选出的高危 IMTMs 患者，共 539 例。采用卡方检验或 Fisher 确切概率法分析不同组 IMTMs 拔除后 IAN 损伤的发生率。采用 Lambda 系数评估第三磨牙牙根方向与 IAN 接触深度/接触程度的相关性。基于 PSM 对年龄、性别、阻生深度和接触程度等混杂因素进行平衡后，采用 Fisher 确切概率法进一步分析牙根方向对 IAN 损伤发生率的影响。
结果
在 PSM 前，在阻生深度、牙根方向和根-ICA 接触程度方面，IAN 损伤发生率存在显著的组间差异。牙根方向与阻生深度和根-ICA 接触程度相关。PSM 后，共发生 9 例 IAN 损伤，257 例无 IAN 损伤。PSM 后颊侧和非颊侧组间存在显著差异，当根位于 IAC 颊侧时，IAN 损伤的风险更高（OR=8.448，RR=8）。
结论
牙根方向是 IAN 损伤的独立危险因素，当根位于 IAC 颊侧时，风险更高。这些发现有助于更好地评估 IMTMs 拔除前 IAN 损伤的风险。
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