Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Lesserstraße 180, 22049, Hamburg, Germany.
Oral Maxillofac Surg. 2024 Sep;28(3):1127-1138. doi: 10.1007/s10006-024-01232-3. Epub 2024 Mar 1.
The surgical removal of impacted third molars is usually carried out by an oral/maxillofacial surgeon. Two specific risks of surgical removal of impacted third molars are oroantral communication (OAC) when extracting upper third molars and hypesthesia of the inferior alveolar nerve (IAN) when extracting lower third molars. The aim of this study is to determine the distribution of complications in deeply impacted third molar surgery, to identify specific risk factors influencing the most common perioperative (OAC, IAN hypesthesia) and to compare these results with other studies.
The clinical findings, digital panoramic radiographs, intra- and postoperative data of 80 patients with a total of 232 impacted third molars that had been subjected for tooth extraction, from December 2022 and August 2023, were collected and analyzed. Perioperative complications (IAN hypesthesia, OAC, hypesthesia lingual nerve, postoperative bleeding, postoperative infection) were identified. A risk analysis for OAC and IAN hypesthesia was performed regarding perioperative data.
Overall, the rate of OAC for the right upper third molar was 12.8% and for the left upper third molar 15.6%. The complication rates regarding transient hypesthesia were 8.1% for the left IAN and 7.3% for the right IAN. The distance to maxillary sinus, the depth score according to Pell and Gregory, the bone coverage score, the operation time, the tooth's angulation and the type of surgeon (oral surgeon, DMD) were identified as significant risk factors for the occurrence of OAC. The minimum distance to IAN, the bone coverage score, the total operation time and the operation by an oral surgeon (DMD) were identified as significant risk factors for hypesthesia of the IAN.
Next to the risk factors from above, the present study is one of the first showing that patients who were primarily operated on by an oral surgeon (DMD) and not a maxillofacial surgeon (MD, DMD) showed higher rates of OAC and IAN hypesthesia in impacted third molar extraction. The results of this study can serve as a baseline for further studies to investigate complication patterns in impacted third molar surgery.
第三磨牙阻生的外科切除通常由口腔颌面外科医生进行。第三磨牙阻生的外科切除有两个特定的风险，即上颌第三磨牙拔除时的口腔上颌窦交通（OAC）和下颌第三磨牙拔除时的下牙槽神经（IAN）感觉迟钝。本研究的目的是确定深埋伏第三磨牙手术中并发症的分布，确定影响最常见围手术期（OAC、IAN 感觉迟钝）的具体危险因素，并将这些结果与其他研究进行比较。
收集并分析了 2022 年 12 月至 2023 年 8 月期间，80 名患者共 232 颗阻生第三磨牙接受拔牙治疗的临床发现、数字化全景片、围手术期数据。确定围手术期并发症（IAN 感觉迟钝、OAC、舌神经感觉迟钝、术后出血、术后感染）。对围手术期数据进行 OAC 和 IAN 感觉迟钝的风险分析。
总体而言，右上第三磨牙 OAC 的发生率为 12.8%，左上第三磨牙为 15.6%。左侧 IAN 暂时性感觉迟钝的发生率为 8.1%，右侧 IAN 为 7.3%。上颌窦距离、Pell 和 Gregory 深度评分、骨覆盖评分、手术时间、牙齿角度和外科医生类型（口腔外科医生、DMD）被确定为 OAC 发生的显著危险因素。最小 IAN 距离、骨覆盖评分、总手术时间和口腔外科医生（DMD）手术被确定为 IAN 感觉迟钝的显著危险因素。
除了上述危险因素外，本研究还首次表明，主要由口腔外科医生（DMD）而不是颌面外科医生（MD、DMD）进行手术的患者，在第三磨牙阻生拔除术中发生 OAC 和 IAN 感觉迟钝的比率更高。本研究的结果可以作为进一步研究埋伏第三磨牙手术并发症模式的基线。
