Zhang Jiankang, Zhang Kun, Zhou Xueer, Ye Li, Liu Yuanyuan, Peng Yiran, Pan Jian
State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd section of Renmin South Road, Chengdu, Sichuan, 610041, China.
State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Department of Oral Radiology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China.
BMC Oral Health. 2024 May 2;24(1):515. doi: 10.1186/s12903-024-04248-z.
Low impacted third molars are usually asymptomatic and are often found by X-ray examination. The removal of asymptomatic low impacted third molars is one of the most controversial clinical issues in oral and maxillofacial surgery.
In this study, 806 patients with low impacted mandibular third molars (LIMTMs) (full bony impaction) were analyzed to determine the prevalence and risk factors for cystic lesions and adjacent tooth root resorption throughout the patients' entire life cycle.
The results showed that the prevalence of adjacent tooth root resorption and cystic lesions was age-related, exhibiting a trend of first increasing and then decreasing; prevalence peaked at the age of 41 to 45 years old, the prevalence rates were 12.50% and 11.11% respectively. And the lowest prevalence rate was 2.86% and 2.44% in ≥ 61 group and 56- to 60-year age group respectively. Age was an independent risk factor for adjacent tooth root resorption of LIMTMs, whereas age and impaction type (especially inverted impaction) were independent risk factors for cystic lesions.
The full life cycle management strategy for LIMTMs may need to be individualized. Surgical removal is recommended for LIMTMs in patients younger than 41 to 45 years, especially for inverted, mesioangular, and horizontally impacted LIMTMs. LIMTMs in patients older than 41 to 45 years may be treated conservatively with regular follow-up, but surgical removal of inverted impacted LIMTMs is still recommended to avoid cyst formation.
低位阻生第三磨牙通常无症状，常通过X线检查发现。拔除无症状的低位阻生第三磨牙是口腔颌面外科最具争议的临床问题之一。
本研究分析了806例下颌低位阻生第三磨牙（完全骨埋伏阻生）患者，以确定其在整个生命周期中囊性病变和邻牙根吸收的患病率及危险因素。
结果显示，邻牙根吸收和囊性病变的患病率与年龄相关，呈先升高后降低的趋势；患病率在41至45岁达到峰值，分别为12.50%和11.11%。≥61岁组和56至60岁年龄组的患病率最低，分别为2.86%和2.44%。年龄是下颌低位阻生第三磨牙邻牙根吸收的独立危险因素，而年龄和阻生类型（尤其是倒置阻生）是囊性病变的独立危险因素。
下颌低位阻生第三磨牙的全生命周期管理策略可能需要个体化。建议对41至45岁以下患者的下颌低位阻生第三磨牙进行手术拔除，尤其是倒置、近中倾斜和水平阻生的下颌低位阻生第三磨牙。41至45岁以上患者的下颌低位阻生第三磨牙可进行保守治疗并定期随访，但仍建议手术拔除倒置阻生的下颌低位阻生第三磨牙以避免囊肿形成。
