Miguel Daniela Camila Nunes, Oliveira Rudyard Dos Santos, Panzarella Francine Kühl
Private Practice, Campinas, São Paulo, Brazil.
Department of Dentistry - Postgraduate Program in Dentistry, Federal University of Paraíba, João Pessoa, Paraíba, Brazil.
J Int Soc Prev Community Dent. 2025 Apr 30;15(2):155-172. doi: 10.4103/jispcd.jispcd_110_24. eCollection 2025 Mar-Apr.
This study examined the associations between the position of impacted mandibular third molars and postoperative complications, with a focus on pain, swelling, and their associations with proximity to the mandibular canal.
A retrospective cohort of 270 patients who underwent surgical extraction of mandibular third molars was analyzed. Preoperative panoramic radiographs were evaluated by three experienced surgeons to classify the tooth position (Winter classification) and proximity to the mandibular canal (Rood and Shehab classification). Postoperative complications (pain, swelling, trismus, paresthesia, hematoma, and hemorrhage) were assessed via standardized questionnaires and clinical records 7 days postoperatively. Data analysis included descriptive statistics and multinomial logistic regression.
Mesioangular and horizontal impactions were significantly associated with increased postoperative pain and swelling. Logistic regression indicated that the mesioangular position increased the odds of pain by 95% (odds ratio [OR] = 1.95) and swelling by 85% (OR = 1.85). The horizontal impact increased the odds of pain by 2.8 times (OR = 2.8) and swelling by 5.0 times (OR = 5.0). Tooth position was a significant predictor of postoperative complications ( = 0.007), whereas proximity to the mandibular canal, patient age, and the mandibular side were not. Root darkening emerged as a notable radiographic finding.
The position of impacted mandibular third molars, particularly mesioangular and horizontal angulations, significantly influences postoperative pain and swelling. These findings highlight the importance of considering the tooth position in surgical planning to reduce complications. Although panoramic radiography is useful in resource-limited settings, cone-beam computed tomography is advised for complex cases or when vital structures are at risk.
本研究探讨了下颌阻生第三磨牙的位置与术后并发症之间的关联，重点关注疼痛、肿胀及其与下颌管的接近程度之间的关系。
对270例行下颌第三磨牙手术拔除的患者进行回顾性队列分析。由三位经验丰富的外科医生对术前全景X线片进行评估，以对牙齿位置（温特分类法）和与下颌管的接近程度（鲁德和谢哈布分类法）进行分类。术后7天通过标准化问卷和临床记录评估术后并发症（疼痛、肿胀、牙关紧闭、感觉异常、血肿和出血）。数据分析包括描述性统计和多项逻辑回归。
近中倾斜和水平阻生与术后疼痛和肿胀增加显著相关。逻辑回归表明，近中倾斜位置使疼痛几率增加95%（优势比[OR]=1.95），肿胀几率增加85%（OR=1.85）。水平阻生使疼痛几率增加2.8倍（OR=2.8），肿胀几率增加5.0倍（OR=5.0）。牙齿位置是术后并发症的显著预测因素（P=0.007），而与下颌管的接近程度、患者年龄和下颌侧则不是。牙根变黑是一个值得注意的影像学表现。
下颌阻生第三磨牙的位置，特别是近中倾斜和水平倾斜，显著影响术后疼痛和肿胀。这些发现突出了在手术规划中考虑牙齿位置以减少并发症的重要性。虽然全景X线摄影在资源有限的环境中很有用，但对于复杂病例或重要结构有风险时，建议使用锥形束计算机断层扫描。
