下颌阻生第三磨牙拔除术邻牙损伤风险及预防

上海口腔医学 ›› 2015, Vol. 24 ›› Issue (5): 429-434.

下颌阻生第三磨牙拔除术邻牙损伤风险及预防

叶周熹¹, 杨驰¹, 樊林峰²

1.上海交通大学医学院附属第九人民医院·口腔医学院口腔外科, 2.放射科,上海市口腔医学重点实验室,上海 200125

收稿日期:2014-09-15 修回日期:2014-12-29 出版日期:2015-10-20 发布日期:2015-11-03
通讯作者: 杨驰,E-mail：yangchi63@hotmail.com
作者简介:叶周熹（1990-）,女,口腔医学七年制学生,

Risk and prevention of adjacent tooth traumatisation in impacted mandibular third molar surgery

YE Zhou-xi¹, YANG Chi¹, FAN Lin-feng²

1.Department of Oral Surgery, 2.Department of Radiology, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; Shanghai Key Lab of Stomatology. Shanghai 200011, China

Received:2014-09-15 Revised:2014-12-29 Online:2015-10-20 Published:2015-11-03
Contact: E-mail：450219713@qq.com

摘要/Abstract

摘要： 目的提出一种基于影像学的下颌阻生第三磨牙邻牙损伤风险分级方法,以预测风险和指导手术。方法从接受全景片检查者中筛选出与邻牙接触的下颌阻生第三磨牙连续病例的1359颗牙作为样本,进行评分：埋伏深度评分,高、中、低位阻生牙分别计1、2、3分;与邻牙接触面积评分,将该面积占牙冠的比例≤1/3（少）、>1/3~≤2/3（中等）、>2/3（多）分别计1、2、3分。将得分之和=3设为I级（低度）风险,得分之和=4设为Ⅱ级（中度）风险,得分之和≥5设为Ⅲ级（高度）风险。对样本中有锥形束CT（CBCT）检查者以相同标准行风险等级评价,用Kappa值和youden指数比较2种影像评价结果。用K-W检验分析阻生牙埋伏深度、与邻牙接触面积及阻生方向与邻牙损伤风险的相关性。采用SAS 8.2软件包对数据进行统计学分析。结果与邻牙接触的阻生牙占96.25%（1359/1412）,其中Ⅰ、Ⅱ、Ⅲ级风险分别占17.88%、13.63%和4.86%。72颗阻生牙CBCT和全景片评价接触面积的Kappa值为0.7844;以CBCT为金标准,全景片评价与邻牙接触少、中等、多的youden指数分别为0.8889、0.6781和0.5560。水平阻生者出现高风险的比例较高（P<0.01）。结论该分级从阻生牙埋伏深度及与邻牙接触面积两方面较全面地反映和预测了邻牙损伤风险。全景片可用于该风险分级, CBCT可作为补充

关键词: 下颌阻生第三磨牙拔除术, 邻牙损伤, 全景片, 锥形束CT

Abstract: PURPOSE:To propose an imaging risk classification of adjacent tooth traumatisation in impacted mandibular third molar surgery for prognosis estimation and surgical design. METHODS: The impacted mandibular third molars contacting the adjacent teeth in panoramic radiographs were collected and scored using two methods. Impacting depth scoring method: position A, B, C were scored 1, 2, 3 (score A). Contacting area scoring method: the contacting area accounting for ≤1/3, >1/3~≤2/3, >2/3 of the crown were scored 1, 2, 3 (score B). Score A plus score B represented the total score. Total score 3 was classified into risk degree I (low risk), total score 4 was classified into risk degree II (moderate risk), total score ≥5 was classified into risk degree III (high risk). Cone-beam CT was used for evaluation in the same way, Kappa test and youden index were used to compare two imaging results. K-W test was used to analyze the correlations of impacting depth, contacting area and impacting direction. All statistical analyses were performed using the SAS 8.2 software package. RESULTS: 96.25% (1359/1412) of impacted teeth contacted adjacent teeth, 17.88% of them had low risks, 13.63% of them had moderate risks, 4.86% of them had high risks. The concordance of two imaging results was better after Kappa test (Kappa=0.7844). Using CBCTs as gold standard, youden index value=0.8889 when score B=1 in panoramic radiographs; youden index value=0.6781 when score B=2, youden index value=0.5560 when score B=3. The horizontally impacted teeth

叶周熹, 杨驰, 樊林峰. 下颌阻生第三磨牙拔除术邻牙损伤风险及预防[J]. 上海口腔医学, 2015, 24(5): 429-434.

YE Zhou-xi, YANG Chi, FAN Lin-feng. Risk and prevention of adjacent tooth traumatisation in impacted mandibular third molar surgery[J]. Shanghai Journal of Stomatology, 2015, 24(5): 429-434.

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