全景片对下颌智齿拔除时神经损伤风险的评估

Panoramic Radiographic Prediction of Inferior Alveolar Nerve Exposure during Third Molar Extraction

目的:评估全景曲面体层片中哪些影像学标志可用于判断智齿与下牙槽神经的解剖关系,以此预测智齿拔除时神经暴露的风险几率方法:选择5个影像学标志,由一名医生先判定上述5个影像学标志是否存在,再由另一名医生判定在智齿拔除后是否会有下牙槽神经暴露,智齿拔除后经临床检查是否有下牙槽神经暴露确定阳性结果经统计学分析判断哪些影像标志可以用于评估下牙槽神经暴露(P<0.05)。结果:评估210名患者的302颗智齿,智齿拔除后神经暴露19例(6.3%),其中4个影像学标志可用于预测智齿拔除后神经暴露,敏感度和特异度分别为0.57～0.79和0.62～0.91;临床的术前预测神经暴露具有统计学意义,可用于判断结果(P<0.001,敏感度0.79,特异度0.83)。结论:4个影像学标志(智齿牙根根尖1/3密度降低、下牙槽神经管上壁的骨白线中断、下牙槽神经管位置上移或方向改变、牙根变窄),可用于预测智齿拔除后神经暴露;临床的术前预测神经暴露具有统计学意义,可用于判断结果。

Objective：To estimate the risk rate of inferior alveolar nerve（IAN） injury during third molar surgery through panoramic radiographic findings.Methods：Five signs in panoramic radiography were chosen to estimate the increased risk for IAN injury in 210 patients（302wisdon teeth）.The IAN exposure,at the time of wisdon teeth extraction were recorded and compared with the measurement before tooth extraction.Using the SPSS 12.0 stastical package,and the level of statistical significance was set at P0.05.Results：After extraction,the nerve was visualized in 19（6.3%） extraction sites. Four of the five radiographic signs were statistically associated with nerve exposure（P0.05）.The sensitivities were ranged 0.57～0.79 and specificities were 0.62-0.91 respectively.The clinician＇s preoperative estimation of the likelihood of IAN exposure was statistically coincided with extraction findings（P0.001;sensitivity 0.79;specificity 0.83）.Conclusion：Four radiographic findings（darkening of the tooth root.narrowing of the tooth root,interruption of the white lines,and diversion of the canal） were statistically associated with IAN exposure following extraction.The surgeon＇s overall estimate of risk based on the panoramic radiograph was also statistically associated with an increased risk of IAN exposure.