下颌阻生第三磨牙拔除难度的预测因素与评估方法

Predictive factors and evaluation methods for the difficulty analysis of impacted mandibular third molar extraction

下颌阻生第三磨牙拔除术是牙槽外科最常见的手术之一。对下颌第三磨牙拔除难度进行准确评估有利于医患沟通并控制术中和术后并发症。目前,最常用于临床判断拔牙难度的方法或量表包括Winter分类系统、Pell&Gregory分类方法及Pederson指数。然而,上述临床常用的分类方法或难度评估量表的特异性和敏感性难以同时得到满足,且尚未有被广泛认可的新难度评估体系的建立。因此,本文系统总结了可能用于下颌阻生第三磨牙拔除难度评估的预测因素,包括阻生齿解剖学特征如牙根形态、阻生角、阻生齿埋伏深度、阻生齿宽度、磨牙后间隙、牙周膜状态和邻牙接触情况等,以及患者基本信息如年龄、性别、体重指数(BMI)等,并分析了目前数个下颌第三磨牙拔除难度评估体系的优缺点,以期为建立新的评估体系提供有益的方向和思路。

As the extraction of the mandibular third molars is one of the most common surgical procedures in oral surgery,accurate assessment of its difficulty is helpful for communication between doctors and patients and for controlling intraoperative and postoperative complications.Currently,the most commonly used methods or scales for clinical evaluation of the difficulty of tooth extraction include Winter′s classification,Pell&Gregory classification,and Pederson index,which are not specified and sensitive enough,and no new widely recognized evaluation system has been established.Therefore,this article systematically summarized the possible predictive factors for assessing the difficulty of extracting mandibular third molars,including the anatomical characteristics of the impacted tooth,such as root morphology,impaction angle,depth of impaction,width of the impacted tooth,distance from the second molar to the ramus,periodontal membrane status,and contact with adjacent teeth,as well as the patient information such as age,gender,and body mass index(BMI).The article analyzed the advantages and disadvantages of several current evaluation systems for assessing the difficulty of extracting the mandibular third molars in order to provide useful directions and ideas for establishing a new evaluation system.