{"title":"Risk factor analysis for perioperative complications in impacted third molar surgery - a single center experience.","authors":"Florian Dudde, Filip Barbarewicz, Kai-Olaf Henkel","doi":"10.1007/s10006-024-01232-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The surgical removal of impacted third molars is usually carried out by an oral/maxillofacial surgeon. Two specific risks of surgical removal of impacted third molars are oroantral communication (OAC) when extracting upper third molars and hypesthesia of the inferior alveolar nerve (IAN) when extracting lower third molars. The aim of this study is to determine the distribution of complications in deeply impacted third molar surgery, to identify specific risk factors influencing the most common perioperative (OAC, IAN hypesthesia) and to compare these results with other studies.</p><p><strong>Materials and methods: </strong>The clinical findings, digital panoramic radiographs, intra- and postoperative data of 80 patients with a total of 232 impacted third molars that had been subjected for tooth extraction, from December 2022 and August 2023, were collected and analyzed. Perioperative complications (IAN hypesthesia, OAC, hypesthesia lingual nerve, postoperative bleeding, postoperative infection) were identified. A risk analysis for OAC and IAN hypesthesia was performed regarding perioperative data.</p><p><strong>Results: </strong>Overall, the rate of OAC for the right upper third molar was 12.8% and for the left upper third molar 15.6%. The complication rates regarding transient hypesthesia were 8.1% for the left IAN and 7.3% for the right IAN. The distance to maxillary sinus, the depth score according to Pell and Gregory, the bone coverage score, the operation time, the tooth's angulation and the type of surgeon (oral surgeon, DMD) were identified as significant risk factors for the occurrence of OAC. The minimum distance to IAN, the bone coverage score, the total operation time and the operation by an oral surgeon (DMD) were identified as significant risk factors for hypesthesia of the IAN.</p><p><strong>Conclusion: </strong>Next to the risk factors from above, the present study is one of the first showing that patients who were primarily operated on by an oral surgeon (DMD) and not a maxillofacial surgeon (MD, DMD) showed higher rates of OAC and IAN hypesthesia in impacted third molar extraction. The results of this study can serve as a baseline for further studies to investigate complication patterns in impacted third molar surgery.</p>","PeriodicalId":47251,"journal":{"name":"Oral and Maxillofacial Surgery-Heidelberg","volume":null,"pages":null},"PeriodicalIF":1.7000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Oral and Maxillofacial Surgery-Heidelberg","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s10006-024-01232-3","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/3/1 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The surgical removal of impacted third molars is usually carried out by an oral/maxillofacial surgeon. Two specific risks of surgical removal of impacted third molars are oroantral communication (OAC) when extracting upper third molars and hypesthesia of the inferior alveolar nerve (IAN) when extracting lower third molars. The aim of this study is to determine the distribution of complications in deeply impacted third molar surgery, to identify specific risk factors influencing the most common perioperative (OAC, IAN hypesthesia) and to compare these results with other studies.
Materials and methods: The clinical findings, digital panoramic radiographs, intra- and postoperative data of 80 patients with a total of 232 impacted third molars that had been subjected for tooth extraction, from December 2022 and August 2023, were collected and analyzed. Perioperative complications (IAN hypesthesia, OAC, hypesthesia lingual nerve, postoperative bleeding, postoperative infection) were identified. A risk analysis for OAC and IAN hypesthesia was performed regarding perioperative data.
Results: Overall, the rate of OAC for the right upper third molar was 12.8% and for the left upper third molar 15.6%. The complication rates regarding transient hypesthesia were 8.1% for the left IAN and 7.3% for the right IAN. The distance to maxillary sinus, the depth score according to Pell and Gregory, the bone coverage score, the operation time, the tooth's angulation and the type of surgeon (oral surgeon, DMD) were identified as significant risk factors for the occurrence of OAC. The minimum distance to IAN, the bone coverage score, the total operation time and the operation by an oral surgeon (DMD) were identified as significant risk factors for hypesthesia of the IAN.
Conclusion: Next to the risk factors from above, the present study is one of the first showing that patients who were primarily operated on by an oral surgeon (DMD) and not a maxillofacial surgeon (MD, DMD) showed higher rates of OAC and IAN hypesthesia in impacted third molar extraction. The results of this study can serve as a baseline for further studies to investigate complication patterns in impacted third molar surgery.
背景：手术拔除撞击性第三磨牙通常由口腔颌面外科医生实施。手术拔除撞击性第三磨牙的两个具体风险是：拔除上第三磨牙时的口腔外沟通（OAC）和拔除下第三磨牙时的下牙槽神经（IAN）感觉减退。本研究的目的是确定深影响第三磨牙手术并发症的分布情况，找出影响最常见围手术期（OAC、IAN 感觉减退）的具体风险因素，并将这些结果与其他研究结果进行比较：收集并分析了2022年12月至2023年8月期间80名患者的临床表现、数字全景X光片、术中和术后数据，这些患者共有232颗影响性第三磨牙需要拔除。确定了围手术期并发症（IAN感觉减退、OAC、舌神经感觉减退、术后出血、术后感染）。对围术期数据进行了OAC和IAN低度麻醉的风险分析：总体而言，右上第三磨牙的 OAC 发生率为 12.8%，左上第三磨牙的 OAC 发生率为 15.6%。左侧 IAN 和右侧 IAN 的一过性低麻醉并发症发生率分别为 8.1%和 7.3%。与上颌窦的距离、根据佩尔和格雷戈里的深度评分、骨覆盖评分、手术时间、牙齿的角度和外科医生的类型（口腔外科医生、DMD）被认为是发生OAC的重要风险因素。与 IAN 的最小距离、骨覆盖评分、总手术时间和口腔外科医生（DMD）的手术被认为是 IAN 过度麻醉的重要风险因素：除上述风险因素外，本研究还首次显示，主要由口腔外科医生（DMD）而非颌面外科医生（MD、DMD）进行手术的患者，在第三磨牙影响性拔除术中出现 OAC 和 IAN 过度麻醉的比例较高。本研究结果可作为进一步研究影响性第三磨牙手术并发症模式的基线。
期刊介绍：
Oral & Maxillofacial Surgery founded as Mund-, Kiefer- und Gesichtschirurgie is a peer-reviewed online journal. It is designed for clinicians as well as researchers.The quarterly journal offers comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery and interdisciplinary aspects of cranial, facial and oral diseases and their management. The journal publishes papers of the highest scientific merit and widest possible scope on work in oral and maxillofacial surgery as well as supporting specialties. Practice-oriented articles help improve the methods used in oral and maxillofacial surgery.Every aspect of oral and maxillofacial surgery is fully covered through a range of invited review articles, clinical and research articles, technical notes, abstracts, and case reports. Specific topics are: aesthetic facial surgery, clinical pathology, computer-assisted surgery, congenital and craniofacial deformities, dentoalveolar surgery, head and neck oncology, implant dentistry, oral medicine, orthognathic surgery, reconstructive surgery, skull base surgery, TMJ and trauma.Time-limited reviewing and electronic processing allow to publish articles as fast as possible. Accepted articles are rapidly accessible online.Clinical studies submitted for publication have to include a declaration that they have been approved by an ethical committee according to the World Medical Association Declaration of Helsinki 1964 (last amendment during the 52nd World Medical Association General Assembly, Edinburgh, Scotland, October 2000). Experimental animal studies have to be carried out according to the principles of laboratory animal care (NIH publication No 86-23, revised 1985).
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