老年人骨埋伏阻生牙37例临床分析

中国口腔颌面外科杂志 ›› 2016, Vol. 14 ›› Issue (1): 72-75.

老年人骨埋伏阻生牙37例临床分析

胡颖恺，徐光宙^*，杨驰^*

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,上海市口腔医学重点实验室,上海 200011

收稿日期:2015-05-16 出版日期:2016-01-20 发布日期:2016-02-01
通讯作者: 徐光宙,E-mail: xgzmy@126.com;杨驰,E-mail: yangchi63@hotmail.com。*共同通信作者
作者简介:胡颖恺(1990-),女,在读硕士研究生, E-mail：hykcangcang@gmail.com
基金资助:
上海市科学技术委员会科研计划项目（14DZ2294300,13XD1402300)

A clinical analysis of impacted teeth in 37 elder patients

HU Ying-kai, XU Guang-zhou, YANG Chi

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

Received:2015-05-16 Online:2016-01-20 Published:2016-02-01

摘要/Abstract

摘要： 目的分析老年人骨埋伏阻生牙的特点,为临床诊治提供依据。方法选择2010年1月—2014年4月治疗的老年完全骨埋伏阻生牙患者37例45颗患牙。其中,男17例,女20例,平均年龄70.85岁（58~82岁）;有高血压史者占51.4%（19/37）,心脏病占32.4%（12/37）,糖尿病占13.5%（5/37）,骨质疏松占24.3%（9/37）;术前拍摄全景片或CT确诊。评估埋伏牙拔除难度及全身状况,选择不同方法拔除埋伏牙。记录每位患者骨埋伏阻生牙牙位、阻生类型和伴发病变。结果阻生牙中,下颌第三磨牙占80%（36/45）,倒置阻生16颗,水平阻生13颗,近中阻生6颗,垂直阻生1颗;上颌第三磨牙占13.3%（6/45）;多生牙占6.7%（3/45）。7颗阻生牙伴发含牙囊肿;5颗伴发局部骨髓炎。结论老年人术前应准备充分,术中注意监测全身情况,应用涡轮钻或超声骨刀降低风险。对于埋伏深度小于2 mm的阻生牙,应尽早拔除,以降低冠周炎、囊肿、感染等病变的发生率。

关键词: 老年人, 骨埋伏阻生牙, 超声骨刀

Abstract: PURPOSE : To analyze the clinical characteristics of impacted teeth in the elderly and provide reference for diagnosis and treatment of them. METHODS : Thirty-seven patients including 17 males and 20 females whose ages ranged from 58 to 82 years were referred to our department from 2010 to 2014. Most of them were associated with systemic diseases. After taking pantomograms and computed tomograms and evaluation of systemic condition, the patients underwent extraction of impacted teeth with different METHODS. The position and impacted type of each tooth, as well as associated lesions were recorded and analyzed. RESULTS : Of all the impacted teeth, mandibular third molars accounted for 80%, of which horizontal and inverted impaction types were mostly seen. Maxillary third molars and supernumerary teeth accounted for 13.3% and 6.7%, respectively. Dentigerous cysts were found in 7 teeth and 5 teeth were accompanied by local osteomyelitis. CONCLUSIONS : Extraction of impacted teeth in elder patients should be performed gently with minor injury after adequate preparation and full evaluation. Elective extraction of impacted teeth was proposed for elder patients when the impaction depth was less than 2 mm, in order to reduce the incidence of pericoronitis, cysts or infection.

Key words: Elderly, Bony impacted teeth, Piezosurgery

中图分类号:

R782.1

胡颖恺，徐光宙，杨驰. 老年人骨埋伏阻生牙37例临床分析[J]. 中国口腔颌面外科杂志, 2016, 14(1): 72-75.

HU Ying-kai, XU Guang-zhou, YANG Chi. A clinical analysis of impacted teeth in 37 elder patients[J]. China J Oral Maxillofac Surg, 2016, 14(1): 72-75.

参考文献

[1] Ventä I. How often do asymptomatic, disease-free third molars need to be removed?[J]. J Oral Maxillofac Surg,2012,70(Suppl 1): S41-47.
[2] Kaminishi RM, Lam PS, Kaminishi KS, et al. A 10-year comparative study of the incidence of third molar removal in the aging population[J]. J Oral Maxillofac Surg,2006,64(2):173-174.
[3] Phillips C, White RP Jr, Shugars DA, et al. Risk factors associated with prolonged recovery and delayed healing after third molar surgery [J]. J Oral Maxillofac Surg, 2003, 61(12): 1436-1448.
[4] Gendreau L, Loewy ZG. Epidemiology and etiology of denture stomatitis [J]. J Prosthodont, 2011, 20(4): 251-260.
[5] Werkmeister R, Fillies T, Joos U, et al. Relationship between lower wisdom tooth position and cyst development, deep abscess formation and mandibular angle fracture [J]. J Craniomaxillofac Surg, 2005, 33(3): 164-168.
[6] Koerner KR. The removal of impacted third molars. Principles and procedures [J]. Dent Clin North Am, 1994, 38(2): 255-278.
[7] National Institute for Clinical Excellence (nice). Guidance on removal of wisdom teeth [R]. London: National Institute for Clinical Excellence, 2000.
[8] Hull DJ, Shugars DA, White RP Jr, et al. Proximity of a lower third molar to the inferior alveolar canal as a predictor of delayed recovery [J]. J Oral Maxillofac Surg, 2006, 64(9): 1371-1376.
[9] Juodzbalys G, Daugela P. Mandibular third molar impaction: review of literature and a proposal of a classification [J]. J Oral Maxillofac Res, 2014, 4(2): e1.
[10] Singhal S, Chand P, Singh BP, et al. The effect of osteoporosis on residual ridge resorption and masticatory performance in denture wearers [J]. Gerodontology, 2012, 29(2): e1059-e1066.
[11] Merrot O, Vacher C, Merrot S, et al. Changes in the edentate mandible in the elderly [J]. Surg Radiol Anat, 2005, 27(4): 265-270.
[12] Ozan O, Orhan K, Aksoy S, et al. The effect of removable partial dentures on alveolar bone resorption: a retrospective study with cone-beam computed tomography [J]. J Prosthodont, 2012, 22(1): 42-48.
[13] 郑家伟. 影响牙槽嵴吸收和下颌骨萎缩的因素 [J].上海口腔医学,1993, 2(2): 112-114.
[14] Heersche JN, Bellows CG, Ishida Y. The decrease in bone mass associated with aging and menopause [J]. J Prosthet Dent, 1998, 79(1): 14-16.
[15] 黄琼, 袁绍沄. 无牙牙槽骨吸收问题 [J]. 国外医学·口腔医学分册, 1989, 16(2): 86-90.
[16] Güler AU, Sumer M, Sumer P, et al. The evaluation of vertical heights of maxillary and mandibular bones and the location of anatomic landmarks in panoramic radiographs of edentulous patients for implant dentistry[J]. J Oral Rehabil, 2005, 32(10): 741-746.
[17] Akyol UK, Salman IA. A case of an extensive dentigerous cyst in the maxillary sinus leading to epiphora and nasal obstruction [J]. J Emerg Med, 2012, 43(6): 1004-1007.
[18] Benn A, Altini M. Dentigerous cysts of inflammatory origin. A clinicopathologic study [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1996, 81(2): 203-209.
[19] Narang RS, Manchanda AS, Arora P, et al. Dentigerous cyst of inflammatory origin-a diagnostic dilemma [J]. Ann Diagn Pathol, 2011, 16(2): 119-123.
[20] Blondeau F, Daniel NG. Extraction of impacted mandibular third molars: postoperative complications and their risk factors [J]. J Can Dent Assoc, 2007, 73(4): 325.
[21] Streckfus CF, Parsell DE, Streckfus JE, et al. Relationship between oral alveolar bone loss and aging among African-American and Caucasian individuals[J]. Gerontology, 1999, 45(2): 110-114.
[22] Jindal SK, Sheikh S, Kulkarni S, et al. Significance of pre-treatment panoramic radiographic assessment of edentulous patients-a survey[J]. Med Oral Patol Oral Cir Bucal,2011,16(4): e600-e606.
[23] Vercellotti T. Technological characteristics and clinical indications of piezoelectric bone surgery[J]. Minerva Stomatol, 2004, 53(5): 207-214.