下顎第二小臼齒立即植牙損及神經之風險

Risk Assessment of Inferior Alveolar Nerve Injury during Immediate Implant Placement around Mandibular Second Premolar Area

宋承恩(Cheng-En Sung) ； 林明鴻(Ming-Hung Lin) ； 黃寶賢(Po-Hsien Huang) ； 毛念平(Lian-Ping Mau) ； 林富煌(Fu-Huang Lin) ； 黃仁勇(Ren-Yeong Huang)

《臨床口腔植體學與科學》 1卷1期 (2014/01) Pp. 1-11

https://doi.org/10.6333/COIS.2014.0101.01

摘要

Background: Immediate implant could reduce the frequency and shorten the overall treatment time, but also increased the surgical potential risks, especially at anatomic critical area (i.e., inferior alveolar nerve damage and/or lingual perforation), such as mandibular second premolar. In this study, we clarified the morphological feature of the mandible around second premolar area, and identified the dimension and relationship between the location of the mandibular concavity and the inferior alveolar canal for risk assessment of inferior alveolar nerve damage by using computerized tomography.Materials and Methods: The morphology of mandible and distance from root tip to the inferior alveolar nerve (RAC) were investigated. In terms of the undercut type, the angle, height, and depth of the concavity, the relationship between the concavity and IAC, and the potential risk of inferior alveolar nerve injury were further analyzed.Results: A total of 62 patients, including 34 males and 28 females (105 teeth), with mean age of 46.87 ± 15.13 years, are included in this study. The results show that the most prevalent morphology of mandibular in second premolar area is P type (43.8%). The average RAC is 6.57 ± 2.74 mm, and the average concavity angle, height, and depth is 70.36 ± 8.16°, 9.73 ± 3.45 mm, 3.38 ± 1.26 mm, respectively. The majority of teeth are located in Area B (46.2%) and Area C (46.2%) in terms of the relationship of the location of the concavity and the inferior alveolar canal. Significant higher incidence of inferior alveolar nerve damaged (RAC ＜ 6 mm) is found in female (81.7%) than in male (46.4%) (p ＜ 0.001).Conclusions: High risk of inferior alveolar nerve damage of immediate implant placement in mandibular second premolar area, especially in female. To increase the safety and success rate of immediate implant placement, carefully evaluate the anatomical features of implant sites in the mandibular posterior area are essential.

關鍵字

牙科植體 ； 診斷 ； 下顎 ； 風險評估 ； 立即植牙

並列摘要

Background: Immediate implant could reduce the frequency and shorten the overall treatment time, but also increased the surgical potential risks, especially at anatomic critical area (i.e., inferior alveolar nerve damage and/or lingual perforation), such as mandibular second premolar. In this study, we clarified the morphological feature of the mandible around second premolar area, and identified the dimension and relationship between the location of the mandibular concavity and the inferior alveolar canal for risk assessment of inferior alveolar nerve damage by using computerized tomography.Materials and Methods: The morphology of mandible and distance from root tip to the inferior alveolar nerve (RAC) were investigated. In terms of the undercut type, the angle, height, and depth of the concavity, the relationship between the concavity and IAC, and the potential risk of inferior alveolar nerve injury were further analyzed.Results: A total of 62 patients, including 34 males and 28 females (105 teeth), with mean age of 46.87 ± 15.13 years, are included in this study. The results show that the most prevalent morphology of mandibular in second premolar area is P type (43.8%). The average RAC is 6.57 ± 2.74 mm, and the average concavity angle, height, and depth is 70.36 ± 8.16°, 9.73 ± 3.45 mm, 3.38 ± 1.26 mm, respectively. The majority of teeth are located in Area B (46.2%) and Area C (46.2%) in terms of the relationship of the location of the concavity and the inferior alveolar canal. Significant higher incidence of inferior alveolar nerve damaged (RAC ＜ 6 mm) is found in female (81.7%) than in male (46.4%) (p ＜ 0.001).Conclusions: High risk of inferior alveolar nerve damage of immediate implant placement in mandibular second premolar area, especially in female. To increase the safety and success rate of immediate implant placement, carefully evaluate the anatomical features of implant sites in the mandibular posterior area are essential.

並列關鍵字

dental implants ； diagnosis ； mandible ； risk assessment ； immediate implant placement