高下牙槽神经损伤风险下颌第三磨牙相关下颌管皮质骨 缺损的危险因素研究

doi:10.13591/j.cnki.kqyx.2026.04.005

摘要/Abstract

摘要：

目的探究影响高下牙槽神经损伤风险下颌第三磨牙(mandibular third molar,M3)相关下颌管皮质骨缺损的危险因素。方法回顾性分析2018年1月—2021年12月于南京医科大学附属口腔医院就诊的2 516例患者,共计3 389颗高下牙槽神经损伤风险M3。所有病例均拍摄曲面断层片和CBCT。通过CBCT评估下颌管皮质骨状态,结合多因素Logistic回归分析影响下颌管皮质骨缺损的危险因素。结果高下牙槽神经损伤风险M3相邻下颌管皮质骨缺损的发生率为38.15%。M3处于近中、中位、低位、Ⅱ类和Ⅲ类阻生,下颌管位于M3牙根舌侧或牙根之间以及狭窄型下颌管是高下牙槽神经损伤风险M3相关下颌管皮质骨缺损的危险因素。结论高下牙槽神经损伤风险M3相关下颌管皮质骨缺损发生率较高,与其影像学特征显著相关。对此类患者进行术前CBCT评估,可帮助临床医生优化拔牙手术方案,降低下牙槽神经损伤的发生风险。

关键词: 下颌第三磨牙, 下颌管皮质骨缺损, CBCT, 危险因素

Abstract:

Objective To identify risk factors influencing cortical bone defect of the mandibular canal related to mandibular third molar with high-risk of inferior alveolar nerve injury (IAN-risk M3). Methods A retrospective study was conducted on 2 516 patients (3 389 M3s) with IAN-risk M3s who attended the Affiliated Stomatological Hospital of Nanjing Medical University between January 2018 and December 2021. All patients underwent panoramic radiography and cone-beam computed tomography (CBCT). Mandibular canal cortical bone condition was assessed on CBCT, and multivariate Logistic regression analysis was performed to determine significant risk factors for cortical bone defect. Results The incidence of mandibular canal cortical bone defect associated with IAN-risk M3 was 38.15%. Mesioangular, middle and low levels impactions, Class Ⅱ and Class Ⅲ impactions, mandibular canal positioned lingual to or between the M3 roots, and a narrow canal morphology were significant risk factors for cortical bone defect. Conclusion Mandibular canal cortical bone defect associated with IAN-risk M3s have a relatively high prevalence and were significantly correlated with radiographic characteristics. Preoperative CBCT evaluation in such cases can assist clinicians in optimizing surgical strategies for third molar extraction and reducing the risk of inferior alveolar nerve injury.

Key words: mandibular third molar, mandibular canal cortical bone defect, CBCT, risk factors

中图分类号:

R782.11

杨昊川, 阳胜军, 刘婧怡, 徐彬豪, 王东苗. 高下牙槽神经损伤风险下颌第三磨牙相关下颌管皮质骨缺损的危险因素研究[J]. 口腔医学, 2026, 46(4): 266-271.

YANG Haochuan, YANG Shengjun, LIU Jingyi, XU Binhao, WANG Dongmiao. Risk factors for cortical bone defect of the mandibular canal related to mandibular third molars with high-risk of inferior alveolar nerve injury[J]. Stomatology, 2026, 46(4): 266-271.

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参考文献 30

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相关因素		下颌管皮质骨状态				P
相关因素		完整		局部缺损		P
性别	男性	926	(64.44%)	511	(35.56%)	0.001^*
性别	女性	1 170	(59.94%)	782	(40.06%)	0.001^*
年龄/岁	18~25	550	(60.98%)	352	(39.02%)	0.063
	26~35	823	(59.99%)	549	(40.01%)
	36~45	512	(65.64%)	268	(34.36%)
	46~55	211	(62.99%)	124	(37.01%)
Winter分类(曲面断层片)	近中	484	(50.26%)	479	(49.74%)	<0.000 1^*
	水平	566	(52.85%)	505	(47.15%)
	垂直	1 046	(77.20%)	309	(22.80%)
Pell-Gregory分类(基于第二磨牙咬合平面,曲面断层片)	高位	1 115	(81.15%)	259	(18.85%)	<0.000 1^*
	中位	786	(51.37%)	744	(48.63%)
	低位	195	(40.21%)	290	(59.79%)
Pell-Gregory分类(基于下颌升支,曲面断层片)	Ⅰ类	762	(84.57%)	139	(15.43%)	<0.000 1^*
	Ⅱ类	888	(63.66%)	507	(36.34%)
	Ⅲ类	446	(40.81%)	647	(59.19%)
下颌管相对M3牙根的位置(CBCT)	下方	816	(70.77%)	337	(29.23%)	<0.000 1^*
	颊侧	1 173	(67.92%)	554	(32.08%)
	舌侧	101	(22.15%)	355	(77.85%)
	中间	6	(11.32%)	47	(88.68%)
下颌管形态(CBCT)	圆形/卵圆形	2 014	(88.02%)	274	(11.98%)	<0.0001^*
下颌管形态(CBCT)	狭窄型	82	(7.45%)	1 019	(92.55%)	<0.0001^*

类别		皮质骨状态		P	OR (95%CI)
类别		完整	局部缺损	P	OR (95%CI)
性别	男性	926(64.44%)	511(35.56%)
	女性	1 170(59.94%)	782(40.06%)	0.090	1.227(0.968,1.555)
年龄	18~25	550(60.98%)	352(39.02%)
	26~35	823(59.99%)	549(40.01%)	0.139	1.237(0.933,1.639)
	36~45	512(65.64%)	268(34.36%)	0.808	1.042(0.746,1.456)
	46~55	211(62.99%)	124(37.01%)	0.118	1.402(0.918,2.140)
Winter分类(曲面断层片)	近中	484(50.26%)	479(49.74%)
	水平	566(52.85%)	505(47.15%)	0.322	0.855(0.627,1.166)
	垂直	1 046(77.20%)	309(22.80%)	0.238	0.808(0.568,1.151)
Pell-Gregory分类(基于第二磨牙咬合平面,曲面断层片)	高位	1 115(81.15%)	259(18.85%)
	中位	786(51.37%)	744(48.63%)	0.007^*	1.587(1.133,2.223)
	低位	195(40.21%)	290(59.79%)	0.047^*	1.569(1.006,2.449)
Pell-Gregory分类(基于下颌升支,曲面断层片)	Ⅰ类	762(84.57%)	139(15.43%)
	Ⅱ类	888(63.66%)	507(36.34%)	0.082	1.389(0.959,2.012)
	Ⅲ类	446(40.81%)	647(59.19%)	<0.0001^*	2.504(1.597,3.926)
下颌管相对M3牙根的位置(CBCT)	下方	816(70.77%)	337(29.23%)
	颊侧	1 173(67.92%)	554(32.08%)	0.055	0.783(0.609,1.005)
	舌侧	101(22.15%)	355(77.85%)	<0.000 1^*	2.365(1.581,3.537)
	中间	6(11.32%)	47(88.68%)	0.020^*	4.243(1.250,14.408)
下颌管形态(CBCT)	圆形/卵圆形	2 014(88.02%)	274(11.98%)
	狭窄型	82(7.45%)	1 019(92.55%)	<0.000 1^*	60.615(46.408,70.181)