Content uploaded by Guido R Sigron
Author content
All content in this area was uploaded by Guido R Sigron on Jul 18, 2016
Content may be subject to copyright.
Zurich Open Repository and
Archive
University of Zurich
Main Library
Strickhofstrasse 39
CH-8057 Zurich
www.zora.uzh.ch
Year: 2014
The most common complications after wisdom-tooth removal: Part 1: A
retrospective study of 1,199 cases in the mandible
Sigron, Guido R; Pourmand, Pièrre P; Mache, Beatrice; Stadlinger, Bernd; Locher, Michael C
Abstract: The knowledge of potential complications after surgical removal of third molars and adequate
risk assessment is indispensable in oral surgery. The present retrospective study analyzed the inuence
of dierent parameters, such as the patient’s age and gender, retention type, and radiological projection
(using orthopantomography) of wisdom teeth on the mandibular canal on postoperative complications
after the removal of 1,199 wisdom teeth. Overall, 101 (8.4%) com- plications occurred: 50 cases of alveolar
osteitis (4.2%), 12 temporary (1%) and 6 persistent (0.5%) sensation disorders, 15 abscesses (1.25%), 7
dehiscences (0.6%), 5 cases of post-operative bleeding (0.4%), 4 sequestra (0.32%), 1 stula (0.08%) and 1
hematoma (0.08%). The risk for developing alveolar osteitis was 6% for patients who suered from a previ-
ous pericoronal infection and was higher for female than male patients. Smoking showed no inuence on
alveolar osteitis. A signicant correlation (p<0.0001) could be shown between the radiological projection
of wisdom teeth on the mandibular canal and post-operative sensation disorders. The experience of the
surgeon and pre-operative 3-dimensional imaging (cone- beam computed tomography, computed tomog-
raphy) did not reduce this risk. No correlation was found for patient’s age and gender. In conclusion, the
surgical decision to remove wisdom teeth must be made with caution in cases of complete radiological
projection of the wisdom tooth on the mandibular canal.
Posted at the Zurich Open Repository and Archive, University of Zurich
ZORA URL: http://doi.org/10.5167/uzh-102777
Published Version
Originally published at:
Sigron, Guido R; Pourmand, Pièrre P; Mache, Beatrice; Stadlinger, Bernd; Locher, Michael C (2014).
The most common complications after wisdom-tooth removal: Part 1: A retrospective study of 1,199
cases in the mandible. Swiss Dental Journal, 124(10):1042-1056.
Research · Science
Forschung · Wissenschaft
Recherche · Science
Publisher
Herausgeber
Editeur
Editor-in-chief
Chefredaktor
Rédacteur en chef
Editors
Redaktoren
Rédacteurs
Assistant Editor
Redaktions-Assistent
Rédacteur assistant
Schweizerische Zahnärzte-
Gesellschaft SSO
Société Suisse
d’Odonto-Stomatologie
CH-3000 Bern 7
Prof. Adrian Lussi
Klinik für Zahnerhaltung,
Präventiv- und
Kinderzahnmedizin
Freiburgstrasse 7
3010 Bern
Andreas Filippi, Basel
Susanne Scherrer, Genève
Patrick R. Schmidlin, Zürich
Simon Flury, Bern
Klaus Neuhaus, Bern
Brigitte Zimmerli, Bern
Articles published in this section have been reviewed by members of the Editorial Review Board.
Jede im Teil «Forschung und Wissenschaft» des SDJ eingereichte Arbeit wird von zahnärztlichen Fachpersonen begutachtet.
Diese genaue Begutachtung macht es möglich, dass die Publikationen einen hohen wissenschaftlichen Standard aufweisen.
Ich bedanke mich bei den unten aufgeführten Kolleginnen und Kollegen für ihre wertvolle Mitarbeit, die sie in den vergan-
genen zwei Jahren geleistet haben.
Adrian Lussi
M. Altenburger, Freiburg
N. Arweiler, Marburg
T. Attin, Zürich
C. Besimo, Brunnen
U. Blunck, Berlin
M. M. Bornstein, Lausanne
D. Bosshardt, Bern
V. Chappuis, Bern
D. Dagassan-Berndt, Basel
S. Eick, Bern
T. Eliades, Zürich
N. Enkling, Bern
A. Filippi, Basel
S. Flury, Bern
A. Friedmann, Witten
K. W. Grätz, Zürich
S. Hänni, Bern
E. Hellwig, Freiburg
I. Hitz Lindenmüller, Basel
T. Imfeld, Zürich
R. Jacobs, Leuven
S. Janner, Bern
C. Katsaros, Bern
J. Katsoulis, Bern
N. Kellerhoff, Bern
S. Kiliaridis, Genf
K. Kislig, Bern
A. Kruse, Zürich
K. Lädrach, Bern
J. T. Lambrecht, Basel
H. T. Lübbers, Zürich
H.-U. Luder, Männedorf
R. Männchen, Winterthur
C. Marinello, Basel
G. Menghini, Zürich
A. Mombelli, Genève
F. Müller, Genève
K. Neuhaus, Bern
I. Nitschke, Zürich
C. Ramseier, Bern
S. Ruf, Giessen
G. Salvi, Bern
M. Schätzle, Luzern
S. Scherrer, Genève
M. Schimmel, Bern
P. R. Schmidlin, Zürich
A. Sculean, Bern
R. Seemann, Bern
V. Suter, Bern
U. üer, Meikirch
J. Türp, Basel
H. van Waes, Zürich
T. von Arx, Bern
C. Walter, Basel
T. Waltimo, Basel
R. Weiger, Basel
M. Zehnder, Zürich
D. Zero, Indianapolis
B. Zimmerli, Bern
N. U. Zitzmann, Basel
1041-1046_T1-1_sigron_e.indd 1041 03.10.14 15:19
SWISS DENTAL JOURNAL VOL 124 10/2014
RESEARCH AND SCIENCE
1042
SUMMARY
e knowledge of potential complications after
surgical removal of third molars and adequate
risk assessment is indispensable in oral surgery.
e present retrospective study analyzed the
influence of different parameters, such as the
patient’s age and gender, retention type, and ra-
diological projection (using orthopantomography)
of wisdom teeth on the mandibular canal on
postoperative complications after the removal
of 1,199 wisdom teeth. Overall, 101 (8.4%) com-
plications occurred: 50 cases of alveolar osteitis
(4.2%), 12 temporary (1%) and 6 persistent
(0.5%) sensation disorders, 15 abscesses
(1.25%), 7 dehiscences (0.6%), 5 cases of
post-operative bleeding (0.4%), 4 sequestra
(0.32%), 1 fistula (0.08%) and 1 hematoma
(0.08%). e risk for developing alveolar osteitis
was 6% for patients who suffered from a previ-
ous pericoronal infection and was higher for
female than male patients. Smoking showed no
influence on alveolar osteitis. A significant cor-
relation (p < 0.0001) could be shown between the
radiological projection of wisdom teeth on the
mandibular canal and post-operative sensation
disorders. e experience of the surgeon and
pre-operative 3-dimensional imaging (cone-
beam computed tomography, computed tomog-
raphy) did not reduce this risk. No correlation was
found for patient’s age and gender. In conclusion,
the surgical decision to remove wisdom teeth
must be made with caution in cases of complete
radiological projection of the wisdom tooth on
the mandibular canal.
KEYWORDS
Wisdom tooth,
mandible,
retention types,
complication,
nerve damage
e most common complications after
wisdom-tooth removal
Part 1: A retrospective study of 1,199 cases in the mandible
G R. S
P P. P
B M
B S
M C. L
Clinic for Dental and Orofacial
Medicine and Maxillary Surgery,
Policlinic for Oral Surgery,
Center for Dental Medicine,
University of Zurich
CORRESPONDENCE
Dr. med. dent. Guido R. Sigron
Klinik für Zahn-, Mund-
und Kieferkrankheiten und
Kieferchirurgie
Poliklinik für Orale Chirurgie
Universität Zürich
Plattenstrasse 15
8032 Zürich
Tel. 044 634 32 90
Fax 044 634 43 28
E-mail: guido.sigron@
zzm.uzh.ch
SWISS DENTAL JOURNAL SSO 124:
1042–1046 (2014)
Accepted for publication:
13 November 2013
Introduction
e removal of mandibular wisdom teeth – both erupted and
retained – is one of the most common oral surgical procedures
in the dental practice. Compared to a simple tooth extraction,
however, the dentist must first perform more comprehensive
pre-operative diagnostics using panoramic radiography and in
some cases even cone-beam computer tomography (CBCT). e
position of the wisdom tooth and the relationship to the man-
dibular canal must be known pre-operatively in order to assess
the risk of complications. With this knowledge, a risk-benefit
analysis and optimal patient information can be conducted if
surgery is indicated. A detailed overview of indications and
contraindications for third-molar removal is given by J
. (). In daily practice, the classification of the respective
tooth by degree of difficulty into simple, advanced, and com-
plex (SAC) has become established (S P ).
Regardless of the operative indication and degree of diffi-
culty, the dentist should be familiar with the possible compli-
1041-1046_T1-1_sigron_e.indd 1042 03.10.14 15:19
SWISS DENTAL JOURNAL VOL 124 10/2014
1043
RESEARCH AND SCIENCE
cations after wisdom-tooth removal and their frequency. How-
ever, most studies have only considered complications
associated with surgical removals (O . , B
, A L , V . ).
us, the aim of this study was to examine the type and fre-
quency of complications after simple extractions and surgical
removal of wisdom teeth. A total of 1,199 removed/extracted
mandibular teeth were evaluated, including the influence of
factors such as age, sex, retention type, and radiological projec-
tion (superimposition). e rate of complications was presented
according to the SAC class of the removed/extracted tooth in
order to determine whether a complex operation was associated
with an increased risk. In addition, the possible relationship
between the occurrence of temporary or permanently impaired
sensation and the retention type as well as the radiological pro-
jection of the tooth on the mandibular canal was examined.
Materials and Methods
In 2004, 1,199 mandibular third molars in 1,001 patients were ex-
tracted or surgically removed under local anesthesia at the Poli-
clinic for Oral Surgery at the University of Zürich. At that time,
the sockets of all operatively removed teeth were left open and
an iodine-vaseline drain was placed in them (S P
). e inclusion criteria were the Swiss Dental Society’s fee
schedule items 4201 (extraction of multi-rooted tooth, n = 401),
4202 (extraction with separation, n = 59), 4203 (extraction with
flap operation, n = 128), 4204 (extraction with flap operation and
separation, n = 57), 4206 (removal of a retained tooth, simple,
n = 383), 4207 (removal of a retained tooth, complex, n = 171) for
the removal of a mandibular third molar as well as the complete
documentation including age, sex, radiographic findings using
OPG or CT, surgery indication, surgical report, and follow-up
progression.
On the OPG, all wisdom teeth were classified either as a re-
tention type I–VII (S P ) or a normally erupt-
ed tooth based on the stage of root growth and the position.
Further, the radiological projection of the wisdom tooth on the
mandibular canal was examined and divided into 5 classes
(none, at the superior border, half, complete, farther to caudal
than inferior border). Existing complications were primarily
divided into 8 main groups: alveolar osteitis (post-operative
pain), impaired sensation, abscess, dehiscence, post-operative
bleeding, sequestrum, fistula, and hematoma. Sensation disor-
ders were further subdivided into type (anesthesia, hypesthe-
sia, hyperesthesia, paresthesia), the nerve affected (N. alveolaris
inferior, N. lingualis) and disorder progression (temporary, per-
manent).
e evaluation examined a possible relationship between
sensation disorder and retention type as well as the radiological
position of the tooth relative to the inferior alveolar nerve. Next,
evaluation was performed according to R S’ ()
seven radiological signs of teeth with complete projection of the
roots on the mandibular canal. R S’ seven signs are:
radiolucent root, curved root, constricted root, dark, split apex,
interruption of the radiopaque superior line of the mandibular
canal, change of direction of canal, constricted canal.
e data were entered into Microsoft Excel, subsequently
graphically displayed using SPSS, and analyzed using single
(Chi-square test) and multiple logistic regression analysis. e
multiple logistic regression analysis was checked again, taking
clustering into account, using STATA 10. e level of signifi-
cance was set at p < 5% (0.05).
Results
Of 1,199 third molars, 569 (47.5%) were in the right mandible
and 630 (52.5%) in the left. Overall, wisdom teeth were re-
moved/extracted more frequently in men (54.5%) than in
women (45.5%). e average age at the time of the operation
was 29 ± 12 years. Most of the teeth were removed prophylacti-
cally upon referral from a dentist or orthodontist in private
practice. e rest were removed due to caries, impaired erup-
tion (pericoronitis/abscess), cysts, and other reasons, e.g., as
part of focal rehabilitation in tumor patients.
Table I shows the respective retention types I–VII relative to
the degrees of difficulty (SAC) according to S P
(). It was possible to classify 877 teeth. 210 teeth were not
retained.
Radiological projection onto the mandibular canal was ob-
served in 1,085 teeth. 387 (35.7%) teeth exhibited no such radio-
logical projection, 355 (32.7%) were projected on the superior
border, 179 (16.5%) were projected over half of the mandibular
canal, and 120 (11%) did so completely. In 44 (4.1%) teeth, the
root apices were farther to the caudal than the inferior border
of the mandibular canal, and CTs were performed in 21 cases for
definitive diagnosis. A total of 34 CTs were done.
A total of 101 (8.4%) complications arose in the 1,199 re-
moved/extracted wisdom teeth. e most frequent complica-
tion was alveolar osteitis (n = 50, 4.2%), followed by temporary
(n = 12, 1%) and permanent (n = 6, 0.5%) sensation disorders,
abscesses (n = 15, 1.3%), dehiscence (n = 7, 0.6%), post-operative
bleeding (n = 5, 0.4%) and other complications, such as forma-
tion of a sequestrum (n = 4, 0.32%), fistula (n = 1, 0.08%) or
hematoma (n = 1, 0.08%).
e risk of developing alveolar osteitis was relatively high
(6%) in patients with pre-existing pericoronitis and was more
common in women than men. No association between smoking
and developing alveolar osteitis was found. e development of
an abscess was most frequent in patients with pre-existing pain
due to caries, pulpitis or apical periodontitis.
Temporary or permanent sensation disorders of the inferior
alveolar nerve occurred more commonly (n = 15, 1.25%) than
Tab. I Retention type distribution by degree of difficulty SAC
(n = 1,087)
S(imple) n relF SD
Type 0: tooth erupted along properly aligned axis 210 0.5
Type II: root growth 2/3 completed 83 0
Type III: retained tooth in normal position 515 2
A(dvanced) n relF SD
Type I: tooth bud, crown formed 10 0
Type IV: tooth tipped to mesial 192 1
Type V: tooth tipped to distal 74 1.4
Type VI: tooth turned perpendicular to alveolar to
alveolar process 1 0
C(omplex) n relF SD
Type VII: highly aberrant tooth 2 0
S = simple, A = advanced, C = complex, relF SD = relative frequency of sensation
disorder (in %)
1041-1046_T1-1_sigron_e.indd 1043 05.10.14 18:11
SWISS DENTAL JOURNAL VOL 124 10/2014
1044 RESEARCH AND SCIENCE
those of the the lingual nerve (n = 3, 0.25%). e left side was
affected more frequently than the right, and in terms of the
number of teeth removed and gender, more sensation disorders
occurred in women (1.8%) than in men (1.2%). However, these
differences were not statistically significant. Similarly, the pa-
tient’s age and the retention type (I–VII) also had no influence
on the development of a sensation disorder. Table II presents an
overview of the affected nerves, type of damage and progres-
sion of the disorder (temporary or permanent).
e occurrence of sensation disorders was statistically signifi-
cantly higher (p < 0.0001) after removal of wisdom teeth whose
OPG showed radiological projection on the inferior border of
the mandibular canal. Figure 1 shows the relative frequency
of sensation disorders in terms of the radiological projections
of the root on the mandibular canal. e evaluation according
to Rood’s seven radiological signs showed no association of any
criterion with the development of a sensation disorder. e
radiolucent roots was by far the most common radiological
finding, followed by the interruption of the radiopaque superior
cortical line. Curved roots and changes of direction were less
common.
In terms of progression, of the 18 (1.5%) sensation disorders
of the inferior alveolar nerve or the lingual nerve, 12 (1%) were
temporary and 6 (0.5%) were permanent. In 4 (0.35%) patients,
it was not possible to follow the progression after the first post-
operative follow-up exam, since they did not attend further
recall appointments. In these cases, the sensation disorder was
presumed to be temporary.
Discussion
In this study, the overall complication rate after the removal
of mandibular wisdom teeth was 8.4%, which agrees with
the frequencies of 4.3% to 9.1% mentioned in the literature
( C . , L . , B . ,
B D ).
e most frequent complication was alveolar osteitis (3.9%).
In comparable studies, the alveolar osteitis rates were 2.6%
( A L ), 2.7% (L . ), 3.6%
(B D ) and 4.2% (V . ). In the
present study, no relationship between smoking as a possible
influencing factor and wound-healing disorders was observed.
In contrast, A L () reported an increased
risk of infection in the fourth quadrant in patients who smoked.
e second most common complication (1.5%) was a post-
operative temporary or permanent sensation disorder. In the
literature, the frequency of this complication varies between
0.6% (O . ) and 14.1% (L . ). us,
the present results fall within the lower end of this range and
are comparable with those of S (), who evaluated the
complication rate after removal of 1,342 mandibular third mo-
lars and found a 2.45% rate of sensation disorders. Table III
shows the results of the present study compared with those
of other authors.
e literature mentions various risk factors (age, local anes-
thetic, radiological signs, etc.) for sensation disorders, some of
which are contentiously discussed. To date, there is no consen-
sus on whether or not a correlation exists between a patient’s
age and developing a sensation disorder. In the present study,
similar to B . () and R . (), no cor-
relation between age and occurrence of a sensation disorder
was found. However, other studies did observe such a relation-
ship (G G , V-C .
). C . () sought to determine the age after
which the risk of complications from wisdom-tooth removal
increases and found it to be 25 years. is was confirmed by
Tab. II Type and frequency of post-operative sensation disorder
(n=1,199)
NAI NL
n (ri/le) t/p n (ri/le) t/p
Anesthesis 0 (0/0) 0/0 2 (1/1) 0/2
Hypesthesia 12 (4/8) 8/4 0 (0/0) 0/0
Paresthesia 2 (1/1) 2/0 1 (0/1) 1/0
Hyperesthesia 1 (1/0) 1/0 0 (0/0) 0/0
Total 15 (6/9) 11/4 3 (1/2) 1/2
NAI = N. alveolaris inferior, NL = N. lingualis, t = temporary, p = permanent
Fig. 1 Relative frequency
of a sensation disorder
of the inferior alveolar
nerve depending on root
position/superimposition
relative to the nerve.
1041-1046_T1-1_sigron_e.indd 1044 03.10.14 15:19
SWISS DENTAL JOURNAL VOL 124 10/2014
1045
RESEARCH AND SCIENCE
other authors (A L , K . ,
B D , V . ). Based on these
results, prophylactic removal of third molars should be per-
formed between the ages of 17 and 24.
Besides the patient’s age, meticulous radiological planning
using OPG and, if necessary, CBCT is important for the suc-
cessful removal of wisdom teeth. Using these imaging tech-
niques, the position of the wisdom tooth – also in relation to
the mandibular canal – must be analyzed. e significant cor-
relation (p < 0.0001) of the occurrence of post-operative sensa-
tion disorders with third molars radiologically shown to be
superimposed on the inferior border of the mandibular canal
emphasizes the importance of this analysis. e indication for
CBCT is clearly given in this situation, since the spatial rela-
tionship between the tooth and the mandibular canal cannot
be interpreted in two dimensions with any certainty (F
O ) but is critical (K . ). Routine CBCT
or CT is not necessary, because in slightly displaced teeth, the
therapeutic benefit is likewise slight (B . ). In the
present study, OPGs showed 164 wisdom teeth to be complete-
ly projected on the mandibular canal. A CT was done in just
31 cases, and 133 radiologically superimposed wisdom teeth
were removed without first performing a CT. It should be men-
tioned that while conducting the study in 2004, CBCT was not
yet available. Interestingly, only 2 cases (1.5%) in the group
without CT had a sensation disorder, but 5 in the group with
CT did so (16.1%). is confirms that despite CT or CBCT imag-
ing and experienced operators, nerve damage cannot be com-
pletely prevented. us, given complete projection of the tooth
on the mandibular canal, the indication for removal must be
particularly strict.
To improve risk assessment, many authors have attempted
to find radiological signs on the OPG which accompany in-
creased risk of nerve damage (R . , B .
, R . ). However, the present study could not
confirm the seven radiological signs defined in the oft-cited and
well-known study by R S () as an influencing
factor. Nevertheless, where these 7 criteria were absent after
third-molar removal, the inferior alveolar nerve was rarely ex-
posed (S . ). It is noteworthy that when the
mandibular canal is opened and the nerve exposed, sensation
disorders occur only rarely (G G , T G
). In the current study, an exposed inferior alveolar nerve
was explicitly described in only 6 of 15 cases of sensation disor-
der of the inferior alveolar nerve.
ere is also some discussion about the influence of the local
anesthetic and the anesthetization itself in sensation disorders.
Currently, the literature shows that the use of articaine 4% and
prilocaine as well as analog sedation or general anesthesia for
wisdom-tooth removal markedly increases the risk of nerve
damage (B . , G G , H
J , P ). In the present study, two patients
developed a temporary sensation disorder, although their wis-
dom teeth had exhibited no radiological projection on the infe-
rior alveolar nerve. Hence, anesthesia cannot be ruled out as an
influencing factor in these cases.
Other complications, such as abscesses and their sequelae or
post-operative bleeding, were relatively infrequent. e risk of
wound infection largely depends on pre-operative oral hygiene,
the type of wound closure, and the patient’s post-operative
behavior. Open wound management including placing an
iodine-vaseline drain results in markedly fewer infections than
does closed wound management (S P ).
However, due to the longer post-operative treatment period,
the former procedure is no longer recommended. For this rea-
son, today the Policlinic for Oral Surgery uses half-open wound
management and places a short iodine-vaseline drain (J
. ). Pre-operative intraoral bacterial reduction by rins-
ing with chlorhexidine 0.12% for 2 minutes statistically signifi-
cantly diminishes the risk of wound infection (H .
, V , C . ), but perioral disinfection of
the lips and facial skin provides no advantage (L ).
In the dental practice, the radiographs/CTs should first be
carefully examined, then the wisdom teeth assigned to the ap-
Tab. III Frequency of sensation disorder compared to literature
No. of cases NAI NL NAI + NL
N % (t/p) % (t/p) % (t/p)
N () 1,320 0.23 (-/-) 0 (-/-) 0.23 (-/-)
O ()
1,6127
- (-/-) - (-/-) 0.6 (-/-)
A () 2,384 0.71 (0.71/0) 0.25 (0.21/0.04) 0.96 (0.92/0.04)
Present study (2004) 1,199 1.25 (0.9/0.35) 0.25 (0.1/0.15) 1.5 (1/0.5)
B ()
3,848
1.2 (1.2/-) 0.9 (0.9/-) 2.1 (2.1/-)
S () 1,342 1.7 (1.7/-) 0.75 (0.75/-) 2.45 (2.45/-)
G () 1,103 4.48 (3.57/0.91) 2.47 (2.1/0.37) 6.95 (5.67/1.28)
B () 741 3.9 (3.9/-) 2.6 (2.6/-) 6.5 (6.5/-)
J () 1,087 4.8 (4.1/0.7) 7.5 (6.5/1) 12.3 (10.6/1.7)
B () 718 - (-/-) - (-/-) 13.4 (-/-)
L () 721 8.4 (8.4/-) 5.7 (5.7/-) 14.9 (14.1/1.2)
NAI = N. alveolaris inferior, NL = N. lingualis, t = temporary, p = permanent, - = no data
1041-1046_T1-1_sigron_e.indd 1045 03.10.14 15:19
SWISS DENTAL JOURNAL VOL 124 10/2014
1046 RESEARCH AND SCIENCE
propriate SAC class. In surgically difficult situations, the opera-
tor should realistically assess his/her own surgical competence
and, if necessary, refer the patient to an oral surgeon or oral
maxillofacial surgeon.
Résumé
En chirurgie orale, il est indispensable de connaître les éven-
tuelles complications suivant l’extraction chirurgicale d’une
troisième molaire et de pouvoir en évaluer les risques. La pré-
sente étude a permis d’évaluer l’influence de l’âge et du sexe
du patient, du type de rétention et du chevauchement radiolo-
gique de la dent avec le canal mandibulaire sur les complica-
tions post opératoires de l’extraction de 1199 dents de sagesse.
Au total, 101 (8,4%) complications ont été constatées: 50 alvéo-
lites (4,2%), 12 troubles temporaires (1%) et 6 troubles perma-
nents de la sensibilité (0,5%), 15 abcès (1,25%), 7 déhiscences
(0,6%), 5 hémorragies (0,4%), 4 séquestres (0,32%), 1 fistule
(0,08%) et 1 hématome (0,08%). Les femmes ainsi que les per-
sonnes ayant souffert d’une péricoronarite présentent un risque
plus élevé de développer une alvéolite, alors que le tabagisme
n’a montré aucune influence. Une corrélation significative
(p < 0,0001) a pu être établie entre une projection radiologique
de la dent de sagesse au-delà de la partie inférieure du canal
mandibulaire sur l’OPT et les troubles de la sensibilité. Aucune
corrélation n’a été établie par rapport à l’âge et au sexe du pa-
tient. Par conséquent, lors d’une planification d’extraction
d’une dent de sagesse présentant une projection radiologique
sur l’OPT au-delà du canal mandibulaire inférieur, il est impé-
ratif de discuter avec le patient des risques plus élevés d’une
lésion du nerf et des troubles de la sensibilité.
References
A J, L J T: Komplikationen bei und
nach operativer Weisheitszahnentfernung.
Schweiz Monatsschr Zahnmed 114: 1271–1286
(2004)
B A B: Sensory nerve impairment following
mandibular third molar surgery. J Oral Maxillo-
fac Surg 59: 1012–1017 (2001)
B H, A I, S B, K A, L Y,
S A, C G: e presurgical workup
before third molar surgery: how much is
enough? J Oral Maxillofac Surg 62: 689–692
(2004)
B C G: Sensory impairment following lower
third molar surgery: a prospective study in New
Zealand. N Z Dent J 93: 68–71 (1997)
B B F, A M A, D R B, K L B,
D T B: Panoramic radiographic risk factors
for inferior alveolar nerve injury after third mo-
lar extraction. J Oral Maxillofac Surg 61: 417–421
(2003)
B F, D N G: Extraction of impacted
mandibular third molars: postoperative compli-
cations and their risk factors. J Can Dent
Assoc 73: 325 (2007)
B C R, B M R, S J P: Factors in-
fluencing nerve damage during lower third mo-
lar surgery. Br Dent J 186: 514–516 (1999)
B C H, S E B, D T B: Types, frequencies,
and risk factors for complications after third
molar extraction. J Oral Maxillofac Surg 61:
1379–1389 (2003)
C A, H L K, B O R: Prevention of alveolar
osteitis with chlorhexidine: a meta-analytic re-
view. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 99: 155–159 (2005)
C M, C M, R G: Germec-
tomy or delayed removal of mandibular impact-
ed third molars: the relationship between age
and incidence of complications. J Oral Maxillo-
fac Surg 53: 418–422; discussion 422–413 (1995)
F L, O A: Preoperative imaging proce-
dures for lower wisdom teeth removal. Clin Oral
Investig 12: 291–302 (2008)
G D, G K L: Inzidenz, Risikofaktoren
und Verlauf von Sensibilitätsstörungen nach
operativer Weisheitszahnentfernung. Mund
Kiefer Gesichtschir 4: 99–104 (2000)
H C B, H T J, B A R, B R A,
C-H J, M S F, G R W:
Perioperative use of 0.12% chlorhexidine gluco-
nate for the prevention of alveolar osteitis: effi-
cacy and risk factor analysis. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 85: 381–387
(1998)
H S, J R: Nerve injury caused by man-
dibular block analgesia. Int J Oral Maxillofac
Surg 35: 437–443 (2006)
J C, P G F, S H F, L J T:
Die Entfernung unterer retinierter Weis heits-
zähne (I). Schweiz Monatsschr Zahnmed 104:
1510–1519 (1994)
J W, S B, M D R, E-M M,
B B, U T, K M, A K M, V-
M, H H, K S, H C: Permanent
sensory nerve impairment following third molar
surgery: a prospective study. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 102: e1–7 (2006)
K M, B J, B P, E P, G G,
H D, H D, H E, K I,
K B, L H C, L H, R E,
S P, S R, T H, T J C,
W M, W D, W R, W W:
Operative Entfernung von Weisheitszähnen.
Mund Kiefer Gesichtschir 10: 205–211 (2006)
K M, M T, K W, W W: ird
molar complications requiring hospitalization.
Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 102: 300–306 (2006)
L V, M R, F C, H M: ird
molar surgery: an audit of the indications for
surgery, post-operative complaints and patient
satisfaction. Br J Oral Maxillofac Surg 33: 33–35
(1995)
L R A: e effect of pre-operative perioral
skin preparation with aqueous povidone-iodine
on the incidence of infection after third molar
removal. Br J Oral Maxillofac Surg 29: 336–337
(1991)
N F: Der Einfluss des chirurgischen Vorge-
hens zum Schutz des Nervus lingualis bei der
Entfernung unterer Weisheitszähne: eine pros-
pektive Studie. Med Diss, Greifswald (2003)
O T P, F G J., S I A, T-
T S: A prospective study of complications
related to mandibular third molar surgery. J Oral
Maxillofac Surg 43: 767–769 (1985)
P M A: Permanent nerve damage from inferi-
or alveolar nerve blocks: a current update. J Calif
Dent Assoc 40: 795–797 (2012)
R K, W K, D M S: Links between
anaesthetic modality and nerve damage during
lower third molar surgery. Br Dent J 193: 43–45
(2002)
R T, H M, S C, M M: A ran-
domised controlled clinical trial to compare
the incidence of injury to the inferior alveolar
nerve as a result of coronectomy and removal
of mandibular third molars. Br J Oral Maxillofac
Surg 43: 7–12 (2005)
R J P, S B A: e radiological prediction of
inferior alveolar nerve injury during third molar
surgery. Br J Oral Maxillofac Surg 28: 20–25
(1990)
S H F, P G F: Retinierte Zähne. In:
Rateitschak K H, Wolf H F (Herausgeber):
Farbatlanten der Zahnmedizin 11, Orale Chirur-
gie. ieme, Stuttgart, pp. 71–140 (1996)
S J: Die operative Entfernung des unteren
Weisheitszahnes unter spezieller Berücksichti-
gung iatrogener Läsionen des Nervus alveolaris
inferior und des Nervus lingualis. Med Diss,
Zürich (1992)
S M, A M A, D T B: Panoram-
ic radiographic findings as predictors of inferior
alveolar nerve exposure following third molar
extraction. J Oral Maxillofac Surg 63: 3–7 (2005)
T A B, G W S: Effect of exposed inferior alveolar
neurovascular bundle during surgical removal of
impacted lower third molars. J Oral Maxillofac
Surg 62: 592–600 (2004)
V-C E, B-A L, G-E-
C: Inferior alveolar nerve damage after lower
third molar surgical extraction: a prospective
study of 1117 surgical extractions. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod 92: 377–383
(2001)
V P J: Dental extraction wound management:
medicating postextraction sockets. J Oral Maxil-
lofac Surg 58: 531–537 (2000)
V T C, S V G, B M M: Kompli-
kationen während und nach chirurgischer Ent-
fernung unterer Weisheitszähne. Einfluss von
Patientenprofil und Anatomie. Schweiz Monats-
schr Zahnmed 118: 192–198 (2008)
1041-1046_T1-1_sigron_e.indd 1046 03.10.14 15:19
