Takaisin

Viisaudenhampaiden ennakoivat poistot parodontiitin ehkäisemiseksi

Näytönastekatsaukset
Marja Pöllänen
12.3.2020

Näytön aste: A

Second molars adjacent to both soft-tissue impacted third molars and nonimpacted (fully erupted) third molars show elevated risk for periodontal pockets and alveolar bone loss compared to sites with absent third molars. Furthermore, patient age > 35 years, wisdom tooth in mandibular arch, smoking and male gender increase the risk for periodontal pathology.

Taulukko 1. Description of the included studies
Reference Study type Population Intervention / Exposure and comparison Outcomes Risk of bias «»1
N-M3 = non-impacted third molar
V-M3 = visible third molar
I-M3 = impacted third molar
* = impaction status (soft tissue/bony) was not analyzed
A-M2= adjacent second molar
«Chou YH, Ho PS, Ho KY ym. Association between the ...»1 Chou 2017 Cross sectional Patients (> 25-years of age, mean age 45 y) with unilateral maxillary or mandibular fully erupted M3s in Periodontal and Dental departments of two hospitals of Kaohsiung city, Taiwan.
Excluded if: pregnant, symptomatic M3s, active periodontal treatment, history of smoking, and a systemic condition (uncontrolled diabetes mellitus, using Ca2þ channel blockers, immunosuppressive medication).
Periodontal disease and caries on second molar (clinical and radiological examination). Comparison between the retained wisdom tooth site and the site with previously extracted wisdom tooth Plaque index Bleeding on probing Periodontal pocket depth (PD) Caries
M3 position
Control of confounding factors Outcome measurement
«Li ZB, Qu HL, Zhou LN ym. Nonimpacted Third Molars...»2 Li 2017 Cross sectional Patients (> 18 y, mean age 41) with at least 1 quadrant with 3 intact molars and a N-M3 and those with at least 1 quadrant with intact first and second molars without a M3 in the Department of Periodontology at the Stomatological Hospital, Fourth Military Medical University (Xi’an, China). Excluded if systemic disease, antibiotic treatment, pregnant, oral tumors, using interdental cleaning devices, periodontal surgery Periodontal parameters on M2 Comparison between sites with N-M3 and sites without M3 Periodontal measurementsof M2: plaque index (PLI), gingival index (GI),PPD, CAL, bleeding on probing (BOP), and gingival recession (GR). The presence of at least 1 PPD5+ Control of confounding factors Outcome measurement
«Li ZB, Qu HL, Zhou LN ym. Influence of Non-Impacte...»3 Li 2017 Cross sectional, retrospective Radiographic survey The influence of asymptomatic N-M3s or I-M3* compared to sites without M3 (adjusted for age and sex) Presence of distal caries, external root resorption (ERR), and alveolar bone loss (ABL) on A-M2s was assessed by orthopantomograms (OPGs) Control of confounding factors Outcome measurement
«Qu HL, Tian BM, Li K ym. Effect of Asymptomatic Vi...»4 Qu 2017 Cross sectional Subjects with at least 1 quadrant having intact first and second molars, either with asymptomatic V-M3s or without adjacent V-M3s in the Department of Periodontology, Stomatological Hospital, Fourth Military Medical University (FMMU), China. Excluded if systemic disease, pregnancy or menstruation, antibiotic treatment, periodontal surgery, M3 extraction within 6 months Periodontal parameters on M2 Comparison between sites with V-M3 and sites without M3 Plaque index (PLI), bleeding on probing (BOP), probing pocket depth (PPD), and at least 1 site with a PPD of 5 mm or more (PPD5+), obtained from M2s Outcome measurement
«Ghaeminia H, Perry J, Nienhuijs ME ym. Surgical re...»5 Ghaeminia 2016 Cochrane systematic review One study «Ghaeminia H, Perry J, Nienhuijs ME ym. Surgical re...»5 included Extraction (absence) compared with retention (presence) for managing asymptomatic disease- free impacted wisdom teeth Periodontal pathology as outcome Eligibility criteria
«Nunn ME, Fish MD, Garcia RI ym. Retained asymptoma...»6 Nunn 2013 Cohort, longitudinal Subjects with both first and second molars present in at least 1 quadrant at baseline and had at least 1 follow-up examination in U.S. Department of Veterans Affairs Dental Third molars were categorized for analyses as absent, erupted, or unerupted, with the last subcategorized as either “soft tissue” or “bony” impacted M2 distal caries experience (either primary or secondary caries), distal alveolar bone loss ≥ 20 %, and distal probing depth > 4 mm. Control of confounding factors Selection of participants Missing data Outcome measurement

Results

Taulukko 2. Outcome 1 Periodontal pathology on second molar adjacent to (partially) erupted wisdom tooth
Reference Number of studies and number of patients (I/C) Follow-up time Absolute number of events (%) I Absolute number of events (%) C Relative effect (95 % CI)
Level of evidence: high
Most evidence comes from cross-sectional studies however, the magnitude of effect is large especially for soft tissue impacted mandibular wisdom teeth.
I = intervention
C = comparison
CI = confidence interval
«Chou YH, Ho PS, Ho KY ym. Association between the ...»1 Chou 2017 81/81 wisdom tooth pairs - - - Higher PD on M2 on the nonextraction side than the extraction side, p = 0,006
«Li ZB, Qu HL, Zhou LN ym. Nonimpacted Third Molars...»2 Li 2017 135 patients - - - OR of having at least 1 PPD5+ in the A-M2s if N-M3 was present 6,79 (1,1–40,2) in mandibular arch 3,33 (1,68–6,59) if patient > 35 y 5,77 (1,27–25,89) male 1,4 (1,1–1,5) smoker 1,7 (1,2–1,9)
«Li ZB, Qu HL, Zhou LN ym. Influence of Non-Impacte...»3 Li 2017 1958 OPGs - - - Both N-M3 and I-M3 increased the risk for alveolar bone loss in M2 (OR respectively 1,77 (1,51 to 2,08) < 0,001 3,84 (3,28 to 4,50) < 0,001)
«Qu HL, Tian BM, Li K ym. Effect of Asymptomatic Vi...»4 Qu 2017 572 subjects (of which 423 had at least one V-M3) - - - Impacted M3s and normally erupted M3s significantly elevated the risk of PPD5+ on their A-M2s (odds ratio 3.20 and 1,67, respectively)
«Ghaeminia H, Perry J, Nienhuijs ME ym. Surgical re...»5 Ghaeminia 2016 416 subjects 3–25 years - - Absence of M3 shows RR of 0,11 (95 % CI 0,06 to 0,22) for periodontal pathology compared to soft tissue impacted M3
«Nunn ME, Fish MD, Garcia RI ym. Retained asymptoma...»6 Nunn 2013 416 subjects 3–25 years - - Second molars adjacent to soft tissue impacted third molars were more likely to have distal bone loss ≥ 20 % (OR = 4,93) and distal probing depth > 4 mm (OR = 3,98). Second molars adjacent to bony impacted third molars were more likely to have distal bone loss ≥ 20 % (OR = 2,64).

Kirjallisuutta

  1. Chou YH, Ho PS, Ho KY ym. Association between the eruption of the third molar and caries and periodontitis distal to the second molars in elderly patients. Kaohsiung J Med Sci 2017;33:246-251 «PMID: 28433071»PubMed
  2. Li ZB, Qu HL, Zhou LN ym. Nonimpacted Third Molars Affect the Periodontal Status of Adjacent Teeth: A Cross-Sectional Study. J Oral Maxillofac Surg 2017;75:1344-1350 «PMID: 28282519»PubMed
  3. Li ZB, Qu HL, Zhou LN ym. Influence of Non-Impacted Third Molars on Pathologies of Adjacent Second Molars: A Retrospective Study. J Periodontol 2017;88:450-456 «PMID: 27976596»PubMed
  4. Qu HL, Tian BM, Li K ym. Effect of Asymptomatic Visible Third Molars on Periodontal Health of Adjacent Second Molars: A Cross-Sectional Study. J Oral Maxillofac Surg 2017;75:2048-2057 «PMID: 28495409»PubMed
  5. Ghaeminia H, Perry J, Nienhuijs ME ym. Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. Cochrane Database Syst Rev 2016;:CD003879 «PMID: 27578151»PubMed
  6. Nunn ME, Fish MD, Garcia RI ym. Retained asymptomatic third molars and risk for second molar pathology. J Dent Res 2013;92:1095-9 «PMID: 24132082»PubMed