Читать книгу Orthodontic Treatment of Impacted Teeth - Adrian Becker - Страница 113

Young patients who are about to undergo surgical exposure of an impacted tooth need to be informed how the procedure may affect their daily life in terms of pain, function, speech and the several other aspects that involve the oral cavity. The risks and benefits of the intended treatment must be clearly set out. Patients are often apprehensive at the thought of surgery, particularly if they are young and healthy with little or no previous experience of surgical procedures. The incidence and magnitude of these challenges are all part of the post‐surgical follow‐up, of which patients and their parents must be apprised. These aspects of the procedures constitute information that the law requires to be explained to them, in order for them to sign a statement of informed consent. While this is true of all types of orthodontic treatment, it is particularly so where surgery is involved.

A number of articles have recently appeared in oral surgery journals regarding these parameters within the context of the extraction of third molars. However, it is a matter of surprise that there is a significant paucity of published works that relate to quality‐of‐life (QoL) issues in the context of the surgical exposure of impacted teeth. The result has been that the information available to both clinicians and patients is often based on a single anecdotal episode or on the biased reports of individuals who have themselves experienced some form of oral surgery. Information thus gleaned is notoriously unreliable and will rarely have any application to the particular surgical exposure then planned.

This lack of professional information was the motivating factor for the prospective clinical studies that were undertaken in Jerusalem, to quantitatively assess the various aspects of QoL consequential to the performance of both open and closed surgery [42–44].

For the purpose of the QoL study, two groups of patients were assembled. One group included young patients who were scheduled for open surgery and the second group for closed surgery. On the day the exposure was performed, each patient was presented with seven identical questionnaires and was instructed to complete one of the questionnaires on each post‐treatment day, for each of the following seven days. Information was then collected from the answers regarding pain, oral function, general disability, limitation in eating, absence from school and related parameters. The results for the group of patients who had had open exposure were then analysed and compared with those for the patients who had undergone closed exposure.

In general, it was found that full recovery from an open eruption exposure required five days, whereas only three days were required for a closed procedure. It was particularly observed that, in the case of the longer recovery period (the open technique), there was a higher level of pain, greater difficulty in eating and swallowing and an increased need for analgesics. More specifically, it was found that there was much greater discomfort with the open exposure in the case of a palatally impacted canine, especially if bone removal had been performed. However, it is noteworthy that exposure of impacted teeth with a buccal approach resulted in a high level of discomfort, regardless of the surgical method that had been employed. It may be speculated that this was due to the fact that paranasal and oral musculature is severed during buccal procedures and the surgical flap is sited in highly mobile oral mucosa.

Table 5.1 summarizes the effects on QoL issues immediately post treatment. We can see the advantages and disadvantages of complete flap closure (healing by primary intention) compared with the alternative open exposure techniques, in which the opening in the tissue over the impacted tooth is maintained by reducing the size of the flap and packing the wound or by repositioning the flap more apically (healing by secondary intention).