Abstract：
The purpose of this study was to measure and compare coronectomy versus extraction in patients at increased risk for inferior alveolar nerve (IAN) injuries associated with third molar removal in terms of IAN injury and other complications.
The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist. We conducted a comprehensive literature search across six databases and the gray literature from July 15 to August 01, 2022. We employed Rayyan software to identify and remove duplicate articles to ensure data integrity. Our research followed the strategy patient (P), intervention (I), comparison (C), outcome (O), and study (S): (P) patients needing lower third molar surgery at higher risk of IAN injury; (I) surgery options, coronectomy or complete extraction; (C) comparisons included reduced risks of nerve injuries, postoperative complications (pain, infection, alveolitis), and increased risks of reoperation, root migration, and extraction; (O) desired outcomes were preventing nerve injuries and reducing other surgical complications; and (S) observational study designs (cohort, case-control). Excluded from consideration were studies involving teeth other than lower third molars, as well as reviews, letters, conference summaries, and personal opinions. To gauge the certainty of evidence, we employed the Grading of Recommendation, Assessment, Development, and Evaluation instrument, selecting the most current papers with the highest levels of evidence for inclusion. The primary outcome variable of our study centered on evaluating the incidence of IAN injury, and secondly, the lingual nerve (LN) injury, the postoperative pain, infection, localized alveolitis, the necessity for surgical reintervention, root migration, and extraction. These assessments were carried out with respect to their chosen operative technique for managing third molars, either coronectomy or extraction, as predictor variables. We also considered covariates such as age, gender, and the presence of systemic diseases in our analysis to account for potential confounding factors. The pooled data underwent rigorous analysis utilizing an inverse variance method with both random and fixed effect models by the \"metabin\" function in the R program\'s meta-package. Additionally, we assessed the risk of bias in the selected studies by utilizing the Joanna Briggs Institute\'s Critical Appraisal Checklist for Studies Reporting Prevalence Data and the Critical Appraisal Checklist for Case Reports.
Of the 1,017 articles found, after applying the inclusion and exclusion criteria, 42 were included in this study (29 cohort and 13 case-control studies), including 3,095 patients from 18 countries. The meta-analysis showed that coronectomy reduced the risk of IAN injury [OR (Odds Ratio): 0.14; 95% CI (confidence intervals): 0.06-0.30; I2 (inconsistency index) = 0%; P = .0001], postoperative pain (OR: 0.97; 95% CI: 0.33-2.86; I2 = 81%; P = .01), and alveolitis (OR: 0.38; 95% CI: 0.13-1.09; I2 = 32.2%; P = .01) when compared to complete tooth extraction. However, it also highlighted a greater risk of reintervention (OR: 5.38; 95% CI: 1.14-25.28; I2 = 0.0%; P = .01).
This study has demonstrated that coronectomy is associated with a decreased risk for IAN injury and decreased pain and localized alveolitis when compared to complete tooth extraction. However, it is essential to acknowledge the higher likelihood of requiring reintervention with coronectomy. Therefore, clinicians should carefully consider the advantages and potential drawbacks of both techniques and tailor their choices to the unique clinical circumstances of each patient.
The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist. We conducted a comprehensive literature search across six databases and the gray literature from July 15 to August 01, 2022. We employed Rayyan software to identify and remove duplicate articles to ensure data integrity. Our research followed the strategy patient (P), intervention (I), comparison (C), outcome (O), and study (S): (P) patients needing lower third molar surgery at higher risk of IAN injury; (I) surgery options, coronectomy or complete extraction; (C) comparisons included reduced risks of nerve injuries, postoperative complications (pain, infection, alveolitis), and increased risks of reoperation, root migration, and extraction; (O) desired outcomes were preventing nerve injuries and reducing other surgical complications; and (S) observational study designs (cohort, case-control). Excluded from consideration were studies involving teeth other than lower third molars, as well as reviews, letters, conference summaries, and personal opinions. To gauge the certainty of evidence, we employed the Grading of Recommendation, Assessment, Development, and Evaluation instrument, selecting the most current papers with the highest levels of evidence for inclusion. The primary outcome variable of our study centered on evaluating the incidence of IAN injury, and secondly, the lingual nerve (LN) injury, the postoperative pain, infection, localized alveolitis, the necessity for surgical reintervention, root migration, and extraction. These assessments were carried out with respect to their chosen operative technique for managing third molars, either coronectomy or extraction, as predictor variables. We also considered covariates such as age, gender, and the presence of systemic diseases in our analysis to account for potential confounding factors. The pooled data underwent rigorous analysis utilizing an inverse variance method with both random and fixed effect models by the \"metabin\" function in the R program\'s meta-package. Additionally, we assessed the risk of bias in the selected studies by utilizing the Joanna Briggs Institute\'s Critical Appraisal Checklist for Studies Reporting Prevalence Data and the Critical Appraisal Checklist for Case Reports.
Of the 1,017 articles found, after applying the inclusion and exclusion criteria, 42 were included in this study (29 cohort and 13 case-control studies), including 3,095 patients from 18 countries. The meta-analysis showed that coronectomy reduced the risk of IAN injury [OR (Odds Ratio): 0.14; 95% CI (confidence intervals): 0.06-0.30; I2 (inconsistency index) = 0%; P = .0001], postoperative pain (OR: 0.97; 95% CI: 0.33-2.86; I2 = 81%; P = .01), and alveolitis (OR: 0.38; 95% CI: 0.13-1.09; I2 = 32.2%; P = .01) when compared to complete tooth extraction. However, it also highlighted a greater risk of reintervention (OR: 5.38; 95% CI: 1.14-25.28; I2 = 0.0%; P = .01).
This study has demonstrated that coronectomy is associated with a decreased risk for IAN injury and decreased pain and localized alveolitis when compared to complete tooth extraction. However, it is essential to acknowledge the higher likelihood of requiring reintervention with coronectomy. Therefore, clinicians should carefully consider the advantages and potential drawbacks of both techniques and tailor their choices to the unique clinical circumstances of each patient.
摘要：
目的：本研究的目的是在下牙槽神经（IAN）损伤与第三磨牙摘除相关的IAN损伤和其他并发症风险增加的患者中，测量和比较冠状动脉切除术与摘除术。
方法：审查遵循系统审查和荟萃分析清单的首选报告项目。从2022年7月15日至8月1日，我们在六个数据库和灰色文献中进行了全面的文献检索。我们使用Rayyan软件来识别和删除重复的文章，以确保数据完整性。我们的研究跟踪了病人，干预，比较,结果策略：（P）IAN损伤风险较高的需要下第三磨牙手术的患者；（I）手术选择，冠状动脉切除术或完全摘除；（C）比较包括降低神经损伤的风险，术后并发症（疼痛，感染,肺泡炎)，增加了再次手术的风险，根迁移,和拔除；（O）期望的结果是预防神经损伤并减少其他手术并发症；（S）观察性研究设计（队列，病例控制)。不考虑涉及第三磨牙以外的牙齿的研究，以及评论,信件,会议摘要,和个人意见。为了衡量证据的确定性，我们采用了推荐等级，评估,发展,和评估仪器，选择具有最高证据水平的最新论文进行收录。我们研究的主要结果变量集中在评估IAN损伤的发生率，其次,舌神经（LN）损伤，术后疼痛,感染,局限性肺泡炎,手术再干预的必要性，根迁移,和提取。这些评估是根据他们选择的用于管理第三磨牙的手术技术进行的，无论是冠状动脉切除术还是摘除术,作为预测变量。我们还考虑了协变量，如年龄，性别,以及我们分析中存在的全身性疾病来解释潜在的混杂因素。通过R程序元包中的“metabin”函数，利用随机和固定效应模型的逆方差方法对汇总数据进行了严格的分析。此外,我们利用JoannaBriggsInstitute的研究报告患病率数据关键评估清单和病例报告关键评估清单评估了选定研究的偏倚风险.
结果：在发现的1,017篇文章中，在应用纳入和排除标准后，42项纳入本研究(29项队列研究和13项病例对照研究)，包括来自18个国家的3095名患者。荟萃分析显示，冠状动脉切除术降低了IAN损伤的风险[OR（赔率比）：0.14；95％CI（置信区间）：0.06-0.30；I2（不一致指数）=0％；P=.0001]，术后疼痛（OR：0.97;95％CI：0.33-2.86;I2=81％;P=0.01），与完全拔牙相比，肺泡炎（OR：0.38；95％CI：0.13-1.09；I2=32.2％；P=0.01）。然而,它还强调了更大的再干预风险(OR:5.38;95%CI:1.14-25.28;I2=0.0%;P=0.01).
结论：这项研究表明，与完全拔牙相比，冠状动脉切除术可降低IAN损伤的风险，减轻疼痛和局部肺泡炎。然而,必须承认,需要再次进行冠状动脉切除术的可能性较高.因此,临床医生应仔细考虑这两种技术的优点和潜在缺点，并根据每位患者的独特临床情况进行选择。
方法：审查遵循系统审查和荟萃分析清单的首选报告项目。从2022年7月15日至8月1日，我们在六个数据库和灰色文献中进行了全面的文献检索。我们使用Rayyan软件来识别和删除重复的文章，以确保数据完整性。我们的研究跟踪了病人，干预，比较,结果策略：（P）IAN损伤风险较高的需要下第三磨牙手术的患者；（I）手术选择，冠状动脉切除术或完全摘除；（C）比较包括降低神经损伤的风险，术后并发症（疼痛，感染,肺泡炎)，增加了再次手术的风险，根迁移,和拔除；（O）期望的结果是预防神经损伤并减少其他手术并发症；（S）观察性研究设计（队列，病例控制)。不考虑涉及第三磨牙以外的牙齿的研究，以及评论,信件,会议摘要,和个人意见。为了衡量证据的确定性，我们采用了推荐等级，评估,发展,和评估仪器，选择具有最高证据水平的最新论文进行收录。我们研究的主要结果变量集中在评估IAN损伤的发生率，其次,舌神经（LN）损伤，术后疼痛,感染,局限性肺泡炎,手术再干预的必要性，根迁移,和提取。这些评估是根据他们选择的用于管理第三磨牙的手术技术进行的，无论是冠状动脉切除术还是摘除术,作为预测变量。我们还考虑了协变量，如年龄，性别,以及我们分析中存在的全身性疾病来解释潜在的混杂因素。通过R程序元包中的“metabin”函数，利用随机和固定效应模型的逆方差方法对汇总数据进行了严格的分析。此外,我们利用JoannaBriggsInstitute的研究报告患病率数据关键评估清单和病例报告关键评估清单评估了选定研究的偏倚风险.
结果：在发现的1,017篇文章中，在应用纳入和排除标准后，42项纳入本研究(29项队列研究和13项病例对照研究)，包括来自18个国家的3095名患者。荟萃分析显示，冠状动脉切除术降低了IAN损伤的风险[OR（赔率比）：0.14；95％CI（置信区间）：0.06-0.30；I2（不一致指数）=0％；P=.0001]，术后疼痛（OR：0.97;95％CI：0.33-2.86;I2=81％;P=0.01），与完全拔牙相比，肺泡炎（OR：0.38；95％CI：0.13-1.09；I2=32.2％；P=0.01）。然而,它还强调了更大的再干预风险(OR:5.38;95%CI:1.14-25.28;I2=0.0%;P=0.01).
结论：这项研究表明，与完全拔牙相比，冠状动脉切除术可降低IAN损伤的风险，减轻疼痛和局部肺泡炎。然而,必须承认,需要再次进行冠状动脉切除术的可能性较高.因此,临床医生应仔细考虑这两种技术的优点和潜在缺点，并根据每位患者的独特临床情况进行选择。
