detstomСтоматология детского возраста и профилактикаPediatric dentistry and dental prophylaxis1683-30311726-7218RPA10.33925/1683-3031-2024-845detstom-845Research ArticleКЛИНИЧЕСКИЙ СЛУЧАЙCASE REPORTФормирование оперативного доступа при удалении ретенированных зубов на нижней челюсти: клинические случаиApproaches to surgical access for impacted tooth removal in the mandible: clinical case reportshttps://orcid.org/0000-0002-5690-0011ГаспарянК. К.GasparyanK. K.

Гаспарян Карен Камоевич, директор, врач-стоматолог

Краснодар

Karen K. Gasparyan, director, dentist

Krasnodar

gasparkaren83@mail.ruhttps://orcid.org/0000-0002-3420-5595МостовойС. О.MostovoyS. O.

Мостовой Семен Олегович, кандидат медицинских наук, доцент кафедры стоматологии и ортодонтии факультета подготовки медицинских кадров высшей квалификации и дополнительного медицинского образования ордена Трудового Красного Знамени Медицинского института имени С. И. Георгиевского 

Симферополь

Semen O. Mostovoy, DMD, PhD, Associate Professor, Department of Dentistry and Orthodontics, Medical Institute named after S. I. Georgievsky

Simferopol

semen-34@yandex.ruhttps://orcid.org/0000-0001-9752-6911ВолобуевВ. В.VolobuevV. V.

Волобуев Владимир Викторович, кандидат медицинских наук, доцент кафедры детской стоматологии, ортодонтии и челюстно-лицевой хирургии

350053, ул. Митрофана Седина, д. 4, г. Краснодар

Vladimir V. Volobuev, DMD, PhD, Associate Professor, Department of Pediatric Dentistry, Orthodontics and Maxillofacial Surgery

4 Mitrofan Sedin Str., Krasnodar, 350053

vladimir.volobueff@yandex.ruhttps://orcid.org/0000-0002-9084-0569УвароваА. Г.UvarovaA. G.

Уварова Анна Георгиевна, кандидат медицинских наук, доцент кафедры хирургической стоматологии и челюстно-лицевой хирургии

Краснодар

Anna G. Uvarova, DMD, PhD, Associate Professor, Department of the Dental and Maxillofacial Surgery

Krasnodar

uvarova.anna.ge@yandex.ru«Авторская стоматология Dr. Gasparyan K»Россия«Аuthor's dentistry Dr. Gasparyan K»Russian FederationКрымский федеральный университет имени В. И. ВернадскогоРоссияV. I. Vernadsky Crimean Federal UniversityRussian FederationКубанский государственный медицинский университетРоссияKuban State Medical UniversityRussian Federation202424012025244399406Copyright © Гаспарян К.К., Мостовой С.О., Волобуев В.В., Уварова А.Г., 20252025Гаспарян К.К., Мостовой С.О., Волобуев В.В., Уварова А.Г.Gasparyan K.K., Mostovoy S.O., Volobuev V.V., Uvarova A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.detstom.ru/jour/article/view/845Актуальность

Актуальность. Задержка прорезывания клыков и премоляров нижней челюсти – довольно частое явление в практической стоматологии, и связано оно с ретенцией или импакцией зуба. В настоящее время имеется несколько путей решения проблемы: либо перемещение зубов в зубной ряд хирургически-ортодонтическим путем, либо их удаление. В связи с особенностями положения причинных зубов в нижней челюсти оперативное вмешательство чаще проводят вестибулярным доступом с образованием значительного костного дефекта, что увеличивает риск дополнительной микротравмы сосудисто-нервного пучка.

Описание клинического случая. В первом случае при удалении ретенированного зуба 3.3 и фоликулярной кисты нижней челюсти слева для обеспечения достаточной видимости использовали портативный назофаринголарингоскоп. Оперативное вмешательство заключалось в щадящей остеотомии селективным методом с помощью хирургического наконечника, позволяющим уменьшить объем костной раны и избежать травмирования сосудисто-нервного пучка. Во втором случае, при удалении ретинированного зуба 3.5, был также использован селективный метод щадящей остэктомии в виде двойного вестибулярного доступа, позволившего уменьшить размер костного дефекта и минимизировать травмирование подбородочного нерва.

Заключение

Заключение. В случае расположения зуба в области нижнечелюстного канала или ментального отверстия необходимо корректировать тактику хирургического доступа. В данной статье приведены клинические случаи удаления ретенированных зубов с использованием различных методик их удаления.

Relevance

Relevance. Delayed eruption of mandibular canines and premolars is a frequent concern in pediatric dentistry, commonly linked to tooth retention or impaction. Several treatment strategies are available to address this issue, including surgical-orthodontic repositioning into the dental arch or extraction of the affected teeth. Given the anatomical positioning of impacted teeth in the mandible, surgical procedures are often performed via a vestibular approach, which can lead to substantial bone defects and an elevated risk of microtrauma to the vascular-nerve bundle.

Description of clinical case. In the first case, during the removal of the impacted tooth 3.3 and a follicular cyst in the left mandibular region, a portable nasopharyngolaryngoscope was used to ensure sufficient visibility. The surgical intervention involved a selective method of minimally invasive osteotomy performed with a surgical hand-piece, which allowed for a reduction in the size of the bony wound and the prevention of trauma to the vascular- nerve bundle. In the second case, during the removal of the impacted tooth 3.5, a selective method of minimally invasive osteotomy was also applied, utilizing a dual vestibular approach. This technique reduced the size of the bone defect and minimized the risk of injury to the mental nerve.

Conclusion

Conclusion. When a tooth is positioned in proximity to the mandibular canal or mental foramen, it is essential to adjust the surgical access approach accordingly. This article provides an overview of clinical cases involving the removal of impacted teeth, highlighting the application of different surgical techniques.

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The authors declare that there are no conflicts of interest present.