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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (1): 106-112. doi: 10.19723/j.issn.1671-167X.2025.01.016

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Clinical application and three-dimensional finite element analysis of along-axis extraction method in mandibular mesial and horizontally impacted third molar surgery

Fei WANG1, Xinyue ZHANG2, Muqing LIU3, Enbo WANG1, Denghui DUAN1,*()   

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
    2. Center for Digital Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
    3. Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
  • Received:2024-10-09 Online:2025-02-18 Published:2025-01-25
  • Contact: Denghui DUAN E-mail:18910188808@163.com
  • Supported by:
    the Clinical Research Program of Peking University School and Hospital of Stomatology(PKUSS-2023CRF202)

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Abstract:

Objective: To investigate the clinical application effect of the along-axis extraction method in the extraction of impacted mandibular third molars (IMTM) and to compare the biomechanical characteristics of different root extraction techniques through three-dimensional finite element analysis. Methods: A total of 68 patients requiring IMTM extraction were enrolled and randomly divided into two groups: the experimental group underwent the along-axis extraction method, while the control group underwent the traditional buccal bone removal and root extraction method. The duration of the procedure, intraoperative and postoperative complications were recorded. Three-dimensional finite element analysis further revealed the stress distribution in the tooth root, jawbone, periodontal ligament, and mandibular canal during different root extraction methods. Results: The duration of root extraction, pain score and swelling on the first postoperative day in the control group were (7.87±3.90) min, 4.62±1.90 and (11.37±5.12) mm, respectively, which were significantly higher than those in the experimental group [(5.74±2.37) min, 3.87±1.19 and (7.22±3.39) mm, respectively]. The root fracture rate and lingual bone plate fracture rate in the control group were significantly higher than those in the experimental group (P < 0.05). The results of finite element analysis showed that the control group ' s lingual al-veolar bone had the higher peak equivalent stress, and lingual bone plate fracture was prone to occur. The periodontal ligament of the experimental group had the higher equivalent stress value, making it more likely to rip and more likely to cause root displacement. When subjected to force, the experimental group' s instantaneous root displacement was higher, but the control group ' s root displacement was more pronounced in the lingual direction. Conclusion: This study suggests that the along-axis extraction me-thod can not only effectively shorten the operative time but also reduce postoperative complications after extraction of impacted mandibular third molars, and enhance the safety of the operation and the patient' s comfort. Three-dimensional finite element analysis shows the biomechanical characteristics of various root extraction techniques visually, serves as a valuable guide for choosing and refining clinical surgical techniques, and confirms that extracting a tooth' s root along its long axis yields better clinical results.

Key words: Mandible, Molar, third, Tooth extraction, Tooth, impacted, Complications

CLC Number: 

  • R782.11

Figure 1

The different root extraction methods of the experimental group (A-F) and the control group (G-L) A and G, digital periapical films of impacted wisdom teeth; B, the state after removal of the crown; C, hole is prepared at the distal root surface; D, loose the mesial root along the long axis of the tooth; E, the state after removal of the mesial root; F, the extracted roots; H, the state after removal of the crown; I, the buccal bone was removed to prepare the space; J, loosen the root lingually; K, tooth extraction socket; L, the extracted roots."

Figure 2

Three-dimensional finite element analysis models of the experimental group (A, B) and the control group (C, D) A and B, three-dimensional finite element analysis model of the test group with root extraction along the long axis; C and D, three-dimensional finite element analysis model of the control group with complete root extraction after buccal bone removal."

Table 1

Properties of materials and components of materials"

Items Modulus of rupture/MPa Poisson’s ratio
Cortical bone 14 000 0.30
Cancellous bone 1 370 0.30
Dentin 20 000 0.31
Periodontal membrane 0.68 0.49
Inferior alveolar neurovascular bundle 12 0.45

Table 2

Comparison of general conditions between the two groups"

Items Control group Experimental group P
Age/years, ${\bar x}$±s 27.8±8.4 29.6±8.0 0.364
Gender, n 0.627
Female 17 19
Male 17 15
Type of impaction, n (%) 0.347
Horizontal 23/41 (56.1) 18/41 (43.9)
Mesioangular 12/27 (44.4) 15/27 (55.6)
Depth of impaction, n (%) 0.165
Low impaction 14/22 (63.6) 8/22 (36.4)
Median impaction 21/46 (54.3) 25/46 (55.6)

Table 3

The values of intraoperative and postoperative indexes of patients in different surgical groups"

Items Control group Experimental group t/χ2 value P
Operation duration for root extraction/min, ${\bar x}$±s 7.87±3.90 5.74±2.37 2.713 0.012
Pain VAS score of Pod1, ${\bar x}$±s 4.62±1.90 3.87±1.19 1.932 0.009
Pain VAS score of Pod7, ${\bar x}$±s 1.96±1.28 2.02±1.12 -0.163 0.875
Degree of swelling of Pod1/mm, ${\bar x}$±s 11.37±5.12 7.22±3.39 3.931 0.014
Degree of swelling of Pod7/mm, ${\bar x}$±s 3.94±1.79 4.45±2.10 -1.274 0.199
Degree of trismus of Pod1/mm, ${\bar x}$±s 9.41±4.83 9.81±5.35 -0.325 0.313
Degree of trismus of Pod7/mm, ${\bar x}$±s 5.46±3.82 4.48±4.30 1.004 0.553
Dental root fracture 8/34 1/34 6.275 0.027
Lingual bone plate fracture 6/34 0/34 6.681 0.025

Table 4

The results of three-dimensional finite element analysis"

Items Control group Experimental group
Maximum displacement of root/mm 0.079 0.161
PES of lingual bone plate/MPa 21.658 11.681
PES of periodontal membrane/MPa 1.655 3.978
PES of root/MPa 71.464 32.453
PES of IAN/MPa 0.010 0.034

Figure 3

Results of three-dimensional finite element mechanical analysis of the experimental group (A-F) and the control group (G-L) models A and G, maximum stress distribution of the jaw; B and H, maximum stress distribution of the periodontal membrane; C and I, maximum stress distribution of IAN; D and J, maximum stress distribution of the roots; E, F, K, and L, the trend and amount of tooth root displacement. IAN, inferior alveolar nerve."

1 Sifuentes-Cervantes JS , Carrillo-Morales F , Castro-Núñez J , et al. Third molar surgery: Past, present, and the future[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2021, 132 (5): 523- 531.
doi: 10.1016/j.oooo.2021.03.004
2 Agarwal SS , Xavier F , Rao S , et al. Does the tooth sectioning method impact surgical removal of the distoangular impacted mandibular third molar?[J]. J Oral Maxillofac Surg, 2023, 81 (3): 318- 328.
doi: 10.1016/j.joms.2022.12.005
3 Bailey E , Kashbour W , Shah N , et al. Surgical techniques for the removal of mandibular wisdom teeth[J]. Cochrane Database Syst Rev, 2020, 7 (7): CD004345.
4 Steel BJ , Surendran KSB , Braithwaite C , et al. Current thinking in lower third molar surgery[J]. Br J Oral Maxillofac Surg, 2022, 60 (3): 257- 265.
doi: 10.1016/j.bjoms.2021.06.016
5 Walia S , Verma D , Bansal S , et al. Comparison of piezosurgery devices and the use of rotatory devices for the extraction of impac-ted mandibular third molars[J]. J Pharm Bioallied Sci, 2024, 6 (3): S2140- S2142.
6 段登辉, 王恩博, 崔念晖, 等. 下颌阻生拔除手术的可预期微创化[J]. 北京大学学报(医学版), 2020, 52 (2): 395- 403.
7 Sammartino G , Gasparro R , Marenzi G , et al. Extraction of mandibular third molars: Proposal of a new scale of difficulty[J]. Br J Oral Maxillofac Surg, 2017, 55 (9): 952- 957.
doi: 10.1016/j.bjoms.2017.09.012
8 Elayah SA , Liang X , Sakran KA , et al. Effect of concentrated growth factor (CGF) on postoperative sequel of completely impac-ted lower third molar extraction: A randomized controlled clinical study[J]. BMC Oral Health, 2022, 22 (1): 368.
doi: 10.1186/s12903-022-02408-7
9 Edoardo M , Paolo GA , Gianmario S , et al. A split-mouth randomized clinical trial to evaluate the performance of piezosurgery compared with traditional technique in lower wisdom tooth removal[J]. J Oral Maxillofac Surg, 2014, 72 (10): 1890- 1897.
doi: 10.1016/j.joms.2014.05.002
10 Xu W , Shen J , Li K , et al. A mechanical and three-dimensional finite element study of the optimum tooth sectioning depth during the extraction of low-level horizontally impacted mandibular third molar[J]. Odontology, 2024, 112 (1): 242- 249.
doi: 10.1007/s10266-023-00822-z
11 张馨月, 王勇, 陈倩, 等. 舌侧金属加强杆种植覆盖义齿的三维有限元分析[J]. 医用生物力学, 2024, 39 (3): 532- 538.
12 Wan B , Chung BH , Zhang MR , et al. The effect of varying occlusal loading conditions on stress distribution in roots of sound and instrumented molar teeth: A finite element analysis[J]. J Endod, 2022, 48 (7): 893- 901.
doi: 10.1016/j.joen.2022.03.009
13 Oenning AC , Freire AR , Rossi AC , et al. Resorptive potential of impacted mandibular third molars: 3D simulation by finite element analysis[J]. Clin Oral Investig, 2018, 22 (9): 3195- 3203.
doi: 10.1007/s00784-018-2403-4
14 姚超, 辛海燕, 高菲, 等. 下颌阻生第三磨牙及其邻近结构三维有限元模型的建立及分析[J]. 中国现代医药杂志, 2020, 22 (12): 10- 13.
15 李大鲁, 魏竹亮, 张文美, 等. 下颌阻生智齿拔除术中牙冠切割方式的选择[J]. 中华口腔医学杂志, 2014, 49 (9): 521- 524.
16 X Zheng , X Lin , Z Wang . Extraction of low horizontally and buccally impacted mandibular third molars by three-piece tooth sectioning[J]. Br J Oral Maxillofac Surg, 2020, 58 (7): 829- 833.
doi: 10.1016/j.bjoms.2020.03.029
17 Boffano P , Roccia F , Gallesio C . Lingual nerve deficit following mandibular third molar removal: Review of the literature and medicolegal considerations[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 113 (3): e10- e18.
doi: 10.1016/j.tripleo.2011.06.034
18 Huang C , Zhou C , Xu M , et al. Risk factors for lingual plate fracture during mandibular third molar extraction[J]. Clin Oral Investig, 2020, 24 (11): 4133- 4142.
doi: 10.1007/s00784-020-03286-5
19 Benediktsdóttir IS , Wenzel A , Petersen JK , et al. Mandibular third molar removal: Risk indicators for extended operation time, postoperative pain, and complications[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2004, 97 (4): 438- 446.
doi: 10.1016/j.tripleo.2003.10.018
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