上颌后牙根尖周病变与上颌窦底病理影响关系的锥形束CT研究

目的通过锥形束CT观察样本人群中上颌窦底黏膜增厚情况及性别、年龄、后牙缺失对上颌窦底黏膜增厚的影响;分析在病理状态下,上颌后牙根尖周病变与上颌窦底黏膜增厚的关系,及上颌后牙根尖周病变的侵犯程度对窦底黏膜增厚的影响。方法选用334例符合标准患者的双侧上颌窦影像资料,包含636个上颌窦。在NNT软件界面下在矢状及冠状面记录患者上颌窦黏膜厚度(A型:≤2 mm; B型:>2 mm)、性别、年龄和上颌后牙缺失及根尖周病变的存在情况。对于无后牙缺失及存在清晰上颌后牙根尖周病变的患者,记录病变与上颌窦底的波及关系:OS型(病变与上颌窦底存在一定距离); CO型(病变仅接触上颌窦底但未突破); IS型(病变突入上颌窦底)。所有患者按照年龄分为3个组:18～40岁; 41～60岁;>60岁。结果上颌窦黏膜病理性增厚的比例为40.4%,上颌后牙根尖周病变对上颌窦底黏膜增厚有明显影响(P=0.00),黏膜增厚比例为77.9%; 3种不同类型的上颌后牙根尖周病变与窦底的波及关系造成的窦底黏膜增厚比例无统计学差异(P=0.30);男性上颌窦黏膜增厚比例(45.6%)显著大于女性(36.3%)(P=0.01); 41～60岁及60岁以上人群上颌窦黏膜增厚比例显著大于40岁以下人群(P=0.00);上颌后牙有缺失时上颌窦底黏膜发生黏膜增厚的比例(58.9%)显著高于上颌后牙无缺失的情况(35.7%)(P=0.00)。结论根尖周病变是导致上颌窦黏膜增厚的主要因素,且随着根尖周病损逐渐侵入上颌窦内,上颌窦底黏膜增厚的发生率逐渐上升,但是,当上颌后牙根尖周存在病变时,即使病变范围未触及上颌窦底,也不能排除上颌窦炎的可能性。另外,男性、中老年人群及上颌后牙缺失患者上颌窦黏膜增厚比例普遍较高。

A study of the pathological influence relation of periapical lesion of maxillary posterior teeth and the maxillary sinus floor using cone beam computed tomography

Objective To observe the thickness of maxillary sinus mucosa and analyze the influence of sex,age and loss of posterior teeth on it,and to evaluate the relationship between periapical lesion of maxillary posterior teeth and the maxillary sinus mucosa thickening,and the influence of the invasion degree of the former on the latter. Methods CBCT images were collected from 334 Chinese patients(including 636 sinus). In NNT,the thickness of maxillary sinus mucosa(Type A: ≤2 mm;Type B: >2 mm),sex,age,loss of adjacent posterior teeth,and the state of periapical lesion were recorded in the sagittal and coronal planes. In patients without tooth loss,the affected relationship was recorded,including Type OS(the lesion had a certain distance to the MSF),Type CO(the lesion contacted the MSF)and Type IS(the lesion intruded into the MSF). All patients were divided into three groups according to age: 18 ~40 years,41 ~ 60 years and >60 years. Results The proportion of pathological maxillary sinus mucosal thickening was 40.4%. There was a significant increase in the proportion of pathological mucosal thickening when periapical lesion existed(P = 0.00)and the thickness of sinus mucosa had no significant difference with three different affected relationships(P = 0. 30). The proportion of mucosal thickening in the male(45.6%)was significantly greater than that of women(36.3%)(P = 0.01).The pathological thickening ratio of maxillary sinus mucosa in people over 40 years old was significantly greater than those under 40(P = 0.00).The proportion of the pathological mucosal thickening with posterior tooth loss(58.9%)was significantly higher than that of tooth loss(35.7%)(P = 0.00). Conclusions Periapical lesion is the main factor leading to the thickening of the maxillary sinus mucosa,and the incidence of mucosal thickening significantly increases with the gradual invasion of periapical lesion. The possibility of maxillary sinusitis can not be ruled out even if the lesion does not reach the MSF. Additionally,there is a high proportion of patients with pathological mucosal thickening in male,middleaged and elderly patients and people with tooth loss.