上颌磨牙腭侧双根发生率及解剖特征的锥形束CT研究

目的 利用锥形束CT观察上颌磨牙腭侧双根的发生率及解剖结构特征,以期为临床提供参考.方法 收集528例(1957颗上颌磨牙)锥形束CT的临床三维影像资料,记录患者年龄、性别、观察牙位及腭根数目,观察腭侧双根的发生率、解剖特征及腭侧双根与性别、观察牙位等因素的关系.结果 上颌磨牙腭侧双根的发生率为0.72％ (14/1957),上颌第二磨牙腭侧双根的发生率[1.12％(11/979)]高于第一磨牙[0.31％ (3/978)].上颌腭侧双根的根管口平均距离为(2.84±0.50) mm,近腭根与远腭根牙根长轴夹角平均值为(34.6±16.1)°,均显著大于两颊根的根管口平均距离[(2.15±0.82) mm]和牙根长轴夹角[(21.3±12.2)°](P＜0.05).上颌磨牙腭侧双根的发生与性别、左右方位因素无显著相关性(P＞0.05).结论 上颌第二磨牙腭侧双根的发生率大于第一磨牙,两腭根的根管口平均距离及两腭根夹角均显著大于两颊根,腭侧双根预备难度大于颊侧双根,需谨防器械分离.     

上颌切牙根尖周炎骨病损的锥形束CT三维分析

目的 利用锥形束CT对上颌切牙慢性根尖周炎的骨质破坏进行三维结构分析,以期揭示上颌切牙慢性根尖周炎骨质破坏的立体形貌.方法 对临床确诊为慢性根尖周炎的33颗上颌切牙进行锥形束CT扫描,从轴位、矢状位和冠状位图像上测量根尖周骨质缺损切龈向、近远中向和唇腭向的最大径,同时观察骨皮质是否有破坏.结果 33颗上颌切牙根尖周骨病损切龈向骨质破坏最严重,且52％ (17/33)的患牙位于唇、腭侧;61％ (20/33)的患牙唇腭向骨质破坏的最大径大于近远中向骨质破坏的最大径;39％(13/33)的患牙骨皮质有破坏,多发生在唇侧.结论 患慢性根尖周炎的上颌切牙骨质破坏可能更多发生于切龈向和唇腭向,在临床上应加以注意.     

口腔颌面锥形束CT评估非手术治疗慢性牙周炎上颌窦的黏膜变化

目的探讨口腔颌面锥形束CT（CBCT）评估非手术治疗对慢性牙周炎上颌窦黏膜变化的影响。 方法回顾性分析2018年1月至2018年10月在深圳市宝安区中心医院口腔科疑诊的30例慢性牙周炎伴黏膜增厚型上颌窦炎患者的临床资料,所有患者均在牙周非手术治疗前及治疗后6个月进行口腔颌面CBCT扫描,分析上颌窦黏膜变化,将治疗前后的各项牙周指标[探诊深度（PD）、临床附着丧失（CAL）、菌斑指数（PLI）、龈沟出血指数（SBI）]、上颌窦黏膜厚度和长度进行比较。采用皮尔逊相关系数分析临床指标与黏膜厚度值之间的相关性,对左右侧黏膜厚度值及长度值、治疗前后各项检查指标的比较采用配对t检验。 结果牙周治疗前30例患者上颌窦黏膜厚度值与PD、CAL呈正相关关系（P<0.05）。共58侧上颌窦黏膜术前出现增厚现象,其中轻度上颌窦黏膜增厚20侧,治疗后6个月黏膜厚度值[（1.1 ± 0.6）mm]小于治疗前[（2.5 ± 0.7）mm],差异有统计学意义（t = 2.983,P = 0.015）;中度上颌窦黏膜增厚30侧,治疗后6个月黏膜厚度值[（2.3 ± 0.6）mm]小于治疗前[（5.8 ± 0.5）mm],差异有统计学意义（t = 3.987,P<0.001）;重度上颌窦黏膜增厚8侧,治疗后6个月黏膜厚度值[（4.2 ± 0.4）mm]亦小于治疗前[（11.2 ± 1.8）mm],差异有统计学意义（t = 3.951,P<0.001）。轻、中、重度上颌窦黏膜增厚者,治疗后各项牙周指标与治疗前相比差异均有统计学意义（P<0.05）。 结论牙周非手术治疗对改善上颌窦黏膜增厚有积极意义,口腔颌面CBCT是一种无创、定量研究牙周组织和上颌窦周围组织的有效影像学检测方法。     

腭中缝融合程度对种植体支抗辅助上颌快速扩弓效果的影响

目的通过分析种植体支抗辅助上颌快速扩弓(micro-implant assisted rapid palatal expansion,MARPE)前后患者上颌锥形束CT图像,探讨腭中缝融合程度对MARPE疗效的影响。方法回顾性分析2017年2月至2019年10月于吉林大学口腔医院正畸科就诊的10～34岁上颌横向发育不足患者28例[男性7例,女性21例,年龄(15.5±5.5)岁],分为未融合组[腭中缝未融合,男性4例,女性14例,年龄(13.0±2.4)岁]和融合组[腭中缝开始融合,男性3例,女性7例,年龄(19.9±6.9)岁]。分别于扩弓器植入当天和扩弓治疗结束当天拍摄锥形束CT,将两时间点锥形束CT数据导入Dolphin Imaging软件,测量并比较两组腭中缝打开量、骨性扩弓百分比等测量项目。结果扩弓后未融合组腭中缝平均打开量和骨性扩弓百分比[分别为(4.97±1.47) mm和(71±20)%]均显著大于融合组[分别为(3.23±1.45) mm和(46±18)%](P<0.05)。结论腭中缝融合程度不同的患者MARPE效果差异显著,扩弓前评估腭中缝融合程度对MARPE...     

健康成人下颌切牙管的锥形束CT测量分析

目的 利用锥形束CT测量下颌切牙管(mandibular incisive canal,MIC),了解其形态和特点,为临床提供参考.方法 观察2011年1月至2013年1月50名成人健康志愿者的锥形束CT图像,测量分析MIC的检出率、管径、长度及其与颌骨的关系.结果 在50例(100侧)锥形束CT图像中:MIC的检出率为100％(100/100),清晰率为71％(71/100);MIC的管径面积(唇舌径×垂直径)从起点至终点逐渐变小(左侧起点2.17 mm× 2.22 mm,终点0.82 mm× 0.92 mm;右侧起点2.14 mm×2.08 mm,终点0.87 mm×0.86 mm);MIC左右侧平均长度分别为17.84和17.73 mm;MIC在下颌骨唇舌向偏唇侧;在垂直方向MIC距下颌骨下缘较近,MIC到根尖的距离在尖牙最小.结论 锥形束CT对MIC有良好的检出率和清晰率;MIC在下颌骨的走行中偏向唇侧和下颌骨下缘.     

广东地区60名正常 青年Monson球面半径的锥形束CT测量

目的:应用锥形束CT测量分析广东地区正常青年Monson球面半径,探讨个性化测量Monson球面半径的方法,为口腔临床咬合重建提供参考。方法:采用单纯随机抽样法从广州医科大学附属口腔医院体检人群中招募60名广东地区正常 青年志愿者［男性30名,女性30名,年龄（22.1±2.0）岁（18~26岁）］,于广州...     

颞下颌关节骨关节病的螺旋CT和锥形束CT影像学比较观察

目的:观察并比较螺旋CT、锥形束CT在颞下颌关节骨关节病成像中的应用,探讨锥形束CT与螺旋CT检测准确性的差异,为临床诊治提供依据。方法:选取2018年1月至2019年12月于解放军总医院口腔颌面外科就诊并诊断为颞下颌关节骨关节病的患者52例,其中男性10例,女性42例,平均年龄38.6岁（21~70岁）。所有患者均经...     

锥形束CT辅助诊断慢性牙周炎牙槽骨缺损的准确性研究

目的 评价锥形束CT在辅助诊断慢性牙周炎牙槽骨缺损中的准确性及其与根尖X线片、曲面体层X线片和临床检查结果的一致性,以期为锥形束CT在辅助诊断慢性牙周炎骨缺损中的应用提供依据.方法 采用单纯随机抽样法纳入2012年12月至2013年12月就诊于西安交通大学医学院附属口腔医院牙周黏膜科并确诊为慢性牙周炎的患者75例,分别进行锥形束CT、根尖X线片及曲面体层X线片检查,用华海MedViewer及EzlmPlant软件测量牙槽骨缺损的高度,同时行全口牙周探诊检查,确定附着丧失水平及釉质牙骨质界至牙槽嵴顶的距离,作为影像学检查结果的临床评判指标.对临床测量值及锥形束CT测量牙槽骨的缺损值行配对t检验,采用单因素方差分析评价4种方法检测近远中牙槽骨缺损的结果,以P＜0.05为差异有统计学意义.结果 共纳入1 494颗牙,8 964个位点,3种影像学方法中仅锥形束CT可以检测出唇(颊)或舌(腭)侧牙槽骨破坏;对近远中向牙槽骨缺损的测量结果显示,锥形束CT[近中:(5.5±0.4)mm,远中:(5.6±0.8)mm]与根尖X线片[近中:(5.1±0.6)mm,远中:(5.1±0.8)mm]、锥形束CT与全口曲面体层X线片[近中:(4.9±0.4)mm,远中:(4.9±0.8)mm]的测量结果相比差异均有统计学意义(P值均＜0.01),临床探诊[近中:(5.5±0.6)mm,远中:(5.5±0.6)mm]与根尖X线片及全口曲面体层X线片相比差异亦有统计学意义(P值均＜0.01),但临床探诊与锥形束CT的测量结果相比差异无统计学意义;锥形束CT与临床探诊对不同区域1 494颗牙齿牙槽骨缺损差异的检出情况一致,两种方法检测不同区域牙齿及1 494颗牙不同位点的牙槽骨缺损差异均无统计学意义(P值均＞0.05),两种方法不存在牙位及位点差异性.结论 锥形束CT与临床探诊在评价不同牙位及不同位点的牙槽骨缺损中一致性最高;锥形束CT在判断慢性牙周炎骨缺损方面与临床检查结果具有较高的一致性,优于根尖X线片和曲面体层X线片.     

应用锥形束CT观察下颌第二乳磨牙牙根及根管形态的研究

目的 应用锥形束CT分析儿童下颌第二乳磨牙牙根及根管形态,为儿童口腔科牙髓及根尖周病的治疗提供参考.方法 收集2009年10月至2012年3月四川大学华西口腔医学院儿童口腔科就诊患者(年龄4～8岁)因多生牙、外伤、正畸治疗、颌面部肿瘤等原因拍摄的共305张锥形束CT片.将牙根完全发育、无根尖周炎、无牙根吸收的下颌第二乳磨牙纳入分析样本,共纳入437颗下颌第二乳磨牙样本,样本的数据录入由经过一致性检验的2名研究生及1名放射科主任医师完成,应用SPSS 19.0统计软件采用卡方检验对下颌第二乳磨牙牙根数的性别差异和左右侧差异进行统计学分析,以双侧P ＜0.05为差异有统计学意义.结果 纳入的437颗下颌第二乳磨牙近中单根者436颗,1颗牙为近中双根;远中单根者325颗(74.4％),双根者111颗(25.4％),1颗牙远中3个牙根.近中双根管者424颗(97.0％),单根管者13颗(3.0％);远中单根单根管者103颗(23.6％),单根双根管者222颗(50.8％),双根双根管者106颗(24.3％),双根三根管者5颗(1.1％),三根三根管者1颗(0.2％).下颌第二乳磨牙有10种不同的牙根及根管类型,其三根变异和根管分型存在性别(P=0.000)和左右侧(P =0.028)分布差异.结论 本组资料中下颌第二乳磨牙以两个牙根居多,也存在三根变异的情况,三根变异的发生率男性高于女性;近远中根多为双根管.     

上颌反复快速扩缩口内前方牵引的临床效果研究

目的 本研究目的是评价双轴扩弓器上颌反复快速扩缩口内前方牵引治疗上颌后缩患者的疗效.方法 29例7～13岁患者随机分入两组.观察组:双轴扩弓器上颌反复快速扩缩口内前方牵引;对照组:Hyrax扩弓器上颌单次快速扩弓面罩前方牵引.对治疗前后的头颅侧位片进行传统和直角坐标系头影测量分析.结果 观察组平均疗程7.04个月短于对照组11.04个月,差异有统计学意义(P＜0.01).观察组A-Np增加量1.28 mm小于对照组2.03 mm,差异有统计学意义(P＜0.05),观察组上颌前移量较小.观察组治疗后下颌向后下旋转移动显著小于对照组(P＜0.05).观察组功能(牙合)平面逆时针旋转显著(P＜0.01),与对照组旋转方向相反.结论 双轴扩弓器上颌反复快速扩缩口内前方牵引是一种快速、有效的早期治疗上颌后缩患者的方法,其治疗后上颌前移量有略小于传统的Hyrax扩弓器上颌单次快速扩弓面罩前方牵引的趋势.     

上颌尖牙腭侧埋伏阻生的锥形束CT定位诊断

目的应用锥形束CT（CBCT）探讨上颌腭侧埋伏阻生尖牙的埋伏特征及邻牙牙根吸收情况。方法选取南京医科大学附属口腔医院正畸科就诊的上颌尖牙腭侧埋伏阻生的青少年患者22例,获取CBCT三维数据,应用Dolphin imaging 11.0软件,分析腭侧埋伏尖牙的埋伏状况、与邻牙位置关系并分类,观察邻牙牙根的吸收情况。结果上颌腭侧埋伏尖牙大多近中、腭向倾斜阻生,近中异位以Ⅰ类和Ⅳ类较为多见,分别占30.8%和38.5%;近中倾斜角度多在53.8°~68.5°,腭侧异位距正中矢状面多在5.4~8.4 mm。年龄越大,上颌腭侧埋伏尖牙近中腭向异位越远,近中倾斜角度越大。84.6%的相邻侧切牙及19.2%的中切牙牙根与埋伏尖牙接触;50%的相邻侧切牙及15.4%的邻中切牙牙根吸收,相邻侧切牙吸收多位于根尖1/3,而相邻中切牙吸收多位于根中1/3;相邻切牙牙根吸收概率与腭侧埋伏尖牙与切牙间的最小距离呈反比关系。结论CBCT能在三维方向诊断上颌尖牙埋伏状况及与邻近组织的关系,准确判断邻牙根吸收情况,准确测量埋伏尖牙倾斜度及埋伏深度,为上颌腭侧埋伏尖牙的治疗提供指导。     

Evaluation of a novel palatal suture maturation classification as assessed by cone-beam computed tomography imaging of a pre- and postexpansion treatment cohort

Objectives:To test the reliability and usefulness of the midpalatal suture maturation classification and methodology proposed in 2013 by Angelieri et al. for successful prediction of rapid maxillary expansion (RME) treatment results.Materials and Methods:Reliability testing focused on 16 patients aged 9.5–17 years with early mixed to full permanent dentition, representing all proposed palatal maturation stages, from available preexpansion cone-beam computed tomography (CBCT). A retrospective observational longitudinal (cohort) study evaluated 63 preadolescent and adolescent patients aged 11–17 years with full permanent dentition treated with tooth-borne RME appliances who had CBCT records taken at pre- (T₁) and postexpansion (T₂). CBCT three-dimensional landmarking produced skeletal and dental widths and dental angulations used to evaluate the extent of skeletal and/or dental expansion. A regression model was used to assess the prediction capability of the T1 palatal suture classification of each subject for dental and skeletal changes.Results:There was almost perfect intraexaminer agreement and slight to poor interexaminer agreement, differing from previously reported reliability, affected by necessary operator calibration and the degree of postacquisition image sharpness and clarity. Further exploration of its scientific basis suggested that the proposed classification was ill-founded. Results from the cohort study were also wholly unsupportive of efficacy of the proposed palatal suture maturation classification in predicting the magnitude of portrayed changes.Conclusions:Clinicians should be cautious in applying this classification. Although it has merits, the palatal classification still needs much more research and validation.     

上颌窦内壁分隔的 CBCT 观测

目的：通过CBCT观测上颌窦内壁间隔的解剖特点及分布规律。方法：调取苏州口腔医院放射科接受CBCT扫描的汉族患者的CT图像资料360例。 Mimics 17．0软件对上颌窦进行三维重建。对上颌窦间隔的发生率、数目、形态、位置及双侧分布状况进行观测。结果：360例中,上颌窦间隔的人群总发生率为37．8％,双侧发生占34．6％,双侧相关系数tau值为0．357（P＜0.01）。分布位置常位于磨牙区。不同性别组、年龄组、牙列缺失缺损及牙列完整组间发生率的差异无统计学意义（P＞0．05）。结论：上颌窦间隔在汉族人具有较高的发生率,了解其解剖特点及分布规律具有重要的临床意义。     

Effects of symmetric and asymmetric rapid maxillary expansion treatments on pharyngeal airway and sinus volume:: A cone-beam computed tomography study

ObjectiveTo evaluate pharyngeal airway and maxillary sinus volumes following symmetric rapid maxillary expansion (RME) and asymmetric rapid maxillary expansion (ARME) treatment using cone-beam computed tomography (CBCT).Materials and MethodsThe study consisted of 60 patients presenting to the orthodontics clinic with an indication that they required symmetric or asymmetric rapid maxillary expansion treatment. Individuals were included if they were aged 12–15 years and had symmetric (RME group; 14 girls, 16 boys) or asymmetric (ARME group; 16 girls, 14 boys) maxillary deficiency. Maxillary sinus volume (mm³) and pharyngeal airway volume (upper, lower, and total; mm³) were evaluated using CBCT records. The parameters were compared before treatment (T1) and after 3 months in retention (T2).ResultsAll measurements at T2 were increased significantly compared with T1 in the RME group (P < .05). In the ARME group, changes in the lower pharyngeal airway and the nonaffected maxillary sinus volumes (non-affected side of maxillary sinus volumes) were not significant; however, the other measurements increased significantly from T1 to T2 (P < .05). Intergroup comparisons revealed that total pharyngeal airway volume and total maxillary sinus volume changes were significantly greater in the RME group.ConclusionsPharyngeal airway and maxillary sinus volumes increased with both RME and ARME treatment. Both were found to be effective for treating transverse maxillary deficiency.     

Cone-beam computed tomography evaluation of maxillary sinusitis

Introduction

Dental pain originating from the maxillary sinuses can pose a diagnostic problem. Periapical lesion development eliciting inflammatory changes in the mucosal lining can cause the development of a sinusitis. The purpose of this study was to describe the radiographic characteristics of odontogenic maxillary sinusitis as seen on cone-beam computed tomography (CBCT) scans and to determine whether any tooth or any tooth root was more frequently associated with this disease.

Methods

Eighty-two CBCT scans previously identified as showing maxillary sinus pathosis were examined for sinusitis of odontogenic origin in both maxillary sinuses.

Results

One hundred thirty-five maxillary sinusitis instances with possible odontogenic origin were detected. Of these, 37 sinusitis occurrences were from nonodontogenic causes, whereas 98 instances were tooth associated with some change in the integrity of the maxillary sinus floor. The average amount of mucosal thickening among the sinusitis cases was 7.4 mm. Maxillary first and second molars were 11 times more likely to be involved than premolars, whereas either molar was equally likely to be involved. The root most frequently associated with odontogenic sinusitis is the palatal root of the first molar followed by the mesiobuccal root of the second molar.

Conclusions

Changes in the maxillary sinuses appear associated with periapical pathology in greater than 50% of the cases. Maxillary first or second molar teeth are most often involved, and individual or multiple roots may be implicated in the sinusitis. The use of CBCT scans can provide the identification of changes in the maxillary sinus and potential causes of the sinusitis.     

锥形束CT在治疗上颌前牙区埋伏牙中的应用

目的:探讨锥形束CT(CBCT)在治疗上颌前牙区埋伏牙中的临床应用价值。方法:收集我院2009—2010年经普通X线片确定有埋伏牙,但不易具体定位的患者11例,进行CBCT扫描和三维重建,确定埋伏牙在颌骨内的具体位置。结果:经CBCT扫描、三维重建后,所有患者均可直观再现埋伏牙的形态、数目、在颌骨中的具体位置和发育情况。11例患者共16颗埋伏牙,其中既有埋伏阻生牙又有埋伏多生牙,3例(4颗)为埋伏多生牙,1例有2颗埋伏牙;2例为倒置埋伏,2例为水平埋伏,3例为垂直埋伏,4例为斜位埋伏。根据CBCT结果制订治疗方案,获得满意的治疗效果。结论:CBCT三维重建对于上颌前牙区埋伏牙治疗方案的设计及实施具有重要意义。     

A cone-beam computed tomography study of the mesial cervical concavity of maxillary first premolars

ObjectiveTo investigate the mesial cervical concavity of maxillary first premolars and its relationship with root and canal configuration using cone-beam computed tomography (CBCT).DesignImages of maxillary first premolars (n = 1056) were collected from patients (n = 601) who had undergonein vivo CBCT scanning. The root and canal number and morphology were evaluated. The following measurements of the mesial cervical concavity of the maxillary first premolars were evaluated in section images: dentine thickness (in concavity at the cemento-enamel junction), concavity angle, depression depth (distance from mesial dentinal surface at concavity to mesial proximity), concavity position (distance from mesial dentinal wall at invagination to the top of the mesial marginal ridge). The reliability of the data was analyzed with an unpaired Student’s t test and Fisher’s exact test.ResultsThe percentages of maxillary first premolars with one root, two, and three roots were 55.5%, 43.7%, and 0.8% respectively. Mesial cervical concavity was recorded in 64.5% of single-root maxillary premolars. The prevalence of two-root maxillary first premolars with mesial cervical concavity was 73.8%. The means of the aforementioned four measurements were 1.705, 147.9, 1.640, and 5.247 mm. The values of dentine thickness (mm), depression depth (mm), and concavity position (mm) of the mesial cervical concavity were largest in two-root maxillary first premolars. The smallest concavity angle of the mesial cervical concavity was found in three-root maxillary first premolars.ConclusionsThere is a high prevalence of mesial cervical concavity among maxillary first premolars. The mesial root concavity is more prevalent in single-rooted maxillary first premolars when there are two canals present, and its prevalence and degree of concavity increase with the number of roots.