锥形束CT对后牙根尖周炎骨病损的评价作用

目的:以锥形束CT(cone-beam computed tomography,CBCT)为标准,评价X线片在诊断后牙根尖周炎骨病损中的作用。方法:收集门诊同时拍摄X线片和CBCT图像的病例80例,共106颗后牙,包括前磨牙和磨牙各53颗,其中健康牙58颗,临床诊断为慢性牙髓炎11颗,诊断为慢性根尖周炎34颗(含8颗根管治疗后的患牙),根管治疗后表现正常的牙3颗。由2名有经验的医师对CBCT图像及X线片进行判读,确定根尖周指数(periapical index,PAI)分级。采用SPSS13.0软件包对所得数据进行χ2检验。结果:分别对106颗疑似患牙的CBCT图像与X线片进行判读,根尖周炎的检出率分别为59.4%和39.6%,差异有显著性(χ2=8.32,P<0.01)。X线片为二维影像,其结构重叠产生伪影,使病变范围界限不清,而CBCT三维图像则对病损范围有明确的显示,有利于疾病的诊断与治疗。另外,X线片不能表现CBCT显示的骨皮质破坏情况。结论:CBCT图像诊断根尖周炎比X线片更有临床价值,可展现X线片无法显示的细节,对疾病的破坏范围和相关结构毗邻显示更清楚,从而准确划分根尖周炎的分级,为临床正确诊断以及科学制定治疗计划提供有效的依据。     

锥形束CT辅助诊断根尖囊肿累及范围的临床应用研究

目的：分析锥形束CT（CBCT）辅助诊断慢性根尖囊肿累及范围的临床应用效果。方法：选取2013年4月－2014年4月诊断为慢性根尖囊肿的CBCT三维重建影像资料42例，观察X线根尖片及CBCT三维重建影像资料，综合评价CBCT在辅助诊断慢性根尖囊肿累及范围中的应用效果。结果：CBCT诊断慢性根尖囊肿累及范围的能力显著优于X线根尖片，42例均能通过CBCT准确诊断囊肿累及患牙，并于根管治疗后根尖囊肿如期愈合。结论：CBCT能够辅助诊断慢性根尖囊肿的累及范围，并指导临床医生判断受累患牙。     

上颌中切牙根中环状侧枝根管1例

目的：报道l例上颌中切牙根中环状侧枝根管病例,探讨上颌中切牙侧枝根管的诊断及治疗方法.方法：1例上颌中切牙牙龈反复肿胀、瘘管病例,X线片发现根中远中侧低密度影,对患牙根管行机械及化学预备、超声荡洗后氢氧化钙封药,热牙胶连续波技术完成根管充填.结果：根充后X线片示根中出现环状侧枝根管影像.患者术后1周复诊无主观症状,牙龈肿胀及瘘管消失.结论：对于上颌中切牙病例,术前仔细阅读X线片,如发现根尖周围或根侧低密度影像,提示侧枝根管存在,应对患牙进行彻底的机械及化学预备、超声荡洗,使用热牙胶连续波技术完成根管的三维充填.     

乳牙根管治疗术失败原因分析

乳牙根管治疗术是乳牙牙髓病、根尖周病最常用的治疗方法,其临床评价的成功率为 95. 45%,X线片评价的成功率为 79. 55%。根管预备、彻底的根管消毒和严密的根管充填,是治疗成功的关键环节。现笔者就临床乳牙根管治疗术失败的病例进行分析。1　临床资料和方法120例乳牙根管治疗术失败患儿,其中乳前牙 32例,乳磨牙 88例。对患牙进行X线片评估,根尖周病变分级标准如下。Ⅰ度:X线片显示根尖周膜稍增宽。Ⅱ度:根分叉处有阴影,继承恒牙胚硬骨板模糊或间断。Ⅲ度:根分叉处有大范围阴影,继承恒牙胚硬骨板完全消失。2　结果(表 1、2)表 1　乳牙根管…     

较大根尖周病变根管治疗术一次法的疗效观察

目的:观察较大根尖周病变患牙根管治疗术一次法的临床疗效。方法:用自制根管糊剂对15 0例较大根尖周病变患牙行根管治疗术一次法治疗,治疗后6个月、12个月、2 4个月随访,通过临床和X线片检查,观察根尖周病变愈合情况并评价其疗效。结果:12 9例1～2周后窦道消失,6个月后X线片检查可见根尖周骨质稀疏区缩小或消失。13例失败,治愈率82 .88%。结论:较大根尖周病变患牙经根管治疗术一次法治疗后,临床疗效满意。     

210例根管治疗失败病例的根尖X线片和锥形束CT的影像学分析

[摘要]目的：比较根尖X线片（periapical radiograph, PR）与锥形束CT（cone-beam computed tomography, CBCT）在诊断根管治疗（root canal treatment, RCT）失败病例时的差异。方法：回顾性分析RCT失败患牙的影像学资料,比较PR与CBCT诊断RCT失败病例的病因和病情时的差异。结果：共分析210颗RCT失败患牙的PR和CBCT资料,根管欠填和遗漏根管是导致RCT失败的主要原因。CBCT能更准确的判断根管充填质量和根折类型,CBCT对遗漏根管的检出率比PR高14.8%,对根折的检出率比PR高5.7%。结论：CBCT对RCT失败病例的病因和病情分析优于PR,能为根管再治疗的方案制定提供更有意义的参考。     

锥形束CT对牙根纵裂的诊断价值

目的评价锥形束CT(CBCT)对牙根纵裂(VRF)的临床诊断价值。方法对61例患者的67颗临床检查怀疑为VRF的患牙拍摄根尖X线片和CBCT,然后对所有患牙进行根尖切除、牙周翻瓣或拔除等外科手术,以确诊VRF是否存在。将根尖X线片和CBCT影像对VRF的诊断结果与外科手术结果进行比较和统计分析。结果外科手术证实62颗患牙VRF明确存在。CBCT诊断VRF的阳性检出率、灵敏度和准确度分别为83.6%、90.3%和91.0%,而根尖X线片为31.3%、33.9%和38.8%(P<0.01)。CBCT诊断颊舌向和近远中向VRF的灵敏度分别为93.2%和62.5%,高于根尖X线牙片的69.6%和12.8%(P<0.05)。结论 CBCT比根尖X线片更准确地诊断VRF。     

CBCT和根尖放射线片诊断根尖周炎的对比性研究

目的：比较应用CBCT和根尖放射线片对慢性根尖周炎的严重程度及病变范围进行评估的差异性,评价CBCT在慢性根尖周病变的诊断、治疗方案的确定及预后等方面的临床价值。方法：选取临床上有根尖周炎症状的53例患者（96颗牙）,均拍摄根尖放射线片和CBCT,分别由2位专家采用单盲法进行放射线影像学诊断,比较两种影像学方法对根尖周炎的存在及病变范围评估的差异性。结果：根尖放射线片发现82.3%,CBCT发现100%的患牙存在根尖周病变。并且在两者都诊断出根尖炎时,CBCT的PAI值明显高于根尖片。结论：在诊断慢性根尖周炎方面,CBCT扫描与根尖放射线片相比具有更高的敏感性和精确度。和根尖放射线片比较,CBCT对临床上根尖周炎的诊断、严重程度及预后判断都更有优势,从而能够更好的指导临床治疗。     

电测法确定根尖孔位置的临床疗效评价

目的观察使用根尖定位仪确定根管工作长度进行根管治疗的临床疗效。方法使用Sono-explorer确定根管工作长度和X线确定根管工作长度,对慢性根尖周炎、牙髓炎的患牙进行一次性根管预备、根管充填,然后摄X线牙片检查,统计比较根充物位置差异及根管治疗后1周6、个月、1年、2年、3年疗效观察统计评价。结果使用根尖定位仪确定根管工作长度进行根管充填的病例根管治疗成功率为97.5%,通过X线片确定根管工作长度的根管治疗成功率为89.2%。结论使用根尖定位仪确定根管工作长度比X线法更准确,根管治疗成功率更高,更方便快捷。     

乳牙根管治疗术后再感染原因分析

1 临床资料 选择2011-01-2012-06来我院就诊的患儿60例,共67个患牙.其中男37例,女23例,年龄3岁7个月～8岁4个月,平均5.9岁.纳入标准:①患牙处于牙根稳定期,就诊前曾因急慢性根尖周炎行常规根管治疗术;②病例资料、术前和术后X线片齐全;③无根折及深牙周袋. 乳牙根管治疗术后再感染诊断标准:①根管治疗术后或治疗过程中反复出现自发痛、咬合痛、牙龈肿胀、窦道等;②窦道经久不愈或根尖周肿胀反复不消;③X线片示根分叉、根尖周骨质破坏区未愈合或扩大,或出现牙根病理性吸收.出现以上任何1项均诊断为根管治疗术后再感染.     

Detection of vertical root fracture using cone beam computed tomography: report of two cases

Abstract – Vertical root fractures (VRFs) often occur in endodontically treated teeth and in patients older than 40 years of age. However, VRFs in teeth without endodontic treatment are relatively uncommon. VRFs are difficult to diagnose as the symptoms are non‐specific or often delayed. The most common radiographic findings are thickening of the periodontal ligament, deep, localized, vertical bone loss, and localized periradicular bone loss. The explicit feature for detecting VRFs is direct visualization of a radiolucent fracture line on radiographs. However, the fracture line can be difficult to directly visualize in conventional diagnostic methods such as periapical radiographs. If unrecognized, VRFs can lead to frustration and inappropriate endodontic treatment. The two cases reported here demonstrate that the use of cone beam computed tomography (CBCT) successfully diagnoses VRFs on teeth without representative clinical and periapical radiographic findings. The clear fracture line can be discerned from the images of CBCT. Thus, CBCT imaging is useful in rapid diagnosis of VRFs and designing of further treatment.     

The potential applications of cone beam computed tomography in the management of endodontic problems

AIM: To provide core information on cone beam computed tomography (CBCT) technology and its potential applications in endodontic practice. SUMMARY: CBCT has been specifically designed to produce undistorted three-dimensional information of the maxillofacial skeleton as well as three-dimensional images of the teeth and their surrounding tissues. This is usually achieved with a substantially lower effective dose compared with conventional medical computed tomography (CT). Periapical disease may be detected sooner using CBCT compared with periapical views, and the true size, extent, nature and position of periapical and resorptive lesions can be assessed. Root fractures, root canal anatomy and the true nature of the alveolar bone topography around teeth may be assessed. CBCT scans are desirable to assess posterior teeth prior to periapical surgery, as the thickness of the cortical and cancellous bone can be accurately determined as can the inclination of roots in relation to the surrounding jaw. The relationship of anatomical structures such as the maxillary sinus and inferior dental nerve to the root apices may also be clearly visualized. KEY LEARNING POINTS: CBCT has a low effective dose in the same order of magnitude as conventional dental radiographs. CBCT has numerous potential applications in the management of endodontic problems.     

CBCT在牙根尖周炎源性上颌窦黏膜炎根管治疗疗效评价中的应用

目的　通过CBCT检查患根尖周炎的上颌后牙,探讨牙根尖周源性上颌窦黏膜炎的特点及根管治疗后黏膜及骨质的改变。方法: 对25例患上颌后牙根尖周炎患者上颌窦进行CBCT扫描重建,确诊为黏膜炎后,根管治疗3个月后CBCT扫描明确黏膜炎消退程度,6个月后扫描通过根尖周指数评估根尖骨质愈合情况。结果: 剔除2例上颌窦炎,14例上颌窦表现为黏膜炎（61％),根管治疗3个月后,黏膜炎完全消退5例（35.7％）;部分消退6例（42.9％）;3例无明显改变（21.4％）。6个月后,3颗牙齿愈合（21.4％）,4颗牙齿好转（28.6％）,7颗牙齿未愈合（50％）。结论:上颌后牙根尖周炎易引发上颌窦黏膜炎,根管治疗是该疾病有效的治疗方法,CBCT影像能精确反映根管治疗前后上颌窦黏膜炎消退及骨质愈合情况,具有重要的临床参考价值。     

偏位投照与锥形束CT在寻找遗漏根管中的准确性比较

目的:分析比较偏位投照与锥形束CT(CBCT)在根管治疗中发现遗漏根管的应用。方法:对200例患牙常规拍摄术前正位根尖片和CBCT,术中插诊断丝拍摄20°～30°偏位投照根尖片,完善根管治疗。比较偏位投照与CBCT发现的遗漏根管数,采用SPSS 19.0软件包对数据进行统计学分析。结果:200例患牙中,偏位投照发现8例患牙有遗漏根管,前牙及前磨牙3例,磨牙5例。而CBCT扫描显示有15例,其中,前牙及前磨牙4例,磨牙11例。CBCT发现数量大于偏位投照,但差异无显著性(P>0.05)。结论:偏位投照与CBCT有利于发现遗漏根管,帮助临床完善根管治疗。     

Cone beam computed tomography and other imaging techniques in the determination of periapical healing

To be able to determine if endodontic treatment of apical pathosis is successful or not, healing of lesions is followed up by radiographic imaging. This can be done by observing changes in apical radiolucencies. Recently, cone beam computed tomography (CBCT) has been introduced as a method of gaining an unabridged view of dental anatomy, thus eliminating some of the most prevalent problems, such as superimposition and distortion. CBCT reduces false diagnosis and is rapidly replacing other radiographic techniques in diagnosis, quality control of treatment methods and techniques, and outcome assessment. Healing assessment using conventional and newer three‐dimensional imaging includes, but is not limited to, periapical osseous lesions, conditions of the maxillary sinus, status after endodontic surgery, hard tissue deposition in regeneration procedures, and horizontal root fractures. Due to a low predictive value of two‐dimensional periapical radiographs to distinguish between periapical disease and health, future assessment of endodontic treatment efficacy may include 3D imaging from small field‐of‐view CBCT units.     

New dimensions in endodontic imaging: Part 2. Cone beam computed tomography

Cone beam computed tomography (CBCT) has been specifically designed to produce undistorted three-dimensional information of the maxillofacial skeleton, including the teeth and their surrounding tissues with a significantly lower effective radiation dose compared with conventional computed tomography (CT). Periapical disease may be detected sooner using CBCT compared with periapical views and the true size, extent, nature and position of periapical and resorptive lesions can be assessed. Root fractures, root canal anatomy and the nature of the alveolar bone topography around teeth may be assessed. The aim of this paper is to review current literature on the applications and limitations of CBCT in the management of endodontic problems.     

Accuracy of cone beam computed tomography and panoramic and periapical radiography for detection of apical periodontitis

The aim of this study was to evaluate the accuracy of imaging methods for detection of apical periodontitis (AP). Imaging records from a consecutive sample of 888 imaging exams of patients with endodontic infection (1508 teeth), including cone beam computed tomography (CBCT) and panoramic and periapical radiographs, were selected. Sensitivity, specificity, predictive values, and accuracy of periapical and panoramic radiographs were calculated. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic accuracy of the panoramic and periapical images. Prevalence of AP was significantly higher with CBCT. Overall sensitivity was 0.55 and 0.28 for periapical and panoramic radiographs, respectively. ROC curves and area under curve (AUC) with periapical radiography showed a high accuracy for the cutoff value of 5 for both periapical (AUC, 0.90) and panoramic (AUC, 0.84) radiographs. AP was correctly identified with conventional methods when showed advanced status. CBCT was proved to be accurate to identify AP.     

锥形束CT用于诊断复杂根尖周病价值研究

目的    评价锥形束CT（CBCT）检查对根尖周病复杂病例的诊断价值 。方法    于2013 年5月至2014年5月从沈阳市铁西区牙病防治所门诊随机选取以不明原因牙痛为主诉的患者40例（患牙40颗）,拍摄患牙X线根尖片（常规正位和远中10°平行投照）并进行CBCT检查,采用根尖周指数（PAI）评价根尖周病损状况,比较两种方法对根尖周病复杂病例诊断及病因判断的差异。结果    X线根尖片与CBCT检查在判断患牙有无根尖周病损上一致性差;两种方法对患牙PAI 分级判断的一致性亦差;CBCT检查能够更好地明确牙痛原因。结论    CBCT 检查有助于诊断临床上不明病因的根尖周病复杂病例。     

Clinical management of dens invaginatus in a maxillary lateral incisor with the aid of cone‐beam computed tomography – a case report

Abstract – This report describes non‐surgical endodontic treatment of Oehlers’ type III dens invaginatus in a maxillary lateral incisor with the aid of postobturation cone‐beam computed tomography (CBCT). The endodontic treatment was initiated with the aid of a surgical operating microscope, and two canals, one of which represented the invagination, were instrumented, irrigated under passive ultrasonic activation and obturated with the lateral condensation technique. As postobturation periapical radiographs suggested the presence of untereated and/or unfilled areas in the root canal and invagination, CBCT was taken to assess the possibility of further treatment. The CBCT scans demonstrated inaccessible and unfilled canal and invagination areas because of complex internal morphology characterized by (i) C‐ or ring‐shaped cross‐sectional canal configuration with constrictions at different points in different root levels and (ii) a prominent intraradicular cavity that was communicated with the enamel‐lined invagination and opened into the apical periodontium. Thus, it was judged that further endodontic treatment was not feasible. A 14‐month follow‐up revealed a satisfactory clinical and radiographic outcome, suggesting that the chemomechanical debridement may have sufficed to induce periapical healing. CBCT greatly helped the decision of avoiding further intervention that could have been difficult to negotiate.     

锥形束CT与根尖片对beagle犬显微根尖手术的预后评估

目的:采用根尖片和锥形束CT(cone beam computed tomography, CBCT)对beagle犬实验性根尖周炎显微根尖手术的预后进行评估。方法:将3条beagle犬18颗前磨牙髓腔暴露于口腔环境中8周, 拍摄根尖片及CBCT显示36个牙根均形成实验性根尖周炎。根管治疗后行显微根尖外科手术,术后即刻、6月分别拍摄根尖片和CBCT,根据根尖片和CBCT的根尖透射影像面积,比较二者在识别根尖骨质缺损的差别。结果:显微根尖手术后即刻CBCT矢状面、冠状面根尖透射影像面积均大于根尖片,差别具有统计学意义(P=0.000,P=0.026);CBCT矢状面、冠状面比较两组间差别无统计学意义(P=0.070)。显微根尖手术后6月复查CBCT矢状面、冠状面根尖透射影像面积均大于根尖片,差别具有统计学意义(P=0.000,P=0.012);CBCT矢状面根尖透射影像面积大于冠状面,两组间差别有统计学意义(P=0.001)。结论:CBCT在根尖周骨质缺损的识别优于根尖片,CBCT在根尖手术骨缺损预后评估中是一项有效的评价手段。