右上颌第三磨牙拔除致上颌窦穿孔l例

拔牙并发症引起上颌窦穿孔以上颌第一磨牙常见,其次足上颌第二磨牙和第二双尖牙,第三磨牙拔除后出现上颌寞穿孔极为罕见。笔者遇到l例,现报道如下。1病例报告患者．女．33岁,维吾尔族．因右上后牙龋坏要求拔除。检查：右侧上颌第三磨牙中位垂直阻生,远中邻袷面龋坏、无叩痛、牙龈无红肿。予术按常规2％盐酸利多卡因麻醉、分离牙龈、牙挺自近中颊角插入．顺利完整挺出患牙．见患牙牙根粗大、融合根。置纱卷压迫止血。告知拔牙后注意事项,患者离去。     

上颌第三磨牙拔除术后上颌窦穿孔与皮下气肿1例报告

报道1例上颌第三磨牙拔除后同时合并上颌窦穿孔与皮下气肿的病例。该牙拔除顺利、完整,术后患者反复擤涕、咳痰,导致皮下气肿形成,但上颌窦穿孔是否与擤涕、咳痰有关,则不能确定。     

上颌后牙缺失病人上颌窦CBCT影像学特征分析

目的:针对上颌后牙缺失病人的CBCT资料,分析上颌窦内异常影像的发生率,为病人行种植术前的评估提供参考。方法:选择2011-01—03因上颌后牙缺失需行种植修复病人的CBCT资料76例,共152个上颌窦。由两名研究人员对影像资料进行观察分析,影像诊断结果分为5类:①未见异常影像;②窦底黏膜增厚;③上颌窦囊肿;④上颌窦炎;⑤上颌窦分隔。同时测量所有窦底黏膜增厚病例的平均厚度以及缺牙区窦嵴距,使用SPSS 16.0软件进行统计分析。结果:152例上颌窦中未见异常影像者65例(42.76%),黏膜增厚者36例(23.68%),上颌窦囊肿23例(15.13%),上颌窦炎17例(11.18%),上颌窦分隔11例(7.24%)。窦底黏膜增厚厚度为(3.65±1.65)mm,缺牙区窦嵴距为(7.05±2.99)mm。结论:上颌窦异常影像诊断发生率最高者为窦底黏膜增厚,其次为上颌窦囊肿;不同上颌窦影像诊断类型间窦嵴距的差异无统计学意义(P>0.05);不同性别及不同缺牙情况下诊断类型的发生率间差异无统计学意义(P>0.05)。     

牙槽上颌窦动脉骨孔的CBCT研究

目的 运用CBCT影像观察统计牙槽上颌窦动脉骨孔的发生率、直径,与剩余牙槽骨、上颌窦外侧壁的关系,为临床提供参考.方法 选择2016年1月2016年12月来首都医科大学附属北京口腔医院种植科要求行上颌后牙区种植手术的患者172名,拍摄CBCT测量其牙槽上颌窦动脉骨孔直径,上颌窦外侧壁的厚度,剩余牙槽嵴高度,骨孔下缘至剩余牙槽嵴顶间距,对各测量值进行统计分析.结果 入选172名患者中牙槽上颌窦动脉骨孔的发现率为53.3％(112/210).骨孔的平均直径为(1.27±0.36)mm;上颌窦外侧壁的厚度平均值为(1.81±0.55)mm;剩余牙槽嵴高度平均值为(7.85±3.09)mm;骨孔下缘距剩余牙槽嵴顶间距均值为(17.49±3.64)mm.经采用独立样本t检验,发现性别对骨孔直径影响差异无统计学意义(P>0.05).牙槽上颌窦动脉骨孔下缘距牙槽嵴顶间距与剩余牙槽嵴高度显著正相关,牙槽上颌窦动脉骨孔直径与上颌窦外侧壁的厚度显著正相关.结论CBCT在检测牙槽上颌窦动脉具有较明显的优势,能为手术中避免血管出血提供参考.     

上颌窦提升术中上颌窦解剖生理及病理的 CBCT 探讨

目的:探讨上颌窦生理及病理性CBCT影像表现,为上颌窦提升术解剖定位和操作入路提供参考依据。方法:收集涉及上颌窦的CBCT资料,分析上颌窦解剖特征及病变。结果:1.上颌窦解剖结构位置及其比邻关系复杂;2.影响上颌窦提升术的解剖因素有生理及病理性两种:生理性如上颌窦内的分隔,上颌窦外侧壁的厚度,窦壁上存在的血管影像的粗细,病理性如窦腔内黏膜的增厚,上颌窦内的黏液囊肿,上颌窦内的大量积液等等。结论:CBCT能够准确地显示完整的上颌窦影像,利用CBCT确定解剖定位标志,确定上颌窦提升手术路径和方式,更符合安全、准确、微创的口腔种植理念。     

上颌第三磨牙牙根与上颌窦底关系的锥形束 CT 研究

选择北京大学口腔医院第二门诊部锥形束CT影像库存中2 130颗上颌第三磨牙影像资料,依据其不同阻生位置分为3组。分析比较各组第三磨牙与上颌窦底的关系,结果发现在低、中、高位阻生的上颌第三磨牙中,牙根根尖水平高于上颌窦底的出现概率分别为4.5%、10.3%及14.6%。     

上颌中高位阻生第三磨牙引起相邻第二磨牙牙根外吸收的CBCT研究

目的:探讨上颌中高位近中水平或垂直阻生智齿与相邻上颌第二磨牙牙根外吸收(ERR)之间的关系。方法:收集2019～2022年就诊的88例患者共计93颗患牙的临床资料,对上颌中高位近中水平或垂直阻生第三磨牙引起相邻第二磨牙ERR的相关因素进行分析。结果:上颌第二磨牙ERR的患病率为44.1%,性别和年龄不同,上颌第三磨牙阻生方向不同,第二磨牙ERR发生率差异无统计学意义(P>0.05);上颌智齿阻生深度不同第二磨牙ERR发生率差异有统计学意义(P<0.05)。结论:上颌第三磨牙高位阻生更易导致相邻第二磨牙ERR的发生,建议临床上尽早预防性拔除。     

上颌窦提升术与上颌窦基本生理的相互作用

随上颌窦提升术提出许多年来,该技术在各个方面均得到了很大的发展,但上颌窦提升术与上颌窦基本生理之间的相互关系和相互影响仍未得到广泛的重视,本文就这一主题展开综述。     

上颌第三磨牙拔除引起口腔上颌窦瘘临床病因分析

1 材料与方法 1．1 临床资料 5例病例来源于我科1991～2002年门诊患者，均为拔除上颌第三磨牙造成。其中男3例，女2例；年龄最小25岁，最大38岁，时间从拔牙后2～8d。5例中1例患者曾有上颌窦息肉手术史。     

Ectopic third molar in the maxillary sinus. Case Report

Ectopic eruption of teeth can occur in a wide variety of sites. These include the mandibular condyle, coronoid process, palate, nasal cavity and maxillary sinus. While this process is unusual, the detection of a third molar in the maxillary antrum is extremely rare. A case is presented of ectopic eruption of a third molar in the left maxillary sinus of a 35-year-old caucasian male giving rise to local morbidity.     

Maxillary molar root protrusion into the maxillary sinus: a comparison of cone beam computed tomography and panoramic findings

This study aimed to examine the prevalence of molar roots protruding into the maxillary sinus and to determine the panoramic radiographic signs as correlated with cone beam computed tomography (CBCT). CBCT images of 354 roots were assessed and classified into three types, according to the relationship between the root and maxillary sinus. The prevalence of root protrusion into the maxillary sinus was calculated then the panoramic images assessed. After excluding some unidentified roots on the panoramic images, 200 were investigated for panoramic signs, including (i) projection of the root apex into the sinus cavity, (ii) interruption of the maxillary sinus floor’s cortex, (iii) absence of periodontal ligament space, (iv) darkening of the involved root region, and (v) upward curving of the sinus floor. The respective correlation between the panoramic signs and CBCT types was assessed. Forty-six percent of roots showed protrusion into the sinus with the palatal root of the first molar having the greatest prevalence (33/200 roots). The panoramic signs ‘projection of the root apex in the sinus cavity’ and ‘darkening of the involved root apical region’ both strongly indicated root protrusion into the maxillary sinus (P < 0.05).     

应用颌面专用CT显示上颌窦与上颌后牙区关系

目的：探讨应用颌面专用CT（QR—DVT 9000 NEWTOM）成像技术，显示上颌窦与上颌后牙区关系的意义。方法：对上颌牙齿拔除、种植牙、肿瘤等需要显示上颌窦与上颌后牙区关系的患者，进行颌面专用CT扫描和重建成像。结果：颌面专用CT成像技术能够分别以水平位、矢状位、冠状位、曲面以及3D影像，清楚地显示出上颌窦与上颌后牙区的解剖关系等信息。结论：应用颌面专用CT显示上颌窦与上颌后牙区的关系具有重要的临床意义，更能有效地指导临床手术。     

下颌阻生第三磨牙拔除术后邻牙远中骨缺损的CBCT评价

目的: 分析成人下颌阻生第三磨牙（impacted mandibular third molar, impacted M3M）拔除术后6个月的第二磨牙（mandibular second molar, M2M）远中骨缺损变化及其影响因素。方法: 回顾性分析已拔除阻生M3M的25例患者（37颗M3M）的术前及术后6个月CBCT资料。采用SPSS 25软件包进行数据统计,采用重复测量方差分析比较手术前、后M2M远中骨缺损深度变化,采用独立样本t检验分析其影响因素。结果: M2M术后6个月远中骨缺损深度减少,骨高度相比术前改善;年龄、阻生类型是影响M2M术后6个月骨缺损的因素。结论: 年轻患者高风险M3M拔除后,M2M远端的骨高度有所恢复;年龄、阻生类型是其影响因素。当M3M需要拔除时,早期拔除可能对M2M的牙周健康产生有益影响;如M3M为低位阻生,应同期植入骨移植材料,以期获得更好的远中骨愈合。     

上颌埋伏第三磨牙与多生牙融合1例

融合牙是由2个牙胚间的釉质或牙本质融合在一起而形成.上颌牙融合多发生在侧切牙和尖牙间,极少发生在第三磨牙和多生牙之间.本文报道1例发生在左上颌埋伏第三磨牙与多生牙之间的融合牙.     

正畸治疗中磨牙的拔除和保留(四十三)——上颌第三磨牙缺失或拔除后上颌结节骨量的对照研究

目的：对照研究上颌第三磨牙缺失或拔除后上颌结节骨量的差异,探讨第三磨牙的发生以及拔除第三磨牙对上颌结节骨量的影响。方法：全部病例均采用同一台西门子Orthophos3型牙科X线机拍摄口腔全景片,拍摄条件选择1．25倍恒定放大率模式。为排除生长发育因素,样本年龄均在18岁以上。选择上颌第三磨牙缺失病例21例,平均年龄26岁,上颌第三磨牙拔除2年以上病例18例,平均年龄28岁。测量上颌第二磨牙远中最突点与上颌结节后缘在上颌殆平面上的投影间距离作为上颌结节骨量。对比两组病例上颌结节骨量的不同。结果：上颌第三磨牙拔除组上颌结节骨量均值12．1mm,第三磨牙缺失组上颌结节骨量均值7．7mm,差异具有显著性。结论：上颌第三磨牙的发生对于上颌结节处牙槽骨的生长具有促进作用。在减数磨牙的矫治设计中,不必担心上颌第三磨牙拔除后上颌结节的改建吸收问题。即使是上颌第三磨牙先天缺失病例,上颌结节骨量与拔除前磨牙所提供的间隙相近,提示通过不拔牙矫治,可将全部牙齿向远中移动,解除前段牙弓问题,而有效保存28个牙齿。     

上颌第三磨牙对第一磨牙近中移动影响的研究

目的探讨萌出中的上颌第三磨牙是否会使上颌第一磨牙向近中移动。方法选择18～24岁正畸患者18例,均拔除4颗第一前磨牙矫治,且随机拔除一侧上颌第三磨牙,两侧其余治疗条件保持一致。治疗3个月后观察两侧上颌第一磨牙近中移动量是否存在差异。结果1)拔除上颌第三磨牙的一侧,其上颌第一磨牙在治疗3个月后未发生明显的近中移动;2)未拔除上颌第三磨牙的一侧,其上颌第一磨牙在治疗3个月后的近中移动量为1mm;3)治疗3个月后,未拔除上颌第三磨牙侧的第一磨牙近中移动量大于拔除第三磨牙侧的第一磨牙的近中移动量,其差异有统计学意义(P<0.01)。结论在正畸治疗的初始阶段,若上颌第三磨牙的萌出间隙不足,其萌出会对其近中的上颌第一磨牙产生影响,导致其近中移动而丧失支抗。     

Vertical relationships between the divergence angle of maxillary molar roots and the maxillary sinus floor: A cone-beam computed tomography (CBCT) study

AimTo assess the relations between the divergence angle of the maxillary molar roots and their proximity to the maxillary sinus floor using CBCT.MethodThis study comprised CBCT scans of the maxilla, including at least the inferior one-third of the maxillary sinus and at least one molar present in any quadrant with complete eruption and root formation. Evaluation included the vertical relations between the maxillary molar root apices and the maxillary sinus floor (MSF), and the root divergence was measured from the root apices to the floor of the pulp chamber. The chi-square test was used for the associations between the study parameters. For the correlation between root divergence angles and MSF vertical relationship types, the Spearman test was used. A P-value < 0.05 was considered significant.ResultsA total of 100 scans were analyzed, including 316 permanent maxillary first and second molars. The MSF Type II vertical relationship was the most prevalent (39.6%), followed by Type I (31.3%). The highest divergence angle was found between the distobuccal and palatal roots (mean = 44.9 ± 10.5°). For the mesiobuccal-distobuccal angle groups, there were higher percentages of the MSF Type I and II relationships among the angle groups < 1° and 21-45°. For the mesiobuccal-palatal angle groups, a higher prevalence of the MSF Type II relationship was found in the <21⁰ and >45⁰ angle groups, and a higher prevalence of the Type I relationship was found in the 21-45⁰ angle group. For the distobuccal-palatal angle groups, higher percentages of the MSF Type II relationship were found in the three angle groups. For all teeth, there was a significant positive correlation between the MSF vertical relationship and the mesiobuccal-palatal angle (r = 0.116; P = 0.039).ConclusionThere was a positive correlation between the divergence angle of the roots and their vertical relationship with the MSF. Clinicians should assess the divergence between the roots before performing extraction or endodontic treatments.