锥形束CT分析中国人群上颌后牙区牙槽骨及牙根与上颌窦位置关系的研究

［摘要］ 目的 利用锥形束CT三维成像分析上颌后牙区牙槽骨高度以及牙根与上颌窦底位置关系,为临床诊断和治疗提供可靠的参考依据。方法 选取500例患者的锥形束CT影像资料,测量上颌前磨牙和磨牙的牙槽骨高度、牙根至上颌窦底距离、磨牙牙根与上颌窦的位置关系（垂直和水平关系）,按照牙位和年龄将这些数据分组,分析在不同牙位和年龄段的差异。结果 上颌前磨牙的牙槽骨高度分别为（11.31±7.39）和（9.52±7.98）mm,显著高于上颌磨牙区,随着年龄的增长牙槽骨高度降低。上颌第二磨牙近颊根至上颌窦底距离最短,其平均值为（1.73±3.63）mm;第一前磨牙牙根至上颌窦底的平均值为（9.53±5.79）mm,至上颌窦底距离最长,随着年龄的增长,牙根与上颌窦底间距离变短。在牙根与上颌窦的垂直关系中,三个牙根均不与上颌窦下壁接触的情况显著高于其他分类;水平关系中,在根尖至根分叉水平观察到上颌窦最为常见;随诊年龄的增长牙根与上颌窦的关系更加密切。结论 不同年龄和牙位牙根与上颌窦的关系差异较大,利用锥形束CT可精确分析上颌后牙区解剖结构,制定个性化治疗方案,降低医源性问题的发生。     

上颌后牙缺失患者上颌窦影像学特征分析

目的：分析上颌后牙缺失患者的上颌窦影像学特征,探讨不同类型上颌后牙缺失患者上颌窦影像学的变化特点。方法：选取上颌后牙缺失患者的700份数字化X线曲面断层片作为研究资料。调查上颌窦分隔和上颌窦囊肿的发生率并根据患者的性别,年龄及缺牙状况进行分组,测量各组缺牙区的窦嵴距及窦底高度,使用SPSS16.0软件对数据进行统计学分析。结果：单牙缺失组窦嵴距〉多牙缺失组窦嵴距,两组之间差异有显著性（P〈0.001）。多牙缺失组窦底高度〉单牙缺失组窦底高度,两组之间差异有显著性（P=0.014）。59岁～77岁组女性窦嵴距〈男性窦嵴距,男性窦低高度〈女性窦低高度,组内比较有显著差异（P〈0.001）。上颌窦分隔发生率为27%,上颌窦囊肿发生率为4.9%。结论：上颌后牙缺失不同缺牙状况窦底高度和窦嵴距有统计学差异,59～77岁年龄段窦底高度和窦嵴距有性别差异。     

Anatomical aspects of sinus floor elevations

Inadequate bone height in the lateral part of the maxilla forms a contra-indication for implant surgery. This condition can be treated with an internal augmentation of the maxillary sinus floor. This sinus floor elevation, formerly called sinus lifting, consists of a surgical procedure in which a top hinge door in the lateral maxillary sinus wall is prepared and internally rotated to a horizontal position. The new elevated sinus floor, together with the inner maxillary mucosa, will create a space that can be filled with graft material. Sinus lift procedures depend greatly on fragile structures and anatomical variations. The variety of anatomical modalities in shape of the inner aspect of the maxillary sinus defines the surgical approach. Conditions such as sinus floor convolutions, sinus septum, transient mucosa swelling and narrow sinus may form a (usually relative) contra-indication for sinus floor elevation. Absolute contra-indications are maxillary sinus diseases (tumors) and destructive former sinus surgery (like the Caldwell-Luc operation). The lateral sinus wall is usually a thin bone plate, which is easily penetrated with rotating or sharp instruments. The fragile Schneiderian membrane plays an important role for the containment of the bonegraft. The surgical procedure of preparing the trap door and luxating it, together with the preparation of the sinus mucosa, may cause a mucosa tear. Usually, when these perforations are not too large, they will fold together when turning the trap door inward and upward, or they can be glued with a fibrin sealant, or they can be covered with a resorbable membrane. If the perforation is too large, a cortico-spongious block graft can be considered. However, in most cases the sinus floor elevation will be deleted. Perforations may also occur due to irregularities in the sinus floor or even due to immediate contact of sinus mucosa with oral mucosa. Obstruction of the antro-nasal foramen is, due to its high location, not a likely complication, nor is the occurrence of severe haemorrhages since the trap door is in the periphery of the supplying vessels. Apart from these two aspects, a number of anatomical considerations are described in connection with sinus floor elevation.     

锥形束CT冠状位分析上颌后牙牙根与上颌窦底垂直向位置关系的初步研究

目的 通过对锥形束CT影像资料的回顾性研究,分析在冠状位上上颌后牙根与上颌窦底的垂直向关系.方法 对162例成年患者锥形束CT的影像资料进行回顾性研究,在冠状位上将根尖与上颌窦底的垂直向位置关系进行分型统计.结果 上颌前磨牙主要是0类关系,上颌磨牙有20％左右根尖突入上颌窦底,磨牙的各个牙根与上颌窦底的关系各不相同.结论 上颌后牙根尖突入上颌窦底的比例不同,以第一磨牙的腭根和第二磨牙的近中颊根比率最高.     

上颌窦囊性改变的影像分类诊断及 上颌窦提升术的探讨

锥形束CT影像上常常可以发现上颌窦囊性改变的存在,这种改变是否影响上颌窦提升术的实施呢?这对临床医生造成了一定的困惑。本文结合临床上常见的各种囊性改变的锥形束CT影像表现,对上颌窦囊性改变的影像分类诊断进行介绍,并探讨囊性改变时上颌窦提升术的实施可行性、手术方式及术后黏膜的影像学改变等,以帮助临床医生作出正确判断。     

上颌窦囊性改变的影像分类诊断及上颌窦提升术的探讨

锥形束CT影像上常常可以发现上颌窦囊性改变的存在,这种改变是否影响上颌窦提升术的实施呢?这对临床医生造成了一定的困惑。本文结合临床上常见的各种囊性改变的锥形束CT影像表现,对上颌窦囊性改变的影像分类诊断进行介绍,并探讨囊性改变时上颌窦提升术的实施可行性、手术方式及术后黏膜的影像学改变等,以帮助临床医生作出正确判断。     

曲面体层片与锥形束CT比较分析上颌后牙牙根与上颌窦的关系

目的 研究曲面体层片与锥形束CT(cone beam computer tomography,CBCT)判断上颌后牙牙根与上颌窦关系的准确性,为临床医师根据曲面体层片信息治疗上颌后牙区相关疾病提供参考.方法 纳入80例符合标准的患者(牙根数671个),以锥形束CT为标准,在曲面体层片及锥形束CT片上测量上颌后牙根尖到上...     

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)。     

上颌窦内提升术种植修复上颌后牙缺失的临床观察

目的:评价上颌窦内提升术并同期植入种植体在上颌后牙区缺失修复中的应用效果。方法:2008年至2010年共完成上颌窦内提升术并同期植入种植体临床病例20例。男12例,女8例,年龄18-65岁。术前CT示:牙槽嵴顶至上颌窦底距离为5-8mm,行上颌窦内提升术,平均提升上颌窦底高度3.8mm(2-5mm),共植入38枚种植体,种植体植入6个月后完成义齿修复。结果:所有患者术后未出现上颌窦炎症,一例术中窦膜穿孔,将种植窝放入明胶海绵,同期植入种植体完成种植手术,术后3天术区疼痛,无其他明显症状。38枚种植体平均负载18个月,种植体稳定,行使功能良好,未见明显骨吸收。结论:对于骨高度不足的患者,行上颌窦内提升术,并同期植入种植体的方法可靠,具有好的疗效,可扩大种植牙的适应症范围。     

锥形束CT研究上颌磨牙根尖与上颌窦底壁的解剖关系

目的采用锥形束CT,观测上颌磨牙根尖与上颌窦底壁的解剖关系,并进行分类,为治疗方案的制定和操作风险评估提供解剖学依据。方法从宿迁口腔医院影像科数据库中筛选出60位成年人,120侧上颌磨牙区锥形束CT影像,对其进行重建,测量磨牙根尖与上颌窦底壁的距离,并按照Shahbazian M分类法进行分析。结果上颌第一磨牙远中颊侧根距离上颌窦底壁的距离最小。分类中出现最多的为Ⅰ型(41.67%),最易引起上颌窦炎的Ⅳ型约占总数的19.85%,且上颌第一磨牙的远颊侧根出现Ⅳ型最多(29.17%)。结论上颌磨牙根尖与上颌窦底壁的关系个体差异较大。因此临床上,涉及该区域的治疗,需个性化的制定治疗方案,增加治疗的成功率且减少医源性问题。     

上颌窦内提升术同期种植体植入术在修复上颌后牙缺失伴颌骨骨量不足病例中的应用

目的探讨上颌窦内提升术同期牙种植术修复剩余牙槽骨高度(RBH)的上颌后牙缺失颌骨骨量不足的临床疗效。方法选择上颌骨骨量不足行种植修复患者45例(85颗种植体)均行上颌窦内提升术同期牙种植术,其中RBH<5 mm患者加用骨挤压并植入骨粉。分别于术后1、3、6、12个月复查X线检查种植体保留情况,并观察骨改建骨小梁形成及骨吸收情况。结果患者均无上颌窦炎症,种植体周围边缘骨稳定,均获良好骨结合。A组、B组种植体的留存率分别为100.0%和95.6%,差异无统计学意义(χ2=0.51,P>0.05);上颌窦底不同提升高度之间的窦底改建程度比较,差异无统计学意义(χ2=4.49,P>0.05)。结论上颌窦内提升术同期牙种植术可有效修复上颌后牙缺失,颌骨骨量不足,对RBH<5 mm的患者有较好的留存率。     

上颌窦底提升的研究进展

上颌窦底提升是有效解决上颌骨后部骨量不足的方法之一,能为后期种植体的成功植入提供保证。长期以来,利用自体髂骨提升上颌窦底被视为"金标准"。但取髂骨术后,疼痛、感染是其常见并发症。组织工程技术和细胞因子的应用,克服了传统方法的不足,成为上颌窦提升的新进展。本文就此作一综述。     

Blood supply to the maxillary sinus relevant to sinus floor elevation procedures

The maxillary blood supply is essential for preserving the vitality of the affected maxillary region, integration of the grafting material, and wound healing such as following sinus floor elevation. Although it is well established that edentulous maxillae demonstrate a decreasing vascularity as bone resorption progresses, the vascular conditions relevant to sinus floor elevation procedures have not been investigated yet. This study deals with maxillary arteries relevant to sinus floor elevation surgery and examines the vascularization of the lateral maxilla after tooth loss. The vessels of the lateral maxilla of 18 maxillary specimens (10 male, 8 female, mean age 67 years) were prepared anatomically and the local main arteries, the number of macroscopically discernible branches and anastomoses, their calibers, and the distance between the caudal main branches and the alveolar ridge recorded. The lateral maxilla is supplied by branches of the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) that form an anastomosis in the bony lateral antral wall, which also supplies the Schneiderian membrane. This intraosseous anastomosis was found in all of the specimens. Eight of 18 also showed an extraosseous anastomosis between PSAA and IOA, vestibular to the antral wall, giving off an average of 3 branches cranially and 5 branches caudally. The two anastomoses form a double arterial arcade to supply the lateral antral wall and, partly, the alveolar process. The PSAA had a mean caliber of 1.6 mm and exhibited an average of 2 endosseous and 1 extraosseous branches. The IOA had a mean diameter of 1.6 mm and showed an average of 1 endosseous and 3 extraosseous branches. The mean distance between the intraosseous anastomosis and the alveolar ridge was 19 mm in 2 defined measuring sites. Its mean length was 44.6 mm. The epiperiosteal vestibular anastomosis was situated further cranially at a mean distance of 23 to 26 mm from the alveolar ridge and had a mean length of 46 mm. The rather large caliber of the vessels supplying the lateral antral wall seems to be crucial to the fact that the periosteal blood supply is maintained even in severe maxillary atrophy and after complete disappearance of the centro-medullary vessels.     

上颌窦底提升术的研究进展

上颌窦底提升骨增量技术是目前解决上颌后牙区骨量不足的最为有效而可靠的方法,本文根据临床体会及当前国际上有关此方面技术的文献,对常见的上颌窦提升技术进行了介绍,对各种术式的优缺点进行了分析评论.上颌窦提升后同期种植可以缩短治疗周期,简化治疗程序,是一个值得研究的方向,本文对其发展及自身的经验进行了总结和介绍.     

螺旋CT在上颌窦底壁分型及内提升术风险评估中的应用

目的 通过上颌窦螺旋CT扫描,初步对上颌窦底壁进行分型,并为种植牙上颌窦内提升术的风险评估提供理论依据。方法 选取55例（110侧）健康成人的鼻窦CT影象,对上颌窦进行螺旋CT连续容积扫描、三维重建,在选取的截面上观察上颌窦底的形态。结果 110侧上颌窦底中,平坦型、凹面型、凸面型各有50侧、53侧、7侧,所占比例分别为45.5%、48.2%、6.3%。其中平坦型与凹面型之间无显著性差异（P<0.05）,而凸面型与另两种分型之间有显著性差异（P>0.05）。性别、左右侧以及不同年龄之间均无显著性差异（P<0.05）。结论 上颌窦内提升术前,进行螺旋CT扫描,观察窦底形态对评估手术风险有重要的临床指导意义。     

上颌窦内提升术后植骨区感染的临床应对探讨

上颌窦内提升术是牙种植骨量不足常用的解决方法之一,植骨区感染并非常见,笔者100多例病例中,仅1例感染.主要表现为患侧偏头痛,全身及局部抗生素使用效果欠佳.笔者在植骨区上颌窦外侧壁窦壁黏膜下钻骨孔引流冲洗,效果良好.     

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。     

牙保存相关上颌窦底提升术的生物学基础

上颌后牙缺失需行种植修复时,如果骨量不足,临床上常规采取上颌窦底提升术进行骨增量,以满足种植体初期稳定性的要求。上颌后牙的根管系统非常复杂,出现牙髓根尖周疾病时,根管治疗有可能无法彻底控制根管内感染,治疗后仍可能再度发生慢性根尖周病变。上颌牙、牙槽骨、上颌窦解剖位置及其功能关系紧密,笔者将其命名为“上颌牙-牙槽骨-上颌窦复合体”。当上颌后牙发生慢性根尖周病变时,牙根进入上颌窦内或者病变扩散至上颌窦可形成牙源性上颌窦炎。采用显微根尖手术治疗这类患牙时,常通过上颌窦底提升术建立手术入路。笔者将这种为治疗牙源性上颌窦炎并保存疑难根尖周病患牙而采取的显微根尖手术联合上颌窦底提升术命名为“牙保存相关上颌窦底提升术”。该技术与牙种植相关上颌窦底提升术不同,是一种全新的治疗术式。本文通过文献回顾分析,结合临床开展该技术的经验和认识,从解剖学、病因学和病理学三方面阐述了该技术的生物学基础：上颌牙-牙槽骨-上颌窦复合体是该技术的解剖学基础,牙源性感染引起上颌窦疾病是其病因学基础,根尖周术区和上颌窦黏骨膜的感染性炎症反应是其病理学基础。本文详细解析上述三方面生物学基础,为牙保存相关上颌窦底提升术临床术式的...     

Comparison of cone‐beam computed tomography and panoramic imaging in assessing the relationship between posterior maxillary tooth roots and the maxillary sinus: A systematic review

The objective of the present systematic review was to analyze research articles that compare the accuracy of panoramic imaging to cone‐beam computed tomography (CBCT) in assessing the relationship between posterior maxillary tooth roots and the maxillary sinus. A comprehensive literature search was conducted using various databases. Initial searching yielded 64 results, and after exclusion, five full‐text articles were eligible. All were cohort studies, and the CBCT and panoramic images were either obtained from a pre‐existing database or patients were recruited specifically for the study. Analysis showed that a panoramic image is sufficient for accurately detecting when the roots are at distinct distance from the sinus. However, if the roots are either laterally or medially projecting over the sinus and “just touching” it, panoramic images generally misinterpret this position, and instead make the root appear to be in the sinus. There were mixed results for when the root tip penetrates the sinus. Some studies claimed there was high agreeance between both modalities in this situation, while others had a low level of agreeance. In these situations, ordering a CBCT should be strongly considered to properly assess oral surgery risk with regard to maxillary posterior teeth.