中重度慢性牙周炎上颌中切牙区解剖形态的锥形束CT测量分析

目的应用锥形束CT（CBCT）测量分析中重度慢性牙周上颌中切牙区牙槽骨的骨量和牙齿偏移度,为上颌中切牙区的种植治疗和方案制定提供解剖学依据。 方法选取2015年1月至2017年12月深圳爱康健口腔医院内150例中重度牙周炎患者的CBCT影像资料,测量共290颗上颌中切牙唇/腭侧骨壁厚度、牙槽骨骨宽/高度、骨内根长、牙体长轴和牙槽骨走行方向的夹角共7个项目,采用SPSS 19.0统计软件包对测量结果进行相关统计分析。 结果中重度慢性牙周炎上颌中切牙牙槽嵴顶处和根尖处的唇腭向骨厚度分别为（7.68 ± 0.78）mm和（8.52 ± 1.55）mm,牙槽骨高度平均为（18.35 ± 3.45）mm,骨内根长1/2处的唇侧和腭侧的骨壁厚度分别为（0.62 ± 0.45）mm和（3.18 ± 1.00）mm,牙体长轴与牙槽骨走行方向夹角的平均值为18.80° ± 5.46°。不同性别间对比测量结果,在牙槽嵴顶骨宽度和根尖区骨宽度处差异均有统计学意义（P<0.05）,男性优于女性。 结论中重度慢性牙周炎上颌中切牙的唇侧骨壁菲薄甚至缺如,骨量条件不理想,牙体长轴与牙槽骨偏移度明显,在制定种植方案时有必要充分利用CBCT了解骨量情况并评估解剖形态,为达到上颌中切牙种植效果长期美观、稳定的需求应有更多的考量。     

恒前牙髓室解剖影像学的初步研究

目的 探讨中国人恒前牙髓室影像解剖学特征及其与牙体外表特征的关系。方法 采用游标卡尺测量137个离体恒前牙冠长、冠宽、冠厚等牙体解剖指标,然后采用平行投照技术拍摄唇舌向和近远中向X线片,并采用Photoshop 8.0软件测量髓室最大唇舌径、最大近远中径、髓室高及舌面髓壁距等影像解剖指标,计算髓室最大唇舌径与冠厚之比、髓室最大近远中径与冠宽之比、髓室高与冠长之比和髓室顶厚,得出以上指标的变异系数。结果 ①上下颌尖牙的髓室近远中径与冠宽之比与其余牙位间的差异有统计学意义（P<0.05）,而上下颌尖牙间则无统计学差异,上下颌中切牙、侧切牙间此比值的均值也无统计学差异（P>0.05）。②髓室指标的变异远大于牙体外表指标的变异程度。③舌面髓壁距的变异系数最小。④除下颌尖牙外,髓室的最大近远中径变异最大。结论 恒前牙的舌面髓壁距可以作为临床开髓洞深的参考指标;而开髓的时候,不要轻易向近远中向扩展。     

使用导杆式矫治器治疗腭侧阻生上中切牙

目的 分析上颌腭侧埋伏阻生中切牙的正畸矫治效果及导杆式矫治器的治疗作用.方法 利用导杆式矫治器治疗7例上颌单侧中切牙腭侧埋伏的患牙,以对侧自然萌出中切牙作为对照.矫治前后拍摄全景片,测量矫治后埋伏牙和对照牙的牙全长、解剖牙根长度、解剖牙冠长度、根长/冠长,用SPSS 17.0软件进行成组t检验.结果 6例腭侧埋伏中切牙经牵引萌出后排齐,牙髓和牙周状况良好.萌出后埋伏牙解剖牙根长度比对照组牙根短4.00 mm（P=0.020）,根长/冠长值平均为1.36±0.31,小于对照组（P=0.048）.其中1例因埋伏牙骨粘连,牵引16个月后无移动而放弃牵引.结论 矫治后腭侧埋伏中切牙有足够的长度,应保留埋伏牙;导杆式矫治器是治疗上颌腭侧埋伏中切牙的一种有效方法.     

西安地区人上颌中切牙牙冠三维结构的研究

目的:探索人上颌恒中切牙牙冠三维结构的建模方法,精确测量其釉质和牙本质解剖学参数。方法:选取牙冠形态、冠根比正常,无磨耗的西安地区人上颌恒中切牙30个,Micro CT扫描后,用Mimics和Geomagic Studio逆向工程软件重建上颌中切牙釉质帽、牙本质核和髓室三维模型,精确测量牙冠不同部位釉质和牙本质核的厚度以及近、远中髓角至各自切端和邻面的距离。结果:建立了人上颌中切牙釉质帽和牙本质核的三维模型,其厚度（mm）分别为:唇侧釉质（0.47±0.12）^1.08±0.19,舌侧釉质（0.39±0.07）^0.71±0.15;唇侧牙本质（0.46±0.09）^2.17±0.48,舌侧牙本质（0.33±0.06）^2.82±0.36,P﹤0.05;近中髓角至切端4.24±1.04,远中髓角至切端4.71±0.98;近中髓角至近中邻面2.09±0.26,远中髓角至远中邻面2.53±0.30,差异均有统计学意义（P﹤0.05）。结论:西安地区人上颌中切牙牙冠不同部位釉质帽和牙本质核厚度存在差异。     

数字化全景片测量江苏地区人群上颌中切牙冠根长度的研究

目的分析总结江苏地区人群上颌中切牙冠部和根部的长度,为上颌中切牙的桩冠修复提供统计学依据。方法收集114例(男57例,女57例)江苏地区人群(年龄15~79岁)的数字化全景片,以近远中牙槽嵴顶连线为界,测量上颌中切牙冠部和根部的长度,并分析性别、年龄和左右侧对数值的影响。结果上颌中切牙冠部长度为(9.20±0.27)mm,根部为(12.28±0.31)mm;男性的冠根长度都长于女性(P<0.05),男女差异主要表现在中年组和老年组(P<0.05);左右侧和年龄对上颌中切牙冠根长度影响的不大(P>0.05);骨内桩长度达到6~8mm才能满足有效的固位支持。结论江苏地区人群中切牙冠根长度左右对称,在不同年龄组间长度也相似,男性的冠根长度均长于女性。     

上前牙牙体测量及临床意义

目的研究恒前牙形态特征并分析各项特征指标间的相互关系。方法采用游标卡尺测量84颗上前牙牙体的全长、冠长、根长、冠宽、冠厚、颈宽和颈厚;采用SPSS软件分析各指标间的相关性。结果上颌中切牙约50%冠长大于根长,牙齿的冠长和根长与全长之间分别存在着相关性。结论不同前牙具有独特的解剖形态,可为临床诊治提供牙体解剖形态依据。     

上颌切牙的牙颈部形态测量及分析

目的 :本研究通过测量获得天然上颌切牙牙颈部宽度、厚度及牙颈曲度等数据,为切削制作个性化愈合基台提供依据。方法:采用电子游标卡尺对173颗离体上颌切牙(中切牙104颗、侧切牙69颗)的颈部近远中宽度、颊舌向厚度,近中牙颈部曲度、远中牙颈部曲度,釉牙骨质界(CEJ)根方1.5 mm颈部宽度、颈部厚度进行测量。每部位测量3次,数据以均数±标准差(x±s)表示,精确到0.01 mm。结果 :上颌中切牙及上颌侧切牙在颈部宽度、颈部厚度、CEJ根方1.5 mm颈部宽度与颈部厚度、近中颈曲度与远中颈曲度方面的差异均具有统计学意义(P<0.05)。上颌中切牙CEJ及CEJ根方1.5 mm颈部宽度大于颈部厚度;上颌侧切牙CEJ及CEJ根方1.5 mm颈部厚度大于颈部宽度。结论:上颌切牙基台顶端应设计为弧形,上颌中切牙、侧切牙基台近中颈部曲度应大于远中颈部曲度,近远中应为外形最高点,唇舌侧应为外形最低点。     

上颌第二磨牙的解剖外形研究

目的:了解上颌第二磨牙的解剖外形,为临床工作提供帮助。方法:收集临床上拔出的61颗上颌第二磨牙,测量牙体全长、牙冠近远中径、牙冠颊舌径、牙冠长和牙根长,观察牙根的数目。结果:上颌第二磨牙牙体全长的平均值为(19.46±1.65)mm,牙冠近远中径大于牙冠颊舌径,牙冠长小于牙根长,且全长与牙冠长、牙根长,及牙冠近远中径与颊舌径之间存在着显著相关关系(P<0.05)。3根居多,占49.18%,其次为融合根(47.54%)和变异根(3.28%)。结论:上颌第二磨牙的解剖外形较为复杂。     

牙科锥形束CT评价上颌前牙唇面形态对转矩的影响

目的研究上颌前牙的唇面形态及牙冠牙根成角关系对转矩的影响,为临床治疗中调整牙齿的转矩提供参考。方法选择206颗离体上颌前牙为研究对象,其中中切牙77颗、侧切牙68颗、尖牙61颗。利用牙科锥形束CT将全部牙齿进行扫描,在CT工具软件下进行影像的三维重建并提取全部牙的正中矢状切面图像,利用Auto CAD软件测量图像,分别测量牙冠唇面4个不同高度的切线与牙冠长轴所成的角度,以及牙冠长轴与牙根长轴所成的角度（冠根角）。结果当托槽高度为3.5～5.0 mm时,其高度每变化0.5 mm,上颌中切牙转矩变化约为1.5°,上颌侧切牙和尖牙的转矩变化约为2°。上颌中切牙、侧切牙、尖牙冠根角的均数分别为0.88°、3.87°、-3.30°。结论牙体形态的生物学变化从多方面影响矫治后牙齿的转矩角。     

不同部位植入种植钉远中移动上颌牙列的临床效果研究

目的　对比不同部位植入种植钉远中移动上颌牙列的治疗效果,为临床有效应用种植钉远中移动骨性Ⅱ类错牙合的上颌牙列提供参考。方法　选取2014年1月至2017年6月就诊于大连医科大学附属大连市口腔医院正畸科的骨性Ⅱ类错牙合成年女性患者24例。年龄21 ~ 26岁,平均（23.8 ± 1.2）岁。按种植钉的植入部位平均分为3组：A组,将种植钉植入上颌第二前磨牙和第一磨牙牙根之间;B组,将种植钉植入颧牙槽嵴区;C组,将种植钉植入第二磨牙颊侧骨皮质区。对所有患者治疗前和种植钉施力4个月后的头颅定位侧位片进行测量分析,观察各组上颌牙列远中移动的临床效果和特征。结果　各组患者种植钉施力4个月后较治疗前,上颌磨牙远中移动明显（均P < 0.05）。其中A组患者上颌第一磨牙远中倾斜最为明显,上颌第一磨牙远中倾斜角度（MTD）为2.28° ± 0.14°;B组患者上颌切牙及上颌磨牙明显压低,上颌中切牙切缘到X轴的距离（U1-X）减小（1.0 ± 0.9）mm,上颌第一磨牙牙冠近中面最突点到X轴的距离（U6-X）减小（1.4 ± 0.7）mm;C组患者上颌牙列远中移动最为明显,上颌中切牙切缘到Y轴的距离（U1-Y）减小（2.0 ± 0.8）mm;上颌第一磨牙牙冠近中面最突点到Y轴的距离（U6′-Y）减小（2.6 ± 1.2）mm;其差异均具有统计学意义（均P < 0.05）。结论　不同部位植入种植钉均可远中移动上颌牙列,在上颌第二前磨牙和第一磨牙牙根之间植入种植钉时,上颌第一磨牙产生明显远中倾斜移动;在颧牙槽嵴区植入种植钉时,对上颌切牙及磨牙产生压低作用;在上颌第二磨牙颊侧骨皮质区植入种植钉时,远移上颌牙列的效率最高。     

上颌扩弓前方牵引配合直丝弓矫治技术治疗恒牙早期骨性Ⅲ类错牙合效果评价

目的    探讨上颌扩弓前方牵引配合直丝弓矫治技术对恒牙早期骨性Ⅲ类错牙合畸形的矫治效果。方法    采用上颌扩弓前方牵引矫治器配合直丝弓矫治技术,对2010—2015年大连市口腔医院正畸科15例恒牙早期骨性Ⅲ类错牙合患者进行代偿性治疗,并对其治疗前后头颅定位侧位片进行测量分析。结果    15例患者治疗后面型改善,磨牙中性关系,前牙覆牙合覆盖正常。SNA角增加（2.87 ± 1.08）°,SNB角减小（0.61 ± 0.8）°,ANB角增加（3.47 ± 1.05）°,SN/MP增加（2.17 ± 1.34）°,OP/FH增加（2.97 ± 0.29）°,U1/SN增加（5.09 ± 3.43）°,L1/MP减小（2.29 ± 3.02）°,结论    上颌扩弓前方牵引配合直丝弓矫治技术可有效治疗恒牙早期中轻度骨性Ⅲ类错牙合畸形。     

不同牙形上颌中切牙近中接触点位置关系的研究

目的研究上海地区青年人上颌中切牙近中接触点的位置关系。方法用CEREC系统测量20例方圆形,20例尖圆形和20例卵圆形上颌中切牙石膏模型近中接触点相关的位置比例,用SPSS软件进行统计分析。结果 3组牙形上颌中切牙近中接触点高度占冠长的百分比差异有统计学意义(P<0.05),方圆形的百分比与宽/长比存在相关性及直线回归关系。3组牙形接触点高度均与冠长存在相关性及直线回归关系,三个牙形组的性别差异无统计学意义(P>0.05)。结论不同牙形的上颌中切牙近中接触点的位置关系不同,本研究结果可为上海地区青年人上颌中切牙的临床诊疗提供理论依据。     

上颌中切牙种植修复结合软硬组织增量后的临床和影像学效果初步分析

目的    应用种植同期结合引导性骨再生（guided bone regeneration,GBR）技术及不同软组织处理方式修复缺失的单颗上颌中切牙,评价其软硬组织的增量效果。方法    纳入于2013—2014年就诊于北京大学口腔医院牙周科因单颗上颌中切牙缺失而接受种植治疗的患者6例。所有患者在种植同期行GBR,并接受不同软组织处理方式。最终修复7 ~ 24个月后,记录患者上颌前牙区牙周状况,通过影像学检查定量测量种植体唇侧骨高度及骨壁厚度,利用标准化临床照片,定量测量种植体与对照牙牙龈顶点的位置关系,以及种植体近远中龈乳头高度和充满程度,并应用粉色美学评分（pink esthetic score,PES）评价美学效果。结果    所有种植体在复查时均处于健康稳定的牙周状态。5颗种植体在复查时可观察到垂直向及水平向骨增量,种植体唇侧中央肩台根方2、4、6 mm处平均骨壁厚度分别为（1.7 ± 1.1）mm、（2.3 ± 1.1）mm、（2.2 ± 1.3）mm。种植体牙龈顶点相比对照牙（同颌对侧中切牙）平均更偏向远中（1.0 ± 0.6）mm,偏向根方（0.4 ± 0.8）mm;远中龈乳头平均高度（2.8 ± 0.5）mm和充满程度（76.9 ± 19.2）%低于近中龈乳头［（4.2 ± 0.7）mm,（89.8 ± 11.1）%］,平均PES为（11.5 ± 1.4）分。结论    对于缺牙区存在软硬组织缺损的患者,上颌中切牙种植同期结合GBR及不同软组织处理方式,可获得较为充足的骨增量效果及与对照牙相对协调的软组织形态,一定程度上改善美学效果。     

��ͬ��λֲ����ֲ��Զ���ƶ�������е��ٴ�Ч���о�

??Objective??To evaluate the treatment effects of maxillary dentition distalization using orthodontic miniscrews placed in different insertion sites and to provide a clinical guidance in choosing the most efficient site of maxillary dentition disatalization. Methods??Twenty-four female patients were selected from January 2014 to June 2017 at Department of Orthodontics??Dalian Stomatological Hospital??the age of all patients in our study ranging from 21 to 26 years old??who presented with dental and skeletal class ?? malocclusion. We divided the samples into three groups??Group A??miniscrews were placed in the region between the second premolar and the first molar??Group B??miniscrews were inserted in the infrazygomaticcrest site?? Group C??miniscrews were inserted and inclined  in the the buccal region of the maxillary second molars. Measurements were performed on the lateral cephalometric radiogragh at two time points??the first was before the orthodontic treatment??and the second was at 4 months after distalization of maxillar dentition. Results??Four months after distalization of the maxillary dentition we found that in group A the molar was obviously distally inclined??the inclination angle of the upper first molar toward distal??MTD??was 2.28° ± 1.4°. In group B??the upper incisors and first molar were intruded??the distance from the incisal edge of the maxillary central incisor to the X axis??U1-X??was decreased??1.0 ± 0.9??mm??the distance from the mesial proximal contact area of maxillary first molar’mesial surface to the X axis??U6-X??was decreased??1.4 ± 0.7??mm. In group C??the upper incisors were retracted obviously??the distance from the incisal edge of the maxillary central incisor to the Y axis??U1-Y??was decreased??2.0 ± 1.8??mm??and the distance from the mesial proximal contact area of maxillary first molar’mesial surface to the Y axis??U6′-Y??was decreased??2.6 ± 1.2??mm??the difference being statistical ??all P < 0.05??. Conclusion??Orthodontic miniscrews placed in different insertion sites all can make maxillary dentition distalization. The molar was obviously distally inclined in group A. The upper incisors and first molar were intruded in group B. The efficiency of maxillary dentition distalization was the highest in group C.     

Morphometric study of length and grooves of maxillary lateral incisor roots

OBJECTIVE: Root grooves are considered a risk factor for periodontal disease. The purpose of this study was to measure the length of the root of maxillary lateral incisors (MLI), as well as the width and depth of the concavities of their proximal surfaces, and also to determine the prevalence of palato-gingival grooves. METHODS: the width and depth of root concavities, as well as root length were evaluated in 73 MLI. All teeth were measured using a digital contour measuring instrument for the root grooves and a caliper for evaluating root length. RESULTS: After statistical analysis (p<0.05) it was possible to confirm: the mean root length on its mesial surface was (15.47+/-1.72 mm), on its distal surface (14.99+/-1.70 mm), on its buccal surface (13.10+/-1.69 mm) and on its lingual surface (12.71+/-1.53 mm); concavities were present in 100% of the samples; concavities were found 2mm, coronally from the CEJ, at the CEJ, and apically up to 8mm; the concavities were wider than deeper; on the mesial surface, the greatest width was (1.05 mm) and the greatest depth was (0.06 mm) both at the CEJ; 5) on the distal surface the greatest width was (0.73 mm) at 6mm apically from the CEJ and the greatest depth was (0.003 mm); the palato-gingival groove was observed in 9.58% of the samples. CONCLUSIONS: The mesial surface of the maxillary lateral incisor is the longest. The root concavities on the proximal surfaces are present in 100%. One must get acquainted to the morphological variations of roots to enhance diagnosis and treatment.     

�������ǰ��ǣ�����ֱ˿�����μ������ƺ������ڹ��Ԣ��������Ч������

??Objective    To evaluate the treatment effects of rapid maxillary expansion and maxillary protraction and straight wire appliance technology on patients with skeletal class ?? malocclusion in early permanent dentition. Methods    A total of 15 skeletal class ?? patients were chosen based on the principle of maxillary retrusion in early permanent dentition and treated by straight wire appliance technology combined with maxillary protraction and rapid maxillary expansion. Results    A total of After treatment the profile improved evidently??and the normal molar relationship??overjet and overbite were established. The cephalometric analysis showed that SNA increased by??2.87 ± 1.08??°??SNB decreased by??0.61 ± 0.8??° and ANB increased by??3.47 ± 1.05??°. SN/MP increased by??2.17 ± 1.34??°??OP/FH increased by??2.97 ± 0.29??°??mandible rotated clockward and propile improved.  U1/SN increased by??5.09 ± 3.43??°??the upper incisors tipped labially??and L1/MP decreased by ??2.29 ± 3.02??°. Conclusion    Straight wire appliance technology with maxillary protraction and rapid maxillary expansion is helpful and specific in treating skeletal class ?? patients with maxillary retrusion in early permanent dentition.