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.     

CBCT在评价慢性牙周炎牙周基础治疗前后牙槽骨变化的应用研究

目的应用锥形束计算机断层摄影(cone beam computed tomography,CBCT)观察慢性牙周炎患者牙周基础治疗后牙槽骨的变化。方法随机选取50例慢性牙周炎患者左下第一磨牙,使用CBCT分别测量4次牙周基础治疗前后患者近远中、颊舌侧4个位点釉质牙骨质界至牙槽嵴顶的距离和近远牙槽间隔顶及颊舌侧牙槽嵴顶至根尖水平牙槽骨的高度和密度,评价牙周基础治疗后牙槽骨的变化。结果慢性牙周炎患者经过4次牙周基础治疗前后牙槽骨高度无明显变化(P>0.05),经过第3次牙周基础治疗后,牙槽骨密度较前有所增加,差异具有统计学意义(P<0.05)。结论 CBCT可评价慢性牙周炎牙周基础治疗前后牙槽骨的改变,有一定的临床应用价值。     

CBCT研究即刻种植愈合期牙槽骨的改变

目的:利用锥形束CT探讨即刻种植后牙槽骨嵴的改变。方法:本研究选择14例上牙即刻种植患者,共植入Ankylos种植体16枚,患者种植手术完成时(T1)和二期手术时(T2)均拍摄锥形束CT(CBCT),测量所有种植体唇颊侧,腭侧,近中,远中四个方向牙槽嵴顶端高度与种植体下端之间的垂直距离。并使用SPSS11.0软件进行配对t检验分析T1-T2期间种植体各方向牙槽骨的吸收变化。结果:T1-T2期间所有种植体唇颊侧,腭侧,近中,远中四个方面牙槽嵴顶端骨高度均发生了明显变化。但吸收情况不尽相同。结论:即刻种植愈合期各方向牙槽骨嵴均发生了明显的骨吸收,唇颊侧骨吸收较其它方向更加明显。     

牙槽骨缺损的锥形束CT评价

目的研究口腔锥形束CT(CBCT)在评价牙槽骨缺损方面的作用。方法拍摄10例牙周病患者全口数字化根尖片和CBCT,分别在医用显示器上观察分析256颗牙位近远中、颊舌向的牙槽骨缺损情况。结果数字化根尖片和CBCT均可以显示近远中牙槽骨情况,两者之间差异无统计学意义;在数字化根尖片上不能准确判断牙槽骨缺损是位于颊侧或舌侧,CBCT可以准确显示颊舌向牙槽骨缺损情况,CBCT明显优于数字化根尖片。结论 CBCT比根尖片更有利于牙槽骨缺损的诊断。     

应用CBCT测量慢性牙周炎患者口服维生素D3牙槽骨密度改变的临床研究

目的 应用锥形束计算机断层扫描（cone beam computed tomography,CBCT）观察慢性牙周炎患者口服维生素D3前后牙槽骨密度的变化。方法 随机选取我科60例50~59岁慢性牙周炎患者口服维生素D3 12个月,应用CBCT分别测量左上中切牙、尖牙、第一磨牙近远中、颊舌侧4个位点的近远中侧牙槽间隔顶及颊舌侧牙槽嵴顶至根尖水平牙槽骨密度,评价口服维生素D3后牙槽骨密度的差异有无统计学变化。结果 研究对象经过6个月后第1次观测牙槽骨密度差异无统计学变化,经过12个月后第2次观测牙槽骨密度差异较前有统计学变化（P＜0.05）。结论 研究表明短期口服维生素D3对慢性牙周炎患者牙槽骨密度变化有统计学意义。     

曲面断层片和锥形束CT对上颌阻生尖牙的定位分析

目的:通过对曲面断层片中上颌阻生尖牙近远中向和垂直向的影像学分区,判定其与锥形束CT (cone-beam computed tomography, CBCT)中相应尖牙唇腭侧位及相邻恒切牙根吸收之间的关系。方法:对68例患者的94颗上颌阻生尖牙进行曲面断层片的拍摄和CBCT扫描。将曲面断层片中上颌阻生尖牙近远中向牙尖所处的位置分为5区(Ⅰ区-Ⅴ区),将牙冠所处的垂直向高度分为3部分(牙冠段,根中段,根尖段),其唇腭侧位置和相邻恒切牙的根吸收情况则由CBCT判定。结果:曲面断层片中上颌阻生尖牙近远中向的区域定位与CBCT中相应阻生牙的唇腭侧位之间有显著相关(P＜0.001),唇侧阻生的尖牙常出现在曲面断层片中的Ⅰ、Ⅱ、Ⅲ区域,正中牙槽阻生的多在Ⅳ区域,腭侧阻生的常在Ⅴ区域,而垂直向的分段与之无显著相关。CBCT中相邻恒切牙的根吸收常发生在Ⅳ、Ⅴ区域和根中段、根尖段。曲面断层片中阻生尖牙近远中向和垂直向的区域划分均与CBCT中相邻恒切牙的根吸收之间有统计学意义(P＜0.05)结论:利用曲面断层片中上颌阻生尖牙近远中向的区域定位可以预测其唇腭侧位和相邻恒切牙的根吸收,垂直向的分段可用来判断相邻恒切牙的根吸收,而不可推测其唇腭侧阻生情况。     

锥形束CT与根尖片在慢性牙周炎诊断中的应用比较

目的:研究CBCT在慢性牙周炎诊断中的价值。方法:通过拍摄20例慢性牙周炎患者的后牙区CBCT及根尖片,并对其进行临床牙周探针检查,比较纳入的276颗牙唇(颊)、舌(腭)、近中、远中牙槽骨缺损情况。结果:CBCT与临床探诊检查后牙区各位点牙槽骨缺损情况未见明显差异,而CBCT、临床探诊、根尖片检查后牙区近远中牙槽骨缺损可见明显差异(P＜0.05),其中根尖片所测结果小于CBCT及临床探诊,均有统计学意义(P＜0.05)。结论:在慢性牙周炎的诊断中CBCT检测较根尖片更加准确。     

正畸伸长重度牙周炎患牙引导牙槽骨增量初探

目的评价正畸伸长重度牙周炎患牙引导牙槽骨增量的临床疗效。方法回顾性纳入2018年10月至2022年5月于北京大学口腔医学院·口腔医院正畸科及牙周科就诊的12例牙周炎伴错畸形患者资料(男性5例, 女性7例), 年龄(38.8±6.6)岁(24～49岁), 共16颗因重度牙周炎致无法保留的上切牙。使用正畸固定矫治器对患牙进行正畸伸长, 收集正畸伸长前后锥形束CT影像资料。使用体素重叠技术对同一例患者两时点锥形束CT影像进行叠加, 在矢状面上测量牙槽骨高度、厚度及牙槽骨根尖区面积, 使用三维重建技术测量正畸伸长前后牙槽骨改建体积, 并分析与牙槽骨改建体积相关的影响因素。结果患牙伸长距离为(2.37±0.82)mm。正畸伸长后, 唇侧和舌侧牙槽骨高度分别增加(1.11±0.79)和(0.98±0.79)mm, 近中和远中侧牙槽骨高度分别增加(1.10±0.78)和(0.86±1.08)mm, 根尖区牙槽骨厚度减少(0.30±0.31)mm, 牙槽骨根尖区面积增加(6.84±5.86)mm2, 牙槽骨改建体积为(53±49)mm3。牙槽骨改建体积与牙齿伸长距离、根尖区及近中侧牙槽骨厚度呈中度正相...     

锥形束CT研究牙周基础治疗前后牙槽骨高度的改变

目的：通过锥形束CT自带Romexis软件测量慢性牙周炎牙周基础治疗前和6个月后牙槽骨高度的改变,以此寻求一种具有良好的可行性、可重复性、无创性的牙槽骨测量方法。方法：随机抽取中度慢性牙周炎患者16名。每位患者牙周基础治疗前行首次锥形束CT影像检查,再行系统的牙周基础治疗,3个月后行全口洁治术,6个月后行二次锥形束CT检查。由两名熟练程度相近的口腔医师通过锥形束CT自带Romexis软件分别测量每位患者牙周基础治疗前后两次影像的右下颌第一磨牙和右上颌中切牙的颊舌侧釉牙骨质界到牙槽嵴顶的距离。结果：中度慢性牙周炎牙周基础治疗前后右下第一磨牙、右上中切牙牙槽骨高度均有显著增加,切牙（P〈0．0001）,磨牙（P〈O．0001）;不同测量人员间所测的中度慢性牙周炎患者治疗前后牙槽骨高度的变化无显著差异,切牙（P=0．55）,磨牙（P=0．19）。结论：锥形束CT自带软件可对慢性牙周炎患者的牙槽骨进行自定点测量,且该定点测量的方法具有良好的可重复性和可行性,可对牙槽骨的高度进行无创的准确测量。     

锥形束CT对牙根外吸收早期诊断价值的探讨

目的:探讨锥形束CT(cone beam CT,CBCT)在牙根外吸收早期诊断中的临床应用价值。方法:对50例牙根外吸收的患者应用CBCT和数字化根尖片检查,对患牙在牙槽骨中的近远中向、颊舌向病损情况进行对比分析。由3名影像学专家采用双盲法对不同方法产生的图像质量进行评价,采用5阶法行ROC曲线解析。结果:50例应用CBCT检查得到的图像可准确显示近远中向、颊舌向的牙根外吸收情况;而数字化根尖片只可显示近远中情况,不能准确判断牙根外吸收颊舌向情况。CBCT图像的ROC曲线解析参数(Az=0.90),大于数字化根尖片的解析参数(Az=0.69)。结论:CBCT有利于牙根外吸收的早期诊断。     

Detection of bone loss with different X-ray techniques in periodontal patients

BACKGROUND: Intraoral radiographs can aid in formulating a more accurate diagnosis of periodontal disease. However, it must be considered whether a comparable amount of information can be obtained with modern panoramic radiographs. The aim of this study was to determine to what degree the diagnosable amount of bone loss in patients with aggressive periodontitis or severe chronic periodontitis depends on the type of x-ray technique used. METHODS: A total of 110 subjects (63 females) were included in this study. The inclusion criteria were the diagnosis of aggressive periodontitis (N = 49) or severe chronic periodontitis (N = 61). In all patients, panoramic radiographs (panoramic) and intraoral films of all regions (eight to 10 single exposures) were available. Analysis of the panoramic and intraoral films was carried out with a computer-assisted technique for linear measurement. The amount of bone loss in reference to the alveolar crest (AC) and bottom of the bony defect (BD) was determined as a percentage of total root length. RESULTS: Depending on the examined tooth and reference point, 47.01% to 81.89% of all subjects showed differences between intraoral and panoramic measurements that were < or =10% of the total root length. For cemento-enamel junction-AC measurements, differences between intraoral and panoramic measurements that were >10% of the total root length were found predominantly in the upper molar and premolar regions. In the mandible, differences between intraoral and panoramic measurements that were >10% of the total root length were observed for BD and AC at the mesial contour of the central incisor. CONCLUSIONS: A preorientation with respect to the expected bone loss is possible using panoramic radiographs. Additional intraoral films might be helpful where rapid changes of bone level are expected (e.g., aggressive periodontitis).     

Radiologic study of marginal bone loss around 108 dental implants and its relationship to smoking, implant location, and morphology

PURPOSE: To investigate peri-implant bone resorption around 108 ITI dental implants 1 year after prosthetic loading using extraoral panoramic, conventional intraoral periapical, and digital radiologic techniques. MATERIALS AND METHODS: A total of 108 implants were placed (59 in the maxilla and 49 in the mandible) in 42 patients (16 men and 26 women) with a mean age of 44.2 years (range 14 to 68 years). Orthopantomographic, conventional periapical, and digital radiographs were obtained at loading and again 1 year later. Bone loss was calculated from the difference between the initial and final measurements. RESULTS: Mean loss in alveolar bone height was determined to be 1.36 mm by extraoral panoramic radiography, 0.76 mm by intraoral periapical radiography, and 0.95 mm by digital radiography. The implants located in the maxilla and those placed in patients who smoked 11 to 20 cigarettes per day were associated with significantly greater bone loss. DISCUSSION: The results in relation to peri-implant bone loss in the first year after loading were similar to those published by other authors. CONCLUSION: Conventional periapical films and digital radiographs were more accurate than orthopantomography in the assessment of peri-implant bone loss. Smoking and implant location in the maxilla were associated with increased peri-implant marginal bone resorption.     

Comparison of cone-beam computed tomography with bitewing radiography for detection of periodontal bone loss and assessment of effects of different voxel resolutions: an in vitro study

Objective

The aim of the study was to compare intraoral radiographs and CBCT images for detection of horizontal periodontal bone loss, and to investigate the diagnostic effect of different voxel resolutions in CBCT imaging.

Methods

A total of 240 sites with horizontal bone loss were measured on the buccal, lingual, mesial, and distal surfaces of 60 posterior teeth in four maxillary and six mandibular bones obtained from cadavers (dry skulls). Direct measurements on the dry skulls were accepted as the gold standard values. Measurements on CBCT images at two different voxel resolutions (0.250 and 0.160 mm³) and intraoral bitewing radiographs were compared with one another and with the gold standard values.

Results

The measurements on the CBCT images at two voxel resolutions and bitewing radiographs did not differ significantly (p?>?0.05) from the direct measurements on the dry skulls. No significant difference was found between the bitewing radiographs and CBCT images for measurements in the mesial and distal regions (p?>?0.05). There was no significant difference between the measurements on the buccal and lingual surfaces at the two different voxel resolutions (p?>?0.05).

Conclusions

CBCT scans are recommended for evaluation of buccal and lingual bone loss to avoid intraoral radiographs that exceed routine examination of interproximal alveolar bone loss. Furthermore, instead of basing the voxel size on the required CBCT scans, it is recommended to select the smallest possible field of view to reduce the dose of radiation.

     

颌骨骨密度和全身骨密度的相关性研究

目的:研究骨质疏松患者与正常对照人群下颌骨相关指标的差异,探讨颌骨骨密度和全身骨密度相关性。方法:应用计算机处理软件对80例健康对照组和40例骨质疏松患者的数字曲面体层片的颌骨骨密度及相关指标测量:牙槽骨骨密度、骨高度、下颌骨下缘皮质厚度(CW)、曲面体层下颌指数(panoramic man-dibular index,PMI)、牙槽骨吸收指数(mandible resorption index,MRI)进行测量分析,并用SPSS12.0进行统计学处理。结果:骨质疏松患者组和健康对照组的CW(3.8vs4.27)、PMI(0.30vs0.33)有显著性差异(P<0.05),而骨高度(10.64vs10.56)、牙槽骨骨密度、MRI没有明显差异(P>0.05)。结论:老年性骨质疏松患者下颌骨骨形态改变明显,全身骨代谢和颌骨骨质的改变有一定相关性。     

Panoramic and restrictive intraoral radiography in comprehensive oral radiographic diagnosis

It has been suggested that information from the panoramic radiograph makes it possible to appropriately select supplementary intraoral radiographs to achieve a comprehensive examination of teeth and surrounding bone with less patient dose but no significant information loss. Number of intraoral radiographs selected, information loss and monetary costs with such a procedure was evaluated in 40 patients. Results show that, on average, 5.1 intraoral radiographs were selected to supplement the panoramic radiograph. Of these, 3.1 contained information different from that in the panoramic radiograph but 2.0 did not. An additional 3.4 ought to have been taken to reach the result of the 'gold standard' achieved from a simultaneous evaluation by two expert observers of panoramic radiographs and full mouth surveys with intraoral radiographs. Sensitivity for the combined use of panoramic and supplementary intraoral radiographs was high (80–96%, depending on type of teeth) as regards periapical lesions and marginal bone loss but low for caries (42–96%). Specificity was high for periapical lesions and caries (95–97%) but low for marginal bone loss (50–92%). In Sweden, patient costs become almost the same for a combination of panoramic radiography and 8.5'intraoral radiographs as for a full mouth survey comprising 20 intraoral radiographs. The radiation dose reduction is 40–50% considering that the dose from a panoramic radiograph approximately corresponds to 2–4 intraoral radiographs. We conclude that using panoramic radiography in combination with selected intraoral radiographs is possible if the radiographic examination is preceded by a thorough clinical examination and the following parameters are correctly evaluated before the examination: patient category, radiation dose, information loss, patient discomfort, time consumption and monetary costs.     

应用锥形束CT浅析牙周基础治疗对慢性牙周炎牙槽骨骨量的影响

目的:应用锥形束CT及Simplant软件测量分析不同类型、不同年龄段的慢性牙周炎患者,经过牙周基础治疗后牙槽骨的骨量恢复情况,以期为进一步治疗计划的制定提供临床依据。方法:采用单纯随机抽样法选取2012年2月~2013年2月就诊于中国医科大学附属口腔医院的慢性牙周炎患者50例,其中轻度牙周炎患者15例,中度牙周炎患者18例,重度牙周炎患者17例。采用Simplant软件及t检验观测并比较基线及牙周基础治疗后6个月慢性牙周炎个体的牙槽骨缺损程度,是否进行了统计学分析,请简要补充统计方法及检验水准。结果:不同年龄、不同病损程度的慢性牙周炎患者治疗后6个月与治疗前相比, 牙槽骨高度和相对骨密度均有改善。<50岁的轻度、中度牙周炎患者治疗后6个月的牙槽骨密度均显著高于治疗前(P<0.05),牙槽骨距釉牙骨质界的缺损高度均有降低,但与治疗前相比差异均无统计学意义;重度牙周炎患者治疗前后牙槽骨密度和牙槽骨缺损高度均有改善但差异均无统计学意义。随着年龄的增长,牙槽骨缺损高度及相对骨密度的改善程度呈下降趋势且治疗前后差异无统计学意义;前磨牙及磨牙的近中、远中位点治疗后6个月牙槽骨缺损高度及相对骨密度较其他位点改善明显(P<0.05)。结论:牙周基础治疗在一定程度上可有效改善慢性牙周炎的牙槽骨缺损高度和相对骨密度;锥形束CT及Simplant软件的应用有助于评估治疗前后牙槽骨骨量的变化。     

Comparison of direct digital and conventional intraoral radiographs in detecting alveolar bone loss

BACKGROUND: Intraoral radiographs are important diagnostic aids in periodontics. The authors conducted a study to compare estimates of bone levels from direct digital and conventional radiographic under normal clinical use. METHODS: A full-mouth series of conventional radiographs was taken for each of 25 subjects who had periodontitis. A long cone paralleling technique was used for periapical, or PA, images, and a paper sleeve with biting tab was employed for bitewing, or BW, images. A set of direct digital radiographs matching the conventional radiographs was taken for each subject under the same conditions. The distance from the cementoenamel junction to the interproximal alveolar crest on all readable surfaces was measured. RESULTS: Examiners measured 857 PA image sites and 315 BW image sites matched on both radiographic systems. Paired t test showed significant differences in bone levels between the two systems. Measurements from conventional PA images were higher in all maxillary sextants (P < or = .02), and measurements from digital PA images were higher in mandibular anterior sextants (P = .007). Measurements in digital BW images were higher in mandibular posterior sextants (P = .002). A chi2 analysis of categorical bone levels (normal, early-to-moderate loss or advanced loss) showed significant differences between the imaging systems in revealing bone levels in both PA (P < .04) and BW (P < .001) images. Digital radiographs showed a higher number of sites with bone loss than did conventional radiographs. CONCLUSIONS: Under normal clinical use, alveolar bone levels revealed on intraoral direct digital radiographs differ from those revealed on conventional radiographs. CLINICAL IMPLICATIONS: Intraoral direct digital radiographs are not an equivalent substitute for conventional radiographs in evaluating alveolar bone levels.     

标准化数字式曲面体层片检测牙周炎患者颌骨骨密度的应用评价

目的比较牙周炎患者与正常人群下颌骨相关指标的差异，寻找一种简单有效的测量牙槽骨骨密度的方法，探讨牙周炎患者局部骨改变和全身骨改变的相关性。方法应用计算机处理软件在60例牙周炎患者和60例牙周健康者的下颌骨数字曲面体层片上测量牙槽骨骨密度（用灰度值表示）和骨高度、颏孔区下颌骨下缘皮质骨厚度（CW）、曲面体层下颌指数（PMI）。用SPSS 12.0软件对数据进行统计学处理。结果牙周炎组牙槽骨灰度值、牙槽骨骨高度、CW和PMI分别为106.08±23.95、（8.76±2.27）mm、（3.80±0.82）mm和0.31±0.06；牙周健康组的4项测量指标分别为113.33±23.79、（11.85±1.62）mm、（4.27±0.70）mm和0.33±0.06。经统计学检验，两组牙槽骨灰度值、牙槽骨骨高度和CW有统计学差异（P<0.05），而PMI无统计学差异（P>0.05）；牙槽骨灰度值、牙槽骨骨高度、PMI与CW均有相关关系（P<0.05），而牙槽骨灰度值、牙槽骨骨高度与PMI无相关关系（P>0.05）。结论建立在标准化数字式曲面体层片的计算机灰度法是一种简单有效的测量牙槽骨骨密度的方法。与正常人相比，牙周炎患者的牙槽骨骨高度和骨密度有所降低，下颌骨下缘皮质骨吸收变薄。