对比数字化X线牙片与CBCT对牙根纵裂诊断价值分析

目的：对比数字化X线牙片与CBCT对牙根纵裂的诊断价值。方法：以济南市口腔医院口腔内科的50例牙根纵裂患者为研究对象。将患者分别定义为观察组和对照组。对照组行数字化X线牙片检查,观察组行CBCT检查。分别根据x线片诊断标准和CT诊断标准对影像学检查结果做出独立判断。再根据牙根纵裂临床诊断金标准分别对x线根尖片的诊断结果和CBCT检查的诊断结果进行比较,得出两组真阳性（TP）、假阳性（FP）、真阴性（TN）、假阴性（FN）,计算敏感性、特异性、阳性预测值、阴性预测值。结果：牙根纵裂临床诊断金标准判断结果显示：本组50例患者中,牙齿纵裂确定46例,排除4例。X线根尖片检查诊断牙根纵裂的敏感度为77％,特异性为75％,阳性检出率为96．88％,阴性检出率为16．67％;CBCT诊断牙根纵裂的敏感度为95．65％,特异性为100％,阳性检出率为100％,阴性检出率为66．67％。CBCT扫描诊断牙根纵裂的敏感度、特异性、阳性检出率明显大于X线根尖检查（P〈0．01）。CBCT扫描诊断牙根纵裂的阳性检出率大于x线根尖片检查（P〈0．05）。结论：在牙根纵裂的临床诊断中,CBCT诊断的敏感度、特异性、阳性检出率、阴性检出率均高于x线牙片,具有更高的临床应用价值。     

锥形束CT在早期诊断牙根纵裂中的应用

目的:探讨锥形束CT对牙根纵裂(简称根裂)早期诊断的价值。方法:对23颗临床检查可疑为根裂且通过X线根尖片不能确诊的患牙,拍摄锥形束CT(cone-beam computed tomography,CBCT)观察是否存在根裂影像,分别记录为明确根裂、可疑或非根裂。根裂的CT诊断标准为:至少连续2个牙根断面上可见明显的低密度裂隙影或折断片明显移位。结果:CBCT显示23颗患牙中明确根裂17颗,可疑4颗,非根裂2颗。17颗明确根裂患牙均经拔除证实;4颗可疑患牙经4～6月观察后亦拔除并确诊为根裂;CT图像未见根裂表现的2颗患牙经临床证实无根裂。经拔除后确诊根裂的21颗患牙中,活髓牙10颗,已牙髓治疗的无髓牙11颗。CBCT的诊断敏感度为81%。结论:锥形束CT有助于牙根纵裂的早期诊断。     

上颌第一磨牙牙根折裂的临床特征分析

目的 探讨上颌第一磨牙牙根折裂的常见类型和方向以及根管治疗对牙根折裂好发部位的影响.方法 纳入274颗经锥形束CT(CBCT)诊断为牙根折裂的上颌第一磨牙,判读患牙的影像学特征,分别分析非根管治疗相关的原发性牙根折裂和根管治疗相关的继发性牙根折裂的好发部位、类型、方向及其差异.结果 在上颌第一磨牙原发性牙根折裂中,腭根...     

口腔颌面锥形束CT在根折诊断中的应用

口腔颌面锥形束CT(cone beam computed tomography,CBCT)现已被广泛应用于口腔医学的各个领域。有关根折,尤其是应用CBCT诊断根纵裂一直是研究热点,其研究内容主要包括以下5个方面：(1)CBCT对根析的诊断效能研究;(2)扫描参数对CBCT诊断根折准确性的影响,如扫描视野、空间分辨率、管电流和管电压等;(3)图像后处理技术,主要是金属伪影消除技术的应用能否提高根管治疗后和根管内有桩核时根折诊断的准确性;(4)根纵裂临床诊断模式的建立与验证;(5)人工智能和对比剂在CBCT图像根折诊断中的应用。与根尖片相比,CBCT可以显著提高未经过根管治疗患牙的根折诊断准确性;但是对于根管治疗后的患牙,根纵裂的诊断需结合临床体征共同判定,其中患牙颊舌（腭）向的垂直性骨吸收是根纵裂的特征性指标。根纵裂的宽度是影响根纵裂诊断准确性的重要原因,而CBCT扫描时采用的体素大小并不是影响根纵裂诊断准确性的必要因素;除个别机型外,根纵裂的折裂方向不影响其诊断准确性;图像后处理技术,特别是金属伪影消除技术不能够提高根纵裂诊断的准确性,还可能降低诊断效能,临床中不建议应用。     

锥形束CT诊断根管纵裂临床价值研究

目的 通过体外模型对比研究锥形束CT和根尖片对根管纵裂的诊断价值。方法 收集2010—2011年郑州大学口腔医学院和肇庆市口腔医院因正畸或牙周病拔除的健康离体单根牙60颗,根管预备充填后,去除根充材料,再用根管钉用轻力使40颗牙根纵裂：20颗完全型牙根纵裂、20颗不完全型牙根纵裂;其余20颗完整牙根为对照。按正常牙位排列置于石膏模型上,分别用根尖片和锥形束CT扫描,阅片后作出诊断。结果 根尖片与CBCT诊断根管纵裂的敏感度差异有统计学意义（P < 0.05）。CBCT诊断根管治疗后完全型牙根纵裂和不完全型牙根纵裂的差异无统计学意义（P > 0.05）。结论 CBCT比根尖片诊断根管治疗后牙根纵裂的敏感度高,临床上可用CBCT辅助诊断早期牙根纵裂。     

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目的通过体外模型对比研究锥形柬CT和根尖片对根管纵裂的诊断价值。方法收集2010—2011年郑州大学口腔医学院和肇庆市口腔医院因正畸或牙周病拔除的健康离体单根牙60颗,根管预备充填后,去除根充材料,再用根管钉用轻力使40颗牙根纵裂：20颗完全型牙根纵裂、20颗不完全型牙根纵裂;其余20颗完整牙根为对照。按正常牙位排列置于石膏模型上,分别用根尖片和锥形束CT扫描,阅片后作出诊断。结果根尖片与CBCT诊断根管纵裂的敏感度差异有统计学意义（P〈0．05）。CBCT诊断根管治疗后完全型牙根纵裂和不完全型牙根纵裂的差异无统计学意义（P〉O．05）。结论CBCT比根尖片诊断根管治疗后牙根纵裂的敏感度高,临床上可用CBCT辅助诊断早期牙根纵裂。     

锥形束CT与根尖牙片诊断牙根折裂的对比分析

目的:对比分析锥形束CT与根尖牙片在根折诊断中的诊断价值。方法:选取经临床拔牙或外科探查证实的35 例(37个患牙)根折裂患者,均作CBCT和根尖牙片检查,对比分析图像。结果:37个患牙中,CBCT在检出根折35个,根尖牙片检出折裂线16个。结论:CBCT检知牙根折裂的准确率明显高于根尖牙片,能清晰显示根折位置及类型,对临床制定根折治疗方案有重要应用价值。     

X线结合锥束CT检测上颌磨牙遗漏根管的研究

目的:评价X线结合锥束CT应用于根管再治疗中寻找上颌磨牙遗漏根管的临床效果,探讨上颌磨牙最容易遗漏根管的类型。方法:123例X线怀疑有根管遗漏需行根管再治疗的上颌磨牙,拍摄CBCT,记录上颌磨牙最容易遗漏的根管类型。按照随机化分组的原则分为2组,第1组61例,第2组62例。第1组根据X线检查结果,手术显微镜下探寻遗漏根管。第2组根据X线及CBCT检查结果,判断根管遗漏的数目及位置,手术显微镜下探寻遗漏根管。分别记录第1组和第2组上颌磨牙遗漏根管的检出率,比较其有无差异。结果:第1组61例患牙中53例通过CBCT确诊为遗漏根管,其中43例显微镜下寻找到遗漏根管,第2组62例患牙中51例通过CBCT确诊为遗漏根管,其中48例显微镜下寻找到遗漏根管。第2组对于遗漏根管的发现率(48/51)高于第1组(43/53),两者之间有统计学差异。上颌第一磨牙和上颌第二磨牙最容易遗漏根管均为MB2。结论:X线结合锥束CT,有助于帮助发现遗漏根管,提高根管再治疗的成功率。     

锥形束CT与根尖X线片对牙根纵裂诊断价值的对比研究

目的:对比研究牙科锥形束CT(CBCT)与普通根尖X线片在牙根纵裂诊断中的价值。方法:对2009-11—2010-10在我科经临床检查疑似牙根纵裂的69例病人(84个患牙)的根尖X线片及CBCT图像资料进行回顾性分析。由2位有经验的牙体牙髓科主治医生独立阅片,商讨达成一致后,与根尖切除、牙周翻瓣、拔除术等外科手术所见结果进行比较。并将CBCT与根尖X线片对牙根纵裂的诊断结果进行统计学分析。结果:CBCT诊断根裂的阳性检出率、灵敏度、准确度分别为82.1%、87.3%、88.1%,而根尖X线则为39.3%、41.8%、45.2%,差异有统计学意义(P<0.05)结论:CBCT与根尖X线片相比可更准确的诊断牙根纵裂,具有重要的临床应用价值。     

锥形束CT诊断左下中切牙不典型性牙根纵折1例报告

将锥形束CT(cone-beam computed tomography, CBCT)应用于口腔部位的三维成像,是近年来的研究热点。牙根纵裂是指发生在牙根的纵裂,未波及牙冠。本文通过CBCT明确诊断罕见左下中切牙牙根纵裂1例。与二维X线根尖片相比,CBCT扫描对牙折裂的诊断具有更高的准确度,具有重要的临床应用价值。     

锥形束CT诊断非牙髓治疗牙齿根纵折的研究

目的:回顾性对比研究X线牙片和锥形束CT在非牙髓治疗牙齿根纵折中的诊断。方法:回顾性对比研究28例32颗非牙髓治疗牙齿根纵折的X线牙片和锥形束CT(Plameca)检查结果。结果:在32颗牙齿中,X线牙片能明确诊断的有24颗牙齿,其中下颌第一磨牙15颗,前磨牙3颗,上颌磨牙近中颊根6颗。8颗上颌磨牙腭根发生根纵折仅靠X线牙片难以诊断,需要锥形束CT检查明确诊断。结论:锥形束CT在非牙髓治疗牙齿根纵折的诊断中明显优于X线牙片。     

CBCT法研究上颌第一磨牙根管形态

目的：探讨应用锥形束CT研究上颌第一磨牙牙根及根管形态的价值。方法选取70例患者83颗上颌第一磨牙的锥形束CT（cone beam computed tomogaphy,CBCT）影像,分析其牙根数目、根管数目及根管系统的解剖结构。参照Vertucci分类法对根管形态进行分类,统计近中颊根第二根管（the seconal mesiobuual canal, MB2）率。结果83颗上颌第一磨牙均为3个独立牙根,其中MB2的发生率为38.6%,近中颊根根管VertucciⅠ型（1?1）、Ⅳ型（2?2型）、Ⅱ型（2?1）、Ⅲ型（1?2?1）所占百分比分别为61.4%、18.1%、15.7%和4.8%。结论上颌第一磨牙根管系统复杂,CBCT影像可反映真实根管形态,为根管治疗提供参考。     

Diagnostic value of computed tomography in re-treatment of root fillings in maxillary molars

AIM: To compare the diagnostic information and radiation dose between intraoral radiography and computed tomography (CT) in re-treatment decision making concerning root fillings in maxillary molars. METHODOLOGY: Thirty-nine root-filled maxillary molars with suspected apical periodontitis were examined with two intraoral periapical radiographs and CT. Presence of periapical lesion/s per tooth and root were analysed for both techniques. In addition, in the CT images, the number of root canals, erosion, or perforation of cortical bone plates, and the distance between palatal root and cortical bone plates were evaluated. Radiation dose for CT was registered and calculated; and that of periapical radiographs used as reported previously (Ekestubbe et al. 2004). RESULTS: Periapical radiographs revealed periapical lesions in 33 teeth compared with 38 on CT images. A lesion of any root was detected more often with CT. The mesiobuccal root had two root canals in 30 teeth of which 27 of the MB2 canals were not filled, and 22 roots with an unfilled canal were associated a periapical lesion. Distances to palatal root, from the buccal and palatal cortex were measured in CT and varied between 5.0-12.0 mm and 0-4.0 mm, respectively. Based on the radiographic information, a variety of treatment alternatives were suggested. Mean effective dose of periapical radiographs was 0.02 mSv and that of CT 0.055 mSv. CONCLUSIONS: Computed tomography may give important information in re-treatment decision when considering root fillings in maxillary molars. The radiation dose should be considered individually.     

Evaluation of horizontal/oblique root fractures in the palatal roots of maxillary first molars using cone‐beam computed tomography: a report of three cases

Abstract – Diagnosis of root fractures is generally based on clinical and radiographic presentations. This case report aims to detect horizontal/oblique root fractures in posterior teeth using a combination of conventional radiographs and cone‐beam computed tomography (CBCT). Three maxillary first molars with horizontal/oblique root fractures in the palatal roots are presented. More detailed information on root fractures can be obtained using CBCT compared with conventional radiography. As such, CBCT might be a useful complementary diagnostic method to conventional radiography in cases of suspected horizontal/oblique root fractures.     

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。     

Evaluation of Root Canal Configuration of Maxillary Molars in a Brazilian Population Using Cone-beam Computed Tomographic Imaging: An In Vivo Study

Introduction

The aim of this study was to analyze and characterize root canal morphology of maxillary molars of the Brazilian population using cone-beam computed tomographic (CBCT) imaging.

Methods

Patients referred for a CBCT radiographic examination for accurate diagnosis and treatment planning were enrolled in the study. A total of 620 healthy, untreated, fully developed maxillary first and second molars were included (314 first molars and 306 second molars). The following observations were recorded: (1) number of roots and their morphology, (2) number of canals per root, (3) fused roots, and (4) primary variations in the morphology of the root canal systems.

Results

First and second molars showed a higher prevalence of 3 separate roots, mesiobuccal, distobuccal, and palatal, with 1 canal in each root (52.87% and 45.09%, respectively). Two canals in the mesiobuccal roots represented 42.63% of teeth, whereas mesiobuccal roots of second molars presented 2 canals in 34.32%. The most common anatomic variation in the maxillary first molar was related to the root canal configuration of the mesiobuccal root, whereas the root canal system of the maxillary second molar teeth showed more anatomic variables.

Conclusions

Mesiobuccal roots of maxillary molar teeth had more variation in their canal system than the distobuccal or palatal roots. The root canal configuration of the maxillary second molars was more variable than the first molars in a Brazilian population. CBCT imaging is a clinically useful tool for endodontic diagnosis and treatment planning.     

Three‐dimensional imaging as a pre‐operative tool in decision making for furcation surgery

Aim: To investigate the use of cone beam computed tomography (CBCT) in assessing furcation involvement (FI) and concomitant treatment decisions in maxillary molars. Material and Methods: Twelve patients with generalized chronic periodontitis were consecutively recruited and CBCT was performed in maxillary molars (n=22) with clinical FI and increased probing pocket depths. CBCT images were analysed and FI, root length supported by bone and anatomical features were evaluated. FI and treatment recommendations based on clinical examinations and periapical radiographs were compared with data derived from CBCT images. Results: The estimated degree of FI based on clinical findings was confirmed in 27% of the sites, while 29% were overestimated and 44% revealed an underestimation according to CBCT analyses. Among degree I FI, 25% were underestimated, among degree II and II–III, the underestimation was as high as 75%, while all sites with degree III FI were confirmed in the CBCT. Discrepancies between clinically and CBCT‐based therapeutic treatment approaches were found in 59–82% of the teeth, depending on whether the less invasive or the most invasive treatment recommendation was selected for comparison. Conclusions: CBCT images of maxillary molars may provide detailed information of FI and a reliable basis for treatment decision.     

Comparison of intraoral radiography and limited cone beam computed tomography for the assessment of root-fractured permanent teeth

Abstract –  Aim : To compare intraoral occlusal (OC) and periapical (PA) radiographs vs. limited cone beam computed tomography (CBCT) in diagnosing root-fractured permanent teeth. Material and methods :  In 38 patients (mean age 24 years, range 8–52 years) with 44 permanent teeth with horizontal root fractures, intraoral radiographs (PA and OC) and limited CBCT were used to evaluate the location (apical, middle, cervical third of the root) and angulation of the fracture line. Furthermore, the conventional radiographs and CBCT images were compared for concordance of fracture location. Results :  In the PA and OC radiographs, 28 fractures (63.6%) were located in the middle third of the root, 11 (25.0%) in the apical third and 5 (11.4%) in the cervical third. The PA/OC radiographs and the sagittal CBCT images (facial aspect) yielded the same level of root fracture in 70.5% of cases (31 teeth; 95% CI: 54.1–82.7%). The PA/OC radiographs and sagittal CBCT images (palatal aspect) showed the same level of root fracture in 31.8% of cases. There was a statistically significant association between the angle at which the root fracture line intersected the axis of the tooth and the level of root fracture in the facial aspect of the sagittal CBCT images. Conclusions :  The diagnosis of the location and angulation of root fractures based on limited CBCT imaging differs significantly from diagnostic procedures based on intraoral radiographs (PA/OC) alone. The clinical significance for treatment strategies and for the prognosis of root-fractured teeth has to be addressed in future studies.