锥形束CT在不同牙周袋深度牙根纵裂患牙诊断中的应用研究

目的 牙根纵裂(vertical root fracture,VRF)是指出现在牙根上的纵向折裂,临床中早期诊断较为困难,本研究旨在探讨锥形束CT(CBCT)在不同牙周探诊深度的牙根纵裂(VRF)患牙诊断中的应用。 方法 纳入2016年8月—2019年8月期间于杭州师范大学附属医院口腔科就诊的95例患者共99颗疑似VRF的患牙,分别进行X线根尖片和CBCT检查。由影像科医生和牙周专科医生分别对每颗患牙进行独立诊断并讨论获得一致结果,患牙治疗中直视观察到裂纹为确诊VRF的金标准,分别对CBCT和X线根尖片2种诊断方法的阳性检出率、特异度、准确度和灵敏度进行统计分析,并根据患牙牙周袋深度(是否≥5 mm)对CBCT诊断结果的影响进行亚组分析。 结果 99颗疑似VRF患牙中最终确诊为VRF的有84颗。对比最终金标准确诊结果,使用CBCT诊断VRF的阳性检出率为75.8%,灵敏度为89.3%,特异度为100.0%,准确度为90.9%。其中,阳性检出率、灵敏度和准确度和根尖X线片法(41.4%、48.8%和54.5%)相比差异均有统计学意义(均P<0.001)。在深牙周袋组(探诊深度≥5 mm)中,使用CBCT进行诊断VRF的阳性检出率为81.7%,灵敏度为93.5%,与非深牙周袋组(探诊深度≤4 mm)相比差异均有统计学意义(均P<0.05),而准确度和特异度比较差异无统计学意义。 结论 使用CBCT诊断VRF优于X线根尖片,深牙周袋的存在对阳性检出率和灵敏度存在影响,牙周探诊推荐作为VRF疑诊患牙的必要临床检查。 

The application of cone beam CT in the diagnosis of vertical root fracture with different depth of periodontal pocket

Objective To evaluate the role of cone beam computed tomography(CBCT) in clinical diagnosis of vertical root fracture(VRF). Methods A total of 99 suspected VRF teeth were included from 95 patients who visited the Department of Stomatology, Affiliated Hospital of Hangzhou Normal University from August 2016 to August 2019. Both digital periapical radiographs and CBCT were performed respectively. Two experienced periodontists independently analyzed each tooth and reached a consensus diagnose. The gold standard for the diagnosis of VRF is the crack observed directly in the treatment of teeth. The positive rate, specificity, accuracy and sensitivity of CBCT and X-ray apical radiography were statistically analyzed, and the influence of deep periodontal pocket(probing depth ≥ 5 mm) on the diagnosis result of CBCT was analyzed. Results In the 99 suspected VRF teeth, 84 teeth were eventually diagnosed with VRF. The positive rate, sensitivity and accuracy of CBCT in diagnosing VRF were 75.8%, 89.3% and 90.9% respectively, which were significantly different from digital periapical radiographs(41.4%, 48.8% and 54.5%, respectively, all P<0.001). In the deep periodontal pocket group(probing depth ≥ 5 mm), the positive rate and sensitivity of using CBCT for diagnosis of VRF were 81.7% and 93.5%, which were different from the non-deep periodontal pocket group(probing depth ≤ 4 mm, all P<0.05), but there was no statistical difference in accuracy and specificity. Conclusion CBCT is superior to digital periapical radiographs in the diagnosis of VRF, and the presence or absence of deep periodontal pocket will affect the positive rate and sensitivity. In future, CBCT is firstly recommended in the diagnosis of suspected VRF, especially combining the clinical sign of deep periodontal pocket.