下颌管在牙种植术中的临床应用解剖学研究

发布时间：2018-06-05 00:52

本文选题：下颌管 + 牙种植术　；参考：《南华大学》2012年硕士论文

【摘要】：目的: 本实验通过对人下颌骨标本解剖和口腔X线计算机断层扫描（DCT）三维重建测量，研究正常成人下颌骨的解剖特点及下颌管走行规律，提出预防下牙槽神经损伤的方法，扩大牙种植术的适应症，提高牙种植术的成功率，为临床牙种植的开展提供可靠的技术保障。方法：对28例下颌骨标本灌注下颌管完成后的模型，先测量下颌牙槽突下1cm的厚度，再用牙科打磨机分别从下颌骨颊舌侧骨板切割，将下颌管解剖暴露，切割时注意切割线勿低于下颌管在下颌骨颊舌侧骨板的相应投影位置。清理松质骨，暴露下颌管的密致骨性管道，剥离暴露下颌后牙各个根尖。观察下颌管的走行位置及其与周围组织的关系。直接测量下颌管的相关数据，每个测量指标均反复测量3次，取其均数记录，数据分组记录。对50例健康成年人DCT影像数据的三维重建测量在DCT软件工作站完成，分别对下颌骨颊侧板厚、舌侧板厚、牙槽突宽、管内壁距、管外壁距、管嵴距、管至下颌下缘距、管颊舌径、管上下径、下颌后牙区各牙根尖至下颌管的距离进行测量评价。结果： 1.下颌骨表层为坚硬的密质骨，内部为骨松质，观测发现下颌骨颊侧板较为厚实，所测得的各个分区的厚度均基本在2mm以上，最厚部位骨皮质的厚度甚至达4mm以上，这样可以保证下颌骨能够承受巨大的咬合力。下颌骨舌侧骨板的厚度相对于颊侧骨板明显比较薄弱，尤其是磨牙区的舌侧骨皮质非常的薄。下颌骨舌侧骨板由A区的(2.74±0.25)mm向后至H区(1.42±0.13)mm逐渐变薄。 2.从测量结果可以看出下颌牙槽嵴顶下方10mm处厚度由A区的(11.90±0.44)mm向后至H区(14.24±0.53)mm逐渐变厚，但在磨牙后区向后，厚度呈逐渐减小，颊舌侧骨板渐渐贴近。 3.下颌管至下颌骨颊侧板的距离较大，，距舌侧骨板较近，而且变化十分明显。在第二前磨牙区的下颌管距颊、舌侧骨板的距离相近，均在5mm左右，但下颌管到颊侧骨板的距离向后有逐渐加大的趋势，到第二磨牙近中距离最大标本为(6.76±0.35)mm，影像为(6.46±0.58)mm，向后又呈现出距离逐渐减小的趋势。下颌管到舌侧骨板的距离却恰恰相反，随着向后的走行，下颌管到下颌骨舌侧骨板的距离明显减小，甚至常常有下颌管壁与下颌骨舌侧骨板融合在一起，加之下颌骨舌侧的骨板很薄，导致下颌管舌侧与外界仅仅相隔一薄层骨壁。 4.下颌管上缘至牙槽嵴顶距离，第二前磨牙区为(17.50±1.63)mm向后到第三磨牙远中区(9.58±0.97)mm，呈逐渐减小趋势。下颌管下缘至下颌骨下缘的距离在第二前磨牙区为(9.82±1.26)mm，向后到第三磨牙远中区(13.52±1.93)mm，呈逐渐增大趋势。 5.下颌管在磨牙后区及第三磨牙区的颊舌径和上下径间具有统计学差异，其横径和纵径，亦即下颌管截面形态为其纵径略长的椭圆形；在第二磨牙及以前各区的颊舌径和上下径无统计学差异，从所测量标本中观察此段的下颌管横断面接近圆形。 6.双侧磨牙近远中根尖至下颌管上缘距离，在第三磨牙区最小为（0.32±0.47）mm，向前走行逐渐变大，至第一磨牙近中根达到测量断面的最大值（3.29±1.74）mm。结论： 1.下颌后牙牙种植术中按牙齿正常解剖位置略偏向颊侧倾斜操作，可以减少损伤下牙槽神经。 2.健康成人下颌后牙区种植时,为避免种植体损伤或挤压下颌管，种植体植入牙槽骨的深度控制在13mm以内。
[Abstract]:Purpose :

Through three - dimensional reconstruction of human mandible specimen and computed tomography ( DCT ) of oral X - ray computed tomography ( DCT ) , the anatomical features of the mandible of normal adult and the law of mandibular canal walking were studied . The method of preventing nerve injury in inferior alveolar groove was put forward , the success rate of dental implant was improved , and reliable technical guarantee was provided for the clinical tooth implant .

Method :

In order to study the relationship between the mandibular canal and the mandibular canal , the mandibular canal was dissected and exposed . The results of the three - dimensional reconstruction of the mandibular canal were measured repeatedly , and the distance between the inner wall and the lower margin of the tube , the length of the canal , the diameter of the canal , the distance between the root tip and the mandibular canal of the mandibular posterior teeth were measured .

Results :

1 . The surface of the mandible is hard dense bone , the internal bone is cancellous bone , the thickness of each zone measured is more than 2mm , the thickness of the bone cortex of the most thick part is even more than 4mm , so that the mandible can bear great bite force . The thickness of the jaw side bone plate is very weak relative to the buccal bone plate , especially the lingual bone cortex of the molar area is very thin . The mandibular lingual side bone plate is gradually thinned from ( 2.74 卤 0.25 ) mm in area A to the H area ( 1.42 卤 0.13 ) mm .

2 . It can be seen from the measurement results that the thickness of 10 mm below the top of the mandibular alveolar ridge is gradually thickened from ( 11.90 卤 0.44 ) mm in area A to ( 14.24 卤 0.53 ) mm in H area ( 14.24 卤 0.53 ) mm .

3 . The distance of the mandibular canal to the buccal side plate of the mandible is larger , and the distance between the mandibular canal and the buccal bone plate is similar to that of the lingual plate . The distance between the mandibular canal and the buccal bone plate is ( 6.76 卤 0.35 ) mm , the image is ( 6.46 卤 0.58 ) mm , the distance between the mandibular canal and the lingual bone plate is obviously reduced , and even the mandibular canal is fused together with the mandibular tongue side bone plate , and the bone plate on the lingual side of the mandible is very thin , which leads to the separation of the lingual side of the mandibular canal from the outside by only a thin layer of bone wall .

4 . The distance between the upper margin of the mandibular canal and the alveolar crest was ( 17.50 卤 1.63 ) mm . The distance between the lower margin of the lower jaw and the lower margin of the mandible was ( 9.82 卤 1.26 ) mm , and the distance from the lower margin of the lower jaw to the lower margin of the mandible was ( 13.52 卤 1.93 ) mm , which gradually increased .

5 . There was a statistical difference between the buccal and vertical diameters of the mandibular canal in the posterior and third molar areas of the molar , the lateral diameter and the longitudinal diameter of the mandibular canal , i.e . the shape of the cross section of the mandibular canal was slightly longer than the longitudinal diameter of the mandibular canal ;
There was no statistical difference between the buccal and vertical diameters of the second molar and the previous sections , and the cross section of the lower jaw of this section was observed to be approximately circular from the measured specimen .

6 . The distance from the root tip to the upper margin of the mandibular canal in the proximal part of the two - sided molar , the smallest in the third molar area ( 0.32 卤 0.47 ) mm , gradually increased to the anterograde line , reaching the maximum value ( 3.29 卤 1.74 ) mm of the measured section in the proximal middle root of the first molar .

Conclusion :

1 . In the post - mandibular dental implant , the normal anatomic location of the teeth is slightly inclined to the buccal - side tilting operation , so that the inferior alveolar nerve can be reduced .

2 . In order to avoid damage to the implant or to squeeze the mandibular canal , the depth of the alveolar bone was controlled within 13 mm in order to prevent the implant from damaging or squeezing the mandibular canal .
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R783;R322

【参考文献】