锥形束CT在下颌第一前磨牙根管系统形态学研究中的应用

发布时间：2018-03-05 05:34

  本文选题：下颌第一前磨牙　切入点：CBCT　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:牙髓病、根尖周病是口腔科常见病,根管治疗(RCT,Root canal treatment)是治疗牙髓根尖周病最有效的方法,其原理是根除根管系统中的感染源,杜绝再感染。正确认识根管形态及其变化才能确保根管治疗取得理想的疗效。下颌第一前磨牙其根管系统的解剖结构复杂多变,是根管治疗失败率最高的牙齿。根管治疗过程中有时会遗漏根管,导致根管预备、充填不到位,导致根管治疗的失败。因此,了解下颌第一前磨牙根管系统解剖结构是非常重要的。对牙齿根管系统的解剖研究可选择的方法可分为破坏性和非破坏性研究两类,其区别是标本是否被破坏。离体透明牙法、离体牙切片法、磨片法等是破坏性研究,非破坏性的研究方法有X线片分角投照法、CBCT(Cone-beam computed tomography,锥形束投照计算机重组)及显微CT法。破坏性的方法需要破坏其原有解剖结构,运用机械或化学手段对标本进处理,标本的处理步骤较复杂且处理过程中干扰因素较多,对根管系统的评价不够全面系统,因此目前多采用非破坏性方法进行研究。本研究利用CBCT研究分析下颌第一前磨牙根管解剖特征,运用Vertucci分类法对下颌第一前磨牙根管结构进行分类,为下颌第一前磨牙疾病的临床诊治提供研究数据。方法:选择自2014年10月至2015年9月期间,因各种病因于山西大医院口腔科门诊就诊患者的822例下颌第一前磨牙CBCT数字影像作为研究对象。纳入标准为:(1)无牙体缺损及龋坏;(2)无修复体或充填体;(3)无根尖周组织病变;(4)牙根发育已完成;(5)未进行根管治疗;(6)未发生牙根内、外吸收,无根管钙化等变化;(7)CBCT图像清楚;(8)无畸形中央尖等特殊结构;(9)患者年龄18-50岁,双侧下颌第一前磨牙均存在且符合上述标准。筛选出CBCT数字影像498例,共996颗下颌第一前磨牙。记录患者的姓名、性别、年龄、牙位等信息,连续性观察并记录所有下颌第一前磨牙的CBCT扫描数据:(1)牙根数目;(2)牙齿在根管口、根中1/3、及根尖1/3处的根管数目;(3)双侧根管的形态是否对称;(4)根管类型。所有需采集的信息均已告知患者,获得患者本人知情同意。结果:996颗下颌第一前磨牙中单根牙发生率为96.48%,双根牙的检出率为3.52%。75.20%的牙齿为单根管,其余24.80%为多根管。按照Vertucci分类法将根管形态分为9型,本研究中I型最为多见,占75.20%,V型的发生率仅次于I型,为21.97%,其余各类型共计发生率2.83%(II型0.56%,III型1.55%,IV型0.42%,VI型0.10%,VII型0.20%)。有10.74%共107颗的牙齿存在根面凹陷,且根面凹陷均位于牙根的近中舌侧,其中多根管牙90颗,单根管牙17颗。498例影像资料中,牙根数目和根管数目的发生率在左右侧的差异均无统计学意义,88.55%例左右侧根管类型一致。结论:下颌第一前磨牙多数只有一个根管,但多根管的发生率达24.80%,其中多数具有1-2型的解剖特点;其牙根常存在位于近中舌侧的根面凹陷,在进行根管治疗时应注意仔细探查根管数目及避免过度切削根管壁;88.55%的下颌第一前磨牙根管类型左右对称,但仍有一部分患者左右侧根管解剖形态不完全一致,临床工作中要避免遗漏根管;临床医生要充分认识下颌第一前磨牙根管系统解剖形态的多样性,以提高治疗的成功率;运用CBCT辅助检查可以帮助确定根管解剖形态的特点,为疑难根管的诊断和治疗提供较准确的信息。
[Abstract]:Objective: to pulpitis and periapical disease is a common disease in Department of Stomatology, root canal treatment (RCT, Root canal treatment) is the most effective method for treating endodontic disease, its principle is to eradicate the root canal infection source in the system, to prevent re infection. Correct understanding of the root canal morphology and change in order to ensure the effect of good roots tube in the treatment of mandibular first premolar. The anatomical structure of the root canal system is complicated, the root canal treatment the highest failure rate. The tooth root canal treatment process can sometimes lead to missing root canals, root canal filling, root canal treatment is not in place, resulting in the failure. Therefore, understanding the mandibular first premolar root canal. The anatomical structure of system is very important. The tooth root canal system anatomy study of alternative methods can be divided into destructive and non destructive study of two types, the difference is whether the specimen was damaged. The isolated transparent tooth teeth, slicing method, grinding method Such destructive research, non destructive research methods of X-ray film with bisecting angle method, CBCT (Cone-beam computed tomography, the cone beam projection computer recombination) and micro CT method. The destructive methods need to destroy the original anatomical structure, the use of mechanical or chemical means into the underlying processing, sample processing steps is complex and many factors interference process, evaluation of the root canal system of the system is not comprehensive, so the current use of non destructive methods. CBCT analysis of mandibular first premolar root canal anatomy features used in this study, using Vertucci classification method to classify the mandibular first premolar root canal structure, provide research data for the diagnosis and treatment of mandibular first premolar disease. Methods: from October 2014 to September 2015, due to various causes in 822 cases of patients with mandibular outpatient department of Stomatology Shanxi hospital 绗�涓�鍓嶇（鐗機BCT鏁板瓧褰卞儚浣滀负鐮旂┒瀵硅薄.绾冲叆鏍囧噯涓，

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