上颌中切牙即刻种植相关解剖要素的CBCT研究

发布时间：2018-03-05 12:21

本文选题：CBCT　切入点：解剖形态　出处：《南昌大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究背景:目前越来越多的患者会关注种植治疗周期的长短、创伤的大小及修复后的美学效果,现代种植修复的理念是简单化、即时化、美学化。这就对口腔种植技术提出了更高的要求和挑战,而经典的延期种植、延期修复治疗周期长,骨组织的生理性吸收造成骨量的丧失,各种植骨方式给延期种植带来了更高的难度和软组织美学风险。不翻瓣即刻种植是在牙齿拔出后直接将种植体植入。其优点是不用翻软组织瓣,保护了牙龈组织,保存了牙槽窝的血供,维持了原天然牙的牙龈生物学和牙龈轮廓的自然形态及软硬组织的完整性。减少了患者的损伤和痛苦,缩短了手术时间,是患者和医生乐于接受的手术方式[1]。然而,美学区什么情况下适合非翻瓣即刻种植和什么情况下适合翻瓣即刻种植并没有明确的适应证划分。因此,研究上颌中切牙区牙槽骨的解剖形态,可以对上颌中切牙区种植手术的术式选择提供理论依据。目的:通过CBCT对上颌中切牙区牙槽骨的解剖形态进行分类,以期对临床医生在上颌中切牙区即刻种植时选择更好的治疗方案提供理论依据。方法:选择2015年10月1号到31号在四川大学华西口腔医学院附属口腔医院放射科拍摄CBCT的110名符合条件患者的CBCT影像资料,男51人,女59人,年龄18-69岁,共110颗左上颌中切牙(左上颌中切牙不符合条件的选取右侧同名牙)。对每颗牙齿唇侧骨板是否清晰并且连续做出判断,并且在最大唇舌径的矢状面上对唇侧最凹点与牙根长轴的位置关系做出分类和统计,对牙根长轴与腭侧骨板切线的交点和根尖点的位置关系做出分类和统计,并且对牙槽嵴顶的宽度、根尖方向牙槽骨的高度、最凹点处的牙槽骨宽度以及最凹点到根尖点沿牙根长轴方向的距离做出测量并统计分析,并依据所得数据对该区牙槽骨的形态进行分类。结果:一、牙根长轴与腭侧骨板切线交点在根尖点切方的约占97.3%,牙根长轴与腭侧骨壁切线平行的约占2.7%。二、最凹点位于牙根长轴唇侧的约占45.5%,位于牙根长轴上的约为35.5%,位于牙根长轴腭侧的约占19.0%。三、根尖骨高度小于5mm的约占0.05%。四、牙槽嵴顶的宽度平均约为7.5mm。五、最凹点处的牙槽骨宽度平均为10.15mm。六、最凹点距离根尖点大于5mm的约占15.5%。七、唇侧骨板清晰完整的比率约为76.4%。结论:1、约97.3%的患者在即刻种植时植体长轴与原天然牙长轴一致并偏向腭侧预备种植床时不会从腭侧侧穿,且越向根尖方,植体腭侧的骨壁厚度会越大。2、牙根长轴与腭侧骨壁切线平行的病例,应在近根尖点处且平行于原牙体长轴制备,若偏腭侧制备很可能造成腭侧骨壁侧穿。3.根尖骨高度小于5mm的约占0.05%,这点说明绝大多数病例根尖方向都有获得初期稳定性所需要的骨高度。4、牙槽嵴顶的平均宽度在7.5mm左右,这点说明临床上大多数病例使用小直径植体可以满足唇侧骨壁最小2mm厚度,腭侧骨壁最小1mm厚度的要求。5、本文对满足第一点和第二点的上颌中切牙区的牙槽骨进行即刻种植难度的分类,1.唇侧骨壁完整型(76.4%):简单型,最凹点A点位于牙根长轴唇侧,适合做非翻瓣即刻种植。风险型:最凹点位于牙根长轴上,侧穿的风险加大,建议翻瓣做。复杂型:最凹点位于牙根长轴腭侧,由于植体根部暴露的可能性大大增加,建议翻瓣做,且如果倒凹过深,很可能无法获得初期稳定性,且由于植体根部暴露过多,形成一壁型骨缺损,GBR效果可能会不好,建议分阶段做[2]。2.唇侧骨壁缺损型,因该型需植入骨替代材料并且盖生物膜,所以需翻开黏骨膜瓣。简单型:最凹点位于牙根长轴唇侧,获得初期稳定性及引导骨组织再生的能力都比较强,建议同期做。风险型,最凹点位于牙根长轴上,植体根部可能在唇侧暴露,需做好GBR的准备。复杂型,最凹点位于牙根长轴腭侧,植体根部暴露的风险更大,需做好GBR的准备,而且倒凹过大的病例,获得初期稳定性的能力大大下降,植体根部会暴露更多,形成一壁型骨缺损,GBR效果可能会不好,建议分期做。
[Abstract]:Background: at present, more and more patients will pay attention to planting treatment cycle length, size and aesthetic effect of wound repair after the repair, the modern planting concept is simple, real-time, aesthetic. The oral implant technology has put forward higher requirements and challenges, and the classic delayed implant, delayed repair the treatment cycle is long, physiological bone cause bone loss, a variety of bone and soft tissue esthetics brought difficulty higher risk to delayed implant. Flapless immediate implant in the teeth pulled out directly after the implant implantation. Its advantages are not over soft tissue flap, protect the gums the organization, preservation of alveolar blood supply, to maintain the integrity of gingival biology and natural tooth profile of the original gum natural shape and soft tissue. To reduce patients' injury and pain, shorten the operation time, patients and doctors Willing to accept the way of operation [1]. however, what aesthetic area suitable for non flapless immediate implant and what conditions suitable for immediate implant flap and no indications of a clear division. Therefore, a study on anatomy of maxillary incisors in the alveolar bone, can operation on maxillary incisor implant surgery can provide a theoretical basis for the objective: through the classification of the anatomical morphology of CBCT in alveolar bone of maxillary incisor region, in order to provide theoretical basis for clinicians in the maxillary incisor area for immediate implantation treatment better. Methods: from October 1, 2015 to 31, shooting CBCT in the radiology department of Stomatology Hospital of Sichuan University College of Stomatology affiliated with CBCT 110 image data of the condition of the patient, male 51, female 59, age 18-69 years, a total of 110 left maxillary central incisors (left maxillary incisor do not meet the conditions to select the right same name teeth). Make judgments on each of the teeth labial bone plate is clear and continuous, make the classification and statistics of position and the maximum sagittal diameter on the surface of the tongue on the labial root axis and the concave point, make classification and statistical relationship to the location of the root and the long axis of the palatal bone plate and apical tangent intersection points. And the alveolar crest width, height of the apical alveolar bone, make statistical analysis and measurement of the concave point of the alveolar bone width and the concave point to point along the root apical long axis distance, and on the basis of the data of the alveolar morphological classification. Results: first, the long axis and the palatal root lateral plate tangent intersection in the root tip cutting point accounted for about 97.3% of the root and the long axis of the palatal bone wall tangent about 2.7%. two, the concave point is located in the root axis of labial accounted for about 45.5%, is located in the root long axis is about 35.5%, is located in the root axis The palatal accounted for about 19.0%. three, periapical bone height less than 5mm accounted for four 0.05%., the average width of the alveolar ridge is about 7.5mm. five, the concave point of the alveolar bone width is 10.15mm. on average six, the concave point of apical point is more than 5mm accounted for seven 15.5%., the labial bone plate is clear and complete the ratio is about 76.4%. conclusions: 1, about 97.3% of the patients in the immediate implant implant when the long axis and the axis of the teeth is not consistent with the original natural bias of palatal implant bed prepared from palatal side wear, and more to the apical side, bone thickness of palatal implant to be more.2, long axis and palatal root the lateral bone wall tangent parallel cases, should be in the near tip point and parallel to the long axis of the tooth preparation, if partial palatal preparation is likely to cause the palatal bone wall side wear.3. periapical bone height less than 5mm accounted for about 0.05%, this shows that there is bone height.4 initial stability needed by the vast most cases of apical tooth direction. The average width of groove ridge at about 7.5mm, it shows that in most cases the clinical use of small diameter implant can meet the minimum wall thickness of labial bone 2mm, palatal bone wall 1mm minimum thickness requirements of.5, the classification of the incisal alveolar bone to meet the first and the second points of the maxillary in immediate implant difficulty the 1. labial bone wall type (76.4%): the most simple type, concave point A is located in the long axis of the labial root, suitable for non flap implants. The risk type: the concave point is located in the root axis, the risk of side wear increased, suggest flap. The complex: the concave point is located the long axis of the palatal root, the possibility of implant root exposed greatly increased, suggest flap, and if the undercut is too deep, it is unlikely to obtain initial stability, and because the implant roots exposed to too much, the formation of a type of bone defect, GBR may not be good, proposed a phased [2].2. labial The bone wall defect, because the type of bone substitute materials and to cover membrane, so the need to open the mucoperiosteal flap. Simple type: the concave point is located in the long axis of the labial root, ability to obtain the initial stability and guided bone regeneration are relatively strong, suggest that during the same period. The risk type, the concave point is located in the root axis on the implant root may be exposed to the labial side, to prepare the GBR. The complex type, the concave point is located in the long axis of the palatal root, plant roots exposed to greater risk, to prepare the GBR, but also undercut excessive cases, to obtain the initial stability of capacity is greatly decreased, plant root will be exposed to more, forming a type of bone defect, GBR may not be good, recommended staging.

【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R783.6

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