CBCT与RVG对慢性根尖周炎根管治疗后骨密度变化的观察

发布时间：2018-03-28 15:49

本文选题：根尖周炎　切入点：根管治疗术　出处：《遵义医学院》2014年硕士论文

【摘要】：目的：通过在临床上诊断慢性根尖周炎患牙行根管治疗后，术后患牙均完全无疼痛，咬合进食正常。定期对患牙拍摄锥形束CT（CBCT）和X线直视影像术（RVG），应用其测量骨密度，观察根管治疗术后骨密度变化，分析两种测量方法的特点，为临床根管治疗术预后判断提供参考和指导。方法：在临床上随机抽取明确诊断患有慢性根尖周炎的男性患者35例，年龄18-40岁，同一个病人由同一影像医生在术后即刻、3个月、6个月、9个月、12个月拍摄X线直视影像术（RVG），其中12例于术后3个月、6个月、9个月、12个月同时拍摄锥形束CT（CBCT），并使用各自的软件测量对患牙根尖区牙槽骨病损区和对照牙相同位置测量骨密度。CBCT：进行矢状、冠状以及轴位体层扫描，然后根据层厚0.25mm、间距0.25mm并进行图像选取。选取患牙根尖病变区冠状、矢状位最大病损面并记录片号，利用CBCT自带软件分别测量根尖区最大病损面，，病损最大直径上两点间的灰度值，将各灰度值相加取均值，对照牙取对颌牙所有相同面相同位置的灰度值均值；RVG：病变区病损最大直径上两点间相对骨密度值均值及对照牙（对颌牙相同位置）两点之间牙槽骨相对骨密度值均值。结果：1、CBCT冠状位测量结果的比较：实验组在不同的时间内组内两两比较，差异具有统计学意义（P0.01）；同一时间内实验组（3、6、9个月）与对照组相比，差异具有统计学意义（P0.01）；实验组12个月与对照组相比，差异无统计学意义（P0.05）。 2、CBCT矢状位测量结果的比较：实验组在不同的时间内组内两两比较，差异具有统计学意义（P0.01）；同一时间内实验组（3、6、9个月）与对照组相比，差异具有统计学意义（P0.01）；实验组12个月与对照组相比，差异无统计学意义（P0.05）。 3、RVG测量结果的比较：RVG仅能做冠状位测量，实验组在（0、3、6、9个月）组内两两比较，差异具有统计学意义（P0.01）；9、12个月相比，差异无统计学意义（P.0.05）；同一时间内实验组（0、3、6个月）与对照组相比，差异具有统计学意义（P0.01）；同一时间内实验组9、12个月与对照组相比，差异无统计学意义（P0.05）。结论：1、CBCT和RVG可以测量根尖区牙槽骨骨密度，CBCT可以显示根尖区冠状位、矢状位骨质破坏及变化情况。RVG不能显示根尖区矢状位骨质破坏及变化情况。 2、慢性根尖周炎行根管治疗术后，成功病例病损区骨质逐渐愈合，病变区骨密度一般9-12个月后趋于正常。 3、CBCT和RVG测量骨密度是安全的、准确的、可重复的方法，能更精确反映根尖区骨密度变化情况。 4、运用CBCT和RVG结合图像分析软件技术在牙髓病、根尖周病根管治疗术后进行病损区骨密度监测,对根管治疗术的疗效及预后判断具有一定的参考价值。
[Abstract]:Objective: the diagnosis of chronic periapical periodontitis treated by root canal therapy in clinic, postoperative teeth were completely free of pain, eating on a regular basis. The normal occlusal teeth shooting cone beam CT (CBCT) and X-ray radiography (RVG), direct application of the measurement of bone density, observe the changes of bone mineral density in root canal treatment after operation two, analysis of the characteristics of the measurement method for clinical root canal therapy and prognosis to provide reference and guidance.
Methods: randomly selected in clinical diagnosis of 35 cases of male patients with chronic periapical periodontitis, 18-40 years of age, with a patient by the same radiologist in the immediate postoperative, 3 months, 6 months, 9 months, 12 months X-ray imaging (RVG) and open surgery in 12 cases 3 months after surgery, 6 months, 9 months, 12 months while filming the cone beam CT (CBCT), and use the software to measure their respective to suffer from apical alveolar bone damage area and the same position control teeth.CBCT bone density measurements: sagittal, coronal and axial tomography. Then according to the thickness 0.25mm, spacing 0.25mm and image selection. Selection of coronary lesions in apical, sagittal plane and the maximum of the documentary, by CBCT software were measured in apical area the largest lesion, lesion diameter between two points on the gray value, the sum of the average gray value, take the control teeth on the jaw The mean value of gray value has the same position and the same position; RVG: the mean value of relative bone mineral density between two points in the lesion area is the same as that in the control area.
Results: 1. Comparison of coronal CBCT measurement results: the experimental group compared with 22 in the different period of time in the group, the difference was statistically significant (P0.01); at the same time, the experimental group (3,6,9 months) compared with the control group, the difference was statistically significant (P0.01); the experimental group was 12 months compared with the control group, the difference was not statistically significant (P0.05).
2, compare the CBCT sagittal measurement results: the experimental group compared with 22 in the different period of time in the group, the difference was statistically significant (P0.01); at the same time, the experimental group (3,6,9 months) compared with the control group, the difference was statistically significant (P0.01); the experimental group was 12 months compared with the control group, the difference was not statistically significant (P0.05).
3, comparison of RVG measurement results: RVG can only do coronal measurements in the experimental group (0,3,6,9 months) compared with group 22, the difference was statistically significant (P0.01); compared to 9,12 months, there was no statistically significant difference (P.0.05); at the same time, the experimental group (0,3,6 months) compared with the control group, the difference was statistically significant (P0.01); the same time within 9,12 months in experimental group compared with control group, the difference was not statistically significant (P0.05).
Conclusion: 1, CBCT and RVG can measure alveolar bone mineral density in the apical area. CBCT can show the coronal and sagittal bone destruction and change in the apical area..RVG can not show sagittal bone destruction and change in the apical area.
2, after the root canal treatment of chronic periapical periodontitis, the bone gradually healed in the damaged area, and the bone mineral density in the lesion area tended to be normal after 9-12 months.
3, CBCT and RVG measurements of bone density are safe, accurate and repeatable methods that can more accurately reflect the changes in the bone mineral density in the apical area.
4, the use of CBCT and RVG combined with image analysis software technology in pulpitis, periapical root canal therapy after operation of bone mineral density monitoring lesion area, has a certain reference value to the curative effect and prognosis of root canal therapy.

【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R781.05

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