基于锥体束CT数据的西安地区恒牙列正常合三维颅颌面形态分析

发布时间：2018-04-12 22:36

  本文选题：正常合 + 锥体束CT　； 参考：《第四军医大学》2016年硕士论文

【摘要】：头影测量是口腔临床诊疗工作中的重要辅助手段。在治疗前,可以配合问诊、模型测量和牙颌面照相获得错合畸形的诊断结果,并制定治疗方案;在治疗过程中,可以根据临床需要,通过阶段性头影测量分析,监测错合畸形的变化情况;在治疗结束后,可以对比治疗前后的牙颌面形态变化,观察矫治效果;在矫治结束后的随访阶段,也可观察疗效的稳定或复发情况。随着三维影像技术的发展,锥形束CT(cone beam computed tomography,CBCT)凭借其价格低廉、辐射剂量小、扫描速度快、对硬组织成像效果好等优势,引起越来越多的学者关注。但由于二维和三维头影测量在定点方式及测量指标的确定等方面有诸多差异,目前尚未建立公认的三维头影测量方法。针对上述问题,本实验采用CBCT对颅颌面硬组织三维定点方法和测量指标的确定进行研究,以期初步探索一套三维头影测量分析方法。本研究分为三个部分:第一部分:三维头影测量标志点定位精确性和可靠性的研究目的:研究同一测量者两次定点和不同测量者之间定点的可靠性。方法:随机选取20名正畸患者的头颅CBCT,选取31个常用颅颌面硬组织标志点,使用Invivo Dental5.2软件,采用多平面重建(multi-planer reconstruction,MPR)方法对其进行三维定点。分别对一名测量者的两次定点结果和两名测量者的定点结果的三维坐标值进行组内相关系数(ICC)分析。结果:1.在同一测量者定点结果中:有47.7%(42/88)的坐标值ICC值大于0.99;46.6%(41/88)坐标值ICC值介于0.9-0.99之间;而B点、U1crown_R点、U1labial_R点在X轴上坐标值可信度稍差,Zyg Arch_R点在Y轴上坐标值可信度稍差;Ar_R点在Z轴上坐标值可信度稍差。2.在两名测量者定点结果中:有31.8%(28/88)的坐标值ICC值大于0.99;59.1%(52/88)坐标值ICC值介于0.9-0.99之间;A点、B点、S点、U1crown_R点、U1labial_R点在X轴上坐标值可信度稍差;Zyg Arch_R点在Y轴上坐标值可信度稍差;Ar_L/R点在Z轴上坐标值可信度稍差。结论:1.采用多平面重建定点方法对基于CBCT数据的颅颌面硬组织三维定点具有较高的精确性和稳定性。2.同一测量者定点的稳定性较不同测量者之间更高。第二部分:基于CBCT数据的三维头影测量值与传统二维头影测量值的差异研究目的:分析比较CBCT三维头影测量数据与传统二维头影测量数据的差异方法:招募18-40周岁西安籍汉族青年正常合志愿者20名(男性10名,女性10名),分别拍摄头颅CBCT和头颅定位侧位片,两次拍摄间隔一个月。选取23个测量指标,分别使用Invivo Dental5.2软件和winceph8.0软件进行三维和二维头影测量,由同一操作者分别对三维影像和二维影像各测量两次,两次间隔一周。用SPSS19.0软件对三维测量值和二维测量值分别进行组内相关系数(ICC)分析,并对三维及二维测量值进行配对t检验。结果:1.组内相关系数(ICC)分析结果显示,除二维头影测量中ANB角ICC值小于0.9外,其他测量指标的ICC值,无论二维头影测量还是三维头影测量,均大于0.9;除U1-NA(°)、L1-NB(mm)、Go Gn-SN(°)、FMA(°)、IMPA(°)、Go_R-Pog(mm)外,其余三维头影测量结果ICC值均大于二维头影测量结果。2.三维与二维头影测量值比较结果显示,除U1-NA(mm)外,其余测量值差异均有统计学意义(P0.05)。其中大多数角度值二维大于三维,而线距值则相反。结论:1.二维头影测量与三维头影测量所得测量结果可靠性均较佳;由于绝大多数三维头影测量结果ICC值大于二维头影测量结果,说明大多数三维头影测量指标比二维测量的可重复性更高。2.由于三维与二维头影测量定点方式不同,二者标志点构成的测量指标也不完全一致,其所得测量结果有统计学差异,故传统二维头影测量分析方法不能直接用于三维诊断分析。第三部分:基于CBCT数据的西安地区青年人恒牙列正常合颅颌面硬组织三维形态分析目的:探索一套基于锥体束CT(CBCT)数据的三维头影测量方法,并获得西安地区青年正常合三维颅颌面硬组织测量数据。方法:选取符合个别正常合标准的18-40岁西安籍青年人150名(男性75名,女性75名)拍摄CBCT。选取43个测量项目,用Invivo Dental5.2软件定点测量,测量结果由SPSS19.0统计软件处理。结果:1.线距测量中,除A-NPog(mm)、U1-NA(mm)、L1-NB(mm)、Overjet(mm)外,其余测量值均有统计学差异(P0.05);其中仅Wits(mm)为女性大于男性。2.角度测量值中,U1-SN(°)、U1-NA(°)、U1-L1(°)、FMIA(°)、IMPA(°)、SN-FH(°)、SN-OP(°)、SN-MP(°)、Y-(growth)Axis(°)、Ar-Go-Me R(°)测量值差异有统计学意义(P0.05),其中U1-SN(°)、U1-NA(°)、IMPA(°)、Y-(growth)Axis(°)男性较大。结论:三维头影测量数据显示,男性颅颌面骨骼形态较女性更为宽大;女性下颌角的角度及下颌平面角均较大,下颌垂直向发育更明显。
[Abstract]:Cephalometric measurement is an important adjunct to dental clinic work. Before the treatment, can be matched with the inquiry, model measurement and diagnosis results obtained photographic dentofacial malocclusion, and treatment plan; in the course of treatment, according to clinical needs, through the stages of cephalometric analysis, monitoring changes of malocclusion deformity; after the end of treatment, can change the dentofacial morphology compared before and after treatment, observe the treatment effect; in the follow-up period after the end of treatment, can also observe the effect and stability or recurrence. With the development of three-dimensional imaging technology, cone beam CT (cone beam computed tomography, CBCT) by virtue of its low price, radiation small dosage, fast scanning speed, the imaging effect of hard tissue and other advantages, more and more scholars attention. But because of the two-dimensional and three-dimensional cephalometric in the aspects of the determination and measurement of the index point There are many differences, has yet to establish a three-dimensional cephalometric method recognized. Aiming at the above problems, this experiment adopts research to determine the craniofacial hard tissue of three dimensional fixed point method and the measurement index of CBCT, preliminary exploration of a three-dimensional cephalometric analysis method in order. This research is divided into three parts: the first part: 3D cephalometric point positioning accuracy and reliability of measurement marks Objective: the reliability of the same point between two measuring point and different measurement. Methods: 20 orthodontic patients head CBCT, selected 31 common craniofacial hard tissue landmarks, the use of Invivo Dental5.2 software, using multi planar reconstruction (multi-planer reconstruction, MPR). The methods of 3D point within group correlation value of three-dimensional coordinates of a point were measured two times and two point results of measurement The coefficient (ICC) analysis. Results: 1. in the same measuring point results: 47.7% (42/88) coordinates ICC values greater than 0.99; 46.6% (41/88) ICC value between 0.9-0.99 and B, the values of the coordinates; U1crown_R, U1labial_R coordinates on the X axis value of reliability is poor, Zyg Arch_R the point on the Y axis coordinate value of reliability is poor; Ar_R points on the Z axis value credibility slightly worse.2. in two point measurement results: 31.8% (28/88) coordinates ICC values greater than 0.99; 59.1% (52/88) ICC values between 0.9-0.99 coordinate values; A, B, S at U1crown_R point, U1labial_R point on the X axis coordinate value of reliability is poor; Zyg Arch_R on the Y axis coordinate value of reliability is poor; Ar_L/R points on the Z axis value of credibility is worse. Conclusion: 1. using multiplanar reconstruction method for 3D point point of craniofacial hard tissue based on CBCT data has a high the accuracy and stability of the same.2. The measuring point is between the stability of different measurement is higher. The second part: the three-dimensional cephalometric CBCT data value objective difference research and traditional 2D cephalometric values based on difference method CBCT three-dimensional cephalometric data with the traditional two-dimensional cephalometric data analysis: 18-40 years of recruiting young normal Han nationality in Xi'an with 20 volunteers (10 male, 10 female), were taken by CBCT and lateral cephalograms, two shot interval for a month. We selected 23 indexes, respectively using Invivo Dental5.2 software and winceph8.0 software for 3D and 2D cephalometric, by the same operator of each measuring 3D image and image two times, two times a week. The interval and two-dimensional measurements were the intraclass correlation coefficient for three-dimensional measurements using SPSS19.0 software (ICC) analysis, and the 2D and 3D measurements of The t test results: 1.. The intraclass correlation coefficient (ICC) analysis showed that in addition to two-dimensional cephalometric ANB angle ICC value is less than 0.9, other measures ICC value, both 2D cephalometric and three-dimensional cephalometry were greater than 0.9; except U1-NA (DEG), L1-NB (mm) Go, Gn-SN (DEG), FMA (DEG), IMPA (DEG), Go_R-Pog (mm), the three-dimensional cephalometric results ICC values were greater than 2D cephalometric results.2. 3D and 2D cephalometric comparison results show that the removal of U1-NA (mm), the measured value of the differences were statistically significant (P0.05). Most of the angle value is greater than the two-dimensional and three-dimensional, line distance value is on the contrary. Conclusion: the measurement results of 1. dimensional cephalometric and three-dimensional cephalometric the reliability were good; because the vast majority of three-dimensional cephalometric results ICC value is greater than the two-dimensional cephalometric measurement results, indicating that most three-dimensional cephalometric indexes two dimensional measurement can be used More complex.2. because of different 3D and 2D cephalometric points, two points constitute the measurement index sign is not entirely consistent, the measurement results had significant difference, so the traditional two-dimensional cephalometric analysis method can not be directly used for 3D diagnosis analysis. The third part: young permanent teeth CBCT data in Xi'an objective to analyze the combined normal cranial maxillofacial hard tissue based on three-dimensional morphology: exploring a set based on cone beam CT (CBCT) three-dimensional cephalometric method data, and access to the Xi'an area youth normal 3D craniofacial hard tissue measurement data. Methods: selected individual normal standard 18-40 year old Xi'an's young people 150 (75 male, 75 female) shooting CBCT. selected 43 measurement items, using Invivo Dental5.2 software measurement, the measurement results from the SPSS19.0 statistical software. Results: 1. line distance measurement, except A-NPog (mm), U 1-NA (mm), L1-NB (mm), Overjet (mm), there were significant differences in the measured value (P0.05); Wits (mm) is the only female than male.2. angle measurements, U1-SN (DEG), U1-NA (DEG), U1-L1 (DEG), FMIA (IMPA (degrees). DEG), SN-FH (DEG), SN-OP (DEG), SN-MP (DEG), Y- (growth) Axis (DEG), Ar-Go-Me R (DEG) measurement value of the difference was statistically significant (P0.05), including U1-SN (DEG), U1-NA (DEG), IMPA (DEG), Y- (growth (Axis) the larger male degrees). Conclusion: the three-dimensional cephalometric data show that male skull shape is more generous than women; female mandibular angle and mandibular plane angle were larger, mandibular vertical development is more obvious.

【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R783.5
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本文编号：1741759