下颌骨颏孔前区解剖结构锥形束CT影像学分析及下前牙种植修复病例报告

发布时间：2018-05-04 20:36

本文选题：下颌管前环 + 下颌切牙管　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的本项研究旨在通过锥形束CT(cone beam computed tomography CBCT)图像的测量和分析，对下颌骨颏孔前区颌骨内重要解剖结构的发生率，下颌切牙管前环的长度值，下颌切牙管、下颌舌侧孔、舌侧管等解剖结构的大小、位置、形态、走向进行分析和探讨。并且根据上述实验项目获得的参数评价种植术前通过CBCT分析与测量颏孔前部解剖结构的准确性。同时提出下颌颏孔前区种植相关手术术前应进行的解剖结构测量项目以及手术安全区域。方法本实验共选取了52名于2013年7月至2014年1月之间在大连医科大学附属医院大连市口腔医院的就诊病人（48位为有牙颌或者少数牙缺失的患者，其中男性25名，女性23名，平均年龄40.9岁，年龄跨度在18到68岁之间；4位无牙颌患者，其中男性3名，女性1名，，平均年龄65岁，年龄跨度在56到72岁之间）。CBCT图像通过Examvision软件图像重建之后，由两名口腔专业医师：（1）在CBCT各维重建图像上，观察下颌管前环、下颌切牙管、下颌舌侧管和舌侧孔的发生率；（2）测量下颌管前环长度，双侧下颌切牙管在各牙位上的管径、距根尖、离唇（颊）舌侧骨皮质、距牙槽嵴顶、距下颌下缘的距离；（3）测量下颌舌侧管孔径、舌侧孔距离牙槽嵴顶距离、舌侧孔距离下颌下缘距离，并对上述解剖结构位置、走形等进行分析和描述。采用SPSS19.0统计软件包对结果进行统计分析。结果（1）在CBCT图像上，下颌管前环的发生率为56.7%，其中右侧下颌管前环的发生率为57.7%，左侧下颌管前环发生率为55.8%。舌侧孔、舌侧管的发生率达到了92.3%。52名患者图像上均发现下颌切牙管，切牙管一般终止于下颌尖牙与侧切牙或者侧切牙根尖附近。（2）下颌管前环的平均长度为1.10mm，其中右侧长度平均值为1.14mm，左侧长度平均值为1.07mm。两侧下颌管前环长度差异无显著性（P0.05）；男性下颌管前环长度均值为1.33mm，而女性为0.84mm，两者没有显著性差异（P0.05）；在CBCT图像上，下颌切牙管距离唇（颊）侧骨皮质缘平均值、距舌侧骨皮质缘平均值、距根尖、距牙槽嵴顶均值和距下颌下缘均值分别为：3.5mm、5.36mm、8.00mm、18.51mm和9.85mm；下颌切牙管平均管径（长*宽）分别为：2.47mm*2.33mm。（3）舌管直径平均值为1.76mm，舌侧孔距牙槽嵴顶平均垂直距离为16.87mm，而距离下颌骨下缘的垂直距离均值为12.83mm；48例存在舌侧管的患者中，18例舌侧管终止于颌骨舌1/3（37.5%），28例舌侧管终止于颌骨中1/3（58.3%），而2例舌侧管延伸终止于颊1/3（4.2%）。结论由于下颌神经管前环、下颌切牙管、下颌舌侧孔及舌侧管的解剖结构变异很大，我们建议将CBCT作为下颌颏孔前区种植术以及颏部取骨手术前的常规影像学检查手段，术前必须通过CBCT图像对相应的解剖结构进行观察和分析。在没有CBCT的条件下，可以参考本次研究结果建议在颏孔前区种植手术或者颏部取骨手术时，以双侧颏孔前缘6mm以上，唇侧骨厚度（取骨时）3mm以内为安全界限；而下颌前牙区种植术，建议种植体长度不超过14mm。
[Abstract]:Purpose

The purpose of this study was to analyze and discuss the incidence of important anatomical structures in the anterior region of the mandible , the length of the anterior ring , the length of the anterior ring , the length of the anterior ring , the length of the anterior ring of the lower jaw , the lateral hole of the mandibular lingual canal , the lingual canal , and the accuracy of the anatomy of the anterior part of the chin via CBCT .

method

Fifty - two patients with missing dental or small teeth were selected in Dalian Medical University Affiliated to Dalian Medical University between July 2013 and January 2014 , including 25 males and 23 females , the mean age was 40.9 years , and the age ranged from 18 to 68 years ;
Four non - dental patients ( 3 male , 1 female , average age 65 years , age range between 56 and 72 years ) . After reconstruction of CBCT image through Examvision software image , two oral professionals : ( 1 ) The incidence of anterior and lower mandibular canal , mandibular lingual canal and lingual hole was observed on the reconstructed images of CBCT .
( 2 ) measuring the length of the anterior ring of the mandibular canal , the diameter of the two - sided lower jaw canal at each tooth position , the cortical distance from the root tip and the lingual side of the lip ( cheek ) , and the distance from the top of the alveolar ridge and the lower margin of the lower jaw ;
( 3 ) To measure the diameter of the lingual canal , the distance of the lingual hole from the alveolar crest , the distance between the lingual hole and the lower margin of the lower jaw , and analyze and describe the position and shape of the anatomical structure .

Results

( 1 ) The incidence of anterior ring of mandibular canal was 56.7 % on CBCT image , and the incidence of anterior ring was 57.8 % .
The mean length of the anterior ring of the male mandibular canal was 1.33mm , while the female was 0.84 mm , and there was no significant difference between them ( P0.05 ) .
On CBCT images , the mean value of the cortical margin of the lateral cortical margin of the mandible was 3.5mm , 5.36mm , 8.00mm , 18.51mm and 9.85mm , respectively .
The mean diameter ( length * width ) was 2.47mm * 2.33mm . ( 3 ) The mean diameter of tongue tube was 1.76mm , the average vertical distance of lingual hole was 16.87 mm , while the vertical distance from the lower margin of the mandible was 12.83 mm ;
Of the 48 patients with lingual canal , 18 tongue - side tubes were terminated at 1 / 3 of the jaw ( 37.5 % ) , while 28 tongue - side tubes terminated in 1 / 3 ( 58.3 % ) of the jaw , while in 2 lingual - sided tubes were terminated on buccal 1 / 3 ( 4.2 % ) .

Conclusion

Under the condition of no CBCT , it is suggested that CBCT should be used as the anterior area of the mandibular submental foramen and the conventional imaging examination before the chin removal . In the absence of CBCT , the corresponding anatomical structure must be observed and analyzed by CBCT image .
However , the implant length should not exceed 14 mm .

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R783.6

【参考文献】