应用锥形束CT对华南地区1877颗第一磨牙的根管形态学研究

发布时间：2018-05-31 14:32

本文选题：锥形束CT + 第一磨牙　；参考：《南方医科大学》2017年硕士论文

【摘要】：研究背景及目的了解牙根解剖和根管构型是牙髓治疗的关键。第一磨牙是口腔内最早萌出的恒牙,常因龋病大面积缺损、牙髓炎症和根尖周炎症等需要进行根管治疗,而成功的根管治疗包括适当的建立根管通路,化学机械制备和清除感染物质,然后进行根管三维充填,密封根管系统。由此可知,熟悉根管系统的解剖结构是极为重要的,根管构型的任何变异都应在根管治疗之前或期间确认。遗漏根管是导致临床根管治疗失败的重要原因。第一磨牙根管系统复杂,下颌第一磨牙远舌根与上颌第一磨牙近中颊根第二根管(the second mesiobuccal root canal,MB2)的存在以及其根管细小、弯曲、变异程度大、定位困难等特点,均是第一磨牙根管治疗的难点,容易导致根管治疗失败。与体外研究相比,采用锥形束CT(cone-bcam computed tomography,CBCT)观察体内牙齿根管形态的方法更容易获得数据资料和进行分类研究。与临床上常用的X线根尖片、曲而体层摄影和医用用用CT相比,CBCT具有操作简便、放射剂量小、图像分辨率高和三维重建成像等优势;且能通过计算机软件进行分析,并在矢状面、冠状面和横截面同时显示,更适合口腔临床的需求,为临床提供第一手可靠的影像学资料。本研究的目的是观察分析华南地区人群第一磨牙的CBCT图像,统计双侧对称性;牙根数目和根管构型;下颌第一磨牙远舌根的发生率、上颌第一磨牙近中颊根第二根管的发现率;对存在远舌根的下颌第一磨牙进行远舌根管口的定位测量;观察年龄对根管形态的影响,以期对临床牙髓治疗提供有效依据。材料与方法1.预先设计课题,并依据课题需求,自2014.01开始收集在南方医科大学南方医院口腔放射科行CBCT检查的正畸、牙体牙髓、牙种植的患者资料,截止至2015.12共获得累计500名患者(年龄为34.2± 12.8岁)的924颗下颌第一磨牙、588名患者(年龄为45.5± 15.4岁)的953颗上颌第一磨牙CBCT图像数据作为研究对象,均符合下列纳入标准:1.无根尖周病损;2.未进行过牙髓治疗及牙根切除术;3.根尖发育完好,无牙根吸收;4.扫描所得的CBCT图像清晰无伪影;5.祖籍为华南地区,汉族。2.同时由2名经过标准一致性检验合格的高年资牙体牙髓专科医生评价CBCT图像,以获得准确的结果。存在复杂根管解剖或相互咨询后不能获得共识的情况下,要求第三评估者(牙髓病专家)确认根管形态和内部解剖。3.对每位患者的记录内容包括:病历号,姓名,性别,年龄,牙位,是否存在对侧同名牙,牙根数目,根管数目,下颌第一磨牙的近中根管分型、远中根管分型,下颌第一磨牙远舌根存在时远舌根管口与远颊根管口之间的距离,上颌第一磨牙的近颊根管分型,根管钙化情况。采用SPSS 20.0统计软件进行统计学分析。结果1.424名存在双侧下颌第一磨牙的患者中,76.2%根管构型完全对称。924颗下颌第一磨牙中,双根率为76.7%,三根率即远舌根发生率为23.3%;近中根最常见根管类型为Vertucci Ⅳ型,占71.97%,其次为Ⅱ型,占23.70%;远中根最常见根管类型为Ⅰ型,占49.35%,其次为ⅣV型占31.82%。存在远舌根时,远舌根管口与远颊根管口距离为2.94±0.27 mm。下颌第一磨牙根管钙化率与年龄有关,老年人钙化率高,中年人次之。2.365名双侧同时存在上颌第一磨牙的患者中,52.6%根管解剖结构完全对称。953颗上颌第一磨牙中,超过97%有3个独立的牙根,超过99%为三根管或四根管。MB2发现率为68.3%。当存在MB2时,上颌第一磨牙近中颊根最常见的根管构型是Ⅳ型和Ⅱ型。不同年龄组上颌第一磨牙的MB2钙化情况存在统计学差异,60岁以上年龄组MB2钙化率最高为25.5%。结论华南地区人群第一磨牙根管形态多样,变异性较大,下颌第一磨牙的远舌根与上颌第一磨牙的近中颊根第二根管均有较高的检出率;CBCT是观察根管形态的有效工具,可以为根管治疗提供辅助诊断。
[Abstract]:Background and objectives to understand root canal anatomy and root canal configuration is the key to the treatment of dental pulp. First molars are the earliest erupted permanent teeth in the mouth. Root canal therapy is often needed for large area defects, pulp inflammation, and periapical inflammation, and successful root canal therapy includes the proper establishment of the root canal pathway, chemical mechanical preparation and scavenging. It is very important to be familiar with the anatomical structure of the root canal system. Any variation in the root canal configuration should be confirmed before or during the root canal treatment. The missing root canal is the major cause of the failure of the clinical root canal treatment. The existence of the second root canal (the second mesiobuccal root canal, MB2) of the distal and maxillary first molar of the molar and the maxillary first molar, and its root canal is small, curved, variable and difficult to locate. It is the difficult point in the treatment of the root canal of the first molar, which can easily lead to the failure of root canal therapy. Compared with the in vitro study, the cone beam CT (cone-bcam com) is used. Puted tomography, CBCT) the method of observing the root canal morphology of the body is easier to obtain data and classification. Compared with the commonly used X-ray root tip, curved and somatic and medical use CT, CBCT has the advantages of simple operation, small radiation dose, high image resolution and three-dimensional reconstruction imaging, and can be used by computer soft. The purpose of this study was to analyze the CBCT images of the first molar in Southern China area, and to analyze the bilateral symmetry, the number of root and the root canal, the far tongue of the first molar of the mandible. The rate of root occurrence, the detection rate of the second canal in the proximal and middle buccal root of the maxillary first molar; the location measurement of the distal root canal of the mandibular first molar with the far tongue root; observation of the effect of age on the root canal morphology in order to provide an effective basis for the treatment of the clinical dental pulp. Material and method 1. pre design subjects, and according to the needs of the subject, from 2014.01 A total of 924 mandibular first molars with 500 patients (age 34.2 + 12.8 years old) and 953 maxillary first molars of 588 patients (age 45.5 + 15.4 years old) were collected from the orthodontic orthodontic, dental pulp and dental implant data at the Department of Stomatology at the Southern Hospital of Southern Medical University, at the end of 2015.12. The data were collected in the Department of Stomatology of the Department of Stomatology at the Southern Medical University. As a study object, all of the following included criteria: 1. without periapical lesions; 2. unperformed dental pulp therapy and root excision; 3. apex development, no root resorption; 4. scan CBCT images clear without artifact; 5. ancestral nationality is Southern China, Han.2. at the same time by standard consistency test qualified high annual dental pulp Specialist The doctor evaluated the CBCT image to obtain accurate results. In the presence of complex root canal anatomy or mutual consultation, the third assessor (dental pulp disease expert) confirmed that the root canal morphology and internal anatomy of the.3. included the record number, name, sex, age, tooth position, and the existence of a contralateral homonym. The teeth, the number of root, the number of root canal, the subtype of the proximal and middle root canal of the first molar, the distance between the distal root canal, the distance between the distal root canal and the buccal root canal in the first molar of the mandibular first molar, the subtype of the proximal and buccal canal of the maxillary first molar and the calcification of the root canal. The statistical analysis was carried out by the SPSS 20 statistical software. The results were 1.424. Among the patients with bilateral mandibular first molar, the rate of double root was 76.7% and the rate of three roots was 23.3% in the 76.2% mandibular first molar. The most common root canal type in the middle root was Vertucci IV, accounting for 71.97%, followed by type II, accounting for 23.70%. The most common root canal type in the distal root was type I, accounting for 49.35%, followed by the most common root canal type of.924. The rate of calcification of the root canal of 2.94 + 0.27 mm. mandibular first molars in the distance of the distal tongue and the root canal of the distal buccal root canal was related to the age of the distal root canal of 31.82%.. The calcification rate of the elderly was high, and the.2.365 name of the middle aged people had both the maxillary first molar and the 52.6% canal anatomical structure was completely symmetrical in the.953 maxillary first molar. More than 97% had 3 independent roots, more than 99% of the three canal or four tube.MB2 was found to be 68.3%. when there was MB2, the most common root canal configuration of the maxillary first molar was type IV and type II. The MB2 calcification of the maxillary first molar in different age groups was statistically different, and the highest MB2 calcification rate in the age group over 60 years old was 25.5%.. Conclusion the root canal of the first molar of Southern China population is varied and the variation is large. The detection rate of the distal and middle buccal root canal of the first molar of the mandible is higher than that of the maxillary first molar; CBCT is an effective tool to observe the root canal morphology, which can provide auxiliary diagnosis for root canal therapy.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R781.05

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