CBCT观察拔牙后上颌窦窦底及牙槽嵴的变化

发布时间：2018-06-06 22:43

本文选题：上颌窦 + 拔牙　；参考：《郑州大学》2017年硕士论文

【摘要】：目的应用CBCT观察测量上颌后牙拔除后上颌窦底、牙槽嵴高度、宽度的变化量以及分析不同因素对窦底变化量的影响,以期为临床种植治疗方案的选择提供参考。资料与方法1、研究对象:选取2015年9月至2016年12月来郑州大学口腔医学院(河南省口腔医院)就诊拔除一侧上颌后牙患牙且对侧无缺失的患者64做为研究对象,且术前与术后三个月均拍摄过CBCT的患者,图像清晰完整,按照筛选要求严格纳入样本。2、研究方法:对来郑州大学口腔医院口腔颌面外科要求拔除上颌后牙的患者进行病史询问,口腔检查,并进行记录。对符合要求的患者术前使用美国KaVo3D eXam锥形束X射线影像设备拍摄CBCT影像。所有患者要求三个月后复诊。电脑软件3D eXam上打开被选入研究对象的CBCT影像,对两次拍摄的图像进行校准,在MPR窗口下选定合适的解剖标志点,选定合适基准线,以减小两次影像拍摄带来的误差。先确定测量方法的可行性利用CBCT自带测量软件测量拔牙后及拔牙三个月后上颌窦底、牙槽嵴宽度、牙槽嵴颊侧舌侧相对于基准线发生的改变量。对患者进行性别、年龄、牙根距窦底距离、拔牙原因、窦底黏膜厚度,窦底形态分组,以研究不同症状对窦底气腔化的影响。3、数据处理:统计描述运用均数±标准差表示。应用spss17.0处理数据分析来分析不同情况的上颌窦状态下对窦底气腔化改变的影响。处理方法为t检验与单因素方差分析。本实验所有数据都重复测量三次,取平均值。结果1、测量方法具有可重复性,测量数据具有参考意义2、样本中男34例,女30例。年龄范围22岁~71岁。1、拔牙后窦底会发生气腔化向牙槽嵴顶方向移动,三个月内移动距离(1.46±0.32)mm。2、根据sharan和madjar分类与数据测量分析发现牙根离上颌窦越近拔牙后气腔化发生改变越明显。研究中i型分类三个月改变量(1.11±0.23)mm;研究中ii型分类三个月改变量(1.29±0.25)mm;研究中iii型分类三个月改变量(1.43±0.23)mm;研究中iv型分类三个月改变量(1.68±0.17)mm;研究中v型分类三个月改变量(1.90±0.26)mm。经统计学分析,i类ii类、ii类与iii类、iv类与v类之间窦底改变量没有统计学差异(p0.05),i类与iii类、iv类、v类;ii类与iv类、v类;iii类与iv类、v类之间统计学差异之间差异有统计学意义(p0.05)。对不同年龄段分为以下几组:20~30岁为青年组。30~50岁为中年组。大于50岁人群为老年组。不同年龄人群之间统计学具有差异p0.05,青年人与中年人、老年人之间拔牙后窦底的改变距离统计学上差异具有意义(p0.05)。中年人与老年人差异具有统计学意义,老年人的改变量(1.52±0.29)mm大于中年人(1.33±0.27)mm,改变量最大的是青年人(1.91±0.22)mm。4、正畸治疗、根尖周炎、牙周炎、根折、残根导致的拔牙对窦底气腔化移动距离影响没有差异(p0.05)。窦底黏膜正常组与窦底黏膜增厚组对窦底气腔化移动距离影响没有差异(p0.05)。增厚组窦底改变距离(1.42±0.32)mm,窦底黏膜正常组(1.51±0.31)mm。实验对窦底形态进行了分类,凹型窦底改变距离为(1.58±0.27)mm、平坦型为(1.48±0.26)mm、凸型为(1.19±0.35)mm。凹型窦底气腔化更容易发生,凸型的改变量最小。窦底形态的不同对窦底距离改变影响具有统计学差异(p0.05),两两之间统计学也具有差异性(p0.05)。5、拔牙后牙槽嵴的宽度减小,选定的样本中初始宽度为(13.15±1.61)mm,拔牙后三个月后为(11.38±1.63)mm;改变量具有统计学意义(P0.05)。牙槽嵴颊舌侧高度在拔牙后都会发生吸收,颊侧吸收量为:(1.46±0.33)mm,舌侧改变量为:(0.86±0.30)mm。颊侧改变量大于舌侧的改变量,在统计学具有意义(P0.05)。结论1.CBCT可以对骨改变量测量进行精确测量,本实验选定的测量方法具有可重复性、可信度较好,研究数据具有可对比性。2.拔牙后上颌窦底向牙槽嵴方向发生了改建。3.年轻患者拔牙后窦底改建较中年、老年人改变量大,老年人较中年人改变量大。患者性别差异对窦底的改建变化量无影响。4.牙根距窦底距离越近,拔除后窦底越容易发生改建;后牙拔除原因及窦底黏膜厚度的不同对窦底改建影响无差异性。5.凹型窦底气腔化更容易发生,平坦型居中,凸型的改变量最小。6.拔牙后牙槽嵴宽度明显变窄,牙槽嵴的颊侧吸收量大于舌侧改变量。
[Abstract]:Objective CBCT observation was used to observe the maxillary sinus floor, the height of the alveolar ridge, the variation of the width of the alveolar ridge, and the influence of different factors on the change of the sinus base, so as to provide reference for the selection of the clinical planting treatment. 1, the object of study: from September 2015 to December 2016, Zhengzhou University Stomatology Hospital (River) South provincial oral hospital) to remove one side of the maxillary posterior teeth and the side of the patients with no missing teeth 64 as the research object, and the preoperative and three months after the operation were taken CBCT patients, the image is clear and complete, according to the screening requirements strictly included in the sample.2, research methods: to the oral and maxillofacial surgery in Zhengzhou University oral hospital to remove the maxillary posterior teeth The patients underwent medical history inquiry, oral examination, and recorded. CBCT images were taken by the American KaVo3D eXam cone beam X ray imaging equipment before operation. All patients were asked to revisit three months later. The computer software 3D eXam opened the CBCT image of the selected subjects, calibrated the two shot images, in MPR Select the appropriate anatomical mark points under the window, select the appropriate reference line to reduce the error caused by the two images. First determine the feasibility of the measurement method and use the CBCT self tape measurement software to measure the maxillary sinus base, the width of the alveolar ridge, the buccal side of the alveolar ridge relative to the base line after three months of extraction and tooth extraction. Sex, age, distance from the root of the teeth to the sinus base, tooth extraction, the thickness of the sinus floor, and the morphology of the sinus base were grouped to study the effect of different symptoms on the antral gas cavity.3. Data processing: statistical description was expressed using mean mean difference of standard deviation. SPSS17.0 processing data analysis was used to analyze the antral sinus cavity change in different cases of maxillary sinus. The treatment method was t test and single factor analysis of variance. All the data were repeated three times and averaging. Results 1, the measurement method was repeatable, the measurement data had reference significance 2, male 34 cases and 30 women in 30 cases. The age range was 22 years old, ~71 years old, and the bottom of the sinus would move to the top of the alveolar ridge after the tooth extraction. The moving distance (1.46 + 0.32) mm.2 within three months. According to the Sharan and Madjar classification and data measurement analysis, the more obvious the gas cavity changes after the tooth root extraction from the maxillary sinus. The I type classification was three months (1.11 + 0.23) mm, and the II type was modified for three months (1.29 + 0.25) mm in the study, and the III classification was changed for three months in the study. The variable (1.43 + 0.23) mm; IV classification for three months in the study (1.68 + 0.17) mm; V classification for three months (1.90 +. 0.26) mm. by statistical analysis, I class II, II and III, IV and V, there is no statistical difference (P0.05). The differences in statistical differences were statistically significant (P0.05). The different age groups were divided into the following groups: 20~30 years old was a middle-aged group of.30~50 years old. The older group was older than 50 years old. There was a difference between the age group and the age group. The difference between the young and the middle-aged was P0.05, the distance between the young and the middle-aged was statistically poor. The difference was significant (P0.05). The difference between the middle-aged and the elderly was statistically significant, the change of the elderly (1.52 + 0.29) mm was greater than that of the middle-aged (1.33 + 0.27) mm, and the largest change was in the young people (1.91 + 0.22) mm.4. There was no difference in the effect of orthodontic treatment, periapical periodontitis, periodontitis, root fracture and residual root extraction on the sinus movement distance (P0 .05). There was no difference between the normal group of sinus floor and the thickening group of the sinus base mucous membrane (P0.05). The thickness of the sinus floor was (1.42 + 0.32) mm, and the normal group (1.51 + 0.31) mm. experiment on the sinus floor was classified. The distance of the sinus floor was (1.58 + 0.27) mm, the flat type was (1.48 + 0.26) mm, and the convex type was (1.19 + 0.35) mm. fovea sinus cavity was easier to occur, and the change of convex type was the smallest. The difference of sinus base shape had statistical difference (P0.05), 22 was statistically different (P0.05).5, the width of alveolar ridge after extraction was reduced, the initial width of selected samples was (13.15 + 1.61) mm, and three after tooth extraction. The change volume was statistically significant (11.38 + 1.63) mm after a month (P0.05). The height of the buccal and lingual side of the alveolar ridge was absorbed after the extraction, the amount of the buccal absorption was (1.46 + 0.33) mm, the change of the tongue side was (0.86 + 0.30) mm. and the change of the cheek side was greater than the change of the tongue side, and was significant (P0.05). Conclusion 1.CBCT can measure the bone change. The measured method is repeatable and reliable, the study data has a good reliability, the research data has the contrast.2. after the extraction of the maxillary sinus bottom to the alveolar ridge direction,.3. young patients are rebuilt in the middle of the middle age after the extraction of the teeth, the old people change a lot, the elderly people have a large change in the middle age. The change of the sinus floor had no effect on the distance between the.4. root and the sinus base, the more easily the sinus floor was rebuilt. The causes of the extraction of the posterior teeth and the thickness of the sinus base had no difference on the reconstruction of the sinus floor. The indifference of the.5. concave sinus was easier to occur, the flat type was in the middle, and the minimum of the convex type was changed, the width of the alveolar ridge was obviously changed after the extraction of.6.. The amount of buccal absorption of alveolar ridge was larger than that of lingual side.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.11

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