上颌后牙即刻种植的应用解剖学研究

发布时间：2018-07-05 16:42

本文选题：上颌窦 + 即刻种植　；参考：《南华大学》2014年硕士论文

【摘要】：目的：通过对上颌骨标本的解剖和口腔锥形束CT扫描（CBCT）、三维重建和测量，研究正常成人上颌骨的解剖特点及上颌窦与上颌后牙的关系，为扩大上颌后牙即刻种植的适应症，预防上颌窦底穿孔，提高上颌后牙种植术的成功率，进一步为临床牙种植术等口腔外科手术及口腔解剖的教学提供解剖学依据。材料和方法： 1.完整成人新鲜上颌骨标本16例（32侧），男8例，女8例。将上颌窦上壁打开，观察上颌窦骨间隔的数目及位置；再将上颌窦前壁打开，用牙科打磨机顺着牙长轴方向将上颌后牙（包括前磨牙和磨牙）牙根表面及其之间的牙槽骨磨除，尽可能完全暴露牙根；用游标卡尺测量上颌后牙根尖、牙槽嵴顶和根分叉到上颌窦底的距离以及各牙牙根（根颈、根中及根尖）之间的距离（包括牙槽间隔和牙根间隔）。每个指标均重复测量3次，记录其均数。 2.完整成人新鲜上颌骨标本16例（32侧），，男9例，女7例。将上颌窦上壁打开，观察上颌窦骨间隔的数目及位置；再将上颌窦前壁打开，用牙科打磨机顺着牙长轴方向将上颌后牙从正中剖开。用游标卡尺测量上颌后牙根尖、牙槽嵴顶、根分叉到上颌窦底的距离、各牙牙根(根颈、根中、根尖)表面牙槽骨的厚度及根分叉至颊、腭侧牙槽骨表面的距离。每个指标均重复测量3次，记录其均数。 3.健康成年人CBCT影像数据60例（120侧），男32例，女28例。在CBCT软件工作站对影像数据进行三维重建，测量上颌后牙根尖、牙槽嵴顶及根分叉到上颌窦底的距离、各牙牙根之间的距离（包括牙槽间隔和牙根间隔）、各牙牙根表面牙槽骨的厚度和根分叉至颊、腭侧牙槽骨表面的距离。每个指标均重复测量3次，记录其均数。三维测量所得数据同大体解剖所得数据进行对比。 4.测量结果用SPSS18.0软件计算出均数和标准差，并将左、右侧数据和男、女间数据分别进行配对t检验。结果： 1.超过50%（标本为53.2%，影像为53.4%）的上颌窦未出现骨间隔，若出现以1个（标本为25.0%，影像为20.0%）或2个（标本为18.8%，影像为23.3%）的概率最大，且常出现在上颌窦底的中部（标本为63.6%，影像为61.9%）。 2.上颌后牙中同名牙的牙槽嵴顶至上颌窦底的距离在性别间存在统计学差异，男性大于女性。牙槽嵴顶至上颌窦底的距离从第一前磨牙[标本为男（22.58±3.18）mm，女（20.68±2.55）mm；影像为男（22.19±3.64）mm，女（19.97±2.46）mm]到第一磨牙[标本为男（13.08±4.09）mm，女（11.46±2.50）mm；影像为男（12.69±2.86）mm，女（11.32±2.16）mm]逐渐变小，从第一磨牙到第三磨牙[标本为男（16.98±3.56）mm，女（13.74±3.81）mm；影像为男（16.27±4.02）mm，女（12.99±2.28）mm]又稍有增大。上颌第一磨牙的牙槽嵴顶到上颌窦底的距离最近。 3.同名牙的同名根根尖与上颌窦底部之间的距离在侧别上存在统计学差异，右侧大于左侧。上颌第二前磨牙[标本为左（4.31±0.91）mm，右（4.63±0.89）mm；影像为左（4.28±0.83）mm，右（4.52±0.90）mm]的根尖到上颌窦底的距离较上颌第一前磨牙[标本为左颊根（9.90±1.13）mm，右颊根（10.68±1.15）mm，左腭根（9.96±1.10）mm，右腭根（10.89±1.17）mm；影像为左颊根（9.68±1.07）mm，右颊根（10.58±1.11）mm，左腭根（9.71±0.98）mm，右腭根（10.81±1.12）mm；]近。 4.上颌后牙中以第一磨牙[标本为根颈处近中颊根颊侧（2.46±0.31）mm，远中颊根颊侧（1.36±0.21）mm，腭根腭侧（2.46±0.27）mm；根中处近中颊根颊侧（2.68±0.43）mm，远中颊根颊侧（1.88±0.27）mm，腭根腭侧（2.72±0.45）mm；根尖处近中颊根颊侧（3.12±0.41）mm，远中颊根颊侧（2.22±0.26）mm，腭根腭侧（4.68±0.52）mm。影像为根颈处近中颊根颊侧（2.29±0.34）mm，远中颊根颊侧（1.30±0.20）mm，腭根腭侧（2.39±0.41）mm；根中处近中颊根颊侧（2.60±0.45）mm，远中颊根颊侧（1.81±0.28）mm，腭根腭侧（2.69±0.47）mm；根尖处近中颊根颊侧（3.06±0.39）mm，远中颊根颊侧（2.17±0.23）mm，腭根腭侧（4.59±0.55）mm]牙根表面的牙槽骨厚度最薄，腭侧的牙槽骨较颊侧厚。由根颈到根中，再到根尖，牙根表面的牙槽骨厚度依次增加。 5.上颌后牙之间的牙槽间隔宽度均是腭侧宽于颊侧（第二磨牙与第三磨牙之间除外）。从根颈到根中，再到根尖，牙槽间隔的宽度依次增大。上颌后牙的牙根间隔，以第一磨牙的牙根间隔最大，标本为根颈处近、远中颊根间（2.06±0.30）mm,近中颊、腭根间（3.44±0.56）mm，远中颊、腭根间（4.16±063）mm,影像为近、远中颊根间（2.03±0.29）mm,近中颊、腭根间（3.31±0.55）mm，远中颊、腭根间（4.03±0.62）mm。 6.上颌后牙根分叉处距上颌窦底的距离在9mm以上，且其至腭侧牙槽骨表面的距离较颊侧远。结论： 1.在行上颌后牙即刻种植修复过程中，种植体长度的选择应注意性别间的差异，其深度在男性不能超过13mm，女性不能超过12mm。 2.上颌后牙牙种植术中可将种植体依正常位置稍偏腭侧倾斜。
[Abstract]:Objective:
The anatomical characteristics of the maxillary maxilla and the relationship between maxillary sinus and maxillary posterior teeth were studied by the anatomy of the maxilla and the three-dimensional reconstruction and measurement of the oral cone beam (CBCT), and the maxillary sinus and the maxillary posterior teeth were studied. In order to enlarge the indication of the immediate implant of the maxillary posterior teeth, prevent the perforation of the maxillary sinus, the success rate of the high maxillary posterior teeth implantation was carried out, and the clinical teeth were further developed. To provide anatomical basis for implant surgery, oral surgery and oral anatomy teaching.
Materials and methods:
1. full adult fresh maxillofacial specimens (32 sides), 8 men and 8 women. The upper wall of the maxillary sinus was opened to observe the number and position of the maxillary sinus bone septum, and then the anterior wall of the maxillary sinus was opened and the surface of the maxillary posterior teeth (including the premolar and molar) and the alveolar bone were removed with the dental grinding machine along the long axis. The root tip of the maxillary posterior teeth was measured with a vernier caliper, the distance between the alveolar crest and the root of the maxillary sinus and the distance between the root (the root neck, the root and the root tip) of the teeth (including the alveolar septum and the root septum) were measured with a vernier caliper. Each index was repeated 3 times, and the number was recorded.
2. full adult fresh maxillofacial specimens, 16 cases (32 sides), 9 men and 7 women. The upper wall of the maxillary sinus was opened to observe the number and position of the maxillary sinus bone septum; then the anterior wall of the maxillary sinus was opened and the maxillary posterior teeth were opened with the dental grinding machine along the long axis. The root tip of the upper jaw, the crest of the alveolar ridge and the root were measured with the vernier caliper. The distance of the maxillary sinus floor, the thickness of the alveolar bone on the surface of the root (root neck, root, root), and the distance between the root and the cheek, and the surface of the alveolar bone on the palate. Each index was repeated 3 times, and the number of them was recorded.
3. CBCT image data of 60 healthy adults (120 sides), 32 men and 28 women. The image data were reconstructed at CBCT software workstation, the distance between the root tip of the upper jaw, the distance between the top of the alveolar ridge and the root of the maxillary sinus, the distance between the roots of the teeth (including the alveolar septum and the root septum), and the thickness of the alveolar bone on the root surface of each tooth and the surface of the tooth root. The distance between the root forked to the cheek and the palatine alveolar bone surface. Each index was repeated 3 times, and the numbers were recorded. The data obtained by the three dimensional measurement were compared with the gross anatomical data.
4. the measured results were calculated by means of SPSS18.0 software. The mean and standard deviations were calculated, and the left and right data were paired t test with male and female data.
Result:
1. of the maxillary sinuses that exceed 50% (specimen 53.2%, 53.4%) have no bone septum in the maxillary sinus. If there are 1 (specimen 25%, image 20%) or 2 (specimen 18.8%, and 23.3%), the probability is greatest and often occurs in the middle of the maxillary sinus floor (specimen 63.6%, shadow as 61.9%).
2. the distance between the alveolar crest and maxillary sinus base of the same teeth in the maxillary posterior teeth was statistically different. The male was greater than the female. The distance from the top of the alveolar ridge to the bottom of the maxillary sinus was from the first premolar (22.58 + 3.18) mm and female (20.68 + 2.55) mm; the image was male (22.19 + 3.64) mm and female (19.97 + 2.46) mm] to the first molar [specimen for male (1) 3.08 + 4.09) mm, female (11.46 + 2.50) mm, images of male (12.69 + 2.86) mm, female (11.32 + 2.16) mm] gradually smaller, from first molar to third molar [specimen for male (16.98 + 3.56) mm, female (13.74 + 3.81) mm, image for male (16.27 + mm]) mm, female mm] slightly increased. The distance between the alveolar crest of the maxillary first molar and the maxillary sinus bottom is the most Near.
3. the distance between the root tip of the same name of the same name and the bottom of the maxillary sinus was statistically different, and the right was larger than the left side. The maxillary second premolar was (4.31 + 0.91) mm and right (4.63 + 0.89) mm; the image was left (4.28 + 0.83) mm, and the distance between the right (4.52 + 0.90) mm] and maxillary sinus floor was more than the maxillary first premolar The buccal root (9.90 + 1.13) mm, the right buccal root (10.68 + 1.15) mm, the left palatine root (9.96 + 1.10) mm and the right palatine root (10.89 + 1.17) mm, the image of the left cheek root (9.68 + 1.07) mm, the right buccal root (10.58 + 1.11), the left palatine root (9.71 + 10.68) mm, and the right palatine root (mm) mm;
4. of the maxillary posterior teeth, the first molar was the first molar (2.46 + 0.31) mm at the proximal and middle buccal root of the root neck, the far middle buccal root (1.36 + 0.21) mm, the palatine palatal side (2.46 + 0.27) mm, the proximal bucchechebuccal lateral (2.68 + 0.43) mm in the root, the distal buccal root (1.88 + 0.27) mm, and the palatalpalatopalatine (2.72 + 0.45) mm in the palatine root, and the distal part of the root to the buccheebuccal side of the root (3.12 + 0.27) mm, far middle. The buccal lateral buccal side (2.22 + 0.26) mm, palatalpalatopalatine (4.68 + 0.52) mm. images of the bucchechebuccal lateral root of the root and neck (2.29 + 0.34) mm, far middle buccal root (1.30 + 0.20) mm and palatalpalatopalatine (2.39 + 0.41) mm in the root, and the proximal bucchechebuccal side of the root (2.60 + 0.45) in the root, (1.81 + 0.28) mm, palatalpalatopalatine mm of the palatine root and palatalpalatopalatine side of the palatine, and the buccal side of the middle buccal root in the root apex. 3.06 + 0.39) mm, the buccal lateral buccal side (2.17 + 0.23) mm, the thickness of alveolar bone on the surface of palatine root and palatal side (4.59 + 0.55) mm], the alveolar bone on the palatine side was thicker than the buccal side. The thickness of alveolar bone on the root and root was increased in turn.
5. the width of the alveolar space between the maxillary posterior teeth is the palatine side of the buccal side (except between the second molar and the third molar). From the root to the root and to the root, the width of the alveolar septum increases in turn. The root septum of the maxillary posterior teeth is the largest in the root of the first molar. The standard is the root neck near, the distal and the middle buccal root (2.06 + 0.30) mm, near the middle cheek. Between the palatine root (3.44 + 0.56) mm, far middle cheek and palatine root (4.16 + 063) mm, the image was near, far middle and middle buccal root (2.03 + 0.29) mm, near the middle cheek, palatine root (3.31 + 0.55) mm, far middle cheek, and palatine root (4.03 + 0.62) mm.
6. the distance between the maxillary posterior root and the maxillary sinus is more than 9mm, and the distance from the maxillary posterior sinus to the palatal alveolar bone is far from the buccal side.
Conclusion:
1. during the immediate implant restoration of maxillary posterior teeth, the choice of implant length should pay attention to gender.
The difference is not more than 13mm in men, and 12mm. in women.
2. in the maxillary posterior dental implant, the implant can be slightly tilted to the palatal side in normal position.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R783.6

【参考文献】