运用锥形束CT对下牙槽神经管的测量及临床意义

发布时间：2018-07-06 07:18

  本文选题：锥形束CT + 下牙槽神经管　； 参考：《遵义医学院》2017年硕士论文

【摘要】：目的:运用锥形束CT(CBCT)观测下牙槽神经管在下颌体部的走行及与下颌后牙根尖的位置关系,为牙槽外科尤其是第三磨牙拔除及下颌磨牙区牙种植手术提供影像学数据,降低该区拔牙及种植手术造成下牙槽神经损伤的几率。方法:1、收集2013年11月至2015年11月就诊于遵义医学院附属口腔医院患者下颌骨的CBCT图像。要求图像包含下颌第三磨牙在内的下颌后牙无缺失、无下颌骨肿瘤、骨折等影响测量的因素。经选择后、符合纳入标准的图像共100例(其中男性55例,女性45例,年龄20-55岁)。将图像导入NNT2.0系统软件。2、以双侧下颌第二前磨牙、第一磨牙、第二磨牙、第三磨牙、第二前磨牙与第一前磨牙间牙槽嵴中点、第一磨牙与第二磨牙间牙槽嵴中点共6个位点为测量点;观察颏孔形态及观察下牙槽神经管走形。3、于第二前磨牙、第一磨牙、第二磨牙及第三磨牙4个牙位点处测量下牙槽神经管上缘与牙根尖最低点间距离(L1)、下牙槽神经管外缘与颊侧骨板距离(L2)、下牙槽神经管外缘与舌侧骨板距离(L3)、下牙槽神经管下缘与下颌骨下缘距离(L5)、下牙槽神经管垂直向内径(d);于第二前磨牙与第一前磨牙间、第一磨牙与第二磨牙间两个牙槽嵴中点处增加测量下牙槽神经管上缘与牙槽嵴顶间距离(L4)。4、以牙根尖最低点与下牙槽神经管上缘间距离(DTC)的测量结果,根据DTC2 mm;2 mm≤DTC6 mm;DTC≥6 mm对下颌磨牙根尖与下牙槽神经管的位置关系进行分类。5、测量结果运用SPSS 19.0软件进行统计学分析。结果:共测量100例患者CBCT图像,1200个测量点,观察到200条下牙槽神经管。1、测量过程中发现1例双下牙槽神经管及1例副颏孔。2、颏孔形态为32%为圆形,68%为椭圆形;下牙槽神经管垂直向内径由前向后无明显变化,平均直径为:2.1mm-2.71 mm,且男女间无差异。3、下牙槽神经管大部分在下颌第一磨牙处为垂直向走行最低点;以该点为中心,其近中段及远中段均向牙槽嵴顶靠近,远中段上升幅度大于近中段。在下颌第二前磨牙与第一磨牙间牙槽嵴中点处下牙槽神经管走行由下颌骨颊侧向舌侧转折;以该点为中心,其近中段靠下颌骨颊侧走行、远中段靠下颌骨舌侧走行;测量结果男女间存在明显差异,男性大于女性。4、根据下颌后牙根尖最低点与下牙槽神经管间距离(DTC)测量结果,将牙根尖与下牙槽神经管位置关系分为:Ⅰ类关系(DTC2 mm)出现率为25%;Ⅱ类关系(2 mm≤DTC6 mm)出现率为48.8%;Ⅲ类关系(DTC≥6 mm)出现率为26.3%;其出现率在男女间无明显差异。结论:下颌后牙根尖与下牙槽神经管间位置关系分类中Ⅰ类关系(DTC2 mm)出现率最低,但在影响Ⅰ类关系的牙位点中,第三磨牙及第二磨牙所占比例高,提示临床医生在颏孔后区进行种植手术及牙槽外科手术前需进行准确的术前评估,制定适宜的手术方案以降低下牙槽神经损伤的风险。
[Abstract]:Objective: to observe the movement of the inferior alveolar nerve tube in the mandibular body and its relationship with the root tip of the mandible by conical beam CT (CBCT), so as to provide the imaging data for alveolar surgery, especially for the third molar extraction and the mandibular molar region implant operation. To reduce the probability of lower alveolar nerve injury caused by extraction and implant operation in this area. Methods: from November 2013 to November 2015, the CBCT images of mandible were collected from November 2013 to November 2015 in affiliated Stomatology Hospital of Zunyi Medical College. No loss of mandibular posterior teeth, no mandibular tumor, fracture and other factors affecting measurement were required. After selection, 100 images met the inclusion criteria (55 males and 45 females aged 20-55 years). The images were imported into the NNT2.0 system software. 2. The second premolars, first molars, second molars, third molars, second premolars and interalveolar crest of the first premolars were used as bilateral mandibular premolars. The first molar and the second molar were measured at the middle point of the alveolar crest, the shape of mental foramen and the shape of the inferior alveolar nerve tube were observed, the second premolar, the first molar, the second premolar, the first molar, The distance between the upper edge of the inferior alveolar canal and the lowest point of the root tip (L1), the distance between the outer edge of the inferior alveolar nerve tube and the buccal bone plate (L2), the distance between the outer edge of the inferior alveolar canal and the lingual lateral bone plate (L3), the distance between the inferior alveolar nerve tube and the lingual lateral bone plate (L3), the distance between the outer edge of the inferior alveolar nerve tube and the root tip (L 2) The distance between the inferior edge of the alveolar canal and the lower margin of the mandible (L5) and the vertical inner diameter of the inferior alveolar canal (d); were found between the second premolar and the first premolar. The distance between the upper edge of the inferior alveolar canal and the top of the alveolar crest (L4). 4 was measured at the midpoint of the two alveolar crest between the first molar and the second molar. The distance between the lowest point of the root tip and the superior edge of the alveolar canal (DTC) was measured. According to DTC2mm 鈮，

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