CBCT评价病变上颌窦及种植手术对其的影响
发布时间：2018-08-27 19:37
【摘要】：目的： 上颌后牙缺失且骨量不足时上颌窦是种植手术需要考虑的一个重要解剖结构，但上颌窦常常存在一些变异或者病变，利用CBCT评价种植体植入术后上颌窦变化情况，分析种植手术对上颌窦影响的相关因素。 方法: 采用回顾性的方法，收集2012年1月1日到2013年3月31日在华西口腔医院种植科和南昌大学附属口腔医院种植科就诊的患者，均为上颌后牙缺失要求行种植手术的病例。 结果： 观察期间共有1861位患者上颌后牙缺失要求行种植修复，通过术前常规拍摄CBCT观察发现上颌窦内未见明显异常者793例（42.61%），上颌窦异常者1068例（57.39%），包括：黏膜扁平样增厚763例（40.99%），黏膜息肉样增厚168例（9.03%），钙化72例（3.87%），积液65例（3.49%）。按照纳入标准，，最终共有93位患者的93例上颌窦纳入研究。患者平均年龄53.51±10.75岁，最小年龄19岁，最大年龄69岁。其中男性57例（61.29%），女性36例（38.71%）。随访时间7.05±2.18个月，其中最短3.6个月，最长15.2个月。扁平样增厚有66例，息肉状增厚15例，积液10例，钙化2例。93例种植手术中，无附加提升术且未穿破上颌窦底的有23例（24.73%），无附加提升术但穿破上颌窦底的有7例（7.53%），附加上颌窦内提升的有60例（64.52%），附加上颌窦外提升术同期种植的有1例（1.08%），附加上颌窦外提升术择期种植的有2例（2.15%）。其中，种植术后出现液平面的有9例（9.68%），通过一系列消炎处理随访时液平面消失的有8例。对术前术后共186张CBCT图像进行分析，测量黏膜增厚及上颌窦积液、钙化等改变，其术前平均厚度为5.93mm，而术后厚度为4.72mm，高度明显降低，有统计学意义（P0.05）；女性术后变化明显大于男性（P0.05）；不同的手术方式也存在差异性。术前缺牙区可用骨高度为5.99mm，术后骨高度为8.50mm，其变化有统计学差异(P0.05)（表4）。 结论： 1.通过种植体植入术或（和）上颌窦内/外提升术，上颌窦内病变尺寸会变小，性别和手术方式是主要原因。 2. CBCT作为一种现代准确的评价工具，既能清楚地反映种植术前及术后的上颌窦状况，又能准确指导手术适应症的选择。 3.选择好合理适应症，在熟练轻柔的外科操作下，上颌窦区域存在良性病变时进行种植体植入术是可行的。
[Abstract]:Objective: maxillary sinus is an important anatomical structure to be considered when maxillary posterior teeth are missing and bone mass is insufficient, but maxillary sinus often has some variation or pathological changes. CBCT was used to evaluate the changes of maxillary sinus after implant implantation. Methods: from January 1, 2012 to March 31, 2013, we collected patients from the Department of Implant and the Department of Orthodontics, affiliated to Nanchang University, from January 1, 2012 to March 31, 2013. All cases of maxillary posterior tooth loss required implant operation. Results: a total of 1861 patients with maxillary posterior tooth loss required implant repair during the observation period. According to routine CBCT before operation, 793 cases (42.61%) had no obvious abnormality in maxillary sinus, 1068 cases (57.39%) had abnormal maxillary sinus, including 763 cases (40.99%) with flattened mucosal thickening, 168 cases (9.03%) with mucosal polypoid thickening, 72 cases (3.87%) with calcification and 65 cases (3.49%) with effusion. According to the inclusion criteria, 93 patients with maxillary sinus were included in the study. The average age of the patients was 53.51 卤10.75 years old, the minimum age was 19 years and the maximum age was 69 years old. There were 57 males (61.29%) and 36 females (38.71%). The follow-up time was 7.05 卤2.18 months, of which the shortest was 3.6 months and the longest was 15.2 months. There were 66 cases of flat thickening, 15 cases of polypoid thickening, 10 cases of effusion and 2 cases of calcification. There were 23 cases (24.73%) without additional lifting and without penetrating the floor of maxillary sinus, 7 cases (7.53%) without additional lifting, 60 cases (64.52%) with lifting in maxillary sinus, 1 case (1.08%) with implantation of external lifting of maxillary sinus at the same time. Two cases (2.15%) were implanted with extracantral lifting. Among them, 9 cases (9.68%) had liquid level after implantation, and 8 cases disappeared during follow up by a series of anti-inflammatory treatment. A total of 186 CBCT images were analyzed before and after operation. The changes of mucosal thickening, maxillary sinus effusion and calcification were measured. The mean preoperative thickness was 5.93 mm, but the postoperative thickness was 4.72 mm. The height was significantly decreased (P0.05). The postoperative changes in women were significantly greater than those in men (P0.05), and there were differences in different surgical methods. The available bone height was 5.99mm before operation and 8.50mm postoperatively (P0.05). Conclusion: 1. Through implant implantation or / and maxillary sinus lifting, the size of the lesions in the maxillary sinus becomes smaller, with gender and surgical methods being the main causes. 2. As a modern and accurate evaluation tool, CBCT can not only clearly reflect the maxillary sinus status before and after implantation, but also guide the selection of surgical indications. It is feasible to apply implant implantation in the presence of benign lesions in the maxillary sinus region.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R783.6
本文编号：2208248
[Abstract]:Objective: maxillary sinus is an important anatomical structure to be considered when maxillary posterior teeth are missing and bone mass is insufficient, but maxillary sinus often has some variation or pathological changes. CBCT was used to evaluate the changes of maxillary sinus after implant implantation. Methods: from January 1, 2012 to March 31, 2013, we collected patients from the Department of Implant and the Department of Orthodontics, affiliated to Nanchang University, from January 1, 2012 to March 31, 2013. All cases of maxillary posterior tooth loss required implant operation. Results: a total of 1861 patients with maxillary posterior tooth loss required implant repair during the observation period. According to routine CBCT before operation, 793 cases (42.61%) had no obvious abnormality in maxillary sinus, 1068 cases (57.39%) had abnormal maxillary sinus, including 763 cases (40.99%) with flattened mucosal thickening, 168 cases (9.03%) with mucosal polypoid thickening, 72 cases (3.87%) with calcification and 65 cases (3.49%) with effusion. According to the inclusion criteria, 93 patients with maxillary sinus were included in the study. The average age of the patients was 53.51 卤10.75 years old, the minimum age was 19 years and the maximum age was 69 years old. There were 57 males (61.29%) and 36 females (38.71%). The follow-up time was 7.05 卤2.18 months, of which the shortest was 3.6 months and the longest was 15.2 months. There were 66 cases of flat thickening, 15 cases of polypoid thickening, 10 cases of effusion and 2 cases of calcification. There were 23 cases (24.73%) without additional lifting and without penetrating the floor of maxillary sinus, 7 cases (7.53%) without additional lifting, 60 cases (64.52%) with lifting in maxillary sinus, 1 case (1.08%) with implantation of external lifting of maxillary sinus at the same time. Two cases (2.15%) were implanted with extracantral lifting. Among them, 9 cases (9.68%) had liquid level after implantation, and 8 cases disappeared during follow up by a series of anti-inflammatory treatment. A total of 186 CBCT images were analyzed before and after operation. The changes of mucosal thickening, maxillary sinus effusion and calcification were measured. The mean preoperative thickness was 5.93 mm, but the postoperative thickness was 4.72 mm. The height was significantly decreased (P0.05). The postoperative changes in women were significantly greater than those in men (P0.05), and there were differences in different surgical methods. The available bone height was 5.99mm before operation and 8.50mm postoperatively (P0.05). Conclusion: 1. Through implant implantation or / and maxillary sinus lifting, the size of the lesions in the maxillary sinus becomes smaller, with gender and surgical methods being the main causes. 2. As a modern and accurate evaluation tool, CBCT can not only clearly reflect the maxillary sinus status before and after implantation, but also guide the selection of surgical indications. It is feasible to apply implant implantation in the presence of benign lesions in the maxillary sinus region.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R783.6
【参考文献】
相关期刊论文 前2条
1 仲维剑;陈斌科;马国武;;种植体穿通上颌窦的实验研究[J];中国口腔种植学杂志;2009年02期
2 林野,王兴,邱立新,张伟;上颌窦提升植骨及同期种植体植入术[J];中华口腔医学杂志;1998年06期
本文编号：2208248
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