基于锥形束CT的影像学分析上颌前牙根尖区作为自体骨供区的可行性研究

doi:10.13701/j.cnki.kqyxyj.2025.03.007

摘要/Abstract

摘要： 目的: 基于锥形束CT(cone beam computed tomography, CBCT)的影像学分析上颌前牙根尖区作为自体骨供区的可行性研究。方法: 选取2022年9月~2024年7月于我院就诊的158例患者为研究对象,均行CBCT检查,按照牙位将患者分为A组:中切牙组(n=88),B组:侧切牙组(n=70),经1∶1倾向性匹配后,最后两组各包含60例患者,比较两组患者CBCT影像学资料及前牙区的窦管(canalis sinuosus, CS)发生情况进行比较,多因素Logistic回归分析CBCT影像学资料与CS开口直径、分支的关系,采用阈值效应分析CBCT影像学资料与CS发生的关系。结果: 倾向性匹配后两组患者各指标均无显著差异(P>0.05),具有可比性。B组患者唇侧骨高度(H1)、鼻底下方骨宽度(W2)、根尖上方唇侧皮质骨厚度(T1)、鼻底下方皮质骨厚度(T2)大于A组,腭侧骨高度(H2)、根尖上方骨宽度(W1)小于A组,两组之间的差异具有统计学意义(P<0.05)。A组患者CS发生率为13.33%,B组患者CS发生率为33.33%,显著高于A组,两组CS发生率差异具有统计学意义(P<0.05)。B组患者CS管道分支数多于A组,CS开口直径、腭侧CS开口距牙槽嵴顶的距离(CSP)大于A组,鼻底侧CS开口距牙槽嵴顶的距离(CSL)小于A组,两组患者在CS管道分支、CS开口距牙槽嵴顶的距离比较差异具有统计学意义(P<0.05)。CS发生组与未发生组患者在牙位、H1、H2、T1、T2方面比较差异具有统计学意义(P<0.05)。H1、W2、T1、T2是CS管道分支、CSL、CS开口直径的危险因素,是CSP的保护因素。H2、W1是CS管道分支、CSL、CS开口直径的保护因素,是CSP的危险因素。结论: 上颌前牙根尖区可以作为自体骨供区,CS主要发生在侧切牙区,中切牙腭侧开口位置更靠近牙槽嵴顶,在进行取骨时应注意保持安全距离。

关键词: 锥形束CT, 上颌前牙根尖区, 自体骨

Abstract: Objective: To study the feasibility of maxillary anterior root tip region as autologous bone donor region based on cone beam CT. Methods: A total of 158 patients admitted to our hospital from September 2022 to July 2024 were selected as the study objects. All patients underwent CBCT examination. According to tooth position, the patients were divided into group A: central incisor group (n=88) and group B: lateral incisor group (n=70). After 1∶1 orientation matching, the last two groups each contained 60 patients. CBCT parameters and the occurrence of CS were compared between two groups. The relationship between CBCT parameters and CS opening diameter and branches was analyzed by multivariate Logistic regression. Threshold effect was used to analyze the relationship between CBCT parameters and CS occurrence. Results: There were no significant differences in all indexes between two groups after propensity matching (P>0.05), which was comparable. The height of labial bone, the width of infrasasal square bone, the thickness of labial cortical bone above the root tip, and the thickness of infrasasal cortical bone above the root tip in group B were higher than those in group A, and the height of palatine bone and the width above the root tip were lower than those in group A, and the differences between two groups were statistically significant (P<0.05). The incidence of CS was 13.33% in group A and 33.33% in group B, which was significantly higher than that in group A, and the difference in the incidence of CS between two groups was statistically significant (P<0.05). The number of CS pipeline branches in group B was more than that in group A, the diameter of CS opening and the distance between CS opening on the palatal side and alveolar crest were greater than that in group A, and the distance between CS opening on the nasal base and alveolar crest was smaller than that in group A. The differences in CA pipeline branches and CS opening and the distance between two groups were statistically significant (P<0.05). There were statistically significant differences in tooth position, labial bone height, palatine bone height, labial cortical bone thickness above the root tip, and nasal cortex bone thickness between CS developing group and non-developing group (P<0.05). The height of labial bone, the width of subnasal quadrate bone, the thickness of labial cortical bone above the root tip, and the thickness of subnasal cortical bone were risk factors for CS duct branch, the distance of nasal CS opening from alveolar crest and the diameter of CS opening, and were protective factors for the distance of palatal CS opening from alveolar crest. The risk of CS increased with the increase of the height of labial bone, the width of subnasal quadrate bone, the thickness of labial cortical bone above the root tip, and the thickness of subnasal cortical bone. The risk of CS decreased with the increase of palatine bone height and apical bone width. Conclusion: The apical area of maxillary anterior tooth can be used as the bone donor area to satisfy the small and medium bone defects. CS mainly occurs in the lateral incisor, and the palatal opening of the central incisor is closer to the crest of the alveolar ridge. Attention should be given to maintaining a safe distance when bone extraction is performed.

Key words: cone beam computed tomography, apical area of maxillary anterior teeth, autogenous bone

宁伟民, 王峰. 基于锥形束CT的影像学分析上颌前牙根尖区作为自体骨供区的可行性研究[J]. 口腔医学研究, 2025, 41(3): 212-219.

NING Weimin, WANG Feng. Study on Feasibility of Maxillary Anterior Root Tip Region as Autologous Bone Donor Region Based on Cone Beam CT[J]. Journal of Oral Science Research, 2025, 41(3): 212-219.

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