下颌第一、第二磨牙与神经管相对位置的CBCT影像分析

doi:10.13701/j.cnki.kqyxyj.2024.09.010

摘要/Abstract

摘要： 目的:分析下颌第一、第二磨牙根型分布以及根尖与下颌神经管的相对方位和距离,为牙体牙髓诊疗提供数据支持,指导防范治疗中的下牙槽神经损伤。方法:选取近2年来于武汉大学中南医院口腔科就诊的患者所拍摄的锥形束CT(cone beam computed tomography, CBCT)影像,经过纳入标准筛选,分析CBCT中下颌第一、第二磨牙各类牙根根型的占比,根尖与下颌神经管的相对方位及距离,比较不同性别间和左、右侧间各根尖与下颌神经管相对位置的差异。结果:(1)在整体人群中下颌第二磨牙二根型多于单根型,男性中二根型较多,女性中单根型较多(P<0.001);下颌第一磨牙二根型多于三根型,男、女性之间差异无统计学意义。第一、第二磨牙的根型分布在左、右侧差异均无统计学意义。(2)第二磨牙的牙根主要分布在神经管的正上方,其次为舌侧上方,最少见分布在颊侧上方;第一磨牙近中根及二根型第一磨牙的远中根主要分布在神经管正上方,其次为颊侧上方,最少见分布在舌侧上方;三根型第一磨牙的远颊根主要分布在颊侧上方,其次为正上方;三根型第一磨牙的远舌根主要分布在舌侧上方,少见分布在正上方。二根型第二磨牙的远中根与神经管的相对方位在左、右侧比较有显著差异(P<0.05);二根型第一磨牙的近中根与神经管的相对方位具有性别差异(P<0.01)。(3)下颌第二磨牙比第一磨牙距离神经管更近(P<0.001)。在以下三类下颌磨牙根尖与神经管的距离比较中男性大于女性:二根型第二磨牙的近中根尖(P<0.001)、二根型第二磨牙的远中根尖(P<0.001)、三根型第一磨牙的远颊根尖(P<0.05)。左、右侧下颌磨牙各根尖与神经管的距离差异无统计学意义。结论:下颌第二磨牙比第一磨牙距离神经管更近。下颌磨牙的根型分布及根尖与神经管的距离在部分牙根中存在性别差异,根尖相对神经管的方位在部分牙根中存在男、女性之间与左、右侧之间的差异。

关键词: 下颌神经管, 锥形束CT, 下颌磨牙, 根尖

Abstract: Objective: To analyze the root distribution of the first and second mandibular molars, as well as the relative orientation and distance between the root tip and the mandibular canal. Methods: The cone beam computed tomography (CBCT) images of patients who visited the Department of Stomatology at Zhongnan Hospital of Wuhan University in the past 2 years were selected. After screening with inclusion criteria, the proportion of root types of the first and second molars in CBCT was analyzed, as well as the relative orientation and distance between the root tips and the mandibular canal. The differences in the relative positions between different genders and between the left and right sides were compared. Results: (1) In the overall population, the number of mandibular second molars with two root types was higher than that with single root types, with more two root types in males and more single root types in females (P<0.001). The number of mandibular first molars with two root types was more than that with three root types, and there was no significant difference between genders. There was no significant difference in the root distribution of the first and second molars on the left and right sides. (2) The root of the second molar was mainly located directly above the neural canal, followed by the upper part of the lingual side, and was least commonly distributed above the buccal side. The mesial root of the first molar and the distal root of the two root type first molar were mainly distributed above the neural canal, followed by the upper buccal side, and the least commonly distributed above the lingual side. The distal buccal roots of the three types of first molars were mainly distributed above the buccal side, followed by directly above. The distal lingual roots of the three types of first molars were mainly distributed above the lingual side, and rarely located directly above. There was a significant difference (P<0.05) in the relative orientation of the second molars with two roots in the left and right sides. There was a gender difference (P<0.01) in the relative orientation of the two root type first molar. (3) The second mandibular molar was closer to the mandibular canal than the first molar (P<0.001). In these three types of roots, males got further distance than females: the mesial root tips of second molars with two roots (P<0.001), the distal root tips of second molars with two roots (P<0.001), and the distal buccal root tips of first molars with three roots (P<0.05). There was no statistically significant difference in the distance between left and right sides. Conclusion: The second mandibular molar is closer to the nerve canal than the first molar. There are gender differences in the distribution of root types and the distance between the root tip and the nerve canal in some mandibular molars, and there are differences in the orientation of the root tip relative to the nerve canal between males and females, as well as between the left and right sides in some root types.

Key words: mandibular canal, cone beam CT, mandibular molars, root tip

杨偲偲, 程波, 尹苗, 翁秀红, 杨福华. 下颌第一、第二磨牙与神经管相对位置的CBCT影像分析[J]. 口腔医学研究, 2024, 40(9): 810-815.

YANG Sisi, CHENG Bo, YIN Miao, WENG Xiuhong, YANG Fuhua. CBCT Imaging Analysis of Relative Position between First and Second Mandibular Molars and Mandibular Canal[J]. Journal of Oral Science Research, 2024, 40(9): 810-815.

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