本文選題：下頜管 + 牙種植術��； 參考：《南華大學》2012年碩士論文

【摘要】：目的: 本實驗通過對人下頜骨標本解剖和口腔X線計算機斷層掃描（DCT）三維重建測量，研究正常成人下頜骨的解剖特點及下頜管走行規(guī)律，提出預防下牙槽神經(jīng)損傷的方法，擴大牙種植術的適應癥，提高牙種植術的成功率，為臨床牙種植的開展提供可靠的技術保障。 方法： 對28例下頜骨標本灌注下頜管完成后的模型，先測量下頜牙槽突下1cm的厚度，再用牙科打磨機分別從下頜骨頰舌側骨板切割，將下頜管解剖暴露，切割時注意切割線勿低于下頜管在下頜骨頰舌側骨板的相應投影位置。清理松質(zhì)骨，暴露下頜管的密致骨性管道，剝離暴露下頜后牙各個根尖。觀察下頜管的走行位置及其與周圍組織的關系。直接測量下頜管的相關數(shù)據(jù)，每個測量指標均反復測量3次，取其均數(shù)記錄，數(shù)據(jù)分組記錄。對50例健康成年人DCT影像數(shù)據(jù)的三維重建測量在DCT軟件工作站完成，分別對下頜骨頰側板厚、舌側板厚、牙槽突寬、管內(nèi)壁距、管外壁距、管嵴距、管至下頜下緣距、管頰舌徑、管上下徑、下頜后牙區(qū)各牙根尖至下頜管的距離進行測量評價。 結果： 1.下頜骨表層為堅硬的密質(zhì)骨，內(nèi)部為骨松質(zhì)，觀測發(fā)現(xiàn)下頜骨頰側板較為厚實，所測得的各個分區(qū)的厚度均基本在2mm以上，最厚部位骨皮質(zhì)的厚度甚至達4mm以上，這樣可以保證下頜骨能夠承受巨大的咬合力。下頜骨舌側骨板的厚度相對于頰側骨板明顯比較薄弱，尤其是磨牙區(qū)的舌側骨皮質(zhì)非常的薄。下頜骨舌側骨板由A區(qū)的(2.74±0.25)mm向后至H區(qū)(1.42±0.13)mm逐漸變薄。 2.從測量結果可以看出下頜牙槽嵴頂下方10mm處厚度由A區(qū)的(11.90±0.44)mm向后至H區(qū)(14.24±0.53)mm逐漸變厚，但在磨牙后區(qū)向后，厚度呈逐漸減小，頰舌側骨板漸漸貼近。 3.下頜管至下頜骨頰側板的距離較大，，距舌側骨板較近，而且變化十分明顯。在第二前磨牙區(qū)的下頜管距頰、舌側骨板的距離相近，均在5mm左右，但下頜管到頰側骨板的距離向后有逐漸加大的趨勢，到第二磨牙近中距離最大標本為(6.76±0.35)mm，影像為(6.46±0.58)mm，向后又呈現(xiàn)出距離逐漸減小的趨勢。下頜管到舌側骨板的距離卻恰恰相反，隨著向后的走行，下頜管到下頜骨舌側骨板的距離明顯減小，甚至常常有下頜管壁與下頜骨舌側骨板融合在一起，加之下頜骨舌側的骨板很薄，導致下頜管舌側與外界僅僅相隔一薄層骨壁。 4.下頜管上緣至牙槽嵴頂距離，第二前磨牙區(qū)為(17.50±1.63)mm向后到第三磨牙遠中區(qū)(9.58±0.97)mm，呈逐漸減小趨勢。下頜管下緣至下頜骨下緣的距離在第二前磨牙區(qū)為(9.82±1.26)mm，向后到第三磨牙遠中區(qū)(13.52±1.93)mm，呈逐漸增大趨勢。 5.下頜管在磨牙后區(qū)及第三磨牙區(qū)的頰舌徑和上下徑間具有統(tǒng)計學差異，其橫徑和縱徑，亦即下頜管截面形態(tài)為其縱徑略長的橢圓形；在第二磨牙及以前各區(qū)的頰舌徑和上下徑無統(tǒng)計學差異，從所測量標本中觀察此段的下頜管橫斷面接近圓形。 6.雙側磨牙近遠中根尖至下頜管上緣距離，在第三磨牙區(qū)最小為（0.32±0.47）mm，向前走行逐漸變大，至第一磨牙近中根達到測量斷面的最大值（3.29±1.74）mm。 結論： 1.下頜后牙牙種植術中按牙齒正常解剖位置略偏向頰側傾斜操作，可以減少損傷下牙槽神經(jīng)。 2.健康成人下頜后牙區(qū)種植時,為避免種植體損傷或擠壓下頜管，種植體植入牙槽骨的深度控制在13mm以內(nèi)。
[Abstract]:Purpose :

Through three - dimensional reconstruction of human mandible specimen and computed tomography ( DCT ) of oral X - ray computed tomography ( DCT ) , the anatomical features of the mandible of normal adult and the law of mandibular canal walking were studied . The method of preventing nerve injury in inferior alveolar groove was put forward , the success rate of dental implant was improved , and reliable technical guarantee was provided for the clinical tooth implant .

Method :

In order to study the relationship between the mandibular canal and the mandibular canal , the mandibular canal was dissected and exposed . The results of the three - dimensional reconstruction of the mandibular canal were measured repeatedly , and the distance between the inner wall and the lower margin of the tube , the length of the canal , the diameter of the canal , the distance between the root tip and the mandibular canal of the mandibular posterior teeth were measured .

Results :

1 . The surface of the mandible is hard dense bone , the internal bone is cancellous bone , the thickness of each zone measured is more than 2mm , the thickness of the bone cortex of the most thick part is even more than 4mm , so that the mandible can bear great bite force . The thickness of the jaw side bone plate is very weak relative to the buccal bone plate , especially the lingual bone cortex of the molar area is very thin . The mandibular lingual side bone plate is gradually thinned from ( 2.74 鹵 0.25 ) mm in area A to the H area ( 1.42 鹵 0.13 ) mm .

2 . It can be seen from the measurement results that the thickness of 10 mm below the top of the mandibular alveolar ridge is gradually thickened from ( 11.90 鹵 0.44 ) mm in area A to ( 14.24 鹵 0.53 ) mm in H area ( 14.24 鹵 0.53 ) mm .

3 . The distance of the mandibular canal to the buccal side plate of the mandible is larger , and the distance between the mandibular canal and the buccal bone plate is similar to that of the lingual plate . The distance between the mandibular canal and the buccal bone plate is ( 6.76 鹵 0.35 ) mm , the image is ( 6.46 鹵 0.58 ) mm , the distance between the mandibular canal and the lingual bone plate is obviously reduced , and even the mandibular canal is fused together with the mandibular tongue side bone plate , and the bone plate on the lingual side of the mandible is very thin , which leads to the separation of the lingual side of the mandibular canal from the outside by only a thin layer of bone wall .

4 . The distance between the upper margin of the mandibular canal and the alveolar crest was ( 17.50 鹵 1.63 ) mm . The distance between the lower margin of the lower jaw and the lower margin of the mandible was ( 9.82 鹵 1.26 ) mm , and the distance from the lower margin of the lower jaw to the lower margin of the mandible was ( 13.52 鹵 1.93 ) mm , which gradually increased .

5 . There was a statistical difference between the buccal and vertical diameters of the mandibular canal in the posterior and third molar areas of the molar , the lateral diameter and the longitudinal diameter of the mandibular canal , i.e . the shape of the cross section of the mandibular canal was slightly longer than the longitudinal diameter of the mandibular canal ;
There was no statistical difference between the buccal and vertical diameters of the second molar and the previous sections , and the cross section of the lower jaw of this section was observed to be approximately circular from the measured specimen .

6 . The distance from the root tip to the upper margin of the mandibular canal in the proximal part of the two - sided molar , the smallest in the third molar area ( 0.32 鹵 0.47 ) mm , gradually increased to the anterograde line , reaching the maximum value ( 3.29 鹵 1.74 ) mm of the measured section in the proximal middle root of the first molar .

Conclusion :

1 . In the post - mandibular dental implant , the normal anatomic location of the teeth is slightly inclined to the buccal - side tilting operation , so that the inferior alveolar nerve can be reduced .

2 . In order to avoid damage to the implant or to squeeze the mandibular canal , the depth of the alveolar bone was controlled within 13 mm in order to prevent the implant from damaging or squeezing the mandibular canal .
【學位授予單位】：南華大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R783;R322

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