本文選題：下頜第一前磨牙　切入點(diǎn)：CBCT　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:牙髓病、根尖周病是口腔科常見(jiàn)病,根管治療(RCT,Root canal treatment)是治療牙髓根尖周病最有效的方法,其原理是根除根管系統(tǒng)中的感染源,杜絕再感染。正確認(rèn)識(shí)根管形態(tài)及其變化才能確保根管治療取得理想的療效。下頜第一前磨牙其根管系統(tǒng)的解剖結(jié)構(gòu)復(fù)雜多變,是根管治療失敗率最高的牙齒。根管治療過(guò)程中有時(shí)會(huì)遺漏根管,導(dǎo)致根管預(yù)備、充填不到位,導(dǎo)致根管治療的失敗。因此,了解下頜第一前磨牙根管系統(tǒng)解剖結(jié)構(gòu)是非常重要的。對(duì)牙齒根管系統(tǒng)的解剖研究可選擇的方法可分為破壞性和非破壞性研究?jī)深?lèi),其區(qū)別是標(biāo)本是否被破壞。離體透明牙法、離體牙切片法、磨片法等是破壞性研究,非破壞性的研究方法有X線(xiàn)片分角投照法、CBCT(Cone-beam computed tomography,錐形束投照計(jì)算機(jī)重組)及顯微CT法。破壞性的方法需要破壞其原有解剖結(jié)構(gòu),運(yùn)用機(jī)械或化學(xué)手段對(duì)標(biāo)本進(jìn)處理,標(biāo)本的處理步驟較復(fù)雜且處理過(guò)程中干擾因素較多,對(duì)根管系統(tǒng)的評(píng)價(jià)不夠全面系統(tǒng),因此目前多采用非破壞性方法進(jìn)行研究。本研究利用CBCT研究分析下頜第一前磨牙根管解剖特征,運(yùn)用Vertucci分類(lèi)法對(duì)下頜第一前磨牙根管結(jié)構(gòu)進(jìn)行分類(lèi),為下頜第一前磨牙疾病的臨床診治提供研究數(shù)據(jù)。方法:選擇自2014年10月至2015年9月期間,因各種病因于山西大醫(yī)院口腔科門(mén)診就診患者的822例下頜第一前磨牙CBCT數(shù)字影像作為研究對(duì)象。納入標(biāo)準(zhǔn)為:(1)無(wú)牙體缺損及齲壞;(2)無(wú)修復(fù)體或充填體;(3)無(wú)根尖周組織病變;(4)牙根發(fā)育已完成;(5)未進(jìn)行根管治療;(6)未發(fā)生牙根內(nèi)、外吸收,無(wú)根管鈣化等變化;(7)CBCT圖像清楚;(8)無(wú)畸形中央尖等特殊結(jié)構(gòu);(9)患者年齡18-50歲,雙側(cè)下頜第一前磨牙均存在且符合上述標(biāo)準(zhǔn)。篩選出CBCT數(shù)字影像498例,共996顆下頜第一前磨牙。記錄患者的姓名、性別、年齡、牙位等信息,連續(xù)性觀察并記錄所有下頜第一前磨牙的CBCT掃描數(shù)據(jù):(1)牙根數(shù)目;(2)牙齒在根管口、根中1/3、及根尖1/3處的根管數(shù)目;(3)雙側(cè)根管的形態(tài)是否對(duì)稱(chēng);(4)根管類(lèi)型。所有需采集的信息均已告知患者,獲得患者本人知情同意。結(jié)果:996顆下頜第一前磨牙中單根牙發(fā)生率為96.48%,雙根牙的檢出率為3.52%。75.20%的牙齒為單根管,其余24.80%為多根管。按照Vertucci分類(lèi)法將根管形態(tài)分為9型,本研究中I型最為多見(jiàn),占75.20%,V型的發(fā)生率僅次于I型,為21.97%,其余各類(lèi)型共計(jì)發(fā)生率2.83%(II型0.56%,III型1.55%,IV型0.42%,VI型0.10%,VII型0.20%)。有10.74%共107顆的牙齒存在根面凹陷,且根面凹陷均位于牙根的近中舌側(cè),其中多根管牙90顆,單根管牙17顆。498例影像資料中,牙根數(shù)目和根管數(shù)目的發(fā)生率在左右側(cè)的差異均無(wú)統(tǒng)計(jì)學(xué)意義,88.55%例左右側(cè)根管類(lèi)型一致。結(jié)論:下頜第一前磨牙多數(shù)只有一個(gè)根管,但多根管的發(fā)生率達(dá)24.80%,其中多數(shù)具有1-2型的解剖特點(diǎn);其牙根常存在位于近中舌側(cè)的根面凹陷,在進(jìn)行根管治療時(shí)應(yīng)注意仔細(xì)探查根管數(shù)目及避免過(guò)度切削根管壁;88.55%的下頜第一前磨牙根管類(lèi)型左右對(duì)稱(chēng),但仍有一部分患者左右側(cè)根管解剖形態(tài)不完全一致,臨床工作中要避免遺漏根管;臨床醫(yī)生要充分認(rèn)識(shí)下頜第一前磨牙根管系統(tǒng)解剖形態(tài)的多樣性,以提高治療的成功率;運(yùn)用CBCT輔助檢查可以幫助確定根管解剖形態(tài)的特點(diǎn),為疑難根管的診斷和治療提供較準(zhǔn)確的信息。
[Abstract]:Objective: to pulpitis and periapical disease is a common disease in Department of Stomatology, root canal treatment (RCT, Root canal treatment) is the most effective method for treating endodontic disease, its principle is to eradicate the root canal infection source in the system, to prevent re infection. Correct understanding of the root canal morphology and change in order to ensure the effect of good roots tube in the treatment of mandibular first premolar. The anatomical structure of the root canal system is complicated, the root canal treatment the highest failure rate. The tooth root canal treatment process can sometimes lead to missing root canals, root canal filling, root canal treatment is not in place, resulting in the failure. Therefore, understanding the mandibular first premolar root canal. The anatomical structure of system is very important. The tooth root canal system anatomy study of alternative methods can be divided into destructive and non destructive study of two types, the difference is whether the specimen was damaged. The isolated transparent tooth teeth, slicing method, grinding method Such destructive research, non destructive research methods of X-ray film with bisecting angle method, CBCT (Cone-beam computed tomography, the cone beam projection computer recombination) and micro CT method. The destructive methods need to destroy the original anatomical structure, the use of mechanical or chemical means into the underlying processing, sample processing steps is complex and many factors interference process, evaluation of the root canal system of the system is not comprehensive, so the current use of non destructive methods. CBCT analysis of mandibular first premolar root canal anatomy features used in this study, using Vertucci classification method to classify the mandibular first premolar root canal structure, provide research data for the diagnosis and treatment of mandibular first premolar disease. Methods: from October 2014 to September 2015, due to various causes in 822 cases of patients with mandibular outpatient department of Stomatology Shanxi hospital 絎竴鍓嶇（鐗機(jī)BCT鏁板瓧褰卞儚浣滀負(fù)鐮旂┒瀵硅薄.綰沖叆鏍囧噯涓，

本文編號(hào)：1568992