本文選題：CBCT　切入點(diǎn)：解剖形態(tài)　出處：《南昌大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景:目前越來越多的患者會(huì)關(guān)注種植治療周期的長(zhǎng)短、創(chuàng)傷的大小及修復(fù)后的美學(xué)效果,現(xiàn)代種植修復(fù)的理念是簡(jiǎn)單化、即時(shí)化、美學(xué)化。這就對(duì)口腔種植技術(shù)提出了更高的要求和挑戰(zhàn),而經(jīng)典的延期種植、延期修復(fù)治療周期長(zhǎng),骨組織的生理性吸收造成骨量的喪失,各種植骨方式給延期種植帶來了更高的難度和軟組織美學(xué)風(fēng)險(xiǎn)。不翻瓣即刻種植是在牙齒拔出后直接將種植體植入。其優(yōu)點(diǎn)是不用翻軟組織瓣,保護(hù)了牙齦組織,保存了牙槽窩的血供,維持了原天然牙的牙齦生物學(xué)和牙齦輪廓的自然形態(tài)及軟硬組織的完整性。減少了患者的損傷和痛苦,縮短了手術(shù)時(shí)間,是患者和醫(yī)生樂于接受的手術(shù)方式[1]。然而,美學(xué)區(qū)什么情況下適合非翻瓣即刻種植和什么情況下適合翻瓣即刻種植并沒有明確的適應(yīng)證劃分。因此,研究上頜中切牙區(qū)牙槽骨的解剖形態(tài),可以對(duì)上頜中切牙區(qū)種植手術(shù)的術(shù)式選擇提供理論依據(jù)。目的:通過CBCT對(duì)上頜中切牙區(qū)牙槽骨的解剖形態(tài)進(jìn)行分類,以期對(duì)臨床醫(yī)生在上頜中切牙區(qū)即刻種植時(shí)選擇更好的治療方案提供理論依據(jù)。方法:選擇2015年10月1號(hào)到31號(hào)在四川大學(xué)華西口腔醫(yī)學(xué)院附屬口腔醫(yī)院放射科拍攝CBCT的110名符合條件患者的CBCT影像資料,男51人,女59人,年齡18-69歲,共110顆左上頜中切牙(左上頜中切牙不符合條件的選取右側(cè)同名牙)。對(duì)每顆牙齒唇側(cè)骨板是否清晰并且連續(xù)做出判斷,并且在最大唇舌徑的矢狀面上對(duì)唇側(cè)最凹點(diǎn)與牙根長(zhǎng)軸的位置關(guān)系做出分類和統(tǒng)計(jì),對(duì)牙根長(zhǎng)軸與腭側(cè)骨板切線的交點(diǎn)和根尖點(diǎn)的位置關(guān)系做出分類和統(tǒng)計(jì),并且對(duì)牙槽嵴頂?shù)膶挾�、根尖方向牙槽骨的高度、最凹點(diǎn)處的牙槽骨寬度以及最凹點(diǎn)到根尖點(diǎn)沿牙根長(zhǎng)軸方向的距離做出測(cè)量并統(tǒng)計(jì)分析,并依據(jù)所得數(shù)據(jù)對(duì)該區(qū)牙槽骨的形態(tài)進(jìn)行分類。結(jié)果:一、牙根長(zhǎng)軸與腭側(cè)骨板切線交點(diǎn)在根尖點(diǎn)切方的約占97.3%,牙根長(zhǎng)軸與腭側(cè)骨壁切線平行的約占2.7%。二、最凹點(diǎn)位于牙根長(zhǎng)軸唇側(cè)的約占45.5%,位于牙根長(zhǎng)軸上的約為35.5%,位于牙根長(zhǎng)軸腭側(cè)的約占19.0%。三、根尖骨高度小于5mm的約占0.05%。四、牙槽嵴頂?shù)膶挾绕骄s為7.5mm。五、最凹點(diǎn)處的牙槽骨寬度平均為10.15mm。六、最凹點(diǎn)距離根尖點(diǎn)大于5mm的約占15.5%。七、唇側(cè)骨板清晰完整的比率約為76.4%。結(jié)論:1、約97.3%的患者在即刻種植時(shí)植體長(zhǎng)軸與原天然牙長(zhǎng)軸一致并偏向腭側(cè)預(yù)備種植床時(shí)不會(huì)從腭側(cè)側(cè)穿,且越向根尖方,植體腭側(cè)的骨壁厚度會(huì)越大。2、牙根長(zhǎng)軸與腭側(cè)骨壁切線平行的病例,應(yīng)在近根尖點(diǎn)處且平行于原牙體長(zhǎng)軸制備,若偏腭側(cè)制備很可能造成腭側(cè)骨壁側(cè)穿。3.根尖骨高度小于5mm的約占0.05%,這點(diǎn)說明絕大多數(shù)病例根尖方向都有獲得初期穩(wěn)定性所需要的骨高度。4、牙槽嵴頂?shù)钠骄鶎挾仍?.5mm左右,這點(diǎn)說明臨床上大多數(shù)病例使用小直徑植體可以滿足唇側(cè)骨壁最小2mm厚度,腭側(cè)骨壁最小1mm厚度的要求。5、本文對(duì)滿足第一點(diǎn)和第二點(diǎn)的上頜中切牙區(qū)的牙槽骨進(jìn)行即刻種植難度的分類,1.唇側(cè)骨壁完整型(76.4%):簡(jiǎn)單型,最凹點(diǎn)A點(diǎn)位于牙根長(zhǎng)軸唇側(cè),適合做非翻瓣即刻種植。風(fēng)險(xiǎn)型:最凹點(diǎn)位于牙根長(zhǎng)軸上,側(cè)穿的風(fēng)險(xiǎn)加大,建議翻瓣做。復(fù)雜型:最凹點(diǎn)位于牙根長(zhǎng)軸腭側(cè),由于植體根部暴露的可能性大大增加,建議翻瓣做,且如果倒凹過深,很可能無法獲得初期穩(wěn)定性,且由于植體根部暴露過多,形成一壁型骨缺損,GBR效果可能會(huì)不好,建議分階段做[2]。2.唇側(cè)骨壁缺損型,因該型需植入骨替代材料并且蓋生物膜,所以需翻開黏骨膜瓣。簡(jiǎn)單型:最凹點(diǎn)位于牙根長(zhǎng)軸唇側(cè),獲得初期穩(wěn)定性及引導(dǎo)骨組織再生的能力都比較強(qiáng),建議同期做。風(fēng)險(xiǎn)型,最凹點(diǎn)位于牙根長(zhǎng)軸上,植體根部可能在唇側(cè)暴露,需做好GBR的準(zhǔn)備。復(fù)雜型,最凹點(diǎn)位于牙根長(zhǎng)軸腭側(cè),植體根部暴露的風(fēng)險(xiǎn)更大,需做好GBR的準(zhǔn)備,而且倒凹過大的病例,獲得初期穩(wěn)定性的能力大大下降,植體根部會(huì)暴露更多,形成一壁型骨缺損,GBR效果可能會(huì)不好,建議分期做。
[Abstract]:Background: at present, more and more patients will pay attention to planting treatment cycle length, size and aesthetic effect of wound repair after the repair, the modern planting concept is simple, real-time, aesthetic. The oral implant technology has put forward higher requirements and challenges, and the classic delayed implant, delayed repair the treatment cycle is long, physiological bone cause bone loss, a variety of bone and soft tissue esthetics brought difficulty higher risk to delayed implant. Flapless immediate implant in the teeth pulled out directly after the implant implantation. Its advantages are not over soft tissue flap, protect the gums the organization, preservation of alveolar blood supply, to maintain the integrity of gingival biology and natural tooth profile of the original gum natural shape and soft tissue. To reduce patients' injury and pain, shorten the operation time, patients and doctors Willing to accept the way of operation [1]. however, what aesthetic area suitable for non flapless immediate implant and what conditions suitable for immediate implant flap and no indications of a clear division. Therefore, a study on anatomy of maxillary incisors in the alveolar bone, can operation on maxillary incisor implant surgery can provide a theoretical basis for the objective: through the classification of the anatomical morphology of CBCT in alveolar bone of maxillary incisor region, in order to provide theoretical basis for clinicians in the maxillary incisor area for immediate implantation treatment better. Methods: from October 1, 2015 to 31, shooting CBCT in the radiology department of Stomatology Hospital of Sichuan University College of Stomatology affiliated with CBCT 110 image data of the condition of the patient, male 51, female 59, age 18-69 years, a total of 110 left maxillary central incisors (left maxillary incisor do not meet the conditions to select the right same name teeth). Make judgments on each of the teeth labial bone plate is clear and continuous, make the classification and statistics of position and the maximum sagittal diameter on the surface of the tongue on the labial root axis and the concave point, make classification and statistical relationship to the location of the root and the long axis of the palatal bone plate and apical tangent intersection points. And the alveolar crest width, height of the apical alveolar bone, make statistical analysis and measurement of the concave point of the alveolar bone width and the concave point to point along the root apical long axis distance, and on the basis of the data of the alveolar morphological classification. Results: first, the long axis and the palatal root lateral plate tangent intersection in the root tip cutting point accounted for about 97.3% of the root and the long axis of the palatal bone wall tangent about 2.7%. two, the concave point is located in the root axis of labial accounted for about 45.5%, is located in the root long axis is about 35.5%, is located in the root axis The palatal accounted for about 19.0%. three, periapical bone height less than 5mm accounted for four 0.05%., the average width of the alveolar ridge is about 7.5mm. five, the concave point of the alveolar bone width is 10.15mm. on average six, the concave point of apical point is more than 5mm accounted for seven 15.5%., the labial bone plate is clear and complete the ratio is about 76.4%. conclusions: 1, about 97.3% of the patients in the immediate implant implant when the long axis and the axis of the teeth is not consistent with the original natural bias of palatal implant bed prepared from palatal side wear, and more to the apical side, bone thickness of palatal implant to be more.2, long axis and palatal root the lateral bone wall tangent parallel cases, should be in the near tip point and parallel to the long axis of the tooth preparation, if partial palatal preparation is likely to cause the palatal bone wall side wear.3. periapical bone height less than 5mm accounted for about 0.05%, this shows that there is bone height.4 initial stability needed by the vast most cases of apical tooth direction. The average width of groove ridge at about 7.5mm, it shows that in most cases the clinical use of small diameter implant can meet the minimum wall thickness of labial bone 2mm, palatal bone wall 1mm minimum thickness requirements of.5, the classification of the incisal alveolar bone to meet the first and the second points of the maxillary in immediate implant difficulty the 1. labial bone wall type (76.4%): the most simple type, concave point A is located in the long axis of the labial root, suitable for non flap implants. The risk type: the concave point is located in the root axis, the risk of side wear increased, suggest flap. The complex: the concave point is located the long axis of the palatal root, the possibility of implant root exposed greatly increased, suggest flap, and if the undercut is too deep, it is unlikely to obtain initial stability, and because the implant roots exposed to too much, the formation of a type of bone defect, GBR may not be good, proposed a phased [2].2. labial The bone wall defect, because the type of bone substitute materials and to cover membrane, so the need to open the mucoperiosteal flap. Simple type: the concave point is located in the long axis of the labial root, ability to obtain the initial stability and guided bone regeneration are relatively strong, suggest that during the same period. The risk type, the concave point is located in the root axis on the implant root may be exposed to the labial side, to prepare the GBR. The complex type, the concave point is located in the long axis of the palatal root, plant roots exposed to greater risk, to prepare the GBR, but also undercut excessive cases, to obtain the initial stability of capacity is greatly decreased, plant root will be exposed to more, forming a type of bone defect, GBR may not be good, recommended staging.

【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R783.6

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相關(guān)期刊論文 前2條

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本文編號(hào)：1570210