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  本文選題：根尖周炎　切入點：根管治療術　出處：《遵義醫(yī)學院》2014年碩士論文

【摘要】：目的：通過在臨床上診斷慢性根尖周炎患牙行根管治療后，術后患牙均完全無疼痛，咬合進食正常。定期對患牙拍攝錐形束CT（CBCT）和X線直視影像術（RVG），應用其測量骨密度，觀察根管治療術后骨密度變化，分析兩種測量方法的特點，為臨床根管治療術預后判斷提供參考和指導。 方法：在臨床上隨機抽取明確診斷患有慢性根尖周炎的男性患者35例，年齡18-40歲，同一個病人由同一影像醫(yī)生在術后即刻、3個月、6個月、9個月、12個月拍攝X線直視影像術（RVG），其中12例于術后3個月、6個月、9個月、12個月同時拍攝錐形束CT（CBCT），并使用各自的軟件測量對患牙根尖區(qū)牙槽骨病損區(qū)和對照牙相同位置測量骨密度。CBCT：進行矢狀、冠狀以及軸位體層掃描，然后根據(jù)層厚0.25mm、間距0.25mm并進行圖像選取。選取患牙根尖病變區(qū)冠狀、矢狀位最大病損面并記錄片號，利用CBCT自帶軟件分別測量根尖區(qū)最大病損面，，病損最大直徑上兩點間的灰度值，將各灰度值相加取均值，對照牙取對頜牙所有相同面相同位置的灰度值均值；RVG：病變區(qū)病損最大直徑上兩點間相對骨密度值均值及對照牙（對頜牙相同位置）兩點之間牙槽骨相對骨密度值均值。 結(jié)果：1、CBCT冠狀位測量結(jié)果的比較：實驗組在不同的時間內(nèi)組內(nèi)兩兩比較，差異具有統(tǒng)計學意義（P0.01）；同一時間內(nèi)實驗組（3、6、9個月）與對照組相比，差異具有統(tǒng)計學意義（P0.01）；實驗組12個月與對照組相比，差異無統(tǒng)計學意義（P0.05）。 2、CBCT矢狀位測量結(jié)果的比較：實驗組在不同的時間內(nèi)組內(nèi)兩兩比較，差異具有統(tǒng)計學意義（P0.01）；同一時間內(nèi)實驗組（3、6、9個月）與對照組相比，差異具有統(tǒng)計學意義（P0.01）；實驗組12個月與對照組相比，差異無統(tǒng)計學意義（P0.05）。 3、RVG測量結(jié)果的比較：RVG僅能做冠狀位測量，實驗組在（0、3、6、9個月）組內(nèi)兩兩比較，差異具有統(tǒng)計學意義（P0.01）；9、12個月相比，差異無統(tǒng)計學意義（P.0.05）；同一時間內(nèi)實驗組（0、3、6個月）與對照組相比，差異具有統(tǒng)計學意義（P0.01）；同一時間內(nèi)實驗組9、12個月與對照組相比，差異無統(tǒng)計學意義（P0.05）。 結(jié)論：1、CBCT和RVG可以測量根尖區(qū)牙槽骨骨密度，CBCT可以顯示根尖區(qū)冠狀位、矢狀位骨質(zhì)破壞及變化情況。RVG不能顯示根尖區(qū)矢狀位骨質(zhì)破壞及變化情況。 2、慢性根尖周炎行根管治療術后，成功病例病損區(qū)骨質(zhì)逐漸愈合，病變區(qū)骨密度一般9-12個月后趨于正常。 3、CBCT和RVG測量骨密度是安全的、準確的、可重復的方法，能更精確反映根尖區(qū)骨密度變化情況。 4、運用CBCT和RVG結(jié)合圖像分析軟件技術在牙髓病、根尖周病根管治療術后進行病損區(qū)骨密度監(jiān)測,對根管治療術的療效及預后判斷具有一定的參考價值。
[Abstract]:Objective: the diagnosis of chronic periapical periodontitis treated by root canal therapy in clinic, postoperative teeth were completely free of pain, eating on a regular basis. The normal occlusal teeth shooting cone beam CT (CBCT) and X-ray radiography (RVG), direct application of the measurement of bone density, observe the changes of bone mineral density in root canal treatment after operation two, analysis of the characteristics of the measurement method for clinical root canal therapy and prognosis to provide reference and guidance.
Methods: randomly selected in clinical diagnosis of 35 cases of male patients with chronic periapical periodontitis, 18-40 years of age, with a patient by the same radiologist in the immediate postoperative, 3 months, 6 months, 9 months, 12 months X-ray imaging (RVG) and open surgery in 12 cases 3 months after surgery, 6 months, 9 months, 12 months while filming the cone beam CT (CBCT), and use the software to measure their respective to suffer from apical alveolar bone damage area and the same position control teeth.CBCT bone density measurements: sagittal, coronal and axial tomography. Then according to the thickness 0.25mm, spacing 0.25mm and image selection. Selection of coronary lesions in apical, sagittal plane and the maximum of the documentary, by CBCT software were measured in apical area the largest lesion, lesion diameter between two points on the gray value, the sum of the average gray value, take the control teeth on the jaw The mean value of gray value has the same position and the same position; RVG: the mean value of relative bone mineral density between two points in the lesion area is the same as that in the control area.
Results: 1. Comparison of coronal CBCT measurement results: the experimental group compared with 22 in the different period of time in the group, the difference was statistically significant (P0.01); at the same time, the experimental group (3,6,9 months) compared with the control group, the difference was statistically significant (P0.01); the experimental group was 12 months compared with the control group, the difference was not statistically significant (P0.05).
2, compare the CBCT sagittal measurement results: the experimental group compared with 22 in the different period of time in the group, the difference was statistically significant (P0.01); at the same time, the experimental group (3,6,9 months) compared with the control group, the difference was statistically significant (P0.01); the experimental group was 12 months compared with the control group, the difference was not statistically significant (P0.05).
3, comparison of RVG measurement results: RVG can only do coronal measurements in the experimental group (0,3,6,9 months) compared with group 22, the difference was statistically significant (P0.01); compared to 9,12 months, there was no statistically significant difference (P.0.05); at the same time, the experimental group (0,3,6 months) compared with the control group, the difference was statistically significant (P0.01); the same time within 9,12 months in experimental group compared with control group, the difference was not statistically significant (P0.05).
Conclusion: 1, CBCT and RVG can measure alveolar bone mineral density in the apical area. CBCT can show the coronal and sagittal bone destruction and change in the apical area..RVG can not show sagittal bone destruction and change in the apical area.
2, after the root canal treatment of chronic periapical periodontitis, the bone gradually healed in the damaged area, and the bone mineral density in the lesion area tended to be normal after 9-12 months.
3, CBCT and RVG measurements of bone density are safe, accurate and repeatable methods that can more accurately reflect the changes in the bone mineral density in the apical area.
4, the use of CBCT and RVG combined with image analysis software technology in pulpitis, periapical root canal therapy after operation of bone mineral density monitoring lesion area, has a certain reference value to the curative effect and prognosis of root canal therapy.

【學位授予單位】：遵義醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R781.05

【參考文獻】

相關期刊論文 前10條

1 曹穎光,凌翔,周彬;上頜種植體邊緣骨吸收的RVG測量分析[J];放射學實踐;2003年06期

2 康寧;宮蘋;;頜骨骨密度的研究進展[J];國際口腔醫(yī)學雜志;2009年03期

3 劉瑞;汪方;張潔;楊慶;王P;王秋根;;定量CT測定骨礦物質(zhì)密度研究進展[J];國際骨科學雜志;2012年04期

4 林梓桐;王鐵梅;林華;葛久禹;吳文蕾;;標準化數(shù)字式曲面體層片檢測牙周炎患者頜骨骨密度的應用評價[J];華西口腔醫(yī)學雜志;2008年01期

5 鄭旭;林久祥;;計算機輔助的牙槽骨密度定量測量系統(tǒng)準確性和靈敏度的研究[J];華西口腔醫(yī)學雜志;2009年03期

6 廖銳;孫苗根;顧亞軍;王仁飛;劉敏;;錐形束CT在頜骨囊腫診治中的臨床應用[J];華西口腔醫(yī)學雜志;2012年03期

7 葛久禹,王鐵梅,韓方凱,陳君;牙科數(shù)字成像系統(tǒng)的特點及臨床應用[J];口腔材料器械雜志;1999年01期

8 邊曉為;馬寧;張莉;車彥海;;PRP/nHA/Co復合材料修復牙周組織缺損的應用研究[J];口腔醫(yī)學研究;2012年02期

9 張燕;秦曉紅;;影響根尖周炎愈合過程中相關因素研究進展[J];臨床口腔醫(yī)學雜志;2010年03期

10 閆征斌;張慧穎;;CBCT與全頜曲面斷層在下頜后牙區(qū)種植術中的診斷價值比較[J];臨床口腔醫(yī)學雜志;2013年02期

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