本文選題：錐形束CT + 上頜竇腭側(cè)壁擴(kuò)張　； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過CBCT影像學(xué)資料分析成年人上頜磨牙區(qū)上頜竇腭側(cè)骨壁最小厚度及上頜磨牙缺失位點(diǎn)牙槽突密度、上頜竇腭側(cè)骨壁密度的變化規(guī)律,為臨床治療提供必要的數(shù)據(jù)。對上頜后牙缺失,種植區(qū)骨高度不足且上頜竇腭側(cè)骨壁厚度(Palatal bone thickness,PBT)4mm的病例采用經(jīng)牙槽嵴頂入路上頜竇腭側(cè)壁擠壓、擴(kuò)張?zhí)嵘项M竇底的手術(shù)方式,不植骨同期植入種植體。隨訪觀察影像學(xué)及臨床效果,探討手術(shù)方法的可行性,為臨床治療提供參考。資料與方法:第一部分:選取2015年1月~2016年6月在解放軍第105醫(yī)院口腔科行CBCT檢查的患者,將符合納入標(biāo)準(zhǔn)的CBCT影像資料175份納入統(tǒng)計(jì),共700個(gè)測量位點(diǎn),分析比較上頜磨牙區(qū)上頜竇腭側(cè)骨壁厚度、上頜磨牙區(qū)牙槽突密度及上頜竇腭側(cè)骨壁密度的變化規(guī)律。通過SPSS 17.0軟件對獲得的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,采用兩獨(dú)立樣本t檢驗(yàn)進(jìn)行比較,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。第二部分:選取2014年1月~2015年12月,在解放軍第105醫(yī)院口腔科行上頜后牙種植修復(fù)的患者共24例,術(shù)前獲取患者知情同意,并告知手術(shù)方式及可能出現(xiàn)的并發(fā)癥,采用經(jīng)牙槽嵴頂入路上頜竇腭側(cè)壁擴(kuò)張?zhí)嵘项M竇底,不植骨同期植入種植體的手術(shù)方式,共植入37顆種植體,平均6個(gè)月左右行單冠修復(fù)。術(shù)后6個(gè)月、12個(gè)月隨訪時(shí),通過cbct影像測量種植體根部新骨形成的高度,冠修復(fù)后6個(gè)月、12個(gè)月隨訪時(shí)統(tǒng)計(jì)種植體的存留率。結(jié)果:第一部分:(1)通過對175份符合條件的影像學(xué)資料進(jìn)行統(tǒng)計(jì)分析獲得以下結(jié)果:男性93例,女性82例,最小年齡26歲,最大年齡96歲,平均年齡57.0歲。共700個(gè)測量位點(diǎn),147個(gè)第一磨牙缺失,pbt值為4.438±2.377mm,203個(gè)第一磨牙存留,pbt值為4.961±2.143mm,163個(gè)第二磨牙缺失,pbt值為3.163±1.891mm,187個(gè)第二磨牙存留,pbt值為3.373±1.705mm。第一磨牙缺失位點(diǎn)pbt最大值為10.48mm,最小值為0.81mm;第一磨牙存留位點(diǎn)pbt最大值為10.31mm,最小值為0.87mm;第二磨牙缺失位點(diǎn)pbt最大值為9.21mm,最小值為0.58mm;第二磨牙存留位點(diǎn)pbt最大值為8.64mm,最小值為0.81mm。(2)129個(gè)骨密度測量位點(diǎn),牙槽突密度為372.78±207.49(hounsfield,hu),上頜竇腭側(cè)骨壁密度為516.74±236.60hu。第二部分:術(shù)后6個(gè)月復(fù)診時(shí),37顆種植體均順利完成單冠修復(fù),冠修復(fù)后12個(gè)月復(fù)診時(shí),37顆種植體均能正常行使功能,一年成功率100%。受植區(qū)平均牙槽骨高度為(6.7±0.8)mm,上頜竇底提升高度為(4.2±0.6)mm。上頜竇底種植體周圍有新骨形成,術(shù)后6個(gè)月平均成骨2.1mm,術(shù)后12個(gè)月平均成骨2.3mm。結(jié)論:(1)上頜第一磨牙位點(diǎn)的上頜竇腭側(cè)骨壁厚度和上頜第二磨牙位點(diǎn)的上頜竇腭側(cè)骨壁厚度存在顯著差異,且第一磨牙位點(diǎn)上頜竇腭側(cè)壁厚度大于第二磨牙位點(diǎn)。(2)上頜第一磨牙存留位點(diǎn)的上頜竇腭側(cè)骨壁厚度大于第一磨牙缺失位點(diǎn),差異有統(tǒng)計(jì)學(xué)意義;上頜第二磨牙存留位點(diǎn)和上頜第二磨牙缺失位點(diǎn)的上頜竇腭側(cè)骨壁厚度無顯著性差異。(3)上頜磨牙區(qū)上頜竇腭側(cè)骨壁密度和牙槽突密度存在顯著差異,且上頜竇腭側(cè)骨壁密度大于牙槽突密度。(4)上頜磨牙區(qū)骨密度在55歲以后有明顯降低,男性的上頜磨牙區(qū)牙槽突和上頜竇腭側(cè)骨壁密度均高于女性。(5)上頜后牙區(qū)骨量不足時(shí)采用上頜竇腭側(cè)壁擴(kuò)張?zhí)嵘项M竇底不植骨同期種植的手術(shù)方式是可行的,擠壓至種植體根部的上頜竇腭側(cè)骨壁具有促進(jìn)新骨形成的能力。
[Abstract]:Objective: through the CBCT imaging data of adult maxillary sinus maxillary molars palatal bone wall and the minimum thickness of maxillary molar missing sites of alveolar density changes of palatal bone density in maxillary sinus wall, to provide the necessary data for clinical treatment. The maxillary posterior teeth missing, planting area and insufficient bone height in maxillary sinus palatal bone wall thickness (Palatal bone thickness, PBT 4mm) were treated with the alveolar ridge approach of maxillary sinus palatal wall extrusion, extended lift operation of maxillary sinus, without bone graft implantation. Follow-up imaging and the clinical effect and feasibility of operation methods, to provide reference for clinical treatment. Materials and methods: the first part: from January 2015 ~2016 year in June in the 105th Hospital of PLA Department of Stomatology patients performed CBCT, will meet the inclusion criteria of 175 CBCT image data included in the statistics, a total of 700 measuring sites, Comparative analysis of maxillary molars maxillary palatal bone thickness, changes of alveolar density of maxillary molars and maxillary sinus wall palatal bone density. By using SPSS 17 software for statistical analysis of the data obtained, using two independent sample t test to compare with P0.05, the difference was statistically significant. The second part: in January 2014 ~2015 year in December, in the 105th Hospital of PLA Department of stomatology for maxillary posterior implant patients with a total of 24 cases of preoperative patients obtain informed consent, and inform the operation methods and possible complications, the alveolar crest into the maxillary sinus on palatal wall expansion of maxillary sinus lifting, surgery without bone graft implantation the implants were implanted, 37 implants, an average of 6 months for single crowns. 6 months after surgery, 12 months follow-up, formed by CBCT imaging measurement of new bone implant root height, crown 6 Months, 12 months follow-up statistical implant retention rate. Results: the first part: (1) the 175 meet the conditions of the imaging data were analyzed to obtain the following results: 93 cases were male, 82 were female, the minimum age of 26 years, the maximum age of 96 years old, the average age of 57 years. 700 measurement sites, 147 of the first molar, the value of PBT was 4.438 + 2.377mm, 203 first molar retention, PBT = 4.961 + 2.143mm, 163 and second molar, the value of PBT was 3.163 + 1.891mm, 187 and second molar retention, PBT value is 3.373 + 1.705mm. first molar missing sites of PBT maximum for 10.48mm, the minimum value is 0.81mm; the first molar retention sites of PBT maximum value is 10.31mm, the minimum value is 0.87mm; second molar sites of PBT maximum value is 9.21mm, the minimum value is 0.58mm; second molar retention sites of PBT maximum value is 8.64mm, the minimum value is 0.81mm. (2) 129 bone density measurement sites, Alveolar density was 372.78 + 207.49 (Hounsfield, Hu), maxillary palatal bone wall density was 516.74 + 236.60hu. second part: after 6 months, 37 implants were successfully completed single crown, crown after 12 months of follow-up, 37 implants were the normal exercise of power can one year, the success rate of 100%. by planting area average alveolar bone height (6.7 + 0.8) mm, the maxillary sinus lifting height is (4.2 + 0.6) mm. maxillary sinus implant and new bone formation, 6 months after surgery, the average bone 2.1mm, 12 months after surgery, the average bone 2.3mm. conclusion: (1) there was significant difference between the maxillary palatal bone thickness of the maxillary first molar sites maxillary palatal bone thickness and maxillary second molar sites, and the first molar sites of maxillary sinus palatal side wall thickness is larger than second molar sites. (2) the first maxillary molar retention of maxillary sinus wall thickness of palatal bone sites is greater than the first molar missing Lost sites, the difference was statistically significant; maxillary second molar retention maxillary palatal bone thickness in maxillary second molar sites and deletion were no significant difference. (3) there was significant difference between the maxillary molars maxillary palatal bone density and density of alveolar wall, and maxillary palatal bone density is greater than the alveolar wall density. (4) the bone mineral density decreased significantly in the maxillary molar area after 55 years old, male bone density in maxillary molars and alveolar wall of maxillary sinus palatal were higher than those of females. (5) the lack of posterior maxillary bone when maxillary sinus palatal side wall expansion improvement of maxillary sinus surgery bone graft at the end of the same period the implant is feasible, maxillary palatal bone to implant root wall extrusion has the ability to promote the formation of new bone.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R782.1

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