發(fā)布時(shí)間：2018-05-31 14:32

  本文選題：錐形束CT + 第一磨牙�。� 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景及目的了解牙根解剖和根管構(gòu)型是牙髓治療的關(guān)鍵。第一磨牙是口腔內(nèi)最早萌出的恒牙,常因齲病大面積缺損、牙髓炎癥和根尖周炎癥等需要進(jìn)行根管治療,而成功的根管治療包括適當(dāng)?shù)慕⒏芡?化學(xué)機(jī)械制備和清除感染物質(zhì),然后進(jìn)行根管三維充填,密封根管系統(tǒng)。由此可知,熟悉根管系統(tǒng)的解剖結(jié)構(gòu)是極為重要的,根管構(gòu)型的任何變異都應(yīng)在根管治療之前或期間確認(rèn)。遺漏根管是導(dǎo)致臨床根管治療失敗的重要原因。第一磨牙根管系統(tǒng)復(fù)雜,下頜第一磨牙遠(yuǎn)舌根與上頜第一磨牙近中頰根第二根管(the second mesiobuccal root canal,MB2)的存在以及其根管細(xì)小、彎曲、變異程度大、定位困難等特點(diǎn),均是第一磨牙根管治療的難點(diǎn),容易導(dǎo)致根管治療失敗。與體外研究相比,采用錐形束CT(cone-bcam computed tomography,CBCT)觀察體內(nèi)牙齒根管形態(tài)的方法更容易獲得數(shù)據(jù)資料和進(jìn)行分類研究。與臨床上常用的X線根尖片、曲而體層攝影和醫(yī)用用用CT相比,CBCT具有操作簡(jiǎn)便、放射劑量小、圖像分辨率高和三維重建成像等優(yōu)勢(shì);且能通過(guò)計(jì)算機(jī)軟件進(jìn)行分析,并在矢狀面、冠狀面和橫截面同時(shí)顯示,更適合口腔臨床的需求,為臨床提供第一手可靠的影像學(xué)資料。本研究的目的是觀察分析華南地區(qū)人群第一磨牙的CBCT圖像,統(tǒng)計(jì)雙側(cè)對(duì)稱性;牙根數(shù)目和根管構(gòu)型;下頜第一磨牙遠(yuǎn)舌根的發(fā)生率、上頜第一磨牙近中頰根第二根管的發(fā)現(xiàn)率;對(duì)存在遠(yuǎn)舌根的下頜第一磨牙進(jìn)行遠(yuǎn)舌根管口的定位測(cè)量;觀察年齡對(duì)根管形態(tài)的影響,以期對(duì)臨床牙髓治療提供有效依據(jù)。材料與方法1.預(yù)先設(shè)計(jì)課題,并依據(jù)課題需求,自2014.01開(kāi)始收集在南方醫(yī)科大學(xué)南方醫(yī)院口腔放射科行CBCT檢查的正畸、牙體牙髓、牙種植的患者資料,截止至2015.12共獲得累計(jì)500名患者(年齡為34.2± 12.8歲)的924顆下頜第一磨牙、588名患者(年齡為45.5± 15.4歲)的953顆上頜第一磨牙CBCT圖像數(shù)據(jù)作為研究對(duì)象,均符合下列納入標(biāo)準(zhǔn):1.無(wú)根尖周病損;2.未進(jìn)行過(guò)牙髓治療及牙根切除術(shù);3.根尖發(fā)育完好,無(wú)牙根吸收;4.掃描所得的CBCT圖像清晰無(wú)偽影;5.祖籍為華南地區(qū),漢族。2.同時(shí)由2名經(jīng)過(guò)標(biāo)準(zhǔn)一致性檢驗(yàn)合格的高年資牙體牙髓專科醫(yī)生評(píng)價(jià)CBCT圖像,以獲得準(zhǔn)確的結(jié)果。存在復(fù)雜根管解剖或相互咨詢后不能獲得共識(shí)的情況下,要求第三評(píng)估者(牙髓病專家)確認(rèn)根管形態(tài)和內(nèi)部解剖。3.對(duì)每位患者的記錄內(nèi)容包括:病歷號(hào),姓名,性別,年齡,牙位,是否存在對(duì)側(cè)同名牙,牙根數(shù)目,根管數(shù)目,下頜第一磨牙的近中根管分型、遠(yuǎn)中根管分型,下頜第一磨牙遠(yuǎn)舌根存在時(shí)遠(yuǎn)舌根管口與遠(yuǎn)頰根管口之間的距離,上頜第一磨牙的近頰根管分型,根管鈣化情況。采用SPSS 20.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果1.424名存在雙側(cè)下頜第一磨牙的患者中,76.2%根管構(gòu)型完全對(duì)稱。924顆下頜第一磨牙中,雙根率為76.7%,三根率即遠(yuǎn)舌根發(fā)生率為23.3%;近中根最常見(jiàn)根管類型為Vertucci Ⅳ型,占71.97%,其次為Ⅱ型,占23.70%;遠(yuǎn)中根最常見(jiàn)根管類型為Ⅰ型,占49.35%,其次為ⅣV型占31.82%。存在遠(yuǎn)舌根時(shí),遠(yuǎn)舌根管口與遠(yuǎn)頰根管口距離為2.94±0.27 mm。下頜第一磨牙根管鈣化率與年齡有關(guān),老年人鈣化率高,中年人次之。2.365名雙側(cè)同時(shí)存在上頜第一磨牙的患者中,52.6%根管解剖結(jié)構(gòu)完全對(duì)稱。953顆上頜第一磨牙中,超過(guò)97%有3個(gè)獨(dú)立的牙根,超過(guò)99%為三根管或四根管。MB2發(fā)現(xiàn)率為68.3%。當(dāng)存在MB2時(shí),上頜第一磨牙近中頰根最常見(jiàn)的根管構(gòu)型是Ⅳ型和Ⅱ型。不同年齡組上頜第一磨牙的MB2鈣化情況存在統(tǒng)計(jì)學(xué)差異,60歲以上年齡組MB2鈣化率最高為25.5%。結(jié)論華南地區(qū)人群第一磨牙根管形態(tài)多樣,變異性較大,下頜第一磨牙的遠(yuǎn)舌根與上頜第一磨牙的近中頰根第二根管均有較高的檢出率;CBCT是觀察根管形態(tài)的有效工具,可以為根管治療提供輔助診斷。
[Abstract]:Background and objectives to understand root canal anatomy and root canal configuration is the key to the treatment of dental pulp. First molars are the earliest erupted permanent teeth in the mouth. Root canal therapy is often needed for large area defects, pulp inflammation, and periapical inflammation, and successful root canal therapy includes the proper establishment of the root canal pathway, chemical mechanical preparation and scavenging. It is very important to be familiar with the anatomical structure of the root canal system. Any variation in the root canal configuration should be confirmed before or during the root canal treatment. The missing root canal is the major cause of the failure of the clinical root canal treatment. The existence of the second root canal (the second mesiobuccal root canal, MB2) of the distal and maxillary first molar of the molar and the maxillary first molar, and its root canal is small, curved, variable and difficult to locate. It is the difficult point in the treatment of the root canal of the first molar, which can easily lead to the failure of root canal therapy. Compared with the in vitro study, the cone beam CT (cone-bcam com) is used. Puted tomography, CBCT) the method of observing the root canal morphology of the body is easier to obtain data and classification. Compared with the commonly used X-ray root tip, curved and somatic and medical use CT, CBCT has the advantages of simple operation, small radiation dose, high image resolution and three-dimensional reconstruction imaging, and can be used by computer soft. The purpose of this study was to analyze the CBCT images of the first molar in Southern China area, and to analyze the bilateral symmetry, the number of root and the root canal, the far tongue of the first molar of the mandible. The rate of root occurrence, the detection rate of the second canal in the proximal and middle buccal root of the maxillary first molar; the location measurement of the distal root canal of the mandibular first molar with the far tongue root; observation of the effect of age on the root canal morphology in order to provide an effective basis for the treatment of the clinical dental pulp. Material and method 1. pre design subjects, and according to the needs of the subject, from 2014.01 A total of 924 mandibular first molars with 500 patients (age 34.2 + 12.8 years old) and 953 maxillary first molars of 588 patients (age 45.5 + 15.4 years old) were collected from the orthodontic orthodontic, dental pulp and dental implant data at the Department of Stomatology at the Southern Hospital of Southern Medical University, at the end of 2015.12. The data were collected in the Department of Stomatology of the Department of Stomatology at the Southern Medical University. As a study object, all of the following included criteria: 1. without periapical lesions; 2. unperformed dental pulp therapy and root excision; 3. apex development, no root resorption; 4. scan CBCT images clear without artifact; 5. ancestral nationality is Southern China, Han.2. at the same time by standard consistency test qualified high annual dental pulp Specialist The doctor evaluated the CBCT image to obtain accurate results. In the presence of complex root canal anatomy or mutual consultation, the third assessor (dental pulp disease expert) confirmed that the root canal morphology and internal anatomy of the.3. included the record number, name, sex, age, tooth position, and the existence of a contralateral homonym. The teeth, the number of root, the number of root canal, the subtype of the proximal and middle root canal of the first molar, the distance between the distal root canal, the distance between the distal root canal and the buccal root canal in the first molar of the mandibular first molar, the subtype of the proximal and buccal canal of the maxillary first molar and the calcification of the root canal. The statistical analysis was carried out by the SPSS 20 statistical software. The results were 1.424. Among the patients with bilateral mandibular first molar, the rate of double root was 76.7% and the rate of three roots was 23.3% in the 76.2% mandibular first molar. The most common root canal type in the middle root was Vertucci IV, accounting for 71.97%, followed by type II, accounting for 23.70%. The most common root canal type in the distal root was type I, accounting for 49.35%, followed by the most common root canal type of.924. The rate of calcification of the root canal of 2.94 + 0.27 mm. mandibular first molars in the distance of the distal tongue and the root canal of the distal buccal root canal was related to the age of the distal root canal of 31.82%.. The calcification rate of the elderly was high, and the.2.365 name of the middle aged people had both the maxillary first molar and the 52.6% canal anatomical structure was completely symmetrical in the.953 maxillary first molar. More than 97% had 3 independent roots, more than 99% of the three canal or four tube.MB2 was found to be 68.3%. when there was MB2, the most common root canal configuration of the maxillary first molar was type IV and type II. The MB2 calcification of the maxillary first molar in different age groups was statistically different, and the highest MB2 calcification rate in the age group over 60 years old was 25.5%.. Conclusion the root canal of the first molar of Southern China population is varied and the variation is large. The detection rate of the distal and middle buccal root canal of the first molar of the mandible is higher than that of the maxillary first molar; CBCT is an effective tool to observe the root canal morphology, which can provide auxiliary diagnosis for root canal therapy.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R781.05

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相關(guān)期刊論文 前10條

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本文編號(hào)：1960102