本文選題：上頜竇 + 拔牙　； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的應(yīng)用CBCT觀察測量上頜后牙拔除后上頜竇底、牙槽嵴高度、寬度的變化量以及分析不同因素對竇底變化量的影響,以期為臨床種植治療方案的選擇提供參考。資料與方法1、研究對象:選取2015年9月至2016年12月來鄭州大學(xué)口腔醫(yī)學(xué)院(河南省口腔醫(yī)院)就診拔除一側(cè)上頜后牙患牙且對側(cè)無缺失的患者64做為研究對象,且術(shù)前與術(shù)后三個月均拍攝過CBCT的患者,圖像清晰完整,按照篩選要求嚴(yán)格納入樣本。2、研究方法:對來鄭州大學(xué)口腔醫(yī)院口腔頜面外科要求拔除上頜后牙的患者進(jìn)行病史詢問,口腔檢查,并進(jìn)行記錄。對符合要求的患者術(shù)前使用美國KaVo3D eXam錐形束X射線影像設(shè)備拍攝CBCT影像。所有患者要求三個月后復(fù)診。電腦軟件3D eXam上打開被選入研究對象的CBCT影像,對兩次拍攝的圖像進(jìn)行校準(zhǔn),在MPR窗口下選定合適的解剖標(biāo)志點,選定合適基準(zhǔn)線,以減小兩次影像拍攝帶來的誤差。先確定測量方法的可行性利用CBCT自帶測量軟件測量拔牙后及拔牙三個月后上頜竇底、牙槽嵴寬度、牙槽嵴頰側(cè)舌側(cè)相對于基準(zhǔn)線發(fā)生的改變量。對患者進(jìn)行性別、年齡、牙根距竇底距離、拔牙原因、竇底黏膜厚度,竇底形態(tài)分組,以研究不同癥狀對竇底氣腔化的影響。3、數(shù)據(jù)處理:統(tǒng)計描述運用均數(shù)±標(biāo)準(zhǔn)差表示。應(yīng)用spss17.0處理數(shù)據(jù)分析來分析不同情況的上頜竇狀態(tài)下對竇底氣腔化改變的影響。處理方法為t檢驗與單因素方差分析。本實驗所有數(shù)據(jù)都重復(fù)測量三次,取平均值。結(jié)果1、測量方法具有可重復(fù)性,測量數(shù)據(jù)具有參考意義2、樣本中男34例,女30例。年齡范圍22歲~71歲。1、拔牙后竇底會發(fā)生氣腔化向牙槽嵴頂方向移動,三個月內(nèi)移動距離(1.46±0.32)mm。2、根據(jù)sharan和madjar分類與數(shù)據(jù)測量分析發(fā)現(xiàn)牙根離上頜竇越近拔牙后氣腔化發(fā)生改變越明顯。研究中i型分類三個月改變量(1.11±0.23)mm;研究中ii型分類三個月改變量(1.29±0.25)mm;研究中iii型分類三個月改變量(1.43±0.23)mm;研究中iv型分類三個月改變量(1.68±0.17)mm;研究中v型分類三個月改變量(1.90±0.26)mm。經(jīng)統(tǒng)計學(xué)分析,i類ii類、ii類與iii類、iv類與v類之間竇底改變量沒有統(tǒng)計學(xué)差異(p0.05),i類與iii類、iv類、v類;ii類與iv類、v類;iii類與iv類、v類之間統(tǒng)計學(xué)差異之間差異有統(tǒng)計學(xué)意義(p0.05)。對不同年齡段分為以下幾組:20~30歲為青年組。30~50歲為中年組。大于50歲人群為老年組。不同年齡人群之間統(tǒng)計學(xué)具有差異p0.05,青年人與中年人、老年人之間拔牙后竇底的改變距離統(tǒng)計學(xué)上差異具有意義(p0.05)。中年人與老年人差異具有統(tǒng)計學(xué)意義,老年人的改變量(1.52±0.29)mm大于中年人(1.33±0.27)mm,改變量最大的是青年人(1.91±0.22)mm。4、正畸治療、根尖周炎、牙周炎、根折、殘根導(dǎo)致的拔牙對竇底氣腔化移動距離影響沒有差異(p0.05)。竇底黏膜正常組與竇底黏膜增厚組對竇底氣腔化移動距離影響沒有差異(p0.05)。增厚組竇底改變距離(1.42±0.32)mm,竇底黏膜正常組(1.51±0.31)mm。實驗對竇底形態(tài)進(jìn)行了分類,凹型竇底改變距離為(1.58±0.27)mm、平坦型為(1.48±0.26)mm、凸型為(1.19±0.35)mm。凹型竇底氣腔化更容易發(fā)生,凸型的改變量最小。竇底形態(tài)的不同對竇底距離改變影響具有統(tǒng)計學(xué)差異(p0.05),兩兩之間統(tǒng)計學(xué)也具有差異性(p0.05)。5、拔牙后牙槽嵴的寬度減小,選定的樣本中初始寬度為(13.15±1.61)mm,拔牙后三個月后為(11.38±1.63)mm;改變量具有統(tǒng)計學(xué)意義(P0.05)。牙槽嵴頰舌側(cè)高度在拔牙后都會發(fā)生吸收,頰側(cè)吸收量為:(1.46±0.33)mm,舌側(cè)改變量為:(0.86±0.30)mm。頰側(cè)改變量大于舌側(cè)的改變量,在統(tǒng)計學(xué)具有意義(P0.05)。結(jié)論1.CBCT可以對骨改變量測量進(jìn)行精確測量,本實驗選定的測量方法具有可重復(fù)性、可信度較好,研究數(shù)據(jù)具有可對比性。2.拔牙后上頜竇底向牙槽嵴方向發(fā)生了改建。3.年輕患者拔牙后竇底改建較中年、老年人改變量大,老年人較中年人改變量大。患者性別差異對竇底的改建變化量無影響。4.牙根距竇底距離越近,拔除后竇底越容易發(fā)生改建;后牙拔除原因及竇底黏膜厚度的不同對竇底改建影響無差異性。5.凹型竇底氣腔化更容易發(fā)生,平坦型居中,凸型的改變量最小。6.拔牙后牙槽嵴寬度明顯變窄,牙槽嵴的頰側(cè)吸收量大于舌側(cè)改變量。
[Abstract]:Objective CBCT observation was used to observe the maxillary sinus floor, the height of the alveolar ridge, the variation of the width of the alveolar ridge, and the influence of different factors on the change of the sinus base, so as to provide reference for the selection of the clinical planting treatment. 1, the object of study: from September 2015 to December 2016, Zhengzhou University Stomatology Hospital (River) South provincial oral hospital) to remove one side of the maxillary posterior teeth and the side of the patients with no missing teeth 64 as the research object, and the preoperative and three months after the operation were taken CBCT patients, the image is clear and complete, according to the screening requirements strictly included in the sample.2, research methods: to the oral and maxillofacial surgery in Zhengzhou University oral hospital to remove the maxillary posterior teeth The patients underwent medical history inquiry, oral examination, and recorded. CBCT images were taken by the American KaVo3D eXam cone beam X ray imaging equipment before operation. All patients were asked to revisit three months later. The computer software 3D eXam opened the CBCT image of the selected subjects, calibrated the two shot images, in MPR Select the appropriate anatomical mark points under the window, select the appropriate reference line to reduce the error caused by the two images. First determine the feasibility of the measurement method and use the CBCT self tape measurement software to measure the maxillary sinus base, the width of the alveolar ridge, the buccal side of the alveolar ridge relative to the base line after three months of extraction and tooth extraction. Sex, age, distance from the root of the teeth to the sinus base, tooth extraction, the thickness of the sinus floor, and the morphology of the sinus base were grouped to study the effect of different symptoms on the antral gas cavity.3. Data processing: statistical description was expressed using mean mean difference of standard deviation. SPSS17.0 processing data analysis was used to analyze the antral sinus cavity change in different cases of maxillary sinus. The treatment method was t test and single factor analysis of variance. All the data were repeated three times and averaging. Results 1, the measurement method was repeatable, the measurement data had reference significance 2, male 34 cases and 30 women in 30 cases. The age range was 22 years old, ~71 years old, and the bottom of the sinus would move to the top of the alveolar ridge after the tooth extraction. The moving distance (1.46 + 0.32) mm.2 within three months. According to the Sharan and Madjar classification and data measurement analysis, the more obvious the gas cavity changes after the tooth root extraction from the maxillary sinus. The I type classification was three months (1.11 + 0.23) mm, and the II type was modified for three months (1.29 + 0.25) mm in the study, and the III classification was changed for three months in the study. The variable (1.43 + 0.23) mm; IV classification for three months in the study (1.68 + 0.17) mm; V classification for three months (1.90 +. 0.26) mm. by statistical analysis, I class II, II and III, IV and V, there is no statistical difference (P0.05). The differences in statistical differences were statistically significant (P0.05). The different age groups were divided into the following groups: 20~30 years old was a middle-aged group of.30~50 years old. The older group was older than 50 years old. There was a difference between the age group and the age group. The difference between the young and the middle-aged was P0.05, the distance between the young and the middle-aged was statistically poor. The difference was significant (P0.05). The difference between the middle-aged and the elderly was statistically significant, the change of the elderly (1.52 + 0.29) mm was greater than that of the middle-aged (1.33 + 0.27) mm, and the largest change was in the young people (1.91 + 0.22) mm.4. There was no difference in the effect of orthodontic treatment, periapical periodontitis, periodontitis, root fracture and residual root extraction on the sinus movement distance (P0 .05). There was no difference between the normal group of sinus floor and the thickening group of the sinus base mucous membrane (P0.05). The thickness of the sinus floor was (1.42 + 0.32) mm, and the normal group (1.51 + 0.31) mm. experiment on the sinus floor was classified. The distance of the sinus floor was (1.58 + 0.27) mm, the flat type was (1.48 + 0.26) mm, and the convex type was (1.19 + 0.35) mm. fovea sinus cavity was easier to occur, and the change of convex type was the smallest. The difference of sinus base shape had statistical difference (P0.05), 22 was statistically different (P0.05).5, the width of alveolar ridge after extraction was reduced, the initial width of selected samples was (13.15 + 1.61) mm, and three after tooth extraction. The change volume was statistically significant (11.38 + 1.63) mm after a month (P0.05). The height of the buccal and lingual side of the alveolar ridge was absorbed after the extraction, the amount of the buccal absorption was (1.46 + 0.33) mm, the change of the tongue side was (0.86 + 0.30) mm. and the change of the cheek side was greater than the change of the tongue side, and was significant (P0.05). Conclusion 1.CBCT can measure the bone change. The measured method is repeatable and reliable, the study data has a good reliability, the research data has the contrast.2. after the extraction of the maxillary sinus bottom to the alveolar ridge direction,.3. young patients are rebuilt in the middle of the middle age after the extraction of the teeth, the old people change a lot, the elderly people have a large change in the middle age. The change of the sinus floor had no effect on the distance between the.4. root and the sinus base, the more easily the sinus floor was rebuilt. The causes of the extraction of the posterior teeth and the thickness of the sinus base had no difference on the reconstruction of the sinus floor. The indifference of the.5. concave sinus was easier to occur, the flat type was in the middle, and the minimum of the convex type was changed, the width of the alveolar ridge was obviously changed after the extraction of.6.. The amount of buccal absorption of alveolar ridge was larger than that of lingual side.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R782.11

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