發(fā)布時間：2018-07-05 16:42

  本文選題：上頜竇 + 即刻種植��； 參考：《南華大學(xué)》2014年碩士論文

【摘要】：目的： 通過對上頜骨標本的解剖和口腔錐形束CT掃描（CBCT）、三維重建和測量，研究正常成人上頜骨的解剖特點及上頜竇與上頜后牙的關(guān)系，為擴大上頜后牙即刻種植的適應(yīng)癥，預(yù)防上頜竇底穿孔，提高上頜后牙種植術(shù)的成功率，進一步為臨床牙種植術(shù)等口腔外科手術(shù)及口腔解剖的教學(xué)提供解剖學(xué)依據(jù)。 材料和方法： 1.完整成人新鮮上頜骨標本16例（32側(cè)），男8例，女8例。將上頜竇上壁打開，觀察上頜竇骨間隔的數(shù)目及位置；再將上頜竇前壁打開，用牙科打磨機順著牙長軸方向?qū)⑸项M后牙（包括前磨牙和磨牙）牙根表面及其之間的牙槽骨磨除，盡可能完全暴露牙根；用游標卡尺測量上頜后牙根尖、牙槽嵴頂和根分叉到上頜竇底的距離以及各牙牙根（根頸、根中及根尖）之間的距離（包括牙槽間隔和牙根間隔）。每個指標均重復(fù)測量3次，記錄其均數(shù)。 2.完整成人新鮮上頜骨標本16例（32側(cè)），，男9例，女7例。將上頜竇上壁打開，觀察上頜竇骨間隔的數(shù)目及位置；再將上頜竇前壁打開，用牙科打磨機順著牙長軸方向?qū)⑸项M后牙從正中剖開。用游標卡尺測量上頜后牙根尖、牙槽嵴頂、根分叉到上頜竇底的距離、各牙牙根(根頸、根中、根尖)表面牙槽骨的厚度及根分叉至頰、腭側(cè)牙槽骨表面的距離。每個指標均重復(fù)測量3次，記錄其均數(shù)。 3.健康成年人CBCT影像數(shù)據(jù)60例（120側(cè)），男32例，女28例。在CBCT軟件工作站對影像數(shù)據(jù)進行三維重建，測量上頜后牙根尖、牙槽嵴頂及根分叉到上頜竇底的距離、各牙牙根之間的距離（包括牙槽間隔和牙根間隔）、各牙牙根表面牙槽骨的厚度和根分叉至頰、腭側(cè)牙槽骨表面的距離。每個指標均重復(fù)測量3次，記錄其均數(shù)。三維測量所得數(shù)據(jù)同大體解剖所得數(shù)據(jù)進行對比。 4.測量結(jié)果用SPSS18.0軟件計算出均數(shù)和標準差，并將左、右側(cè)數(shù)據(jù)和男、女間數(shù)據(jù)分別進行配對t檢驗。 結(jié)果： 1.超過50%（標本為53.2%，影像為53.4%）的上頜竇未出現(xiàn)骨間隔，若出現(xiàn)以1個（標本為25.0%，影像為20.0%）或2個（標本為18.8%，影像為23.3%）的概率最大，且常出現(xiàn)在上頜竇底的中部（標本為63.6%，影像為61.9%）。 2.上頜后牙中同名牙的牙槽嵴頂至上頜竇底的距離在性別間存在統(tǒng)計學(xué)差異，男性大于女性。牙槽嵴頂至上頜竇底的距離從第一前磨牙[標本為男（22.58±3.18）mm，女（20.68±2.55）mm；影像為男（22.19±3.64）mm，女（19.97±2.46）mm]到第一磨牙[標本為男（13.08±4.09）mm，女（11.46±2.50）mm；影像為男（12.69±2.86）mm，女（11.32±2.16）mm]逐漸變小，從第一磨牙到第三磨牙[標本為男（16.98±3.56）mm，女（13.74±3.81）mm；影像為男（16.27±4.02）mm，女（12.99±2.28）mm]又稍有增大。上頜第一磨牙的牙槽嵴頂?shù)缴项M竇底的距離最近。 3.同名牙的同名根根尖與上頜竇底部之間的距離在側(cè)別上存在統(tǒng)計學(xué)差異，右側(cè)大于左側(cè)。上頜第二前磨牙[標本為左（4.31±0.91）mm，右（4.63±0.89）mm；影像為左（4.28±0.83）mm，右（4.52±0.90）mm]的根尖到上頜竇底的距離較上頜第一前磨牙[標本為左頰根（9.90±1.13）mm，右頰根（10.68±1.15）mm，左腭根（9.96±1.10）mm，右腭根（10.89±1.17）mm；影像為左頰根（9.68±1.07）mm，右頰根（10.58±1.11）mm，左腭根（9.71±0.98）mm，右腭根（10.81±1.12）mm；]近。 4.上頜后牙中以第一磨牙[標本為根頸處近中頰根頰側(cè)（2.46±0.31）mm，遠中頰根頰側(cè)（1.36±0.21）mm，腭根腭側(cè)（2.46±0.27）mm；根中處近中頰根頰側(cè)（2.68±0.43）mm，遠中頰根頰側(cè)（1.88±0.27）mm，腭根腭側(cè)（2.72±0.45）mm；根尖處近中頰根頰側(cè)（3.12±0.41）mm，遠中頰根頰側(cè)（2.22±0.26）mm，腭根腭側(cè)（4.68±0.52）mm。影像為根頸處近中頰根頰側(cè)（2.29±0.34）mm，遠中頰根頰側(cè)（1.30±0.20）mm，腭根腭側(cè)（2.39±0.41）mm；根中處近中頰根頰側(cè)（2.60±0.45）mm，遠中頰根頰側(cè)（1.81±0.28）mm，腭根腭側(cè)（2.69±0.47）mm；根尖處近中頰根頰側(cè)（3.06±0.39）mm，遠中頰根頰側(cè)（2.17±0.23）mm，腭根腭側(cè)（4.59±0.55）mm]牙根表面的牙槽骨厚度最薄，腭側(cè)的牙槽骨較頰側(cè)厚。由根頸到根中，再到根尖，牙根表面的牙槽骨厚度依次增加。 5.上頜后牙之間的牙槽間隔寬度均是腭側(cè)寬于頰側(cè)（第二磨牙與第三磨牙之間除外）。從根頸到根中，再到根尖，牙槽間隔的寬度依次增大。上頜后牙的牙根間隔，以第一磨牙的牙根間隔最大，標本為根頸處近、遠中頰根間（2.06±0.30）mm,近中頰、腭根間（3.44±0.56）mm，遠中頰、腭根間（4.16±063）mm,影像為近、遠中頰根間（2.03±0.29）mm,近中頰、腭根間（3.31±0.55）mm，遠中頰、腭根間（4.03±0.62）mm。 6.上頜后牙根分叉處距上頜竇底的距離在9mm以上，且其至腭側(cè)牙槽骨表面的距離較頰側(cè)遠。 結(jié)論： 1.在行上頜后牙即刻種植修復(fù)過程中，種植體長度的選擇應(yīng)注意性別間 的差異，其深度在男性不能超過13mm，女性不能超過12mm。 2.上頜后牙牙種植術(shù)中可將種植體依正常位置稍偏腭側(cè)傾斜。
[Abstract]:Objective:
The anatomical characteristics of the maxillary maxilla and the relationship between maxillary sinus and maxillary posterior teeth were studied by the anatomy of the maxilla and the three-dimensional reconstruction and measurement of the oral cone beam (CBCT), and the maxillary sinus and the maxillary posterior teeth were studied. In order to enlarge the indication of the immediate implant of the maxillary posterior teeth, prevent the perforation of the maxillary sinus, the success rate of the high maxillary posterior teeth implantation was carried out, and the clinical teeth were further developed. To provide anatomical basis for implant surgery, oral surgery and oral anatomy teaching.
Materials and methods:
1. full adult fresh maxillofacial specimens (32 sides), 8 men and 8 women. The upper wall of the maxillary sinus was opened to observe the number and position of the maxillary sinus bone septum, and then the anterior wall of the maxillary sinus was opened and the surface of the maxillary posterior teeth (including the premolar and molar) and the alveolar bone were removed with the dental grinding machine along the long axis. The root tip of the maxillary posterior teeth was measured with a vernier caliper, the distance between the alveolar crest and the root of the maxillary sinus and the distance between the root (the root neck, the root and the root tip) of the teeth (including the alveolar septum and the root septum) were measured with a vernier caliper. Each index was repeated 3 times, and the number was recorded.
2. full adult fresh maxillofacial specimens, 16 cases (32 sides), 9 men and 7 women. The upper wall of the maxillary sinus was opened to observe the number and position of the maxillary sinus bone septum; then the anterior wall of the maxillary sinus was opened and the maxillary posterior teeth were opened with the dental grinding machine along the long axis. The root tip of the upper jaw, the crest of the alveolar ridge and the root were measured with the vernier caliper. The distance of the maxillary sinus floor, the thickness of the alveolar bone on the surface of the root (root neck, root, root), and the distance between the root and the cheek, and the surface of the alveolar bone on the palate. Each index was repeated 3 times, and the number of them was recorded.
3. CBCT image data of 60 healthy adults (120 sides), 32 men and 28 women. The image data were reconstructed at CBCT software workstation, the distance between the root tip of the upper jaw, the distance between the top of the alveolar ridge and the root of the maxillary sinus, the distance between the roots of the teeth (including the alveolar septum and the root septum), and the thickness of the alveolar bone on the root surface of each tooth and the surface of the tooth root. The distance between the root forked to the cheek and the palatine alveolar bone surface. Each index was repeated 3 times, and the numbers were recorded. The data obtained by the three dimensional measurement were compared with the gross anatomical data.
4. the measured results were calculated by means of SPSS18.0 software. The mean and standard deviations were calculated, and the left and right data were paired t test with male and female data.
Result:
1. of the maxillary sinuses that exceed 50% (specimen 53.2%, 53.4%) have no bone septum in the maxillary sinus. If there are 1 (specimen 25%, image 20%) or 2 (specimen 18.8%, and 23.3%), the probability is greatest and often occurs in the middle of the maxillary sinus floor (specimen 63.6%, shadow as 61.9%).
2. the distance between the alveolar crest and maxillary sinus base of the same teeth in the maxillary posterior teeth was statistically different. The male was greater than the female. The distance from the top of the alveolar ridge to the bottom of the maxillary sinus was from the first premolar (22.58 + 3.18) mm and female (20.68 + 2.55) mm; the image was male (22.19 + 3.64) mm and female (19.97 + 2.46) mm] to the first molar [specimen for male (1) 3.08 + 4.09) mm, female (11.46 + 2.50) mm, images of male (12.69 + 2.86) mm, female (11.32 + 2.16) mm] gradually smaller, from first molar to third molar [specimen for male (16.98 + 3.56) mm, female (13.74 + 3.81) mm, image for male (16.27 + mm]) mm, female mm] slightly increased. The distance between the alveolar crest of the maxillary first molar and the maxillary sinus bottom is the most Near.
3. the distance between the root tip of the same name of the same name and the bottom of the maxillary sinus was statistically different, and the right was larger than the left side. The maxillary second premolar was (4.31 + 0.91) mm and right (4.63 + 0.89) mm; the image was left (4.28 + 0.83) mm, and the distance between the right (4.52 + 0.90) mm] and maxillary sinus floor was more than the maxillary first premolar The buccal root (9.90 + 1.13) mm, the right buccal root (10.68 + 1.15) mm, the left palatine root (9.96 + 1.10) mm and the right palatine root (10.89 + 1.17) mm, the image of the left cheek root (9.68 + 1.07) mm, the right buccal root (10.58 + 1.11), the left palatine root (9.71 + 10.68) mm, and the right palatine root (mm) mm;
4. of the maxillary posterior teeth, the first molar was the first molar (2.46 + 0.31) mm at the proximal and middle buccal root of the root neck, the far middle buccal root (1.36 + 0.21) mm, the palatine palatal side (2.46 + 0.27) mm, the proximal bucchechebuccal lateral (2.68 + 0.43) mm in the root, the distal buccal root (1.88 + 0.27) mm, and the palatalpalatopalatine (2.72 + 0.45) mm in the palatine root, and the distal part of the root to the buccheebuccal side of the root (3.12 + 0.27) mm, far middle. The buccal lateral buccal side (2.22 + 0.26) mm, palatalpalatopalatine (4.68 + 0.52) mm. images of the bucchechebuccal lateral root of the root and neck (2.29 + 0.34) mm, far middle buccal root (1.30 + 0.20) mm and palatalpalatopalatine (2.39 + 0.41) mm in the root, and the proximal bucchechebuccal side of the root (2.60 + 0.45) in the root, (1.81 + 0.28) mm, palatalpalatopalatine mm of the palatine root and palatalpalatopalatine side of the palatine, and the buccal side of the middle buccal root in the root apex. 3.06 + 0.39) mm, the buccal lateral buccal side (2.17 + 0.23) mm, the thickness of alveolar bone on the surface of palatine root and palatal side (4.59 + 0.55) mm], the alveolar bone on the palatine side was thicker than the buccal side. The thickness of alveolar bone on the root and root was increased in turn.
5. the width of the alveolar space between the maxillary posterior teeth is the palatine side of the buccal side (except between the second molar and the third molar). From the root to the root and to the root, the width of the alveolar septum increases in turn. The root septum of the maxillary posterior teeth is the largest in the root of the first molar. The standard is the root neck near, the distal and the middle buccal root (2.06 + 0.30) mm, near the middle cheek. Between the palatine root (3.44 + 0.56) mm, far middle cheek and palatine root (4.16 + 063) mm, the image was near, far middle and middle buccal root (2.03 + 0.29) mm, near the middle cheek, palatine root (3.31 + 0.55) mm, far middle cheek, and palatine root (4.03 + 0.62) mm.
6. the distance between the maxillary posterior root and the maxillary sinus is more than 9mm, and the distance from the maxillary posterior sinus to the palatal alveolar bone is far from the buccal side.
Conclusion:
1. during the immediate implant restoration of maxillary posterior teeth, the choice of implant length should pay attention to gender.
The difference is not more than 13mm in men, and 12mm. in women.
2. in the maxillary posterior dental implant, the implant can be slightly tilted to the palatal side in normal position.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R783.6

【參考文獻】

相關(guān)期刊論文 前10條

1 王遠勤;王臻;呂杰;魏彪;米德伶;姚富光;肖沙里;;螺旋X-CT三維成像技術(shù)在口腔種植定位中的應(yīng)用[J];廣東牙病防治;2006年01期

2 盧賢欣;曾慧儀;張鳳;李結(jié)超;;不同牙位即刻種植成功率的臨床研究[J];廣東牙病防治;2012年01期

3 劉紅敏;趙紅軍;李占生;;X線片上推測上頜竇的側(cè)面積[J];解剖學(xué)雜志;2007年01期

4 儲順禮;周延民;孟維艷;張興樂;;上頜后牙區(qū)、上頜竇、顴骨及顴骨種植體的三維有限元模型建立[J];口腔醫(yī)學(xué)研究;2006年02期

5 黃建生,周磊,宋光保;上頜竇提升植骨同期人工牙種植修復(fù)[J];中國口腔種植學(xué)雜志;2003年04期

6 王遠勤,王臻,呂杰,魏彪,米德伶,姚富光,肖沙里;三維重建技術(shù)在口腔虛擬種植導(dǎo)航定位中應(yīng)用的方法學(xué)研究[J];中國口腔種植學(xué)雜志;2005年03期

7 蔣峰;谷志遠;張雄;;上后牙拔除致上頜竇氣腔化的研究進展[J];中國口腔種植學(xué)雜志;2009年01期

8 孔祥槐;胡圣望;;上頜后牙種植術(shù)與上頜竇的關(guān)系探討[J];現(xiàn)代醫(yī)學(xué);2011年03期

9 黃建生,周磊,宋光保,徐淑蘭,張國金;閉合式上頜竇擠壓提升同期人工牙種植修復(fù)45例分析[J];中國口腔頜面外科雜志;2005年01期

10 李明霞;王光平;王虎;;上頜竇相關(guān)解剖結(jié)構(gòu)的錐形束CT影像學(xué)特征[J];中國組織工程研究;2013年02期

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