本文選題：錐形束CT + 下牙槽神經(jīng)管　； 參考：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:運(yùn)用錐形束CT(CBCT)觀測下牙槽神經(jīng)管在下頜體部的走行及與下頜后牙根尖的位置關(guān)系,為牙槽外科尤其是第三磨牙拔除及下頜磨牙區(qū)牙種植手術(shù)提供影像學(xué)數(shù)據(jù),降低該區(qū)拔牙及種植手術(shù)造成下牙槽神經(jīng)損傷的幾率。方法:1、收集2013年11月至2015年11月就診于遵義醫(yī)學(xué)院附屬口腔醫(yī)院患者下頜骨的CBCT圖像。要求圖像包含下頜第三磨牙在內(nèi)的下頜后牙無缺失、無下頜骨腫瘤、骨折等影響測量的因素。經(jīng)選擇后、符合納入標(biāo)準(zhǔn)的圖像共100例(其中男性55例,女性45例,年齡20-55歲)。將圖像導(dǎo)入NNT2.0系統(tǒng)軟件。2、以雙側(cè)下頜第二前磨牙、第一磨牙、第二磨牙、第三磨牙、第二前磨牙與第一前磨牙間牙槽嵴中點(diǎn)、第一磨牙與第二磨牙間牙槽嵴中點(diǎn)共6個(gè)位點(diǎn)為測量點(diǎn);觀察頦孔形態(tài)及觀察下牙槽神經(jīng)管走形。3、于第二前磨牙、第一磨牙、第二磨牙及第三磨牙4個(gè)牙位點(diǎn)處測量下牙槽神經(jīng)管上緣與牙根尖最低點(diǎn)間距離(L1)、下牙槽神經(jīng)管外緣與頰側(cè)骨板距離(L2)、下牙槽神經(jīng)管外緣與舌側(cè)骨板距離(L3)、下牙槽神經(jīng)管下緣與下頜骨下緣距離(L5)、下牙槽神經(jīng)管垂直向內(nèi)徑(d);于第二前磨牙與第一前磨牙間、第一磨牙與第二磨牙間兩個(gè)牙槽嵴中點(diǎn)處增加測量下牙槽神經(jīng)管上緣與牙槽嵴頂間距離(L4)。4、以牙根尖最低點(diǎn)與下牙槽神經(jīng)管上緣間距離(DTC)的測量結(jié)果,根據(jù)DTC2 mm;2 mm≤DTC6 mm;DTC≥6 mm對(duì)下頜磨牙根尖與下牙槽神經(jīng)管的位置關(guān)系進(jìn)行分類。5、測量結(jié)果運(yùn)用SPSS 19.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:共測量100例患者CBCT圖像,1200個(gè)測量點(diǎn),觀察到200條下牙槽神經(jīng)管。1、測量過程中發(fā)現(xiàn)1例雙下牙槽神經(jīng)管及1例副頦孔。2、頦孔形態(tài)為32%為圓形,68%為橢圓形;下牙槽神經(jīng)管垂直向內(nèi)徑由前向后無明顯變化,平均直徑為:2.1mm-2.71 mm,且男女間無差異。3、下牙槽神經(jīng)管大部分在下頜第一磨牙處為垂直向走行最低點(diǎn);以該點(diǎn)為中心,其近中段及遠(yuǎn)中段均向牙槽嵴頂靠近,遠(yuǎn)中段上升幅度大于近中段。在下頜第二前磨牙與第一磨牙間牙槽嵴中點(diǎn)處下牙槽神經(jīng)管走行由下頜骨頰側(cè)向舌側(cè)轉(zhuǎn)折;以該點(diǎn)為中心,其近中段靠下頜骨頰側(cè)走行、遠(yuǎn)中段靠下頜骨舌側(cè)走行;測量結(jié)果男女間存在明顯差異,男性大于女性。4、根據(jù)下頜后牙根尖最低點(diǎn)與下牙槽神經(jīng)管間距離(DTC)測量結(jié)果,將牙根尖與下牙槽神經(jīng)管位置關(guān)系分為:Ⅰ類關(guān)系(DTC2 mm)出現(xiàn)率為25%;Ⅱ類關(guān)系(2 mm≤DTC6 mm)出現(xiàn)率為48.8%;Ⅲ類關(guān)系(DTC≥6 mm)出現(xiàn)率為26.3%;其出現(xiàn)率在男女間無明顯差異。結(jié)論:下頜后牙根尖與下牙槽神經(jīng)管間位置關(guān)系分類中Ⅰ類關(guān)系(DTC2 mm)出現(xiàn)率最低,但在影響Ⅰ類關(guān)系的牙位點(diǎn)中,第三磨牙及第二磨牙所占比例高,提示臨床醫(yī)生在頦孔后區(qū)進(jìn)行種植手術(shù)及牙槽外科手術(shù)前需進(jìn)行準(zhǔn)確的術(shù)前評(píng)估,制定適宜的手術(shù)方案以降低下牙槽神經(jīng)損傷的風(fēng)險(xiǎn)。
[Abstract]:Objective: to observe the movement of the inferior alveolar nerve tube in the mandibular body and its relationship with the root tip of the mandible by conical beam CT (CBCT), so as to provide the imaging data for alveolar surgery, especially for the third molar extraction and the mandibular molar region implant operation. To reduce the probability of lower alveolar nerve injury caused by extraction and implant operation in this area. Methods: from November 2013 to November 2015, the CBCT images of mandible were collected from November 2013 to November 2015 in affiliated Stomatology Hospital of Zunyi Medical College. No loss of mandibular posterior teeth, no mandibular tumor, fracture and other factors affecting measurement were required. After selection, 100 images met the inclusion criteria (55 males and 45 females aged 20-55 years). The images were imported into the NNT2.0 system software. 2. The second premolars, first molars, second molars, third molars, second premolars and interalveolar crest of the first premolars were used as bilateral mandibular premolars. The first molar and the second molar were measured at the middle point of the alveolar crest, the shape of mental foramen and the shape of the inferior alveolar nerve tube were observed, the second premolar, the first molar, the second premolar, the first molar, The distance between the upper edge of the inferior alveolar canal and the lowest point of the root tip (L1), the distance between the outer edge of the inferior alveolar nerve tube and the buccal bone plate (L2), the distance between the outer edge of the inferior alveolar canal and the lingual lateral bone plate (L3), the distance between the inferior alveolar nerve tube and the lingual lateral bone plate (L3), the distance between the outer edge of the inferior alveolar nerve tube and the root tip (L 2) The distance between the inferior edge of the alveolar canal and the lower margin of the mandible (L5) and the vertical inner diameter of the inferior alveolar canal (d); were found between the second premolar and the first premolar. The distance between the upper edge of the inferior alveolar canal and the top of the alveolar crest (L4). 4 was measured at the midpoint of the two alveolar crest between the first molar and the second molar. The distance between the lowest point of the root tip and the superior edge of the alveolar canal (DTC) was measured. According to DTC2mm 鈮，

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