CBCT評(píng)價(jià)病變上頜竇及種植手術(shù)對(duì)其的影響
發(fā)布時(shí)間：2018-08-27 19:37
【摘要】：目的： 上頜后牙缺失且骨量不足時(shí)上頜竇是種植手術(shù)需要考慮的一個(gè)重要解剖結(jié)構(gòu)，但上頜竇常常存在一些變異或者病變，利用CBCT評(píng)價(jià)種植體植入術(shù)后上頜竇變化情況，分析種植手術(shù)對(duì)上頜竇影響的相關(guān)因素。 方法: 采用回顧性的方法，收集2012年1月1日到2013年3月31日在華西口腔醫(yī)院種植科和南昌大學(xué)附屬口腔醫(yī)院種植科就診的患者，均為上頜后牙缺失要求行種植手術(shù)的病例。 結(jié)果： 觀察期間共有1861位患者上頜后牙缺失要求行種植修復(fù)，通過術(shù)前常規(guī)拍攝CBCT觀察發(fā)現(xiàn)上頜竇內(nèi)未見明顯異常者793例（42.61%），上頜竇異常者1068例（57.39%），包括：黏膜扁平樣增厚763例（40.99%），黏膜息肉樣增厚168例（9.03%），鈣化72例（3.87%），積液65例（3.49%）。按照納入標(biāo)準(zhǔn)，，最終共有93位患者的93例上頜竇納入研究�；颊咂骄挲g53.51±10.75歲，最小年齡19歲，最大年齡69歲。其中男性57例（61.29%），女性36例（38.71%）。隨訪時(shí)間7.05±2.18個(gè)月，其中最短3.6個(gè)月，最長15.2個(gè)月。扁平樣增厚有66例，息肉狀增厚15例，積液10例，鈣化2例。93例種植手術(shù)中，無附加提升術(shù)且未穿破上頜竇底的有23例（24.73%），無附加提升術(shù)但穿破上頜竇底的有7例（7.53%），附加上頜竇內(nèi)提升的有60例（64.52%），附加上頜竇外提升術(shù)同期種植的有1例（1.08%），附加上頜竇外提升術(shù)擇期種植的有2例（2.15%）。其中，種植術(shù)后出現(xiàn)液平面的有9例（9.68%），通過一系列消炎處理隨訪時(shí)液平面消失的有8例。對(duì)術(shù)前術(shù)后共186張CBCT圖像進(jìn)行分析，測量黏膜增厚及上頜竇積液、鈣化等改變，其術(shù)前平均厚度為5.93mm，而術(shù)后厚度為4.72mm，高度明顯降低，有統(tǒng)計(jì)學(xué)意義（P0.05）；女性術(shù)后變化明顯大于男性（P0.05）；不同的手術(shù)方式也存在差異性。術(shù)前缺牙區(qū)可用骨高度為5.99mm，術(shù)后骨高度為8.50mm，其變化有統(tǒng)計(jì)學(xué)差異(P0.05)（表4）。 結(jié)論： 1.通過種植體植入術(shù)或（和）上頜竇內(nèi)/外提升術(shù)，上頜竇內(nèi)病變尺寸會(huì)變小，性別和手術(shù)方式是主要原因。 2. CBCT作為一種現(xiàn)代準(zhǔn)確的評(píng)價(jià)工具，既能清楚地反映種植術(shù)前及術(shù)后的上頜竇狀況，又能準(zhǔn)確指導(dǎo)手術(shù)適應(yīng)癥的選擇。 3.選擇好合理適應(yīng)癥，在熟練輕柔的外科操作下，上頜竇區(qū)域存在良性病變時(shí)進(jìn)行種植體植入術(shù)是可行的。
[Abstract]:Objective: maxillary sinus is an important anatomical structure to be considered when maxillary posterior teeth are missing and bone mass is insufficient, but maxillary sinus often has some variation or pathological changes. CBCT was used to evaluate the changes of maxillary sinus after implant implantation. Methods: from January 1, 2012 to March 31, 2013, we collected patients from the Department of Implant and the Department of Orthodontics, affiliated to Nanchang University, from January 1, 2012 to March 31, 2013. All cases of maxillary posterior tooth loss required implant operation. Results: a total of 1861 patients with maxillary posterior tooth loss required implant repair during the observation period. According to routine CBCT before operation, 793 cases (42.61%) had no obvious abnormality in maxillary sinus, 1068 cases (57.39%) had abnormal maxillary sinus, including 763 cases (40.99%) with flattened mucosal thickening, 168 cases (9.03%) with mucosal polypoid thickening, 72 cases (3.87%) with calcification and 65 cases (3.49%) with effusion. According to the inclusion criteria, 93 patients with maxillary sinus were included in the study. The average age of the patients was 53.51 鹵10.75 years old, the minimum age was 19 years and the maximum age was 69 years old. There were 57 males (61.29%) and 36 females (38.71%). The follow-up time was 7.05 鹵2.18 months, of which the shortest was 3.6 months and the longest was 15.2 months. There were 66 cases of flat thickening, 15 cases of polypoid thickening, 10 cases of effusion and 2 cases of calcification. There were 23 cases (24.73%) without additional lifting and without penetrating the floor of maxillary sinus, 7 cases (7.53%) without additional lifting, 60 cases (64.52%) with lifting in maxillary sinus, 1 case (1.08%) with implantation of external lifting of maxillary sinus at the same time. Two cases (2.15%) were implanted with extracantral lifting. Among them, 9 cases (9.68%) had liquid level after implantation, and 8 cases disappeared during follow up by a series of anti-inflammatory treatment. A total of 186 CBCT images were analyzed before and after operation. The changes of mucosal thickening, maxillary sinus effusion and calcification were measured. The mean preoperative thickness was 5.93 mm, but the postoperative thickness was 4.72 mm. The height was significantly decreased (P0.05). The postoperative changes in women were significantly greater than those in men (P0.05), and there were differences in different surgical methods. The available bone height was 5.99mm before operation and 8.50mm postoperatively (P0.05). Conclusion: 1. Through implant implantation or / and maxillary sinus lifting, the size of the lesions in the maxillary sinus becomes smaller, with gender and surgical methods being the main causes. 2. As a modern and accurate evaluation tool, CBCT can not only clearly reflect the maxillary sinus status before and after implantation, but also guide the selection of surgical indications. It is feasible to apply implant implantation in the presence of benign lesions in the maxillary sinus region.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R783.6
本文編號(hào)：2208248
[Abstract]:Objective: maxillary sinus is an important anatomical structure to be considered when maxillary posterior teeth are missing and bone mass is insufficient, but maxillary sinus often has some variation or pathological changes. CBCT was used to evaluate the changes of maxillary sinus after implant implantation. Methods: from January 1, 2012 to March 31, 2013, we collected patients from the Department of Implant and the Department of Orthodontics, affiliated to Nanchang University, from January 1, 2012 to March 31, 2013. All cases of maxillary posterior tooth loss required implant operation. Results: a total of 1861 patients with maxillary posterior tooth loss required implant repair during the observation period. According to routine CBCT before operation, 793 cases (42.61%) had no obvious abnormality in maxillary sinus, 1068 cases (57.39%) had abnormal maxillary sinus, including 763 cases (40.99%) with flattened mucosal thickening, 168 cases (9.03%) with mucosal polypoid thickening, 72 cases (3.87%) with calcification and 65 cases (3.49%) with effusion. According to the inclusion criteria, 93 patients with maxillary sinus were included in the study. The average age of the patients was 53.51 鹵10.75 years old, the minimum age was 19 years and the maximum age was 69 years old. There were 57 males (61.29%) and 36 females (38.71%). The follow-up time was 7.05 鹵2.18 months, of which the shortest was 3.6 months and the longest was 15.2 months. There were 66 cases of flat thickening, 15 cases of polypoid thickening, 10 cases of effusion and 2 cases of calcification. There were 23 cases (24.73%) without additional lifting and without penetrating the floor of maxillary sinus, 7 cases (7.53%) without additional lifting, 60 cases (64.52%) with lifting in maxillary sinus, 1 case (1.08%) with implantation of external lifting of maxillary sinus at the same time. Two cases (2.15%) were implanted with extracantral lifting. Among them, 9 cases (9.68%) had liquid level after implantation, and 8 cases disappeared during follow up by a series of anti-inflammatory treatment. A total of 186 CBCT images were analyzed before and after operation. The changes of mucosal thickening, maxillary sinus effusion and calcification were measured. The mean preoperative thickness was 5.93 mm, but the postoperative thickness was 4.72 mm. The height was significantly decreased (P0.05). The postoperative changes in women were significantly greater than those in men (P0.05), and there were differences in different surgical methods. The available bone height was 5.99mm before operation and 8.50mm postoperatively (P0.05). Conclusion: 1. Through implant implantation or / and maxillary sinus lifting, the size of the lesions in the maxillary sinus becomes smaller, with gender and surgical methods being the main causes. 2. As a modern and accurate evaluation tool, CBCT can not only clearly reflect the maxillary sinus status before and after implantation, but also guide the selection of surgical indications. It is feasible to apply implant implantation in the presence of benign lesions in the maxillary sinus region.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R783.6
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 仲維劍;陳斌科;馬國武;;種植體穿通上頜竇的實(shí)驗(yàn)研究[J];中國口腔種植學(xué)雜志;2009年02期
2 林野,王興,邱立新,張偉;上頜竇提升植骨及同期種植體植入術(shù)[J];中華口腔醫(yī)學(xué)雜志;1998年06期
本文編號(hào)：2208248
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