上颌骨的曲面重组技术重建及可视化观测

Curve-planar reconstruction and visualization observations of the maxilla

目的为上颌牙种植术等临床口腔外科技术提供解剖学基础。方法选取全牙志愿者20名,在螺旋X线计算机断层摄影机以眦耳线为基线连续扫描,采用ADW 4.2重建软件的曲面重组(CPR)技术重建上颌骨内的上颌窦,观察上颌窦的位置、形态和测量上颌窦下壁至上颌后牙牙根的距离。在Amira三维重建软件下重建上颌骨及其结构的可视化模型,观察半透明上颌骨内上颌窦的位置及其与上颌牙根的关系。结果上颌骨内的上颌窦呈三边形或四边形的锥形腔隙,其下壁常有凸起的骨隔。半透明上颌骨可视化模型内的上颌窦可清晰显示其位置、形态及其与上颌牙根的关系。上颌骨内的上颌窦下壁至上颌后牙牙根的距离以第1磨牙最近,由近及远依次为第1磨牙、第2磨牙、第3磨牙、第2前磨牙和第1前磨牙。上颌窦下壁至左、右侧第1前磨牙、第2前磨牙、第1磨牙、第2磨牙的牙根,以及第3磨牙的舌根、远中颊根的最短距离比较,差异均有统计学意义(P<0.05),至左、右侧第3磨牙近中颊根的最短距离比较,差异无统计学意义(P>0.05)。结论上颌骨的CPR技术重建及可视化对选择适宜长度的牙种植体、避免牙种植体误入上颌窦等具有重要的临床意义。

Objective To provide anatomical basis for the maxillary dental implant operation of the clinical oral surgery. Methods Twenty volunteers with whole tooth were selected, and scanned in series by spiral X ray computed tomography from the canthomeatal line, the maxillary sinus in maxilla was reconstructed by the curve-planar reconstruction （CPR） technology under the ADW 4.2 reconstruction software. The position and shape of maxillary sinus were observed, and the distance from the inferior wall of maxillary sinus to the dental root of maxillary posterior teeth was measured. The visual model of maxilla and its structures were reconstructed by the Amira three-dimensional reconstruction software, the position of maxillary sinus in the semi-diaphanous maxilla and the relationship of the dental root of maxillary teeth with it were observed. Results It was trian- gular or quadrilateral cone-shaped space of the maxillary sinus in maxilla, the processes of bony septum were often appeared on the inferior wall of maxillary sinus. The visual model of maxillary sinus in the semi-diaphanous maxilla could clearly display its position, shape and the relationship of the dental root of maxillary teeth with it. The distance from the inferior wall of maxillary sinus in maxilla to the dental root of first molar was the nearest than the others, it was the first molar, second molar,third molar, second premolar and first premolar from near and far. There were significant difference in the nearest distance from the inferior wall of maxillary sinus to the left and right dental root of first premolar, second premolar, first molar, second molar,lingual and disobuccal root of third molar（P 〈 0.05 ）, therh was no significant difference in the nearest distance from the inferior wall of maxillary sinus to the left and right mesiobuccal root of third molar（ P 〉 0.05 ）. Conclusion It has an important clinical significance for choosing appropriate length of dental implantation and avoiding dental implantation to pierce into the maxillary sinus of the CPR and visualization of maxilla.