口腔颌面锥形束CT三维重建诊断上颌磨牙早期根折:与传统根尖片比较

Detection of early root fracture in maxillary molar: cone beam CT versus periapical radiographs

背景:牙根折裂因发生部位隐蔽,其诊断是临床难点之一。近期有系统回顾研究显示诊断牙根折裂影像方法的临床准确性尚不统一。目的:回顾性对比研究传统根尖片与锥形束CT在上颌磨牙早期根折诊断中的准确性。方法:对38例患者40颗临床检查疑为早期根折的上颌磨牙X射线根尖片与锥形束CT的检查结果分别进行分析,并作出诊断。结果与结论:在40颗可疑早期根折的上颌磨牙中,根尖片能明确诊断的有19颗,且根折部分均为上颌磨牙的近中颊根。而锥形束CT检查结果显示30颗患牙根折,其中23颗根折发生在近中颊根,7颗发生在腭根。另外一颗未发现根折影像的患牙,经6个月保守治疗无效后拔除,证实为腭根折断。结果证实,锥形束CT在诊断上颌磨牙早期根折尤其是腭根的根折方面明显优于传统根尖X射线片。

BACKGROUND： Detection of root fracture is difficult since the fracture line is not apparent. A recent systematic review concluded that there was a lack of evidence-based data regarding the diagnostic accuracy of conventional radiographic signs for root fracture. OBJECTIVE： To compare the diagnosis of maxillary molars with early root fracture by periapical film and cone-beam CT retrospectively. METHODS： Forty teeth diagnosed as early root fracture of maxillary molars from 38 patients were included. Results of periapical film and cone-beam CT were compared. RESULTS AND CONCLUSION： Among the 40 suspected teeth, 19 teeth were diagnosed as early root fracture by periapical film. The fracture line was located in the mesiobuccal root of maxillary molars. However, 30 teeth were diagnosed as early root fracture by cone-beam CT. Among them, 23 teeth had fracture lines in mesiobuccal root and 7 teeth had fracture line in palatal root. One tooth could not be found any fracture sign Jn cone-beam CT. After 6 months of conservative treatment, this tooth was extracted for palata~ root fracture. Compared with periapical film, cone-beam CT is better in early root fracture diagnosis, especially for the teeth with fracture line in palatal root.