3种不同口腔慢性炎症引起牙源性上颌窦炎的锥形束CT比较

Comparative study of the CBCT findings of odontogenic maxillary sinusitis caused by 3 different chronic oral inflammations

目的比较单纯慢性牙周炎、牙周牙髓联合病变及慢性根尖周炎引起牙源性上颌窦炎(OMS)的影像学特征,探讨3种口腔慢性炎症导致的骨质破坏情况与上颌窦粘膜的形态学变化。方法选择未经治疗的3种口腔慢性炎症引起OMS患者各50例,对其锥形束CT影像学表现进行分析和精确测量,记录病源牙及其周围骨质破坏情况、上颌窦炎性肥厚的最大厚度值(DSM),进行统计分析。结果 3种OMS中,病源牙为上颌第一磨牙者最多,占35.33%;其次为上颌第三磨牙,占27.33%;再次为上颌第二磨牙,占20.00%;病源牙超过2颗者占14.67%。颊/腭侧骨壁破坏患者上颌窦粘膜DSM为9.04±5.04 mm,高于无颊/腭侧骨壁破坏患者的6.94±5.03 mm(t=2.560,P=0.011);上颌窦底壁瘘患者上颌窦DSM为11.49±6.68 mm,高于无上颌窦底壁瘘患者的6.67±3.75 mm(t=5.541,P<0.001)。单纯慢性牙周炎、牙周牙髓联合病变及慢性根尖周炎上颌窦底壁瘘发生率分别为40%、34%和24%,组间差异无统计学意义(χ2=2.703,P=0.259)。单纯牙周炎源性(9.26±5.33 mm)和牙周牙髓联合病变(10.24±4.93 mm)的DSM显著高于慢性根尖周炎(4.26±2.49 mm)(F=26.157,P<0.001)。结论单纯慢性牙周炎和牙周牙髓联合病损骨质破坏范围较广,上颌窦粘膜炎性肥厚改变的程度较重,相对于慢性根尖周炎更易发生牙源性上颌窦炎。

Objective To compare the imaging characteristics of odontogenic maxillary sinusitis（OMS） caused by simple chronic periodontitis, combined periodontal-endodontic lesions and chronic periapical periodontitis and to analyze the correlation between the morphological changes of schneiderian membrance（DSM） and the bone damage caused by 3 types of chronic oral inflammations. Methods A total of 150 untreated OMS cases were selected, with 50 cases for each type of chronic oral inflammation, and all subjects received CBCT scan, the result of which was acutely measured and analyzed. Pathogenic teeth and the surrounding bone damage were recorded, and the axillary sinus mucosal thickness was measured in sagittal and coronary position. Results The most common pathogenic teeth were the maxillary first molar（35.33%）, followed by the maxillary third molar（27.33%） and the maxillary second molar（20.00%）. There were 14.67% patients with more than 1 pathogenic tooth. The DSM（9.04±5.04 mm） in cases with buccal/palatal lateral bone damage was significantly higher than that without buccal/palatal lateral bone damage（6.94±5.03 mm）（t=2.560,P=0.011）. The DSM in cases with oral-maxillary fistula（11.49±6.68 mm） was significantly higher than that without oral-maxillary sinus fistula（6.67±3.75 mm）（t=5.541,P〈0.001）. The incidences of oral-maxillary fistula in chronic periodontitis, periodontal-endodontic combined lesions and chronic apical periodontitis were 40%, 34% and 24% respectively. There were no statistically significant differences among the 3 groups（x=2.703, P= 0.259）. The DSMs in both groups of chronic periodontitis and periodontal-endodontic combined lesions were significantly higher than that in chronic apical periodontitis group（4.26±2.49 mm）（F= 26.157, P〈0.001）Conclusion Odontogenic maxillary sinusitis is more likely to happen in cases with chronic periodontitis and periodontal-endodontic combined lesions, in which the range of maxillary bone damage and extent of the maxillary sinus mucosa thickening are larger than those in cases with chronic apical periodontitis.