上颌前牙美学区牙槽骨骨量及形态的研究

Study of alveolar bone morphometry in aesthetics area

目的:通过对牙槽骨量的测量及形态分类,探索可能引起即刻种植美学风险的危险因素,归纳美学区牙槽骨的分类并提出临床意见,为美学区即刻种植的术前评估与术式选择提供参考依据。方法:利用螺旋CT测量100例口腔门诊患者上颌骨美学区各牙位牙槽骨骨量及形态参数值,包括牙槽骨唇(颊)腭向厚度、牙根长轴与牙槽骨角度关系,以及根尖距唇侧骨壁凹陷区的最近距离。根据年龄、性别、受测牙是否患有牙周炎,以及有无根管治疗(RCT)史对570颗前牙进行分组。根据数据测量结果和组间对比,量化分析上颌美学区牙槽骨骨量及形态。采用SPSS 19.0软件包对数据进行统计学分析。结果:①上前牙中尖牙的牙槽骨厚度(CD)最大,老年组平均CD值小于中、青年组,女性小于男性,牙周炎患牙小于健康组牙,均有统计学差异(P<0.05)。②中切牙根尖处唇侧骨量(BE)最大,牙周炎患牙、RCT治疗史患牙BE值均小于健康对照牙,女性平均BE值小于男性,老年组平均BE值小于中、青年组,均有统计学差异(P<0.05)。③上前牙牙根与牙槽骨长轴角度(β),中切牙角度更小,侧切牙和尖牙更偏向唇侧(P<0.05)。在570例前牙中,Ⅰ类关系(β>10°)占85%,Ⅱ类关系(0°<β<10°)占10%,Ⅲ类关系(β<0°牙根偏向牙槽骨腭侧)占0%,Ⅳ类关系占5%。结论:即刻种植前对上颌前牙美学区骨量及形态进行CT测量,可有效评估种植位点的条件,减少术后发生美学风险的概率。

PURPOSE: In this study, the risk factors that may cause aesthetic risk of the immediate implant were explored through the measurement of alveolar bone morphometry, and different classifications of the alveolar bone morphometry were summarized to provide different clinical opinions for preoperative evaluation, in order to provide a reference for preoperative evaluation and surgical selection for immediate implantation in the aesthetic area. METHODS:100 patients were included in this study who were treated in our department from 2011 to 2017. Spiral CT was used to measure the morphological parameters of the alveolar bone in maxillary aesthetic areas, including the thickness of the buccal bone, the relationship between root and socket and the distance between tip of the root and the buccal sag area.The data were classified according to age, sex, with or without periodontitis and RCT. The data were analyzed with SPSS19.0 software package. RESULTS:①Canine’s alveolar bone thickness(CD) was the greatest. The average CD value of the elderly group was smaller than that of the young and middle-aged group, and the female was smaller than the male.The average CD value of teeth with periodontitis were smaller than that of the healthy one’s( P<0.05).②Central incisors’ buccal bone in apex area(BE) was the greatest. BE of teeth with periodontitis and teeth after RCT was smaller than that of healthy teeth. Female’s BE was smaller than that of male. The elderly group’s BE was smaller than that of the young and middle-aged group(P<0.05).③The angle between the incisor axis and the alveolar bone axis(β) was smallest in central incisors area, and the lateral incisors and canines were more inclined to the labial side. The difference between the three groups was statistically significant(P<0.05). In 570 anterior teeth, class Ⅰ relationship(β>10°) accounted for about 85%,class Ⅱ relationship(0°<β<10°) accounted for about 10%, class Ⅲ relationship(β<0°) accounted for 0% and the Ⅳrelationship accounted for about 5%. CONCLUSIONS: CT measurement of the bone morphology in maxillary anterior teeth before immediate implantation can effectively evaluate the conditions of the implantation site and reduce the probability of postoperative aesthetic risk.