应用锥形束CT对种植区牙槽骨质量分类方法的改良研究

Improved classification of alveolar bone quality in implant area by cone beam CT

目的 应用锥形束CT(cone beam CT,CBCT)测量种植区牙槽骨质量并结合Lekholm和Zarb分类法对骨质量分类方法进行改良,以期为提高牙槽骨质量分类的准确性提供指导。方法 选择2015年10月至2017年10月在呼和浩特市口腔医院种植科进行种植修复的196例患者术前CBCT影像资料,应用Invivo5诊断设计软件测量306个种植位点的牙槽骨皮质骨厚度和松质骨密度(皮质骨与松质骨的CT值差值),以Lekholm和Zarb分类法为基础结合测量数据对骨质量进行改良后的量化分类。结果 牙槽骨皮质骨厚度为0.18~2.89 mm,中位数为0.92 mm。皮质骨与松质骨的CT值差值为88.5~667.8 HU,应用百分位数法找到33.3%和66.6%对应的数值分别为297.8 HU和356.1 HU。依据此数据结合Lekholm和Zarb分类法将196例患者的306个种植位点骨质量分为4类,其中Ⅰ类骨种植位点46个(占15.0%),Ⅱ类骨104个(占34.0%),Ⅲ类骨114个(占37.3%),Ⅳ类骨42个(占13.7%)。结论 结合Lekholm和Zarb分类法,应用CBCT测量种植区牙槽骨质量并进行分类方法的改良,可为临床医生术前评估牙槽骨质量提供一定参考。

Objective To measure the alveolar bone quality in planting area by using cone beam CT(CBCT),and through combination with Lekholm and Zarb classification method to improve the classification method of bone quality with the aim of providing guidance for improving the accurary of classification of alveolar bone quality. Methods Select preoperative CBCT imaging data of 196 patients with dental implants admitted to the Implant Department of Hohhot Stomatological Hospital from October 2015 to October 2017. The thickness of alveolar cortical bone and the difference between cortical bone and cancellous bone CT values at 306 implant sites were measured by invivo5 diagnostic design software;based on Lekholm and Zarb classification methods and measurement data,quantitative classification of bone quality was improved. Results Cortical thickness ranged from 0.18 mm to 2.89 mm,with a median of 0.92 mm. CT values of cortical bone mineral density(BMD)and cancellous BMD ranged from 88.5 HU to 667.8 HU,and the percentile method was used to find that 33.3% and 66.6% corresponded to 297.8 HU and 356.1 HU,respectively. According to these data and through combination with Lekholm and Zarb classification,bone quality was divided into four categories,in which type Ⅰ bone accounted for 46(15.0%),type Ⅱ 104(34.0%),type Ⅲ114(37.3%),and type Ⅳ 42(13.7%). Conclusion Combined with Lekholm and Zarb classification methods,CBCT is used to measure the bone quality of alveolar bone in planting areas and to improve the classification method,which can provide some reference for clinical doctors to evaluate bone quality before operation.