CBCT分析上颌磨牙牙根及其牙槽嵴顶与上颌窦底壁的位置关系

A cone-beam computed tomography study on relationship between the root and the alveolar ridge crest of maxillary molars and maxillary sinus floor

目的利用CBCT分析上颌第一、第二磨牙各牙根根尖及其牙槽嵴顶与上颌窦底壁位置关系,为临床诊断和治疗提供可靠的参考依据。方法选取大连医科大学口腔医学院附属口腔医院锥形束CT(CBCT)数据库中初诊180例,分为6~12岁、13~18岁和19~35岁三组,每组各60例。利用CBCT测量上颌第一、第二磨牙各牙根根尖与上颌窦底壁的距离、上颌磨牙牙槽嵴顶与上颌窦底壁距离,分别进行左右两侧与性别差异对比,记录上颌第一、第二磨牙各牙根根尖与上颌窦底壁的位置关系分型,并进行统计学分析。结果上颌第一磨牙在6~12岁组距离上颌窦底壁平均距离最短的为近颊根(1.21±3.09)mm,13~18岁组根尖均在上颌窦内,19~35岁组的腭根为(0.41±2.73)mm;上颌第二磨牙在13~18岁组与19~35岁组距离上颌窦底壁平均距离最短的均为近颊根,为(0.36±2.37)mm和(0.43±2.21)mm。随着年龄增长,牙槽嵴顶至上颌窦底壁的平均距离逐渐降低(P<0.05)。水平关系中,上颌第一磨牙13~18岁组、19~35岁组牙根根尖至根分叉区域观察到上颌窦最常见;垂直关系中,6~12岁组与19~35岁组中第一磨牙、13~18岁组的第二磨牙三个牙根都没有接触上颌窦底壁的情况最常见。结论上颌第一、第二磨牙与上颌窦底壁联系密切,建议在开展临床治疗前应用CBCT,对于上颌后区解剖位置关系的分析和降低上颌窦并发症发生率具有积极意义。

Objective To evaluate the relationship between the root and alveolar ridge crest of the first and second maxillary molars and maxillary sinus floor by cone-beam computed tomography(CBCT), and to provide reliable reference for clinical diagnosis and treatment. Methods One hundred and eighty cases were selected from the CBCT database of the Affiliated Stomatological Hospital, School of Stomatology, Dalian Medical University, and divided into three groups(6-12 years old, 13-18 years old and 19-35 years old), with 60 cases in each group. CBCT was used to measure distance between each root apex of the first and second maxillary molars and maxillary sinus floor, distance between the alveolar ridge crest and the maxillary sinus floor. Comparison was conducted between different sides and genders respectively. Classification of the vertical relationship between each root of the first and second maxillary molars and the maxillary sinus floor was recorded and statistical analysis was carried out. Results In 6-12 age group, average distance between the mesiobuccal root of the first maxillary molar and the maxillary sinus floor((1.21±3.09) mm) was the shortest among the maxillary roots. In 13-18 age group, the apices were all in the maxillary sinus. In 19-35 age group, the palatal root was((0.41±2.73) mm). In 13-18 and 19-35 age groups, average distances between the mesiobuccal root of the second maxillary molar and the maxillary sinus floor(0.36±2.37) mm and(0.43±2.21) mm both were the shortest among the maxillary roots. The average distance between the alveolar ridge crest and the maxillary sinus floor decreased with ages(P<0.05). In the horizontal relationship, in all age groups, the maxillary sinus was most frequently observed at the level of root apices to root furcation in 13-18 age group and 19-35 age group. In the vertical relationship, in all age groups, the most common condition was that all three root apices were not in contact with the maxillary sinus floor of the first molar in 6-12 age group and 19-35 age group, and the second molar in 13-18 age group. Conclusion The first and second maxillary molars are closely related to maxillary sinus floor. It is suggested that CBCT should be applied before clinical treatment, which has positive significance for analyzing anatomical position of the posterior maxillary region and reducing incidence of maxillary sinus complications.