基于锥形束CT影像的下颌第一恒磨牙根管治疗后根分叉病变的分类研究

Classification of furcation involvement of endodontically treated mandibular first permanent molars based on cone beam CT

目的探讨基于口腔颌面锥形束CT(cone beam CT,CBCT)的下颌第一恒磨牙根管治疗后根分叉病变(furcation involvement,FI)的分类,为根分叉病变个体化治疗提供参考。方法回顾性收集就诊于南京大学医学院附属口腔医院的163例患者的164颗下颌第一恒磨牙根管治疗后根分叉病变的CBCT影像资料。根据患牙牙周及根尖周骨吸收的形态和范围,髓室底和根管侧壁剩余牙本质的厚度,结合患者全口其他牙情况,将根分叉病变分为牙周来源、根尖周来源、穿孔性因素及混合来源;并对根尖周来源根分叉病变患牙的根管充填情况进行评估。结果164颗下颌第一恒磨牙根管治疗后根分叉病变患牙中,根尖周来源的根分叉病变最多,占41.5%,其次是混合来源,占26.2%,穿孔性因素占18.3%,牙周来源占14.0%。68例根尖周来源的根分叉病变患牙中,CBCT图像显示48.5%的患牙根充良好,44.1%的患牙根充不全,7.4%的患牙超填。43例混合来源的根分叉病变患牙中,同时存在牙周来源和根尖周来源的患牙最多,占72.1%。结论CBCT可对根分叉病变进行细致的评价并进行分类,对临床治疗有指导意义。

Objective To classify the furcation involvement(FI)of endodontically treated mandibular first permanent molars based on cone beam computed tomography(CBCT),provide reference for individualized treatment of FI.Methods CBCT images of the FI of 164 endodontically treated mandibular first permanent molars from 163 patients in Nanjing Stomatological Hospital,Medical School of Nanjing University were collected retrospectively.On the CBCT images,the shape and extent of periapical and periodontitis bone resorption,the thickness of residual dentin in the pulp floor and root canal wall,and the periodontal bone resorption of the complete dentition were evaluated.The FI was classified into periodontal,periapical,perforated and mixed types.Results Among the 164 FIs of endodontically treated mandibular first permanent molars,the periapical type was the most common(41.5%),followed by the mixed type(26.2%),perforated type(18.3%),and periodontal type(14.0%).Among the 68 periapical-type FIs of endodontically treated mandibular first permanent molars,48.5%were proper root canal filling,44.1%were insufficient filling and7.4%were overfilling.Among the 43 mixed-type FIs,the periodontal mixed periapical type was the most common(72.1%).Conclusion Detailed evaluation and classification of furcation involvement could be performed using CBCT images;therefore,the study has guiding significance for clinical treatment.