基于口腔全景片和锥形束CT多生牙发病状况及形态特点的分析

Analysis of the disease status and morphological characteristics of patients with polydontia based on oral panorama and conical beam CT

目的基于口腔全景片和锥形束CT(CBCT)探讨多生牙患者发病状况及特点。方法横断面研究。2017年8月—2021年7月江南大学附属中心医院行口腔全景片检查的患者共35541例,其中男14460例、女21081例,年龄3~97(43.3±18.6)岁;纳入其中确诊为多生牙的患者1343例,其中男708例、女635例,年龄3~95(42.3±18.8)岁。1343例患者中,同时行CBCT检查者64例。观察项目:(1)根据年龄将患者分为<20岁、20~<40岁、40~<60岁、60~<80岁、≥80岁5个年龄段,统计多生牙的总体发生情况,比较不同性别间及不同年龄段多生牙的发生情况;(2)比较不同性别间多生牙的类型、位置、生长方向的差异;(3)在CBCT上观察不同类型多生牙及邻牙萌出受阻、邻牙牙根吸收、含牙囊肿等并发症的影像学特点,并比较不同性别间并发症发生情况的差异。结果(1)35541例患者中,发现多生牙1343例(1667颗),发生率3.8%;其中男性发生率为4.9%(708/14460),女性发生率为3.0%(635/21081);男女患病比例为1.1∶1(708∶635)。1343例1667颗多生牙,存在1颗多生牙的患者最多为1084例,4颗多生牙的患者最少为14例,不同性别间多生牙数的差异无统计学意义(χ^(2)=0.83,P=0.842)。不同年龄段组不同性别间多生牙占比比较,差异有统计学意义(χ^(2)=17.08,P=0.002)。(2)1667颗多生牙中,不同类型多生牙的占比由高到低男性依次为圆锥型38.0%(353/929)、磨牙型29.2%(271/929)、牙瘤样型19.5%(181/929)、切牙型13.3%(124/929),女性依次为圆锥型42.3%(312/738)、牙瘤样型27.5%(203/738)、磨牙型20.2%(149/738)、切牙型10.0%(74/738);多生牙的位置,男性、女性均最常发生于上颌,且均以上颌中切牙区占比最大[49.7%(462/929)、29.2%(216/738)];多生牙的生长方向,男性正常方向占比最大29.2%(271/929)、其次为倾斜方向24.5%(228/929),而女性以倾斜方向占比最大28.5%(210/738)、其次为正常方向26.8%(198/738)。不同性别间多生牙的类型、位置、生长方向构成比差异均有统计学意义(P值均<0.001)。(3)64例多生牙患者CBCT检查发现多生牙84颗,其中圆锥型44颗,CBCT显示牙冠宽度大于牙颈宽度,牙冠呈锥形;磨牙型24颗,CBCT显示有𬌗面,𬌗面向内凹陷,呈沟状;切牙型9颗,CBCT显示牙冠呈楔形,牙颈部最厚,向切端逐渐变薄;牙瘤样型7颗,CBCT显示许多小型牙齿状结构彼此密切适应,并由一个或多或少完整的连接囊结合在一起。CBCT显示邻牙萌出受阻4颗、邻牙牙根吸收23颗、邻牙含牙囊肿16颗,邻牙萌出受阻、邻牙牙根吸收、邻牙含牙囊肿的总发生率51.2%(43/84),不同性别间多生牙邻牙萌出受阻、邻牙牙根吸收、邻牙含牙囊肿等并发症发生率比较,差异均无统计学意义(P值均>0.05)。结论多生牙的总发生率为3.8%,多生牙的发生率和多生牙的特点存在性别、年龄的差异。

Objective This study aimed to investigate the incidence status and characteristics of patients with supernumerary teeth on the basis of oral panoramic radiographs and cone beam CT(CBCT).Method This study was a cross-sectional study.A total of 35541 patients,including 14460 males and 21081 females aged 3-97(43.3±18.6)years,who underwent oral panoramic radiographs at Jiangnan University Medical Center from August 2017 to July 2021,were included.Among them,1343 patients,including 708 males and 635 females aged 3-95(42.3±18.8)years,with a confirmed diagnosis of supernumerary teeth were included.Simultaneous CBCT was performed in 64 of the 1343 patients.Observational items:(1)Based on age,patients were divided into five age groups:<20 years,20-<40 years,40-<60 years,60-<80 years,and≥80 years.The overall occurrence of supernumerary teeth was statistically compared between different genders and the occurrence of supernumerary teeth among different age groups and between different genders.(2)Differences in the type,location,and growth direction of supernumerary teeth between different ages and senders were compared.(3)The radiographic characteristics of different types of supernumerary teeth and complications,such as disturbed eruption of the adjacent teeth,root resorption of the adjacent teeth,and dentigerous cysts,were observed on CBCT,and the differences in the occurrence of complications between different genders were compared.Results(1)Among the 35541 patients,1343(1667)were found to have supernumerary teeth,with an incidence of 3.8%.Among them,4.9%(708/14460)occurred in men and 3.0%(635/21081)occurred in women.The male-to-female ratio was 1.1∶1(708∶635).Of the 1343 patients with 1667 supernumerary teeth,those with one supernumerary tooth presented the most(1084 patients),whereas those with four supernumerary teeth presented the least(14 patients),and no significant difference was found in the number of supernumerary teeth between different genders(χ^(2)=0.83,P=0.842).Meanwhile,significant differences were observed in the proportion of supernumerary teeth of different genders among different age groups(χ^(2)=17.08,P=0.002).(2)Among the 1667 supernumerary teeth,the percentage order of different types of supernumerary teeth in males from high to low was as follows:conical type,38.0%(353/929);molar type,29.2%(271/929);odontoma type,19.5%(181/929);and incisor type,13.3%(124/929).In females,the order from high to low was as follows:conical type,42.3%(312/738);odontoma type,27.5%(203/738);molar type,20.2%(149/738);and incisor type,10.0%(74/738).The supernumerary teeth were most frequently located in the upper jaw of both genders,and all had the largest percentage of the maxillary central incisor area[49.7%(462/929),29.2%(216/738)].For the growth direction of supernumerary teeth,males had the largest proportion of normal direction at 29.2%(271/929),followed by oblique direction at 24.5%(228/929).Meanwhile,females had the largest proportion of oblique direction at 28.5%(210/738),followed by normal direction at 26.8%(198/738).Significant differences were found on the type,location,and growth direction composition ratio of supernumerary teeth between genders(all P values<0.001).(3)CBCT was performed in 64 cases,and supernumerary teeth were found in 64 cases(84),of which 44 had conical type.CBCT showed that the width of the crown was larger than the width of the neck,and the crowns were tapered.For molar type(24 teeth),CBCT showed an occlusal surface with the occlusal facing inward concavity and sulcus-like shape.For incisor type(nine teeth),CBCT showed a wedge-shaped crown with the thickest neck and gradual thinning towards the incisal end.For odontoma type(seven teeth),CBCT revealed numerous small tooth-like structures closely adapted to one another and united by a more or less complete connective capsule.CBCT also revealed four disturbed eruptions,23 resorptions of adjacent roots,and 16 dentigerous cysts.While the overall incidence of any disturbed eruption,root resorption of adjacent teeth,and dentigerous cyst was 51.2%(43/84),no significant difference could be seen in any of the incidence of complications,such as disturbed eruption of supernumerary teeth,root resorption of adjacent teeth,and dentigerous cyst between genders(all P values>0.05).Conclusion The overall incidence of supernumerary teeth is 3.8%,and age and gender differences are found in the incidence of supernumerary teeth and the characteristics of supernumerary teeth.