基于CBCT的上颌中切牙区高位埋伏多生牙的分型及定位拔除

Classification and localization extraction of high-impacted supernumerary teeth in maxillary esthetic area based on CBCT

目的:研究利用锥形束CT(cone beam computed tomography,CBCT)对上颌中切牙区高位埋伏多生牙的分型及定位拔除方法。方法:应用CBCT检查320例上颌切牙区高位埋伏多生牙,根据其与相邻中切牙的关系,可分为高位唇侧向、腭侧向、垂直向、水平向埋伏多生牙。测量不同类型多生牙冠部距唇侧、腭侧、鼻底的牙槽骨骨质厚度,比较其差异。根据分型及测量结果选择手术入路方式,包括唇侧入路、鼻底下入路与腭侧入路,并定位去骨位置及去骨量。结果:320例上颌中切牙区高位唇侧向、腭侧向、垂直向、水平向埋伏多生牙距唇侧、鼻底、腭侧的牙槽骨厚度差异有统计学意义。其中唇侧入路101例、鼻底下入路29例、腭侧入路190例,术后无恒牙松动、坏死及创腔感染等并发症发生。结论:应用CBCT检查高位埋伏多生牙,并将其分为高位唇侧向、腭侧向、垂直向、水平向这些类型,不同类型多生牙距唇侧、腭侧、鼻底的骨厚度有差异,由此确定手术入路及定位去骨位置可减少邻牙损伤及去骨量。

Objective:To study the classification and localization extraction of high-impacted supernumerary teeth in maxillary esthetic area based on cone beam computed tomography(CBCT).Methods:A total of 320 cases of high-impacted supernumerary teeth in maxillary esthetic area were examined by CBCT.According to their relationship with adjacent central incisors,they were classified as high-impacted labial,high-impacted palatal,high-impacted vertical,and high-impacted horizontal teeth.The thicknesses of the alveolar bone of different types of supernumerary from crowns to labial sides,palatal sides,and nasal floors were measured and statistically compared.Based on the typing and measuring results,extraction approaches were determined,which included labial approach,palatal approach,and nasal floor approach.Also,the location and the amount of bone resection were determined.Results:Among the 320 patients,the thickness of the alveolar bone varied at different types.On the extraction approaches,101 had labial approach,29 had nasal floor approach,and 190 had palatal approach.No complications such as permanent tooth loosening,necrosis,or wound cavity infection were observed.Conclusion:CBCT is effective in identifying and categorizing different types of high-impacted supernumerary teeth.There are differences in bone thickness between different types of supernumerary teeth on the labial sides,palatal sides,and nasal floors.These findings are beneficial to determining the extraction approach and the position of bone resection,which can reduce damage of adjacent teeth and amount of bone resection.