上颌磨牙重度牙周炎对上颌窦的影响及牙周炎相关上颌窦炎的治疗原则

Effect of severe periodontitis of maxillary molars on the maxillary sinus and the treatment principles of periodontitis related maxillary sinusitis

上颌窦位于上颌骨内,在所有鼻窦中容积最大,且与上颌后牙牙根距离最近,尤其是上颌第二磨牙的近中颊根。正常上颌窦黏膜厚度约1 mm,当其受到刺激或感染后,表现出黏膜增厚。牙周炎是人类最常见的口腔疾病之一,而上颌磨牙复杂的牙根解剖形态加剧了炎症控制的难度,且未得到有效治疗的上颌磨牙重度牙周炎可累及上颌窦,可使上颌窦黏膜增厚,亦是导致牙源性上颌窦炎发生的原因之一。上颌磨牙重度牙周炎引起的牙源性上颌窦炎的治疗,有诸多不同方案,拔除无保留价值的重度牙周炎患牙以及成功的牙周治疗均可使上颌窦黏膜厚度显著减小;而对于药物治疗和消除牙源性病因仍无法控制以及鼻窦炎症状严重的感染者,则可通过牙周治疗和鼻窦内镜手术联合治疗,使牙周炎相关上颌窦炎得到有效控制。

Maxillary sinus is located in the maxilla bone with the largest volume in all sinuses and is closest to the roots of maxillary posterior teeth,especially the mesiobuccal root of the maxillary second molar.The thickness of the normal maxillary sinus mucosa is about 1 mm.When stimulated or infected,it shows thickening of the mucosa.Periodontitis is one of the most common oral diseases in human beings,and the complex root anatomy of the maxillary molars aggravates the difficulty of inflammation control.Severe periodontitis of maxillary molars without effective treatment can affect the maxillary sinus,increasing the possibility of the mucosa thickening,and is also one of the reasons for the occurrence of odontogenic maxillary sinusitis(OMS).There are many different schemes for the treatment of OMS caused by severe periodontitis of maxillary molars.Extraction of teeth with severe periodontal disease without retention value or successful periodontal treatment can significantly reduce the thickness of maxillary sinus mucosa.For the patients with uncontrollable sinusitis by using drug treatment and eliminating odontogenic causes,or ones with severe symptoms,periodontal treatment and endoscopic sinus surgery can be combined to effectively control the periodontitis related maxillary sinusitis.