下颌第二磨牙近中阻生的局部牙列及颌骨形态的三维分析

doi:10.13591/j.cnki.kqyx.2023.11.008

摘要/Abstract

摘要：

目的通过CBCT三维测量比较下颌第二磨牙近中阻生患者与非阻生患者下颌第二磨牙区域牙列及颌骨形态的差异,分析下颌第二磨牙近中阻生患者的局部牙列及下颌骨形态特征。方法选取下颌第二磨牙近中阻生与非阻生患者总计148例,共分为三组,第一组(G1):下颌第二磨牙单侧阻生患者(50例);第2组(G2):双侧阻生患者(48例);第3组(G3):对照组(50例)。收集患者治疗前的CBCT影像,共测量15个指标并进行统计学分析,其中牙性指标10个,骨性指标5个。结果单侧及双侧阻生患者下颌第二磨牙牙冠长度、宽度均大于对照组,而萌出间隙颌骨高度均小于对照组;双侧阻生患者萌出间隙长度及宽度均显著小于单侧阻生患者;单侧阻生患者萌出间隙长度及高度均小于非阻生侧(P<0.05)。结论下颌第二磨牙近中阻生患者下颌第一磨牙、第二磨牙牙冠相对较大;下颌第二磨牙近中阻生患者萌出间隙不足,且双侧阻生较单侧萌出间隙不足更为严重,而下颌第三磨牙的存在及性别差异与下颌第二磨牙近中阻生无显著关联。

关键词: 下颌第二磨牙阻生, 下颌骨形态, 三维测量

Abstract:

Objective To investigate the morphological differences of localized dentition and mandible between patients with mesio-impacted mandibular second molars(MM2) and non-impacted patients in three dimensions and analyze the morphological characteristics. Methods A total of 148 patients who underwent cone-beam computed tomography(CBCT) were included and divided into three groups. Group 1(G1) included 50 patients with unilaterally mesio-impacted MM2; group 2(G2) was composed of 48 patients with bilaterally mesio-impacted MM2, and group 3(G3) was made up of 50 age- and gender-matched controls. Fifteen measurements were selected, including 10 dental measurements and 5 bony measurements. Results The length and width of MM2 were significantly higher in G1 and G2 than in G3, while the height of localized mandibular bone was smaller in G1 and G2. The length and width of localized mandibular bone were statistically smaller in patients with bilaterally impacted MM2 than those with unilaterally impacted MM2. The length and height of localized mandibular bone on unilaterally impacted side were smaller than those on the non-impacted side(P<0.05). Conclusion The crown of MM1 and MM2 were larger in patients with mesio-impacted MM2. The eruption space of MM2 was insufficient, and the space in bilaterally impacted area was narrower than in unilaterally impacted area. Besides, the presence of the mandibular third molar and gender were not significantly associated with mesial impaction of the mandibular second molar.

Key words: impacted mandibular second molar, mandibular morphology, three dimensional measurement

中图分类号:

R783.5

周志捷, 洪越扬, 许衍. 下颌第二磨牙近中阻生的局部牙列及颌骨形态的三维分析[J]. 口腔医学, 2023, 43(11): 1008-1013.

ZHOU Zhijie, HONG Yueyang, XU Yan.

Three dimensional analysis of localized dentition and mandibular morphology in patients with mesio-impacted mandibular second molars

[J]. Stomatology, 2023, 43(11): 1008-1013.

图/表 4

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指标	定义
牙性指标
L6	下颌第一磨牙牙冠长度——近远中接触点之间的距离
W6	下颌第一磨牙牙冠宽度——过近远中接触点线段中点(O点)并垂直于该线段的颊舌向距离
L7	下颌第二磨牙牙冠长度
W7	下颌第二磨牙牙冠宽度
∠6-7	下颌第一磨牙和下颌第二磨牙牙体长轴之间的夹角
∠7-MR	下颌第二磨牙牙体长轴和下颌升支长轴之间的夹角
L6-7	下颌第一磨牙O点与下颌第二磨牙O点到Z平面的距离之差
H6-7	下颌第一磨牙O点与下颌第二磨牙O点到X平面的距离之差
W6-Y	下颌第一磨牙O点到Y平面的距离
W7-Y	下颌第二磨牙O点到Y平面的距离
骨性指标
L6-MR	下颌第一磨牙O点与下颌升支前缘转折点(MR点)到Z平面的距离之差
L7-MR	下颌第二磨牙O点与下颌升支前缘转折点(MR点)到Z平面的距离之差
L7-B	下颌第二磨牙萌出间隙长度——下颌第一磨牙远中牙槽嵴顶到下颌升支前缘转折点之间的距离
W7-B	下颌第二磨牙萌出间隙宽度——取L7-B线段的中垂线与颊舌侧牙槽嵴顶两个交点之间的距离
H7-B	过下颌第二磨牙O点作下颌平面Go-Me垂线反向延长线与牙槽嵴顶和下颌下缘的两个交点之间的距离

指标	单侧阻生(G1)	双侧阻生(G2)	对照组(G3)	F/Welch	P	P
指标	单侧阻生(G1)	双侧阻生(G2)	对照组(G3)	F/Welch	P	G1 vs. G3	G2 vs. G3	G1 vs. G2
牙性指标
L6/mm	10.53±0.55	10.60±0.54	10.36±0.47	5.55	0.004^*	0.053	0.001^*	0.461
W6/mm	9.05±0.50	9.00±0.44	8.68±0.39	18.17	0.000^*	0.000^*	0.000^*	0.481
L7/mm	10.47±0.61	10.58±0.69	10.17±0.55	11.00	0.000^*	0.005^*	0.000^*	0.338
W7/mm	8.95±0.58	8.85±0.54	8.57±0.50	11.26	0.000^*	0.000^*	0.000^*	0.289
∠6-7/(°)	47.73±21.38	45.18±18.36	10.65±5.43	217.93	0.000^*	0.000^*	0.000^*	0.856
∠7-MR/(°)	65.81±15.94	65.48±14.66	36.42±7.73	196.41	0.000^*	0.000^*	0.000^*	0.999
L6-7/mm	8.06±2.17	8.16±1.62	10.45±0.87	92.55	0.000^*	0.000^*	0.000^*	0.991
H6-7/mm	2.35±3.44	2.24±3.51	-2.34±1.54	99.31	0.000^*	0.000^*	0.000^*	0.997
W6-Y/mm	21.74±1.87	21.69±1.92	21.64±1.77	0.07	0.936	0.724	0.830	0.861
W7-Y/mm	24.90±1.97	25.30±2.18	24.74±1.85	1.93	0.147	0.654	0.054	0.256
骨性指标
L6-MR/mm	14.92±3.15	13.60±2.84	15.02±2.86	6.65	0.002^*	0.846	0.001^*	0.010^*
L7-MR/mm	6.86±3.73	5.44±3.40	4.56±3.13	7.79	0.001^*	0.000^*	0.069	0.017^*
L7-B/mm	18.00±1.68	17.26±1.43	18.61±1.04	28.27	0.000^*	0.068	0.000^*	0.027^*
W7-B/mm	15.00±0.91	15.51±1.00	15.63±1.06	6.83	0.001^*	0.000^*	0.397	0.004^*
H7-B/mm	21.94±2.22	22.39±2.42	24.68±2.52	30.81	0.000^*	0.000^*	0.000^*	0.287

测量值	阻生侧	非阻生侧	Z	P
牙性指标
L6/mm	10.53±0.55	10.38±0.42	-2.59	0.010^*
W6/mm	9.05±0.50	9.10±0.51	-1.01	0.311
L7/mm	10.47±0.61	10.28±0.56	-2.57	0.010^*
W7/mm	8.95±0.58	8.88±0.44	-1.00	0.315
∠6-7/(°)	47.73±21.38	14.72±10.36	-5.91	0.000^*
∠7-MR/(°)	65.81±15.94	33.89±14.80	-5.97	0.000^*
L6-7/mm	8.06±2.17	10.61±1.90	-5.36	0.000^*
H6-7/mm	2.35±3.44	-1.93±1.34	-5.98	0.000^*
W6-Y/mm	21.74±1.87	21.88±1.70	-0.50	0.619
W7-Y/mm	24.90±1.97	25.40±2.17	-0.97	0.334
骨性指标
L6-MR/mm	14.92±3.15	15.44±3.42	-0.91	0.363
L7-MR/mm	6.86±3.73	4.82±3.50	-4.59	0.000^*
L7-B/mm	18.00±1.68	18.33±1.65	-3.14	0.002^*
W7-B/mm	15.00±0.91	15.07±0.96	-0.56	0.577
H7-B/mm	21.94±2.22	23.15±2.38	-4.46	0.000^*