基于CBCT的上颌第三磨牙拔除术与上颌窦穿孔的相关性分析

doi:10.13591/j.cnki.kqyx.2022.04.009

摘要/Abstract

摘要： 目的调查分析拔除上颌第三磨牙患者的临床因素及局部多种解剖学因素对上颌窦穿孔的影响。方法选取2017年6月—2021年9月在新疆医科大学第一附属医院接受上颌第三磨牙拔除术的患者,所有患者术前均拍摄CBCT,共有1 350例。分别从年龄、性别、术前症状、阻生情况、位置、牙齿倾斜度、牙根发育度、RS分类、垂直关系、水平关系、牙根数目、牙根分叉度、牙根折断、切口、去骨等方面进行统计分析。结果多因素分析显示:牙齿部分萌出(OR=13.509)、未萌出(OR＝8.401)、牙齿近中阻生(OR=1.262)、有切口(OR=12.205)、去骨(OR=23.422)、牙根折断(OR=15.320)与上颌窦穿孔发生显著相关。牙根分叉度0°(OR=0.066)是上颌窦穿孔发生的保护因素。结论上颌第三磨牙部分萌出、未萌出、近中阻生、有切口、去骨以及牙根折断可显著增加上颌窦穿孔发生的风险,术前使用CBCT 对上颌后牙区各解剖结构间的关系充分评估,进行精确诊断和设计,可有效减少上颌窦穿孔的发生率。

关键词: 上颌第三磨牙, CBCT, 上颌窦穿孔, 相关性

Abstract: Objective To investigate and analyze clinical factors of maxillary third molar extraction and effects of various local anatomical factors on maxillary sinus perforation. Methods A total of 1 350 patients who underwent maxillary third molar extraction in the First Affiliated Hospital of Xinjiang Medical University from June 2017 to September 2021 were selected. CBCT was taken before operation. Statistical analysis was carried out from aspects of age, gender, preoperative symptoms, impaction, position, tooth inclination, root development, RS classification, vertical relationship, horizontal relationship, root number, root curvature, root furcation, incision, bone removal and so on. Results Multivariate analysis showed that partial eruption (OR=13.509), non eruption (OR=8.401), mesial impaction (OR=1.262), incision (OR=12.205), osteotomy (OR=23.422), root fracture (OR=15.320) were significantly correlated with maxillary sinus perforation. Root furcation 0° (OR=0.066) is a protective factor for maxillary sinus perforation. Conclusion Maxillary third molar partially erupted, not erupted, mesial impaction, intraoperative incision, intraoperative bone removal and root fracture can significantly increase the risk of maxillary sinus perforation. CBCT should be used to fully evaluate the relationship between anatomical structures of maxillary posterior tooth area before operation, and carry out accurate diagnosis and design, which can effectively reduce the incidence of maxillary sinus perforation.

Key words: maxillary third molar, CBCT, perforation of maxillary sinus, correlation

中图分类号:

R782.11

唐诗雨, 艾力麦尔旦·艾尼瓦尔, 马廷林, 苏庆玲, 王珊, 王玲. 基于CBCT的上颌第三磨牙拔除术与上颌窦穿孔的相关性分析[J]. 口腔医学, 2022, 42(4): 327-331.

TANG Shiyu, AILIMAIERDAN Ainiwaer, MA Tinglin, SU Qingling, WANG Shan, WANG Ling. Correlation between extraction of maxillary third molar and perforation of maxillary sinus based on CBCT[J]. Stomatology, 2022, 42(4): 327-331.

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