下颌第一前磨牙的形态特征与根管系统解剖的相关性分析

doi:10.13591/j.cnki.kqyx.2023.07.008

摘要/Abstract

摘要：

目的研究下颌第一前磨牙在全景片(dental panoramic tomograms, DPTs)的形态特征与根管系统解剖的相关性,为临床诊疗提供参考。方法 266例种植患者拍摄全景片和锥形束CT(cone-beam computer tomography,CBCT),共计532例样本。利用CBCT根据Vertucci分类,识别根管数目和形态,Ⅰ型记为单根管,其余为复杂根管;在DPTs上测量外形长度,获取比值。分析形态特征与根管系统解剖的相关性。结果单根管与复杂根管在性别、根中1/2水平近远中径与最大近远中径比值、根管影像突然消失及消失的位置有统计学差异(P<0.05)。生成受试者工作特征(receiver operating characteristic,ROC)曲线,曲线下面积(area under curve, AUC)值为0.851,预测结果较好,诊断复杂根管的灵敏度0.765,特异度0.846。结论根管影像是否突然消失以及消失的位置、性别和根中1/2水平近远中径与最大近远中径的比值对于根管解剖复杂性判断具有实用意义。

关键词: 下颌第一前磨牙, 根管形态, 锥形束CT, 全景片, 牙齿测量

Abstract:

Objective To study the correlation between morphological features and the anatomy of the root canal of the first mandibular premolars in dental panoramic tomograms (DPTs) in order to provide reference for clinical diagnosis and treatment. Methods DPTs and cone-beam CT (CBCT) of implant patients were selected and a total of 532 samples from 266 patients were included. CBCT was used to identify the number and morphology of root canals according to Vertucci classification, and type Ⅰ was recorded as a single canal, and the rest was a complex root canal. The length on DPTs was measured to obtain the ratio. And then the correlation of morphological features with root canal anatomy was analyzed. Results There were significant differences between single and complex root canals in gender, the ratio of 1/2 horizontal mesiodistal diameter in the root to maximum mesiodistal diameter, the sudden disappearance of root canal images and their location (P<0.05). The receiver operating characteristic (ROC) curve was generated with an AUC value of 0.851. The sensitivity for diagnosing complex canals was 0.765 and the specificity was 0.846. Conclusion Whether and where root canal images suddenly disappear, gender and the ratio of 1/2 horizontal mesiodistal diameter in the root to maximum mesiodistal diameter are of practical significance for determining the anatomical complexity of root canals.

Key words: mandibular first premolar, root canal morphology, cone-beam computer tomography, dental panoramic tomogram, tooth measurement

中图分类号:

R322.41

徐青清, 王宇萌, 李梦圆, 张悦蓉, 徐海, 江飞, 张光东. 下颌第一前磨牙的形态特征与根管系统解剖的相关性分析[J]. 口腔医学, 2023, 43(7): 625-632.

XU Qingqing, WANG Yumeng, LI Mengyuan, ZHANG Yuerong, XU Hai, JIANG Fei, ZHANG Guangdong. Correlation analysis of morphological features with root canal anatomy of mandibular first premolars[J]. Stomatology, 2023, 43(7): 625-632.

图/表 7

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图2

图3

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表1

单根管和复杂根管相关临床参数和影像参数的单因素分析表"

变量	分类项	总计(n=532)	单根管 (n=396)	复杂根管 (n=136)	统计量	P
牙位, n(%)	左	266(50.000)	192(48.485)	74(54.412)	1.422	0.233
	右	266(50.000)	204(51.515)	62(45.588)
性别, n(%)	女	256(48.120)	200(50.505)	56(41.176)	5.182	0.023^*
	男	276(51.880)	196(49.495)	80(58.824)
年龄, n(%)	16~25	130(24.436)	92(23.232)	38(27.941)	2.262	0.688
	26~35	118(22.180)	87(21.970)	31(22.794)
	36~45	106(19.925)	79(19.949)	27(19.853)
	46~55	94(17.669)	71(17.929)	23(16.912)
	>55	84(15.789)	67(16.919)	17(12.500)
根尖影像是否变化, n(%)	否	355(66.729)	325(82.071)	30(22.059)	164.22	<0.001^*
	是	177(33.271)	71(17.929)	106(77.941)
CMDD-1/3, M(Q1, Q3)		1.644(1.494,1.819)	1.633(1.491,1.815)	1.686(1.517,1.828)	-1.454	0.146
CMDD-1/2,M(Q1, Q3)		1.438(1.333,1.564)	1.421(1.325,1.545)	1.473(1.362,1.609)	-2.841	0.005^*
CMDD-2/3, M(Q1, Q3)		1.249(1.182,1.320)	1.244(1.178,1.310)	1.286(1.186,1.354)	-2.726	0.006^*
1/2-1/3,M(Q1, Q3)		1.138(1.089,1.199)	1.139(1.093,1.201)	1.134(1.080,1.190)	1.261	0.207
2/3-1/2,M(Q1, Q3)		1.143(1.103,1.201)	1.141(1.102,1.197)	1.149(1.104,1.207)	-0.632	0.528
2/3-1/3,M(Q1, Q3)		1.307(1.234,1.394)	1.309(1.237,1.396)	1.294(1.232,1.387)	0.971	0.332
RL/CL, M(Q1, Q3)		1.764(1.563,1.945)	1.771(1.563,1.952)	1.754(1.575,1.908)	0.643	0.521
CL/MMDD, $\bar{x}±s$		1.024±0.117	1.029±0.120	1.010±0.108	1.622	0.105
1/3-MMDD,M(Q1, Q3)		0.474(0.423,0.524)	0.481(0.423,0.528)	0.464(0.423,0.513)	1.615	0.106
1/2-MMDD,M(Q1, Q3)		0.542(0.485,0.597)	0.547(0.487,0.605)	0.514(0.480,0.573)	2.700	0.007^*
2/3-MMDD, M(Q1, Q3)		0.622(0.563,0.683)	0.628(0.566,0.687)	0.605(0.561,0.660)	2.604	0.009^*
CMDD/MMDD, M(Q1, Q3)		0.781(0.729,0.830)	0.785(0.729,0.838)	0.773(0.726,0.821)	1.458	0.145
DL/RL, M(Q1, Q3)		0.264(0.148,0.372)	0.235(0.101,0.316)	0.377(0.283,0.464)	-6.036	<0.001^*
MDD/BLD, M(Q1, Q3)		0.896(0.861,0.932)	0.896(0.863,0.931)	0.895(0.860,0.939)	0.104	0.918

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参考文献 30

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参数	B	SE	Z	P	Odds Ratio	Lower	Upper
DL/RL	3.334	0.89	3.745	0.000^*	28.057	5.024	166.172
1/2-MMDD	-4.370	1.518	-2.878	0.004^*	0.013	0.001	0.235
根尖影像是否变化:是	2.302	0.276	8.339	0.000^*	9.998	5.888	17.425
性别:男	0.579	0.254	2.276	0.023^*	1.785	1.089	2.958
常量	0.837	1.361	0.615	0.538	2.310	0.162	34.120