基于CBCT骨微参数与骨阻力分析辅助下颌第三磨牙微创拔除

doi:10.13591/j.cnki.kqyx.2024.09.005

摘要/Abstract

摘要：

目的锥形束CT(cone-beam computed tomography,CBCT)结合CTAn软件辅助下颌第三磨牙拔除术骨阻力分析的可行性研究。方法选取我院口腔科2021年1月1日至2023年7月31日因第三磨牙阻生拍摄CBCT患者共53例,91颗下颌第三磨牙。CTAn处理CBCT图像获取下颌第三磨牙颊、舌侧骨体积区域,进行骨三维微结构参数分析。结果总样本和分层分析(下颌第三磨牙近中倾斜阻生与垂直阻生、性别分组),颊、舌侧总骨组织体积、骨小梁体积/总骨组织体积,骨组织表面积/骨小梁体积,骨组织表面积/总骨组织体积,骨密度之间的差异均有统计学意义(P<0.05)。高、中位近中倾斜阻生、垂直阻生分组中,女性下颌第三磨牙颊、舌侧骨三维微结构参数差异与男性相比更显著。结论 CBCT结合CTAn 辅助下颌第三磨牙拔除术骨阻力分析可行,舌侧总骨体积小于颊侧,但舌侧骨单位体积内骨组织含量更多,骨小梁更致密。下颌第三磨牙拔除过程中挤压颊侧牙槽骨容易获得骨小梁压缩间隙、磨除颊侧牙槽骨相对舌侧容易、从而实现合理的牙根颊侧脱位。高、中位近中倾斜阻生、垂直阻生四种类型,女性患者拔除下颌第三磨牙时,更应遵循颊侧路径。通过骨微参数及精准骨阻力分析,对于阻生齿微创拔除有指导意义。

关键词: 下颌第三磨牙, CBCT, CTAn, 牙微创拔除术骨阻力分析

Abstract:

Objective To study the possibility of using cone-beam computed tomography(CBCT)with CTAn software to analyze bone resistance during mandibular third molar extraction surgery. Methods Fifty-three patients who underwent CBCT scans for third molars at the Department of Stomatology from January 1st 2021 to July 31th 2023 were induded, involving a total of 91 mandibular third molars. CTAn software was used to analyze the buccal and lingual bone volume regions around mandibular third molars in CBCT images, assessing three-dimensional bone microstructural parameters. Results Significant differences(P<0.05)in tissue volume, trabecular bone volume/tissue volume, bone surface/trabecular bone volume, bone surface/tissue volume, and bone mineral density between the buccal and lingual bone volume areas were observed in both the total sample and in stratified analyses based on themesially inclined/verticalmandibular third molar impactionand gender. In high/mid-level mesially inclined and vertical impactions, females showed more significant differences in microstructural parameters of the buccal and lingual bone volume compared to males. Conclusion The integration of CBCT with CTAn software offers a viable method for assessing bone resistance during mandibular third molar extractions. Lingual bone exhibits greater bone tissue content, denser trabeculae with smaller tissue volume compared to buccal bone. During mandibular third molar extraction, compressing the buccal alveolar bone helps create trabecular compression space more easily.Additionally, the buccal alveolar bone is more amenable to grinding than the lingual side, thereby achieving a reasonable buccal dislocation of root. For female patients with high/mid-level mesially inclined and vertical impactions of the mandibular third molars, a buccal approach is more advisable to be followed. The evaluation of bone microstructural parameters and accurate determination of bone resistance offer valuable insights for the minimally invasive removal of impacted teeth.

Key words: mandibular third molar, CBCT, CTAn, analysis of bone resistance in tooth minimally invasive extraction surgery

中图分类号:

R782.11

孙皖苏, 吴辰一, 查楚萍, 洪礼琳, 张亨国. 基于CBCT骨微参数与骨阻力分析辅助下颌第三磨牙微创拔除[J]. 口腔医学, 2024, 44(9): 663-669.

SUN Wansu, WU Chenyi, ZHA Chuping, HONG Lilin, ZHANG Hengguo. CBCT-based analysis of bone microparameters and bone resistance in the minimally invasive extraction of mandibular third molars[J]. Stomatology, 2024, 44(9): 663-669.

图/表 5

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