CBCT评价526颗上颌第二磨牙牙根根管形态及其与上颌窦的关系

doi:10.13591/j.cnki.kqyx.2024.11.005

摘要/Abstract

摘要：

目的研究上颌第二磨牙(MSM)的牙根、根管系统的解剖学特征以及根尖与上颌窦的关系。方法回顾性分析了263例患者526颗MSM的CBCT成像资料。记录并分析患者的年龄、牙根及根管数量、融合根数量、根管弯曲类型以及牙根与窦底的解剖关系。结果大多数上颌第二磨牙有3个根(59.1%)。三根三管的发生率最高(47.3%)。有192颗(36.5%)的牙齿出现牙根融合。两根两管和三根三管MSM的腭根管在颊舌方向的弯曲度大于近远中向。三根MSM的近中颊根有向上颌窦内延伸的趋势,腭根有远离上颌窦的倾向。MSM牙根到上颌窦底的距离随年龄增长而增加(P<0.05)。结论 MSM的牙根和根管形状差异较大。

关键词: 锥形束计算机断层扫描, 融合牙, 根管弯曲度, 上颌第二磨牙, 上颌窦

Abstract:

Objective To study anatomical structures of the maxillary second molars (MSM) roots and canals and the relationship between root apices and the maxillary sinus. Methods Cone beam computed tomography imaging data of 526 MSM from 263 patients were evaluated retrospectively. The patient age, number of roots and canals, number of fused roots, type of root canal curvature, and anatomical relationship to the sinus floor were all documented and analyzed. Results It was found that the majority of MSM had three roots (59.1%), and the incidence of three root canals with three roots was the highest (47.3%). Fused roots were found in 192 (36.5%) of the teeth examined. Palatal root canals of two-root, two-canal, and three-root, three-canal teeth had more curvature in the buccolingual direction than in the mesiodistal direction. The mesial buccal roots of MSM with three roots tended to extend into the maxillary sinus and the palatine roots of the three-rooted MSM tended to separate from the maxillary sinus. The distance between MSM and the sinus floor increased with age(P<0.05). Conclusion The root and canal shape of MSM varies widely among a sample of individuals.

Key words: cone beam computed tomography, fused teeth, root canal curvature, maxillary second molars, maxillary sinus

中图分类号:

R816.98

张文娟, 白希婧, 饶潇潇, 王伟, 尼娜. CBCT评价526颗上颌第二磨牙牙根根管形态及其与上颌窦的关系[J]. 口腔医学, 2024, 44(11): 824-830.

ZHANG Wenjuan, BAI Xijing, RAO Xiaoxiao, WANG Wei, NI Na. Evaluation of root and root canal morphology of 526 maxillary second molars and anatomical relationship with the sinus floor using CBCT[J]. Stomatology, 2024, 44(11): 824-830.

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牙根数	根管类型	15~岁	25~岁	35~岁	45~岁	55~岁	合计
1个根	1R1C	3(0.6)	5(0.9)	1(0.2)	2(0.4)	0	11(2.1)
	1R2C	2(0.4)	9(1.7)	4(0.8)	6(1.1)	1(0.2)	22(4.2)
	1R3C	1(0.2)	29(5.5)	11(2.1)	6(1.1)	2(0.4)	49(9.3)
	1R4C	0	2(0.4)	0	0	0	2(0.4)
2个根	2R2C	2(0.4)	5(0.9)	2(0.4)	1(0.2)	0	10(1.9)
	2R3C	14(2.7)	54(10.2)	28(5.3)	10(1.9)	3(0.6)	109(20.7)
	2R4C	0	6(1.1)	3(0.6)	0	0	9(1.7)
3个根	3R3C	47(8.9)	99(18.8)	60(11.4)	31(5.9)	12(2.3)	249(47.3)
3个根	3R4C	11(2.1)	27(5.1)	16(3.1)	8(1.5)	0	62(11.8)
4个根	4R3C	0	0	1(0.2)	0	0	1(0.2)
4个根	4R4C	0	1(0.2)	0	1(0.2)	0	2(0.4)
合计		80(15.2)	237(45.1)	126(24.0)	65(12.4)	18(3.3)	526(100.0)

根管		颊舌方向			近远中方向			P
根管		Ⅰ型	Ⅱ型	Ⅲ型	Ⅰ型	Ⅱ型	Ⅲ型	P
1R1C		5(55.6)	2(22.2)	2(22.2)	7(70.0)	1(10.0)	2(20.0)	0.820
2R2C	B(M)	8(80.0)	1(10.0)	1(10.0)	7(70.0)	1(10.0)	2(20.0)	1.000
	P(D)	2(20.0)	6(60.0)	2(20.0)	8(80.0)	2(20.0)	0(0.0)	0.033^*
3R3C	MB	-	-	-	1(0.4)	22(8.9)	225(90.7)	-
	DB	174(71.6)	48(19.8)	21(8.6)	76(30.9)	127(51.6)	43(17.5)	0.000^*
	P	99(39.8)	97(38.9)	53(21.3)	205(82.7)	32(12.9)	11(4.4)	0.000^*

牙根数	牙根位置	牙根的数目与出现频率(n(%))			合计	牙根到上颌窦底距离
牙根数	牙根位置	IS型	CO型	OS型	合计	平均值/mm	最小值至最大值/mm
1个根		26(2.0)	38(2.9)	16(1.2)	80(6.1)	-0.9±2.6	-8.0~3.9
2个根	B(M)	24(1.9)	28(2.2)	27(2.1)	79(6.2)	0.0±2.5	-6.6~8.0
	P(D)	12(0.9)	26(2.0)	42(3.2)	80(6.1)	-0.9±2.3	-4.9~6.4
3个根	MB	130(10.0)	127(9.8)	96(7.4)	353(27.2)	-0.6±2.6	-7.8~10.5
	DB	89(6.9)	136(10.5)	127(9.8)	352(27.2)	-0.4±2.4	-5.2~10.6
	P	69(5.3)	119(9.2)	165(12.7)	353(27.2)	-0.8±2.8	-6.4~10.6
合计		350(27.0)	474 (36.6)	473 (36.4)	1 297(100)	-0.2±2.6	-8.0~10.6

年龄组/岁	牙根数	牙根到上颌窦底距离/mm	P
15~	206	-0.9±2.2^a	0.000^*
25~	570	-0.2±2.4^a,b
35~	317	0.7±2.9^b,c
45~	160	1.1±2.4^c
55~	43	2.6±2.6^d

作者(年份)	样本量 (n)	地区	研究方法	1个根管/%	2个根管/%	3个根管/%	4个根管/%	5个根管/%
Olczak等(2017)^[19]	207	波兰	CBCT	1.0	3.9	70.0	23.2	-
李建华(2017)^[5]	607	中国山东	CBCT	2.31	7.41	72.32	17.96	-
Kim等(2012)^[7]	775	韩国	CBCT	3.9	8.1	56.9	30.8	0.3
Tian等(2016)^[15]	1539	中国上海	CBCT	3.2	6.1	66.4	22.9	1.4
Xia等(2020)^[22]	400	中国重庆	CBCT	1.25	11.25	61.75	25.75	-
Felsypremila等(2015)^[23]	371	印度	CBCT	2.4	7.3	38.8	50.4	0.5
Ahmed Mostafa Ghobashy等(2017)^[24]	610	埃及	CBCT	1.64	10.66	36.89	50.82	-
Mirza等(2022)^[17]	668	沙特阿拉伯	CBCT	0.6	1.5	53.3	44.3	0.3
Silva等(2014)^[25]	306	巴西	CBCT	1.96	7.84	55.88	34.31	-