牙周炎患者上颌磨牙区剩余牙槽嵴高度和上颌窦黏膜厚度变化的影响因素分析

doi:10.13591/j.cnki.kqyx.2026.08.003

摘要/Abstract

摘要：

目的探究影响牙周炎患者上颌磨牙区剩余牙槽嵴高度(residual ridge height,RRH)及上颌窦黏膜厚度(maxillary sinus mucosal thickness,MT)变化的相关因素。方法回顾性分析200例牙周炎患者(共742颗上颌磨牙)的临床及锥形束CT(CBCT)资料,分析磨牙是否缺失、牙槽骨吸收程度、上颌窦黏膜(maxillary sinus mucosa,MSM)增厚情况、观察期间接受的治疗、RRH初始值、MT初始值及患者性别、年龄对RRH和对应部位MT变化的影响。结果 742颗上颌磨牙的RRH变化量为(-0.30±1.27)mm,变化速率为(-0.05±0.24)mm/月;MT变化量为(-0.42±3.55)mm,变化速率为(-0.06±0.61)mm/月。牙槽骨吸收<根中1/3(P=0.010)和观察期间牙周基础治疗(P=0.006)与RRH变化量正相关,初始RRH(P<0.001)和MSM增厚(P=0.007)与RRH变化量负相关;牙槽骨吸收<根中1/3(P=0.009)和观察期间牙周基础治疗(P=0.042)与RRH变化速率正相关,初始RRH(P<0.001)和观察期间患牙拔除(P=0.010)与RRH变化速率负相关。初始MT(P<0.05)和观察期间牙周基础治疗后拔除患牙(P<0.05)与MT变化量和变化速率负相关。结论观察期间,牙周炎患者上颌磨牙区RRH及MT变化总体呈下降趋势。牙周基础治疗有利于减少牙周炎患者上颌磨牙区牙槽骨吸收,恢复因炎症增厚的MSM;拔牙会促进牙槽骨吸收。

关键词: 牙周炎, 上颌磨牙区, 上颌窦, CBCT, 线性回归

Abstract:

Objective To investigate the factors influencing changes in residual ridge height (RRH) and maxillary sinus mucosal thickness (MT) in the maxillary molar region of patients with periodontitis. Methods A retrospective analysis was conducted on clinical and cone beam computed tomography(CBCT) data from 200 patients with periodontitis (742 maxillary molars). Factors analyzed included molar loss status, severity of alveolar bone loss, maxillary sinus mucosa (MSM) thickening, treatments received during the observation period, baseline RRH and MT, as well as patients’ gender and age, to evaluate their effects on changes in RRH and corresponding MT. Results The mean change in RRH among the 742 maxillary molars was (-0.30±1.27) mm, with a rate of (-0.05±0.24) mm/month. The mean change in MT was (-0.42±3.55) mm, with a rate of (-0.06±0.61) mm/month. Alveolar bone loss less than the middle third of the root (P=0.010) and initial periodontal therapy during the observation period (P=0.006) were positively correlated with RRH change, whereas baseline RRH (P<0.001) and thickened MSM (P=0.007) were negatively correlated. Alveolar bone loss less than the middle third of the root (P=0.009) and initial periodontal therapy during the observation period (P=0.042) were positively correlated with the rate of RRH change, while baseline RRH (P<0.001) and tooth extraction during the observation period (P=0.010) were negatively correlated. Baseline MT (P<0.05) and tooth extraction after initial therapy during the observation period (P<0.05) were negatively correlated with both the magnitude and rate of MT change. Conclusion During the observation period, both RRH and MT in the maxillary molar region of patients with periodontitis showed an overall decreasing trend. Initial periodontal therapy may reduce alveolar bone loss and promote recovery of inflamed, thickened MSM, whereas tooth extraction has been clearly shown to accelerate alveolar bone loss.

Key words: periodontitis, maxillary molar region, maxillary sinus, cone beam computed tomography, linear regression

中图分类号:

R781.4

山轶凡, 张恒致, 张宇航, 朱宪昕, 江飞, 卢伟. 牙周炎患者上颌磨牙区剩余牙槽嵴高度和上颌窦黏膜厚度变化的影响因素分析[J]. 口腔医学, 2026, 46(8): 574-581.

SHAN Yifan, ZHANG Hengzhi, ZHANG Yuhang, ZHU Xianxin, JIANG Fei, LU Wei. Analysis of factors influencing changes in residual ridge height and maxillary sinus mucosal thickness in the maxillary molar region of patients with periodontitis[J]. Stomatology, 2026, 46(8): 574-581.

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参考文献 36

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自变量	赋值
性别	男为0,女为1
牙槽骨吸收程度	牙槽骨吸收≥根中1/3为0,牙槽骨吸收<根中1/3为1
磨牙是否缺失	是为0,否为1
MSM增厚情况	正常为0,增厚为1

类别	n(%)
磨牙是否缺失
是	106(14.3)
否	636(85.7)
牙槽骨吸收程度
牙槽骨吸收≥根中1/3	234(31.5)
牙槽骨吸收<根中1/3	508(68.5)
MSM增厚情况
正常	406(54.7)
增厚	336(45.3)
观察期间接受的治疗
无处理	282(38.0)
牙周基础治疗	358(48.2)
患牙拔除	64(8.6)
牙周基础治疗后拔除患牙	38(5.2)

因素	单因素		多因素
因素	β(95%CI)	P	β(95%CI)	P
常量			0.189(-0.394,0.773)	0.524
性别	-0.043(-0.266,0.180)	0.707
男
女
年龄	-0.013(-0.022,-0.005)	0.002^**	-0.006(-0.015,0.002)	0.162
间隔时间	-0.002(-0.020,0.016)	0.836
磨牙是否缺失	0.096(-0.207,0.398)	0.535
是
否
牙槽骨吸收程度	0.426(0.201,0.651)	<0.001^***	0.359(0.086,0.632)	0.010^*
牙槽骨吸收≥根中1/3
牙槽骨吸收<根中1/3
MSM增厚情况	-0.225(-0.437,-0.014)	0.037^*	-0.428(-0.740,-0.116)	0.007^**
正常
增厚
初始RRH	-0.040(-0.065,-0.014)	0.002^**	-0.047(-0.073,-0.022)	<0.001^***
初始MT	-0.005(-0.028,0.018)	0.664
观察期间接受的治疗
无处理
牙周基础治疗	0.347(0.125,0.569)	0.002^**	0.314(0.090,0.538)	0.006^**
患牙拔除	-0.567(-0.954,-0.180)	0.004^**	-0.199(-0.640,0.241)	0.374
基础治疗后拔除患牙	-0.102(-0.596,0.392)	0.686	0.179(-0.360,0.718)	0.515

因素	单因素		多因素
因素	β(95%CI)	P	β(95%CI)	P
常量			0.071(-0.042,0.184)	0.216
性别	0.004(-0.040,0.048)	0.851
男
女
年龄	-0.003(-0.005,-0.001)	0.001^**	-0.001(-0.003,0.001)	0.096
磨牙是否缺失	-0.006(-0.066,0.053)	0.834
是
否
牙槽骨吸收程度	0.098(0.054,0.142)	<0.001^***	0.070(0.018,0.123)	0.009^**
牙槽骨吸收≥根中1/3
牙槽骨吸收<根中1/3
MSM增厚情况	-0.057(-0.106,-0.007)	0.024^*	-0.027(-0.068,0.014)	0.197
正常
增厚
初始RRH	-0.009(-0.014,-0.004)	0.001^**	-0.010(-0.015,-0.005)	<0.001^***
初始MT	-0.001(-0.005,0.004)	0.702
观察期间接受的治疗
无处理
牙周基础治疗	0.054(0.011,0.097)	0.002^**	0.045(0.002,0.088)	0.042^*
患牙拔除	-0.181(-0.256,-0.106)	<0.001^***	-0.112(-0.197,-0.027)	0.010^*
基础治疗后拔除患牙	-0.018(-0.114,0.078)	0.716	-0.029(-0.076,0.133)	0.052

因素	单因素		多因素
因素	β(95%CI)	P	β(95%CI)	P
常量			1.581(0.871,3.076)	0.038^*
性别	0.669(-0.017,1.354)	0.056
男
女
年龄	-0.033(-0.059,-0.006)	0.015^*	-0.018(-0.043,0.008)	0.183
间隔时间	-0.012(-0.067,0.042)	0.657
磨牙是否缺失	-0.487(-1.420,0.446)	0.306
是
否
牙槽骨吸收程度	0.583(-0.120,1.286)	0.104
牙槽骨吸收≥根中1/3
牙槽骨吸收<根中1/3
MSM增厚情况	-1.873(-2.504,-1.242)	<0.001^***	-0.607(-1.375,0.160)	0.120
正常
增厚
初始RRH	0.062(-0.018,0.141)	0.129
初始MT	-0.248(-0.314,-0.183)	<0.001^***	-0.188(-0.269,-0.107)	<0.001^***
观察期间接受的治疗
无处理
牙周基础治疗	-0.394(-1.089,0.302)	0.266	-0.249(-0.927,0.429)	0.471
患牙拔除	-1.408(-2.628,-0.196)	0.023	-0.669(-1.841,0.504)	0.263
基础治疗后拔除患牙	-2.600(-4.144,-1.056)	0.001^**	-1.614(-3.114,-0.113)	0.035^*