锥形束CT对后牙根尖周炎骨病损的评价作用  

The application of cone-beam computed tomography in diagnosing the lesions of apical periodontitis of posterior teeth

作　　者：马兰[1] 詹福良[1] 仇丽鸿[1] 薛明[1] 

机构地区：[1]中国医科大学附属口腔医院牙体牙髓病科,辽宁沈阳110002

出　　处：《上海口腔医学》2012年第4期442-446,共5页Shanghai Journal of Stomatology

基　　金：辽宁省教育厅高校科研计划(2008856)~~

摘　　要：目的:以锥形束CT(cone-beam computed tomography,CBCT)为标准,评价X线片在诊断后牙根尖周炎骨病损中的作用。方法:收集门诊同时拍摄X线片和CBCT图像的病例80例,共106颗后牙,包括前磨牙和磨牙各53颗,其中健康牙58颗,临床诊断为慢性牙髓炎11颗,诊断为慢性根尖周炎34颗(含8颗根管治疗后的患牙),根管治疗后表现正常的牙3颗。由2名有经验的医师对CBCT图像及X线片进行判读,确定根尖周指数(periapical index,PAI)分级。采用SPSS13.0软件包对所得数据进行χ2检验。结果:分别对106颗疑似患牙的CBCT图像与X线片进行判读,根尖周炎的检出率分别为59.4%和39.6%,差异有显著性(χ2=8.32,P<0.01)。X线片为二维影像,其结构重叠产生伪影,使病变范围界限不清,而CBCT三维图像则对病损范围有明确的显示,有利于疾病的诊断与治疗。另外,X线片不能表现CBCT显示的骨皮质破坏情况。结论:CBCT图像诊断根尖周炎比X线片更有临床价值,可展现X线片无法显示的细节,对疾病的破坏范围和相关结构毗邻显示更清楚,从而准确划分根尖周炎的分级,为临床正确诊断以及科学制定治疗计划提供有效的依据。PURPOSE： To evaluate the effect of periapical radiography in diagnosing the lesions of the apical periodontitis（AP） of posterior teeth,with CBCT imaging as a standard.METHODS： One hundred and six posterior teeth in 80 patients were examined by periapical radiography and CBCT,which consisted of healthy teeth（58 teeth）,chronic pulpitis（11 teeth）,chronic apical periodontitis（34 teeth）,remnant teeth with normal apical images after root canal therapy（3 teeth）.All images were measured and evaluated by two experienced dentists by using periapical index（PAI） to ensure the classifications.The results were analyzed statistically with SPSS 13.0 software package for χ2 test.RESULTS： AP was identified in 39.6% and 59.4% of 106 cases by radiography and CBCT,the difference was significant（χ2=8.32,P〈0.01）.The use of conventional radiography for detection of AP should be done with care because of the great possibility of artifacts which might lead to misdiagnosis.Because of its accuracy,CBCT is more useful for clinic diagnosis and therapy.Furthermore,the images of CBCT could show destruction of cortical bone that couldn’t detect by periapical radiography.CONCLUSIONS： CBCT is more accurate than periapical radiography for AP diagnosis.CBCT can reveal the details of the lesions and adjacent structures and provide correct clinical diagnosis and scientific treatment planning with accurate evidence.

关 键 词：锥形束CT 慢性根尖周炎 PAI 

分 类 号：R781.34[医药卫生—口腔医学]