牙源性上颌窦炎的锥形束CT影像学特征研究  

The radiographic features of odontogenic maxillary sinusitis on cone-beam computed tomography images

作　　者：张淬锋 李铭铭 冷迪雅 王莹[1] 荣迪 周广超[2] 孙超[2] 吴大明[1,2] ZHANG Cuifeng;LI Mingming;LENG Diya;WANG Ying;RONG Di;ZHOU Guangchao;SUN Chao;WU Daming(Jiangsu Key Laboratory of Oral Diseases,Nanjing Medical University,Department of Endodontics,the Affiliated Stomatological Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Radiology&Maxillofacial Imaging,the Affiliated Stomatological Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学口腔疾病研究江苏省重点实验室,南京医科大学附属口腔医院牙体牙髓病科,江苏南京210029 [2]南京医科大学颌面医学影像科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2021年第7期1069-1074,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省卫生计生委科研课题(H2017050)。

摘　　要：目的:分析牙源性上颌窦炎(odontogenic maxillary sinusitis,OMS)锥形束CT(cone-beam computed tomography,CBCT)图像的影像学特征。方法:收集196例OMS患者的CBCT数据,利用专用软件NNT重建和观察,对导致OMS的病因进行分析,包括病原牙/牙根的根尖周病或牙周病与上颌窦底(maxillary sinus floor,MSF)的关系、根管治疗质量、MSF的完整性、窦内黏膜增厚等,测量最大黏膜厚度和最小MSF厚度。结果:根尖周病是窦内黏膜增厚最重要的危险因素。上颌磨牙导致的OMS是前磨牙的5.21倍,且上颌第一磨牙(maxillary first molar,MFM)明显高于第二磨牙。MFM的近颊根(23.37%)和腭根(20.31%)与OMS关系最密切;MSF破坏后黏膜增厚更明显(P <0.05)。根管治疗不完善与OMS最相关,尤其是根管清理不到位(35.25%)和根管遗漏(31.15%)。在遗漏根管中,44.74%为MFM的近颊根第二根管。结论:完善的根管治疗并有效控制根尖感染、保护MSF的完整性是减少OMS发生的重要因素。Objective:To analyze the radiographic characteristics of odontogenic maxillary sinusitis(OMS)using cone-beam computed tomography(CBCT)images. Methods:CBCT data of 196 patients with OMS was collected,and was analyzed using NNT software. The etiologies of OMS and the situations of the etiologic teeth/roots were assessed,including the relationship between the radiographic periapical lesion or periodontal disease and the maxillary sinus floor(MSF),the previous endodontic therapy quality of the etiologic tooth/root,the integrity of the MSF and mucosal thickening. The maximum mucosal thickness and the minimum MSF thickness were measured. Results:Periapical lesion was the most important risk factor related to sinus mucosal thickening. Molars were 5.21 times more likely to be involved than premolars,whereas maxillary first molars(MFMs)were significantly higher than second molars(MSMs)to be involved(P < 0.05). Mesiobuccal(23.37%)and palatal roots(20.31%)of MFM were the common etiologic roots associated with OMS. The mean maximum mucosal thickness showed significant differences between destroyed and not destroyed MSF(P < 0.05). The correlation between inadequate endodontic treatment and OMS was closest,especially poor clean and obturation(35.25%)and missed canals(31.15%). Of the missed root canals,44.74% were the second mesiobuccal root canals of MFM.Conclusion:Adequate root canal treatment for effective control of apical infection and the protection of the MSF integrity are important factors for reducing the occurrence of OMS.

关 键 词：CBCT 上颌后牙 上颌窦 牙源性上颌窦炎 

分 类 号：R814.42[医药卫生—影像医学与核医学]