跨下牙槽神经种植相关解剖结构的影像学测量及分析研究  

Radiological measurement and analysis of trans-inferior alveolar nerve implantation

作　　者：刘金明 吴雯丽 杜令仪 沈铭 LIU Jinming;WU Wenli;DU Lingyi;SHEN Ming(Jiangsu Key Laboratory of Oral Disease,Nanjing 210029,China)

机构地区：[1]江苏省口腔疾病研究重点实验室,江苏南京210029 [2]南京医科大学附属口腔医院综合诊疗科,江苏南京210029 [3]江苏省口腔转化医学工程研究中心,江苏南京210029

出　　处：《口腔医学》2023年第2期130-134,共5页Stomatology

基　　金：国家自然科学基金青年基金(81400535);江苏省自然科学基金面上项目(BK20221302);江苏省高校优势学科建设工程(PAPD,2018-87)。

摘　　要：目的 通过锥形束CT影像数据测量下颌第二磨牙处下颌神经管位置,分析跨下牙槽神经种植术的理论植入范围,为临床上使用该方法解决下颌后牙区种植骨量不足问题提供理论依据。方法 选取80例下颌第二磨牙缺失且缺牙区垂直骨高度<9 mm的患者CBCT图像,测量该处下颌神经管到颊侧骨皮质、舌侧骨皮质、牙槽嵴顶距离,并模拟跨下牙槽神经种植,测量种植体颊舌向倾斜的角度范围。结果 下颌第二磨牙处下颌神经管到颊侧骨皮质、舌侧骨皮质、牙槽嵴顶的距离分别是(6.913±1.222)、(2.859±0.891)、(7.991±0.783)mm,下颌神经管到颊侧骨皮质距离明显大于到舌侧骨皮质距离。75%的患者可行跨下牙槽神经种植术,模拟植入种植体颊舌向倾斜最小角度为19.360°±7.086°,最大角度为39.462°±6.924°。结论 下颌第二磨牙处下颌神经管明显偏向舌侧,保障了颊侧足够的骨量,多数下颌第二磨牙处无法垂直植入短种植体的患者仍可通过跨下牙槽神经种植术植入常规长度种植体。Objective To measure the position of the mandibular nerve canal at the mandibular second molar by CBCT image data, analyze the theoretical implantation range of trans-alveolar implantation, and provide a theoretical solution to insufficiency of posterior mandibular bone volume in clinical practice. Methods Eighty patients with missing mandibular second molars whose vertical bone height of the edentulous area was less than 9 mm were selected for CBCT image measurement, and the distances from the mandibular nerve canal to the buccal cortex, lingual cortex, and alveolar crest were measured to simulate trans-inferior alveolar nerve implantation. The angular range of the buccolingual inclination of the implant was also measured. Results The distances from the mandibular nerve canal to the buccal cortex, lingual cortex and alveolar crest at the mandibular second molar were(6.913±1.222)mm,(2.859±0.891)mm and(7.991±0.783)mm, respectively. The distance from the mandibular nerve canal to the buccal cortex was significantly greater than that to the lingual cortex. And, 75% of the patients could be implanted by the inferior alveolar nerve. The minimum angle of buccolingual inclination of the simulated implant was 19.360°±7.086°, and the maximum angle was 39.462°±6.924°. Conclusion The mandibular nerve canal at the mandibular second molar is inclined toward the lingual side, which ensures sufficient buccal bone volume. Most patients with severe mandibular atrophy can still adopt implants of conventional length by trans-inferior alveolar nerve implantation to keep a safe distance from the nerve canal.

关 键 词：下颌第二磨牙 跨下牙槽神经种植 CBCT 牙槽骨萎缩 

分 类 号：R783.4[医药卫生—口腔医学]