腭侧微种植钉在成人上颌第二前磨牙、第一磨牙间植入的安全位置分析  

Analysis of the safe zone for palatal mini-implant insertion between the maxillary second premolar and first molar in adult patients

作　　者：陈凌云 詹华勇[1] 吴志远 林毅[1] 林有籁[1] CHEN Lingyun;ZHAN Huayong;WU Zhiyuan;LIN Yi;LIN Youlai(Department of Stomatology,Provincial Clinical Medical College of Fujian Medical University,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院福建省立医院口腔科,福建福州350001

出　　处：《医学影像学杂志》2024年第10期20-24,共5页Journal of Medical Imaging

摘　　要：目的探讨运用锥形束X线计算机断层扫描系统(cone beam CT,CBCT)对成人上颌第二前磨牙(the second premolar,P2)与第一磨牙(the first molar,M1)腭根间距离(interradicular distances between palatal roots of the second premolar and the first molar,DPM)及其中点位置(themidpointofthe,MDM)与邻接面的位置关系,腭侧骨组织厚度(palatal bonethickness,PBT)和黏膜厚度(palatal mucosal thickness,PMT)以及两腭根间近远中宽度(mesiodistal width,MDW)进行测量,分析P2与M1腭侧微种植钉的最佳植入位点及植入角度。方法选取CBCT扫描的成人患者40例,以其颌骨扫描重建的CBCT资料,在P2与M1腭侧之间选取距牙槽嵴顶3.00、6.00、9.00 mm,分别测量DPM及其MDM;同时将MDM作为植入位点,模拟微种植钉与牙长轴呈30°、45°、60°、90°植入,测量植入路径的PMT和PBT及种植钉到达M1近中颊根腭平面时两根间的MDW。采用SPSS 21.0进行统计学分析数据。结果距牙槽嵴顶越远,P2与M1的DPM越大,且P2与M1的MDM均位于牙冠邻接面远中。植入位置越高,PMT越大,差异有统计学意义(P<0.001);以30°、45°、60°植入时,植入位置越高PBT越小;以90°植入时,高度越高PBT越大,差异有统计学意义(P<0.001);植入位置距离牙槽嵴顶越远,腭根间DPM越大,差异有统计学意义(P<0.05)。结论在P2与MI间腭侧,建议微种植钉于邻接面远中1.42~2.48 mm植入;距离牙槽嵴顶3.00 mm、6.00 mm位置,均不建议以90°植入微种植钉;距离牙槽嵴顶6.00 mm处,以60°植入时,建议选择直径不超过1.60 mm的微种植钉;而以45°植入时,可选择的微种植钉的种类更多;在距离牙槽嵴顶9.00 mm处,以60°植入更加安全和稳定。Objective The goal of this work was to investigate the palatal interradicular distances and the midpoints,palatal bone tissue thickness,palatal mucosal thickness and mesiodistal width of neighboring roots by using cone beam computed tomography(CBCT)in the region of maxillary palatal interradicular space between the second premolar(P2)and the first molar(M1).We analyzed and compared the difference of the measurements for better determining the optimal implantation site and insertion angle of mini-implants.Methods 40 adult patients who underwent CBCT scanning were selected as the research object for this study,and the jaw bone was reconstructed by scanning.The maxillary palatal interradicular distance between P2 and M1(DPM)was measured at 3.00,6.00 and 9.00 mm from the alveolar crest,in all,the midpoint of DPM(MDM)was marked.The palatal mucosal thickness,palatal bone tissue thickness and mesiodistal width of neighboring roots where mini�implants were touched the mesiobuccal root’s palatal side were measured when mini-implants were implanted in MDM with 30°,45°,60°and 90°angle.The data were analyzed statistically by using software of SPSS 21.0.Results The farther away from the alveolar crest,the wider the palatal interradicular distance between P2 and M1 palatal roots.Moreover,the lower away from the alveolar crest,the higher probability of touching the adjacent root.All midpoints between the P2 and M1 palatal roots were located distal in the proximity surface of the crown.The higher the implantation position,the greater the mucosal thickness,and the results showed a significant difference(P<0.001).When implanted at angle of 30°,45°,60°,the higher the implantation position,the smaller the bone tissue thickness;when implanted at 90°,the higher the height,the greater the bone tissue thickness,the difference was significant(P<0.001);the farther the implantation position from the alveolar crest,the greater the mesiodistal distance of neighboring roots,and the difference was statistically significant(P<0.05).

关 键 词：磨牙 微种植钉 体层摄影术 X线计算机 上颌腭侧 植入角度 

分 类 号：R782.1[医药卫生—口腔医学] R814.42[医药卫生—临床医学]