锥形束CT测量成人上颌前磨牙根尖与上颌窦位置关系及其对即刻种植的影响

Measurement of the relationship between maxillary premolar roots and the maxillary sinus floor using cone beam CT and analysis of the impact on immediate implantation

摘要

目的 分析上颌前磨牙牙根与上颌窦空间位置关系，为该位点即刻种植时机、方案、术式及种植体选择等提供解剖依据。方法 本研究已通过单位伦理委员会审查批准，并获得患者知情同意。收集2017年1月-2023年3月瑞华口腔门诊部就诊的264例患者（年龄20~65岁）口腔锥形束CT（cone beam CT，CBCT）影像，选取冠状面测量上颌前磨牙根尖到上颌窦下壁的最短距离，对牙根与上颌窦下壁的垂直关系分类，并就双侧、性别及不同年龄组进行比较。结果 上颌前磨牙根尖至上颌窦下壁最短距离：上颌第一前磨牙单根型中位数为7.34 mm，双根型颊根中位数为7.80 mm，腭根中位数为7.36 mm；上颌第二前磨牙单根型中位数为2.56 mm，双根型中颊根中位数为1.73 mm，腭根中位数为1.23 mm。上颌第二前磨牙右侧单根型根尖至上颌窦下壁间最短距离在各年龄组间有统计学差异（P<0.05），20~29岁组最小（中位数1.52 mm），≥ 40岁组最大（中位数4.44 mm）。性别和左右侧对根尖到窦下壁距离的影响无统计学差异（P>0.05）。上颌前磨牙根尖与上颌窦垂直关系中，根尖不与上颌窦下壁接触的情况占比最高，垂直关系分类在单根型和双根型间无统计学差异（P>0.05）。结论 上颌第一前磨牙根方大多可为即刻种植提供足够高度骨量，较易实现即刻种植；上颌第二前磨牙根方骨量不足常见，需充分利用拔牙窝骨壁或窦底皮质骨实现初期稳定性；根尖与窦下壁垂直关系分型分布受年龄及牙位影响，青年组较其他年龄组更易出现骨高度不足，需谨慎选择即刻种植适应证；牙根数量对牙根与上颌窦垂直关系影响不大，双根型因牙根直径小及根间骨性分隔，可为即刻种植提供更多骨支持。

Abstract

Objective To analyze the spatial relationship between the roots of maxillary anterior premolars and the maxillary sinus, thus providing an anatomical basis for timing, planning, surgical approaches, and implant selection at this site. Methods Cone beam CT (CBCT) images were collected from 264 patients (aged 20-65 years) who visited the Ruihua Dental Clinic between January 2017 and March 2023. The minimum distance from the apex of the maxillary anterior premolar roots to the lower wall of the maxillary sinus was measured on the coronal plane. The classification of the vertical relationship between the tooth root and the lower wall of the maxillary sinus was performed, and comparisons were made bilaterally, between genders, and among different age groups. Results The minimum distance (Q₅₀) from the apex of the first maxillary premolar root to the lower wall of the maxillary sinus was 7.34 mm for the single-root type, 7.80 mm for the buccal root of the double-root type, and 7.36 mm for the palatal root. For the second maxillary premolar, the median distance was 2.56 mm for the single root type, 1.73 mm for the buccal root type, and 1.23 mm for the palatal root type. There was a significant difference in the shortest distance from the apex of the right second maxillary premolar single root to the lower wall of the maxillary sinus among the different age groups (P<0.05), with the 20-29-year-old group having the smallest median distance (1.52 mm) and the ≥ 40-year-old group having the largest (4.44 mm). There was no significant difference in the effect of sex or laterality on distance (P>0.05). The most common vertical relationship between the apex of the maxillary anterior premolar roots and the lower wall of the maxillary sinus was noncontact. There was no significant difference in the vertical relationship classification between the single-root and double-root types (P>0.05). Conclusion Most maxillary first premolar roots can provide sufficient bone height, which makes it easy to achieve immediate implantation. The maxillary second premolar root frequently involves insufficient bone, which is necessary to make full use of the bone wall of the extraction socket or the sinus floor cortical bone to achieve initial stability. The vertical relationship between the premolar root and maxillary sinus was influenced by age and dental position. Younger age groups often exhibit inadequate bone height, and the indication for immediate implantation should be carefully considered. The number of roots does not significantly affect the relationship between the sinus and root; however, double-rooted premolars offer more support for immediate implantation and socket healing due to the small root diameter and bony separation between the roots.

关键词

上颌前磨牙 / 上颌窦 / 牙根 / 锥形束CT / 最短距离 / 牙根数量 / 垂直关系 / 即刻种植

Key words

maxillary premolars / maxillary sinus / root / cone beam CT / the shortest distance / the number of roots / vertical relationship / immediate implant