目的 通过对400例成人上前牙区CBCT图像进行测量统计，了解上前牙区种植相关解剖因素，为美学区种植提供参考。 方法 筛选纳入400例患者CBCT图像，测量唇、腭侧不同位点的骨量并探索上前牙根和牙槽骨的位置关系。 结果 唇侧骨壁厚度在根尖处较厚，在唇侧牙槽嵴顶下2 mm处较薄，在根中1/2处最薄,唇侧牙槽嵴顶下2 mm和根中1/2处骨壁厚度>1 mm所占比率在中切牙至尖牙分别为37%、30%；31%、27%；56%、34%。腭侧骨壁厚度自牙槽嵴顶向根方递增，根方骨量>5 mm所占比率在中切牙至尖牙分别为94%、82%、97%。中切牙至尖牙相对于牙槽骨的位置关系分型Ⅰ、Ⅱ、Ⅲ、Ⅳ型分别为79.5%、10.5%、1.0%、2.0%；72.0%、14.5%、3.0%、5.0%；83.0%、5.5%、0.0%、0.5%。Ⅰ亚类（根尖区唇侧骨板厚度图像精度上难以分辨）各牙位占比分别为7.0%、5.5%、11.0%。 结论 上前牙区唇侧嵴顶及根中处骨板厚度普遍很薄，绝大多数位点骨厚度<1 mm，根中1/2厚度最小；腭侧骨壁厚度自嵴顶向根方递增。上前牙根和牙槽骨多数属于Ⅰ类位置关系，为美学区即刻种植提供有利解剖位置，但I亚类的位置，因唇侧骨壁菲薄并可能缺损，提示种植手术前对植骨方式的更多考量。
Abstract
Objective To have a better understanding of the anatomical factors related to the anterior dental implants through measurement and analysis of CBCT images of 400 adult anterior dental regions, , so as to provide reference for implant in aesthetic. Methods CBCT images of 400 patients were selected and enrolled in this study. The bone thickness at different sites of the labial and palate were measured and the positional relationship between the root of the upper anterior teeth and the alveolar bone was explored. Results The labial bone wall thickness was thicker at the apex of the root, thinner at 2 mm below the crest of the labial alveolar side and the thinnest at 1/2 the mid- root. The percentage of bone wall thickness > the proportion of 1mm in the in central incisor teeth to cuspid teeth was 37%, 30%; 31%, 27%; and 56%, 34%, respectively. The thickness of palatal bone showed an increasing tend from the crest of alveolar to the root. The proportion of root bone mass > the proportion of 5 mm in the in central incisor teeth to cuspid teeth was 94%, 82% and 97%, respectively. The position relationship of central incisor teeth, cuspid teeth and alveolar bone was classified as Type Ⅰ, Ⅱ, Ⅲ and Ⅳ. Type Ⅰ, Ⅱ, Ⅲ and Ⅳ were 79.5%, 10.5%, 1.0%, 2.0%; 72.0%, 14.5%, 3.0%, 5.0%; 83.0%, 5.5%, 0.0%, 0.5%, respectively. Subtype I: (it was difficult to distinguish the thickness of the labial bone plate in the accuracy images) the proportion of each tooth position was 7.0%, 5.5%, 11.0%, respectively. Conclusions The thickness of bone plate at the crest of labial alveloar and the mid-root of anterior dental area is generally thin, and the thickness of alveolar bone in most sites was less than 1mm. The labial bone wall thickness in the mid-root is the minimum. The palatal bone wall thickness showed an increasing tend from the crest of alveolar to the root. The position relationship between maxillary anterior root and alveolar bone is mostly type I, which provides a favorable anatomical position for immediate implantation in the aesthetic area, but the location of subtype I, due to the thin labial bone wall and possible defect, suggesting that more consideration should be given to the way of bone grafting before implantation.
关键词
上前牙区 /
/
/
CBCT /
/
/
解剖 /
/
/
骨壁厚度
Key words
Anterior dental region /
/
/
Cone Beam CT /
/
/
/
Anatomy /
/
/
Bone wall thickness
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 马悦, 宋珂.美学区即刻种植共识化流程的探讨[J].口腔医学研究, 2021, 37(10):879-882. DOI: 10.13701/j.cnki.kqyxyj.2021.10.003.
[2] Ferrus J, Cecchinato D,Pjetursson EB,et al. Factors influencing ridge alterations following immediate implant placement into extraction sockets[J].Clin Oral Implants Res, 2010, 21(1):22-29. DOI: 10.1111/j.1600-0501.2009.01825.x.
[3] Buser D, Martin W, Belser UC. Optimizing aesthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations [J]. Int J Oral Maxillofac Implants, 2004,19(Suppl ):43-61. PMID: 15635945.
[4] Blanes RJ, Bernard JP, Blanes ZM, et al. A 10-year prospective study of ITI dental implants placed in the posterior region. II: Influence of the crown-to-implant ratio and different prosthetic treatment modalities on crestal bone loss[J]. Clin Oral Implants Res, 2007,18(6):707-714. DOI: 10.1111/j.1600-0501.2006.01307.x.
[5] Kheur MG, Kantharia NR, Kheur SM, et al. Three-dimensional evaluation of alveolar bone and soft tissue dimensions of maxillary central incisors for immediate implant placement: A cone-beam computed tomography assisted analysis[J]. Implant Dent, 2015, 24(4):407-415. DOI: 10.1097/ID.0000000000000259.
[6] Kan JY, Rungcharassaeng K. Immediate placement and provisiona lization of maxillary anterior single implants: a surgical and prosthodontic rational[J]. Pract Periodontics Aesthet Dent, 2000,12(9):817-824. PMID: 11405020.
[7] Wang HM, Shen JW, Yu MF, et al. Analysis of facial bone wall dimensions and sagittal root position in the maxillary esthetic zone: A retrospective study using cone beam computed tomography[J]. Int J Oral Maxillofac Implants, 2014, 29(5):1123-1129. DOI: 10.11607/jomi.3348.
[8] Fuentes R, Flores T, Navarro P, et al. Assessment of buccal bone thickness of aesthetic maxillary region: a cone-beam computed tomography study[J]. J Periodontal Implant Sci, 2015, 45(5):162-168. DOI: 10.5051/jpis.2015.45.5.162.
[9] Nowzari H, Molayem S, Chiu CHK, et al. Cone beam computed tomographic measurement of maxillary central incisors to determine prevalence of facial alveolar bone width≥2mm[J]. Clin Implant Dent Relat Res, 2012,14(4):595-602. DOI:10.1111/j.1708-8208.2010.00287.x.
[10] 沈建伟, 何福明, 江巧红, 等. 上颌前牙与前磨牙唇侧骨壁厚度的CBCT测量分析 [J]. 浙江大学学报, 2012, 41(3):234-238. DOI: 10.3785/j.issn.1008-9292.2012.03.002.
[11]Braut V, Bornstein MM, Belser U, et al. Thickness of the anterior maxillary facial bone wall-a retrospective radiographic study using cone beam computed- tomography[J]. Int J Periodontics Restorative Dent, 2011,31(2):125-131. PMID: 21491011.
[12]Chan HL, Garaicoa-Pazmino C, Suarez F, et al Incidence of implant buccal plate fenestration in the esthetic zone: a cone beam computed tomography study[J]. Int J Oral Maxillofac Implants, 2014, 29(1):171-177. DOI: 10.11607/jomi.3397.
[13]Chung MP, Wang IC, Chan HL, et al. Evaluation of Buccal Bone Concavity in the Esthetic Zone: A Cadaver Study.[J].Implant Dent, 2017, 26(5):751-755. DOI: 10.1097/ID.0000000000000661.
[14]Hubar JS. Quantification of the lamina dura[J]. J Can Dent Assoc,1993, 59(12): 997-1000. PMID: 8275394.
[15]Gluckman H, Pontes CC, Du Toit J. Radial plane tooth position and bone wall dimensions in the anterior maxilla: A CBCT classification for immediate implant placement[J]. J Prosthet Dent, 2018,120(1):50-56. DOI: 10.1016/j.prosdent. 2017.09.005.
[16]Buser D, Wittneben J, Bornstein MM, et al. Stability of contour augmentation and esthetic outcomes of implant-supported single crowns in the esthetic zone: 3-year results of a prospective study with early implant placement postextraction[J]. J Periodontol, 2011, 82(3):342-349. DOI:10.1902/jop.2010.100408.
[17]Evans CD, Chen ST. Esthetic outcomes of immediate implant placements[J]. Clin Oral Implants Res, 2008,19(1):19-73. DOI: 10.1111/j.1600-0501.2007.01413.x.
[18]Suaid FA, Novaes AB Jr, Queiroz AC, et al. Buccal bone plate remodeling after immediate implants with or without synthetic bone grafting and flapless surgery: a histomorphometric and fluorescence study in dogs[J]Clin Oral Implants Res, 2014, 25(2):e10-e21. DOI: 10.1111/clr.12036.
[19] 孙亮, 杨苗苗, 赵佳明,等. 上前牙区即刻种植与早期种植术后软硬组织变 化的短期临床观察[J]. 中华口腔医学杂志, 2020, 55(11):857-863. DOI：10.3760/cma.j.cn112144-20200610-00328.
基金
河北省自然科学基金资助项目（H2021206165）；河北省政府专科能力建设和带头人培养项目（361029）
PDF(2437 KB)
京ICP备08002354号-3
