【作者】 张岩；

【导师】 徐欣；

【作者基本信息】 山东大学 ， 口腔临床医学， 2013， 硕士

【摘要】 目的：应用锥体束CT(Cone-Beam Computed Tomography, CBCT)对不同垂直骨面型成人后牙区下颌骨内下颌神经管的三维位置进行测量分析,探讨不同垂直骨面型人群的下颌神经管在后牙区下颌骨内分布的空间差异,为临床正畸治疗时种植支抗和牙齿缺失时种植体的选用提供参考依据,避免手术时因对下颌管解剖位置的不清楚伤及下齿槽血管(IAV)和下齿槽神经(IAN)。材料和方法：按照标准随机抽取2011年12月—2013年2月在山东省口腔医院门诊部就诊并拍摄CBCT的具有完整下颌牙列的男女患者各45例,年龄19—40岁(排除严重错颌畸形、半侧颜面萎缩、下颌部外伤、肿瘤、一二鳃弓综合征、外科正畸整形治疗等明显颜面部不对称的患者；排除乳牙滞留者；排除影响骨骼功能和发育的疾病,如类风湿性关节炎；排除牙周疾病,如有重度牙周炎导致的骨质吸收,使牙槽骨高度与厚度降低等、排除下颌后牙区使用金属修复体者)。将CBCT扫描资料进行回顾性分析并合成头颅侧位片,根据眶耳平面与下颌平面角(FH-MP角)、后面高与前面高之比(S-Go/N-Me)、垂直向异常指数(ODI),将其分为高角组、均角组、低角组,其中男性高角者15例,均角者19例,低角者11例；女性高角者14例,均角者20例,低角者11例。选取下领磨牙所在的下领骨的冠状截面进行相关数据测量：(1)后牙区各牙齿(第三磨牙除外)牙槽嵴顶至下领管上壁距离(MA)。(2)下领神经外侧缘到颊侧骨板外缘距离(MB)。(3)下领神经管内侧缘到舌侧骨板外缘距离(ML)。每个距离测量3次,均由同一人员测量,取三次平均值。将研究对象的所有数据输入SPSS16.0软件对测量值进行统计学分析,利用配对t检验分析、单因素方差分析、组间多重比较等方法,分析不同垂直骨面型成年男女后牙区各牙位处下颌神经管颊舌侧骨板厚度的差异以及下颌管上壁至牙槽嵴顶距离(MA)的差异,并探讨不同垂直骨面型与下颌管在后牙区下颌骨内的三维位置测量参数之间的相关关系。结果：1.男女不同性别两组下颌骨后牙区各牙槽嵴顶至下颌管上缘距离(MA)、下颌管内侧缘到舌侧骨板的距离(ML)、下颌管外侧缘到颊侧骨板的距离(MB)无明显差异,无统计学意义(P>0.05)。2.下颌骨左右两侧各组测量数据结果经比较没有显著性差异,无统计学意义(P>0.05)。因此本研究只选用样本人员左侧下颌骨后牙区内下颌管的相关测量数据进行分析比较(单位mm)。3.高角组、均角组和低角组的下颌骨后牙区各牙槽嵴顶至下颌管上缘(MA)距离在第一前磨牙处男性高角组17.52,均角组18.01,低角组18.23；女性高角组16.46,均角组16.53,低角组16.93。第二前磨牙处男性高角组17.96,均角组18.43,低角组19.07；女性高角组17.16,均角组17.53,低角组18.23。第一磨牙处男性高角组17.56,均角组18.35,低角组19.10；女性高角组16.84,均角组17.71,低角组18.11。第二磨牙处男性高角组16.23,均角组17.54,低角组18.32；女性高角组15.93,均角组16.81,低角组17.21。将各组数据进行分析比较,在第二前磨牙和第一、二磨牙处P<0.05,差异有统计学意义。高角组、均角组和低角组的下颌管内侧缘到舌侧骨板(ML)的距离在第一前磨牙处男性高角组4.22,均角组4.64,低角组5.04；女性高角组4.17,均角组4.58,低角组5.01。第二前磨牙处男性高角组4.82,均角组5.04,低角组5.21；女性高角组4.66,均角组4.98,低角组5.14。第一磨牙处男性高角组2.12,均角组2.27,低角组2.44；女性高角组2.08,均角组2.25,低角组2.38。第二磨牙处男性高角组1.58,均角组1.72,低角组1.96；女性高角组1.48,均角组1.67,低角组1.90。将各组数据进行分析比较,P>0.05,差异无统计学意义。高角组、均角组和低角组的下颌管外侧缘到颊侧骨板(MB)的距离在第一前磨牙处男性高角组1.13,均角组1.35,低角组1.74；女性高角组1.12,均角组1.28,低角组1.64。第二前磨牙处男性高角组4.82,均角组5.21,低角组5.64；女性高角组4.62,均角组4.88,低角组5.24。第一磨牙处男性高角组6.48,均角组6.76,低角组7.28；女性高角组6.26,均角组6.62,低角组7.18。第二磨牙处男性高角组5.46,均角组5.96,低角组6.52；女性高角组5.36,均角组6.01,低角组6.44。将各组数据进行分析比较,P>0.05,差异无统计学意义。结论：1.下颌管上壁至牙槽嵴顶距离,无论男女还是高角或低角均呈第二前磨牙向后到第二磨牙逐渐减小趋势。2.随着下颌平面角(FH-MP角)的逐渐增大,即低角→高角,下颌骨磨牙区各牙槽嵴顶至下颌管上缘(MA)距离会逐渐减小,成负相关关系。由此可知在临床进行牙种植手术和正畸种植支抗时,高角患者要比低角患者面临风险大一些,高角患者的下颌管更容易受到损伤。更多还原

【Abstract】 Objective:The purpose of this study is to measure the three-dimensional structure of the mandibular canal in the mandibular posterior for adult men and women with the different vertical skeletal patterns by using cone-beam computed tomography (CBCT), in order to find the difference of the mandibular canal in the mandibular, which can provide reference for the clinical medicine, that would avoid to hurt the inferior alveolar nerve and the inferior alveolar vessels.Materials and Methods:From December2011to February2013,45female and45male patients with CBCT examination were chosen from the patients who have all the teeth in the mandible accepted the cone-beam computed tomography (CBCT) in Department of Orthodontic of school of Stomatology of Shandong University, aged from19to40years old,{get rid of the patients who have serious malocclusion, hemifacial atrophy, mandibular trauma, tumor, one or two branchial arch syndrome, surgical orthodontic surgery treatment; excluding the adult retained deciduous teeth; eliminate the effect of skeletal function and development of diseases, such as rheumatoid arthritis; exclusion of periodontal diseases, such as periodontitis resulted in resorption of alveolar bone height reduction, excluding mandible molar metal restorations.},which were divided into3groups according to the mandibular plane [2], the ratio of between the posterior face height and the anterior face height (the male patients:15in the high-angle group,19in the average-angle group,11in the low-angle group; the female patients:14in the high-angle group,20in the average-angle group,11in the low-angle group).The measurements included:(1) the distance between the upper edge mandibular canal and the alveolar crest of each molar tooth(MA);(2)the distance between the lateral border inferior alveolar canal and the buccal cortex of mandible (MB);(3) the distance between the interior border of inferior alveolar canal and lingual cortex of the mandible (ML). Each distance measure3times and the mean value were recorded. All the measure datas of the subject investigated are analysed by the means of SPSS16.0. The statistical methods used in this study are One-way AN OVA and multiple comparisons between groups (LSD), Paired T-test, Pearson correlation analysis, which used to compare the differences of the MA, MB and ML between different vertical skeletal pattern adults, and determine the correlation of these parameters with the vertical skeletal pattern.Results:l.In different gender(male and female), datas of the distance between the upper edge mandibular canal and the alveolar crest of each molar tooth(MA), the distance between the lateral border inferior alveolar canal and the buccal cortex of mandible (MB) and the distance between the interior border of inferior alveolar canal and lingual cortex of the mandible (ML) showed little difference, which was not significantly different.(P>0.05).2.Measurement results of left or right mandile was obtained separately, however, there was no statistical significance between the two sides(P>0.05). Datas of left mandible that related to mandibular canal are as follows (unit/mm).3.Among different vertical facial types, the distance between the upper edge mandibular canal and the alveolar crest of each molar tooth(MA):for the first premolar plane, male high-angle group,17.52; male average-angle group,18.01; male low-angle group,18.23; and female high-angle group,16.46; female average-angle group,16.53; female low-angle group,16.93. for the second premolar plane, male high-angle group,17.96; male average-angle group.18.43; male low-angle group,19.07; and female high-angle group,17.16:female average-angle group.17.53; female low-angle group,18.23. for the firs molar plane,male high-angle group,17.56; male average-angle group,18.35; male low-angle group,19.10; and female high-angle group,16.84; female average-angle group,17.71; female low-angle group,18.11.for the second molar plane,male high-angle group,16.23; male average-angle group,17.54; male low-angle group,18.32; and female high-angle group,15.93; female average-angle group,16.81; female low-angle group,17.21.From here we see that high-angle group was significantly shorter than low-angle group(P<0.05).The distance between the interior border of inferior alveolar canal and lingual cortex of the mandible (ML):for the first premolar plane, male high-angle group,4.22; male average-angle group,4.64; male low-angle group,5.04; and female high-angle group,4.17; female average-angle group,4.58; female low-angle group,5.01. for the second premolar plane, male high-angle group,4.82; male average-angle group,5.04; male low-angle group,5.21; and female high-angle group,4.66; female average-angle group,4.98; female low-angle group,5.14. for the firs molar plane,male high-angle group,2,12; male average-angle group,2.27; male low-angle group,2.44; and female high-angle group,2.08; female average-angle group,2.25; female low-angle group,2.38. for the second molar plane,male high-angle group,1.58; male average-angle group,1.72; male low-angle group,1.96; and female high-angle group,1.48; female average-angle group,1.67; female low-angle group,1.90. Those show no statistical significance between high-angle and low-angle group,either(P>0.05).While the distance between the lateral border inferior alveolar canal and the buccal cortex of mandible (MB)::for the first premolar plane, male high-angle group,1.13; male average-angle group,1.35; male low-angle group,1.74; and female high-angle group,1.12; female average-angle group,1.28; female low-angle group,1.64. for the second premolar plane, male high-angle group,4.82; male average-angle group,5.21; male low-angle group,5.64; and female high-angle group,4.62; female average-angle group,4.88; female low-angle group,5.24. for the firs molar plane,male high-angle group,6.48; male average-angle group,6.76; male low-angle group,7.28; and female high-angle group,6.26; female average-angle group.6.62; female low-angle group,7.18. for the second molar plane.male high-angle group,5.46; male average-angle group.5.96; male low-angle group,6.52; and female high-angle group,5.36; female average-angle group,6.01; female low-angle group.6.44.Those show high-angle group had no significant difference compared to low-angle group (P>0.05).Conclusion: 1. The distance between the upper edge mandibular canal and the alveolar crest of each molar tooth(MA) decreased from the mandibular pemolar to the posterior segment.whether the gender or vertical skeletal pattern.2.In molar segment, with the englargement of mandibular plane angle(FH-MP angle),that is,from the low-angle to high-angle, the distance between the upper edge mandibular canal and the alveolar crest of each molar tooth(MA) decreased,which reveals that there is a significantly negative relationship between FH-MP angle and MA.Thus it can be seen, high-angle patients facing higher risk in certain oral therapies, such as dental implant surgery and bone anchorage implant, while the mandibular canal of high-angle patient are more easily impaired.更多还原