【作者】 张杰； 岳林； 张万林；

【Author】 J.Zhang L.Yue W.L.Zhang

【机构】 北京大学口腔医学院牙体牙髓科； 北京大学口腔医学院放射科；

【摘要】 目的:评价锥形束CT(CBCT)在评判前牙根尖周病损影像中的作用。方法:收集临床上同时具有根尖X线片和CBCT图像的病例28人,共45颗前牙。其中包括15颗健康牙,7颗临床诊断为慢性牙髓炎的患牙,1颗临床诊断为牙髓坏死的患牙,20颗临床诊断为慢性根尖周炎的患牙(含2颗经过根管治疗的患牙),2颗为根管治疗后正常根尖表现的患牙。组成牙髓病学医生和影像学医生的3人小组,盲法对根尖片进行PAI分级并对CBCT影像的三维图像进行判读,确定根尖病变的有无和程度。结果:①临床诊断与X线片PAI的关系:15颗健康牙的X线片中13颗牙PAI评为1,2颗牙评为2;7颗慢性牙髓炎患牙X线片中6颗PAI评为1,1颗评为2;1颗牙髓坏死患牙X线片PAI评为1;2颗根管治疗后的患牙PAI分别为1和2;20颗慢性根尖周炎患牙X线片PAI评为3-5,其中10颗PAI评为3,3颗评为4,7颗评为5。②根尖X线片与CBCT在判断根尖周病损中的作用:X线片PAI为1的21颗牙的CBCT影像也均表现为根尖周间隙均匀一致,无增宽;PAI为2的4颗牙的CBCT影像中,3颗在三维均表现出根尖周膜不规则增宽,骨内板不完整,1颗除上述表现外,还有根尖周近远中方向的骨质缺损,最大径为3.5mm;PAI为3的10颗牙的CBCT影像表现为根尖周三维的透射区,骨质缺损或骨质结构紊乱,其三维骨损害的最大范围为5-10mm,以唇舌向更多;PAI为4的3颗牙的CBCT影像表现为骨缺损最大范围为6-9mm,唇舌向居多;PAI为5的7颗牙的CBCT影像表现为骨缺损区大而不规则,边界不清,最大范围为8-20mm(唇舌向稍多)。此外,CBCT还可以显示根尖X线片所不能显示的骨皮质膨隆和破坏。结论:1.根尖X线片可满足前牙慢性根尖周炎的临床诊断需求,但根尖X线片PAI在反映根尖周骨质缺损程度上有所局限。PAI分级2时,CBCT影像已显示有少许的骨不完整,甚至骨缺损;而3、4、5级在X线片上的界定并不清晰,评片中的重复性也不理想,CBCT影像的三维骨缺损测量结果也显示三者互相重叠和覆盖。2.CBCT可更准确的显示根尖周骨损害的三维形貌,从颊舌向、近远中向和轴向三个方向逐层断层扫描骨质的破坏,展现那些X线片无法显示的细节,对根尖周骨损害程度的判断比X线片更准确,为临床正确诊断、科学制定治疗方案,判断疾病的严重程度及预后提供有效工具。更多还原

【Abstract】 Objective:To evaluate the effects of Cone Beam Computed Tomography(CBCT) in judging lesions of periapical images of anterior teeth.Methods The clinic diagnosis of 45 anterior teeth in 28 patients which were examined by periapical radiograph and CBCT were healthy teeth(15 teeth),chronic pulpitis(7 teeth),pulp necrosis(1 tooth),chronic apical periodontitis(20 teeth),remnant root with normal apical images after root canal treating(2 remnant root).All the images were evaluated by 3 observers by using the periapical index(PAI) to periapical radiograph and analysis of images in 3 dimension to CBCT scans.Results①the relation of clinic diagnosis and PAI:PAI of 15 healthy teeth were 1-2;PAI of 7 teeth(chronic pulpitis) were 1-2;PAI of 1 tooth(pulp necrosis) was 1;PAI of 20 teeth(chronic apical periodontitis) were 3-5;PAI of 2 remnant root after root canal treating were 1 and 2 separately.②The effect of detecting the apical lesions of periapical radiograph and CBCT:When PAI were 1,the images of CBCT showed intact periapical bone structures;when PAI were 2,the images of CBCT showed irregular broadening of periapical membrane or lesions in buccopalatal dimension with the largest diameter of the lesion of 3.5mm;when PAI were 3,the range of the largest diameter of the lesion were 5-10mm,mostly in buccopalatal dimension;when PAI were 4 the range of the largest diameter of the lesion were 6-9mm,mostly in buccopalatal dimension;when PAI were 5,the range of the largest diameter of the lesion were 8-20mm mostly in buccopalatal dimension.Furthermore,the images of CBCT could showed expansion or destruction of periapical cortical bone which periapical radiograph couldn’t detect.Conclusion Apical periodontitis were correctly identified with periapical radiograph in most anterior teeth,but the limitations of the periapical radiograph in detecting root apical lesion were distinct.When PAI were 3,4 and 5 the range of the largest diameter of the lesion were overlapping in CBCT.CBCT was more accurate than periapical radiograph for apical periodontitis diagnosis because CBCT images showed 3 dimensional lesions and details of lesion which periapical radiograph couldn’t show.CBCT were viable and accurate tools for correct clinic diagnosis, making scientific treat planning,judging the severity and prognosis of the disease.更多还原