【作者】 李建华；

【导师】 熊世江；

【作者基本信息】 山东大学 ， 口腔医学（专业学位）， 2017， 硕士

【摘要】 背景:牙髓病和根尖周病是口腔临床中常见的细菌性、感染性疾病,其有效的治疗方法是根管治疗。根管治疗的关键是对根管系统进行彻底清理、适当成形、严格消毒、严密充填,防止根尖周病的发生或促进根尖病变愈合。上颌磨牙位于牙弓后方,操作时可视性差,而上颌磨牙的根管系统复杂多样,给临床治疗带来了困难,因此口腔医生需要全面系统掌握上颌磨牙根管系统的解剖形态。目前,根管系统的研究方法有多种,其中锥形束CT(CBCT,cone-beam computed tomography)可以在冠状位、矢状位、水平位上清晰、立体、直观的显示上颌磨牙根管系统的解剖结构。目的:应用CBCT技术研究山东地区人群上颌第一、第二磨牙牙根及根管系统的解剖结构,分析牙根数目,根管数目、类型、长度及根管口间距与年龄、性别之间的关系,为上颌第一、第二磨牙根管系统的进一步研究提供第一手资料,并为临床治疗提供理论依据。方法:收集2015年9月至2017年8月于山东大学口腔医院放射科拍摄CBCT的患者的影像资料,共490名患者1321颗上颌第一及第二磨牙,记录患者姓名、性别、年龄、牙位等基本信息,同时分析并研究以下内容:①牙位;②牙根数目;③根管数目及类型;④根管口到解剖性根尖孔的距离;⑤根管口之间的距离,并分析以上研究内容与年龄、性别之间的关系。结果:1.山东地区人群上颌第一磨牙牙根及根管解剖形态1.1牙根数目714颗上颌第一磨牙中3根700颗,发生率为98.04%;2根13颗,发生率为1.82%;4根1颗,发生率为0.14%;1根0颗。1.2根管数目714颗上颌第一磨牙中四根管368颗,发生率为51.54%,其中MB2 367颗,发生率为51.400%,DB21颗,发生率为0.14%;三根管344颗,发生率为48.18%;双根管2颗,发生率0.28%;单根管发生率为0。1.3根管类型根据Vertucci根管形态分型,714颗上颌第一磨牙中数量最多的是Ⅷ型共344颗,比例为48.18%。本研究中发现双根管2例,均为Ⅰ型;三根管各根管类型如下:MB:变异较多,以Ⅰ型数量最多共344颗(48.31%),其次是Ⅴ型共143颗(20.08%),再次是Ⅲ型共 136 颗(19.100%)。DB:以Ⅰ型数量最多共708颗,比例为99.44%。本研究中还发现远中颊根管变异4例,分别为Ⅱ型1例、V型2例和1-2-1-2-1-2-1-2型1例。P:均为Ⅰ型,比例为100%。1.4根管口到解剖性根尖孔的距离范围在4mm～18mm之间,分布频率最高的范围是7.1～12mm,比例为87.31%;其余依次是12.1～15mm,比例为8.15%;5.1～7mmm,比例为4.26%;15.1～18mm,比例为0.19%;4～5mm,比例为0.09%。1.5根管口之间的距离范围在0～8mm之间,MB-DB分布频率最高的范围是1.1～3mm,比例为29.56%;其余依次是3.1～4mm,比例为1.00%;0～1mm,比例为0.39%;4.1～5mm和7.1～8mmm,比例均为0.04%。MB-P分布频率最高的范围是4.1～6mm,比例为25.54%;其余依次是3.1～4mmm,比例为3.66%;6.1～7mm,比例为1.74%;7.1～8mm,比例为0.09%。DB-P分布频率最高的范围是2.1～5mm,比例为29.73%;其余依次是5.1～6mm,比例为0.96%;1.1～2mmm,比例为0.31%;6.1～7mm,比例为0.04%。MB-MB2分布频率最高的范围是1.1～3mm,比例为2.88%;其余依次是0～1mm,比例为0.48%;3.1～4mm,比例为0.09%。MB2-P分布频率最高的范围是2.1～5mm,比例为3.23%;其余依次是5.1～6mm,比例为0.17%;1.1～2mm,比例为0.04%。2.山东地区人群上颌第二磨牙牙根及根管解剖形态2.1牙根数目607颗上颌第二磨牙中3根423颗,发生率为69.69%;2根109颗,发生率为17.96%;1根73颗,发生率为12.03%;4根2颗,发生率为0.33%。2.2根管数目607颗上颌第二磨牙中三根管439颗,发生率72.32%;四根管109颗,发生率17.96%,其中MB2 108颗,发生率为17.79%,P2 1颗,发生率为0.16%;双根管45颗,发生率为7.41%;单根管14颗,发生率2.31%。2.3根管类型根据Vertucci根管形态分型,607颗上颌第二磨牙中数量最多的是Ⅷ型共421颗,比例为69.36%。本研究中还发现有双根管及单根管,均以Ⅰ型为主;三根管各根管类型如下:MB:变异较多,以Ⅰ型数量最多共422颗(77.01%),其次是Ⅲ型共62颗(11.31%),再次是Ⅴ型共19颗(3.47%)。DB:以Ⅰ型数量最多共547颗,比例为99.82%。P:以Ⅰ型数量最多共592颗,比例为99.83%。本研究中还发现腭根第二根管1例,其根管类型为2-1-2-1。2.4根管口到解剖性根尖孔的距离三根管各根管口到解剖性根尖孔的距离范围在4mm～18mm之间,分布频率最高的范围是7.1～11mm,比例为79.77%;其余依次是11.1～14mm,比例为13.10%,5.1～7mm,比例为 6.34%;14.1～15mm,比例为 0.37%;4～5mm,比例为 0.31%;15.1～18mm,比例为0.12%;双根管各根管口到解剖性根尖孔的距离范围在7mm～13mm,主要集中在8.1～12mm,比例为91.11%;其余依次是7.1～8mm,比例为6.67%;7mm 和 12.1～13mm,比例均为 1.11%。2.5根管口之间的距离范围在0～9mm之间,MB-DB分布频率最高的范围是1.1～3mm,比例为30.09%;其余依次是0～1mm,比例为1.10%;3.1～4mm,比例为0.46%。MB-P分布频率最高的范围是4.1～6mm,比例为24.19%;其余依次是3.1～4mm,比例为 5.15%;6.1～7mm,比例为 1.68%;2.1～3mm,比例为 0.52%;7.1～9mm,比例为0.12%。DB-P分布频率最高的范围是3.1～5mm,比例为24.48%;其余依次是2.1～3mm,比例为5.38%;5.1～6mm,比例为1.27%;1.1～2mm,比例为0.41%;6.1～7mm,比例为0.12%。MB-MB2分布频率最高的范围是1.1～2mmm,比例为0.81%;其次是2.1～3mm,比例为0.29%;0～1mm,比例为0.12%。MB2-P分布频率最高的范围是2.1～4mm,比例为0.75%;其余依次是1.1～2mm和4.1～5mmm,比例为均0.17%;5.1～8mm,比例为0.12%。B-P(双根管)分布频率最高的范围是2.1～4mm,比例为2.08%;其余依次是1.1～2mm,比例为0.29%;4.1～5mm,比例为0.17%;5.1～6mm,比例为 0.06%。结论:山东地区人群上颌第一、第二磨牙牙根及根管解剖形态复杂多样,尤其是近中颊根管,但远中颊根管和腭根根管也会发生变异,而CBCT技术可以清晰、真实地显示上颌第一、第二磨牙牙根及根管系统的解剖结构。本研究的研究结果如下:①上颌第一、第二磨牙均以3根数量最多;②上颌第一磨牙主要为四根管,发生率为51.54%,其中MB2发生率为51.40%;上颌第二磨牙则以三根管为主,发生率为72.32%,其中MB2发生率为17.79%;③上颌第一、第二磨牙根管类型均以Ⅷ型为主;④上颌第一、第二磨牙根管口到解剖性根尖孔的距离虽然主要分布在7.1～13mm;⑤上颌第一、第二磨牙根管口之间的距离MB-DB主要分布在1.1～3mm,DB-P主要分布在2.1～5mm,MB-P主要分布在4.1～6mm,MB-MB主要分布在1.1～3mm,MB2-P主要分布在2.1～5mm,B-P主要分布在2.1～4mm。本研究结果有助于口腔医生了解山东地区人群上颌第一、第二磨牙牙根及根管形态和结构,从而更加准确的定位根管口,确定工作长度,为临床治疗及深入研究提供理论依据。更多还原

【Abstract】 Background:Dental pulp disease and periapical disease are the common bacterial and infectious diseases in oral clinic,and the effective treatment is root canal treatment.The key of root canal treatment is cleaning thoroughly,forming properly,disinfection strictlyl,and filling closely,so as to prevent the periapical disease and promote healing of periapical lesions.The maxillary molars in the rear arch,poor visibility of operation,and the root canal system of the maxillary molars are complicated,and it brings difficulties to the clinical treatment,therefor dentists need a comprehensive and systematic grasp of the anatomical morphology of the maxillary molars root canal system.At present,there are many research methods of the root canal system,and the cone beam CT(CBCT cone-beam,computed tomography)can display a clear,three-dimensional and intuitive anatomical morphology of the maxillary molars root canal system in coronal,sagittal,horizontal position.Objective:The anatomic structure and morphology of the root canal system of maxillary first and second molars in Shandong region were studied by CBCT technique,analysis of the root number,root canal number,type,length,and root canal orifice spacing with age and sex,and to provide the first data for further study of the root canal system of the maxillary first and second molars,and to provide theoretical basis for clinical treatment.Methods:A total of 1321 cone-beam computed tomography images of maxillary first and second molars were collected from 490 patients who visiting the Shandong University Stomatological Hospital radiology department between September 2015 to August 2017,and the patients’ name,gender,age,teeth and other basic information were recorded,and at the same time analyzed and researched the following contents:①Tooth position;②Root number;③Number and type of root canal;④The distance from the root canal to the anatomical root hole;⑤The distance of root canal orifice,and analysed the correlation between age and sex.Results:1.Anatomical morphology of root and root canal of the maxillary first molars in Shandong region1.1 Root numberIn the 714 maxillary first molars,there were 700 teeth were 3 roots,the incidence was 98.04%;13 teeth were 2 roots,the incidence was 1.82%;1 tooth were 4 roots,the incidence was 0.14%;1 tooth were 0 root.1.2 Root canal numberIn the 714 maxillary first molars,there were 368 teeth were four canals,the incidence was 51.54%,and 367 teeth were MB2,the incidence was 51.40%,and 1 tooth were DB2,the incidence was 0.14%;344 teeth were three canals,the incidence was 48.18%;2 teeth were double root canals,the incidence was 0.28%;the incidence of single tube was 0.1.3 Root canal typeAccording to Vertucci root canal morphology classification,the largest number of root canal type was Ⅷ type of a total of 344 teeth in the 714 maxillary first molars,and the incidence was 48.18%.This study found that the double root canal 2 cases,and the root canal type were all Ⅰ type,and the types of three root canals were as follows:MB:There were more variation,with the largest number of type Ⅰ,a total of 344 teeth(48.31%),followed by type Ⅴ,a total of 143 teeth(20.08%),and again type Ⅲ,a total of 136 teeth(19.10%).DB:The largest number of type Ⅰ,a total of 708 teeth,the incidence was 99.44%.In this study,4 cases of distalbuccal canal variation were found,including 1 case of typeⅡ,2 cases of type Ⅴ,and 1 case of type 1-2-1-2-1-2-1-2.P:All were of type Ⅰ,the incidence was 100%.1.4 The distance from the root canal to the anatomical root holeIn the range of 4mm～18mm,and the maximum distribution was 7.1～12mm,the ratio was 87.31%;and the remaining was 12.1～15mm,the ratio was 8.15%;5.1～7mm,the ratio was 4.26%;15.1～18mm,the ratio was 0.19%;4～5mm,the ratio was 0.09%.1.5 The distance of root canal orificeIn the range of 0～8mm,and the maximum distribution of MB-DB was between 1.1～3mm,the ratio was 29.56%;and the remaining was 3.1～4mm,the ratio was 1.00%;0～1mm,the ratio was 0.39%;4.1～5mm and 7.1～8mm,the ratio were all 0.04%.The maximum distribution of MB-P was between 4.1～6mm,the ratio was 25.54%;and the remaining was 3.1～4mm,the ratio was 3.66%;6.1～7mm,the ratio was 1.74%;7.1～8mm,the ratio was 0.09%.The maximum distribution of DB-P was between 2.1～5mm,the ratio was 29.73%;and the remaining was 5.1～6mm,the ratio was 0.96%;1.1～2mm,the ratio was 0.31%;6.1～7mm,the ratio was 0.04%.The maximum distribution of MB-MB2 was between 1.1～3mm,the ratio was 2.88%;and the remaining was 0～1mm,the ratio was 0.48%;3.1～4mm.the ratio was 0.09%.The maximum distribution of MB2-P was between 2.1～5mm,and the ratio was 3.23%;and the remaining was 5.1～6mm.the ratio was 0.17%;1.1～2mm,the ratio was 0.04%.2.Anatomical morphology of root and root canal of the maxillary second molars in Shandong region2.1 Root numberIn the 607 maxillary second molars,there were 423 teeth were 3 roots,the incidence was 69.69%;109 teeth were 2 roots,the incidence was 17.96%;73 teeth were 1 root,the incidence was 12.03%;2 teeth were 4 roots,the incidence was 0.33%.2.2 Root canal numberIn the 607 maxillary second molars,there were 439 teeeth were three canals,the incidence was 72.32%;109 teeth were four canals,the incidence was 17.96%,and 108 teeth were MB2,the incidence was 17.79%,and 1 tooth were P2,the incidence was 0.16%;45 teeth were double root canals,the incidence was 7.41%;14 teeth were single canal,the incidence was 2.31%.2.3 Root canal typeAccording to Vertucci root canal morphology classification,the largest number of root canal type was Ⅷ type of a total of 421 teeth in the 607 maxillary second molars,and the incidence was 69.36%.This study also found the double root canals and single tube type,and the root canal types were all Ⅰ type,and the types of three root canals were as follows:MB:There were more variation,with the largest number of type Ⅰ,a total of 422 teeth(77.01%),followed by type Ⅲ,a total of 62 teeth(11.31%),and again type Ⅴ,a total of 19 teeth(3.47%).DB:The largest number of type I,a total of 547 teeth,the incidence was 99.82%.P:The largest number of type I,a total of 592 teeth,the incidence was 99.83%.This study also found the palatal second root canal 1 case,the type of root canal was 2-1-2-1.2.4 The distance from the root canal to the anatomical root holeThe distance of the root canals of each three canals to the anatomical root hole was from 4mm～18mm,and the maximun distribution was 7.1～11 mm,the ratio was 79.77%;and the remaining was 11.1～14mm,the ratio was 13.10%;5.1～7mm,the ratio was 6.34%;14.1～15mm,the ratio was 0.37%;4-5mm,the ratio was 0.31%;15.1～18mm,the ratio was 0.12%.The distance of the root canals of each double canals to the anatomical root hole was from 7mm～13mm,and mainly distribution between 8.1～12mm,the ratio was 91.11%;and the remaining was 7.1～8mm,the ratio was 6.67%;7mm and 12.1～13mm,the ratio were all 1.11%.2.5 The distance of root canal orificeIn the range of 0～9mm,and the maximum distribution of MB-DB was between 1.1～3mm,the ratio was 30.09%;and the remaining was 0～1 mm,the ratio was 1.10%;3.1～4mm.the ratio was 0.46%.The maximum distribution of MB-P was between 4.1～6mm,the ratio was 24.19%;and the remaining was 3.1～4mm,the ratio was 5.15%;6.1～7mm,the ratio was 1.68%;2.1～3mm,the ratio was 0.52%;7.1～9mm,the ratio was 0.12%.The maximum distribution of DB-P was between 3.1～5mm,the ratio was 24.48%;and the remaining was 2.1～3mm,the ratio was 5.38%;5.1～6mm,the ratio was 1.27%;1.1～2mm,the ratio was 0.41%;6.1～7mm.the ratio was 0.12%.The maximum distribution of MB-MB2 was between 1.1～2mm.the ratio was 0.81%;and the remaining was 2.1～3mm,the ratio was 0.29%;0～1mm,the ratio was 0,12%.The maximum distribution of MB2-P was between 2.1～4mm,and the ratio was 0.75%;and the remaining was 1.1～2mm and 4.1～5mm,the ratio were all 0.17%;5.1～8mm,the ratio was 0.12%.The maximum distribution of B-P(double root canal)was between 2.1～4mm,and the ratio was 2.08%;and the remaining was 1.1～2mm,the ratio was 0.29%;4.1～5mm,the ratio was 0.17%;5.1～6mm,the ratio was 0.06%.Conclusion:The anatomy form of root and root canal was complex and changeful of the maxillary first and second molar in Shandong region,especially mesialbuccal root canal,but the distalbuccal canal and palatal canal were also occurring mutate,and CBCT technology can be more clear,true to display the root and root canal form of maxillary first and second molar in Shandong region.The results of this study were as follows:①The maximum root number of maxillary first and second molars were 3 roots;②?The incidence of MB2 of maxillary first molar was 51.40%,and maxillary second molar was 17.79%;③The mainly root canal type of maxillary first and second molars were type Ⅷ;The distance from the root canal to the anatomical root hole of maxillary first and second molars were mainly distribution between 7.1～13mm;⑤In the maxillary first and second molars,the maximum distribution of MB-DB was between 1.1～3mm,the maximum distribution of DB,P was between 2.1～5mm,the maximum distribution of MB-P was between 4.1～6mm,the maximum distribution of MB-MB2 was between 1.1～3mm,the maximum distribution of MB2-P was between 2.1～5mm,the maximum distribution of B-P was between 2.1～4mm.The results of this study can help dentists to know the root and root canal morphology and structure of maxillary first and second molar in Shandong region,and to location the root canal orifice more accurate,and determine the work length,so as to provide theoretical basis for clinical treatment and further study.更多还原