个别正常▌成人上前牙美学区唇、腭侧骨板厚度测量分析

中国口腔颌面外科杂志 ›› 2016, Vol. 14 ›› Issue (4): 337-343.

个别正常▌成人上前牙美学区唇、腭侧骨板厚度测量分析

郭鹏女^{1, 2}, 郭华艳³, 钟华星³, 黄兰³, 陈卫东³, 张迎娣¹, 黄远亮³

1. 同济大学口腔医学院,上海 200120;
2. 赤峰学院附属医院口腔科,内蒙古赤峰 024000;
3. 同济大学附属东方医院口腔种植科,上海 200120

出版日期:2016-08-20 发布日期:2016-12-08
通讯作者: 黄远亮,E-mail:ylhuang0115@163.com
作者简介:郭鹏女（1989-）,女,医师,在读硕士研究生,E-mail:gpn0476@163.com
基金资助:
上海市科学技术委员会西医引导项目（14411963500）

Measurement and analysis of the labial and palatal bone thickness of the maxillary anterior (esthetic zone) teeth in Chinese adults with individual normal occlusion

GUO Peng-nv^{1, 2}, GUO Hua-yan², ZHONG Hua-xing², HUANG Lan², CHEN Wei-dong², ZHANG Ying-di^{1, 2}, HUANG Yuan-liang²

1.Tongji University School of Stomatology. Shanghai 200120;
2.Department of Oral Implantology, East Hospital Affiliated to Tongji University. Shanghai 200120;
3. Department of Stomatology, Affiliated Hospital of Chifeng College. Chifeng 024000, Inner Mongolia Autonomous Region, China

Online:2016-08-20 Published:2016-12-08

摘要/Abstract

摘要： 目的测量分析国人个别正常▌成人上前牙美学区唇、腭侧骨板厚度,为口腔种植手术,尤其是即刻种植的术前分析、方案制定提供数据支持,并为构建数据库奠定基础。方法应用KaVo 3D eXam CBCT机对符合纳入标准的60例受试者进行锥形束CT（CBCT）扫描,所得Dicom格式三维重建数据导入InVivo 5软件,测量垂直于牙体长轴L3、L6、L9、L12水平处相应唇、腭侧骨板厚度,所得数据应用SPSS 18.0软件包进行95%参考值范围、频率、配对样本t检验、独立样本t检验、方差分析及多重比较。结果在各牙位各参考线水平,唇侧骨板厚度均较腭侧薄（P<0.05）,唇侧骨板较多出现小于1 mm及骨板缺如的情况（40.6%~93.1%）,腭侧骨板厚度普遍大于2 mm（L6及以上水平：60%~100%）;左右同名牙、同牙位唇腭侧、性别、年龄段、同参考线不同牙位、同牙位不同参考线间骨板厚度存在差异。结论上前牙区种植时常存在骨量不足情况,以侧切牙处尤为明显;唇侧骨板厚度较腭侧更薄,且常存在凹陷。种植手术时应在CBCT指导下,适当偏腭侧植入,必要时应用自体骨移植以及骨替代材料、骨劈开、骨增量技术,保证唇侧骨壁的完整性及足够的骨板厚度。

关键词: 口腔种植, 锥形束CT, 上前牙, 骨板厚度

Abstract: PURPOSE: To measure and analyze the labial and palatal bone thickness of the maxillary anterior (esthetic zone) teeth in Chinese adults with individual normal occlusion, in order to lay a foundation for database and to provide data support and references for preoperative analysis and plan making of implant surgery, especially immediate implantation. METHODS: Sixty subjects who met the inclusion criteria were scanned by KaVo 3D eXam CBCT(cone-beam computed tomography). The three-dimensional reconstruction CBCT data in a Dicom (digital imaging and communication in medicine)format were imported to InVivo 5 software. The data obtained from the measurement of the labial and palatal bone thickness on reference lines (which were perpendicular to tooth long axis) L3, L6, L9, L12 were statistically analyzed with 95% reference range, frequency, paired sample t test, independent sample t test, ANOVA (analysis of variance)and multiple comparison using SPSS 18.0 software package. RESULTS: The data showed that the mean labial bone thicknesses were less than the corresponding palatal bone on every reference line of each tooth (P<0.05), bone absence or thickness less than 1 mm often occurred at the labial bone (40.6%~93.1%), the palatal bone thicknesses were generally more than 2 mm (L6 and upper levels: 60%~100%), and there were diversities of bone thickness between left and right teeth, labial and palatal plate, gender, ages, different teeth positions at same reference line, and different reference lines at same tooth position. CONCLUSIONS: Bone is often insufficient at the maxillary anterior teeth when implanting, particularly at the lateral incisors. The labial bone plates are thinner than the palatal bone and frequently exhibit depression. In order to ensure intact labial bone wall and enough bone thickness, the implants should be placed appropriately palatally after measuring and analyzing with CBCT. Moreover, the bone substitute materials, bone splitting and bone augmentation technique should be applied when necessary.

Key words: Oral implant, Cone-beam CT, Maxillary anterior teeth, Bone thickness

中图分类号:

R782.13

郭鹏女, 郭华艳, 钟华星, 黄兰, 陈卫东, 张迎娣, 黄远亮. 个别正常▌成人上前牙美学区唇、腭侧骨板厚度测量分析[J]. 中国口腔颌面外科杂志, 2016, 14(4): 337-343.

GUO Peng-nv, GUO Hua-yan, ZHONG Hua-xing, HUANG Lan, CHEN Wei-dong, ZHANG Ying-di, HUANG Yuan-liang. Measurement and analysis of the labial and palatal bone thickness of the maxillary anterior (esthetic zone) teeth in Chinese adults with individual normal occlusion[J]. China J Oral Maxillofac Surg, 2016, 14(4): 337-343.

参考文献

[1] Albrektsson T, Zarb G, Worthington P, et al. The long-term efficacy of currently used dental implants: a review and proposed criteria of success [J]. Int J Oral Maxillofac Implants, 1986, 1(1): 11-25.
[2] Belser UC, Grütter L, Vailati F, et al. Outcome evaluation of early placed maxillary anterior single-tooth implants using objective esthetic criteria: a cross-sectional, retrospective study in 45 patients with a 2- to 4-year follow-up using pink and white esthetic scores [J]. J Periodontol, 2009, 80(1):140-151.
[3] 贾筱诗, 张秋霞, 许孟杰, 等. 67 名正常▌青年人上前牙区唇、腭侧骨厚度测量分析[J]. 上海口腔医学, 2015, 24(2): 199-205.
[4] 刘宝林. 口腔种植学[M]. 北京: 人民卫生出版社, 2011.
[5] Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice [J].J Can Dent Assoc, 2006, 72(1): 75-80.
[6] Sukovic P. Cone beam computed tomography in craniofacial imaging [J]. Orthod Craniofac Res, 2003, 6(Suppl 1): 31-36.
[7] Chan HL, Misch K, Wang HL. Dental imaging in implant treatment planning [J]. Implant Dent, 2010, 19(4): 288-298.
[8] Barone A, Rispoli L, Vozza I, et al. Immediate restoration of single implants placed immediately after tooth extraction [J]. J Periodontol, 2006, 77(11): 1914-1920.
[9] Chen ST, Buser D. Esthetic outcomes following immediate and early implant placement in the anterior maxilla-a systematic review [J]. Int J Oral Maxillofac Implants, 2014, 29 (suppl): 186-215.
[10] Martin WC, Morton D, Buser D. Pre-operative analysis and prosthetic treatment planning in esthetic implant dentistry [C]// Buser D, Chen S, Wismeijer D, et al. ITI Treatment Guide [M]. Berlin: Quintessenz Verlags GmbH, 2007.
[11] Kan JY, Roe P, Rungcharassaeng K, et al. Classification of sagittal root position in relation to the anterior maxillary osseous housing for immediate implant placement: a cone beam computed tomography study [J]. Int J Oral Maxillofac Implants, 2010, 26(4): 873-876.
[12] Pinsky HM, Dyda S, Pinsky RW, et al. Accuracy of three-dimensional measurements using cone-beam CT [J]. Dentomaxillofac Radiol, 2006, 35(6):410-416.
[13] 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.
[14] Han JY, Jung GU. Labial and lingual/palatal bone thickness of maxillary and mandibular anteriors in human cadavers in Koreans [J]. J Periodontal Implant Sci, 2011, 41(2): 60-66.
[15] Vera C, De Kok IJ, Reinhold D, et al. Evaluation of buccal alveolar bone dimension of maxillary anterior and premolar teeth: a cone beam computed tomography investigation [J]. Int J Oral Maxillofac Implants, 2012, 27(6): 1514-1519.
[16] Lee SL, Kim HJ, Son MK, et al. Anthropometric analysis of maxillary anterior buccal bone of Korean adults using cone-beam CT [J]. J Adv Prosthodont, 2010, 2(3): 92-96.
[17] Hebel KS, Gajjar RC. Cement-retained versus screw-retained implant restorations: achieving optimal occlusion and esthetics in implant dentistry [J]. J Prosthet Dent, 1997, 77(1): 28-35.
[18] Vigolo P, Givani A, Majzoub Z, et al. Clinical evaluation of small-diameter implants in single-tooth and multiple-implant restorations: a 7-year retrospective study [J]. Int J Oral Maxillofac Implants, 2003, 19(5): 703-709.
[19] 张震. 悬臂梁式种植固定义齿的回顾性研究 [J]. 口腔颌面外科杂志, 2013, 23(2):116-119.
[20] Romeo E, Storelli S. Systematic review of the survival rate and the biological, technical, and aesthetic complications of fixed dental prostheses with cantilevers on implants reported in longitudinal studies with a mean of 5 years follow-up [J]. Clin Oral Implants Res, 2012, 23 (Suppl 6): 39-49.