锥形束CT与曲面断层片在后牙区可用骨高度测量与种植模拟中的临床评价

摘要

背景:锥形束CT和曲面断层片是口腔种植术前评估中应用最广泛的两种影像学方法,锥形束CT应用成本高,普及率低,但曲面断层片在二维平面上测量分析误差较大.目的:对比锥形束CT与曲面断层片在上下颌后牙区对可用骨量的测量准确性,并评价种植模拟的临床效果.方法:从复旦大学附属眼耳鼻喉科医院收治的后牙种植患者中选择72例共115颗种植体作为研究对象,分别在术前的锥形束CT和曲面断层片上进行可用牙槽骨高度的测量,测量结果进行统计学分析.并分别在Planmeca Romexis 3.8(锥形束CT)和Cliniview 9.3(曲面断层片)软件中进行种植体模拟植入,比较模拟种植体底部至重要解剖结构的距离和术后实际距离的差异.结果与结论:①锥形束CT与曲面断层片对种植区可用骨高度测量值之间的差异有显著性意义(P<0.05),上颌测量值之间的差异有非常显著性意义(P<0.01);②锥形束CT与曲面断层片种植模拟结果与术后实际结果之间的差异有显著性意义(P<0.05);③曲面断层片模拟种植结果的平均误差和标准差均较锥形束CT偏大;锥形束CT在上颌后牙区模拟种植的平均误差较曲面断层片明显偏小,在下颌差别不大;④结果提示,锥形束CT在后牙缺牙区能为可用骨高度提供更为清晰准确的测量,并且在上颌优势更大.锥形束CT与曲面断层片在种植模拟上的准确性还有待提高.在下颌,锥形束CT和曲面断层片模拟种植都有较好的准确性;在上颌锥形束CT比曲面断层片更可靠.%BACKGROUND: Cone-beam CT (CBCT) and orthopantography are two imaging methods mostly used in the preoperative evaluation of dental implantation. CBCT has high cost and low penetration rate, but orthopantography can result in a larger error in the measurement of bone quantity.OBJECTIVE: To compare the accuracy of bone quantity measurement using CBCT and orthopantography, and to evaluate the clinical effect of simulation in posterior implant region. METHODS: 115 implants from 72 patients undergoing implantation of posterior teeth in the Eye & ENT Hospital of Fudan University were selected. The horizontal heights from the top of the alveolar bone to the important anatomic structures (mandibular nerve or maxillary sinus floor) were measured using CBCT and orthopantography and then analyzed statistically. The implantation simulations were performed using Planmeca Romexis3.8 (for CBCT) and Cliniview9.3 (for orthopantography) to compare the differences in stimulated and postoperative horizontal heights.RESULTS AND CONCLUSION: There were significant differences in the measured data between CBCT and orthopantography (P < 0.05), especially in the maxilla (P < 0.01). There were significant differences between the simulated and postoperative results of the two methods (P < 0.05). The average error and standard deviation in orthopantography were larger than those in CBCT. The average error of implantation simulation using CBCT in the maxilla was smaller than that using orthopantography, whereas the error was similar in mandibular simulations. To conclude, CBCT is more accurate for assessing the quantity of bone in posterior implant region, especially in the maxilla. The accuracy of CBCT and orthopantography in implantation simulation needs to be improved.