中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2014, Vol. 12 ›› Issue (6): 515-520.

• 临床研究 • 上一篇    下一篇

骨埋伏阻生下颌第三磨牙颊舌侧骨壁厚度测量及分类

戈旌, 杨驰, 樊林峰, 何冬梅   

  1. 上海交通大学附属第九人民医院·
    口腔医学院 口腔外科,上海市口腔医学重点实验室,上海 200011
  • 收稿日期:2014-03-27 出版日期:2014-11-10 发布日期:2015-01-01
  • 通讯作者: 杨驰,E-mail：yangchi63@hotmail.com
  • 作者简介:戈旌（1985-）,女,在读博士研究生,E-mail：

Classification and measurement of alveolar bone thickness of deeply impacted mandibular third molar

GE Jing, YANG Chi, FAN Lin-feng, HE Dong-mei   

  1. Department of Oral Surgery, College of Stomatology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine,Shanghai Key Laboratory of Stomatology. Shanghai 200011, China
  • Received:2014-03-27 Online:2014-11-10 Published:2015-01-01

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摘要： 目的 根据颊舌侧牙槽骨壁厚度差异,将骨埋伏阻生下颌第三磨牙进行分类,为选择去骨方式提供依据。方法 以在我院放射科做过锥形束CT（cone-beam computed tomography, CBCT）的连续病例为对象,筛选110颗重度骨埋伏阻生的下颌第三磨牙作为研究样本。采用3种方法对CBCT图像进行测量,第1种方法为线距测量法,即用CBCT图像分析软件测量牙冠中点、釉牙骨质界中点和牙根中点处的颊舌侧骨壁厚度,以平均颊舌侧骨壁厚度差值作为分类标准（差值的绝对值小于1 mm为中央位,大于1 mm为颊侧位或舌侧位）。第2种方法为目测法,即目测CBCT图像并按颊舌侧骨壁厚度分类。第3种方法为按牙列的位置分为颊侧移位、舌侧移位和正中位。以线距测量法为金标准,比较后2种方法的诊断价值。结果 110颗阻生牙按线距测量法分类,舌侧位96例（87.3%）,中央位13例（11.8%）,颊侧位1例（0.9%）。按目测法分类,舌侧位93例（84.5%）,中央位16例（14.5%）,颊侧位1例（0.9%）。按牙列的位置分类,颊侧移位59例（53.6%）,正中位48例（43.6%）,舌侧移位3例（2.7%）。以线距测量法为金标准,目测法的一致率为88.18%,在判断舌侧位、中央位和颊侧位上的敏感度分别为91.67%、61.54%和100%,特异度分别为64.29%、91.75%和100%,youden指数分别为0.56、0.53和1。牙列分类法的一致率为3.64%,在判断舌侧位、中央位、颊侧位上的敏感度分别为3.13%、0%和100%,特异度分别为100%、50.52%和46.79%,youden指数分别为0.03、0.49和0.53。结论 骨埋伏阻生下颌第三磨牙以舌侧位居多、中央位次之、颊侧位最少。提示骨埋伏阻生牙应以舌侧去骨为主。临床上可用目测法判断颊舌侧位置。按牙列分类与骨壁厚度无关。

关键词: 锥形束CT, 骨埋伏阻生下颌第三磨牙, 牙槽骨壁厚度

Abstract: PURPOSE : The aim of the present study was to measure the alveolar bone thickness of the deeply impacted mandibular third molar, and classify the molar based on the proximity to the external cortical bone. METHODS : Cone-beam CT(CBCT) data from 110 deeply impacted mandibular third molars were measured. At the center of crown, cenmeto-enamel junction and root, the distance between the tooth and the external bone surface was measured for both buccal and lingual side. The samples were classified into 3 groups (buccal, central and lingual position) by the following 3 methods: the first method was distance comparison: if the average difference of buccal-lingual alveolar bone thickness was less than 1 mm, the tooth was classified as central position,otherwise, the tooth was classified as buccal or lingual position. The second method was visual observation on CBCT images. The third method was to compare the relationship of third molar and dentition. Take distance comparison as gold standard to evaluate the sensitivity and specificity of the latter two methods. RESULTS : The samples were classified by distance comparison as: 1 buccal position (0.9%), 13 central position (11.8%), and 96 lingual position (87.3%). The samples were classified by visual observation as: 1 buccal position (0.9%), 16 central position (14.5%), and 93 lingual position (84.5%). The samples were classified by dentition relationship as: 59 buccal position (53.6%), 48 central position (43.6%), and 3 lingual position (2.7%). The sensitivity of visual observation for lingual, central and buccal position was 91.67%, 61.54% and 100%, respectively,the specificity was 64.29%, 91.75% and 100%, respectively,the youden index was 0.56, 0.53 and 1, respectively. The sensitivity of dentition relationship classification for lingual, central and buccal position was 3.13%, 0% and 100%, respectively,the specificity was 100%, 50.52% and 46.79%, respectively,the youden index was 0.03, 0.49 and 0.53, respectively. CONCLUSIONS : Among deeply impacted mandibular third molars, lingual position ranks the first, central position ranks the second and buccal position ranks the third. Visual observation is reliable for lingually or buccally displaced molar. Dentition relationship classification is not related to alveolar bone thickness.

Key words: Cone-beam CT, Deeply impacted mandibular third molar, Bone thickness

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