CBCT在牙根尖周炎源性上颌窦黏膜炎根管治疗疗效评价中的应用
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摘要
目的通过CBCT检查患根尖周炎的上颌后牙,探讨牙根尖周源性上颌窦黏膜炎的特点及根管治疗后黏膜及骨质的改变。方法对25例患上颌后牙根尖周炎患者上颌窦进行CBCT扫描重建,确诊为黏膜炎后,根管治疗3个月后CBCT扫描明确黏膜炎消退程度,6个月后扫描通过根尖周指数评估根尖骨质愈合情况。结果剔除2例上颌窦炎,14例上颌窦表现为黏膜炎(61%),根管治疗3个月后,黏膜炎完全消退5例(35.7%);部分消退6例(42.9%);3例无明显改变(21.4%)。6个月后,3颗牙齿愈合(21.4%),4颗牙齿好转(28.6%),7颗牙齿未愈合(50.0%)。结论上颌后牙根尖周炎易引发上颌窦黏膜炎,根管治疗是该疾病有效的治疗方法,CBCT影像能精确反映根管治疗前后上颌窦黏膜炎消退及骨质愈合情况,具有重要的临床参考价值。
Objective To investigate the characteristics of maxillary sinus mucositis adjacent to teeth with apical periodontitis(AP) and evaluate its resolution after endodontic treatment with cone beam computed tomography(CBCT). Methods 25 maxillary sinuses in patients who had AP associated with maxillary posterior teeth were scanned with CBCT. When mucositis was found, its resolution was evaluated with CBCT imaging 3 months after endodontic treatment, and periapical healing was assessed by the periapical index(PAI) after 6 months. Results Excluding 2 sinusitis, mucositis was found in 14 of 23 sinuses(61%). Three months after therapy, mucositis was fully resolved in 5 of 14 patients(35.7%), partially resolved in 6 of 14 patients(42.9%), unchanged in 3 patients(21.4%). Six months after treatment, a total of 3 of 14 teeth(21.4%) were healed, 4 of 14 teeth(28.6%) were healing, 7 of 14 teeth(50.0%) had persistent AP. Conclusion Endodontic treatment is an effective therapy for posterior teeth associated with AP which can easily trigger maxillary sinus mucositis. CBCT can accurately assess the resolution of maxillary sinus mucositis before and after endodontic treatment, which has important clinical reference value.
Objective To investigate the characteristics of maxillary sinus mucositis adjacent to teeth with apical periodontitis(AP) and evaluate its resolution after endodontic treatment with cone beam computed tomography(CBCT). Methods 25 maxillary sinuses in patients who had AP associated with maxillary posterior teeth were scanned with CBCT. When mucositis was found, its resolution was evaluated with CBCT imaging 3 months after endodontic treatment, and periapical healing was assessed by the periapical index(PAI) after 6 months. Results Excluding 2 sinusitis, mucositis was found in 14 of 23 sinuses(61%). Three months after therapy, mucositis was fully resolved in 5 of 14 patients(35.7%), partially resolved in 6 of 14 patients(42.9%), unchanged in 3 patients(21.4%). Six months after treatment, a total of 3 of 14 teeth(21.4%) were healed, 4 of 14 teeth(28.6%) were healing, 7 of 14 teeth(50.0%) had persistent AP. Conclusion Endodontic treatment is an effective therapy for posterior teeth associated with AP which can easily trigger maxillary sinus mucositis. CBCT can accurately assess the resolution of maxillary sinus mucositis before and after endodontic treatment, which has important clinical reference value.
引文
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[13] Sheikhi M,Pozve N,Khorrami L.Using cone beam computed tomography to detect the relationship between the periodontal bone loss and mucosal thickening of the maxillary sinus[J].Dent Res J,2014(4):495-501.
[14] Ariji Y,Obayashi N,Goto M,et al.Roots of the maxillary first and second molars in horizontal relation to alveolar cortical plates and maxillary sinus:computed tomography assessment for infection spread[J].Clin Oral Investig,2006,10(1):35-41.
[15] Nunes CA,Guedes OA,Alencar AH,et al.Evaluation of periapical lesions and their association with maxillary sinus abnormalities on cone-beam computed tomographic images[J].J Endod,2016,42(1):42-46.
[16] Metzger Z,Huber R,Slavescu D,et al.Healing kinetics of periapical lesions enhanced by the apexum procedure:a clinical trial[J].J Endod,2009,35(2):153-159.
[17] 闵艺,李航,万新辉.CBCT在根管治疗后疾病诊治中的临床应用研究[J].口腔医学研究,2013,29(10):955-958.
[18] de Lima CO,Devito KL,Baraky Vasconcelos LR,et al.Corr-elation between endodontic infection and periodontal disease and their association with chronic sinusitis:a clinical-tomographic Study[J].J Endod,2017,43(12):1978-1983.
[19] 胡颖恺,徐光宙,杨驰.牙源性上颌窦炎治疗进展[J].中国口腔颌面外科杂志,2014,12(6):558-564.
[20]Block M,Dastoury K.Incidence of sinus membrane thickening and association with unhealthy teeth:a retrospective review of 831 consecutive cone beam scans[J].J Oral Maxillofac Surg,2014,72(9):e75-e76.
[2] Maillet M,Bowles WR,McClanahan SL,et al.Cone-beam computed tomography evaluation of maxillary sinusitis[J].J Endod,2011,37(6):753-757.
[3] 汪小彤,孙超,朱洁,等.应用CBCT评判根管治疗失败原因[J].口腔医学,2015,35(5):373-375.
[4] Costa F,Emanuelli E,Robiony M.Incidence of maxillary sinus disease before sinus floor elevation surgery as identified by conebeam computed tomography:a literature review[J].J Oral Implantol,2018,44(2):161-166.
[5] Estrela C,Bueno MR,Azevedo BC,et al.A new periapical index based on cone beam computed tomography[J].J Endod,2008,34(11):1325-1331.
[6] Legert KG,Zimmerman M,Stierna P.Sinusitis of odontogenic origin:pathophysiological implications of early treatment[J].Acta Otolaryngol,2004,124(6):655-663.
[7] Block M,Dastoury K.Incidence of sinus membrane thickening and association with unhealthy teeth:a retrospective review of 831 consecutive cone beam scans[J].J Oral Maxillofac Surg,2014,72(9):e75-e76.
[8] Maloney PL,Doku HC.Maxillary sinusitis of odontogenic origin[J].J Can Dent Assoc(Tor),1968,34(11):591-603.
[9] Maillet M,Bowles WR,McClanahan SL,et al.Cone-beam computed tomography evaluation of maxillary sinusitis[J].J Endod,2011,37(6):753-757.
[10] Nascimento EH,Pontual ML,Pontual AA,et al.Association between odontogenic conditions and maxillary sinus isease:a study using cone-beam computed tomography[J].J Endod,2016,42(10):1509-1515.
[11] Patel NA,Ferguson BJ.Odontogenic sinusitis:an ancient but under-appreciated cause of maxillary sinusitis[J].Curr Opin Otolaryngol Head Neck Surg,2012,20(1):24-28.
[12] Estrela C,Bueno MR,Azevedo BC,et al.A new periapical index based on cone beam computed tomography[J].J Endod,2008,34(11):1325-1331.
[13] Sheikhi M,Pozve N,Khorrami L.Using cone beam computed tomography to detect the relationship between the periodontal bone loss and mucosal thickening of the maxillary sinus[J].Dent Res J,2014(4):495-501.
[14] Ariji Y,Obayashi N,Goto M,et al.Roots of the maxillary first and second molars in horizontal relation to alveolar cortical plates and maxillary sinus:computed tomography assessment for infection spread[J].Clin Oral Investig,2006,10(1):35-41.
[15] Nunes CA,Guedes OA,Alencar AH,et al.Evaluation of periapical lesions and their association with maxillary sinus abnormalities on cone-beam computed tomographic images[J].J Endod,2016,42(1):42-46.
[16] Metzger Z,Huber R,Slavescu D,et al.Healing kinetics of periapical lesions enhanced by the apexum procedure:a clinical trial[J].J Endod,2009,35(2):153-159.
[17] 闵艺,李航,万新辉.CBCT在根管治疗后疾病诊治中的临床应用研究[J].口腔医学研究,2013,29(10):955-958.
[18] de Lima CO,Devito KL,Baraky Vasconcelos LR,et al.Corr-elation between endodontic infection and periodontal disease and their association with chronic sinusitis:a clinical-tomographic Study[J].J Endod,2017,43(12):1978-1983.
[19] 胡颖恺,徐光宙,杨驰.牙源性上颌窦炎治疗进展[J].中国口腔颌面外科杂志,2014,12(6):558-564.
[20]Block M,Dastoury K.Incidence of sinus membrane thickening and association with unhealthy teeth:a retrospective review of 831 consecutive cone beam scans[J].J Oral Maxillofac Surg,2014,72(9):e75-e76.