下颌第一恒磨牙远中舌侧根管口定位的锥体束CT分析
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摘要
目的:采用受试者工作特征(receiver operating characteristic,ROC)曲线分析下颌第一恒磨牙的锥体束CT(cone-beam computed tomography,CBCT)数据,分析远中舌侧根管口发生率及探寻其定位规律。方法:随机抽取江苏省口腔医院放射科行CBCT检查的患者图像数据。记录下颌第一恒磨牙的远中根管数目,测量各根管口间的距离(近中颊侧根管口MBO、近中舌侧根管口MLO、远中颊侧根管口DBO、远中舌侧根管口DLO)和形成的角度(MBO-DBO连线与MBO-MLO连线的夹角∠DBML、MBO-DBO连线与MBO-DLO连线的夹角∠DBDL)。通过ROC曲线筛选出下颌第一恒磨牙远中舌侧根管口存在的最佳诊断指标,并计算其临界值。对远中舌侧根管口及其他各根管口间形成的角度、距离之间比例关系进行分析,定位远中舌侧根管口。结果:共获取300例患者572颗下颌第一恒磨牙CBCT图像数据。远中出现双根管共213例,比例为37.2%。下颌第一恒磨牙远中根管分组在性别、年龄、左右侧牙位上的分布无统计学差异(P> 0.05)。∠DBML为判断下颌第一恒磨牙存在远中舌侧根管口的最佳指标,其ROC曲线下面积为0.988,其诊断的临界值为72.143°。∠DBDL和∠DBML比值为0.551;MBO-DLO和MLO-DBO比值为1.035。结论:下颌第一恒磨牙远中舌侧根管发生率较高,下颌第一恒磨牙∠DBML为远中舌侧根管口存在的诊断指标。∠DBML和∠DBDL角度和MBO-DLO和MLO-DBO距离比例关系可为临床上定位下颌第一恒磨牙远中舌侧根管口提供重要依据。
Objective:To investigate the incidence and location of distolingual canal orifice in permanent mandibular first molars using cone-beam computed tomography(CBCT)and the relevant receiver operating characteristic(ROC)analysis. Methods:A total of572 mandibular first molars were chosen from 300 patients undergoing CBCT scan in Department of Radiology,Stomatology Hospital of Jiangsu. The number of the distal roots and the root canals of mandibular first molars were recorded by the analysis of the CBCT data using SIMPLANT software,and the distance and angle(∠DBML and ∠DBDL)between the root orifices were measured accordingly.The best diagnostic index for the presence of the distolingual canal orifice in the permanent mandibular first molars was selected by ROC curve,and the critical value was calculated by Youden index. Then,the relationships between the angles and distances formed by the distolingual canal orifice and other root canals orifice were analyzed. Results:The prevalence of two distolingual canals in mandibular first molars was 37.2%(213/572). The balance test of the classification of distal roots showed no statistically significant difference in gender,age and side(P > 0.05). ROC analysis showed a high diagnostic accuracy of 0.988 of the area under the ROC curve,which suggested that the ∠DBML could be used as a prediction data to the presence of distolingual canal orifice. The critical value for the diagnosis of distolingual canal orifice of mandibular first molars by ∠DBML is 72.143°. The distolingual canal orifice can be located using the ∠DBDL and ∠DBML angle ratio(∠DBDL=0.551×∠DBML),and the MBO-DLO and MLO-DBO distance ratio(MBO-DLO=1.035 × MLO-DBO). Conclusion:The angle of ∠DBDL and the distance of MLO-DBO in permanent mandibular first molars could be used clinically for the location of the distolingual canal orifice.
Objective:To investigate the incidence and location of distolingual canal orifice in permanent mandibular first molars using cone-beam computed tomography(CBCT)and the relevant receiver operating characteristic(ROC)analysis. Methods:A total of572 mandibular first molars were chosen from 300 patients undergoing CBCT scan in Department of Radiology,Stomatology Hospital of Jiangsu. The number of the distal roots and the root canals of mandibular first molars were recorded by the analysis of the CBCT data using SIMPLANT software,and the distance and angle(∠DBML and ∠DBDL)between the root orifices were measured accordingly.The best diagnostic index for the presence of the distolingual canal orifice in the permanent mandibular first molars was selected by ROC curve,and the critical value was calculated by Youden index. Then,the relationships between the angles and distances formed by the distolingual canal orifice and other root canals orifice were analyzed. Results:The prevalence of two distolingual canals in mandibular first molars was 37.2%(213/572). The balance test of the classification of distal roots showed no statistically significant difference in gender,age and side(P > 0.05). ROC analysis showed a high diagnostic accuracy of 0.988 of the area under the ROC curve,which suggested that the ∠DBML could be used as a prediction data to the presence of distolingual canal orifice. The critical value for the diagnosis of distolingual canal orifice of mandibular first molars by ∠DBML is 72.143°. The distolingual canal orifice can be located using the ∠DBDL and ∠DBML angle ratio(∠DBDL=0.551×∠DBML),and the MBO-DLO and MLO-DBO distance ratio(MBO-DLO=1.035 × MLO-DBO). Conclusion:The angle of ∠DBDL and the distance of MLO-DBO in permanent mandibular first molars could be used clinically for the location of the distolingual canal orifice.
引文
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[20]Tian XM,Yang XW,Qian L,et al.Analysis of the root and canal morphologies in maxillary first and second molars in a chinese population using cone-beam computed tomography[J].J Endod,2016,42(5):696-701
[2]Mohammadzadeh AN,Khalilak Z,Vatanpour M,et al.Root canal anatomy and morphology of mandibular first molars in a selected iranian population:an in vitro study[J].Iran Endod J,2017,12(1):87-91
[3]Yang R,Yang C,Liu Y,et al.Evaluate root and canal morphology of primary mandibular second molars in chinese individuals by using cone-beam computed tomography[J].J Formos Med Assoc,2013,112(7):390-395
[4]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
[5]Kim Y,Roh BD,Shin Y,et al.Morphological characteristics and classification of mandibular first molars having 2distal roots or canals:3-dimensional biometric analysis using cone-beam computed tomography in a korean population[J].J Endod,2018,44(1):46-50
[6]Zhang X,Xiong S,Ma Y,et al.A cone-beam computed tomographic study on mandibular first molars in a chinese subpopulation[J].PLoS One,2015,10(8):e134919
[7]Da SP,Vizzotto MB,Liedke GS,et al.Detection of vertical root fractures by conventional radiographic examination and cone beam computed tomography-an in vitro analysis[J].Dent Traumatol,2013,29(1):41-46
[8]李卫吴剑花税艳青彭艺.云南地区人群下颌第一恒磨牙根管形态的锥形束CT分析[J].昆明医科大学学报,2017
[9]Carter JV,Pan J,Rai SN,et al.Roc-ing along:evaluation and interpretation of receiver operating characteristic curves[J].Surgery,2016,159(6):1638-1645
[10]Yin J,Tian L.Joint confidence region estimation for area under roc curve and youden index[J].Stat Med,2014,33(6):985-1000
[11]Koc C,Sonmez G,Yilmaz F,et al.Comparison of the accuracy of periapical radiography with cbct taken at 3 different voxel sizes in detecting simulated endodontic complications:an ex vivo study[J].Dentomaxillofac Radiol,2018,47(4):20170399
[12]Chen J,Li X,Su Y,et al.A micro-computed tomography study of the relationship between radicular grooves and root canal morphology in mandibular first premolars[J].Clin Oral Investig,2015,19(2):329-334
[13]Huang CC,Chang YC,Chuang MC,et al.Evaluation of root and canal systems of mandibular first molars in taiwanese individuals using cone-beam computed tomography[J].J Formos Med Assoc,2010,109(4):303-308
[14]Martins J,Gu Y,Marques D,et al.Differences on the root and root canal morphologies between asian and white ethnic groups analyzed by cone-beam computed tomography[J].J Endod,2018,44(7):1096-1104
[15]Zhang D,Chen J,Lan G,et al.The root canal morphology in mandibular first premolars:a comparative evaluation of cone-beam computed tomography and micro-computed tomography[J].Clin Oral Investig,2017,21(4):1007-1012
[16]Patel S,Durack C,Abella F,et al.Cone beam computed tomography in endodontics-a review[J].INT ENDOD J,2015,48(1):3-15
[17]Tu MG,Huang HL,Hsue SS,et al.Detection of permanent three-rooted mandibular first molars by cone-beam computed tomography imaging in taiwanese individuals[J].J Endod,2009,35(4):503-507
[18]姚娜,贾立辉,张晓东,等.辽沈地区人群下颌第一磨牙牙根及根管解剖的CBCT观察[J].临床口腔医学杂志,2014,30(4):205-207
[19]姜楠,周洲,周耀,等.华东地区中国人下颌第一恒磨牙根管形态的锥形束CT分析[J].南京医科大学学报(自然科学版),2013,33(5):693-697
[20]Tian XM,Yang XW,Qian L,et al.Analysis of the root and canal morphologies in maxillary first and second molars in a chinese population using cone-beam computed tomography[J].J Endod,2016,42(5):696-701