正常成人上颌骨三维重建与测量的研究
摘要
目的：本研究应用螺旋CT扫描，对正常人的上颌骨及上颌窦进行三维重建和测量，以建立国人上颌骨及上颌窦的一些参考数据，为上颌种植义齿的术前设计，手术方案的制定提供理论和临床的参考，确定种植义齿的局部适应症，以提高种植成功率和减少并发症的发生。
方法：选择健康的成人志愿受试者17例(34侧)，对上颌骨进行螺旋CT连续容积扫描，三维重建，扫描层厚3mm，重建层厚1mm。在每一牙位上截取与牙弓曲线垂直的截面，在选取的截面上测量上颌骨的牙槽骨及上颌窦的有关数据，对所测得数据进行统计分析。
结果：1、全部受试者上颌骨三维立体显示良好，获得影象细致逼真、与实体一致的上颌骨模型。2、对测量所得的各项数据进行统计学处理，获得其正常值范围。3、左右两侧各项对应数据经统计学分析，无显著性差异(P＞0.05)。4、牙槽嵴顶及其上方10mm的牙槽骨宽度，总体上从前向后逐渐增宽，而侧切牙的牙槽嵴顶及其上方10mm牙槽骨最窄(P＜0.05)。5、后牙区的牙槽嵴顶与上颌窦底壁之间的距离以第一磨牙最近，依次为第二磨牙、第二前磨牙和第一前磨牙，前三者之间统计学分析无明显差异性(P＞0.05)，与第一前磨牙之间差异有显著性(P＜0.05)。6、尖牙的牙体长轴与牙槽嵴长轴之间的夹角与中、侧切牙之间有显著性差异(P＜0.05)。7、上颌窦的三径左右对比无显著性差异(P＞0.05)。
结论：临床上应用螺旋CT连续容积扫描，三维重建上颌骨及上颌窦，影像细致逼真，可以被任意角度旋转、任选层面切割观察和测量；所得各项数据可靠，总结了上颌骨及上颌窦的解剖特点及一般规律，为牙种植的术前设计提供了准确可靠的数据。从三维的角度确认种植的解剖条件，对指导临床医师选择适宜的种植体及植入数量、植入方向，制定最佳手术方案，对提高种植成功率，减少并发症的发生具有重要意义。
Objective: The purpose of this study is to set up a series of data of the maxilla and maxillary sinus for the adults on the basis of three-dimensional reconstruction and measurement by spiral CT scans. The data can provide an objective basis for an exact preoperative layout and the selection of dental implants. Precise planning resulted in good success and decreased complications.
Method:17 healthy adult volunteers(34 sides) were selected, and three-dimensional models to the maxilla were reconstructed on the basis of spiral volume scans. Collimation was 3 mm, Reconstruction interval was 1 mm. The slices vertical to the compensating curve were made in every dental position and collected the data of alveoli and maxillary sinus on the advantage workstation (AW 4. 0-3). Then the data were analyzed. The same works were done on both sides.
Results: 1.All three-dimensional models of maxilla were constructed. 2. The normal data of maxila was got.. 3. There is no significant difference between the data of the left and right maxilla. 4. The alveolar ridge and the place of it up 10mm were more and more wider from mesial to distal except for lateral incisor. 5. The distance between the alveolar ridge of posterior teeth to the floor of maxillary sinus: the first molar is the nearest, then the second molar, the second bicuspid and the first bicuspid. There is no significant difference among the front there teeth .But it has significant difference with the first bicuspid. 6. The angle between the labial teeth long axis and alveoli long axis: There is no significant difference between maxillary canine and maxillary incisors. Conclusion: Different types of dental implant should be chosen
according to the anatomic characteristic of the maxillary bone in every dental position before the operation to avoid complications. The data on the basis of spiral CT scans can lead to reliable, precise planning.
Postgraduate Yanhui Wang
(Oral & Maxillofacial Surgery) Directed by Ningyi Li
方法：选择健康的成人志愿受试者17例(34侧)，对上颌骨进行螺旋CT连续容积扫描，三维重建，扫描层厚3mm，重建层厚1mm。在每一牙位上截取与牙弓曲线垂直的截面，在选取的截面上测量上颌骨的牙槽骨及上颌窦的有关数据，对所测得数据进行统计分析。
结果：1、全部受试者上颌骨三维立体显示良好，获得影象细致逼真、与实体一致的上颌骨模型。2、对测量所得的各项数据进行统计学处理，获得其正常值范围。3、左右两侧各项对应数据经统计学分析，无显著性差异(P＞0.05)。4、牙槽嵴顶及其上方10mm的牙槽骨宽度，总体上从前向后逐渐增宽，而侧切牙的牙槽嵴顶及其上方10mm牙槽骨最窄(P＜0.05)。5、后牙区的牙槽嵴顶与上颌窦底壁之间的距离以第一磨牙最近，依次为第二磨牙、第二前磨牙和第一前磨牙，前三者之间统计学分析无明显差异性(P＞0.05)，与第一前磨牙之间差异有显著性(P＜0.05)。6、尖牙的牙体长轴与牙槽嵴长轴之间的夹角与中、侧切牙之间有显著性差异(P＜0.05)。7、上颌窦的三径左右对比无显著性差异(P＞0.05)。
结论：临床上应用螺旋CT连续容积扫描，三维重建上颌骨及上颌窦，影像细致逼真，可以被任意角度旋转、任选层面切割观察和测量；所得各项数据可靠，总结了上颌骨及上颌窦的解剖特点及一般规律，为牙种植的术前设计提供了准确可靠的数据。从三维的角度确认种植的解剖条件，对指导临床医师选择适宜的种植体及植入数量、植入方向，制定最佳手术方案，对提高种植成功率，减少并发症的发生具有重要意义。
Objective: The purpose of this study is to set up a series of data of the maxilla and maxillary sinus for the adults on the basis of three-dimensional reconstruction and measurement by spiral CT scans. The data can provide an objective basis for an exact preoperative layout and the selection of dental implants. Precise planning resulted in good success and decreased complications.
Method:17 healthy adult volunteers(34 sides) were selected, and three-dimensional models to the maxilla were reconstructed on the basis of spiral volume scans. Collimation was 3 mm, Reconstruction interval was 1 mm. The slices vertical to the compensating curve were made in every dental position and collected the data of alveoli and maxillary sinus on the advantage workstation (AW 4. 0-3). Then the data were analyzed. The same works were done on both sides.
Results: 1.All three-dimensional models of maxilla were constructed. 2. The normal data of maxila was got.. 3. There is no significant difference between the data of the left and right maxilla. 4. The alveolar ridge and the place of it up 10mm were more and more wider from mesial to distal except for lateral incisor. 5. The distance between the alveolar ridge of posterior teeth to the floor of maxillary sinus: the first molar is the nearest, then the second molar, the second bicuspid and the first bicuspid. There is no significant difference among the front there teeth .But it has significant difference with the first bicuspid. 6. The angle between the labial teeth long axis and alveoli long axis: There is no significant difference between maxillary canine and maxillary incisors. Conclusion: Different types of dental implant should be chosen
according to the anatomic characteristic of the maxillary bone in every dental position before the operation to avoid complications. The data on the basis of spiral CT scans can lead to reliable, precise planning.
Postgraduate Yanhui Wang
(Oral & Maxillofacial Surgery) Directed by Ningyi Li
引文
1 邱蔚六主编。口腔颌面外科理论与实践。第一版。北京：人民卫生出版社。1998：302-313
2 孙波，刘宝林，薛振恂。上颌窦及鼻底植骨在口腔种植术中的应用。国外医学口腔医学分册，1995，22(3)：151-154
3 孟翔峰，陈建钢，李清，等。牙种植体植入方向在修复设计与颌骨骨量间的差异。临床口腔医学杂志，2002，18(1)：38-39
4 张志勇，黄伟，余强，等。CT扫描在种植义齿术前设计中的应用。上海口腔医学，2002，11(1)：86-88
5 徐袁瑾，沈国芳，唐友盛。曲面断层摄影变形失真的初步研究。临床口腔医学杂志，2001，17(3)：185-186
6 陈建国，刘兴坤，顾霖。下颌骨各部位曲面体层影像放大率的定量分析。上海口腔医学，2001，10(2)：149-150
7 Lan EWN, Ruprecht A, Yang J. Comparision of two-dimensional orthoradially reformatted computed tomography and panoramic radiography for dental implant treatment planning. J Prosth Dent, 1995,74:42-46 8(2): 70-72
8 夏纪严。鼻及鼻窦疾病的CT诊断价值。中国中西医结合耳鼻咽喉科杂志，2000，8(2)：70-72
9 秦永，李志光。CT扫描对上颌窦骨间隔畸形的诊断价值。临床耳鼻咽喉科杂志，1999，13(2)：53-55
10 杨星，马彪，苏勤，等。螺旋CT三维重建的方法及技巧。中华放射学杂志，1999，33(7)：492-493
11 张蔚国，赵弘，佟丹，等。螺旋CT的原理及应用。中华放射学杂志，1995，29(1)：60-61
12 Madrid D. Two-dimensional and three dimensional computed tomographic imaging in musculoskeletal tumors. Radiol Clin North Am, 1993,31:425-447
13 Rigauts H, Marchal G, Baert AL, et al. Initial experience with volume scanning. J Comput Assist Tomogr, 1990,14:675
14 张彤，刘洪臣，王延荣，等。上颌骨复合体三维有限元模型的建立。中华口腔医学杂志，2000，35(5)：375-376
15 赵保东，李宁毅，周仰光，等。下颌骨的三维重建及实体解剖研究。华西口腔医学杂志，2002，20(1)：21-23
16 Abrahams JJ. CT assessment of dental implant planning. In:Contemporary
Maxillofacial Imaging.Oral&Maxillofacial Surgery Clinics of North America. Philadelphia:Saunders, 1992, 19
17 Santini a, Land M. A comparison of the position of the mental foramen in Chinese and British mandibles. Acta Anat(Basel), 1990, 137(3) :208-212
18姚小武，朱明仁，殷学民。恒牙牙槽窝的解剖学观测及意义。广东牙病防治，1997， 5(4) ：10-11
19 Buser D. Long-term evaluation of non-submerged ITI implants. Part 1:8-year life table analysis of a prospective multi-center study with 2359 implants. Clin Oral Impl Res,1997, 8:161-172
20林野，王兴，邱立新，等。上颌窦提升植骨及同期种植体植入术。中华口腔医学 杂志，1998，33(6) ：326-328
21 A.Omar Abubaker. Applied anatomy of the maxillary sinus. Oral and MaxillofacialSugery Clinics of North America, 1999, 11 (1) :1-13
22 Anon JB, Rontal M, Zinreich.SJ.Maxillary sinus anatomy. Anatomy of the Paranasal Sinuses. New York, Thieme, 1996, 18-21
23 Anderhuber W, Weiglein A, Wolf G. Nasal cavities and paranasal sinuses in newborns and children. Acta Anat (Basel)1992, 144:120
24 Ariji Y, Ariji E, Yoshiura K, et al. Computed tomographic indices for maxillary sinus size in comparison with the sinus volume. Dentomaxillofacial Radiology, 1996, 25:19
25 Uchida Y, Aoto M, Katanki T, et al. Acadaveric study of maxillary sinus size as an aid in bone grafting of the maxillary sinus floor. J Oral Maxillofac Surg 1998,56:1158
26 Ulm CW, Solar P, Krennmair, et al. Incidence and suggested surgical management of septa in sinus-lift procedures. Int J Oral Maxillofac Implants 1995, 10:462
27 Effie loannidou, John W. Osteotome Sinus floor Elevation and Simultaneous, Non-Submerged Implant Placement:Case Report and Literature Review. J Periodontol, 2000, 1613-1619
28 Kelley HC, Kay LW. The Maxillary Sinus and its Dental Implications: Dental Practice Handbook. Bristol, England, John Wright & Sons,1975,1-13
29 Forsgren K, Stierna P, Kumlien, et al. Regeneration of maxillary sinus mucosa following surgical removal:Experimental study in rabbits. Ann Otol Rhinol Laryngol 1993,102:459
30马著彬，陈金城。上颌窦形态的CT分析。中国临床解剖学杂志，11(3) ：198-200
31 Bergh JP, Bruggenkate CM, Disch FJ, et al. Anatomical aspects of sinus floor elevations. Clin Oral Implants Res, 2000, 11(3) :256-65
32 Bryant SR. The effects of age, jaw site, and bone condition on oral implant outcomes. Int J Prosthodont, 1998,11(5) :470-490
33 Clelland NL, Lee JK, Bimbenet OC, et al.A three-dimensional finite element stress analysis of angled abutments for an implant placed in the anterior maxilla. J Prosthodont,1995,4(2) :95-100
2 孙波，刘宝林，薛振恂。上颌窦及鼻底植骨在口腔种植术中的应用。国外医学口腔医学分册，1995，22(3)：151-154
3 孟翔峰，陈建钢，李清，等。牙种植体植入方向在修复设计与颌骨骨量间的差异。临床口腔医学杂志，2002，18(1)：38-39
4 张志勇，黄伟，余强，等。CT扫描在种植义齿术前设计中的应用。上海口腔医学，2002，11(1)：86-88
5 徐袁瑾，沈国芳，唐友盛。曲面断层摄影变形失真的初步研究。临床口腔医学杂志，2001，17(3)：185-186
6 陈建国，刘兴坤，顾霖。下颌骨各部位曲面体层影像放大率的定量分析。上海口腔医学，2001，10(2)：149-150
7 Lan EWN, Ruprecht A, Yang J. Comparision of two-dimensional orthoradially reformatted computed tomography and panoramic radiography for dental implant treatment planning. J Prosth Dent, 1995,74:42-46 8(2): 70-72
8 夏纪严。鼻及鼻窦疾病的CT诊断价值。中国中西医结合耳鼻咽喉科杂志，2000，8(2)：70-72
9 秦永，李志光。CT扫描对上颌窦骨间隔畸形的诊断价值。临床耳鼻咽喉科杂志，1999，13(2)：53-55
10 杨星，马彪，苏勤，等。螺旋CT三维重建的方法及技巧。中华放射学杂志，1999，33(7)：492-493
11 张蔚国，赵弘，佟丹，等。螺旋CT的原理及应用。中华放射学杂志，1995，29(1)：60-61
12 Madrid D. Two-dimensional and three dimensional computed tomographic imaging in musculoskeletal tumors. Radiol Clin North Am, 1993,31:425-447
13 Rigauts H, Marchal G, Baert AL, et al. Initial experience with volume scanning. J Comput Assist Tomogr, 1990,14:675
14 张彤，刘洪臣，王延荣，等。上颌骨复合体三维有限元模型的建立。中华口腔医学杂志，2000，35(5)：375-376
15 赵保东，李宁毅，周仰光，等。下颌骨的三维重建及实体解剖研究。华西口腔医学杂志，2002，20(1)：21-23
16 Abrahams JJ. CT assessment of dental implant planning. In:Contemporary
Maxillofacial Imaging.Oral&Maxillofacial Surgery Clinics of North America. Philadelphia:Saunders, 1992, 19
17 Santini a, Land M. A comparison of the position of the mental foramen in Chinese and British mandibles. Acta Anat(Basel), 1990, 137(3) :208-212
18姚小武，朱明仁，殷学民。恒牙牙槽窝的解剖学观测及意义。广东牙病防治，1997， 5(4) ：10-11
19 Buser D. Long-term evaluation of non-submerged ITI implants. Part 1:8-year life table analysis of a prospective multi-center study with 2359 implants. Clin Oral Impl Res,1997, 8:161-172
20林野，王兴，邱立新，等。上颌窦提升植骨及同期种植体植入术。中华口腔医学 杂志，1998，33(6) ：326-328
21 A.Omar Abubaker. Applied anatomy of the maxillary sinus. Oral and MaxillofacialSugery Clinics of North America, 1999, 11 (1) :1-13
22 Anon JB, Rontal M, Zinreich.SJ.Maxillary sinus anatomy. Anatomy of the Paranasal Sinuses. New York, Thieme, 1996, 18-21
23 Anderhuber W, Weiglein A, Wolf G. Nasal cavities and paranasal sinuses in newborns and children. Acta Anat (Basel)1992, 144:120
24 Ariji Y, Ariji E, Yoshiura K, et al. Computed tomographic indices for maxillary sinus size in comparison with the sinus volume. Dentomaxillofacial Radiology, 1996, 25:19
25 Uchida Y, Aoto M, Katanki T, et al. Acadaveric study of maxillary sinus size as an aid in bone grafting of the maxillary sinus floor. J Oral Maxillofac Surg 1998,56:1158
26 Ulm CW, Solar P, Krennmair, et al. Incidence and suggested surgical management of septa in sinus-lift procedures. Int J Oral Maxillofac Implants 1995, 10:462
27 Effie loannidou, John W. Osteotome Sinus floor Elevation and Simultaneous, Non-Submerged Implant Placement:Case Report and Literature Review. J Periodontol, 2000, 1613-1619
28 Kelley HC, Kay LW. The Maxillary Sinus and its Dental Implications: Dental Practice Handbook. Bristol, England, John Wright & Sons,1975,1-13
29 Forsgren K, Stierna P, Kumlien, et al. Regeneration of maxillary sinus mucosa following surgical removal:Experimental study in rabbits. Ann Otol Rhinol Laryngol 1993,102:459
30马著彬，陈金城。上颌窦形态的CT分析。中国临床解剖学杂志，11(3) ：198-200
31 Bergh JP, Bruggenkate CM, Disch FJ, et al. Anatomical aspects of sinus floor elevations. Clin Oral Implants Res, 2000, 11(3) :256-65
32 Bryant SR. The effects of age, jaw site, and bone condition on oral implant outcomes. Int J Prosthodont, 1998,11(5) :470-490
33 Clelland NL, Lee JK, Bimbenet OC, et al.A three-dimensional finite element stress analysis of angled abutments for an implant placed in the anterior maxilla. J Prosthodont,1995,4(2) :95-100