中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (8): 1572-1577.doi: 10.12307/2025.333

• 口腔组织构建 oral tissue construction • 上一篇    下一篇

锥形术CT测量分析下颌第一磨牙拟种植区剩余牙槽嵴的骨量

蔡尧昊1，郎  律2，黎  红3   

  1. 1浙江中医药大学口腔医学院，杭州口腔医院，浙江省杭州市  310000；2中国科学技术大学附属第一医院(安徽省立医院)口腔医学中心，安徽省合肥市  230002；3浙江中医药大学口腔医学院，杭州口腔医院萧山分院，浙江省杭州市  310000
  • 收稿日期:2024-03-23 接受日期:2024-05-06 出版日期:2025-03-18 发布日期:2024-07-05
  • 通讯作者: 黎红，博士，主任医师，教授，浙江中医药大学口腔医学院，杭州口腔医院萧山分院，浙江省杭州市 310000
  • 作者简介:蔡尧昊，男，1998年生，浙江省宁波市人，汉族，浙江中医药大学在读硕士，执业医师，主要从事口腔种植相关研究。
  • 基金资助:
    国家自然科学基金项目(81571003)，项目负责人：黎红

Assessing the bone mass of the residual alveolar ridge in the first molar for implant placement by cone-beam computed tomography 

Cai Yaohao1, Lang Lyu2, Li Hong3   

  1. 1Hangzhou Stomatological Hospital, School of Stomatology, Zhejiang Chinese Medical University, Hanzhou 310000, Zhejiang Province, China; 2Stomatological Center, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei 230002, Anhui Province, China; 3Hangzhou Stomatological Hospital Xiaoshan Branch, School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
  • Received:2024-03-23 Accepted:2024-05-06 Online:2025-03-18 Published:2024-07-05
  • Contact: Li Hong, MD, Chief physician, Professor, Hangzhou Stomatological Hospital Xiaoshan Branch, School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
  • About author:Cai Yaohao, Master candidate, Physician, Hangzhou Stomatological Hospital, School of Stomatology, Zhejiang Chinese Medical University, Hanzhou 310000, Zhejiang Province, China
  • Supported by:
    the National Natural Science Foundation of China, No. 81571003 (to LH)

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摘要：


文题释义：
下颌第一磨牙拟种植区：下颌第一磨牙缺失计划行口腔种植的区域，该区域牙齿缺失，软组织无红肿，且有足够的种植修复空间。常规种植时间为拔牙后3个月，此时拔牙创口愈合，牙槽骨已骨化，达到种植手术的标准。
剩余牙槽嵴：是指牙缺失后残留的成嵴状牙槽骨及其上覆盖的黏骨膜组织。根据缺牙区剩余牙槽嵴吸收程度不同可以将之分为4级：高圆形牙槽嵴、刃状牙槽嵴、低圆形牙槽嵴及低平状或凹形牙槽嵴。对于不同类型的剩余牙槽嵴，应采取不同的种植方案。

背景：随着口腔领域的发展与进步，口腔种植技术逐渐成为替代传统义齿的主流选择。近年来，多种骨增量技术的成熟以及口腔数字化领域的不断发展，使种植适应证不断扩大，种植手术的成功率也越来越高。但是种植手术前使用锥形术CT对剩余牙槽嵴骨量进行准确测量并且个性化制定合适的种植方案，成为一部分临床医师的难题。
目的：采用锥形束CT对下颌第一磨牙拟种植区剩余牙槽嵴骨量进行测量分析，为优化下颌第一磨牙区种植方案的设计提供参考。
方法：采用回顾性研究设计，纳入205例下颌第一磨牙缺失患者的锥形术CT影像，测量下颌第一磨牙拟种植区剩余牙槽嵴高度及宽度，并将剩余牙槽嵴形态分为Ⅰ、Ⅱ、Ⅲ、Ⅳ 4类(Ⅱ、Ⅲ、Ⅳ类剩余牙槽嵴为骨量不足)，统计分析下颌第一磨牙剩余牙槽嵴高度、宽度、形态频数分布，不同性别患者下颌第一磨牙剩余牙槽嵴高度和牙槽嵴顶宽度的差异，剩余牙槽嵴高度与剩余牙槽嵴顶宽度、剩余牙槽嵴底宽度的相关性，年龄与剩余牙槽嵴顶宽度、高度的相关性。
结果与结论：①下颌第一磨牙拟种植区剩余牙槽嵴高度平均为(12.14±2.96) mm，其中< 12 mm者占43.41%(89/205)，下颌第一磨牙拟种植区牙槽嵴顶宽度平均为(6.80±1.65) mm，其中< 6 mm者占26.34%(54/205)；②男性下颌第一磨牙剩余牙槽嵴高度高于女性，但差异无显著性意义(P > 0.05)，男性下颌第一磨牙剩余牙槽嵴顶宽度宽于女性，差异有显著性意义(P < 0.01)；③剩余牙槽嵴高度与剩余牙槽嵴顶宽度和剩余牙槽嵴底宽度呈负相关(P < 0.05)；年龄与剩余牙槽嵴顶宽度呈正相关(P < 0.05)，与剩余牙槽嵴高度无明显相关性(P > 0.05)；④剩余牙槽嵴形态Ⅰ类占58.05%(119/205)，Ⅱ类占9.27%(19/205)，Ⅲ类占20.49%(42/205)，Ⅳ类占12.19%(25/205)，其中多数为Ⅲ类剩余牙槽嵴骨量不足，临床医生需要根据剩余牙槽嵴类型个性化设计最佳的种植方案。
https://orcid.org/0009-0004-9524-088X(蔡尧昊)

关键词: 下颌第一磨牙, 剩余牙槽嵴形态, 锥形术CT, 种植修复, 引导骨再生术, 牙槽骨劈开术, 骨移植术, 短种植体, 计算机辅助种植

Abstract: BACKGROUND: With the development and progress in the field of stomatology, oral implant technology has gradually become the mainstream alternative to traditional dentures. In recent years, the maturity of various bone increment techniques and the continuous development of the oral digital field have expanded the indications of dental implantation, and the success rate of implantation surgery is also increasing. However, it has become a difficult problem for some clinicians to use cone-beam computed tomography (CBCT) to accurately measure the residual alveolar ridge bone mass before implantation and to make a suitable implantation plan. 
OBJECTIVE: To measure the residual alveolar ridge bone mass in the proposed implant area of the mandibular first molar using the CBCT.  
METHODS: In a retrospective study design, the CBCT images of 205 patients with mandibular first molar loss were included to measure the height and width of the residual alveolar ridge in the proposed implant area of the mandibular first molar. The residual alveolar ridges were divided into four categories: I, II, III and IV (Class II, III, and IV residual alveolar ridge defined as insufficient bone). Statistical analyses were conducted in terms of frequency distribution of residual alveolar ridge height, width, and morphology of the mandibular first molar, differences in residual alveolar ridge height and alveolar ridge crest width of the mandibular first molar in patients of different sexes, correlation of the residual alveolar ridge height with the crest width and bottom width of the residual alveolar ridge, as well as correlation of age with the width and height of the residual alveolar ridge crest. 

RESULTS AND CONCLUSION: (1) The average height of the residual alveolar ridge in the proposed implant area of the mandibular first molar was (12.14±2.96) mm, of which 43.41% (89/205) were less than 12 mm. The average width of the residual alveolar ridge in the proposed implant area of the mandibular first molar was (6.80±1.65) mm, of which 26.34% (54/205) were less than 6 mm. (2) The height of the residual alveolar ridge of the mandibular first molar was higher in males than in females, with no significant difference (P > 0.05), and the width of the residual alveolar ridge of the mandibular first molar was significantly wider in males than in females (P < 0.01). (3) The height of the residual alveolar ridge was negatively correlated with the top and bottom width of the residual alveolar ridge (P < 0.01). Age showed a positive correlation with the residual alveolar ridge width (P < 0.05) and no significant correlation with the residual alveolar ridge height (P > 0.05). (4) The residual alveolar ridge of class I accounted for 58.05% (119/205), class II accounted for 9.27% (19/205), class III accounted for 20.49% (42/205), and class IV accounted for 12.19% (25/205), most of which were class III with insufficient remaining alveolar ridge bone mass. Clinicians need to individualize and design the optimal implantation plan based on the type of residual alveolar ridge. 


中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: mandibular first molar, morphology of the residual alveolar ridge, cone-beam CT, implant restoration, guided bone regeneration, alveolar bone splitting, bone grafting, short implant, computer aided planting

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