不同根管内容物对口腔颌面锥...T诊断牙根纵裂准确性的影响_章锦花.pdf

论著不同根管内容物对口腔颌面锥形束 CT 诊断牙根纵裂准确性的影响章锦花1，3，潘洁1，孙志鹏2，王霄3(1 北京大学口腔医学院口腔医院综合科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，北京100081;2 北京大学口腔医学院口腔医院放射科，北京100081;3 北京大学第三医院口腔科，北京100191)摘要目的:研究不同根管内容物对口腔颌面锥形束 CT(cone-beam computed tomography，CBCT)诊断牙根纵裂(vertical root fracture，VF)准确性的影响。方法:选择因正畸治疗或牙周病而拔除的结构完整的单根管干燥离体牙 24 颗，沿釉牙骨质界去除牙冠，进行根管和桩道预备后制备为研究样本。将 24 个样本分为两组，每组 12 个。A组为对照组(无 VF 组)，根据根管内容物分为 5 个亚组:空白组、纤维桩组、牙胶尖组、钛桩组和金钯桩组;B 组为实验组(VF 组)，亚组分组同上。VF 组使用统一方法制备为 VF 模型，以专用根管钉使牙根发生颊舌向完全裂开后再粘接复位;对照组不进行模拟 VF 的操作。钛桩和金钯桩根据根管预备情况个性制作，通过 X 线检查确认桩与根管壁的密合性。所有样本均置于猪下颌骨牙槽窝中进行 CBCT 扫描，由经验丰富的牙体牙髓病学专科医师和口腔颌面医学影像学专科医师进行盲法判读，统计分析诊断准确率。结果:空白组、纤维桩组、牙胶尖组、钛桩组、金钯桩组中 VF 的诊断准确率依次为 95 83%、91 67%、87 50%、79 17%和 45 83%，与空白组相比，纤维桩组(P 0 999)、牙胶尖组(P=0 500)和钛桩组(P=0 125)的诊断准确率差异均无统计学意义。金钯桩组中 VF诊断准确率最低，与其他各组相比差异均有统计学意义(P 0 001)。结论:不同根管内容物在 CBCT 中的伪影对VF 诊断的准确性产生不同程度的影响，纤维桩、牙胶尖和钛桩的影响较小，而金钯桩影响较显著。关键词锥形束 CT;根管内容物;牙根纵裂 中图分类号781 文献标志码A 文章编号1671-167X(2023)02-0333-06doi:10 19723/j issn 1671-167X 2023 02 019Effect of various intracanal materials on the diagnostic accuracy of cone-beam com-puted tomography in vertical root fracturesZHANG Jin-hua1，3，PAN Jie1，SUN Zhi-peng2，WANG Xiao3(1 Department of Stomatology，Peking University School and Hospital of Stomatology National Center for Stomatology National Clinical esearch Center for Oral Diseases National Engineering esearch Center of Oral Biomaterials and Digi-tal Medical Devices，Beijing 100081，China;2 Department of adiology，Peking University School and Hospital of Stoma-tology，Beijing 100081，China;3 Department of Stomatology，Peking University Third Hospital，Beijing 100191，China)Corresponding author s e-mail，panjie72 sina com网络出版时间:2023-3-179:47:50网络出版地址:http:/kns cnki net/kcms/detail/11 4691 202303160946002 htmlABSTACTObjective:To study the effect of various intracanal materials on the accuracy of oral maxil-lofacial cone-beam computed tomography(CBCT)for the diagnosis of vertical root fracture(VF)Methods:A total of twenty-four structurally intact single root canal dried and isolated teeth extracted fororthodontic treatment or periodontal disease were collected The teeth were decrowned along the cemento-enamel junction(CEJ)and then used as samples for the study after conventional root canal preparationand post preparation The 24 samples were divided into two groups with 12 samples in each group GroupA was the control group(no VF group)According to intracanal materials，they were divided into fivesubgroups:blank group，fiber post group，gutta-percha point group，titanium post group and gold-palla-dium post group Group B was the experimental group(VF group)，and subgroups were grouped asabove The VF model was prepared by a unified method in the VF group:the root was completely frac-tured in the buccolingual direction with a custom root canal nail and then cemented and reset The controlgroup was not subjected to the simulation of VF Titanium post and gold-palladium post were made ac-cording to the individuality of the root canal preparation，and the tightness of the post to the root canalwall was confirmed by X-ray radiograph Then all the samples were scanned by CBCT in the isolate swinemandibular alveolar sockets The diagnostic accuracy was statistically analyzed via blind interpretation byexperienced endodontic specialists and oral and maxillofacial medical imaging specialists esults:Theaccuracy of the diagnosis of VF in the blank group，fiber post group，gutta-percha point group，titanium333北京大学学报(医学版)JOUNAL OF PEKING UNIVESITY(HEALTH SCIENCES)Vol55No2Apr 2023post group，and gold-palladium post group in CBCT was 95 83%，91 67%，87 50%，79 17%，and45 83%，respectively Compared with the blank group，the differences were not statistically significantin the fiber post group(P 0 999)，the gutta-percha point group(P=0 500)and the titanium postgroup(P=0 125)The lowest diagnostic accuracy of VF was found in the gold-palladium post group，and the difference was statistically significant compared with all other groups(P 0 001)Conclusion:Various intracanal materials have different degrees of influence on the diagnostic accuracy of VF diagno-sis in CBCT The influence of fiber post，gutta-percha point and titanium post was small，while theinfluence of gold-palladium post was significantKEY WODSCone-beam computed tomography;Intracanal materials;Vertical root fractures牙根纵裂(vertical root fracture，VF)是指发生在牙根、平行于牙长轴、由根尖向冠方的纵向裂纹，属于牙体硬组织的非龋性疾病1。一项根管治疗后 5 年的随访研究显示，VF 占牙髓治疗后牙齿拔除原因的 321%2，所以临床最常见的是继发性VF。继发性 VF 发病部位隐蔽，患者在早期通常无明显的临床症状，容易与根尖周病及其他牙周疾病相混淆3。因此，及时和准确的诊断显得尤其重要。口腔颌面锥形束 CT(cone-beam computed tomo-graphy，CBCT)虽然在 VF 的诊断领域发挥了非常重要的作用4，但是由于一些根管内填充材料会产生伪影，增加了医生解读的难度，很容易误读和误判，进而导致误诊与漏诊率增高5 7。本研究利用离体牙制备继发性 VF 模型，分别使用纤维桩、牙胶尖、钛桩和金钯桩作为根管内容物，比较不同根管内容物对 CBCT 检测 VF 的影响，为临床上应用CBCT 诊断继发性 VF 的准确性提供理论依据。1材料与方法1 1样本制备及分组收集北京大学口腔医院综合科因正畸治疗或牙周病而拔除的 24 颗单根离体牙(牙根长度大于 12mm，无根面龋、根管钙化、牙根内外吸收、折断或裂纹，根管弯曲度小于15)，去除表面牙周膜和牙石，3%(质量分数)次氯酸钠浸泡1 h 消毒备用8，高速金刚砂车针在釉牙骨质界处截除牙冠，修整牙根使其长度为 12 mm，暴露根管，使用 ProTaper NeXt 机用镍钛锉(Dentsply 公司，美国)采用冠向下法进行根管预备，先用 SX 扩大根管口，形成进入根管的直线通路9 10，再按 X1、X2、X3 顺