[锥形束计算机断层扫描在牙周再生手术前后作为常规检查的应用评估]

Second Clinical Division, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100101, China.

Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing 100081, China.

Beijing Da Xue Xue Bao Yi Xue Ban. 2018 Feb 18;50(1):110-116.

OBJECTIVE

To test the accuracy and credibility of cone-beam computed tomography (CBCT) on measuring the height and volume of alveolar bone defects before periodontal regeneration surgery. By comparing the bone density measured by CBCT before and after the operation, the time to evaluate the efficacy of the periodontal regenerative surgery would be determined.

METHODS

Periodontal regenerative surgeries were performed on three-wall bone defects of ten teeth in nine patients. The height of bone defects was measured using both periapical film of distant parallel technique and CBCT before periodontal regenerative surgery. Before the surgery, CBCT data were used to measure the volume of the bone defects and the bone density around the defective areas. The height of the bone defects was measured during periodontal regeneration surgery, and the volume of the defective areas was obtained with bone wax in operation. CBCT was taken 6, 12 and 24 weeks after surgery to measure the bone density in the regenerated region.

RESULTS

The Wilcoxon test showed that the height of the bone defects measured preoperatively using periapical film was (0.822±0.222) mm deeper than the intraoperative measurement results, and the difference was statistically significant (P<0.05). Whereas CBCT measurement results was (0.150±0.171) mm less than the intraoperative measurement results, without statistical significant (P>0.05). The regression analysis and the Bland-Altman method also showed that the results of CBCT measurement were more accurate. The Wilcoxon test showed that the bone defect volume measured by CBCT preoperatively was accurate, and the difference between the preoperative and the intraoperative measurements was not statistically significant, ranging from 0.38 to 2.83 mm3 (P>0.05). The bone density of the regenerated areas measured by CBCT was (0.49±0.03) times in the sixth week, (0.74±0.09) times in the twelfth week and (1.16±0.11) times in the twentieth week as that of the areas around the bone defects after the surgery.

CONCLUSION

The present data suggest that using CBCT before periodontal regenerative surgery could result in accurate measurement of height and volume of alveolar bone defects. For the purpose of evaluating the effectiveness of regenerative surgery, CBCT could be taken 24 weeks after surgery.

目的

测试锥形束计算机断层扫描（CBCT）在测量牙周再生手术前牙槽骨缺损高度和体积方面的准确性和可信度。通过比较手术前后CBCT测量的骨密度，确定评估牙周再生手术疗效的时间。

方法

对9例患者的10颗牙齿的三壁骨缺损进行牙周再生手术。在牙周再生手术前，使用远距平行技术根尖片和CBCT测量骨缺损高度。手术前，利用CBCT数据测量骨缺损体积和缺损区域周围的骨密度。在牙周再生手术过程中测量骨缺损高度，并在手术中用骨蜡获取缺损区域的体积。术后6周、12周和24周进行CBCT检查，测量再生区域的骨密度。

结果

Wilcoxon检验显示，术前使用根尖片测量的骨缺损高度比术中测量结果深（0.822±0.222）mm，差异有统计学意义（P<0.05）。而CBCT测量结果比术中测量结果少（0.150±0.171）mm，无统计学意义（P>0.05）。回归分析和Bland-Altman方法也显示CBCT测量结果更准确。Wilcoxon检验显示，术前CBCT测量的骨缺损体积准确，术前与术中测量结果差异无统计学意义，范围为0.38至2.83mm³（P>0.05）。CBCT测量的再生区域骨密度在术后第6周为缺损区域周围骨密度的（0.49±0.03）倍，第12周为（0.74±0.09）倍，第20周为（1.16±0.11）倍。