儿童自体牙移植中使用 CBCT 引导。
Use of CBCT Guidance for Tooth Autotransplantation in Children.
机构信息
1 OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
2 Department of Oral Health Sciences, KU Leuven and Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Leuven, Belgium.
出版信息
J Dent Res. 2019 Apr;98(4):406-413. doi: 10.1177/0022034519828701. Epub 2019 Feb 20.
Tooth autotransplantation (TAT) offers a viable biological approach to tooth replacement in children and adolescents. The aim of this study was to evaluate the outcome of the cone-beam computed tomographic (CBCT)-guided TAT compared to the conventional TAT protocol and to assess the 3-dimensional (3D) patterns of healing after CBCT-guided TAT (secondary aim). This study included 100 autotransplanted teeth in 88 patients. Each experimental group consisted of 50 transplants in 44 patients (31 males and 19 females). The mean (SD) age at the time of surgery was 10.7 (1.1) y for the CBCT-guided group. This was 10.6 (1.3) y for the conventional group. The mean (SD) follow-up period was 4.5 (3.1) y (range, 1.1 to 10.4 y). Overall survival rate for the CBCT-guided TAT was 92% with a success rate of 86% compared to an 84% survival rate and a 78% success rate for the conventional group ( P > 0.005). The following measurements were extracted from the 3D analysis: root hard tissue volume (RV), root length (RL), apical foramen area (AFA), and mean and maximum dentin wall thickness (DWT). Overall, the mean (SD) percentage of tissue change was as follows: RV gain by 65.8% (34.6%), RL gain by 37.3% (31.5%), AFA reduction by 91.1% (14.9%), mean DWT increase by 107.9% (67.7%), and maximum DWT increase by 26.5% (40.1%). Principal component analysis (PCA) identified the mean DWT, RV, and maximum DWT as the parameters best describing the tissue change after TAT. Cluster analysis applied to the variables chosen by the PCA classified the CBCT group into 4 distinct clusters (C1 = 37.2%, C2 = 17.1%, C3 = 28.6%, C4 = 17.1%), revealing different patterns of tissue healing after TAT. The CBCT-guided approach increased the predictability of the treatment. The 3D analysis provided insights into the patterns of healing. CBCT-guided TAT could be adopted as an alternative for the conventional approach. (Clinical trial center and ethical board University Hospitals, KU Leuven: S55287; ClinicalTrials.gov Identifier: NCT02464202).
牙自体移植（TAT）为儿童和青少年的牙齿替代提供了一种可行的生物学方法。本研究旨在评估与传统 TAT 方案相比，锥形束 CT（CBCT）引导的 TAT 的结果，并评估 CBCT 引导的 TAT 后的 3 维（3D）愈合模式（次要目标）。本研究共纳入 88 例患者的 100 颗自体移植牙。每个实验组由 50 颗移植牙组成，共 44 例患者（31 名男性和 19 名女性）。CBCT 引导组的手术时平均（SD）年龄为 10.7（1.1）岁。常规组为 10.6（1.3）岁。平均（SD）随访期为 4.5（3.1）年（范围为 1.1 至 10.4 年）。CBCT 引导的 TAT 的总生存率为 92%，成功率为 86%，而传统组的生存率为 84%，成功率为 78%（P>0.005）。从 3D 分析中提取了以下测量值：根硬组织体积（RV）、根长（RL）、根尖孔面积（AFA）以及平均和最大牙本质壁厚度（DWT）。总体而言，组织变化的平均（SD）百分比如下：RV 增加 65.8%（34.6%），RL 增加 37.3%（31.5%），AFA 减少 91.1%（14.9%），平均 DWT 增加 107.9%（67.7%），最大 DWT 增加 26.5%（40.1%）。主成分分析（PCA）确定平均 DWT、RV 和最大 DWT 是描述 TAT 后组织变化的最佳参数。应用于 PCA 选择的变量的聚类分析将 CBCT 组分为 4 个不同的聚类（C1=37.2%，C2=17.1%，C3=28.6%，C4=17.1%），揭示了 TAT 后不同的组织愈合模式。CBCT 引导的方法提高了治疗的可预测性。3D 分析提供了对愈合模式的深入了解。CBCT 引导的 TAT 可以作为传统方法的替代方法。（临床试验中心和伦理委员会大学医院，鲁汶大学：S55287；临床试验.gov 标识符：NCT02464202）。
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