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多层螺旋CT测量下颌神经管解剖位置的临床价值

[The clinical value of multislice CT for measuring the anatomical position of the mandibular nerve canal].

作者信息

Tan Zhi, Shen Li, Yang Jing, Liu Ping

机构信息

Affiliated Hospital of North Sichuan Medical College. Nanchong 637003, Sichuan Province, China. E-mail:

出版信息

Shanghai Kou Qiang Yi Xue. 2023 Jun;32(3):314-317.

Abstract

PURPOSE

To investigate the clinical value of multislice CT(MSCT) for measuring the anatomical position of the mandibular nerve canal during implantation in the posterior mandibular regions.

METHODS

A total of 109 patients with mandibular posterior dental implants were included,and the linear distance between the alveolar ridge and the mandibular nerve canal in the posterior mandibular region to be implanted was measured by MSCT and CBCT before implantation. All 109 patients were divided into the MSCT navigation group and CBCT navigation group, and the imaging data from both groups were imported into the dynamic real-time navigation system for implant design, in parallel and in real time. The patients in both groups underwent MSCT or CBCT to measure the deviation of the actual position of the implant from the preoperative design position, including the deviation of the cervical centrum and apical part of the implant and the deviation of the distance between the implant and the mandibular nerve canal, and to assess their clinical results after treatment. The data were statistically analyzed with SPSS 21.0 software package.

RESULTS

The deviations from the linear spacing between the top of the alveolar ridge and the upper arm of the mandibular nerve canal of the different dental implants in the area to be implanted were detected by MSCT as well as CBCT methods with no significant difference. In addition, there was no significant difference in the cervical deviation, tip deviation, depth deviation, angular deviation and deviation of the spacing between the implant and the mandibular nerve canal in the postoperative implant position in MSCT navigation group compared to the preoperative implant design position in CBCT navigation group. There was also no significant difference in the incidence of functional impairment of the inferior alveolar nerve between CBCT-guided and MSCT-guided group of patients.

CONCLUSIONS

MSCT can achieve precise localization of the anatomical structures of the mandibular nerve canal, and the operation according to MSCT navigation during dynamic real-time guided dental implant surgery can avoid damage to the inferior alveolar nerve.

摘要

目的

探讨多层螺旋CT(MSCT)在下颌后牙区种植术中测量下颌神经管解剖位置的临床价值。

方法

纳入109例下颌后牙种植患者,术前采用MSCT和CBCT测量拟种植下颌后牙区牙槽嵴与下颌神经管之间的直线距离。将109例患者分为MSCT导航组和CBCT导航组,两组的影像数据并行实时导入动态实时导航系统进行种植体设计。两组患者均接受MSCT或CBCT检查,测量种植体实际位置与术前设计位置的偏差,包括种植体颈部中心和根尖部分的偏差以及种植体与下颌神经管之间距离的偏差,并评估治疗后的临床效果。采用SPSS 21.软件包对数据进行统计学分析。

结果

采用MSCT和CBCT方法检测拟种植区不同牙种植体牙槽嵴顶与下颌神经管上臂之间的直线间距偏差,差异无统计学意义。此外,MSCT导航组术后种植体位置与CBCT导航组术前种植体设计位置相比,种植体颈部偏差、根尖偏差、深度偏差、角度偏差以及种植体与下颌神经管之间间距偏差差异均无统计学意义。CBCT引导组和MSCT引导组患者下牙槽神经功能障碍发生率差异也无统计学意义。

结论

MSCT能够实现下颌神经管解剖结构的精确定位,在动态实时引导下的牙种植手术中按照MSCT导航进行操作可避免损伤下牙槽神经。

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