Alqutaibi Ahmed Yaseen, Aloufi Aseel Mohammed, Hamadallah Hatem Hazzaa, Khaleefah Feras Ahmad, Tarawah Raneem Ahmad, Almuzaini Abdulrahman Saad, Almashraqi Abeer, Halboub Esam
Associate Professor, Substitutive Dental Sciences Department (Prosthodontics), College of Dentistry, Taibah University, Medina, Saudi Arabia; and Associate Professor, Department of Prosthodontics, College of Dentistry, Ibb University, Ibb, Yemen.
Graduate student, College of Dentistry, Taibah University, Medina, Saudi Arabia.
J Prosthet Dent. 2024 Aug 1. doi: 10.1016/j.prosdent.2024.07.010.
Immediate implant placement in the maxillary premolar area is challenged by anatomic variations imposing risks such as perforation of the buccal bone and the maxillary sinus. Previous studies have addressed the potentially relevant factors individually; a study assessing all relevant variables comprehensively and with a large sample size is lacking.
The purpose of this observational study was to analyze multiple anatomic considerations, including sagittal root position, alveolar bone concavity angle, buccal bone perforation, maxillary sinus floor root proximity, and maxillary sinus perforation in the maxillary premolar area, using cone beam computed tomography (CBCT) to inform, perceive, and simplify the placement of immediate implants.
The analysis involved 333 CBCT images (189 of men, 144 of women). A total of 1332 first and second maxillary premolars were assessed for sagittal root position, alveolar bone concavity angle, buccal bone perforation, maxillary sinus floor root proximity, and maxillary sinus perforation. Chi-squared and kappa tests were used to analyze the distributions and agreement, respectively, while dependent and independent t tests were used to assess sex and tooth-specific differences. The Spearman correlation test was used to explore the potential correlations (α=.05) RESULTS: The majority of sagittal root position distribution was on the buccal side, ranging from 79.3% to 88.3%, while maxillary sinus floor root proximity showed a predominance of the T0 category (roots separated from the maxillary sinus floor), with noticeable sex disparities in the second right premolar (73% in men versus 50.7% in women; P<.001). The "perforation" category of buccal bone perforation was highest in the right first premolar (54.1%), being higher in women across all teeth. The "perforation" category of maxillary sinus perforation was highest in the left second premolar (21.9%). Associations were found between buccal bone perforation and sagittal root position in the second premolars. The Spearman correlation between root proximity and sinus perforation was high, ranging from 0.68 to 0.78.
The alveolar bone concavity angle in first premolars, compared with second premolars, poses a higher risk of buccal bone perforation, especially in women. The buccal position is the most common sagittal root position. The risk of sinus perforation is higher in maxillary second premolars, with proximity to or protrusion into the maxillary sinus floor categories strongly correlating with this complication. These findings highlight the importance of thorough assessment and strategic planning to ensure successful immediate implant placement and minimize potential complications.
在上颌前磨牙区即刻种植面临解剖变异带来的挑战，存在如颊侧骨穿孔和上颌窦穿孔等风险。以往研究分别探讨了潜在的相关因素；缺乏一项全面评估所有相关变量且样本量较大的研究。
本观察性研究的目的是利用锥形束计算机断层扫描（CBCT）分析上颌前磨牙区的多种解剖因素，包括矢状根位置、牙槽骨凹陷角度、颊侧骨穿孔、上颌窦底与牙根的距离以及上颌窦穿孔情况，以指导、认识并简化即刻种植体的植入。
分析包括333张CBCT图像（男性189张，女性144张）。共评估了1332颗上颌第一和第二前磨牙的矢状根位置、牙槽骨凹陷角度、颊侧骨穿孔、上颌窦底与牙根的距离以及上颌窦穿孔情况。分别采用卡方检验和kappa检验分析分布情况和一致性，同时采用配对t检验和独立t检验评估性别差异和牙齿特异性差异。采用Spearman相关检验探索潜在相关性（α = 0.05）。结果：矢状根位置分布大多在颊侧，范围为79.3%至88.3%，而上颌窦底与牙根的距离显示T0类别（牙根与上颌窦底分离）占优势，在右上第二前磨牙存在明显的性别差异（男性为73%，女性为50.7%；P < 0.001）。颊侧骨穿孔的“穿孔”类别在右第一前磨牙最高（54.1%），在所有牙齿中女性的发生率更高。上颌窦穿孔的“穿孔”类别在左第二前磨牙最高（21.9%）。在第二前磨牙中发现颊侧骨穿孔与矢状根位置之间存在关联。牙根与窦穿孔之间的Spearman相关性较高，范围为0.68至0.78。
与第二前磨牙相比，第一前磨牙的牙槽骨凹陷角度导致颊侧骨穿孔的风险更高，尤其是在女性中。颊侧位置是最常见的矢状根位置。上颌第二前磨牙发生窦穿孔的风险更高，与上颌窦底接近或突入上颌窦底类别与该并发症密切相关。这些发现凸显了全面评估和战略规划对于确保即刻种植成功并将潜在并发症降至最低的重要性。
