以錐狀束電腦斷層分析上頷後牙區牙齒健康程度與上頜竇黏膜厚度的關係

Analysis of the relationship between the health status of maxillary posterior teeth and membrane thickness of maxillary sinus by cone-beam computed tomography

黃彥婷(Yen-Ting Huang)

指導教授 ： 張育超

中山醫學大學/口腔醫學院/牙醫學系/碩士(2019年)

https://doi.org/10.6834/CSMU201900205

摘要

頭頸部所使用的錐狀束電腦斷層影像，除了可以看上、下顎骨的病變或是骨頭高度、寬度等硬組織之外，還可以看到上頷竇黏膜等構造，藉由分析影像可以了解上頷竇黏膜厚度與其鄰近的上頷後牙區牙周病變、根尖病變、或是剩餘牙齒數目之間的關係。之前鮮少有這方面相關研究，且之前的研究較常採用左、右側上頷竇黏膜厚度的平均值，較容易忽略牙齒疾病所造成的區域性上頷竇黏膜增厚。本研究利用某醫學中心在2014年到2018年所拍攝的錐狀束電腦斷層影像，符合納入條件的共235張影像，進行回溯性的研究，去分析個別上頷後牙的根尖病變或牙周病變與其鄰近的上頷竇黏膜厚度，並進行統計分析來確認上頷後牙牙齒健康程度與上頷竇黏膜厚度之間是否有相關性。研究結果顯示有36.6％的樣本平均上頷竇黏膜超過2mm，有增厚的現象。有牙周病變的牙齒鄰近的上頷竇黏膜會出現增厚，經統計分析具有統計意義（p<0.0001），有根尖病變的牙齒鄰近的上頷竇黏膜也會出現發炎性增厚，經統計分析具有統計意義（p<0.0001）。隨著年齡的增生也發現上頷竇黏膜隨之增厚，具有統計意義（p=0.0110）。由本研究結果顯示，上頷竇黏膜的厚度會受到年齡、性別、後牙區的牙周病變、根尖病變所影響，因此上頷竇炎的治療也需要把齒源性的感染考慮進去。

關鍵字

錐狀束電腦斷層 ； 上頷竇黏膜增厚 ； 根尖病變 ； 牙周病變

並列摘要

The cone-beam computed tomography image used in the head and neck region, in addition to the upper and lower jaw bone lesions or the height and width of the bone, can also see the structure of the maxillary sinus. The relationship between the thickness of the sinus membrane and the adjacent periodontal lesions, apical lesions of the teeth, or the number of remaining teeth in the posterior maxilla. There have been few studies in this field before, and previous studies have used the average of the thickness of the left and right upper sinus membrane, which is easier to ignore the regional upper sinus mucosa thickening caused by dental disease. This study used a cone-beam computed tomography image taken by a medical center from 2014 to 2018. A total of 235 images were included in the study, and retrospective studies were performed to analyze the relationship between apical lesions or periodontal lesions of teeth at posterior maxilla and their adjacent sinus membrane thickness, and statistical analysis to determine whether there is a correlation. The results of the study showed that 36.6% of the subjects had an average upper sinus mucosa of more than 2 mm, which was thickened. Inflammatory thickening occurs in the sinus membrane adjacent to the periodontal lesion, statistical analysis is significant (p<0.0001). Inflammatory thickening may also occur in the sinus membrane adjacent to the apical lesion of the tooth, statistical analysis was significant (p < 0.0001). With the age increasing, the sinus membrane was also thickened, which was statistically significant (p=0.0110). The results of this study reveal that the thickness of the sinus membrane is influenced by age, gender, periodontal lesions and apical lesions of teeth in the posterior maxilla. Therefore, the treatment of sinusitis should take odontogenic infection into considered.

並列關鍵字

cone-beam computed tomography ； sinus membrane thickening ； apical lesions ； periodontal lesions

參考文獻

Abramovitch K and D D Rice (2014). "Basic principles of cone beam computed tomography." Dent Clin North Am 58(3): 463-484.

Ahmad M, J Jenny and M Downie (2012). "Application of cone beam computed tomography in oral and maxillofacial surgery." Aust Dent J 57 Suppl 1: 82-94.

Angelopoulos C, S L Thomas, S Hechler, N Parissis and M Hlavacek (2008). "Comparison between digital panoramic radiography and cone-beam computed tomography for the identification of the mandibular canal as part of presurgical dental implant assessment." J Oral Maxillofac Surg 66(10): 2130-2135.

Arai Y, E Tammisalo, K Iwai, K Hashimoto and K Shinoda (1999). "Development of a compact computed tomographic apparatus for dental use." Dentomaxillofac Radiol 28(4): 245-248.

Bayrak S, G Ustaoglu, K O Demiralp and E S Kursun Cakmak (2018). "Evaluation of the Characteristics and Association Between Schneiderian Membrane Thickness and Nasal Septum Deviation." J Craniofac Surg 29(3): 683-687.