上颌后牙根尖与上颌窦底关系对上颌窦黏膜厚度的影响

doi:10.19439/j.sjos.2025.02.015

摘要/Abstract

摘要： 目的：通过锥形术CT（cone-beam CT,CBCT）测量分析不同上颌后牙根尖与上颌窦底关系下的上颌窦黏膜厚度。方法：选择2020年1月—2022年12月上海交通大学医学院附属瑞金医院因牙列缺损或缺失要求行种植手术的患者987例,通过CBCT观测与上颌窦关系最紧密的上颌后牙,并记录牙位及根尖;同时测量该后牙根尖至上颌窦底的垂直距离,根据后牙根尖与上颌窦底的位置距离分为3类,Ⅰ类—根尖至上颌窦底距离（d）>0 mm;Ⅱ类—根尖与上颌窦底贴合且上颌窦底骨皮质连续,即d=0 mm;Ⅲ类—根尖突入上颌窦底,即d<0 mm。测量上颌窦底黏膜最厚处的厚度。比较不同牙根与上颌窦底关系下的牙根至上颌窦底的距离及上颌窦黏膜厚度的差异,并进行相关性分析。采用SPSS 26.0软件包对数据进行统计学分析。结果：987例患者的1 974个上颌窦中,后牙根尖与上颌窦底I类关系450个,126个（28%）上颌第二磨牙近颊根与上颌窦底关系最紧密。Ⅰ类关系中,牙根至上颌窦底平均距离为（2.9±2.7） mm,上颌窦黏膜平均厚度为（2.9±4.0） mm,两者之间无相关性。后牙根尖与上颌窦底Ⅱ类关系808个,其中,132个（16.3%）上颌第一磨牙腭根与上颌窦底关系最紧密。Ⅱ类关系中,上颌窦黏膜平均厚度为（3.0±4.6） mm。后牙根尖与上颌窦底Ⅲ类关系249个,其中87个（34.9%）上颌第一磨牙腭根与上颌窦底关系最紧密。Ⅲ类关系中,牙根至上颌窦底平均距离为（-1.9±-1.4） mm,上颌窦黏膜平均厚度为（2.4±4.9）mm,两者之间呈正相关（r=0.18,P=0.004）。结论：上颌后牙根尖与上颌窦底最常见的关系为Ⅱ类关系。在所有与上颌窦底关系最紧密的上颌后牙根尖中,上颌第一磨牙腭根最常见,其次为上颌第二磨牙近颊根。上颌后牙根尖与上颌窦底的关系不同,上颌窦黏膜厚度不同,Ⅲ类牙根的上颌窦黏膜平均厚度小于Ⅱ类及Ⅰ类。Ⅲ类牙根中,随着牙根突入上颌窦底的距离增加,上颌窦黏膜厚度增加。

关键词: 上颌窦黏膜, 上颌后牙根尖, 上颌窦底, 锥形术CT, 上颌窦底提升术

Abstract: PURPOSE: To measure and analyze the thickness of the maxillary sinus mucosa under different relationships between the maxillary posterior teeth apex and the maxillary sinus floor on cone beam CT (CBCT). METHODS: A total of 987 patients requiring implant surgery due to dentition defect or loss were selected from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2020 to December 2022. The maxillary posterior teeth most closely related to the maxillary sinus were observed on CBCT, the tooth position and root apex were recorded, and the vertical distance between the apex of the posterior tooth and the base of the maxillary sinus was measured. According to the distance between the root apex and the maxillary sinus floor, the posterior teeth were divided into three categories: Class Ⅰ: the distance between the root apex and the maxillary sinus floor (d >0 mm); Class Ⅱ : the root apex was attached to the maxillary sinus floor and the cortical bone of the maxillary sinus floor was continuous (d=0 mm); Class Ⅲ : apical protrusion into the maxillary sinus floor(d<0 mm). The thickness of the thickest part of the maxillary sinus floor mucosa was measured. The distance between the root and the maxillary sinus floor and the thickness of the maxillary sinus mucosa were compared under different root-sinus floor relationship, and the correlation analysis was performed. SPSS 26.0 software package was used to analyze the data. RESULTS: Among the 1974 maxillary sinuses of 987 patients, there were 450 maxillary sinuses with Class I relationship between the posterior root apex and the maxillary sinus floor, while 126 (28%) of the maxillary second molar proximal root and the maxillary sinus floor were the most closely related. In ClassⅠrelationship, the average distance from root to the maxillary sinus floor was (2.9±2.7) mm, and the average thickness of the maxillary sinus mucosa was (2.9±4.0) mm. There was no correlation between the distance from root to the maxillary sinus floor and the thickness of the maxillary sinus mucosa. There were 808 maxillary sinuses with ClassⅡ relationship between the posterior root apex and the maxillary sinus floor, among which 132 (16.3%) maxillary first molars had the closest relationship with the maxillary sinus floor. In Class Ⅱ relationship, the average thickness of the maxillary sinus mucosa was (3.0±4.6) mm. There were 249 maxillary sinuses with Class Ⅲ relationship between the posterior tooth root apex and the maxillary sinus floor, among which 87 (34.9%) palatal roots of the maxillary first molar were the most closely related to the maxillary sinus floor. The average distance from the root to the maxillary sinus floor was (-1.9±-1.4) mm, and the average thickness of maxillary sinus mucosa was (2.4±4.9) mm. There was a positive correlation between them (r=0.18, P=0.004). CONCLUSIONS: The most common relationship between the posterior maxillary tooth apex and the maxillary sinus floor is Class Ⅱ. The palatal root of the first molar is most closely related to the maxillary sinus floor, the mesiobuccal root of the second molar ranks second. The thickness of the maxillary sinus mucosa varies on the relationship between the different maxillary posterior teeth apex and the maxillary sinus floor. The average thickness of the maxillary sinus mucosa in Class Ⅲ is thicker than Class Ⅱ and Class I. In Class Ⅲ, as the distance from the apices to the maxillary sinus floor increases, the thickness of maxillary sinus mucosa increases.

Key words: Maxillary sinus mucosa, Maxillary sinus floor, Apex of posterior teeth, CBCT, Maxillary sinus floor elevation

中图分类号:

R782.1

吴炯睿, 高益鸣, 陈梁. 上颌后牙根尖与上颌窦底关系对上颌窦黏膜厚度的影响[J]. 上海口腔医学, 2025, 34(2): 196-201.

Wu Jiongrui, Gao Yiming, Chen Liang. The influence of the relationship between the root apex of the posterior teeth and the maxillary sinus floor on the thickness of the maxillary sinus mucosa[J]. Shanghai Journal of Stomatology, 2025, 34(2): 196-201.

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