基于锥形线束CT的上颌后牙区牙槽骨增龄性变化研究

doi:10.3969/j.issn.1674-8115.2024.10.009

摘要/Abstract

摘要：

目的·测量分析上颌骨后牙区皮质骨厚度，以及牙槽骨高度和宽度的增龄性变化。方法·收集2019年1月—2022年12月于上海交通大学医学院附属瑞金医院口腔科就诊的种植患者锥形线束CT（cone-beam CT，CBCT）资料，其中青年组（18~30岁）40例、老年组（≥60岁）40例，男女比例为1∶1。应用i-Dixel软件分别对牙列整齐的一侧上颌后牙牙间3个区域（区域Ⅰ为上颌第一前磨牙和第二前磨牙间，区域Ⅱ为上颌第二前磨牙和第一磨牙间，区域Ⅲ为上颌第一磨牙和第二磨牙间）的牙槽骨颊、腭侧皮质骨厚度，以及牙槽骨宽度和高度进行测量，比较不同组间的差异。结果·在区域Ⅲ，老年男性颊侧皮质骨厚度［（1.49±0.29）mm］显著大于青年男性［（1.11±0.34）mm］（P<0.001）；在区域Ⅰ、Ⅱ，老年女性腭侧皮质骨厚度［区域Ⅰ：（1.27±0.30）mm；区域Ⅱ：（1.28±0.27）mm］均显著小于青年女性［区域Ⅰ：（1.70±0.32）mm；区域Ⅱ：（1.58±0.61）mm］（均P<0.05）。牙槽骨宽度在3个区域均呈现老年组小于青年组的趋势，但仅在区域Ⅱ、Ⅲ，老年男性［区域Ⅱ：（8.61±1.15）mm；区域Ⅲ：（11.06±2.40）mm］与青年男性［区域Ⅱ：（10.29±1.69）mm；区域Ⅲ：（13.39±1.59）mm］之间差异有统计学意义（均P<0.05）。牙槽骨高度在区域Ⅰ、Ⅱ，老年男性和老年女性分别显著大于青年男性和青年女性（均P<0.05）。老年组中，男性颊侧皮质骨厚度在区域Ⅰ、Ⅲ均显著大于女性（均P<0.05）。结论·女性上颌后牙区腭侧皮质骨厚度随着年龄增加显著变薄；上颌后牙区牙槽骨宽度随着年龄增长都呈现缩窄趋势，老年男性变化尤为显著；老年人上颌后牙区牙槽骨的高度显著增加。

关键词: 上颌, 牙槽骨, 锥形线束CT, 老年人, 皮质骨

Abstract:

Objective ·To measure and analyze age-related changes in cortical bone thickness and alveolar bone height and width in the posterior teeth of the maxilla. Methods ·Cone-beam CT (CBCT) data of the implant patients in the Department of Stomatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were collected from January 2019 to December 2022. There were 40 cases in the youth group (18?30 years) and 40 cases in the elderly group (≥60 years), with a male-to-female ratio of 1∶1. The i-Dixel software was used to measure the thickness of buccal and palatal cortical bone, and the width and height of alveolar bone in three regions of the posterior teeth of the maxilla on the side with regular dentition (part Ⅰ: between the first and the second premolar of maxillary; part Ⅱ: between the second premolar and the first molar of maxillary; part Ⅲ: between the first and the second molar of maxillary), and the differences between different groups were compared. Results ·In part Ⅲ, the buccal cortical bone thickness of the elderly men [(1.49±0.29) mm] was significantly greater than that of the young men [(1.11±0.34) mm] (P<0.001). In part Ⅰ and Ⅱ, the thickness of palatal cortical bone in the elderly women [part Ⅰ: (1.27±0.30) mm; part Ⅱ: (1.28±0.27) mm] was significantly smaller than that in the young women [part Ⅰ: (1.70±0.32) mm; part Ⅱ: (1.58±0.61) mm] (P<0.05). The width of alveolar bone showed a trend of being smaller in the elderly group than in the young group in all three regions, but there were significant differences only between the elderly males [part Ⅱ: (8.61±1.15) mm; part Ⅲ: (11.06±2.40) mm] and the young males [part Ⅱ: (10.29±1.69) mm; part Ⅲ: (13.39±1.59) mm] in the part Ⅱ and Ⅲ (P<0.05). The alveolar bone height in part Ⅰ and Ⅱ was significantly greater in elderly men and women than that in the young men and women, respectively (P<0.05). In the elderly group, the thickness of buccal cortical bone in men was significantly greater than that in women in part Ⅰ and Ⅲ (P<0.05). Conclusion ·The thickness of palatal cortical bone in female maxillary posterior teeth significantly decreases with age; the width of alveolar bone in maxillary posterior region shows a narrowing trend with age, especially in elderly men; the height of alveolar bone in the maxillary posterior region of the elderly increases significantly.

Key words: maxillary, alveolar bone, cone-beam CT (CBCT), the elderly, cortical bone

中图分类号:

R782.1

赵萌, 江莉婷, 高益鸣. 基于锥形线束CT的上颌后牙区牙槽骨增龄性变化研究[J]. 上海交通大学学报（医学版）, 2024, 44(10): 1273-1278.

ZHAO Meng, JIANG Liting, GAO Yiming. Age-related changes of alveolar bone in maxillary posterior based on cone-beam CT[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(10): 1273-1278.

图/表 6

图1 上颌骨测量区域Note： Part Ⅰ—between the first and second premolar; Part Ⅱ—between the second premolar and the first molar; Part Ⅲ—between the first and second molar.

Fig 1 Measurement areas of maxillary alveolar bone

图2 在CBCT影像中确定测量平面及测量的方法Note： On the sagittal plane, the palatal plate was aligned parallel to the horizontal line. On the coronal plane, the horizontal line (red) was adjusted to coincide with the line connecting the necks of the adjacent teeth in the test area. On the axial plane, the image was rotated so that the horizontal line (blue) passed through the center points of the pulp cavities of the two teeth, and the vertical line (green) was adjusted to pass through the midpoint of the line connecting the pulp cavities. On the coronal plane, the vertical line (green) was then adjusted to pass through the midpoint of the two adjacent teeth. On the sagittal (measurement) plane, a line l0 was created perpendicular to the long axis of the alveolar bone, passing through the crest of the alveolar ridge, with a parallel line l1 positioned 7 mm toward the tooth root from l0. The thickness of the buccal and palatal cortical bone and the width of the alveolar bone were measured at the level of l1. A line l2, parallel to l1, was created through the lowest point of the maxillary sinus floor, and the distance between l0 and l2 was measured as the height of the maxillary alveolar bone. If the height of the alveolar ridge was less than 7 mm, cortical bone thickness and alveolar bone width were measured at the l2 level. These planes were acquired through rotation rather than conventional positioning.

Fig 2 Determination of the measurement plane and measurement method in CBCT images

表1 上颌后牙区牙槽骨颊侧皮质骨厚度的比较

Tab 1 Comparison of thickness of buccal cortical bone in the alveolar bone of the posterior maxillary region

Location	Female			Male
Location	Elderly (n=20)	Young (n=20)	P value	Elderly (n=20)	Young (n=20)	P value
Part Ⅰ/mm	1.13±0.23	1.15±0.23	0.817	1.32±0.37^①	1.19±0.30	0.152
Part Ⅱ/mm	1.19±0.22	1.13±0.24	0.484	1.25±0.26	1.19±0.26	0.356
Part Ⅲ/mm	1.30±0.28	1.13±0.21	0.063	1.49±0.29^②	1.11±0.34	<0.001

表2 上颌后牙区牙槽骨腭侧皮质骨厚度的比较

Tab 2 Comparison of thickness of palatal cortical bone in the alveolar bone of the posterior maxillary region

Location	Female			Male
Location	Elderly (n=20)	Young (n=20)	P value	Elderly (n=20)	Young (n=20)	P value
Part Ⅰ/mm	1.27±0.30	1.70±0.32	<0.001	1.54±0.47^①	1.34±0.32^②	0.084
Part Ⅱ/mm	1.28±0.27	1.58±0.61	0.028	1.22±0.36	1.26±0.42^③	0.741
Part Ⅲ/mm	1.47±0.34	1.44±0.22	0.749	1.22±0.29^④	1.14±0.26^⑤	0.382

表3 上颌后牙区牙槽骨宽度的比较

Tab 3 Comparison of width of the alveolar bone in the posterior maxillary region

Location	Female			Male
Location	Elderly (n=20)	Young (n=20)	P value	Elderly (n=20)	Young (n=20)	P value
Part Ⅰ/mm	6.49±1.29	6.54±1.66	0.901	6.73±0.87	7.37±1.49	0.143
Part Ⅱ/mm	8.79±2.03	9.37±2.32	0.329	8.61±1.15	10.29±1.69	0.005
Part Ⅲ/mm	11.72±1.77	12.81±1.76	0.073	11.06±2.40	13.39±1.59	<0.001

表4 上颌后牙区牙槽骨高度的比较

Tab 4 Comparison of height of the alveolar bone in the posterior maxillary region

Location	Female			Male
Location	Elderly (n=20)	Young (n=20)	P value	Elderly (n=20)	Young (n=20)	P value
Part Ⅰ/mm	16.77±3.84	12.68±4.21	0.002	17.59±3.79	15.42±4.41	0.025
Part Ⅱ/mm	11.90±4.01	9.07±3.29	0.022	13.91±3.94	10.03±4.07	0.002
Part Ⅲ/mm	9.33±2.83	7.44±2.45	0.058	9.50±4.00	8.08±2.91	0.151

参考文献 27

1	BUCK D W 2nd, DUMANIAN G A. Bone biology and physiology: part Ⅰ. The fundamentals[J]. Plast Reconstr Surg, 2012, 129(6): 1314-1320.
2	WANG I I, BAROOTCHI S, TAVELLI L, et al. The peri-implant phenotype and implant esthetic complications. Contemporary overview[J]. J Esthet Restor Dent, 2021, 33(1): 212-223.
3	RAMANAUSKAITE A, BECKER K, KASSIRA H C, et al. The dimensions of the facial alveolar bone at tooth sites with local pathologies: a retrospective cone-beam CT analysis[J]. Clin Oral Investig, 2020, 24(4): 1551-1560.
4	CHUGH T, GANESHKAR S V, REVANKAR A V, et al. Quantitative assessment of interradicular bone density in the maxilla and mandible: implications in clinical orthodontics[J]. Prog Orthod, 2013, 14(1): 38.
5	谢彬, 麦理想, 蔡斌, 等. 青少年下颌后牙区牙槽骨和基骨骨皮质密度的锥形束CT测量[J]. 中华口腔医学研究杂志(电子版), 2013, 7(2): 39-43.
	XIE B, MAI L X, CAI B, et al. Density of the alveolar and basal cortical bones in the mandibular posterior area in adolescents: a CBCT analysis[J]. Chinese Journal of Stomatological Research (Electronic Edition), 2013, 7(2): 39-43.
6	DI STEFANO D A, AROSIO P, CAPPARÈ P, et al. Stability of dental implants and thickness of cortical bone: clinical research and future perspectives. A systematic review[J]. Materials, 2021, 14(23): 7183.
7	WANG S H, SHEN Y W, FUH L J, et al. Relationship between cortical bone thickness and cancellous bone density at dental implant sites in the jawbone[J]. Diagnostics, 2020, 10(9): 710.
8	ABD-ELRAHMAN A, SHAHEEN M, ASKAR N, et al. Socket shield technique vs conventional immediate implant placement with immediate temporization. Randomized clinical trial[J]. Clin Implant Dent Relat Res, 2020, 22(5): 602-611.
9	STEFFENS J P, VALENGA H M, SANTANA L C L, et al. Role of testosterone and androgen receptor in periodontal disease progression in female rats[J]. J Periodontol, 2020, 91(4): 545-553.
10	LANDWEHR V C, FRETWURST T, HEINEN J, et al. Association of sex steroid hormones and new bone formation rate after iliac onlay grafting: a prospective clinical pilot study[J]. Int J Implant Dent, 2022, 8(1): 53.
11	PORTO O C L, SILVA B S F, SILVA J A, et al. CBCT assessment of bone thickness in maxillary and mandibular teeth: an anatomic study[J]. J Appl Oral Sci, 2020, 28: e20190148.
12	LALO J, ADOUANI H, BOURAOUI S, et al. Maxillary alveolar bone ridge width augmentation using the frame-shaped corticotomy expansion technique[J]. J Stomatol Oral Maxillofac Surg, 2020, 121(2): 163-171.
13	HAMEED S, BAKHSHALIAN N, ALWAZAN E, et al. Maxillary sinus floor and alveolar crest alterations following extraction of single maxillary molars: a retrospective CBCT analysis[J]. Int J Periodontics Restorative Dent, 2019, 39(4): 545-551.
14	ATIEH M A, ALSABEEHA N H, PAYNE A G, et al. Interventions for replacing missing teeth: alveolar ridge preservation techniques for dental implant site development[J]. Cochrane Database Syst Rev, 2021, 4(4): CD010176.
15	LEBLEBICIOGLU B, TATAKIS D N. Complications following alveolar ridge augmentation procedures[J]. Periodontol 2000, 2023, 93(1): 221-235.
16	CHOI Y J, KIM Y H, HAN S S, et al. Alveolar bone height according to the anatomical relationship between the maxillary molar and sinus[J]. J Periodontal Implant Sci, 2020, 50(1): 38-47.
17	AKTUNA BELGIN C, BAYRAK S, ATAKAN C. Determination of alveolar bone height according to the relationship between molar teeth and maxillary sinus[J]. Oral Maxillofac Surg, 2021, 25(2): 175-180.
18	REGNSTRAND T, TORRES A, PETITJEAN E, et al. CBCT-based assessment of the anatomic relationship between maxillary sinus and upper teeth[J]. Clin Exp Dent Res, 2021, 7(6): 1197-1204.
19	刘毅赓, 卢云. CBCT分析上颌磨牙牙根及其牙槽嵴顶与上颌窦底壁的位置关系[J]. 口腔医学, 2022, 42(10): 889-894.
	LIU Y G, LU Y. A cone-beam computed tomography study on relationship between the root and the alveolar ridge crest of maxillary molars and maxillary sinus floor[J]. Stomatology, 2022, 42(10): 889-894.
20	GU Y C, SUN C, WU D M, et al. Evaluation of the relationship between maxillary posterior teeth and the maxillary sinus floor using cone-beam computed tomography[J]. BMC Oral Health, 2018, 18(1): 164.
21	TIAN X M, QIAN L, XIN X Z, et al. An analysis of the proximity of maxillary posterior teeth to the maxillary sinus using cone-beam computed tomography[J]. J Endod, 2016, 42(3): 371-377.
22	LORKIEWICZ-MUSZYŃSKA D, KOCIEMBA W, REWEKANT A, et al. Development of the maxillary sinus from birth to age 18. Postnatal growth pattern[J]. Int J Pediatr Otorhinolaryngol, 2015, 79(9): 1393-1400.
23	AKTUNA BELGIN C, COLAK M, ADIGUZEL O, et al. Three-dimensional evaluation of maxillary sinus volume in different age and sex groups using CBCT[J]. Eur Arch Otorhinolaryngol, 2019, 276(5): 1493-1499.
24	VELASCO-TORRES M, PADIAL-MOLINA M, AVILA-ORTIZ G, et al. Maxillary sinus dimensions decrease as age and tooth loss increase[J]. Implant Dent, 2017, 26(2): 288-295.
25	KUMAR K, SINGH R, MUGAL V, et al. Preservation of alveolar ridge using graft material after tooth extraction: a clinical trial[J]. J Pharm Bioallied Sci, 2021, 13(Suppl 1): S456-S460.
26	MACBETH N D, DONOS N, MARDAS N. Alveolar ridge preservation with guided bone regeneration or socket seal technique. A randomised, single-blind controlled clinical trial[J]. Clin Oral Implants Res, 2022, 33(7): 681-699.
27	AVILA-ORTIZ G, CHAMBRONE L, VIGNOLETTI F. Effect of alveolar ridge preservation interventions following tooth extraction: a systematic review and meta-analysis[J]. J Clin Periodontol, 2019, 46(Suppl 21): 195-223.

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