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中华口腔医学研究杂志(电子版)

中华口腔医学研究杂志(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 158 -165. doi: 10.3877/cma.j.issn.1674-1366.2019.03.005

所属专题： 文献；

基础研究

锥形束CT与导板引导微创开髓精确性的体外研究
王文铄1, 蔡艳玲1, 蒋宏伟1,†(), 韦曦1   
  1. 1. 中山大学光华口腔医学院·附属口腔医院，广东省口腔医学重点实验室，广州　510055
  • 收稿日期:2019-01-12 出版日期:2019-06-01
  • 通信作者: 蒋宏伟

Accuracy of using cone-beam computed tomography and guided templates for minimally invasive endodontic cavity preparation: an in vitro study

Wenshuo Wang1, Yanling Cai1, Hongwei Jiang1,†(), Xi Wei1   

  1. 1. Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
  • Received:2019-01-12 Published:2019-06-01
  • Corresponding author: Hongwei Jiang
  • About author:
    Corresponding author: Jiang Hongwei, Email:
  • Supported by:
    Natural Science Foundation of Guangdong Province(2017A030308011)
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引用本文：

王文铄, 蔡艳玲, 蒋宏伟, 韦曦. 锥形束CT与导板引导微创开髓精确性的体外研究[J]. 中华口腔医学研究杂志(电子版), 2019, 13(03): 158-165.

Wenshuo Wang, Yanling Cai, Hongwei Jiang, Xi Wei. Accuracy of using cone-beam computed tomography and guided templates for minimally invasive endodontic cavity preparation: an in vitro study[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2019, 13(03): 158-165.

目的

研究锥形束CT（CBCT）与三维打印导板引导微创开髓造成的偏移距离与偏移角度，探讨该操作的精确性。

方法

收集40颗人离体单根双根管上颌第一前磨牙，开髓前进行CBCT扫描。对所有样本进行编号，通过随机数字表法将样本分为A、B两组，每组20颗牙，包括40个根管。微创开髓洞型采用"Truss"开髓洞型的设计。其中A组为三维打印导板引导开髓组，根据CBCT图像制作导板；B组为CBCT引导开髓组，根据CBCT图像确定面开髓的位置与方向，于样本标记后直接开髓。两组样本开髓后，在CBCT图像中测量并计算各开髓孔在面与髓角平面的面积、颊腭向与近远中向的偏移距离及偏移角度，使用SPSS 20.0软件进行统计学分析。

结果

各组数据不满足正态分布及方差齐性，故采用Mann-Whitney U检验分析。开髓孔在面平面的面积分别为A组（1.34 ± 0.18）mm2、B组（1.30 ± 0.15）mm2，差异无统计学意义（U=0.876，P=0.393）。髓角平面的面积分别为A组（1.74 ± 0.20）mm2、B组（1.67 ± 0.24）mm2，差异无统计学意义（U=1.290，P=0.194）。B组面近远中偏移距离[（0.37 ± 0.26）mm]小于A组[（0.52 ± 0.30）mm]，差异具有统计学意义（U=2.237，P=0.024）。两组的面颊腭向偏移距离、髓角颊腭向偏移距离、髓角近远中偏移距离、颊腭向偏移角度及近远中偏移角度间差异均无统计学意义（P>0.05）。

结论

单独使用CBCT可精确引导常规根管解剖形态患牙的微创开髓，CBCT结合导板对引导微创开髓的精确性与单独使用CBCT相比无显著提高，且两种引导方法对微创开髓洞型的大小无明显影响。

关键词: 牙髓病学，微创, 牙窝洞制备, 锥束计算机体层摄影术, 三维打印, 偏移
Objectives

The aim of this study was to investigate the accuracy of minimally invasive endodontic cavity preparation with the guidance of cone-beam computed tomography (CBCT) and three-dimensional printed templates through analyzing distance deviation and angle deviation.

Methods

Forty extracted human single-rooted maxillary first premolars with double root canals were selected. Preoperative CBCT scanning of all specimens was used for designing access cavities. All teeth were numbered and assigned into two groups according to the random number table. There were twenty teeth including forty root canals in each group. The minimally invasive endodontic cavity was designed as "Truss" access cavity. Preparation for access cavities in group A was guided by three-dimensional printed templates which were fabricated according to the CBCT images. Access cavities in group B were prepared according to the marks on occlusal surface after the analysis of CBCT images. Distance deviations and angle deviations in buccopalatal and mesiodistal directions as well as the areas of access cavities at occlusal and pulp horn levels were measured and calculated in the CBCT images. Statistical analysis for the data was performed by SPSS 20.0.

Results

The data were analyzed with Mann-Whitney U test, since they were not satisfied with the normal distribution and the homogeneity of variance. No statistic difference was observed between the two groups in the areas of access cavities at occlusal level [group A: (1.34 ± 0.18) mm2, group B: (1.30 ± 0.15) mm2; U=0.876, P=0.393] or at pulp horn level [group A: (1.74 ± 0.20) mm2, group B: (1.67 ± 0.24) mm2; U=1.290, P=0.194]. The mesiodistal distance deviations at occlusal level in group B [ (0.37 ± 0.26) mm] were less than that in group A [ (0.52 ± 0.30) mm], which had significant difference (U=2.237, P=0.024) . There was no significant difference between the two groups in the buccopalatal distance deviations of occlusal level [group A: (0.45 ± 0.40) mm, group B: (0.41 ± 0.28) mm; U=0.385, P=0.697], the buccopalatal distance deviations of pulp horn level [group A: (0.32 ± 0.25) mm, group B: (0.41 ± 0.30) mm; U=1.290, P=0.199], the mesiodistal distance deviations of pulp horn level [group A: (0.38 ± 0.24) mm, group B: (0.35 ± 0.26) mm; U=0.905, P=0.500], as well as the buccopalatal angle deviations [group A: (4.76 ± 3.04) °, group B: (4.72 ± 3.61) °; U=0.404, P=0.679] or the mesiodistal angle deviations [group A: (3.04 ± 1.97) °, group B: (3.05 ± 2.45) °; U=0.467, P=0.637].

Conclusions

CBCT scanning was able to accurately guide the preparation of the minimally invasive endodontic cavities for the teeth with normal root canal anatomy. The guidance of CBCT scanning with templates did not significantly enhance the accuracy of access cavities, compared to that of CBCT scanning alone. Moreover, no significant difference was detected in the actual sizes of "Truss" access cavities prepared with the guidance of the two approaches.

Key words: Endodontics, minimally invasive, Dental cavity preparation, Cone-beam computed tomography, Printing, three-dimensional, Deviation
图2 石膏灌注A组离体上颌第一前磨牙样本样本模型
图3 Mimics软件读取样本CBCT图像确定开髓前开髓起点与开髓角度　A：确定点r为根管口中心；B：确定点p为髓角中心；C：在矢状面确定开髓起点位置与开髓前的颊腭向开髓角度，其中o为开髓起点，p为髓角中点，t为腭尖最高点，x1和x2分别为o和p与腭尖最高点在矢状面上的垂直距离，a1和a2分别为o和p与腭尖最高点在矢状面上的水平距离，α为开髓前的颊腭向开髓角度；D：在冠状面确定开髓起点位置与开髓前的近远中向开髓角度，其中o为开髓起点，p为髓角中点，h为o与p的垂直距离，b1和b2分别为o和p与近中最凸处在冠状面上的水平距离，β为开髓前的近远中开髓角度
图4 应用GuideMia软件设计导板引导开髓的髓腔通路　A：确定髓腔通路与牙髓的位置关系；B：确定髓腔通路与牙的位置关系
图5 Project 3D打印机制作不同引导高度的开髓导板
图6 "Truss"洞型制备后样本的面观
图8 Mimics软件测定冠状面面和髓角开髓中点与近中最凸处的近远中向距离以及开髓后的近远中向开髓角度o′为面开髓中点；p′为髓角开髓中点；h为o′与p′的垂直距离；b′1和b′2分别为o′和p′与近中最凸处在冠状面上的水平距离；β′为颊腭向开髓角度
表1 开髓孔在面及髓角平面的面积（mm2）
组别 面开髓孔面积 髓角开髓孔面积
均值±标准差 最小值 最大值 95%可信区间 均值±标准差 最小值 最大值 95%可信区间
A组 1.34 ± 0.18 1.16 1.76 1.29 ~ 1.40 1.74 ± 0.20 1.32 2.12 1.68 ~ 1.81
B组 1.30 ± 0.15 1.16 1.68 1.26 ~ 1.35 1.67 ± 0.24 1.28 2.04 1.59 ~ 1.74
表2 面开髓中点在颊腭向与近远中向的偏移距离（mm）
组别 颊腭向偏移距离 近远中偏移距离
均值±标准差 最小值 最大值 95%可信区间 均值±标准差 最小值 最大值 95%可信区间
A组 0.45 ± 0.40 0.01 1.62 0.32 ~ 0.58 0.52 ± 0.30 0.03 1.15 0.42 ~ 0.61
B组 0.41 ± 0.28 0.00 1.19 0.32 ~ 0.50 0.37 ± 0.26 0.02 0.96 0.28 ~ 0.45
表3 髓角开髓中点在颊腭向与近远中向的偏移距离（mm）
组别 颊腭向偏移距离 近远中偏移距离
均值±标准差 最小值 最大值 95%可信区间 均值±标准差 最小值 最大值 95%可信区间
A组 0.32 ± 0.25 0.00 1.39 0.24 ~ 0.39 0.38 ± 0.24 0.04 0.85 0.30 ~ 0.46
B组 0.41 ± 0.30 0.01 1.01 0.32 ~ 0.51 0.35 ± 0.26 0.01 0.87 0.27 ~ 0.44
表4 开髓前后的"Truss"洞型在颊腭向与近远中向的偏移角度（°）
组别 颊腭向偏移角度 近远中偏移角度
均值±标准差 最小值 最大值 95%可信区间 均值±标准差 最小值 最大值 95%可信区间
A组 4.76 ± 3.04 0.49 12.03 3.79 ~ 5.74 3.04 ± 1.97 0.00 7.36 2.41 ~ 3.68
B组 4.72 ± 3.61 0.24 14.59 3.57 ~ 5.87 3.05 ± 2.45 0.00 10.24 2.27 ~ 3.84
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