Page 139 - 南京医科大学学报自然科学版

第41卷第7期 南京医科大学学报（自然科学版）
2021年7月 Journal of Nanjing Medical University（Natural Sciences） ·1069 ·

·影像医学·

牙源性上颌窦炎的锥形束CT影像学特征研究

张淬锋 ，李铭铭 ，冷迪雅 ，王 莹 ，荣 迪 ，周广超 ，孙 超 ，吴大明 1，2*
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南京医科大学口腔疾病研究江苏省重点实验室，南京医科大学附属口腔医院牙体牙髓病科，颌面医学影像科，江苏 南京 210029
［摘 要］ 目的：分析牙源性上颌窦炎（odontogenic maxillary sinusitis，OMS）锥形束CT（cone⁃beam computed tomography，CBCT）
图像的影像学特征。方法：收集196例OMS患者的CBCT数据，利用专用软件NNT重建和观察，对导致OMS的病因进行分析，
包括病原牙/牙根的根尖周病或牙周病与上颌窦底（maxillary sinus floor，MSF）的关系、根管治疗质量、MSF的完整性、窦内黏膜
增厚等，测量最大黏膜厚度和最小MSF厚度。结果：根尖周病是窦内黏膜增厚最重要的危险因素。上颌磨牙导致的OMS是前
磨牙的 5.21 倍，且上颌第一磨牙（maxillary first molar，MFM）明显高于第二磨牙。MFM 的近颊根（23.37%）和腭根（20.31%）与
OMS关系最密切；MSF破坏后黏膜增厚更明显（P < 0.05）。根管治疗不完善与OMS最相关，尤其是根管清理不到位（35.25%）
和根管遗漏（31.15%）。在遗漏根管中，44.74%为MFM的近颊根第二根管。结论：完善的根管治疗并有效控制根尖感染、保护
MSF的完整性是减少OMS发生的重要因素。
［关键词］ CBCT；上颌后牙；上颌窦；牙源性上颌窦炎
［中图分类号］ R814.42 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）07⁃1069⁃06
doi：10.7655/NYDXBNS20210722

The radiographic features of odontogenic maxillary sinusitis on cone ⁃ beam computed
tomography images
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ZHANG Cuifeng ，LI Mingming ，LENG Diya ，WANG Ying ，RONG Di ，ZHOU Guangchao ，SUN Chao ，WU
Daming 1，2*
1 Jiangsu Key Laboratory of Oral Diseases，Nanjing Medical University，Department of Endodontics，Department of
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Radiology & Maxillofacial Imaging，the Affiliated Stomatological Hospital of Nanjing Medical University，Nanjing
210029，China
［Abstract］ Objective：To analyze the radiographic characteristics of odontogenic maxillary sinusitis（OMS）using cone ⁃ beam
computed tomography（CBCT）images. Methods：CBCT data of 196 patients with OMS was collected，and was analyzed using NNT
software. The etiologies of OMS and the situations of the etiologic teeth/roots were assessed，including the relationship between the
radiographic periapical lesion or periodontal disease and the maxillary sinus floor（MSF），the previous endodontic therapy quality of
the etiologic tooth/root，the integrity of the MSF and mucosal thickening. The maximum mucosal thickness and the minimum MSF
thickness were measured. Results：Periapical lesion was the most important risk factor related to sinus mucosal thickening. Molars
were 5.21 times more likely to be involved than premolars，whereas maxillary first molars（MFMs）were significantly higher than second
molars（MSMs）to be involved（P < 0.05）. Mesiobuccal（23.37%）and palatal roots（20.31%）of MFM were the common etiologic roots
associated with OMS. The mean maximum mucosal thickness showed significant differences between destroyed and not destroyed MSF
（P < 0.05）. The correlation between inadequate endodontic treatment and OMS was closest，especially poor clean and obturation
（35.25%）and missed canals（31.15%）. Of the missed root canals，44.74% were the second mesiobuccal root canals of MFM.
Conclusion：Adequate root canal treatment for effective control of apical infection and the protection of the MSF integrity are important
factors for reducing the occurrence of OMS.
［Key words］ cone⁃beam computed tomography；maxillary posterior teeth；maxillary sinus；odontogenic maxillary sinusitis
［J Nanjing Med Univ，2021，41（07）：1069⁃1074］
［基金项目］ 江苏省卫生计生委科研课题（H2017050）
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通信作者（Corresponding author），E⁃mail：wudamingdds@163.com