PDF(Pubmed)
Abstract：
Implant surgery in individuals with atrophic maxilla presents challenges, particularly concerning nasal cavity complications such as perforations, implant migration, and airway obstruction. While panoramic radiographs offer diagnostic convenience, their two-dimensional nature limits the evaluation of anatomical structures. Cone beam computed tomography (CBCT) provides a three-dimensional assessment, enhancing surgical planning accuracy and potentially reducing complications. With the aim of understanding the measurement differences between panoramic radiographs and CBCT images, this retrospective study examined CBCT images of patients with severely atrophic maxilla taken between September 2021 and December 2023 at the Ahmet Keleşoğlu Faculty of Dentistry. Virtual implants were placed in various tooth regions using OnDemand3D software. The incidence of nasal cavity perforations and vertical bone height differences between panoramic radiographs and CBCT images were evaluated. For this purpose, vertical bone length measurements in panoramic and CBCT images were compared for the virtual implant placement areas. Statistical analyses, including t-tests and ANOVA, were performed to determine significant differences among quantitative measurements, and a chi square test with Bonferroni corrected z-tests were used for possible associations between ratios. CBCT data from 59 patients, totaling 1888 virtual implants, revealed significant differences in implant depths among tooth regions (F = 9.880, p < 0.001). Canine regions showed higher perforation risks, especially with 12 mm and 14 mm implants. Panoramic radiographs often overestimated vertical bone height in canine and first premolar regions compared to CBCT measurements, which could lead to increased perforation risks. Radiographic evaluations using CBCT prior to implant surgery in atrophic maxilla cases are crucial to prevent nasal cavity complications. Panoramic radiographs may inadequately represent three-dimensional anatomy, underscoring the importance of CBCT for accurate implant placement and surgical planning. Further studies should consider varying implant sizes and brands to generalize findings.
摘要：
患有萎缩性上颌骨的个体的植入手术提出了挑战，特别是关于鼻腔并发症，如穿孔，植入物迁移，和气道阻塞。虽然全景射线照片提供诊断便利，它们的二维性质限制了对解剖结构的评估。锥形束计算机断层扫描（CBCT）提供了三维评估，提高手术计划的准确性，并有可能减少并发症。为了了解全景射线照片和CBCT图像之间的测量差异，这项回顾性研究检查了在2021年9月至2023年12月期间在AhmetKeleoälu牙科学院拍摄的严重萎缩性上颌骨患者的CBCT图像.使用OnDemand3D软件将虚拟植入物放置在各个牙齿区域中。评估了全景X射线照片和CBCT图像之间的鼻腔穿孔发生率和垂直骨高度差异。为此,比较了虚拟植入物放置区域的全景和CBCT图像中的垂直骨长度测量值.统计分析，包括t检验和方差分析，进行是为了确定定量测量之间的显著差异，卡方检验和Bonferroni校正的z检验用于分析比率之间可能的关联。来自59名患者的CBCT数据，总共1888个虚拟植入物，显示牙齿区域之间的植入物深度存在显着差异（F=9.880，p<0.001）。犬科地区显示出较高的穿孔风险，尤其是12毫米和14毫米的植入物。与CBCT测量相比，全景X光片通常高估了犬和第一前磨牙区域的垂直骨高度，这可能导致穿孔风险增加。在萎缩性上颌骨植入手术前使用CBCT进行影像学评估对于预防鼻腔并发症至关重要。全景X光片可能不足以代表三维解剖结构，强调CBCT对准确植入和手术计划的重要性。进一步的研究应该考虑不同的植入物尺寸和品牌，以推广发现。
