摘要
牙根纵裂是一种源自牙根的纵向裂纹,可发生在活髓牙和根管治疗后牙齿,是病因复杂、预后较差的牙体硬组织疾病。发生于牙髓治疗后的牙根纵裂称为继发性牙根纵裂(secondary vertical root fracture,SVRF),对SVRF的诊断,应结合临床体征(如疼痛、肿胀、牙齿松动、位于牙龈边缘附近的窦道和深而窄的孤立牙周袋)和根尖片(如牙周膜增宽、垂直骨丧失和根周骨丧失、根周“晕圈状”或“J”形的透射影)进行综合判断。对疑似牙根纵裂的牙齿,应通过锥形束CT(cone⁃beam computed tomography,CBCT)等三维影像学辅助诊断,如CBCT显示牙根上的折裂线以及颊侧或舌侧骨板缺损;优化设置CBCT参数,如选用小视野CBCT、增强染料辅助的应用、使用金属伪影还原工具(metal artifact reduction,MAR)等方法提高CBCT诊断SVRF的精确度。使用多种影像技术可对不同宽度的裂纹进行检测,如核磁共振成像(magnetic resonance imaging,MRI)中表现为异常的高强度信号;使用数字减影技术(digital subtraction radiography,DSR)进行图像处理后出现的黑色线状区域;不同宽度的裂纹在光学相干断层扫描(optical coherence tomography,OCT)可表现为高亮度线或暗区。人工智能(artificial intelligence,AI)诊断技术和预测模型也是SVRF诊断的辅助手段。通过各种无创手段仍然无法确诊的SVRF病例,可通过根管内直视和翻瓣手术中直视发现SVRF。
Vertical root fracture is a type of longitudinal crack originating from the roots of teeth that can occur in vital teeth and teeth after root canal treatment.It is a hard tissue disease of teeth with a complex etiology and poor prognosis.The vertical root fracture that occurs in teeth after pulp treatment is called secondary vertical root fracture(SVRF).A comprehensive judgment should be made based on clinical signs such as pain,swelling,tooth looseness,sinus located near the gum edge,and deep and narrow isolated periodontal pockets,as well as apical films such as periodontal membrane widening,vertical and root bone loss,and“halo”or“J”shaped transmission shadows around the root.For teeth suspected of longitudinal root fractures,threedimensional imaging such as cone beam computed tomography(CBCT)should be used to assist in the diagnosis.If CBCT shows a defect in the buccal or lingual bone plate,it can increase the possibility of diagnosing SVRF.The setting of CBCT parameters should be optimized by using small field CBCT,enhancing dyeassisted applications,and metal artifact reduction(MAR)tools to reduce the impact of artifacts and improve the accuracy of CBCT diagnosis of SVRF.Magnetic resonance imaging(MRI),digital subtraction radiography(DSR),optical coherence tomography(OCT),and other imaging techniques can detect cracks of different widths,and artificial intelligence(AI)diagnostic technology and predictive models provide further auxiliary means for SVRF diagnosis.SVRF cannot be determined through noninvasive methods,and the final diagnostic method is to detect the presence of SVRF through direct observation within the root canal and during flap surgery.
作者
徐海明
齐斌
卢志山
XU Haiming;QI Bin;LU Zhishan(Yantai Stomatological Hospital Affiated to Binzhou Medical College,Yantai 264008,China)
出处
《口腔疾病防治》
2024年第8期646-652,共7页
Journal of Prevention and Treatment for Stomatological Diseases
基金
山东省医药卫生科技计划发展计划项目(2018WS038)。
关键词
继发性牙根纵裂
锥形束CT
核磁共振成像
数字减影技术
光学相干断层扫描
金属伪影还原工具
人工智能
临床诊断
secondary vertical root fracture
conebeam computed tomography
magnetic resonance imaging
digital subtraction radiography
optical coherence tomography
metal artifact reduction
artificial intelligence
clinical diagnosis
