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医学影像学检查是牙周病治疗的重要组成部分,其中包括从诊断、治疗计划到结果评价等方面。由于传统的X线片把三维图像压缩成了二维的重叠图像,无法显示牙周组织的立体解剖学形态,获取的图像信息量有限,由于影像重叠,互相干扰,影响诊断。另外,X线片显示的解剖结构还可能发生几何失真变形。传统CT虽可显示三维的口腔组织结构,但费用较高且放射剂量大,不宜视为常规辅助检查手段。锥状束CT(cone beam computed tomography,CBCT)具有低辐射剂量、高空间分辨率、三维影像呈现等特点,CBCT的出现,为重度牙周病的诊断及预后、治疗计划的制定提供了更加有力的信息。它的最小断层精度为0.25mm,能够通过计算机后期处理软件在扫描范围内进行任何方向上的重建,获得各个方向、层面、间隔的截图,对口腔组织进行清晰而细致的立体观察。CBCT成像优势包括:(1)射线范围局限,有效放射剂量较小;(2)三维影像重建技术。CBCT直接对原始数据进行重建,可获得感兴趣区的水平位、冠状位、矢状位的三维影像;(3)图像精确,图像质量好,尤其适合颌面骨成像;(4)操控简便,临床医生可在个人计算机上轻松地操作软件系统,独立完成各种常规及复杂的三维图像重建。通过使用CBCT技术对复杂重度牙周病患者进行三维立体的精确测量和重建,观察牙槽骨的吸收量和根分叉病变的程度,测量缺失牙齿牙槽骨量,与种植、修复、正畸科会诊,探讨CBCT技术在重度牙周病诊断和辅助制定治疗计划的应用价值,同时探讨在CBCT在揭示牙周病的本质、优化治疗计划、评价疗效和维护期的监测方面的临床应用前景。
Medical imaging examination is an important part of the treatment of periodontal disease, including from diagnosis, treatment planning to the results of evaluation and so on. Traditional X-ray films compress three-dimensional images into two-dimensional overlapping images and can not display the three-dimensional anatomy of periodontal tissues. The amount of image information obtained is limited, and the overlapping images interfere with each other and affect the diagnosis. In addition, the X-ray shows the anatomy may also occur geometric distortion. Although the traditional CT can show three-dimensional oral tissue structure, but the higher the cost and radiation dose should not be regarded as a routine auxiliary examination. Cone beam computed tomography (CBCT) has the characteristics of low radiation dose, high spatial resolution and three-dimensional image presentation. The emergence of CBCT provides more powerful diagnosis and prognosis for severe periodontal disease and the formulation of treatment plan Information. Its minimum fault resolution is 0.25mm, which can be reconstructed in any direction within the scanning range by computer post-processing software to obtain screenshots of all directions, levels and intervals, and clear and detailed oral observation of the oral tissues. CBCT imaging advantages include: (1) limited range of radiation, effective radiation dose is small; (2) three-dimensional image reconstruction techniques. CBCT directly reconstructs the original data to obtain the horizontal, coronal and sagittal images of the region of interest; (3) the image is accurate and the image quality is good, especially for maxillofacial bone imaging; (4) the operation is simple, Clinicians can easily manipulate software systems on personal computers and independently perform a variety of routine and complex 3D image reconstruction. To accurately measure and reconstruct complex three-dimensional periodontal disease patients by using CBCT technique, the amount of alveolar bone absorption and the degree of root bifurcation lesions were observed, and the amount of alveolar bone loss was measured, which was compared with implant, repair, orthodontic And discuss the application value of CBCT technique in the diagnosis and auxiliary treatment planning of severe periodontal disease. Meanwhile, the clinical application prospect of CBCT in revealing the essence of periodontal disease, optimizing the treatment plan, evaluating the curative effect and monitoring the maintenance period is also discussed.