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目的:检验牙周再生性手术前用锥形束CT(cone beam computed tomography,CBCT)测量牙槽骨缺损高度和体积的精确性,通过比较手术前后CBCT测得的骨密度值来确定其评估牙周再生性手术疗效的检查时机。方法:对9例患者口内的10颗因牙周破坏造成的三壁骨袋进行再生性手术,术前拍摄CBCT和平行投照根尖片,测量骨缺损的高度,并利用CBCT数据测量骨缺损体积及骨缺损周边区域的骨密度。在牙周再生性手术过程中测量骨缺损的高度,并在术中充填骨蜡以获得缺损区域的体积。术后6、12、24周再次拍摄CBCT,测量原骨缺损区的骨密度。结果:Wilcoxon检验非参数检验显示,术前用根尖片测量的骨缺损高度比术中测量结果高出(0.822±0.222)mm,差异有统计学意义(P<0.05),但术前CBCT测量结果只较术中测量结果降低(0.150±0.171)mm(P>0.05),可见CBCT测量结果比根尖片更精确。回归分析和Bland-Altman图也提示CBCT测量结果较根尖片精确。Wilcoxon检验提示,术前CBCT测量的骨缺损体积与术中测量值的差值在0.38~2.83 mm3之间,差异无统计学意义(P>0.05)。CBCT测量的原骨缺损区的骨密度(CT值)在再生性手术后第6、12和24周分别是原骨缺损区周边区域的(0.49±0.03)倍、(0.74±0.09)倍和(1.16±0.11)倍,可见术后24周时骨再生区域骨密度更接近术前骨缺损区域周边骨密度。结论:CBCT可以在牙周再生性手术前精确测量牙槽骨缺损的高度和体积,可选择在术后24周时拍摄CBCT进行疗效评估。
OBJECTIVE: To test the accuracy of alveolar bone defect height and volume measured by cone beam computed tomography (CBCT) before periodontal regeneration surgery, and to assess the value of bone mineral density by CBCT before and after surgery Zhou regenerative surgery time to check the effect. Methods: Ten rabbits in three patients with periodontal damage caused by periodontal resuscitation were enrolled in this study. CBCT and radiographs were performed preoperatively to measure the height of bone defects. CBCT data were used to measure the bone defect Bone mineral density in the area around the bone defect and bone defect. The height of the bone defect was measured during periodontal regenerative surgery and the bone wax was filled intraoperatively to obtain the volume of the defect area. CBCT was taken again 6, 12, and 24 weeks after surgery to measure the bone mineral density in the defect area. Results: The Wilcoxon test showed that the height of the bone defect preoperatively measured by the apical patch was (0.822 ± 0.222) mm higher than the intraoperative measurement (P <0.05), but preoperative CBCT measurement The result was only lower than that of the intraoperative measurement (0.150 ± 0.171) mm (P> 0.05). The results of CBCT measurement were more accurate than the apical slices. Regression analysis and Bland-Altman plots also suggested that CBCT measurements were more accurate than apical slices. The Wilcoxon test showed that the difference between the volume measured by CBCT and the measured intraoperative value was between 0.38 and 2.83 mm3, with no significant difference (P> 0.05). The bone mineral density (CT) measured by CBCT was (0.49 ± 0.03) times and (0.74 ± 0.09) times and (0.74 ± 0.09) times respectively in the peri-bone defect area at 6, 12 and 24 weeks after regenerative surgery 1.16 ± 0.11) times, showing bone mineral density in the bone regeneration area was closer to the bone mineral density around the bone defect area at 24 weeks after operation. Conclusion: CBCT can accurately measure the height and volume of alveolar bone defect before periodontal regenerative surgery. CBCT can be selected at 24 weeks after operation to evaluate the curative effect.