不同影像学手段对判断根管治疗后根尖病变的价值

Value of different imaging methods in judging apical lesions after root canal therapy

摘要:

目的研究根尖片与锥形束CT运用于根管治疗后根尖病变中的诊断价值。方法按照回顾性分析法选择南方医科大学深圳医院2017年6月至2018年11月纳入的90例慢性根尖周炎患者作为研究对象,复查时采取根尖片与锥形束CT检查,观察治疗后患者根尖病变情况及病变变化。结果共90例研究对象,经过根尖片检查发现根尖病变有57例,占63.33%;而锥形束CT检查发现根尖病变有69例,占76.67%,两种影像学检查方式在有无病变上差异有统计学意义(P<0.05)。另外根尖片检查发现病变消失有33例(36.67%),病变缩小有49例(54.44%),病变未变有8例(8.89%),病变增大有0例(0.00%);而锥形束CT检查发现病变消失有21例(23.33%),病变缩小有62例(68.89%),病变未变有7例(7.78%),病变增大有0例(0.00%),两种影像学检查方式在病变变化上差异有统计学意义(P<0.05);不同牙位在根尖片上诊断结果的准确性为前牙95.00%(19/20)、前磨牙64.00%(16/25)、磨牙70.83%(17/24)。结论根尖片与锥形束CT运用于根管治疗后根尖病变中均具有较高的诊断意义,但在诊断有无病变上存在一定差异,其中牙位是影响根尖片检出根尖病变的主要因素之一。

Abstract:

【Objective】To study the diagnostic value of apical X-ray film and cone-beam CT in apical lesions after root canal therapy and to reveal the difference of the changes of the lesions.【Methods】According to the retrospective analysis method,90 patients with chronic periapical periodontitis admitted in our hospital from June 2017 to November 2018 were selected as the research objects.The X-ray film and cone-beam CT were used to examine the apical lesions and changes after treatment.【Results】A total of 90 cases were studied in our hospital,57 cases(63.33%)of apical lesions were found by apical X-ray examination.However,conebeam CT showed 69 cases of apical lesions,accounted for 76.67%.Therefore,there was a significant difference between the two imaging methods(P<0.05).In addition,apical X-ray examination showed that the lesions disappeared in 33 cases(36.67%),reduced in 49 cases(54.44%),unchanged in 8 cases(8.89%)and increased in 0 case(0.00%).Cone-beam CT showed that 21 cases(23.33%)disappeared,62 cases(68.89%)shrunk,7 cases(7.78%)remained unchanged and 0 case(0.00%)enlarged.Therefore,there was a significant difference between the two imaging methods in pathological changes(P<0.05).The diagnostic accuracy of different teeth on apical X-ray films was 95.00%(19/20),64.00%(16/25)and 70.83%(17/24)of anterior teeth,premolars and molars.【Conclusion】Apical X-ray film and cone-beam CT have high diagnostic value in apical lesions after root canal therapy,but there are some differences in the diagnosis of lesions and revealing the changes of lesions,the location of teeth is one of the main factors affecting the detection of apical lesions by apical X-ray films.