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浙江大学学报(医学版)  2022, Vol. 51 Issue (1): 87-94    DOI: 10.3724/zdxbyxb-2021-0334
原著     
浙江地区人群上颌腭侧咀嚼黏膜厚度与腭穹窿解剖形态的量化分析
沈晨露1,高碧聪1,吕柯佳1,叶伟佳2,姚华1,*()
1.浙江大学医学院附属第一医院口腔科,浙江 杭州 310003
2.丽水市中心医院口腔科,浙江 丽水 323020
Quantitative analysis of maxillary palatal masticatory mucosa thickness and anatomical morphology of palatal vault in Zhejiang province
SHEN Chenlu1,GAO Bicong1,LYU Kejia1,YE Weijia2,YAO Hua1,*()
1. Department of Stomatology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China;
2. Department of Stomatology, Lishui Central Hospital, Lishui 323020, Zhejiang Province, China
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摘要:

目的:应用锥形束计算机断层扫描(CBCT)测定浙江地区人群上颌尖牙至第二磨牙区腭侧咀嚼黏膜厚度的影响因素以及腭大孔的分布位置。方法:从浙江大学医学院附属第一医院口腔科门诊筛选符合纳入标准的146例受检者的CBCT影像资料,调整基准线进行重建,选取受测牙矢状面进行分析,分别在距离龈缘3、6、9、12?mm水平处测量上颌双侧尖牙至第二磨牙区的腭侧咀嚼黏膜厚度。同时测量腭穹窿的高度和宽度,确定腭大孔相对第二磨牙位置以及距腭中缝和牙槽嵴顶的距离。采用Spearman相关性分析和多元回归分析探究上颌腭侧各牙位黏膜厚度的影响因素,采用单因素方差分析和多重比较LSD分析不同年龄组各牙位腭黏膜厚度的差异,采用两个独立样本t检验比较不同腭穹窿解剖形态的各牙位黏膜厚度以及腭大孔到腭中缝、牙槽嵴距离差异。结果:146例患者上颌尖牙、第一前磨牙、第二前磨牙、第一磨牙、第二磨牙区平均腭侧咀嚼黏膜厚度分别为(2.94±0.48)、(3.28±0.49)、(3.43±0.53)、(3.01±0.55)、(3.49±0.70)mm。尖牙、第一前磨牙、第二前磨牙区黏膜厚度随着距龈缘距离的增加先增加后减少,尖牙区的黏膜厚度在距龈缘6?mm处最厚,第一前磨牙和第二前磨牙区在距龈缘9?mm处最厚。第一磨牙区黏膜厚度随着距龈缘距离的增加明显增加,第二磨牙区黏膜厚度在6?mm处最薄,之后随着距龈缘距离的增加而增加。受检者年龄和腭穹窿高宽比是尖牙、第一前磨牙、第一磨牙区黏膜厚度的主要影响因素,受检者年龄是第二前磨牙区黏膜厚度的主要影响因素,腭穹窿高宽比是第二磨牙区黏膜厚度的主要影响因素,各变量间无明显共线性(VIF<10)。分层分析结果显示,上颌尖牙至第一磨牙区腭侧黏膜厚度与受检者年龄呈正相关,且45岁及以上人群黏膜增厚更显著;高腭穹窿组的尖牙黏膜厚度大于低腭穹窿组(P<0.05),第二磨牙区黏膜厚度小于低腭穹窿组(P<0.05)。腭大神经血管束多位于第二磨牙牙冠远中区域。腭大孔到牙槽嵴顶距离高腭穹窿组大于低腭穹窿组(P<0.05),而两组间腭大孔到腭中缝距离无明显差异(P>0.05)。结论:自体软组织移植的供区部位以第一前磨牙、第二前磨牙区距龈缘3~9?mm处黏膜较合适。

关键词: 腭侧咀嚼黏膜厚度腭穹窿腭大神经血管束锥形束计算机断层扫描自体软组织移植    
Abstract:

Objective: To quantitatively analyze the maxillary palatal masticatory mucosa thickness and anatomical morphology of palatal vault in Zhejiang province. Methods: Cone beam computed tomography (CBCT) images of 146 adult patients were collected from outpatients in Department of Stomatology, the First Affiliated Hospital, Zhejiang University School of Medicine. The images were reconstructed by adjusting the reference line and analyzed on the sagittal plane of the measured teeth. The thickness of masticatory mucosa from maxillary canine to second molar area was measured at the level of 3, 6, 9, 12?mm from the gingival margin. At the same time, the height and width of the palatal vault were measured, the position of the greater palatal foramen relative to the second molar, and the distance from the greater palatal foramen to the mid-palatal suture and the alveolar crest were determined. Spearman correlation analysis and multiple regression analysis were used to explore the influencing factors of the maxillary masticatory mucosa thickness. One-way analysis of variance and LSD multiple comparisons were used to analyze the difference in palatal mucosal thickness of each tooth position in different age groups. The sample t-test was used to analyze the differences in the mucosal thickness of each tooth position and the distance from the greater palatal foramen to the mid-palatal suture and the alveolar crest in different anatomical forms of the palatal vault. Results: The mean palatal masticatory mucosa thickness from maxillary canines, first premolars, second premolars, first molar and second molar areas were (2.94±0.48), (3.28±0.49), (3.43±0.53), (3.01±0.55), (3.49±0.70)?mm, respectively. The mucosa thickness of canines, first premolars and second premolars areas showed increasing at first and then decreasing trend. The mucosal thickness of the canines area was greatest at 6?mm from the gingival margin, and the thickness of the first and second premolars areas was greatest at 9?mm from the gingival margin. Premolars are thickest at 9?mm from the gingival margin. The thickness of the mucosa of the first molars area increased with the increase of the distance from the gingival margin, and the thickness of the mucosa of the second molars area was the thinnest at 6?mm, and then increased with the increase of the distance from the gingival margin. The main influencing factors of the mucosal thickness of canines, first premolars and first molars areas were age and palatal vault aspect ratio, the main influencing factor of the mucosal thickness of second premolars area was age, and the main influencing factor of the mucosal thickness of second molars area was palatal vault aspect ratio. There was no significant colinearity among the variables (VIF<10). The results of the further stratified analysis showed that the mucosal thickness of the maxillary canine to the first molar area was positively correlated with age, and mucosal thickening is more pronounced in people aged 45 years old and above. The thickness of the canine mucosa in the high palate vault group was greater than that in the low palate vault group (P<0.05), and the thickness of the second molar mucosa was smaller than that in the low palate vault group (P<0.05). The greater palatal foramen was mostly located in the distal region of the second molar crown. The distance from the greater palatal foramen to the alveolar crest in the high palatal vault group was greater than that in the low palatal vault group (P<0.05), while there was no significant difference between the two groups in the distance from the foramen magnum to the mid-palatal suture (P>0.05).Conclusion: The most suitable donor site for autologous soft tissue graft may be 3–9?mm from the gingival margin of the first and second premolars area.

Key words: Palatal masticatory mucosa thickness    Palatal vault    Palatal neurovascular bundle    Cone beam computed tomography    Autologous soft tissue graft
收稿日期: 2021-10-31 出版日期: 2022-05-17
CLC:  R781  
基金资助: 浙江省医药卫生科技计划(2021PY007)
通讯作者: 姚华     E-mail: yaohua@zju.edu.cn
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引用本文:

沈晨露,高碧聪,吕柯佳,叶伟佳,姚华. 浙江地区人群上颌腭侧咀嚼黏膜厚度与腭穹窿解剖形态的量化分析[J]. 浙江大学学报(医学版), 2022, 51(1): 87-94.

SHEN Chenlu,GAO Bicong,LYU Kejia,YE Weijia,YAO Hua. Quantitative analysis of maxillary palatal masticatory mucosa thickness and anatomical morphology of palatal vault in Zhejiang province. J Zhejiang Univ (Med Sci), 2022, 51(1): 87-94.

链接本文:

https://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0334        https://www.zjujournals.com/med/CN/Y2022/V51/I1/87

图 1  各位点测量示意图A:腭侧黏膜的厚度测量. 在每个位点作垂直于黏膜表面直达骨面的直线,直线与牙龈表面和骨面相交分别得a、b点,ab即该测量位点黏膜厚度. B:腭穹窿的宽度和高度测量. 腭穹窿宽度为双侧第一磨牙牙槽嵴顶连线的长度,腭穹窿高度为双侧第一磨牙牙槽嵴顶连线到腭中缝的距离. C:腭大孔的相对位置分区. 以上颌第二磨牙近中面、中央、远中面为基准,作3条切线,将区域分为c、d、e三部分. 图中数据单位为mm.
图 2  距龈缘不同距离的各牙位黏膜厚度比较与距龈缘3 mm比较,<0.05;与距龈缘6 mm比较,<0.05;与距龈缘9 mm比较,<0.05.

影响因素

尖牙区

第一前磨牙区

第二前磨牙区

第一磨牙区

第二磨牙区

r

P

r

P

r

P

r

P

r

P

牙位

0.001

>0.05

–0.005

>0.05

–0.038

>0.05

–0.057

>0.05

0.043

>0.05

受检者性别

0.001

>0.05

–0.069

>0.05

–0.046

>0.05

0.088

>0.05

0.113

>0.05

受检者年龄

0.357

<0.01

0.328

<0.01

0.456

<0.01

0.413

<0.01

0.103

>0.05

腭穹窿高宽比

0.220

<0.01

0.140

<0.05

0.080

>0.05

–0.135

<0.05

–0.245

<0.01

表 1  受检者上颌腭侧黏膜厚度影响因素的Spearman相关性分析
图 3  不同年龄组各牙位黏膜厚度比较与18~<30岁组比较,<0.05;与30~<45岁组比较,<0.05;与45~<60岁组比较,<0.05.
图 4  不同腭穹隆解剖形态者各牙位黏膜厚度比较与低腭穹窿组比较,<0.05.

牙位

影响因素

β

t

P

VIF

尖牙区

受检者年龄

0.013

6.580

<0.01

1.011

腭穹窿高宽比

1.908

4.542

<0.01

1.011

第一前磨牙区

受检者年龄

0.012

6.009

<0.01

1.011

腭穹窿高宽比

1.306

2.964

<0.01

1.011

第二前磨牙区

受检者年龄

0.019

9.034

<0.01

1.000

第一磨牙区

受检者年龄

0.019

8.419

<0.01

1.011

腭穹窿高宽比

–1.381

–2.834

<0.01

1.011

第二磨牙区

腭穹窿高宽比

–2.884

–4.323

<0.01

1.000

表 2  受检者上颌腭侧黏膜厚度影响因素的多元回归分析
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