基于AutoCAD软件测量的牙槽骨吸收界线在辅助诊断Ⅱ期牙周炎中应用初探OA
A preliminary study on the application of AutoCAD-based measurements of alveolar bone loss boundaries in assisting the diagnosis of stage Ⅱ periodontitis
目的 应用AutoCAD软件测量牙槽骨吸收界线,初步分析其作为辅助诊断Ⅱ期牙周炎参考值的可行性.方法 选取2023-2024年于山西医科大学口腔医院放射科拍摄根尖片的612例患者的临床和影像学资料行回顾性分析,共纳入牙齿1 272颗,其中中切牙116颗、侧切牙110颗、尖牙106颗、第一前磨牙340颗、第二前磨牙330颗、磨牙270颗.应用AutoCAD软件对纳入牙齿根尖片中的牙根长度、15％和33％牙根长度进行精确测量,并计算釉牙骨质界(cemento-enamel junction,CEJ)下1 mm和2 mm分别占牙根长度的百分比.针对1例轻度牙周炎病例,由20名牙周科医生分别采用临床医生目测判断法、基于AutoCAD软件测量判断法、基于本研究参考值判断法对根尖片中下颌第二前磨牙骨吸收程度进行判定.结果 在上颌中,中切牙、侧切牙、尖牙、第一前磨牙、第二前磨牙牙根及磨牙颊根、磨牙腭根长度的15％依次为(2.35±0.16)、(2.24±0.16)、(2.83±0.08)、(2.14±0.18)、(2.15±0.17)、(1.50±0.23)、(2.20±0.15)mm,其 33％依次为(5.17±0.35)、(4.93±0.36)、(6.24±0.19)、(4.70±0.40)、(4.72±0.37)、(3.31±0.51)、(4.83±0.32)mm,其CEJ下 2 mm依次占牙根长度的(13±1)、(13±1)、(11±0)、(14±1)、(14±1)、(20±3)、(14±1)％.在下颌中,中切牙、侧切牙、尖牙、第一前磨牙、第二前磨牙、第一磨牙、第二磨牙牙根长度的 15％依次为(2.13±0.10)、(2.22±0.12)、(2.72±0.22)、(2.28±0.16)、(2.26±0.18)、(2.03±0.16)、(1.99±0.19)mm,其 33％依次为(4.68±0.21)、(4.88±0.26)、(5.98±0.47)、(5.01±0.35)、(4.97±0.40)、(4.48±0.34)、(4.38±0.42)mm,其 CEJ 下 2 mm 依次占牙根长度的(14±1)、(14±1)、(11±1)、(13±1)、(13±1)、(15±1)、(15±1)％.基于病例分析结果显示,在临床医生目测判断法中,10％(2/20)的医生判断为Ⅰ期牙周炎,90％(18/20)的医生判断为Ⅱ期牙周炎;在基于AutoCAD软件测量判断法和基于本研究参考值判断法中,20名医生的测量结果一致性良好,组内相关系数分别为0.86、0.89,均支持Ⅱ期牙周炎的诊断.结论 基于AutoCAD软件在根尖片中测量的15％和33％牙根长度参考值可用于辅助诊断Ⅱ期牙周炎,且CEJ至牙槽嵴顶距离＞2 mm作为牙槽骨吸收的判断依据具有局限性.
Objective To apply AutoCAD software to measure alveolar bone loss boundaries and to preliminarily evalu-ate its feasibility as reference values for assisting the diagnosis of stage Ⅱ periodontitis.Methods A retrospective anal-ysis was conducted on clinical and radiographic data from 612 patients who underwent periapical radiography at the De-partment of Radiology,Stomatology Hospital of Shanxi Medical University between 2023 and 2024.A total of 1 272 teeth were included,comprising 116 central incisors,110 lateral incisors,106 canines,340 first premolars,330 second premo-lars,and 270 molars.AutoCAD software was used to pre-cisely measure root length,as well as 15％and 33％of root length on periapical radiographs.In addition,the propor-tions of root length corresponding to distances of 1 mm and 2 mm apex to the cemento-enamel junction(CEJ)were calculated.For a representative case of mild periodontitis,20 periodontists independently assessed the degree of alveolar bone loss of the mandibular second premolar using three ap-proaches:visual estimation by clinicians,AutoCAD-based measurement,and assessment based on the reference values established in this study.Results In the maxilla,15％of root length for central incisors,lateral incisors,canines,first premolars,second premolars,buccal roots of molars,and palatal roots of molars was(2.35±0.16)mm,(2.24±0.16)mm,(2.83±0.08)mm,(2.14±0.18)mm,(2.15±0.17)mm,(1.50±0.23)mm,and(2.20±0.15)mm,respectively,while the corresponding 33％values were(5.17±0.35)mm,(4.93±0.36)mm,(6.24±0.19)mm,(4.70±0.40)mm,(4.72±0.37)mm,(3.31±0.51)mm,and(4.83±0.32)mm.The proportions of root length represented by 2 mm apex to the CEJ were(13±1)％,(13±1)％,(11±0)％,(14±1)％,(14±1)％,(20±3)％,and(14±1)％,respectively.In the mandible,15％of root length for central incisors,lateral incisors,canines,first premolars,second premolars,first molars,and second molars was(2.13±0.10)mm,(2.22±0.12)mm,(2.72±0.22)mm,(2.28±0.16)mm,(2.26±0.18)mm,(2.03±0.16)mm,and(1.99±0.19)mm,respectively,while the corresponding 33％values were(4.68±0.21)mm,(4.88±0.26)mm,(5.98±0.47)mm,(5.01±0.35)mm,(4.97±0.40)mm,(4.48±0.34)mm,and(4.38±0.42)mm.The proportions of root length represented by 2 mm apex to the CEJ were(14±1)％,(14±1)％,(11±1)％,(13±1)％,(13±1)％,(15±1)％,and(15±1)％,respectively.Case-based analysis showed that using visual estimation,10％(2/20)of clinicians made the di-agnosis of stage Ⅰ periodontitis and 90％(18/20)made the diagnosis of stage Ⅱ periodontitis.In contrast,assessments based on AutoCAD-based measurements and the reference values established in this study demonstrated good inter-ob-server agreement among all clinicians,with intraclass correlation coefficients of 0.86 and 0.89,respectively,both support-ing a diagnosis of stage Ⅱ periodontitis.Conclusion AutoCAD-based reference values of 15％and 33％of root length measured on periapical radiographs may be used to assist the diagnosis of stage Ⅱ periodontitis.In contrast,a CEJ-to-al-veolar crest distance greater than 2 mm as the criterion for deciding alveolar bone loss has limitations.
张碧桐;任秀云
山西医科大学口腔医学院·口腔医院牙周科,山西太原 030001山西医科大学口腔医学院·口腔医院牙周科,山西太原 030001
医药卫生
Ⅱ期牙周炎牙周病新分类诊断AutoCAD骨吸收
stage Ⅱ periodontitisnew classification of periodontal diseasesdiagnosisAutoCADbone loss
《中国实用口腔科杂志》 2026 (2)
202-208,7
山西省重点研发计划项目(202302130501009)
评论