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目的 探讨口腔颌面锥形束CT在上颌磨牙根分叉病变临床治疗决策中的作用.方法 回顾2015年1月至2016年12月因慢性牙周炎于天津市口腔医院·南开大学附属口腔医院就诊的患者32例,上颌后磨牙根分叉病变患牙95颗,2名牙周专业主治医师分别使用传统诊断方法(传统诊断组)与锥形束CT(锥形束CT组)对根分叉病变程度诊断并选择治疗方案,治疗方案无法确定时可选两项.比较两种诊断方法对根分叉病变程度诊断及治疗方案选择的差异.结果 95颗患牙中,两组方法的根分叉病变诊断结果差异有统计学意义(P=0.000);传统诊断组有35颗患牙(17例患者,36.8％)选择两项治疗方案,锥形束CT组则仅7颗患牙(5例患者,7.4％).有两项治疗方案时,均取偏保守治疗进行比较,两组差异有统计学意义(P=0.001),其中63.2％(60/95)的患牙治疗方案相同,29.5％(28/95)的患牙锥形束CT组选择治疗方案保守度低于传统诊断方法组;取偏侵袭治疗时,两组差异有统计学意义(P=0.045),其中86.3％(82/95)的患牙治疗方案相同,3.2％(3/95)的患牙锥形束CT组选择治疗方案保守度低于传统诊断方法组.结论 锥形束CT可为临床医师提供更多根分叉病变的结构信息,为制定治疗计划提供可靠的基础.

Objective To compare the use of cone beam computed tomography (CBCT) and conventional approach (clinical probing and periapical radiograph) in assessing furcation involvement (FI) of maxillary molars and making treatment decisions.Methods Thirty-two subjects were selected from the pool of patients at the Department of Periodontology,Tianjin Stomatology Hospital & Hospital of Stomatology,NanKai University from January 2015 to December 2016.All the patients have a diagnosis of generalized chronic periodontitis.Ninety-five maxillary molar with FI from the radiography database were analysed.Two doctors used conventional approach and CBCT images to assess FI and make treatment decision respectively.If the clinical and radiographic findings did not clearly indicate a distinct periodontal therapy,two treatment options were considered.Results There was statistical difference of the FI diagnosis between traditional group and CBCT group assessment of the 95 molars (P=0.000).Thirty-five maxillary molars (36.8％,17 patients) got two treatment recommendations by conventional approach but 7 (7.4％,5 patients) by CBCT-based approach.When with the less invasive treatment recommendation,there was statistical difference between conventional approach and CBCT-based approach (P=0.001).An agreement was observed in 63.2％ (60/95) of the teeth,while in another 29.5％ (28/95) the CBCT-based treatment decision was more invasive than the conventional approach.When with the more invasive treatment recommendation,there was also statistical difference between two approaches (P=0.045).An agreement was observed in 86.3％ (82/95) of the teeth,while in another 3.2％ (3/95) the CBCT-based treatment decision was more invasive than the conventional approach.Conclusions CBCT images of maxillary molars may provide detailed information of FI and a reliable basis for treatment decision.