Prediktivna vrednost radiografskih znakova ortopantomografije koji ukazuju na mogući bliski odnos bočnih zuba sa okolnim anatomskim strukturama: CBCT studija
Sažetak
Uvod/Cilj. U planiranju ekstrakcije bočnih zuba neophodno je odrediti njihov tačan položaj i odnos sa okolnim anatomskim strukturama. Ciljevi istraživanja bili su izvršiti procenu prediktivne vrednosti radiografskih znakova ortopantomografije i utvrditi značaj Cone Beam Computed Tomography (CBCT) u određivanju odnosa bočnih zuba sa madibularnim kanalom u donjoj vilici i odnosa bočnih zuba sa maksilarnim sinusom u gornjoj vilici. Metode. U prospektivnoj studiji analizirano je 460 slučajeva od 423 pacijenta. Na ortopantomografskim snimcima praćeno je sedam radiografskih znakova za određivanje odnosa bočnih zuba sa mandibularnim kanalom dok je pet radiografskih znakova praćeno za određivanje odnosa poda maksilarnog sinusa sa korenovima bočnih zuba. Za svaki radiografski znak vršena je precizna CBCT analiza na aksijalnim presecima. Rezultati. Prekid bele linije je radiografski znak koji je na aksijalnim presecima statistički značajno pokazivao prekide kontinuiteta madnibularnog kanala (p = 0.002). Skretanje kanala na aksijalnim presecima pokazao statistički značajno čest prekid kontinuiteta mandibulanog kanala (p = 0.003). Radiografski znak zatamnjenja korenova pokazao je superponiranje anatomskih struktura, blizak odnos sa bočnim zubom ali često bez prekida kontinuiteta (p < 0.001). Odsustvo lamine dure, prekid kontinuiteta poda maksilarnog sinusa i projekcija vrha korena u lumen sinusa su radiografski znaci koji su statistički najčešće bili povezani sa prekidom kontinuiteta poda maksilarnog sinusa na aksijalnim presecima (p < 0.001). Zaključak. Rezultati naše studije pokazali su da prisustvo određenih radiografskih znakova na ortopantomografskim snimcima može imati prediktivni značaj. Takođe, na ortopantomografskim snimcima se ne može sa sigurnošću proceniti tačan odnos anatomskih struktura i bočnih zuba. Precizan položaj bočnih zuba u odnosu na mandibularni kanal i maksilarni sinus moguće je izvršiti na trodimenzionalnim snimcima CBCT.
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