下颌管解剖结构及牙种植关系探究.docVIP

下颌管解剖结构及牙种植关系探究 　【摘要】 ［目的］探讨下颌管的解剖结构与牙种植的关系［方法］选取15具牙列完整的成人离体下颌骨标本和5具经过动脉血管内灌注的新鲜标本，测量下颌骨在每个牙位截面上有关牙槽嵴及下颌管的相关数据，进行统计学分析［结果］牙槽嵴顶以及下方10mm宽度由前向后逐渐增宽；牙槽嵴由上向下逐渐增宽；下颌管位于下颌骨体内下方走行中偏舌侧，并近下颌骨下缘，在下颌第1,2磨牙区下颌管走行与下颌下缘成平行状，在近颏孔处转向外和向颊侧出颏孔；下颌管内血管位于下牙槽神经之上［结论］牙种植术中按正常解剖部位并且侧重颊侧骨板操作，可避免损伤下牙槽神经；如果术中下颌管内突然涌出大量新鲜血液，则提示若继续手术可能损伤下牙槽神经. 【关键词】 下颌管 牙种植 下牙槽神经 ABSTRACT:OBJECTIVETo study the correlation between anatomic structure of the inferior alveolar nerve canal and dental implantation by measuring mandible innervation esemplarsMETHODSThe intramandibular course of mandibular canal and its dimendion were measured in 15 mandibles with teeth; the relationship between blood vessel and nerve was observed in 5 fresh samples in which the artery was filled; and then the data were analyzed by statisticsRESULTSThe mandibular canal was close to the lingual side and the inferior margin of the mandible, the mandibular canal and the 10mm underside of mandible were parallel in the region of the first and the second molars, it runned outboard to genal aperture when it was hereabout genal aperture, and the blood vessel lay above nerve in the mandibular canalCONCLUSIONIn implant operation performed according to normal anatomy, injury to inferior alveolar nerve may be avoided. Hemorrhage is the earliest manifestation, suggesting that continuing drill may damage the inferior alveolar nerve. Key words:mandibular canal;dental implantation;inferior alveolar nerve 牙种植技术是近十几年来发展起来的修复牙齿缺损的新技术，为牙齿缺失或缺损的较好的修复方法，但在操作过程中，有时可能伤及下牙槽神经，从而导致下颌部麻木或感觉丧失.本研究通过对成人离体下颌骨标本进行多断面观测，探讨了正常成人下颌骨的解剖特点、下颌管的走行及解剖规律，提出了避免下牙槽神经损伤的方法. 1 材料与方法 1.1 材料 取成人离体完整有牙下颌骨标本15具，共30侧，均为死亡后立即用100g/L福尔马林溶液浸泡的头颅标本（未经灌注），经分次用清水煮熟后剔除软组织而制得；另取动脉血管灌注红色乳胶漆的标本5具,共10侧.所有标本均无下颌骨骨折等病史，缺牙数不超过3颗，连续缺牙不超过2颗，牙列排列整齐，无明显牙错位，牙槽嵴无明显吸收.实验器材有常用手术器械、厚度约为1mm的钢锯、20倍的手术显微镜及SMIEC游标卡尺. 1.2 方法 1.2.1 制作下颌骨截面 参照吴氏法［1］先观察15具未经灌注的下颌骨标本，共30侧，即于各标本两侧765和567将每个磨牙近远中接触点连成一线，在连线的中点作垂直线，并将此线向下颌骨内外侧骨板表面延伸，直至下颌骨下缘，即颏孔后缘、第1磨牙牙槽嵴、第2磨牙牙槽嵴、下颌升支前缘和下颌牙槽平面垂直将下颌骨锯开，获得每个牙位的下颌骨截面. 1.2.2 测量标准及