数字化印模模型置换技术修复下颌末端游离缺失的临床应用研究

发布时间：2018-07-26 15:51

【摘要】：[目的]通过对下颌末端游离缺失患者进行口内扫描,获得数字化印模,3D打印RPD支架后,取游离端功能性二次印模,模型置换后制作修复体,与传统制作法制作的修复体比较修复后咀嚼效率、义齿基托密合度的差别,并对患者进行满意度调查,来探讨数字化印模模型置换技术修复下颌末端游离缺失牙列缺损的可行性,为下颌末端游离缺失修复提供制作方法参考和客观依据。[方法]选择2015年7月至2016年7月到昆明医科大学附属口腔医院口腔修复科就诊的双侧、单侧下颌远中游离端后牙缺失患者并选择可摘局部义齿修复者15例,7例患者回访,其中2例为下颌双侧末端游离缺失,5例为单侧末端游离缺失。详细了解患者主诉,与患者沟通交代,均采用3Shape TRIOS口内扫描仪直接口扫获得印模数据,经3Shape CAD程序设计支架,以STL格式保存,导入3D打印机,3D打印钴铬合金支架,在支架的基础上制作末端游离段个别托盘进行游离端的功能性二次印模,模型置换后制作义齿一副,为实验组;同期常规取模灌模按传统修复工艺制作第二副义齿,为对照组;随访2月,通过临床检查基托密合度,可见分光光度计分析比较同一患者两副义齿修复后的咀嚼效率及患者义齿满意度调查评价其临床修复效果。[结果]成功应用3Shape数字化印模模型置换技术修复下颌末端游离缺失患者,获得游离端的功能性印模,实验组患者初次戴用义齿即感觉舒适,基托组织面受力均匀,戴牙后复诊调改次数明显少于对照组,实验组与对照组咀嚼效率数据进行单一因素方差分析统计,结果显示有统计学意义,实验组较对照组咀嚼效率高,随访调查患者对实验组义齿较对照组更满意。[结论]1、对于下颌末端游离缺失患者,通过CAD/CAM数字化技术打印修复体支架是可行的,该方法减少了患者印模制取、石膏模型灌注的繁琐,避免了传统制作支架蜡型的雕刻、包埋、铸造等程序,节省了材料及人力物力,提高了支架制作的精度。2、在支架的基础上进行咬合关系记录,并获得游离端的功能性印模,模型置换后完成义齿的制作,较压力性印模及解剖性印模,更能反映游离端软组织的功能状态,减少患者义齿游离端鞍基在功能负荷时的下沉。3、对于下颌末端游离缺失牙列缺损,应用数字化印模模型置换技术修复,随访调查患者表示满意,为下颌末端游离缺失病例修复治疗提供制作方法参考和客观依据。4、对于下颌末端游离缺失患者可采用闭口印模法制取功能性印模,完成数字化印模模型置换。5、数字化印模置换技术是提高末端游离缺失义齿制作质量的可行方法。
[Abstract]:[objective] by scanning the mandibular end of the patients with free loss of mandible, we obtained the digital impression of 3D printing RPD stent, took the functional secondary impression of the free end, and made the prosthesis after the replacement of the model. The difference of masticatory efficiency and denture base Pementification was compared with the traditional prosthesis, and the satisfaction of the patients was investigated. To explore the feasibility of the digital impression model replacement technique for the repair of mandibular end free missing dentition defect, and to provide the method reference and objective basis for the mandibular end free loss repair. [methods] from July 2015 to July 2016, 15 patients with unilateral distal free posterior teeth loss and 7 patients with removable partial denture were selected from the Department of Stomatology, Department of Stomatology, affiliated Hospital of Kunming Medical University. Among them, 2 cases were bilateral distal free deletion of mandible, 5 cases were unilateral terminal free deletion. Understand the patient's main complaint in detail, communicate and explain with the patient, all use the 3Shape TRIOS intraoral scanner to obtain the impression data directly, design the stent by 3Shape CAD program, save it in the form of STL, import the 3D printer into 3D printing cobalt-chromium alloy stent, On the basis of the support, the functional secondary impression of the free end was made on individual pallet of the terminal free segment, one pair of dentures was made after model replacement, and the second denture was made as the control group according to the traditional repairing technology. After 2 months follow up, the masticatory efficiency of two dentures and the satisfaction degree of denture were investigated and evaluated by clinical examination, visible spectrophotometer analysis and evaluation of the clinical effect of the two dentures in the same patient. [results] the 3Shape digital impression model replacement technique was successfully used to repair the patients with free loss of mandibular end, and the functional impression of the free end was obtained. The patients in the experimental group felt comfortable wearing denture for the first time, and the base tissue plane was under uniform stress. The masticatory efficiency data of the experimental group and the control group were analyzed by single factor variance analysis. The results showed that the masticatory efficiency of the experimental group was higher than that of the control group, and the masticatory efficiency of the experimental group was higher than that of the control group. The patients were more satisfied with the dentures in the experimental group than in the control group. [conclusion] 1. It is feasible to print the prosthetic stent by CAD/CAM digital technique for the patients with free mandibular end loss. This method can reduce the complexity of impression making and the perfusion of gypsum model, and avoid the traditional wax engraving of the scaffold. The procedure of embedding, casting and so on saves material and manpower and material resources, improves the precision of scaffold manufacture. On the basis of scaffold, the occlusion relationship is recorded, and the functional impression of free end is obtained. After model replacement, the denture is made. Compared with pressure-impression and anatomical impression, it can better reflect the functional state of free end soft tissue, reduce the sinkage of saddle base at the free end of denture, and reduce the free loss of dentition defect at the end of mandible. The digital impression model replacement technique was used to repair the patients. To provide a reference and objective basis for the repair of patients with free mandibular end defect. The functional impression can be made by closed impression for the patients with free loss of mandible end. It is a feasible method to improve the quality of end-free missing denture by digital impression model replacement and digital impression replacement.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.1

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