3D打印种植导板在牙种植中的临床应用

发布时间：2018-11-14 16:12

【摘要】：目的:评价基于临床CBCT数据、计算机辅助设计/计算机辅助制造(CAD/CAM)技术、3D打印技术制作的3D打印种植导板应用于牙列缺损或牙列缺失患者种植术中及术后的临床效果,并分析其精确性。方法:通过对上颌或者下颌牙列缺损患者12例,使用具有高分辨率的CBCT对患者颌骨进行扫描,然后设计制作12例3D打印种植导板,在导板的辅助下于前牙区/后牙区植入23枚种植体,待种植体植入后行术后CBCT扫描,其数据利用Mimics软件进行颌骨三维重建,同时单独重建种植体,然后采用点对点配准技术(N点配准)实现术前、术后CBCT的三维重建模型配准,最后利用工具测量并记录实际种植体和虚拟种植体颈部、根部及深度的偏差值,实际种植体与虚拟种植体中心轴线之间在颊舌向、近远中向的角偏差值,对比术前虚拟植入位点与术后实际植入位点之间的误差。患者于术后2周进行临床检查,观察种植体周围粘膜情况,有无红肿溢脓,口腔卫生保持状况;3~6个月后行CBCT检查,观察种植体骨结合情况,有无种植体松动脱落,是否达到义齿修复条件;术后6个月,12个月进行临床检查或电话随访,观察种植体义齿修复效果,患者满意度。结果:所有12例患者在3D打印种植导板辅助下完成种植后的23枚种植体均获得良好的种植位置,在颈部、根部、深度和轴向角度的三维方向上与原设计的平均偏差值分别为(1.10±0.63)mm,(1.35±0.64)mm,(0.76±0.68)mm,角度平均偏差值在近远中向为(3.41±2.73)°,在颊舌向为(4.39±2.70)°。平均每例手术导板费用为1583.33元,平均完成每颗种植体手术时间为21.39min。为了评价测量的可靠性,对实验数据分别测试两次,两次测量结果P0.05,差异无统计学意义。对完成种植后的12例患者,术后2周进行临床检查,种植体周围粘膜色泽红润,未发现红肿溢脓者,种植体无叩痛、无松动脱落,患者口腔卫生保持良好;术后3个月对8例患者进行术后CBCT检查,CBCT示种植体骨结合良好,种植体周围未见低密度影,种植体无叩痛、无松动脱落情况,无种植体周围炎,予以义齿修复,另外4例未到观察时间,不予拍片观察;术后6个月对8例患者进行电话随访,患者未诉不适,种植义齿咬合接触良好,亦无种植体松动脱落,患者近期使用效果满意,另外4例未到观察时间,未进行随访观察;术后12个月对1例患者进行电话随访,患者未诉不适,种植义齿咬合接触良好,亦无松动脱落,患者使用效果满意,另外11例未到观察时间,未进行随访观察。结论:(1)3D打印种植导板应用于口腔种植,可提高种植的精确性,缩短手术时间并保障种植的安全。(2)3D打印种植导板也存在误差,其近远中向的精确性优于颊舌向。
[Abstract]:Objective: to evaluate the computer aided design (CAD) / computer-aided manufacturing (CAD/CAM) technology based on clinical CBCT data. The 3D print implant guide made by 3D printing technology was used to evaluate the clinical effect of implant and post implantation in patients with dentition defect or dentition loss, and its accuracy was analyzed. Methods: the maxillary bone of 12 patients with maxillary or mandibular dentition defect was scanned with high resolution CBCT. After implant implantation, 23 implants were implanted in the anterior / posterior dental region with the aid of the guide plate. The data were scanned by CBCT after implant implantation. The data were reconstructed by Mimics software, and the implants were reconstructed alone. Then using point to point registration (N point registration) to achieve preoperative and postoperative CBCT 3D reconstruction model registration, finally using tools to measure and record the actual implant and virtual implant neck, root and depth of deviation. The angle deviation between the central axis of the actual implant and the virtual implant in the buccal and lingual direction and near far and middle direction was compared between the preoperative virtual implant site and the actual implant site after operation. The patients underwent clinical examination 2 weeks after operation to observe the mucous membrane around the implants, whether there were redness, swelling and abscess, and to maintain oral hygiene. After 3 ~ 6 months, CBCT examination was performed to observe the osseous bonding of implants, whether the implants loosened and shed, and whether the prosthesis conditions were met. 6 months and 12 months after operation, clinical examination or telephone follow-up were performed to observe the effect of implant prosthesis and patient satisfaction. Results: in all 12 patients, 23 implants were successfully implanted in the neck, root and neck, assisted by 3D printed implant guide. The average deviation of depth and axial angle from the original design was (1.10 卤0.63) mm, (1.35 卤0.64) mm, (卤0.76 卤0.68) mm, in the near and far direction, respectively, and the average deviation was (3.41 卤2.73) 掳in the near and far direction. (4.39 卤2.70) 掳on cheek and tongue. The average cost of each implant was 1583.33 yuan and the average operation time of each implant was 21.39 minutes. In order to evaluate the reliability of the measurement, the experimental data were tested twice, the results of the two measurements were P0.05.The difference was not statistically significant. Clinical examination was carried out 2 weeks after implantation in 12 patients. The mucosa around the implant was ruddy with no redness and abscess, no percussive pain, no loosening and falling off, and the oral hygiene of the patients was good. Three months after operation, 8 patients were examined by CBCT. CBCT showed that the implant bone was well bonded, there was no low density image around the implant, there was no percussion pain, no loosening and shedding, no peri-implant inflammation, and the denture was restored. In the other 4 cases, the time of observation was not reached and no film was taken. After 6 months of operation, 8 patients were followed up by telephone. The patients did not complain of discomfort, had good contact with implant denture, and had no loosening and falling of implants. The patients had satisfactory results in the short term, the other 4 cases did not have the time to observe, and no follow-up observation was carried out. 12 months after operation, one patient was followed up by telephone. The patient did not complain of discomfort, had good contact with implant denture, and had no loosening and falling off. The patient was satisfied with the effect of application. The other 11 cases did not have the time of observation and were not followed up. Conclusion: (1) 3D print implant guide can improve the accuracy of implant, shorten the operation time and ensure the safety of implant. (2) there are errors in 3D print implant guide, and the accuracy of 3D print implant guide is better than that of buccal and lingual direction.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.6

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