轻咬合和重咬合状态对下颌运动轨迹及虚拟预调的影响  

Study on mandibular movement trajectory and virtual occlusal pre-adjustment under light and heavy bite force

作　　者：朱家奕 王俊杰 王宇轩 杨静文[1] 姜婷[1] Zhu Jiayi;Wang Junjie;Wang Yuxuan;Yang Jingwen;Jiang Ting(Department of Prosthodontics,Peking University School and Hospital of Stomatology&National Center of Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Research Center of Oral Biomaterials and Digital Medical Devices&Beijing Key Laboratory of Digital Stomatology,Beijing 100081,China;Beijing WeCare Digital Technology Co.,Ltd,Beijing 100076,China)

机构地区：[1]北京大学口腔医学院·口腔医院修复科、国家口腔医学中心、国家口腔疾病临床医学研究中心、口腔生物材料和数字诊疗装备国家工程研究中心、口腔数字医学北京市重点实验室,北京100081 [2]北京为开数字科技有限公司,北京100076

出　　处：《中华口腔医学杂志》2023年第1期50-56,共7页Chinese Journal of Stomatology

基　　金：国家重大疾病多学科合作诊疗能力建设项目(PKUSSNMP-201901);北京市科学技术委员会首都临床特色应用研究基金(Z171100001017096)。

摘　　要：目的探讨轻咬合和重咬合状态对下颌运动轨迹的影响及咬合状态对数字化全冠修复体虚拟预调的影响。方法 2021年10月至2022年3月于北京大学口腔医学院·口腔医院招募10名个别正常研究生志愿者(男性3名, 女性7名, 年龄22~26岁), 通过口内扫描获得其上下颌牙列数字化模型, 重咬合状态下完成数字化颌间关系转移并利用下颌运动分析系统记录轻咬合和重咬合状态下的下颌运动轨迹, 标定3个下颌标志点(中切牙近中邻接点及双侧第一磨牙近中颊尖顶点), 测量两种咬合状态下相同标志点牙尖交错位时的三维距离、对刃颌位时三维距离的矢状面投影以及侧方运动至上下后牙颊尖顶相对(尖对尖位)时三维距离的冠状面投影, 分别采用单样本t检验比较各测量值与0的差异。利用Geomagic Studio 2015逆向工程软件, 对左上中切牙及左下第一磨牙进行虚拟牙体预备, 利用牙科设计软件通过复制法设计数字化全冠修复体, 分别用轻咬合和重咬合下颌运动轨迹对修复体进行预调;分析预调后左上中切牙修复体舌面或左下第一磨牙面与预备前天然牙的三维偏差(平均偏差和均方根), 结果分为轻咬合组和重咬合组(每组左上中切牙和左下第一磨牙样本量均为10), 采用配对样本t检验比较两组差异。结果两种咬合状态下牙尖交错位时中切牙近中邻接点、左侧和右侧第一磨牙近中颊尖顶点的三维距离分别为(0.217±0.135)、(0.210±0.133)和(0.237±0.101)mm, 对刃颌位时上述标志点三维距离的矢状面投影分别为(0.204±0.133)、(0.288±0.148)和(0.292±0.136)mm;尖对尖位时左侧和右侧第一磨牙近中颊尖顶点三维距离的冠状面投影分别为(0.254±0.140)和(0.295±0.190)mm, 以上各测量值与0的差异均有统计学意义(P<0.05)。预调结果显示, 轻咬合和重咬合组左上中切牙全冠修复体舌面与预备前天然牙的平均偏差分别为(0.215Objective To investigate the influence of light and heavy bite force on the mandibular movement trajectories,and the influence of bite force on virtual occlusal pre-adjustment of digital full crown.Methods From October 2021 to March 2022,10 postgraduate volunteers(3 males and 7 females,aged 22-26 years)were recruited from Peking University School and Hospital of Stomatology.Maxillary and mandibular digital models of the participants were obtained by intraoral scanning.Jaw relations were digitally transferred under heavy bite force and mandibular movement trajectories under light and heavy bite force were recorded by jaw motion analyser.Three mandibular markers were chosen,namely the mesial proximal contact point of the central incisor(incisal point)and the mesial buccal cusp tips of the bilateral first molars.The three-dimensional displacements of the markers under two kinds of bite force in the intercuspal position(ICP),the sagittal projection of the three-dimensional displacements in the protrusive edge-to-edge position,and the coronal projection of the three-dimensional displacements in the lateral edge-to-edge position of upper and lower posterior teeth were measured.Single-sample t-test was used to compare the three-dimensional displacements and the corresponding sagittal projection and coronal projection with 0,respectively.The left maxillary central incisor and left mandibular first molar were virtually prepared by the reverse engineering software.Then dental design software was used to design digital full crown using the copy method.The mandibular movement trajectories under light and heavy bite force were separately used to guide virtual occlusal pre-adjustment.The three-dimensional deviations(mean deviations and root mean square)between the lingual surface of the left maxillary central incisor or the occlusal surface of the left mandibular first molar and that of the natural tooth before preparation were calculated(light bite force group and heavy bite force group),and the differences between the two gr

关 键 词：咬合力 调 牙修复体设计 牙冠(假体) 下颌运动轨迹 

分 类 号：R781[医药卫生—口腔医学]