下颌阻生第三磨牙拔除序列分牙导板的数字化设计方法应用初探  

Designing method of the digital sequential tooth-sectioning guide for the extraction of mandibular impacted third molars

作　　者：高梓翔 赵一姣[2] 朱玉佳 萧宁 温奥楠 周维 毛渤淳 张昀 齐伟 王勇 Gao Zixiang;Zhao Yijiao;Zhu Yujia;Xiao Ning;Wen Aonan;Zhou Wei;Mao Bochun;Zhang Yun;Qi Wei;Wang Yong(Institute of Medical Technology,Peking University Health Science Center,Beijing 100191,China;Center of Digital Dentistry,Faculty of Prosthodontics,Peking University School and Hospital of Stomatology&National Center for Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Research Center of Oral Biomaterials and Digital Medical Devices&Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health&Beijing Key Laboratory of Digital Stomatology,Beijing 100081,China;Department of General Dentistry,Peking University School and Hospital of Stomatology&National Center for 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;Department of Orthodontics,Peking University School and Hospital of Stomatology&National Center for 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;Department of VIP Dental Service,Lanzhou Stomatological Hospital,Lanzhou 730031,China)

机构地区：[1]北京大学医学部医学技术研究院,北京100191 [2]北京大学口腔医学院·口腔医院口腔医学数字化研究中心、口腔修复教研室、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、国家卫生健康委口腔医学计算机应用工程技术研究中心、口腔数字医学北京市重点实验室,北京100081 [3]北京大学口腔医学院·口腔医院综合科、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 [4]北京大学口腔医学院·口腔医院正畸科、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 [5]兰州市口腔医院特诊科,兰州730031

出　　处：《中华口腔医学杂志》2023年第5期435-441,共7页Chinese Journal of Stomatology

基　　金：北京大学口腔医院临床新技术新疗法重点项目(PKUSSNCT-20A08);甘肃省重点研发计划(21YF5FA165);兰州市人才创新项目(2019-RC-22)。

摘　　要：目的探索一种能辅助下颌水平阻生第三磨牙拔除的序列分牙导板的数字化设计制作方法,初步评价其可行性,以期为口腔临床应用提供参考。方法选择2021年3月至2022年1月于北京大学口腔医学院·口腔医院综合科就诊的下颌第三磨牙低位水平阻生患者20例,其中男性11例,女性9例,年龄(30.2±2.8)岁。术前拍摄锥形束CT显示牙根与下颌管直接接触,取患者口内全牙列范围印模、进行牙颌模型光学扫描。通过Mimics24.0、Geomagic Wrap 2021、Magics21.0等软件对患者的锥形束CT数据、光学扫描数据进行三维重建、解剖结构提取、配准融合,以及进行序列分牙导板(含截冠导板、分根导板)结构的设计,然后三维打印钛金属导板,导板在牙颌模型试戴确认后,辅助医师进行分牙操作。观察导板是否就位、分牙次数、牙齿分块与术前设计匹配度、手术时间及是否有并发症。结果本研究成功打印20例分牙导板,均在患者口内就位良好,平均分牙次数3.4次,牙齿分块与术前设计较匹配,导板平均手术时间(29.2±9.8)min,未出现骨皮质穿孔等并发症。结论初步验证在下颌阻生第三磨牙拔除术中采用序列分牙导板辅助分牙操作可准确实现术前分牙设计的效果,有望为提高手术精度、保证安全性提供一种数字化解决方案,其精度与安全性需要进一步更大样本量的研究评估。Objective To explore a method for digitally designing and fabricating a sequential tooth-sectioning guide that can assist in the extraction of mandibular horizontal impacted third molars,preliminarily evaluate its feasibility and provide a reference for clinical application.Methods Twenty patients with mandibular low level impacted third molars who visited the Department of General Dentistry,Peking University School and Hospital of Stomatology from March 2021 to January 2022 were selected.Cone-beam CT showed direct contact between the roots and mandibular canal,and full range impressions of the patients'intraoral teeth were taken and optical scans of the dental model were performed.The patients'cone-beam CT data and optical scan data were reconstructed in three dimensions,anatomical structure extraction,registration fusion,and the design of the structure of the guide(including crown-sectioning guide and root-sectioning guide)by Mimics 24.0,Geomagic Wrap 2021,and Magics 21.0 software,and then the titanium guide was three dimensional printed,and the guide was tried on the dental model.After confirmation,the guide was used to assist the dentist in the operation.We observed whether the guide was in place,the number of tooth splitting,the matching of tooth splitting with the preoperative design,the operation time,and whether there were any complications.Results In this study,20 sectioning guides were successfully printed,all of them were well fitted in the patients'mouth,the average number of section was 3.4 times,the tooth parts was better matched with the preoperative design,and the average operative time of the guides was(29.2±9.8)minutes without complications such as perforation of the bone cortex.Conclusions The use of sequential sectioning guides to assist in the extraction of mandibular impacted third molars was initially validated to accurately replicate the preoperative sectioning design,and is expected to provide a digital solution to improve surgical precision and ensure safety.Further studies with larger

关 键 词：牙 阻生 计算机辅助设计 手术定位导板 三维打印 微创 

分 类 号：R782.11[医药卫生—口腔医学]