空心环钻联合手术导板用于自体牙移植牙槽窝备洞  

Combined application of hollow trephine and surgical guide for the preparation of alveolar cavity in autologous tooth transplantation

作　　者：刘竹影 周年苟 李泳祺 周丽斌[1] Zhuying Liu;Niangou Zhou;Yongqi Li;Libin Zhou(Department of Oral and Maxillofacial Surgery,School and Hospital of Stomatology,Guangdong Engineering Research Center of Oral Restoration and Reconstruction&Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine,Guangzhou Medical University,Guangzhou 510182,China;Department of Stomatology,74th Army Group Hospitalof the People′s Liberation Army of China,Guangzhou 510315,China)

机构地区：[1]广州医科大学附属口腔医院口腔颌面外科·广东省口腔组织修复与重建工程技术研究中心·广州市口腔再生医学基础与应用研究重点实验室,广州510182 [2]中国人民解放军陆军第七十四集团军医院口腔科,广州510315

出　　处：《中华口腔医学研究杂志（电子版）》2023年第6期418-423,共6页Chinese Journal of Stomatological Research(Electronic Edition)

基　　金：广州医科大学科研能力提升项目(02-410-2302191XM)。

摘　　要：目的探讨空心环钻与数字化手术导板联合应用于制备自体牙移植受植窝洞的有效性及准确性。方法从2022年5—8月就诊于广州医科大学附属口腔医院颌面外科的患者中招募了16例磨牙缺失并接受自体牙移植修复的患者,实验对象采用随机数字表方法分为自由手组和导板组,每组8例。导板组用锥形束CT(CBCT)和口内扫描系统进行扫描,将结果导入Mimics 21.0,分析受体部位区域选择供体牙,模拟供体牙的植入以确定植入位置。设计基于空心环钻的数字化导板导向套,并生成数字化导板。自由手组按照常规自体牙移植手术流程,术中采用3D打印供牙模型试植,自由手预备窝洞。术后对患者重新进行CBCT扫描,使用Geomagic Control X匹配并对术前设计牙齿位置与术后实际牙齿位置进行比较。结果自体牙移植术后1年的随访中,两组的移植牙均成功愈合。导板组备洞时间为(323±50)s,自由手组为(522±91)s,两者相比差异有统计学意义(t=5.394,P<0.001)。导板组3D供牙试植次数(2.9±0.8)次,自由手组3D供牙试植次数(4.1±1.2)次,两者相比差异有统计学意义(t=2.357,P=0.034)。导板组术前术后牙齿的三维位置对比分析,显示牙体长轴的角度偏差为(9.0±5.5)°,3D偏差显示牙齿中心点的偏差为(1.0±0.6)mm,根尖偏差为(2.1±1.1)mm,移植牙相对于术前设计牙齿位置偏差较小。结论通过使用新方法,自体牙移植备洞时间缩短,过程可靠精确,深度可控,备洞流程简化,备洞过程中空心环钻取出骨块可用于自体牙移植牙槽骨缺损的骨移植,自体骨愈合效果好,节约成本。Objective To explore the effectiveness and accuracy of hollow trephines and digital surgical guides used in the preparation of autologous tooth transplantation cavities.Methods This study recruited 16 patients with missing molars who received autologous tooth transplantation from the patients who visited the Department of Maxillofacial Surgery,Stomatological Hospital,Guangzhou Medical University,from May 2022 to August 2022.The participants were randomly divided into a freehand group and a guided group,with eight cases in each group.The guided group took both a CBCT and an intraoral scanning.The scan results were imported into Mimics 21.0 software to analyze the recipient site and select the donor tooth region.Simulation of donor tooth implantation was performed to determine the implantation position.A digital guide template based on the hollow trephine was designed and generated.The freehand group followed the conventional autologous tooth transplantation surgical procedure.During the operation,a 3D printed donor tooth model was used for trial implantation,and the cavity was prepared manually.After surgery,patients underwent a CBCT scanning,and Geomagic Control X software was used to match and compare the preoperative designed tooth positions with the actual postoperative tooth positions.Results In the 1-year follow-up,successful healing of transplanted teeth was observed in both groups.The alveolar preparation time of the guided group was(323±50)s,compared with the freehand group(522±91)s,and the difference between the two was statistically significant(t=5.394,P<0.001).There was significant difference between the number of 3D donor tooth trials in the guided group(2.9±0.8)and the freehand group(4.1±1.2)(t=2.357,P=0.034).Comparative analysis of the three-dimensional position of the teeth in the guided group before and after surgery showed that the angular deviation,the 3D deviation,and the apical deviation were(9.0±5.5)°,(1.0±0.6)mm and(2.1±1.1)mm,respectively.The positional deviation between the transpl

关 键 词：自体牙移植 计算机辅助设计 3D打印 数字化导板 环钻术 

分 类 号：R78[医药卫生—口腔医学]