影响3D打印个性化钛网骨增量效果的原因与对策  

Factors affecting the bone augmentation outcome of 3D⁃printed individualized titanium mesh and countermea⁃sures

作　　者：于德栋[1,2] 张佳园 吴轶群[2] YU Dedong;ZHANG Jiayuan;WU Yiqun(Fengcheng Branch,Shanghai Ninth People's Hospital Af-filiated to Shanghai Jiao Tong University School of Medicine,Shanghai 201400,China;Department of 2nd Dental Center,Shanghai Ninth Peoples Hospital,Shanghai Jiao Tong University School of Medicine&College of Stomatology,Shanghai Jiao Tong University&National Center for Stomatology,National Clinical Research Center for Oral Diseases&Shanghai Key Laboratory of Stomatology,Shanghai Research Institute of Stomatology,Shanghai 201999,China;West Campus of Hangzhou Stomatological Hospital,Hangzhou 310000,China)

机构地区：[1]上海交通大学医学院附属第九人民医院奉城分院,上海201400 [2]上海交通大学医学院附属第九人民医院口腔第二门诊部、上海交通大学口腔医学院、国家口腔医学中心、国家口腔疾病临床医学研究中心、上海市口腔医学重点实验室、上海市口腔医学研究所,上海201999 [3]杭州口腔医院城西院区,浙江杭州310000

出　　处：《口腔疾病防治》2025年第2期89-99,共11页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金项目(52175422,32101094);上海市卫生健康委员会卫生行业临床研究专项(202240194)。

摘　　要：3D打印个性化钛网技术正逐渐成为严重牙槽骨缺损骨增量治疗的一种重要手段,但其存在成骨效果与预期不一致的情况。针对3D打印个性化钛网技术目前存在的骨增量效果偏差问题,本文综合分析了该技术的优势、成骨效果评估以及在临床应用中的研究进展,深入探讨了影响骨增量效果的多个因素,包括术前钛网设计(钛网的厚度、孔径、孔形态、孔隙率、外形轮廓、钛合金材料选择及3D打印技术)、术中操作(3D打印个性化钛网术中放置的精确性)以及术后维护(包括并发症的预防、假骨膜/类骨膜的形成、钛网的稳定性等)。并结合本团队的临床经验和研究成果,提出了一系列比较有针对性的优化策略,包括:设计制作并临床应用自就位个性化钛网(定位翼+个性化钛网),以提高钛网就位精度;根据牙槽骨缺损的具体情况和软组织状况,提出个性化的治疗流程和钛网设计方案;强调钛网长期稳定固位的重要性,以降低术后钛网的松动和偏移风险。此外,还对3D打印个性化钛网的骨增量效果评价方法进行了适当总结,涵盖了以下关键指标:(1)垂直骨增量与水平骨增量;(2)骨轮廓形态变化;(3)骨体积增量;(4)临床指标(手术成功率、钛网暴露和感染率以及术后恢复情况);(5)美学效果评估;(6)长期稳定性;(7)影像学评估;(8)患者满意度;(9)手术操作的精准性;以期辅助医生全面评估和深入分析手术效果,实现最佳的治疗效果。本文的目的是为3D打印个性化钛网技术的优化和临床应用提供参考,为实现最佳成骨效果奠定理论基础。In the field of oral medicine,3D-printed individualized titanium mesh technology is gradually becoming an important means for the treatment of severe alveolar bone defect augmentation.This article provides a comprehensive analysis of the advantages of this technology,the evaluation of osteogenic effects,and the progress of research in clinical applications.In response to the current issue of variability in bone augmentation outcomes,this paper delves into multi-ple factors affecting bone augmentation effects,including individualized titanium mesh design(involving the thickness,pore size,pore shape,porosity,contour shape,selection of titanium alloy materials,and 3D printing technology),intraop-erative procedures(the accuracy of placement during 3D-printed individualized titanium mesh surgery),and postopera-tive care(including the prevention of complications,formation of pseudoperiosteum,and stability of the titanium mesh).By integrating the clinical experience and research findings of our team,we propose a series of targeted optimization strategies,including designing,manufacturing,and clinically applying self-positioning individualized titanium meshs(posi-tioning wings+individualized titanium meshs)to improve the positioning accuracy of the titanium mesh;propose individ-ualized treatment processes and titanium mesh design schemes based on specific conditions of alveolar bone defects and soft tissue status;and emphasize the importance of long-term stable fixation of the titanium mesh to reduce the risk of postoperative mesh loosening and displacement.In addition,we appropriately summarize the evaluation methods for the bone augmentation effects of 3D-printed individualized titanium meshes,covering the following key indicators:(1)vertical bone augmentation and horizontal bone augmentation;(2)changes in bone contour morphology;(3)bone volume increase;(4)clinical indicators(surgical success rate,titanium mesh exposure,infection rate,and postoperative recov-ery);(5)aesthetic effect evaluation;(6)long-term stability;(7

关 键 词：牙槽骨缺损 个性化钛网 钛网形貌 孔径 孔隙率 3D打印 精准 骨增量效果与评价 并发症 类骨膜 钛网暴露 

分 类 号：R78[医药卫生—口腔医学]