高精度三维整合牙颌模型个体化微种植体手术导板的计算机辅助设计与制作

《中国组织工程研究》 Chinese Journal of Tissue Engineering Research文章编号:2095-4344(2018)10-01529-05 1529www.CRTER .org·研究原著·陈妍曲，女，1992年生，重庆市人，汉族，广西医科大学在读硕士，主要从事口腔正畸学和口腔颌面外科学方面的研究。

共同第一作者：唐敏，博士，主治医师，主要从事正畸研究。

通讯作者：黄旋平，博士，主任医师，教授，广西医科大学附属口腔医院颌面外科，广西壮族自治区 530000中图分类号:R318 文献标识码:A稿件接受：2017-11-20Chen Yan-qu, Mastercandidate, Guangxi Medical University, Nanning 530000, Guangxi ZhuangAutonomous Region, ChinaTang Min, M.D., Attendingphysician, Stomatological Hospital of Guangxi Medical University, Nanning 530000,Guangxi ZhuangAutonomous Region, ChinaChen Yan-qu and Tang Min contributed equaly to this work.Corresponding author: Huang Xuan-ping, M.D., Chief physician, Professor, Department of Maxillofacial Surgery, Stomatological Hospital of Guangxi Medical University, Nanning 530000, Guangxi ZhuangAutonomous Region, China高精度三维整合牙颌模型个体化微种植体手术导板的 计算机辅助设计与制作陈妍曲1，唐 敏2，黄旋平3，周奉城2，王家烯2 (1广西医科大学，广西壮族自治区南宁市 530000；2广西医科大学附属口腔医院，广西壮族自治区南宁市 530000；3广西医科大学附属口腔医院颌面外科，广西壮族自治区南宁市 530000) DOI:10.3969/j.issn.2095-4344.0711 ORCID: 0000-0003-2633-6779(唐敏)文章快速阅读：文题释义：口腔种植体支抗：是将纯钛制作的特殊微小钛钉植入到患者的上颌后牙区、下颌后牙区、硬腭部及牙齿槽间隔等等部位，利用这种植入微小钛钉作正畸治疗的支抗，牵引排列不齐的牙齿作移动，达到矫治牙列不齐的目的。

口腔种植支抗的种类：①颌内支抗：与矫治牙在同一牙弓内，利用一些牙作为支抗而使其他一些矫治牙移动，这种支抗一般可来自牙周膜面积较大的后牙；②颌间支抗：以上颌(上牙弓)或下颌(下牙弓)做支抗来矫正对颌(牙齿)，或是以上下颌间的交互支抗来矫正颌位。

颌间支抗是一种交互支抗，一般具有较充分的支抗作用；③颌外支抗：是指支抗部位在口外，如以枕部、颈部、头顶部等作为支抗部位，这样可作为较大矫治力的支抗来源。

摘要背景：基于三维锥形束CT 模型设计的手术导板已有报道，但由于锥形束CT 不能重建精细的牙龈等软组织，只能设计单纯牙齿固位的导板，稳定性相对较差。

目的：采用三维自动配准方法将锥形束CT 模型和三维数字化牙颌模型进行匹配，建立高精度三维整合牙颌模型，以此模型为基础设计与制作个体化微种植体手术导板。

方法：选择6例错颌畸形患者进行头颅锥形束CT 扫描、牙列石膏模型光学扫描，分别获取三维模型，采用三维自动配准方法将两模型重叠，获得三维整合牙颌模型。

在三维整合模型上精确定位并虚拟植入微种植体，以此为基础设计并采用快速成型技术制作高精度个体化树脂手术导板，利用游标卡尺检测导板的轨道内径。

于患者口内试戴树脂手术导板，嘱患者咬合，检查其就位及固位情况。

结果与结论：模型配准精度高，所有树脂手术导板口内试戴吻合，患者咬紧后固位增强，患者佩戴舒适，无压迫或其他不适感；树脂手术导板轨道内径为(1.79±0.23) mm ，不同操作者间的测量误差无统计学意义(P > 0.05)。

结果表明，基于高精度三维整合模型设计的手术导板精度高，能够为进一步研究手术导板的临床应用提供基础。

关键词：三维整合牙颌模型；锥形束CT ；生物材料；口腔材料；计算机辅助设计与制作(CAD/CAM)；微种植体手术导板；3D 打印技术主题词： 牙种植体；正畸支抗；计算机辅助设计；组织工程 基金资助：广西自然科学基金项目(2015GXNSFBA139141)The computer-aided design and manufacturing of individualized miniscrew surgical guides based on a high-precision three-dimensional integrated digital maxillodental modelChen Yan-qu 1, Tang Min 2, Huang Xuan-ping 3, Zhou Feng-cheng 2, Wang Jia-xi 2 (1Guangxi Medical University,Nanning 530000, Guangxi Zhuang Autonomous Region, China; 2Stomatological Hospital of Guangxi MedicalUniversity, Nanning 530000, Guangxi Zhuang Autonomous Region, China; 3Department of Maxillofacial Surgery, Stomatological Hospital of Guangxi Medical University, Nanning 530000, Guangxi Zhuang Autonomous Region, China)陈妍曲，唐敏，黄旋平，周奉城，王家烯. 高精度三维整合牙颌模型个体化微种植体手术导板的计算机辅助设计与制作[J]. 中国组织工程研究. 2018，22(10):1529-1533. DOI:10.3969/j.issn.2095-4344.0711ISSN 2095-4344 CN 21-1581/R CODEN: ZLKHAH1530AbstractBACKGROUND: Surgical guides designed based on a three-dimensional cone-beam CT (CBCT) model have been reported. However, CBCT cannot remodel fine soft tissue such as gums, and it can only be used to design a simple dental retainer with relatively poor stability. OBJECTIVE: To establish a high-precision three-dimensional (3D) integrated maxillodental model by matching CBCT model with 3D digital maxillodental model using 3D automatic registration method, based on which, we designed and manufactured individualized miniscrew surgical guides.METHODS: CBCT maxillodental models and laser-scanned dentition models obtained from six malocclusion cases were matched and overlapped using the 3D automatic registration method to fabricate the 3D integrated maxillodental model. Then, we accurately positioned and virtually implanted a micro-implant into the 3D integrated maxillodental model. Subsequently we prepared a high-precision individualized resin surgical guide by rapid prototyping technology. The inner diameter of the guide track was detected by a vernier caliper. Patients tried on the resin surgical guide, and then occlusion condition, guide seating and retention were detected.RESULTS AND CONCLUSION: Due to the high-precision registration of the model, all the resin surgical guide plates were suitable. The plate retention was enhanced after tooth clinching, and all the patients felt comfort when wearing the surgical guide plate, with no compression or other discomforts. The inner diameter of the guide track was (1.79±0.23) mm, and the measurement error was not statistically significant (P > 0.05). These findings demonstrate that the high-precision surgical guide plate based on the high-precision 3D integrated model can provide the foundation for further investigations on the clinical application of surgical guides.Subject headings: Dental Implants; Orthodontic Anchorage Procedures; Computer-Aided Design; Tissue Engineering Funding: the Natural Science Foundation of Guangxi Zhuang Autonomous Region, No. 2015GXNSFBA1391410 引言 Introduction支抗控制是正畸治疗成功的关键，传统增加支抗的手段有头帽、Nance 弓和颌间牵引等，然而这些加强支抗的方法需要患者配合才有效，而且患者很不舒适。