數(shù)字化印模模型置換技術(shù)修復(fù)下頜末端游離缺失的臨床應(yīng)用研究
發(fā)布時間：2018-07-26 15:51
【摘要】：[目的]通過對下頜末端游離缺失患者進行口內(nèi)掃描,獲得數(shù)字化印模,3D打印RPD支架后,取游離端功能性二次印模,模型置換后制作修復(fù)體,與傳統(tǒng)制作法制作的修復(fù)體比較修復(fù)后咀嚼效率、義齒基托密合度的差別,并對患者進行滿意度調(diào)查,來探討數(shù)字化印模模型置換技術(shù)修復(fù)下頜末端游離缺失牙列缺損的可行性,為下頜末端游離缺失修復(fù)提供制作方法參考和客觀依據(jù)。[方法]選擇2015年7月至2016年7月到昆明醫(yī)科大學(xué)附屬口腔醫(yī)院口腔修復(fù)科就診的雙側(cè)、單側(cè)下頜遠中游離端后牙缺失患者并選擇可摘局部義齒修復(fù)者15例,7例患者回訪,其中2例為下頜雙側(cè)末端游離缺失,5例為單側(cè)末端游離缺失。詳細了解患者主訴,與患者溝通交代,均采用3Shape TRIOS口內(nèi)掃描儀直接口掃獲得印模數(shù)據(jù),經(jīng)3Shape CAD程序設(shè)計支架,以STL格式保存,導(dǎo)入3D打印機,3D打印鈷鉻合金支架,在支架的基礎(chǔ)上制作末端游離段個別托盤進行游離端的功能性二次印模,模型置換后制作義齒一副,為實驗組;同期常規(guī)取模灌模按傳統(tǒng)修復(fù)工藝制作第二副義齒,為對照組;隨訪2月,通過臨床檢查基托密合度,可見分光光度計分析比較同一患者兩副義齒修復(fù)后的咀嚼效率及患者義齒滿意度調(diào)查評價其臨床修復(fù)效果。[結(jié)果]成功應(yīng)用3Shape數(shù)字化印模模型置換技術(shù)修復(fù)下頜末端游離缺失患者,獲得游離端的功能性印模,實驗組患者初次戴用義齒即感覺舒適,基托組織面受力均勻,戴牙后復(fù)診調(diào)改次數(shù)明顯少于對照組,實驗組與對照組咀嚼效率數(shù)據(jù)進行單一因素方差分析統(tǒng)計,結(jié)果顯示有統(tǒng)計學(xué)意義,實驗組較對照組咀嚼效率高,隨訪調(diào)查患者對實驗組義齒較對照組更滿意。[結(jié)論]1、對于下頜末端游離缺失患者,通過CAD/CAM數(shù)字化技術(shù)打印修復(fù)體支架是可行的,該方法減少了患者印模制取、石膏模型灌注的繁瑣,避免了傳統(tǒng)制作支架蠟型的雕刻、包埋、鑄造等程序,節(jié)省了材料及人力物力,提高了支架制作的精度。2、在支架的基礎(chǔ)上進行咬合關(guān)系記錄,并獲得游離端的功能性印模,模型置換后完成義齒的制作,較壓力性印模及解剖性印模,更能反映游離端軟組織的功能狀態(tài),減少患者義齒游離端鞍基在功能負荷時的下沉。3、對于下頜末端游離缺失牙列缺損,應(yīng)用數(shù)字化印模模型置換技術(shù)修復(fù),隨訪調(diào)查患者表示滿意,為下頜末端游離缺失病例修復(fù)治療提供制作方法參考和客觀依據(jù)。4、對于下頜末端游離缺失患者可采用閉口印模法制取功能性印模,完成數(shù)字化印模模型置換。5、數(shù)字化印模置換技術(shù)是提高末端游離缺失義齒制作質(zhì)量的可行方法。
[Abstract]:[objective] by scanning the mandibular end of the patients with free loss of mandible, we obtained the digital impression of 3D printing RPD stent, took the functional secondary impression of the free end, and made the prosthesis after the replacement of the model. The difference of masticatory efficiency and denture base Pementification was compared with the traditional prosthesis, and the satisfaction of the patients was investigated. To explore the feasibility of the digital impression model replacement technique for the repair of mandibular end free missing dentition defect, and to provide the method reference and objective basis for the mandibular end free loss repair. [methods] from July 2015 to July 2016, 15 patients with unilateral distal free posterior teeth loss and 7 patients with removable partial denture were selected from the Department of Stomatology, Department of Stomatology, affiliated Hospital of Kunming Medical University. Among them, 2 cases were bilateral distal free deletion of mandible, 5 cases were unilateral terminal free deletion. Understand the patient's main complaint in detail, communicate and explain with the patient, all use the 3Shape TRIOS intraoral scanner to obtain the impression data directly, design the stent by 3Shape CAD program, save it in the form of STL, import the 3D printer into 3D printing cobalt-chromium alloy stent, On the basis of the support, the functional secondary impression of the free end was made on individual pallet of the terminal free segment, one pair of dentures was made after model replacement, and the second denture was made as the control group according to the traditional repairing technology. After 2 months follow up, the masticatory efficiency of two dentures and the satisfaction degree of denture were investigated and evaluated by clinical examination, visible spectrophotometer analysis and evaluation of the clinical effect of the two dentures in the same patient. [results] the 3Shape digital impression model replacement technique was successfully used to repair the patients with free loss of mandibular end, and the functional impression of the free end was obtained. The patients in the experimental group felt comfortable wearing denture for the first time, and the base tissue plane was under uniform stress. The masticatory efficiency data of the experimental group and the control group were analyzed by single factor variance analysis. The results showed that the masticatory efficiency of the experimental group was higher than that of the control group, and the masticatory efficiency of the experimental group was higher than that of the control group. The patients were more satisfied with the dentures in the experimental group than in the control group. [conclusion] 1. It is feasible to print the prosthetic stent by CAD/CAM digital technique for the patients with free mandibular end loss. This method can reduce the complexity of impression making and the perfusion of gypsum model, and avoid the traditional wax engraving of the scaffold. The procedure of embedding, casting and so on saves material and manpower and material resources, improves the precision of scaffold manufacture. On the basis of scaffold, the occlusion relationship is recorded, and the functional impression of free end is obtained. After model replacement, the denture is made. Compared with pressure-impression and anatomical impression, it can better reflect the functional state of free end soft tissue, reduce the sinkage of saddle base at the free end of denture, and reduce the free loss of dentition defect at the end of mandible. The digital impression model replacement technique was used to repair the patients. To provide a reference and objective basis for the repair of patients with free mandibular end defect. The functional impression can be made by closed impression for the patients with free loss of mandible end. It is a feasible method to improve the quality of end-free missing denture by digital impression model replacement and digital impression replacement.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R782.1
本文編號：2146511
[Abstract]:[objective] by scanning the mandibular end of the patients with free loss of mandible, we obtained the digital impression of 3D printing RPD stent, took the functional secondary impression of the free end, and made the prosthesis after the replacement of the model. The difference of masticatory efficiency and denture base Pementification was compared with the traditional prosthesis, and the satisfaction of the patients was investigated. To explore the feasibility of the digital impression model replacement technique for the repair of mandibular end free missing dentition defect, and to provide the method reference and objective basis for the mandibular end free loss repair. [methods] from July 2015 to July 2016, 15 patients with unilateral distal free posterior teeth loss and 7 patients with removable partial denture were selected from the Department of Stomatology, Department of Stomatology, affiliated Hospital of Kunming Medical University. Among them, 2 cases were bilateral distal free deletion of mandible, 5 cases were unilateral terminal free deletion. Understand the patient's main complaint in detail, communicate and explain with the patient, all use the 3Shape TRIOS intraoral scanner to obtain the impression data directly, design the stent by 3Shape CAD program, save it in the form of STL, import the 3D printer into 3D printing cobalt-chromium alloy stent, On the basis of the support, the functional secondary impression of the free end was made on individual pallet of the terminal free segment, one pair of dentures was made after model replacement, and the second denture was made as the control group according to the traditional repairing technology. After 2 months follow up, the masticatory efficiency of two dentures and the satisfaction degree of denture were investigated and evaluated by clinical examination, visible spectrophotometer analysis and evaluation of the clinical effect of the two dentures in the same patient. [results] the 3Shape digital impression model replacement technique was successfully used to repair the patients with free loss of mandibular end, and the functional impression of the free end was obtained. The patients in the experimental group felt comfortable wearing denture for the first time, and the base tissue plane was under uniform stress. The masticatory efficiency data of the experimental group and the control group were analyzed by single factor variance analysis. The results showed that the masticatory efficiency of the experimental group was higher than that of the control group, and the masticatory efficiency of the experimental group was higher than that of the control group. The patients were more satisfied with the dentures in the experimental group than in the control group. [conclusion] 1. It is feasible to print the prosthetic stent by CAD/CAM digital technique for the patients with free mandibular end loss. This method can reduce the complexity of impression making and the perfusion of gypsum model, and avoid the traditional wax engraving of the scaffold. The procedure of embedding, casting and so on saves material and manpower and material resources, improves the precision of scaffold manufacture. On the basis of scaffold, the occlusion relationship is recorded, and the functional impression of free end is obtained. After model replacement, the denture is made. Compared with pressure-impression and anatomical impression, it can better reflect the functional state of free end soft tissue, reduce the sinkage of saddle base at the free end of denture, and reduce the free loss of dentition defect at the end of mandible. The digital impression model replacement technique was used to repair the patients. To provide a reference and objective basis for the repair of patients with free mandibular end defect. The functional impression can be made by closed impression for the patients with free loss of mandible end. It is a feasible method to improve the quality of end-free missing denture by digital impression model replacement and digital impression replacement.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R782.1
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