【摘要】：目的:評(píng)價(jià)基于臨床CBCT數(shù)據(jù)、計(jì)算機(jī)輔助設(shè)計(jì)/計(jì)算機(jī)輔助制造(CAD/CAM)技術(shù)、3D打印技術(shù)制作的3D打印種植導(dǎo)板應(yīng)用于牙列缺損或牙列缺失患者種植術(shù)中及術(shù)后的臨床效果,并分析其精確性。方法:通過(guò)對(duì)上頜或者下頜牙列缺損患者12例,使用具有高分辨率的CBCT對(duì)患者頜骨進(jìn)行掃描,然后設(shè)計(jì)制作12例3D打印種植導(dǎo)板,在導(dǎo)板的輔助下于前牙區(qū)/后牙區(qū)植入23枚種植體,待種植體植入后行術(shù)后CBCT掃描,其數(shù)據(jù)利用Mimics軟件進(jìn)行頜骨三維重建,同時(shí)單獨(dú)重建種植體,然后采用點(diǎn)對(duì)點(diǎn)配準(zhǔn)技術(shù)(N點(diǎn)配準(zhǔn))實(shí)現(xiàn)術(shù)前、術(shù)后CBCT的三維重建模型配準(zhǔn),最后利用工具測(cè)量并記錄實(shí)際種植體和虛擬種植體頸部、根部及深度的偏差值,實(shí)際種植體與虛擬種植體中心軸線之間在頰舌向、近遠(yuǎn)中向的角偏差值,對(duì)比術(shù)前虛擬植入位點(diǎn)與術(shù)后實(shí)際植入位點(diǎn)之間的誤差。患者于術(shù)后2周進(jìn)行臨床檢查,觀察種植體周圍粘膜情況,有無(wú)紅腫溢膿,口腔衛(wèi)生保持狀況;3~6個(gè)月后行CBCT檢查,觀察種植體骨結(jié)合情況,有無(wú)種植體松動(dòng)脫落,是否達(dá)到義齒修復(fù)條件;術(shù)后6個(gè)月,12個(gè)月進(jìn)行臨床檢查或電話隨訪,觀察種植體義齒修復(fù)效果,患者滿意度。結(jié)果:所有12例患者在3D打印種植導(dǎo)板輔助下完成種植后的23枚種植體均獲得良好的種植位置,在頸部、根部、深度和軸向角度的三維方向上與原設(shè)計(jì)的平均偏差值分別為(1.10±0.63)mm,(1.35±0.64)mm,(0.76±0.68)mm,角度平均偏差值在近遠(yuǎn)中向?yàn)?3.41±2.73)°,在頰舌向?yàn)?4.39±2.70)°。平均每例手術(shù)導(dǎo)板費(fèi)用為1583.33元,平均完成每顆種植體手術(shù)時(shí)間為21.39min。為了評(píng)價(jià)測(cè)量的可靠性,對(duì)實(shí)驗(yàn)數(shù)據(jù)分別測(cè)試兩次,兩次測(cè)量結(jié)果P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。對(duì)完成種植后的12例患者,術(shù)后2周進(jìn)行臨床檢查,種植體周圍粘膜色澤紅潤(rùn),未發(fā)現(xiàn)紅腫溢膿者,種植體無(wú)叩痛、無(wú)松動(dòng)脫落,患者口腔衛(wèi)生保持良好;術(shù)后3個(gè)月對(duì)8例患者進(jìn)行術(shù)后CBCT檢查,CBCT示種植體骨結(jié)合良好,種植體周圍未見(jiàn)低密度影,種植體無(wú)叩痛、無(wú)松動(dòng)脫落情況,無(wú)種植體周圍炎,予以義齒修復(fù),另外4例未到觀察時(shí)間,不予拍片觀察;術(shù)后6個(gè)月對(duì)8例患者進(jìn)行電話隨訪,患者未訴不適,種植義齒咬合接觸良好,亦無(wú)種植體松動(dòng)脫落,患者近期使用效果滿意,另外4例未到觀察時(shí)間,未進(jìn)行隨訪觀察;術(shù)后12個(gè)月對(duì)1例患者進(jìn)行電話隨訪,患者未訴不適,種植義齒咬合接觸良好,亦無(wú)松動(dòng)脫落,患者使用效果滿意,另外11例未到觀察時(shí)間,未進(jìn)行隨訪觀察。結(jié)論:(1)3D打印種植導(dǎo)板應(yīng)用于口腔種植,可提高種植的精確性,縮短手術(shù)時(shí)間并保障種植的安全。(2)3D打印種植導(dǎo)板也存在誤差,其近遠(yuǎn)中向的精確性優(yōu)于頰舌向。
[Abstract]:Objective: to evaluate the computer aided design (CAD) / computer-aided manufacturing (CAD/CAM) technology based on clinical CBCT data. The 3D print implant guide made by 3D printing technology was used to evaluate the clinical effect of implant and post implantation in patients with dentition defect or dentition loss, and its accuracy was analyzed. Methods: the maxillary bone of 12 patients with maxillary or mandibular dentition defect was scanned with high resolution CBCT. After implant implantation, 23 implants were implanted in the anterior / posterior dental region with the aid of the guide plate. The data were scanned by CBCT after implant implantation. The data were reconstructed by Mimics software, and the implants were reconstructed alone. Then using point to point registration (N point registration) to achieve preoperative and postoperative CBCT 3D reconstruction model registration, finally using tools to measure and record the actual implant and virtual implant neck, root and depth of deviation. The angle deviation between the central axis of the actual implant and the virtual implant in the buccal and lingual direction and near far and middle direction was compared between the preoperative virtual implant site and the actual implant site after operation. The patients underwent clinical examination 2 weeks after operation to observe the mucous membrane around the implants, whether there were redness, swelling and abscess, and to maintain oral hygiene. After 3 ~ 6 months, CBCT examination was performed to observe the osseous bonding of implants, whether the implants loosened and shed, and whether the prosthesis conditions were met. 6 months and 12 months after operation, clinical examination or telephone follow-up were performed to observe the effect of implant prosthesis and patient satisfaction. Results: in all 12 patients, 23 implants were successfully implanted in the neck, root and neck, assisted by 3D printed implant guide. The average deviation of depth and axial angle from the original design was (1.10 鹵0.63) mm, (1.35 鹵0.64) mm, (鹵0.76 鹵0.68) mm, in the near and far direction, respectively, and the average deviation was (3.41 鹵2.73) 擄in the near and far direction. (4.39 鹵2.70) 擄on cheek and tongue. The average cost of each implant was 1583.33 yuan and the average operation time of each implant was 21.39 minutes. In order to evaluate the reliability of the measurement, the experimental data were tested twice, the results of the two measurements were P0.05.The difference was not statistically significant. Clinical examination was carried out 2 weeks after implantation in 12 patients. The mucosa around the implant was ruddy with no redness and abscess, no percussive pain, no loosening and falling off, and the oral hygiene of the patients was good. Three months after operation, 8 patients were examined by CBCT. CBCT showed that the implant bone was well bonded, there was no low density image around the implant, there was no percussion pain, no loosening and shedding, no peri-implant inflammation, and the denture was restored. In the other 4 cases, the time of observation was not reached and no film was taken. After 6 months of operation, 8 patients were followed up by telephone. The patients did not complain of discomfort, had good contact with implant denture, and had no loosening and falling of implants. The patients had satisfactory results in the short term, the other 4 cases did not have the time to observe, and no follow-up observation was carried out. 12 months after operation, one patient was followed up by telephone. The patient did not complain of discomfort, had good contact with implant denture, and had no loosening and falling off. The patient was satisfied with the effect of application. The other 11 cases did not have the time of observation and were not followed up. Conclusion: (1) 3D print implant guide can improve the accuracy of implant, shorten the operation time and ensure the safety of implant. (2) there are errors in 3D print implant guide, and the accuracy of 3D print implant guide is better than that of buccal and lingual direction.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R783.6

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