国际口腔医学杂志

国际口腔医学杂志 ›› 2025, Vol. 52 ›› Issue (6): 701-712.doi: 10.7518/gjkq.2025102

• 专家笔谈 •    下一篇

数字化技术在全口义齿修复中的应用和体会

冯志宏()   

  1. 空军军医大学口腔医学院 口颌系统重建与再生全国重点实验室国家口腔疾病临床医学研究中心 陕西省口腔医学重点实验室 西安 710032
  • 收稿日期:2025-06-04 修回日期:2025-08-20 出版日期:2025-11-01 发布日期:2025-10-23
  • 通讯作者: 冯志宏
  • 作者简介:冯志宏，空军军医大学口腔医院修复科副教授，副主任医师，硕士研究生导师。中华口腔医学会颌面修复专业委员会常务委员，陕西省口腔种植专业委员会常务委员，陕西省口腔医学会理事，陕西省口腔修复专业委员会常务委员。发表论文50余篇，科学引文索引（Science Citation Index，SCI）数据库收录论文22篇。主译专著2部。获国家发明专利5项，实用新型专利8项。完成国际首创“数字化一体成型钛网加强树脂基托全口义齿”技术流程，高校成果转化“数字化一体成型树脂基托全口义齿”项目。作为主要完成人获国家科技进步一等奖1项，军队科技进步一等奖1项，陕西省高等教育教学成果特等奖1项。擅长规范化全口义齿、数字化全口义齿、无牙颌即刻种植即刻修复技术、复杂骨增量及复杂牙列缺损的修复重建等。
  • 基金资助:
    陕西省创新能力支撑计划(2023?CX?PT?27);国家口腔疾病临床医学研究中心项目(LCB202403)

Application and experience of digital technology in complete denture restoration

Zhihong Feng()   

  1. School of Stomatology, Air Force Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Xi’an 710032, China
  • Received:2025-06-04 Revised:2025-08-20 Online:2025-11-01 Published:2025-10-23
  • Contact: Zhihong Feng
  • Supported by:
    National Clinical Research Center for Oral Diseases General Program(LCB202403);Innovation Capability Support Program in Shaanxi Province(2023-CX-PT-27)

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摘要：

随着口腔医学数字化技术的快速发展，其已日益深入地应用于全口义齿修复的各个环节。以计算机辅助设计和计算机辅助制造（CAD/CAM）为核心，整合口内扫描、面部扫描、3D打印以及数控切削的数字化技术已经给全口义齿的修复流程带来了巨大的变化。本文就无牙颌数字化初模型、初步颌位关系记录、个别托盘复合体设计制作、无牙颌数字化终模型及最终颌位关系获取、全口义齿的数字化制作5个主要环节，探讨数字化技术在全口义齿修复中应用的注意事项及体会。相较依赖经验和手工操作的传统模式，数字化技术已经能够提高全口义齿修复的精度、可预测性和效率，同时减少就诊次数，提升患者的舒适度和就诊体验。然而，目前并未实现全口义齿修复的全程数字化，数字化技术与全口义齿修复的交叉融合、临床应用仍面临诸多亟待规范和深入研究的问题。

关键词: 全口义齿, 数字化技术, 口内扫描, 3D打印, 数控切削

Abstract:

With the rapid development of digital technology in stomatology, it has been increasingly applied in all aspects of complete denture restoration. With computer aided design and computer aided manufacturing (CAD/CAM) as the core, digital technology integrating intraoral scanning, face scanning, 3D printing and computer numerical control cutting has brought great changes to the restoration process of full dentures. This paper discusses the attention and experience of the application of digital technology in complete denture restoration from five main links: the preliminary digital model of edentulous jaw, the record of preliminary law relationship, the design and production of individual tray complex, the master digital model of edentulous jaw and the acquisition of final jaw relationship, and the digital production of complete denture. Compared to traditional models that rely on experience and manual operation, digital technology has been able to improve the accuracy, predictability and efficiency of complete denture restoration, while reducing the number of visits and improving patient comfort and experience. However, the whole-process digitalization of complete denture restoration has not been realized at present, and the cross-fusion and clinical application of digital technology and complete denture restoration still face many problems that need to be standardized and further studied.

Key words: complete denture, digital technology, in-traoral scanning, 3D printing, numerical control cutting

中图分类号: 

  • R783.4

图 1

口内扫描获取的良好的上颌无牙颌数字化初模型A：黄色箭头所示区域为唇颊黏膜，绿色箭头所示为黏膜反折处；B：红色箭头所示为腭小凹，黄色虚线为翼上颌切迹与腭小凹连线，绿色虚线为翼上颌切迹与腭小凹连线后4~5 mm的位置。"

图 2

上颌边缘整塑终印模红色箭头所示为腭小凹，黄色虚线区域为后堤区，该区的边缘整塑及印模材料要有硬性的树脂托盘支撑（浅白色图像为虚化的个别托盘，展示其用以后堤区边缘整塑及印模材料的支撑）。"

图 3

口内扫描获取的良好的下颌无牙颌数字化初模型A：唇颊面观，红色虚线所示为牙槽嵴唇颊面，绿色虚线所示为黏膜反折处，黄色虚线所示为部分唇颊黏膜；B：舌侧面观，红色虚线所示为牙槽嵴舌侧面，绿色虚线所示为舌侧翼缘区，黄色虚线所示为部分口底黏膜。"

图 4

下颌无牙颌数字化初模型舌侧观红色虚线所示为欠佳区域，因在该处无法确定是否已经到达舌侧翼缘区，也有可能会更向下伸展；而绿色虚线所示位置，则能明确定位舌侧翼缘区，因黄色虚线所示区域已经为口底黏膜组织。"

图 5

下颌无牙颌数字化初模型唇颊面观红色箭头所示为软件自动修复区域，与实际扫描获取的模型不能很好地连续协调。"

图 6

牙槽嵴黏膜粘贴树脂标记点A：上颌舌侧黏膜分散粘贴树脂标记点；B：下颌牙槽嵴黏膜分散粘贴树脂标记点。粘贴区域充分干燥，涂布粘接剂固化后再注射树脂固化。"

图 7

下颌后牙区牙槽嵴舌侧扫描操作A：嘱患者卷舌上台，舌体与牙槽嵴轻微离开，后牙区牙槽嵴舌侧就会部分暴露；B：卷舌上抬的状态下，扫描头紧贴舌体伸入到牙槽嵴舌侧进行扫描。"

图 8

一体式正中颌托盘记录初步颌位关系A：一体式正中颌托盘加低流动性硅橡胶记录初步颌位关系，口内正面观；B：托盘把手把上下唇分开，其支撑致口唇突出，无法确定上唇以下1 mm的位置；C：一体式结构，无法较准确确定_平面。"

图 9

分体式颌位记录托盘记录上颌无牙颌初步颌位关系A：分体式颌位记录托盘加低流动性硅橡胶记录初步垂直距离；B：咬合记录硅橡胶记录托盘与下颌牙列的咬合关系；C：取出颌位及咬合记录；D：扫描颌位及咬合记录，获得数字化颌位及咬合关系。"

图 10

组织终止器与个别托盘的组装、拆分A：上颌个别托盘与组织终止器，红色箭头所示为组织终止器上的栓道，绿色箭头所示为个别托盘组织面的栓道；B：下颌个别托盘与组织终止器，红色箭头所示为组织终止器上的栓道，绿色箭头所示为个别托盘组织面的栓道；C：个别托盘与组织终止器通过栓体、栓道组装在一起。"

图 11

常规设计形式的个别托盘-_堤复合体A：个别托盘-_堤复合体侧面观，红色箭头所示为_堤咬合面的凹槽，用以暂时固定咬合记录硅橡胶，绿色箭头所示为上_堤前牙区唇面的洞形结构，可用于暂时固定调整上唇支撑程度的蜡或硅橡胶；B：个别托盘-_堤复合体咬合面，红色箭头所示为_堤咬合面的凹槽，用以暂时固定咬合记录材料。"

图 12

个别托盘-_堤-哥特式弓复合体，_堤采用可组装拆分的多层片式设计A：上颌个别托盘-哥特式弓复合体侧面观，红色箭头所示为描记针固定支架，通过栓体栓道结构与_堤组装，绿色箭头所示为描记针，可在支架中旋进旋出，调节高度，黄色箭头所示为与片式_堤组装用的栓道；B：上颌个别托盘-片式_堤-哥特式弓复合体侧面观，蓝色箭头所示为2层片式_堤，相互之间、与个别托盘之间均可通过栓体栓道组装和拆分，便于调节_堤高度，根据颌间距离可增加或减少片式_堤数量；C：下颌个别托盘-片式_堤-哥特式弓描记板复合体侧面观，红色箭头所示为描记板，与个别托盘通过栓体栓道连接，蓝色箭头所示为片式_堤；D：上下颌个别托盘-片式_堤-哥特式弓复合体正面观。"

图 13

利用个别托盘-组织终止器复合体制取终印模A：除组织终止器外，个别托盘组织面、边缘及外表面3~5 mm涂抹托盘粘接剂；B：加载边缘整塑硅橡胶于托盘边缘、除组织终止器外的组织面区域；C：借助组织终止器就位托盘，边缘整塑；D：整塑完成的个别托盘，除组织终止器外，组织面亦有一层与终止器厚度一致的硅橡胶；E：通过栓体、栓道结构，去除组织终止器；F：组织终止器去除后；G：原组织终止器区域加载稍厚的高流动性硅橡胶，其他区域加载一薄层即可；H：借助边缘整塑硅橡胶的引导，托盘复位于口内；I：取出终印模，修剪后缘腭小凹之后4~5 mm之外的多余部分；J：修剪唇颊侧多余硅橡胶，观察上唇支撑度，必要时再次修剪，或添加材料；K：完成的终印模组织面观；L：完成的终印模侧面观。"

图 14

最终颌位关系记录口内正面照终印模完成后，直接咬合法行颌位关系记录。"

图 15

个别托盘-片式_堤-哥特式弓确定正中关系A：确定垂直距离后，将描记针螺丝旋转至恰好接触描记板，并去除下颌的片式_堤；B：去除下颌片式_堤口内观，上_堤与下颌个别托盘间空出间隙；C：下颌运动在描记板上刻画的痕迹：红色箭头所示为下颌向左侧运动痕迹，绿色箭头所示为下颌前伸运动痕迹，黄色箭头所示为下颌向右侧运动痕迹。"

图 16

使用直线分界的双色树脂盘数控切削制作全口义齿A：设计义齿时，在软件内，将龈缘曲线尽可能接近树脂盘分界线，同时需兼顾基托在树脂盘中的位置；B：切削完成的全口义齿，黄色箭头所示为预留的用以充填基托树脂以修整龈缘及龈外展隙的凹槽；C：以基托树脂充填预留凹槽；D：修整龈缘曲线，并打磨抛光充填树脂后，完成的最终全口义齿正面观；E：完成的最终全口义齿侧面观。"

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