国际口腔医学杂志

国际口腔医学杂志 ›› 2025, Vol. 52 ›› Issue (2): 272-280.doi: 10.7518/gjkq.2025010

• 综述 • 上一篇    

口腔颌面缺损修复数字化设计方法的研究进展

秦庆钊1(),温奥楠1,高梓翔2,朱玉佳1,王勇1,2,赵一姣1,2()   

  1. 1.北京大学口腔医学院·口腔医院;数字化研究中心 国家口腔医学中心 国家口腔疾病临床医学研究中心;口腔生物材料和数字诊疗装备国家工程研究中心;国家卫生健康委员会口腔数字医学重点实验室（中国医学科学院口腔数字医学重点实验室）;口腔数字医学北京市重点实验室 北京 100081
    2.北京大学医学部医学技术研究院 北京 100191
  • 收稿日期:2023-12-05 修回日期:2024-07-30 出版日期:2025-03-01 发布日期:2025-03-01
  • 通讯作者: 赵一姣
  • 作者简介:秦庆钊，医师，学士，Email：1526678223@qq.com
  • 基金资助:
    国家自然科学基金(82271039);国家重点研发计划(2022YFC2405401);甘肃省科技计划重点研发计划项目(21YF5FA16-5);北大医学顶尖学科及学科群发展专项(BMU2022-XKQ003);北京大学口腔医学院实验室开放课题(PKUSS20220301)

Progress in research on digital methods for the morphological rehabilitation of maxillofacial defects

Qingzhao Qin1(),Aonan Wen1,Zixiang Gao2,Yujia Zhu1,Yong Wang1,2,Yijiao Zhao1,2()   

  1. 1.Peking University School and Hospital of Stomatology & Center of Digital Dentistry & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & National Health Commission Key Laboratory of Digital Stomatology (Key Laboratory of Digital Stomatology, Chinese Academy of Medical Sciences) & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2.Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
  • Received:2023-12-05 Revised:2024-07-30 Online:2025-03-01 Published:2025-03-01
  • Contact: Yijiao Zhao
  • Supported by:
    National Natural Science Foundation of China(82271039);National Key R&D Program of China(2022YFC2405401);Key R&D Program of Gansu Province of China(21YF5FA165);Peking University Medicine Fund for World's Leading Discipline or Discipline Cluster Development(BMU2022XKQ003);Open Subject Foundation of Peking University Hospital of Stomatology(PKUSS20220301)

RichHTML

21

PDF (PC)

258

摘要：

口腔颌面缺损严重影响患者的容貌外观、引起生理功能障碍，随着口腔医学数字化技术的发展，应用各种数字化方法设计颌面缺损修复形态已成为国内外研究热点。本综述系统回顾近年来针对颌面缺损修复形态设计的算法研究，并根据算法原理分为4类：传统数字化方法（镜像法和数据库法）、模型变形法、统计形状模型法和机器学习算法，分析和评价上述方法的原理和特点，以期为口腔临床应用和研究提供参考。

关键词: 颌骨缺损, 颌骨重建, 颜面缺损, 赝复体, 数字化设计

Abstract:

Severe maxillofacial defects considerably affect the facial appearance and physiological functions of patients. Advancements in digital technologies have focused the attention of research toward the application of various digital solutions for the morphological restoration of maxillofacial defects. This review systematically examines algorithmic research focusing on morphological restoration designs for maxillofacial defects. Based on algorithmic principles, these methods are categorized into four types: classical methods (mirroring and database methods), model deformation method, statistical shape model method, and machine learning algorithms. The review analyzes and evaluates the principles and characteristics of these metho-ds, aiming to provide insights into clinical applications and research in the field of oral healthcare.

Key words: jaw defects, jaw reconstruction, facial defetcs, prosthesis, digital design

中图分类号: 

  • R782.2

表 1

颌面缺损修复设计的4种数字化方法横向对比表"

项目镜像法、数据库法模型变形法SSM法机器学习算法
原理

镜像法：健侧数据镜像至患侧，作为缺损修复的参考

数据库法：从数据库中检索合适的完整数据，作为缺损修复的参考

将参考模型变形匹配到缺损模型上，作为缺损修复的参考。参考模型可以为颌面平均形状、健侧镜像数据、数据库检出数据首先基于正常颌面部数据建立参数化模型，然后通过提取缺损数据的形状参数，计算生成个性化目标参照数据基于学习到的颅颌面先验形状特征知识，实现缺损补全
适用缺损类型

镜像法：单侧缺损

数据库法：跨中线缺损

单侧缺损及跨中线缺损单侧缺损及跨中线缺损单侧缺损及跨中线缺损
优势临床最常用，可解决大部分单侧、跨中线缺损修复设计的临床需求提高了修复设计的自动化程度，降低医生经验依赖性，提高了缺损重建效果提高了修复设计的自动化程度，降低医生经验依赖性具有自动化、个性化与智能化的优势
局限性医生经验依赖性强；修复设计耗时费力；镜像法只适用单侧缺损；数据库法的数据库在不同地区、医院之间缺乏通用性修复重建效果受缺损数据与参考模型相似程度的影响生成的目标参照数据与缺损数据的表面不完全匹配重叠目前在颜面缺损修复设计中的研究较少
1 周永胜. 口腔修复学[M]. 3版. 北京: 北京大学医学出版社, 2020: 387-414.
Zhou YS. Prosthodontics[M]. 3rd ed. Beijing: Peking University Medical Press, 2020: 387-414.
2 Cristache CM, Tudor I, Moraru L, et al. Digital workflow in maxillofacial prosthodontics-an update on defect data acquisition, editing and design using open-source and commercial available software[J]. Appl Sci, 2021, 11(3): 973.
3 徐文颖. 数字化技术在赝复体修复治疗中的应用[D]. 南昌: 南昌大学, 2019.
Xu WY. The application of digital technique in prosthesis restoration[D]. Nanchang: Nanchang Unversity, 2019.
4 吴国锋. 颌面缺损与颌面赝复[J]. 中华老年口腔医学杂志, 2015, 13(2): 122.
Wu GF. Maxillofacial defect and maxillofacial prosthesis[J]. Chin J Geriatr Dent, 2015, 13(2): 122.
5 顾晓宇. 数字化口腔颌面缺损赝复技术[J]. 中国实用口腔科杂志, 2012, 5(5): 272-276.
Gu XY. Digital technology in prosthesis of oral-maxillofacial defection[J]. Chin J Pract Stomatol, 2012, 5(5): 272-276.
6 郭传瑸, 张益. 口腔颌面外科学[M]. 3版. 北京: 北京大学医学出版社, 2021: 583-591.
Guo CB, Zhang Y. Oral and maxillofacial surgery[M]. 3rd ed. Beijing: Peking University Medical Press, 2021: 583-591.
7 农晨, 艾俊, 沈澄波. 颌面缺损赝复的研究进展[J]. 口腔颌面修复学杂志, 2015, 16(3): 186-189.
Nong C, Ai J, Shen CB. Research progress of maxillofacial defect prosthesis[J]. Chin J Prosthodont, 2015, 16(3): 186-189.
8 揭璧朦. 面中部骨缺损重建目标参照数据自动化获取和配准算法的临床研究[D]. 北京: 北京大学, 2021.
Jie BM. Clinical Research on automatic acquisition and registration algorithm of reference data for mid-facial bone defect reconstruction[D]. Beijing: Peking University, 2021.
9 Buonamici F, Furferi R, Genitori L, et al. Reverse engineering techniques for virtual reconstruction of defective skulls: an overview of existing approaches[J]. Comput Aided Des Appl, 2018, 16(1): 103-112.
10 焦婷, 张富强, 孙健. 计算机辅助设计颌面缺损修复技术的开发应用研究[J]. 中华口腔医学杂志, 2004, 39(2): 129-132.
Jiao T, Zhang FQ, Sun J. Research and development for the CAD system of maxillofacial prosthesis[J]. Chin J Stomatol, 2004, 39(2): 129-132.
11 黄雪梅, 张文强, 叶铭, 等. 基于快速成型技术的人耳赝复体的设计与制造[J]. 上海交通大学学报, 2003, 37(5): 733-736.
Huang XM, Zhang WQ, Ye M, et al. Design and fabrication of auricular prostheses based on rapid prototype technology[J]. J Shanghai Jiaotong Univ, 2003, 37(5): 733-736.
12 Yadav S, Narayan AI, Choudhry A, et al. CAD/CAM-assisted auricular prosthesis fabrication for a quick, precise, and more retentive outcome: a clinical report[J]. J Prosthodont, 2017, 26(7): 616-621.
13 Bi YP, Zhou MH, Wei HB. Digital workflow for auricular prosthesis fabrication with a negative mold[J]. J Prosthet Dent, 2024, 131(6): 1254-1258.
14 潘景光. 彩色睁眼数字化面模的三维重建及在眶缺损仿真赝复中的应用[D]. 西安: 第四军医大学, 2006.
Pan JG. 3D reconstruction of the chromatic digital face model representing the eye open and its application in emulational orbital prostheses[D]. Xi’an: Fourth Military Medical University, 2006.
15 于晓楠, 李志文, 刘欢, 等. 改良数字化技术设计制作赝复体修复单侧眶缺损1例[J]. 实用口腔医学杂志, 2023, 39(6): 821-823.
Yu XN, Li ZW, Liu H, et al. Rehabilitation of a unilateral orbital defect with a prosthesis fabricated by the improved digital technology: a case report[J]. J Pract Stomatol, 2023, 39(6): 821-823.
16 Bi Y, Wu S, Zhao Y, et al. A new method for fabricating orbital prosthesis with a CAD/CAM negative mold[J]. J Prosthet Dent, 2013, 110(5): 424-428.
17 Bockey S, Berssenbrügge P, Dirksen D, et al. Computer-aided design of facial prostheses by means of 3D-data acquisition and following symmetry analysis[J]. J Craniomaxillofac Surg, 2018, 46(8): 1320-1328.
18 侯劲松, 汪淼, 唐海阔, 等. 预成钛网联合自体髂骨及松质骨游离移植二期修复单侧下颌骨缺损[J]. 中华口腔医学研究杂志(电子版), 2010, 4(6): 597-603.
Hou JS, Wang M, Tang HK, et al. Secondary reconstruction of unilateral mandible defect using CAD/CAM-prefabricated titanium mesh combined with autogenous iliac cancellous bone grafts[J]. Chin J Stomatol Res (Electr Ed), 2010, 4(6): 597-603.
19 Yu Y, Zhang WB, Liu XJ, et al. Three-dimensional accuracy of virtual planning and surgical navigation for mandibular reconstruction with free fibula flap[J]. J Oral Maxillofac Surg, 2016, 74(7): 1503.e1-1503.e10.
20 Schramm A, Suarez-Cunqueiro MM, Rücker M, et al. Computer-assisted therapy in orbital and mid-facial reconstructions[J]. Int J Med Robot, 2009, 5(2): 111-124.
21 Davies JC, Chan HHL, Jozaghi Y, et al. Analysis of simulated mandibular reconstruction using a segmental mirroring technique[J]. J Craniomaxillofac Surg, 2019, 47(3): 468-472.
22 刘晓芳, 赵铱民, 吴国锋, 等. 鼻缺损修复CAD/CAM系统的开发——汉族人三维标准外鼻形态数据库的建立[J]. 实用口腔医学杂志, 2006, 22(6): 835-837.
Liu XF, Zhao YM, Wu GF, et al. Construction of 3D standard external nasal morphological database for nasal prostheses[J]. J Pract Stomatol, 2006, 22(6): 835-837.
23 董岩. 汉族人外鼻三维形态数据库的建立与应用[D]. 西安: 第四军医大学, 2010.
Dong Y. Establishment and applications of the three-dimensional nasal morphological database in Han Ethnicity[D]. Xi’an: Fourth Military Medical University, 2010.
24 Reitemeier B, Götzel B, Schöne C, et al. Creation and utilization of a digital database for nasal prosthesis models[J]. Onkologie, 2013, 36(1/2): 7-11.
25 Zeng W, Chen G, Ju R, et al. The combined application of database and three-dimensional image registration technology in the restoration of total nose defect[J]. J Craniofac Surg, 2018, 29(5): e484-e487.
26 王晶. 颅颌面三维形态数据库建立及三维检索的初步研究[D]. 北京: 北京大学, 2011.
Wang J. Construction of a database and method of 3D retrival for three-dimensional craniomaxillofacial features-a pilot study[D]. Beijing: Peking University, 2011.
27 Yao BC, He Y, Jie BM, et al. Reconstruction of bilateral post-traumatic midfacial defects assisted by three-dimensional craniomaxillofacial data in normal Chinese people-a preliminary study[J]. J Oral Maxillofac Surg, 2019, 77(11): 2302.e1-2302.e13.
28 仇师禹. 正常下颌骨形态学数据库的人工智能匹配及其在下颌骨重建中的应用研究[D]. 北京: 北京大学, 2022.
Qiu SY. Artificial intelligence matching of normal mandibular morphology database and its application in mandibular reconstruction[D]. Beijing: Peking University, 2022.
29 Benazzi S, Senck S. Comparing 3-dimensional vir-tual methods for reconstruction in craniomaxillofacial surgery[J]. J Oral Maxillofac Surg, 2011, 69(4): 1184-1194.
30 Xie SD, Leow WK, Lim TC. Laplacian deformation with symmetry constraints for reconstruction of defective skulls[M]//Lecture notes in computer science. Cham: Springer International Publishing, 2017: 24-35.
31 Xie S, Leow WK, Lee H, et al. Flip-avoiding interpolating surface registration for skull reconstruction[J]. Int J Med Robot, 2018, 14(4): e1906.
32 Chui H, Rangarajan A. A new point matching algorithm for non-rigid registration[J]. Comput Vis Image Underst, 2003, 89(2/3): 114-141.
33 温奥楠, 王勇, 叶红强, 等. 基于三维人脸模板的外鼻缺损三维形态补全方法初探[J]. 中华口腔医学杂志, 2023, 58(5): 414-421.
Wen AN, Wang Y, Ye HQ, et al. Preliminary study on three-dimensional morphological reconstruction method for external nose defect based on three-dimensional face template[J]. Chin J Stomatol, 2023, 58(5): 414-421.
34 Senck S, Coquerelle M, Weber GW, et al. Virtual reconstruction of very large skull defects featuring partly and completely missing midsagittal planes[J]. Anat Rec, 2013, 296(5): 745-758.
35 Sun J, Chen X, Liao H, et al. Template-based framework for nasal prosthesis fabrication[J]. Rapid Prototyp J, 2013, 19(2): 68-76.
36 Benazzi S, Fiorenza L, Kozakowski S, et al. Comparing 3D virtual methods for hemimandibular body reconstruction[J]. Anat Rec, 2011, 294(7): 1116-1125.
37 徐铸业, 赵小强, 罗文菲. 基于统计形状模型的三维解剖结构预测[J]. 华中科技大学学报(自然科学版), 2021, 49(11): 58-63.
Xu ZY, Zhao XQ, Luo WF. Three-dimensional anatomical structure prediction based on statistical shape model[J]. J Huazhong Univ Sci Tech (Nat Sci Ed), 2021, 49(11): 58-63.
38 Wang E, Tran KL, D’Heygere E, et al. Predicting the premorbid shape of a diseased mandible[J]. Laryngoscope, 2021, 131(3): E781-E786.
39 Ambellan F, Lamecker H, von Tycowicz C, et al. Statistical shape models: understanding and maste-ring variation in anatomy[J]. Adv Exp Med Biol, 2019, 1156: 67-84.
40 Fuessinger MA, Schwarz S, Neubauer J, et al. Vir-tual reconstruction of bilateral midfacial defects by using statistical shape modeling[J]. J Craniomaxillofac Surg, 2019, 47(7): 1054-1059.
41 Swanepoel HF, Matthews HS, Claes P, et al. A statistical shape model for estimating missing soft tissues of the face in a black South African population[J]. J Prosthodont, 2024, 33(6): 565-573.
42 Gillingham RL, Mutsvangwa TEM, van der Merwe J. Reconstruction of the mandible from partial inputs for virtual surgery planning[J]. Med Eng Phys, 2023, 111: 103934.
43 Semper-Hogg W, Fuessinger MA, Schwarz S, et al. Virtual reconstruction of midface defects using statistical shape models[J]. J Craniomaxillofac Surg, 2017, 45(4): 461-466.
44 Fuessinger MA, Schwarz S, Cornelius CP, et al. Planning of skull reconstruction based on a statistical shape model combined with geometric morphometrics[J]. Int J Comput Assist Radiol Surg, 2018, 13(4): 519-529.
45 Gass M, Füßinger MA, Metzger MC, et al. Virtual reconstruction of orbital floor defects using a statistical shape model[J]. J Anat, 2022, 240(2): 323-329.
46 Morais A, Egger J, Alves V. Automated computer-aided design of cranial implants using a deep volumetric convolutional denoising autoencoder[M]//Ad-vances in intelligent systems and computing. Cham: Springer International Publishing, 2019: 151-160.
47 周子疌, 朱向阳, 韩婧, 等. 基于机器学习的颌骨特征点还原法辅助跨中线颌骨缺损重建[J]. 中国口腔颌面外科杂志, 2020, 18(4): 323-327.
Zhou ZJ, Zhu XY, Han J, et al. Landmarks restore, a machine learning algorithm-aided surgical planning for cross-midline maxillo-mandibular defect[J]. China J Oral Maxillofac Surg, 2020, 18(4): 323-327.
48 Xu L, Xiong Y, Guo J, et al. An intelligent system for craniomaxillofacial defecting reconstruction[J]. Int J Intell Sys, 2022, 37(11): 9461-9479.
49 Xiong YT, Zeng W, Xu L, et al. Virtual reconstruction of midfacial bone defect based on generative adversarial network[J]. Head Face Med, 2022, 18(1): 19.
50 杨柳, 吴晓群. 基于深度学习的三维形状补全研究综述[J]. 图学学报, 2023, 44(2): 201-215.
Yang L, Wu XQ. 3D shape completion via deep lear-ning: a method survey[J]. J Graph, 2023, 44(2): 201-215.
51 褚彤. 基于多尺度点云和表面纹理特征的兵马俑修复方法研究与应用[D]. 西安: 西北大学, 2021.
Chu T. Research and application on repairing me-thod of terracotta warriors amy based on multi-scale point clouds and surface texture features[D]. Xi’an: Northwest University, 2021.
[1] 王勇. 全口义齿数字化技术分析[J]. 国际口腔医学杂志, 2020, 47(1): 1-9.
[2] 张兴乐 李乐 王鹏 霍峰 许莹莹. 心理健康教育对上颌赝复体修复疗效的影响[J]. 国际口腔医学杂志, 2015, 42(3): 299-301.
[3] 王涛 廖天安 邱勋永 王鸿. 带蒂颞肌颅骨瓣修复上颌骨上份的缺损[J]. 国际口腔医学杂志, 2014, 41(3): 265-267.
[4] 钱超综述 孙健审校. 快速成型技术在口腔修复中的应用[J]. 国际口腔医学杂志, 2012, 39(3): 390-393.
[5] 王明一综述 张陈平审校. 快速成型技术在上颌骨缺损赝复治疗中的应用[J]. 国际口腔医学杂志, 2010, 37(6): 724-726.
[6] 何庆银综述 侯劲松审校. 异位预成血管化骨在下颌骨缺损重建中的应用[J]. 国际口腔医学杂志, 2010, 37(3): 298-298～301.
[7] 许哲武综述 李彦审校. 颌面赝复体硅橡胶改性的研究进展[J]. 国际口腔医学杂志, 2010, 37(01): 98-98～100.
[8] 莫文娟综述 李彦审校. 影响颌面硅橡胶赝复体颜色的因素[J]. 国际口腔医学杂志, 2010, 37(01): 109-109～112.
[9] 魏裕综述 李彦审校. 颜面赝复体粘接剂的研究进展[J]. 国际口腔医学杂志, 2009, 36(5): 594-596.
[10] 王戎,曹颖光,. 基因治疗干预颌骨重建的研究进展[J]. 国际口腔医学杂志, 2006, 33(05): 379-381.
[11] 牛学刚,赵铱民,. 上颌骨缺损的种植赝复体修复治疗[J]. 国际口腔医学杂志, 2006, 33(04): 306-308.
[12] 白明海. 放疗后牵张成骨重建下颌骨研究进展[J]. 国际口腔医学杂志, 2004, 31(S1): -.
[13] 姚声,李祖兵. 体内预成血管化骨在下颌骨重建中的应用[J]. 国际口腔医学杂志, 2004, 31(05): 359-361.
[14] 洪珍珍 唐瞻贵. 下颌骨大部缺损余留下颌骨及颌周组织远期变化的研究进展[J]. 国际口腔医学杂志, 2004, 31(02): 145-146.
[15] 杨辛 沈国芳. 牵张成骨在下颌骨缺损修复中的应用和进展[J]. 国际口腔医学杂志, 2004, 31(02): 141-143.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 张京剧. 青年期至中年期颅面复合体变化的头影测量研究[J]. 国际口腔医学杂志, 1999, 26(06): .
[2] 刘玲. 镍铬合金中铍对可铸造性和陶瓷金属结合力的影响[J]. 国际口腔医学杂志, 1999, 26(06): .
[3] 王昆润. 在种植体上制作固定义齿以后下颌骨密度的动态变化[J]. 国际口腔医学杂志, 1999, 26(06): .
[4] 张新春. 桩冠修复与无髓牙的保护[J]. 国际口腔医学杂志, 1999, 26(06): .
[5] 王昆润. 长期单侧鼻呼吸对头颅发育有不利影响[J]. 国际口腔医学杂志, 1999, 26(05): .
[6] 潘劲松. 颈总动脉指压和颈内动脉球囊阻断试验在大脑血液动力学中的不同影响[J]. 国际口腔医学杂志, 1999, 26(05): .
[7] 逄键梁. 两例外胚层发育不良儿童骨内植入种植体后牙槽骨生长情况[J]. 国际口腔医学杂志, 1999, 26(05): .
[8] 王昆润. 后牙冠根斜形牙折的治疗[J]. 国际口腔医学杂志, 1999, 26(05): .
[9] 轩东英. 不同赋形剂对氢氧化钙抗菌效果的影响[J]. 国际口腔医学杂志, 1999, 26(05): .
[10] 杨凯. 淋巴化疗的药物运载系统及其应用现状[J]. 国际口腔医学杂志, 1999, 26(05): .