国际口腔医学杂志

国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (2): 156-164.doi: 10.7518/gjkq.2021024

• 论著 • 上一篇    下一篇

不同方法制作正颌手术数字化牙合板的研究及精确性分析

王立冬(),马文,付帅,张长彬,崔庆赢,梁燕,黎明()   

  1. 昆明医科大学附属口腔医院口腔颌面外科 昆明 650000
  • 收稿日期:2020-06-15 修回日期:2020-11-20 出版日期:2021-03-01 发布日期:2021-03-17
  • 通讯作者: 黎明
  • 作者简介:王立冬,医师,硕士,Email： 1141657618@qq.com
  • 基金资助:
    云南省应用基础研究项目（昆医联合专项）(2017FE467（-193）)

Research and accuracy of different methods of digital occlusal splint fabrication for orthognathic surgery

Wang Lidong(),Ma Wen,Fu Shuai,Zhang Changbin,Cui Qingying,Liang Yan,Li Ming()   

  1. Dept. of Oral and Maxillofacial Sur-gery, Affiliated Stomatological Hospital of Kunming Medical University, Kunming 650000, China
  • Received:2020-06-15 Revised:2020-11-20 Online:2021-03-01 Published:2021-03-17
  • Contact: Ming Li
  • Supported by:
    Applied Basic Research Foundation of Yunnan Province (Applied Basic Research Foundation of Kunming Medical University)(2017FE467（-193）)

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摘要：

目的 探讨不同方法制作正颌手术数字化牙合板的流程,并评估其精确性及临床应用价值。方法 选择2017年6月—2019年2月就诊于昆明医科大学附属口腔医院口腔颌面外科的牙颌面畸形患者10例为研究对象。分别利用单个软件和多个软件进行术前模拟设计,虚拟截骨,设计数字化牙合板,并评估二者精确性和工作时间。同时传统模型外科制作传统牙合板,评估单软件数字化牙合板的临床运用价值。结果 单软件数字化牙合板最大拟合误差平均值上颌为（0.011 1±0.003 8） mm,下颌为（0.010 7±0.003 7） mm。单软件数字化牙合板最大拟合误差优于多软件数字化牙合板（P<0.001）,各自上下颌面间差异无统计学意义（P>0.05）。牙合板术中未出现无法就位情况。无论是单颌还是双颌手术,单软件手术模拟时间均少于多软件手术模拟时间。结论 不同方法制作数字化牙合板精确性存在差异,单软件数字化牙合板精确性优于多软件数字化牙合板,模拟耗时更少,具有实际应用价值。

关键词: 正颌外科, 计算机辅助技术, 锥形束计算机断层扫描, 三维重建, 牙合板

Abstract:

Objective To explore different methods of digital occlusal splint fabrication for orthognathic surgery and evaluate their accuracy and clinical application value. Methods Ten patients at the Department of Oral and Maxillofacial Surgery of Affiliated Stomatological Hospital of Kunming Medical University with dental and maxillofacial deformities were selected from June 2017 to February 2019. Pre-operative simulation design, virtual osteotomy, and digital occlusal splint design were conducted using single and multiple software, and the accuracy and working time of the resulting digital occlusal splints were evaluated. A traditional occlusal splint was also manufactured by plaster model surgery to evaluate the accuracy and clinical application value of single-software digital occlusal splints. Results The average maximum fusion error of the single-software digital occlusal splint was (0.011 1±0.003 8) mm in the maxilla and (0.010 7±0.003 7) mm in the mandible. The maximum fusion error of the single-software digital occlusal splint was better than that of the multi-software digital occlusal splint (P<0.001), and no significant difference between the maxilla and mandible was observed (P>0.05). There was no case that the occlusal splint can,t be brought in during the operation. The simulation time of single-software operation was less than that of multi-software operation in both single- and double-jaw operations. Conclusion Digital occlusal splints prepared by different methods show different levels of accuracy. Single-software digital occlusal splints offer higher accuracy than multi-software digital occlusal splints. Moreover, the simulation time of single-software operation is less than that of multi-software operation. Thus, single-software digital occlusal splints have great practical application value.

Key words: orthognathic surgery, computer aided technology, cone beam computed tomography, three-dimensio-nal reconstruction, occlusal splint

中图分类号: 

  • R622

图1

ProPlan CMF 1.4中三维重建的上下颌骨模型 A：冠状面;B：水平面;C：矢状面;D：上下颌骨三维模型。"

图2

拟合石膏模型精确牙面的复合模型 A：冠状面;B：水平面;C：矢状面;D：颌骨三维模型拟合石膏模型。"

图3

模拟手术后上颌骨及下颌骨移动到计划位置 A：冠状面;B：水平面;C：矢状面;D：上下颌骨骨块三维模型移动至终末位置。"

图4

单软件数字化牙合板的设计制作 A、B：牙合板边缘调整;C：牙合板打孔调整。"

图5

数字化牙合板的模型和实体 A：数字化牙合板模型;B：牙合板实体模型。"

图6

单软件vs标准组与多软件vs标准组上下颌间的拟合误差 A：单软件vs标准组上颌面;B：单软件vs标准组下颌面;C：多软件vs标准组上颌面;D：多软件vs标准组下颌面。"

表1

单软件vs标准组与多软件vs标准组误差的比较"

组别 例数/例 （均值±标准差）/mm t值 P值
总体 单软件vs标准 38 0.001 1±0.003 7 -32.36 <0.001
多软件vs标准 38 0.131 0±0.022 6
上颌 单软件vs标准 19 0.011 1±0.003 8 -25.18 <0.001
多软件vs标准 19 0.133 3±0.020 8
下颌 单软件vs标准 19 0.010 7±0.003 7 -20.69 <0.001
多软件vs标准 19 0.128 8±0.024 6
单软件VS标准 上颌 19 0.011 1±0.003 8 0.58 0.567
下颌 19 0.010 7±0.003 7
多软件VS标准 上颌 19 0.133 3±0.020 8 0.67 0.511
下颌 19 0.128 8±0.024 6

图7

术中对比 A：单软件数字化牙合板;B：传统牙合板。"

表2

手术方式及术中牙合板的比较结果"

手术方式 例数/例 结果
BSSRO 1 牙合板无偏差
Le Fort Ⅰ型截骨+BSSRO 7 牙合板无偏差
Le Fort Ⅰ型截骨+BSSRO+颏成形术 2 牙合板无偏差
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