国际口腔医学杂志

国际口腔医学杂志 ›› 2024, Vol. 51 ›› Issue (5): 550-557.doi: 10.7518/gjkq.2024086

• 牙体牙髓病专栏 • 上一篇    下一篇

数字化导板技术在牙髓治疗领域的研究进展

焦明阳1(),周煜萃1,蒋正源1,刘雨欣2,曲柳2()   

  1. 1.中国医科大学口腔医学院 沈阳 110002
    2.中国医科大学附属口腔医院牙体牙髓病科;中国医科大学口腔医学院;辽宁省口腔疾病重点实验室 沈阳 110002
  • 收稿日期:2023-12-02 修回日期:2024-05-29 出版日期:2024-09-01 发布日期:2024-09-14
  • 通讯作者: 曲柳
  • 作者简介:焦明阳，学士，Email：jiaomingyangsd@163.com
  • 基金资助:
    辽宁省自然科学基金(2022-MS-212);中国医科大学大学生创新创业训练计划(X202310159011)

Research progress on digital template technology in endodontic treatment

Mingyang Jiao1(),Yucui Zhou1,Zhengyuan Jiang1,Yuxin Liu2,Liu Qu2()   

  1. 1.School of Stomatology, China Medical University, Shenyang 110002, China
    2.Dept. of Endodontics, School and Hospital of Stomatology, China Medical University & Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang 110002, China
  • Received:2023-12-02 Revised:2024-05-29 Online:2024-09-01 Published:2024-09-14
  • Contact: Liu Qu
  • Supported by:
    Natural Science Foundation of Liaoning Province(2022-MS-212);Innovation and Entrepreneurship Trai-ning Program for College Students of China Medical University(X202310159011)

RichHTML

46

PDF (PC)

613

摘要：

随着数字化技术和3D打印技术的飞速发展，数字化导板在口腔医学领域的应用日渐广泛。近年来，许多学者开始将这项技术应用于牙髓治疗领域，以完成更精准、更微创、更高效的牙髓治疗。本文将对数字化导板技术在牙髓治疗中的工作流程，以及该技术在非手术牙髓治疗及根尖手术中的应用现状进行阐述。

关键词: 数字化导板, 锥形束CT, 3D打印, 根管通路建立

Abstract:

Digital template technology is widely applied in the field of stomatology along with the rapid development of digital technology and 3D printing. Its application in endodontic treatment has expanded in recent years, providing clinicians with more accurate, minimally invasive, and efficient operations. This paper reviews the workflow of digital template technology and the present status of its clinical applications in non-surgical and surgical endodontic treatment.

Key words: digital template, cone beam CT, 3D printing, root canal access establishment

中图分类号: 

  • R781.05

图 1

数字化导板技术的工作流程"

图 2

开髓导板的设计、制作与使用A：软件中虚拟手术规划（黄线为虚拟车针，蓝线为虚拟车针中轴延伸方向）；B：软件中设计数字化导板外形；C：打印开髓导板；D：导板辅助开髓。"

图 3

根尖手术导板的设计与制作A、B：计算机规划切割轨迹；C：根尖手术导板设计；D：打印完成的根尖手术导板。"

1 Byun C, Kim C, Cho S, et al. Endodontic treatment of an anomalous anterior tooth with the aid of a 3-dimensional printed physical tooth model[J]. J Endod, 2015, 41(6): 961-965.
2 Zehnder MS, Connert T, Weiger R, et al. Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location[J]. Int Endod J, 2016, 49(10): 966-972.
3 Leontiev W, Connert T, Weiger R, et al. Guided en-dodontics: three-dimensional planning and template-aided preparation of endodontic access cavities[J]. J Vis Exp, 2022(183). doi: 10.3791/63781 .
doi: 10.3791/63781
4 高学军, 岳林. 牙体牙髓病学[M]. 2版. 北京: 北京大学医学出版社, 2013: 356.
Gao XJ, Yue L. Endodontics[M]. 2nd ed. Beijing: Peking University Medical Press, 2013: 356.
5 Tomson PL, Simon SR. Contemporary cleaning and shaping of the root canal system[J]. Prim Dent J, 2016, 5(2): 46-53.
6 McCabe PS, Dummer PM. Pulp canal obliteration: an endodontic diagnosis and treatment challenge[J]. Int Endod J, 2012, 45(2): 177-197.
7 Ballester B, Giraud T, Ahmed HMA, et al. Current strategies for conservative endodontic access cavity preparation techniques-systematic review, meta-ana-lysis, and decision-making protocol[J]. Clin Oral Investig, 2021, 25(11): 6027-6044.
8 Krastl G, Zehnder MS, Connert T, et al. Guided endo-dontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology[J]. Dent Traumatol, 2016, 32(3): 240-246.
9 van der Meer WJ, Vissink A, Ng YL, et al. 3D computer aided treatment planning in endodontics[J]. J Dent, 2016, 45: 67-72.
10 Fonseca Tavares WL, Diniz Viana AC, de Carvalho Machado V, et al. Guided endodontic access of calcified anterior teeth[J]. J Endod, 2018, 44(7): 1195-1199.
11 Torres A, Shaheen E, Lambrechts P, et al. Micro-guided endodontics: a case report of a maxillary lateral incisor with pulp canal obliteration and apical periodontitis[J]. Int Endod J, 2019, 52(4): 540-549.
12 Mena‑Álvarez J, Rico-Romano C, Lobo-Galindo AB, et al. Endodontic treatment of dens evaginatus by performing a splint guided access cavity[J]. J Esthet Restor Dent, 2017, 29(6): 396-402.
13 封琼, 王一舟, 黄雨婷, 等. 精准微创根管治疗: 3D导板指引下的钙化根管疏通术[J]. 口腔医学研究, 2017, 33(4): 427-431.
Feng Q, Wang YZ, Huang YT, et al. Negotiation of calcified root canal under guidance of 3D guides: precise minimally invasive root canal treatment[J]. J Oral Sci Res, 2017, 33(4): 427-431.
14 林捷, 林珍香, 郑志强, 等. 根管导板技术辅助冠修复后磨牙的根管治疗[J]. 实用口腔医学杂志, 2018, 34(5): 648-651.
Lin J, Lin ZX, Zheng ZQ, et al. Endodontic treatment of the molars following crown restoration by using endodontic guide technique[J]. J Pract Stomatol, 2018, 34(5): 648-651.
15 高羽轩, 汪鎏, 傅裕杰, 等. 数字化导板引导技术辅助微创治疗前牙钙化根管[J]. 华西口腔医学杂志, 2022, 40(1): 111-120.
Gao YX, Wang L, Fu YJ, et al. Minimally invasive treatment of calcified root canals in anterior teeth with digital guide technique[J]. West China J Stomatol, 2022, 40(1): 111-120.
16 陆志伟, 黄英, 邱小玲, 等. 数字化根管定位导板应用于完全钙化根管的临床报道1例[J]. 实用口腔医学杂志, 2022, 38(1): 133-135.
Lu ZW, Huang Y, Qiu XL, et al. Treatment of an anterior teeth with completed calcified root canal by guided endodontic access: clinical report of a case[J]. J Pract Stomatol, 2022, 38(1): 133-135.
17 Krug R, Volland J, Reich S, et al. Guided endodontic treatment of multiple teeth with dentin dysplasia: a case report[J]. Head Face Med, 2020, 16(1): 27.
18 Maia LM, de Carvalho Machado V, da Silva NRFA, et al. Case reports in maxillary posterior teeth by guided endodontic access[J]. J Endod, 2019, 45(2): 214-218.
19 Buchgreitz J, Buchgreitz M, Mortensen D, et al. Guided access cavity preparation using cone-beam computed tomography and optical surface scans-an ex vivo study[J]. Int Endod J, 2016, 49(8): 790-795.
20 Connert T, Krug R, Eggmann F, et al. Guided endo-dontics versus conventional access cavity preparation: a comparative study on substance loss using 3-dimensional-printed teeth[J]. J Endod, 2019, 45(3): 327-331.
21 Loureiro MAZ, Elias MRA, Capeletti LR, et al. Guided endodontics: volume of dental tissue removed by guided access cavity preparation-an ex vivo study[J]. J Endod, 2020, 46(12): 1907-1912.
22 Kostunov J, Rammelsberg P, Klotz AL, et al. Minimization of tooth substance removal in normally calcified teeth using guided endodontics: an in vitro pilot study[J]. J Endod, 2021, 47(2): 286-290.
23 Buchgreitz J, Buchgreitz M, Bjørndal L. Guided root canal preparation using cone beam computed tomography and optical surface scans-an observational study of pulp space obliteration and drill path depth in 50 patients[J]. Int Endod J, 2019, 52(5): 559-568.
24 Zhang CF, Zhao X, Chen C, et al. The accuracy of using guided endodontics in access cavity preparation and the temperature changes of root surface: an in vitro study[J]. BMC Oral Health, 2022, 22(1): 504.
25 Fonseca Tavares WL, de Oliveira Murta Pedrosa N, Moreira RA, et al. Limitations and management of static-guided endodontics failure[J]. J Endod, 2022, 48(2): 273-279.
26 Ali A, Arslan H, Jethani B. Conservative management of type Ⅱ dens invaginatus with guided endo-dontic approach: a case series[J]. J Conserv Dent, 2019, 22(5): 503-508.
27 王红, 张倩倩, 李旭光, 等. 3D打印根管定位数字化导板治疗OehlersⅡ型牙内陷1例[J]. 实用口腔医学杂志, 2021, 37(3): 428-431.
Wang H, Zhang QQ, Li XG, et al. Endodontic treatment of type Ⅱ dens invaginatus by using 3D splint guides for cavity access: a case report[J]. J Pract Stomatol, 2021, 37(3): 428-431.
28 Zubizarreta Macho Á, Ferreiroa A, Rico-Romano C, et al. Diagnosis and endodontic treatment of type Ⅱ dens invaginatus by using cone-beam computed tomography and splint guides for cavity access: a case report[J]. J Am Dent Assoc, 2015, 146(4): 266-270.
29 Ali A, Arslan H. Guided endodontics: a case report of maxillary lateral incisors with multiple dens invaginatus[J]. Restor Dent Endod, 2019, 44(4): e38.
30 Sato M, Garcia-Sanchez A, Sanchez S, et al. Use of 3-dimensional-printed guide in hemisection and autotransplantation of a fusion tooth: a case report[J]. J Endod, 2021, 47(3): 526-531.
31 Buchgreitz J, Buchgreitz M, Bjørndal L. Guided endodontics modified for treating molars by using an intracoronal guide technique[J]. J Endod, 2019, 45(6): 818-823.
32 Torres A, Lerut K, Lambrechts P, et al. Guided en-dodontics: use of a sleeveless guide system on an upper premolar with pulp canal obliteration and apical periodontitis[J]. J Endod, 2021, 47(1): 133-139.
33 Connert T, Zehnder MS, Amato M, et al. Microgui-ded endodontics: a method to achieve minimally invasive access cavity preparation and root canal location in mandibular incisors using a novel computer-guided technique[J]. Int Endod J, 2018, 51(2): 247-255.
34 Connert T, Zehnder MS, Weiger R, et al. Microgui-ded endodontics: accuracy of a miniaturized technique for apically extended access cavity preparation in anterior teeth[J]. J Endod, 2017, 43(5): 787-790.
35 Schwindling FS, Tasaka A, Hilgenfeld T, et al. Three-dimensional-guided removal and preparation of dental root posts-concept and feasibility[J]. J Prosthodont Res, 2020, 64(1): 104-108.
36 Maia LM, Moreira Júnior G, Albuquerque RC, et al. Three-dimensional endodontic guide for adhesive fiber post removal: a dental technique[J]. J Prosthet Dent, 2019, 121(3): 387-390.
37 Maia LM, Bambirra Júnior W, Toubes KM, et al. Endodontic guide for the conservative removal of a fiber-reinforced composite resin post[J]. J Prosthet Dent, 2022, 128(1): 4-7.
38 Liu RL, Xie CY, Sun ML, et al. Guided removal of a fractured fiber post and immediate restoration with a digitally prefabricated titanium post-and-core and zirconia crown: a clinical report[J]. J Prosthet Dent, 2023, 129(5): 684-689.
39 Perez C, Finelle G, Couvrechel C. Optimisation of a guided endodontics protocol for removal of fibrereinforced posts[J]. Aust Endod J, 2020, 46(1): 107-114.
40 Xue Y, Zhang L, Cao Y, et al. A three-dimensional printed assembled sleeveless guide system for fiber-post removal[J]. J Prosthodont, 2023, 32(2): 178-184.
41 Mo S, Xu Y, Zhang L, et al. Accuracy of a 3D prin-ted sleeveless guide system used for fiber post remo-val: an in vitro study[J]. J Dent, 2023, 128: 104367.
42 Setzer FC, Kratchman SI. Present status and future directions: surgical endodontics[J]. Int Endod J, 2022, 55(): 1020-1058.
43 Geo TD, Saxena P, Gupta S. Static vs. dynamic na-vigation for endodontic microsurgery-A comparative review[J]. J Oral Biol Craniofac Res, 2022, 12(4): 410-412.
44 Ray JJ, Giacomino CM, Wealleans JA, et al. Targe-ted endodontic microsurgery: digital workflow options[J]. J Endod, 2020, 46(6): 863-871.
45 Nagy E, Braunitzer G, Gryschka DG, et al. Accuracy of digitally planned, guided apicoectomy with a conventional trephine and a custom-made endodontic trephine: an in vitro comparative study[J]. J Stomatol Oral Maxillofac Surg, 2022, 123(4): 388-394.
46 王安琪, 吴丽, 赵丹, 等. 3D打印根尖切除手术导板的设计及体外模型效果评价[J]. 实用口腔医学杂志, 2021, 37(6): 739-742.
Wang AQ, Wu L, Zhao D, et al. Evaluation and case analysis of 3D printing apicoectomy guide plate[J]. J Pract Stomatol, 2021, 37(6): 739-742.
47 彭俐, 王祖华, 孙玉春, 等. 根尖切除手术导板的计算机辅助设计及三维打印[J]. 北京大学学报(医学版), 2018, 50(5): 905-910.
Peng L, Wang ZH, Sun YC, et al. Computer aided design and three-dimensional printing forapicoectomy guide template[J]. J Peking Univ Health Sci, 2018, 50(5): 905-910.
48 Pinsky HM, Champleboux G, Sarment DP. Periapical surgery using CAD/CAM guidance: preclinical results[J]. J Endod, 2007, 33(2): 148-151.
49 Strbac GD, Schnappauf A, Giannis K, et al. Guided modern endodontic surgery: a novel approach for guided osteotomy and root resection[J]. J Endod, 2017, 43(3): 496-501.
50 Giacomino CM, Ray JJ, Wealleans JA. Targeted endodontic microsurgery: a novel approach to anatomically challenging scenarios using 3-dimensio-nal-printed guides and trephine burs-a report of 3 ca-ses[J]. J Endod, 2018, 44(4): 671-677.
51 汤芝伟, 高莺. 靶向牙髓显微外科技术的应用与进展[J]. 国际口腔医学杂志, 2022, 49(6): 678-683.
Tang ZW, Gao Y. Application and progress on targeted endodontic microsurgery techniques[J]. Int J Stomatol, 2022, 49(6): 678-683.
52 Hawkins TK, Wealleans JA, Pratt AM, et al. Targe-ted endodontic microsurgery and endodontic microsurgery: a surgical simulation comparison[J]. Int Endod J, 2020, 53(5): 715-722.
53 Ahn SY, Kim NH, Kim S, et al. Computer-aided design/computer-aided manufacturing-guided endodontic surgery: guided osteotomy and apex localization in a mandibular molar with a thick buccal bone plate[J]. J Endod, 2018, 44(4): 665-670.
54 Smith BG, Pratt AM, Anderson JA, et al. Targeted endodontic microsurgery: implications of the grea-ter palatine artery[J]. J Endod, 2021, 47(1): 19-27.
55 George R, Cameron A, Meer M. Streamlining and simplification of surgical stent fabrication for micro-endodontic surgery[J]. Aust Endod J, 2020, 46(3): 445-451.
56 Benjamin G, Ather A, Bueno MR, et al. Preserving the neurovascular bundle in targeted endodontic microsurgery: a case series[J]. J Endod, 2021, 47(3): 509-519.
57 Antal M, Nagy E, Braunitzer G, et al. Accuracy and clinical safety of guided root end resection with a trephine: a case series[J]. Head Face Med, 2019, 15(1): 30.
58 Popowicz W, Palatyńska-Ulatowska A, Kohli MR. Targeted endodontic microsurgery: computed tomography-based guided stent approach with platelet-rich fibrin graft: a report of 2 cases[J]. J Endod, 2019, 45(12): 1535-1542.
59 Buniag AG, Pratt AM, Ray JJ. Targeted endodontic microsurgery: a retrospective outcomes assessment of 24 cases[J]. J Endod, 2021, 47(5): 762-769.
60 满毅, 黄定明. 美学区种植骨增量与邻牙慢性根尖周病的联合治疗策略(上): 应用基础及适应证[J]. 国际口腔医学杂志, 2022, 49(5): 497-505.
Man Y, Huang DM. Combined treatment strategy of oral implantology and endodontic microsurgery for bone augmentation and endodontic diseases in aesthetic area (part 1): application basis and indications[J]. Int J Stomatol, 2022, 49(5): 497-505.
61 满毅, 黄定明. 美学区种植骨增量与邻牙慢性根尖周病的联合治疗策略(下): 临床诊治流程及实践病例[J]. 国际口腔医学杂, 2022, 49(6): 621-632.
Man Y, Huang DM. Combined treatment strategy of oral implantology and endodontics microsurgery: clinical protocol and practical cases (part 2)[J]. Int J Stomatol, 2022, 49(6): 621-632.
62 Mainkar A, Zhu Q, Safavi K. Incidence of altered sensation after mandibular premolar and molar periapical surgery[J]. J Endod, 2020, 46(1): 29-33.
63 Wang J, Luo YL, Tan XL, et al. Horizontal bone augmentation of the edentulous area with simultaneous endodontic microsurgery of the adjacent tooth: a digitally-driven multidisciplinary case report with a 1-year follow-up[J]. Int J Oral Implantol, 2021, 14(4): 435-451.
64 Gambarini G, Galli M, Morese A, et al. Precision of dynamic navigation to perform endodontic ultraconservative access cavities: a preliminary in vitro ana-lysis[J]. J Endod, 2020, 46(9): 1286-1290.
65 Dianat O, Gupta S, Price JB, et al. Guided endodontic access in a maxillary molar using a dynamic na-vigation system[J]. J Endod, 2021, 47(4): 658-662.
66 Gambarini G, Galli M, Stefanelli LV, et al. Endodontic microsurgery using dynamic navigation system: a case report[J]. J Endod, 2019, 45(11): 1397-1402.e6.
67 Ribeiro D, Reis E, Marques JA, et al. Guided en-dodontics: static vs. dynamic computer-aided techniques-a literature review[J]. J Pers Med, 2022, 12(9): 1516.
[1] 杨雨楠,刘鹏,王虎,游梦. 上颌窦黏膜增厚的锥形束CT影像分析[J]. 国际口腔医学杂志, 2023, 50(3): 302-307.
[2] 汤芝伟,高莺. 靶向牙髓显微外科技术的应用与进展[J]. 国际口腔医学杂志, 2022, 49(6): 678-683.
[3] 蔡娉娉,卓盈颖,林捷,郑志强. 计算机辅助技术在纤维桩拆除中的应用[J]. 国际口腔医学杂志, 2022, 49(6): 731-736.
[4] 吴文智,冯达兴,陈垂壮,周丽鹃. 海口地区下颌第一恒磨牙近中中央根管发生率及相关因素[J]. 国际口腔医学杂志, 2022, 49(4): 420-425.
[5] 庞瑜,刘显,王了. 数字化导板在埋伏多生牙拔除中的应用[J]. 国际口腔医学杂志, 2022, 49(4): 448-452.
[6] 马建斌,薛超然,王沛棋,李彬,白丁. 不同补偿间隙3D打印正颌手术𬌗板对咬合精度的影响[J]. 国际口腔医学杂志, 2022, 49(3): 296-304.
[7] 叶泽林,刘璐,龙虎,游梦. 弯曲前牙的影像评价及治疗的研究进展[J]. 国际口腔医学杂志, 2022, 49(2): 173-181.
[8] 田浩楠,林敏,谢丛蔓,任嫒姝. 上颌腭侧阻生尖牙与寰椎后桥相关性的锥形束CT研究[J]. 国际口腔医学杂志, 2021, 48(5): 536-540.
[9] 施丹妮,杨鑫,吴建勇. 锥形束CT三维头影测量参考坐标系的研究进展[J]. 国际口腔医学杂志, 2021, 48(4): 398-404.
[10] 丁张帆,郭陟永,苗诚,李春洁,宣鸣,王晓毅,张壮. 基于锥形束CT的三维可视化技术在颌骨囊性病变手术中的应用[J]. 国际口腔医学杂志, 2021, 48(2): 180-186.
[11] 王奔,许喆桢,韦曦. 数字化微创技术在牙髓根尖周病学中的应用与进展[J]. 国际口腔医学杂志, 2021, 48(1): 110-118.
[12] 张心驰,吴炜. 颌面骨再生领域3D打印技术及应用材料的研究进展[J]. 国际口腔医学杂志, 2020, 47(6): 677-685.
[13] 唐蓓,赵文俊,王虎,郑广宁,游梦. 根管超填导致下牙槽神经损伤2例[J]. 国际口腔医学杂志, 2020, 47(3): 293-296.
[14] 刘春煦,鲁雨晴,贾璐铭,董博,张倩倩,于海洋. 选择性激光熔融与铸造钛合金卡环的模拟摘戴固位力研究[J]. 国际口腔医学杂志, 2020, 47(2): 152-158.
[15] 章婷婷,胡常红,彭燕,周文翘,张慧聪,刘蝶. 300例不同年龄段有牙颌人群上唇软组织侧貌的锥形束CT三维测量分析[J]. 国际口腔医学杂志, 2020, 47(2): 182-188.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 李承浩 李精韬 石冰. 猪舌模拟腭裂整复的手术初探[J]. 国际口腔医学杂志, 2016, 43(5): 500 -504 .