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北京大学学报（医学版） ›› 2023, Vol. 55 ›› Issue (1): 101-107. doi: 10.19723/j.issn.1671-167X.2023.01.015

• 论著 • 上一篇    下一篇

数字化制作简易口内哥特式弓在全口义齿修复正中关系确定中的应用

周团锋*(),杨雪,王睿捷,程明轩,张华,韦金奇   

  1. 北京大学口腔医院·口腔医学院第一门诊部, 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, 口腔数字医学北京市重点实验室, 国家卫生健康委员会口腔医学计算机应用工程技术研究中心, 国家药品监督管理局口腔生物材料重点实验室, 北京 100034
  • 收稿日期:2022-10-13 出版日期:2023-02-18 发布日期:2023-01-31
  • 通讯作者: 周团锋 E-mail:1442880187@qq.com
  • 基金资助:
    北京大学口腔医院临床新技术新疗法项目(PKUSSNCT-21A01)

A clinical application study of digital manufacturing simple intraoral Gothic arch-tracing device in determining the centric relation of complete dentures

Tuan-feng ZHOU*(),Xue YANG,Rui-jie WANG,Ming-xuan CHENG,Hua ZHANG,Jin-qi WEI   

  1. First Clinical Division, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100034, China
  • Received:2022-10-13 Online:2023-02-18 Published:2023-01-31
  • Contact: Tuan-feng ZHOU E-mail:1442880187@qq.com
  • Supported by:
    the Program for New Clinical Techniques and Therapies of Peking University School and Hospital of Stomatology(PKUSSNCT-21A01)

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摘要：

目的: 验证数字化制作简易口内哥特式弓与传统口内哥特式弓在全口义齿修复正中关系确定中的一致性。方法: 选择门诊无牙颌患者10例, 分别采用数字化制作简易口内哥特式弓(T1)与传统口内哥特式弓(T2)两种方法确定每例的正中关系; 记录两种方法临床操作时间的差异; 扫描两种上下无牙颌石膏模型的正中关系, 将Standard Triangle Language (STL)文件导入Geomagic studio软件中, 上无牙颌模型多点完全最佳拟合后, 测量T1组与T2组下颌中线区和磨牙区垂直向及唇(颊)舌向最大位置偏差; 临床试戴牙时观察T1组与T2组口内有无中线偏斜和后牙区咬合是否稳定。结果: T1、T2组临床确定正中关系时间分别为(41.90±2.64) min和(57.50±2.37) min, 配对t检验, P < 0.01, 差异有统计学意义; T1组与T2组在下颌中线区唇舌向的最大位置偏差为(0.32±0.14) mm, 垂直向的最大位置偏差为(0.40±0.23) mm; 磨牙区颊舌向的最大位置偏差为(0.35±0.23) mm, 垂直向的最大位置偏差为(0.33±0.20) mm, 在垂直向及水平向, T1组下颌相对T2组下颌的最大位置偏差均控制在0.5 mm内。在临床试戴牙过程中, T1组及T2组均未发现全口义齿中线偏离及翘动、摆动等稳定性不良现象。结论: 数字化制作简易口内哥特式弓可以用于临床全口义齿修复正中关系的确定, 不仅可以节约临床操作时间, 而且也能保证正中关系的准确性。

关键词: 数字化制作, 口内哥特式弓, 全口义齿, 正中关系

Abstract:

Objective: To verify the consistency between the digital manufacturing simple intraoral Gothic arch-tracing device and the traditional intraoral Gothic arch-tracing device in determining the centric relation of complete dentures restoration. Methods: Ten outpatients with edentulous jaws were selec-ted, and the centric relation of the patients was determined by digital manufacturing of simple intraoral Gothic arch-tracing device (T1) and traditional intraoral Gothic arch-tracing device (T2); the difference of clinical operation time between the two methods was recorded; the upper and lower edentulous jaw plaster models were scanned with two kinds of centric relation, the Standard Triangle Language (STL) files imported into Geomagic studio software to apply the best fitting of multiple points of the both upper jaw models, the fitted STL files imported into the 3 shape viewer software, and the maximum position deviations of the vertical, labial (buccal) and lingual directions of the mandibular midline area and molar areas in T1 and T2 groups measured. During the clinical complete dentures try-in, we observed whether there was midline deviation in the mouth of T1 group and T2 group, and whether the occlusion of posterior teeth was stable or not. Results: The mean time spent on determining the centric relation of T1 and T2 groups was (41.90±2.64) min, (57.50±2.37) min respectively. Paired t test was conducted in the two groups, P < 0.01 with significant statistical difference; The mean maximum position deviation between T1 group and T2 group of the midline mandibular region in labial lingual direction was (0.32±0.14) mm, that was (0.40±0.23) mm in vertical direction; the mean maximum position deviation of molar area in buccal lingual direction was (0.35±0.23) mm and that was (0.33±0.20) mm in vertical direction. In the vertical and horizontal directions, the maximum position deviation of mandibles between group T1 and group T2 was controlled within 0.5 mm. In the process of clinical complete dentures try-in, there was no deviation from the center line of dentures. There was not warping, swinging and other poor stability phenomena in T1 and T2 groups. Conclusion: The digital manufacturing of simple intraoral Gothic arch-tracing device can be used to determine the centric relation of complete dentures, which can not only save time of clinical operation, but also ensure the accuracy of the centric relation.

Key words: Digital manufacture, Gothic arch-tracing device, Complete dentures, Centric relation

中图分类号: 

  • R781.0

图1

数字化制作简易口内哥特式弓设计图及构成"

图2

安装数字化制作简易口内哥特式弓，保证上颌描记板与上颌平面平行"

图3

完全固定上颌描记板和下颌固位板后，去除周围4个支撑柱"

图4

在口内验证垂直距离的正确性"

图5

数字化制作简易哥特式弓下颌前伸及侧方运动后在上颌描记板描记的3个“↓”样的轨迹"

图6

确定3个描记运动轨迹的顶点，与描记针固定片外周3个圆孔的中心对齐后固定"

图7

用描记针固定片固定3个描记针的位置"

图8

数字化制作简易口内哥特式弓确定正中关系后咬合记录硅橡胶固定"

图9

全口义齿在架上排牙完成"

图10

全口义齿口内试牙，上下中线对齐，后牙咬合稳定"

图11

T1、T2组上颌模型拟合图"

图12

T1、T2组上颌拟合对齐后上下颌偏差的三维云图"

图13

T1、T2组下颌中线唇舌侧及垂直向最大位置偏差的测量"

图14

T1、T2组下颌左侧磨牙区颊舌侧及垂直向最大位置偏差的测量"

图15

T1、T2组下颌右侧磨牙区颊舌侧及垂直向最大位置偏差的测量"

表1

T1、T2组两种哥特式弓的临床操作时间"

Groups Case number Mean±SD P
1 2 3 4 5 6 7 8 9 10
T1/min 46 43 40 45 42 44 39 42 40 38 41.90±2.64 < 0.001
T2/min 62 58 55 61 57 58 56 57 56 55 57.50±2.37

表2

T1、T2组上颌拟合后下颌在中线区唇舌向及垂直向的位置偏差值"

Items Case number Mean±SD
1 2 3 4 5 6 7 8 9 10
Labial-lingual/mm 0.02 0.22 0.47 0.40 0.35 0.34 0.53 0.25 0.31 0.26 0.32±0.14
Vertical/mm 0.01 0.39 0.52 0.21 0.73 0.23 0.62 0.60 0.53 0.20 0.40±0.23

表3

T1、T2组上颌拟合后在双侧下后牙区颊舌向及垂直向的位置偏差值"

Items Case number Mean±SD
1L 1R 2L 2R 3L 3R 4L 4R 5L 5R 6L 6R 7L 7R 8L 8R 9L 9R 10L 10R
Buccal-lingual/mm 0.02 0.05 0.34 0.14 0.78 0.34 0.39 0.12 0.68 0.26 0.36 0.09 0.7 0.4 0.14 0.57 0.62 0.22 0.41 0.27 0.35±0.23
Vertical/mm 0.01 0.03 0.25 0.14 0.54 0.46 0.30 0.21 0.72 0.35 0.40 0.26 0.81 0.23 0.20 0.51 0.45 0.35 0.37 0.30 0.33±0.20
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ISSN 1671-167X
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