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北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (1): 105-110. doi: 10.19723/j.issn.1671-167X.2019.01.019

• 论著 • 上一篇    下一篇

全程数字化夜磨牙保护牙合垫的制作和初步应用

王时敏1,李峥1,王冠博1,叶红强1,刘云松1,△(),佟岱1,2,高文慧2,周永胜1   

  1. 1. 北京大学口腔医学院·口腔医院　修复科,北京　100081
    2. 北京大学口腔医学院·口腔医院　义齿加工中心,国家口腔疾病临床医学研究中心　口腔数字化医疗技术和材料国家工程实验室　口腔数字医学北京市重点实验室,北京　100081
  • 收稿日期:2018-10-09 出版日期:2019-02-18 发布日期:2019-02-26
  • 通讯作者: 刘云松 E-mail:kqliuyunsong@163.com
  • 基金资助:
    首都卫生发展科研专项(2016-1-4101);科技北京百名领军人才培养工程(Z171100001117169);北京大学口腔医院新技术新疗法项目(PKUSSNCT-17A01)

Preliminary clinical application of complete digital workflow of design and manufacturing occlusal splint for sleep bruxism

Shi-min WANG1,Zheng LI1,Guan-bo WANG1,Hong-qiang YE1,Yun-song LIU1,△(),Dai TONG1,2,Wen-hui GAO2,Yong-sheng ZHOU1   

  1. 1. Department of Prosthodontics, Beijing 100081, China
    2. Dental Laboratory, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2018-10-09 Online:2019-02-18 Published:2019-02-26
  • Contact: Yun-song LIU E-mail:kqliuyunsong@163.com
  • Supported by:
    Supported by the Capital Health Research and Development of Special(2016-1-4101);the Project for Culturing Leading Talents in Scientific and Technological Innovation of Beijing(Z171100001117169);and the New Clinical Technology Program of Peking University Hospital and Stomatology(PKUSSNCT-17A01)

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摘要：

目的:建立一套夜磨牙保护牙合垫的全程数字化设计制作流程,并将其初步应用于临床,观察其临床效果。方法:选取需要通过佩戴牙合垫缓解夜磨牙症的患者24名,使用随机数表法分为两组,实验组使用口内扫描仪获取患者的上下牙列数字印模和抬高后的咬合关系,采用计算机辅助设计软件(computer aided design, CAD)进行数字化设计,将设计数据导入计算机辅助制作软件(computer aided manufacturing, CAM)进行切削;对照组通过真空压膜法制作传统软牙合垫。将两种方法制作的牙合垫分别让两组患者进行口内试戴,应用T-scan Ⅲ咬合分析系统分析佩戴两种牙合垫后的牙合接触特征,并由患者对牙合垫的固位、美观与咬合舒适度进行评分,采用IBM SPSS 20.0软件进行Mann-Whitney双侧检验,P<0.05为差异有统计学意义。结果:成功建立了夜磨牙保护牙合垫的全程数字化设计制作流程。临床应用发现,两组患者对两种牙合垫的固位评价差异无统计学意义(Z=-0.538,P=0.590), 实验组的美观评分(Z=2.038,P=0.042)与咬合舒适度评分(Z=-2.579,P=0.010)均高于对照组,差异有统计学意义。T-scan结果显示,正中咬合时,对照组仅有双侧第二磨牙区存在牙合接触,而实验组可与下颌全牙列接触,前后牙合力均匀。结论:全程数字化设计制作的夜磨牙保护牙合垫改良了咬合设计,极大地简化和优化了牙合垫的制作流程,节约了医疗资源,有益环保,能够更加便捷、高效地为患者服务。

关键词: 计算机辅助设计, 夜磨牙症, 牙合垫

Abstract:

Objective: To establish a complete workflow of digital design and manufacturing occlusal splint for sleep bruxism, which can be preliminarily applied in clinical use, thus observe the clinical efficacy. Methods: Twenty-four patients with sleep bruxism were recruited in the study and randomly divi-ded into two groups by using random number tables. Digital-occlusal-splint (experimental group) treatment plan and traditional-occlusal-splint (control group) treatment plan were carried out for each group, respectively. For experimental group, digital models of patients’ both dental arches and the occlusion relationship after elevation were captured using an intraoral scanner. The occlusal splint was carried out by computer aided design/computer aided manufacturing (CAD/CAM), including splint designing and milling. For control group, the traditional soft occlusal splint was fabricated by vacuum laminator. The two kinds of occlusal splints were tried in the patients from each group, and the occlusal contacts were tested respectively by T-scan analysis system, which recorded the changes of occlusal indicators in the two groups. The retention, appearance and occlusal comfort degree were evaluated by the two groups of patients. Mann-Whitney test was performed with IBM SPSS 20.0 software, and bilateral test was performed. P<0.05 was considered to be statistically significant. Results: The complete workflow of digital design and manufacturing occlusal splint was successfully established. During the clinical use, there was no statistical difference in the retention evaluation of two kinds of occlusal splints between the two groups of patients (Z=-0.538, P=0.590). The appearance score (Z=2.038, P=0.042) and the occlusal comfort score (Z=-2.579, P=0.010) of the experimental group were higher than those of the control group, with statistically significant differences. The T-scan analysis results showed that only the second molar on both sides of the traditional occlusal splint had occlusal contact in intercupsal position, while the digital occlusal splint had stable and bilaterally balanced contact between the maxillary and mandibular teeth. Furthermore, the occlusal force was uniformly distributed in the experimental group. Conclusion: The complete workflow of digital occlusal splint improves the occlusal design, greatly simplifies and optimizes the traditional process of making occlusal splint. This new method is resource-saving and environmental-friendly, and it is able to serve patients more conveniently and efficiently.

Key words: Computer-aided design, Sleep bruxism, Occlusal splints

中图分类号: 

  • R783.2

表1

两组患者对两种夜磨牙保护牙合垫固位的评价"

Group A B C Z value P value
Experimental group, n 6 5 1 -0.538 0.590
Control group, n 5 5 2

表2

两组患者对两种夜磨牙保护牙合垫美观的评价"

Group A B C Z value P value
Experimental group, n 7 4 1 -2.038 0.042
Control group, n 2 7 3

表3

两组患者对两种夜磨牙保护牙合垫咬合舒适度的评价"

Group A B C Z value P value
Experimental group, n 9 3 0 -2.579 0.010
Control group, n 3 6 3

图1

实验组夜磨牙保护牙合垫的设计与制作"

图2

实验组的患者1夜磨牙保护牙合垫的口内佩戴情况"

图3

对照组的患者2夜磨牙保护牙合垫的口内佩戴情况"

图4

实验组正中咬合的T-scan结果"

图5

对照组正中咬合的T-scan结果"

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ISSN 1671-167X
CN 11-4691/R
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