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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (1): 81-87. doi: 10.19723/j.issn.1671-167X.2024.01.013

• 论著 • 上一篇    下一篇

上前牙种植单冠修复体切导的数字化设计正确度

李穗1,马雯洁1,王时敏2,丁茜1,*(),孙瑶1,张磊1,*()   

  1. 1. 北京大学口腔医学院·口腔医院修复科，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，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，北京 100081
  • 收稿日期:2023-10-10 出版日期:2024-02-18 发布日期:2024-02-06
  • 通讯作者: 丁茜,张磊 E-mail:dingqian@hsc.pku.edu.cn;drzhanglei@yeah.net
  • 基金资助:
    北京大学口腔医(学)院临床研究基金(PKUSS-2023CRF503);国家重大疾病多学科合作诊疗能力建设项目(PKUSSNMP-202004)

Trueness of different digital design methods for incisal guidance of maxillary anterior implant-supported single crowns

Sui LI1,Wenjie MA1,Shimin WANG2,Qian DING1,*(),Yao SUN1,Lei ZHANG1,*()   

  1. 1. Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for 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, Beijing 100081, China
    2. Center of Dental Laboratory, Peking University School and Hospital of Stomatology & National Center for 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, Beijing 100081, China
  • Received:2023-10-10 Online:2024-02-18 Published:2024-02-06
  • Contact: Qian DING,Lei ZHANG E-mail:dingqian@hsc.pku.edu.cn;drzhanglei@yeah.net
  • Supported by:
    the Clinical Research Foundation of Peking University School and Hospital of Stomatology(PKUSS-2023CRF503);the National Program for Multidisciplinary Cooperative Treatment on Major Diseases(PKUSSNMP-202004)

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摘要：

目的: 通过虚拟数字模型实验比较动态咬合记录法(patient-specific motion, PSM)和平均值数字牙合架法设计前牙种植单冠修复体切导的正确度。方法: 招募12名牙列完整、有稳定切导的健康受试者, 口内扫描获得受试者牙列模型, 并采集两种动态咬合记录:(1)仅包括前伸运动; (2)包括前伸运动及侧前伸运动。加高原始模型上中切牙参与前伸引导的部分舌面作为参考模型; 虚拟拔除单个上中切牙, 虚拟种植获得上颌工作模型。在修复体设计软件中使用复制功能进行种植单冠形态设计, 使用不同数字化方法设计切导:对照组为平均值数字牙合架法, 试验组为仅包括前伸运动的动态咬合记录法(PSM1)和包括前伸运动和侧前伸运动的动态咬合记录法(PSM2)。通过逆向工程软件分析比较修复体切导形态与原始切导形态的三维偏差, 评价指标包括代表高牙合程度的正值平均值、正面积比、最大值, 代表低牙合程度的负值平均值、负面积比、最小值, 以及代表整体偏差程度的均方根。结果: 数据采用中位数(四分位距)表示。PSM2组的正值平均值、正面积比、负值平均值小于对照组[8.0(18.8) μm vs. 37.5(47.5) μm; 0 vs. 7.2%(38.1%); -109.0(63.8) μm vs.-66.5(64.5) μm], 负面积比大于对照组[52.9%(47.8%) vs. 17.3%(45.3%)], 差异均具有统计学意义(P＜0.05);PSM1组的正面积比[0.1%(7.0%)]和负值平均值[-97.0(61.5) μm]均小于对照组, 负面积比[40.7%(39.2%)]大于对照组, 差异具有统计学意义(P＜0.05);PSM1组的正值平均值[20.0(42.0) μm]和正面积比均大于PSM2组, 差异具有统计学意义(P＜0.05)。结论: 设计前牙种植单冠修复体切导时, 相较于平均值数字牙合架法和仅包括前伸运动的动态咬合记录法, 包括前伸运动和侧前伸运动的动态咬合记录法更有利于减少修复体的咬合干扰, 提高咬合适合性。

关键词: 牙种植, 牙修复体设计, 计算机辅助设计, 上颌前牙, 切导

Abstract:

Objective: To compare the trueness of incisal guidance of implant-supported single crowns designed by patient-specific motion (PSM) with that designed by average-value virtual articulator (AVA). Methods: The study had recruited 12 participants with complete dentition and stable incisal guidance. An intraoral scanner was used to scan digital casts and record two types of patient-specific motion (data only including protrusive movement, and data including protrusive movement and lateral protrusive movement). The lingual surfaces of the maxillary incisors which guided the protrusive movement was selected and elevated to create a reference cast. A maxillary central incisor of original casts was vir-tually extracted and implanted to generate a working cast. The Dental system software program was used to design implant-supported single crowns with the anatomical coping design method. The incisal guidance was designed by different methods. The incisal guidance in control group was designed by the average-value virtual articulator. The incisal guidance in experiment groups was designed by the patient-specific motion only including protrusive movement (PSM1) and with the patient-specific motion including protrusive movement and lateral protrusive movement (PSM2). The incisal guidance of prosthesis designed by these 3 methods were compared with the original incisal guidance in Geomagic Control 2015 (3DSystem, America). The measurements included: Average of positive values, ratio of positive area and maximum value reflecting supra-occlusion; average of negative values, ratio of negative area and minimum value reflecting over-correction; and root mean square reflecting overall deviation. Results: Statistical data were collected using the median (interquartile range) method. The average of positive values, ratio of positive area and average of negative values of the PSM2 group were smaller than those of the control group [8.0 (18.8) μm vs. 37.5 (47.5) μm; 0 vs. 7.2% (38.1%); -109.0 (63.8) μm vs.-66.5 (64.5) μm], and the ratio of negative area of PSM2 group was larger than those of the control group [52.9% (47.8%) vs. 17.3% (45.3%)], with significant differences (P all < 0.05). The ratio of positive area [0.1% (7.0%)] and average of negative values [-97.0 (61.5) μm] of PSM1 group, were smaller than those of the control group, and the ratio of negative area [40.7% (39.2%)] of the PSM1 group was larger than that of the control group, with significant differences (P < 0.05). The average of positive values [20.0 (42.0) μm] and ratio of positive area of PSM1 group was larger than that of the PSM2 group with significant differences (P < 0.05). Conclusion: To establish the incisor guidance of implant-supported single crowns, compared with the average-value virtual articulator and the patient-specific motion only including protrusive movement, the patient-specific motion including protrusive movement and lateral protrusive movement is more conducive to reducing the protrusive interference of prosthesis and improving the occlusal fit.

Key words: Dental implant, Dental prosthesis design, Computer-aided design, Maxillary anterior teeth, Incisal guidance

中图分类号: 

  • R782.1

图1

两种动态咬合记录"

图2

数字模型预处理过程"

图3

3组种植单冠修复体的切导设计"

图4

各组设计修复体切导形态与原始切导3D比较结果"

表1

3组修复体与原始牙齿形态的偏差分析结果(n = 24)"

Group Measurements indicating supra-occlusion Measurements indicating over-correction RMS/μm
MAX/μm +AVG/μm +S/% MIN/μm -AVG/μm -S/%
AVA 97.0 (128.8) 37.5 (47.5) 7.2 (38.1) -201.5 (136.8) -66.5 (64.5) 17.3 (45.3) 90.0 (55.5)
PSM1 46.0 (117.3) 20.0 (42.0) 0.1 (7.0) -234.5 (162.0) -97.0 (61.5) 40.7 (39.2) 104.5 (67.0)
PSM2 14.0 (47.5) 8.0 (18.8) 0 (0) -252.5 (105.5) -109.0 (63.8) 52.9 (47.8) 118.5 (62.5)

表2

偏差分析结果的两两比较(Wilcoxon符号秩检验)"

Group 1 Group 2 Measurements Z P
PSM2 PSM1 MAX -2.949 0.003
+AVG -2.876 0.004
+S -2.271 0.023
MIN -0.486 0.627
-AVG -1.263 0.207
-S 1.943 0.052
RMS 0.786 0.432
PSM2 AVA MAX -3.467 0.001
+AVG -3.391 0.001
+S -3.173 0.002
MIN -2.000 0.045
-AVG -2.615 0.009
-S 3.200 0.001
RMS 1.986 0.047
PSM1 AVA MAX -1.886 0.059
+AVG -1.506 0.132
+S -1.964 0.050
MIN -1.743 0.081
-AVG -2.429 0.015
-S 2.986 0.003
RMS 2.458 0.014
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ISSN 1671-167X
CN 11-4691/R
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