患者参与的数字化设计在前牙美学修复中的应用

Application of patient-participated digital design in esthetic rehabilitation of anterior teeth

目的:探索一种患者能够参与的前牙美学修复的数字化设计、预测和制作方法,为前牙美学修复提供新思路。方法:选取需要进行前牙美学修复的患者32人,随机分为实验组和对照组,每组各16人。实验组通过口内扫描和面部三维扫描获取牙列和面部图像并进行配准,在计算机辅助设计(computer-aided design,CAD)软件中设计修复体,得到三维数字化修复效果图,根据患者意见调整修复体形态后,用牙科计算机辅助制作(computer-aided manufacturing,CAM)设备根据设计好的修复体形态制作前牙修复体。对照组采用常规方法制作修复。记录两组患者初戴修复体时每单位修复体所用时间,请未参与实验的医师对修复体质量进行盲评,并请患者对修复体以及修复后面部整体外观进行满意度评价。结果:成功建立了患者参与的前牙美学修复数字化设计和效果预测流程,并用数字化技术制作出患者满意的前牙修复体。实验组患者对于数字化修复方式的接受率为100%。实验组与对照组的修复体经过未参与实验的医师盲评,在外形准确性、边缘密合性以及表面光滑性上差异均无统计学意义(P>0.05)。实验组患者对修复体及修复后面部整体外观的满意度明显高于对照组(P<0.05),且实验组修复体初戴时每单位修复体调改时间较对照组明显缩短(P<0.01)。结论:患者参与的前牙美学修复的数字化设计、预测和制作方法可行,此方法有助于缩短修复体初戴时间并能够提高患者对修复效果的满意度。

Objective： To explore a new method of patient-involved digital design, esthetic outcome prediction and fabrication for the esthetic rehabilitation of anterior teeth, and to provide an alternative choice for the restoration of anterior teeth. Methods： In this study, 32 patients with esthetic problems in their anterior teeth were included and divided into two groups randomly： the experimental group （16 pa- tients） and control group （16 patients）. In the experimental group, the dentition and facial images were obtained by intra-oral scanning and three-dimensional （3 D） facial scanning and then calibrated. The de- sign of the rehabilitation and the esthetic outcome prediction were created by computer-aided design （CAD） software. After morphologic modification according to the patients＇ opinions, prostheses were fabricated according to the final design by computer-aided manufacturing （CAM） equipment. As for the control group, the regular design method was applied to restore their anterior teeth. The time consuming in the first insertion of each restoration in both groups was recorded. The quality of the prostheses was as- sessed by another prosthedontist. The satisfaction to prostheses and the facial appearance were evaluated by the patients. Results： The process of the patient-involved digital design and outcome anticipation was successfully established. The patients were satisfied with the esthetic effects of the anterior restoration made by the digital technique. The acceptance rate of the patients on the digital rehabilitation in the ex- perimental group was 100%. There was no significant difference of the quality of the prostheses between the two groups. The satisfaction rate of the patients on prostheses and facial appearance was significantly higher in the experimental group than in the control group （P 〈 0.05 ）. In addition, the time consuming in the first insertion of the experimental group was much shorter than that in the control group （P 〈 0.01 ）. Conclusion： The new method of the patient-involved digital design, esthetic outcome prediction and fabrication for the esthetic rehabilitation of anterior teeth is a practical technique. This method is use- ful in shortening the time consuming of the restoration of anterior teeth and improving the patient satisfac- tion with the esthetic outcome.