数字化修复结合牙周手术解决复杂前牙美学缺陷

Diagnossis and treatment of complicated anterior teeth esthetic defects by combination of whole-process digital esthetic rehabilitation with periodontic surgery

目的:针对伴有牙周软组织形态不良的复杂前牙美学缺陷病例,探索一种全程数字化修复的治疗流程,为解决复杂前牙美学诊疗问题提供新思路。方法:选取复杂前牙美学缺陷的患者12例,通过口内和面部三维扫描获取牙列和面部三维数据并进行配准,在计算机辅助设计(computer-aided design,CAD)软件中进行两种美学设计(仅考虑"白色美学"、综合考虑"粉白美学"),结合数码摄影得到相应的彩色三维数字化修复效果模拟图。以患者评分为标准评价两种美学设计,并由患者自主选择,针对选择后一种设计的患者,三维打印其诊断模型并制作导板指导牙周手术,后续采用数字化方法完成前牙美学修复。结果:患者针对基于口内和面部三维扫描及数码摄影的两种数字化美学设计进行评价,综合考虑"粉白美学"设计的患者满意度更高(P<0.05),且更多患者(66.7%)选择牙周手术改善软组织形态后再行修复;将该设计通过三维打印制作诊断模型及导板指导牙周手术,实现了数字化设计向最终手术效果的转移;后续数字化方法制作最终修复体,实现全程数字化。结论:通过数字化美学分析和设计,修复效果预测,三维打印诊断模型制作导板指导牙周手术,并用数字化方法完成前牙美学修复诊疗流程的方法可行,临床显著提高医生、患者、技师相互间的沟通效率,体现了多学科联合治疗复杂前牙美学诊疗问题的优势。

Objective： To explore a new method of whole-process digital esthetic prosthodontic rehabilitation combined with periodontic surgery for complicated anterior teeth esthetic defects accompanied by soft tissue morphology,to provide an alternative choice for solving this problem under the guidance of three-dimensional（ 3D） printing digital dental model and surgical guide,thus completing periodontic surgery and digital esthetic rehabilitation of anterior teeth. Methods： In this study,12 patients with complicated esthetic problems accompanied by soft tissue morphology in their anterior teeth were included. The dentition and facial images were obtained by intra-oral scanning and three-dimensional（ 3D） facial scanning and then calibrated. Two esthetic designs and prosthodontic outcome predictions were created by computer aided design/computer aided manufacturing（ CAD/CAM） software combined with digital photography,including consideration of white esthetics and comprehensive consideration of pink-white esthetics. The predictive design of prostheses and the facial appearances of the two designs were evaluated by the patients. If the patients chose the design of comprehensive consideration of pink-white esthetics,they would choose whether they would receive periodontic surgery before esthetic rehabilitation. The dentition design cast of those who chose periodontic surgery would be 3D printed for the guide of periodontic surgery accordingly. Results： In light of the two digital designs based on intra-oral scanning,facing scanning and digital photography,the satisfaction rate of the patients was significantly higher for the comprehensive consideration of pink-white esthetic design（ P 〈0. 05） and more patients tended to choose priodontic surgery before esthetic rehabilitation. The 3D printed digital dental model and surgical guide provided significant instructions for periodontic surgery,and achieved success transfer from digital design to clinical application. The prostheses were fabricated by CAD/CAM,thus realizing the whole-process digital esthetic rehabilitation. Conclusion： The new method for esthetic rehabilitation of complicated anterior teeth esthetic defects accompanied by soft tissue morphology,including patient-involved digital esthetic analysis,design,esthetic outcome prediction,3D printing surgical guide for periodontic surgery and digital fabrication is a practical technology. This method is useful for improvement of clinical communication efficiency between doctor-patient,doctor-technician and doctors from different departments,and is conducive to multidisciplinary treatment of this complicated anterior teeth esthetic problem.