三维打印个性化钛网联合引导骨再生术修复牙槽骨缺损的临床初探

Preliminary application assessment of individualized three-dimensional printing titanium mesh combined with guided bone regeneration for repairing alveolar bone defects

目的初步评价三维打印个性化钛网联合引导骨再生术修复牙槽骨缺损的临床效果。方法选择2018年1月至6月于重庆医科大学附属口腔医院种植科就诊的6例牙槽骨缺损患者(男性4例,女性2例,年龄18~27岁,平均23.3岁)。根据患者锥形束CT数据,综合种植体周围骨量要求、牙槽骨形态、软组织状况等因素设计个性化钛网并进行三维打印。术中取自体骨与骨替代材料混合,联合个性化钛网进行骨增量。所有患者术后1、3、6个月复查,观察是否出现钛网暴露等并发症;术后6~9个月评估骨增量效果:将钛网取出后锥形束CT与术前锥形束CT对比,测量增加的骨高度与骨宽度并计算骨增量体积。结果术后1周2例患者出现钛网暴露,术区均未出现明显感染,无提前取出钛网的病例。6例患者骨宽度增加1.75~7.54mm(平均3.58mm),骨高度增加0.91~11.80mm(平均3.37mm),骨增量体积为247~676mm^3(平均503mm^3),术后6~9个月恢复的牙槽骨骨量利于后期种植体植入。结论个性化钛网联合引导骨再生术可修复牙槽骨缺损,临床效果良好,但还需进一步探索更适宜的设计方案以解决或延缓钛网暴露的问题。

Objective To preliminarily evaluate the clinical effect of the three-dimensional (3D) printing individualized titanium mesh combined with guided bone regeneration technology for repairing alveolar bone defects. Methods Six patients with alveolar bone defects (4 males and 2 females, aged 18-27 years, mean 23.3 years) were selected from the Department of Oral Implantology, Stomatological Hospital of Chongqing Medical University from January to June 2018. The patients′ cone-beam CT (CBCT) data was imported into the digital design software, and the individualized titanium meshes were designed based on the ideal bone mass around the implant, alveolar bone morphology and soft tissue condition. Then, the ".stl" files were output and the meshes were fabricated by 3D printing technology. The individualized titanium meshes combined with the mixture of autogenous bone and bone substitute materials were used to augmentation during operation. All patients were reviewed at 1, 3 and 6 months after surgery to observe the complications and evaluate the effect of bone augmentation. After taking out the titanium mesh, the CBCT was compared with the preoperative CBCT. The increased bone height and bone width were measured and the bone incremental volume was calculated. Results Titanium mesh exposure occurred in 2 patients with no obvious infection, and no early removal. In 6 patients, the bone width increased by 1.75-7.54 mm (mean 3.58 mm), the bone height increased by 0.91-11.80 mm (mean 3.37 mm), and bone incremental volume increased by 247-676 mm^3 (mean 503 mm^3). All of the cases showed sufficiently grafted volume for implant placement. Conclusions The individualized 3D printing titanium meshes combined with guided bone regeneration could repair alveolar bone defects with excellent clinical effect, but a better design needed to be explored in the future to solve or delay the exposure of titanium mesh.