口腔内扫描和三维打印在可摘局部义齿制造中的应用

Application of intraoral scanning and 3D printing in the manufacture of removable partial dentures

背景:在国内可摘局部义齿制备中尚无成熟的计算机辅助设计与制造系统,也无大样本的病例应用报道,现有研究多数只观察了少数病例的试戴效果,临床数据尚需积累和丰实。目的:探讨口腔内扫描和三维打印在可摘局部义齿制造中的应用价值。方法:选择上海交通大学医学院附属第九人民医院2014年6至12月收治的63例KennedyⅠ类牙列缺损患者,其中男29例,女34例,年龄44-63岁,研究组23例采用口腔内扫描和三维打印方式制备义齿支架,对照组40例采用传统印模方式制备义齿支架。对比两组试戴效果;修复前及修复后6,12,24个月,对比两组咀嚼效率;末次随访时,对比两组患者满意度及并发症发生情况。试验获得上海交通大学医学院附属第九人民医院委员会批准(批准号:TJBDYY-2014-13-R1,批准时间:2014年3月)。结果与结论:(1)试戴后,研究组适合性、固位性和稳定性均高于对照组(适合性:96%,70%;固位性:83%,58%;稳定性:83%,53%,P均<0.05);(2)修复前与修复后6个月,两组间咀嚼效率比较差异无显著性意义(P>0.05);修复后12,24个月,研究组咀嚼效率高于对照组(P<0.05);(3)研究组患者舒适满意度高于对照组(82%,50%,P<0.05),美观和发音功能满意度与对照组比较差异无显著性意义(美观满意度:70%,53%;发音功能满意度:65%,40%,P>0.05);(4)研究组基牙牙周病发生率、义齿性口腔炎发生率及继发性龋病发生率与对照组比较差异均无显著性意义(基牙牙周病发生率:0,5%;义齿性口腔炎发生率:4%,5%;继发性龋病发生率:9%,18%,P>0.05);(5)结果表明,口腔内扫描和三维打印可获得较传统印模方式更加准确、稳定的支架模型,具有较高的临床应用价值。

BACKGROUND: There is no mature computer-aided design and manufacturing system for the preparation of removable partial denture in China so far. There is no report involving large sample size. Most of the existing studies only investigated the wear effect of a few cases, and there is a need to accumulate and enrich clinical data. OBJECTIVE: To explore the application value of intraoral scanning and 3D printing in the manufacture of removable partial dentures for patients. METHODS: Sixty-three patients with Kennedy class I dentition defect who received treatment in the Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, China were included in this study. These p atients consisted of 29 males and 34 females and were aged 44-63 years. In the study group, 23 patients were treated with denture scaffolds by intraoral scanning and three-dimensional printing, while in the control group, 40 patients were treated with denture scaffolds by traditional impression. The wear effect was compared between two groups after repair. The masticatory efficiency was compared between two groups before and 6, 12 and 24 months af ter repair. At the last follow-up, patients’ satisfaction and complications were compared between the study and control groups. This study was approved by Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine(approval No. TJBDYY-2014-13-R1) in March, 2014. RESULTS AND CONCLUSION: The fitness(96% vs. 70%), retention(83% vs. 58%) and stability index(83% vs. 53%) of the study group were significantly higher than those of the control group(all P<0.05). There was no significant difference in masticatory efficiency between before and 6 months after repair(P>0.05). At 12 and 24 months after repair, the masticatory efficiency in the study group was significantly higher than that in the control group(P<0.05). Patients’ comfort satisfaction in the study group was significantly higher than that in the control group(82% vs. 50%, P<0.05). There were no significant differences in aesthetic appearance(70% vs. 53%) and pronunciation function satisfaction(65% vs. 40%) between study and control groups. During the follow-up, there were no statistically significant differences in the incidences of periodontal disease(0 vs. 5%), denture stomatitis(4% vs. 5%) and secondary caries(9% vs. 18%) between groups(P>0.05). These results suggest that intraoral scanning and 3D printing could obtain a more accurate stent model in the manufacture of partial dentures compared with traditional impression, thereby has a higher application value.