激光熔融数字化导板技术辅助钙化根管的治疗

Guided endodontic access of calcified root canal by laser melting templates

目的利用激光熔融数字化导板技术获得钙化根管治疗的新方法,并评估其准确性。方法采用激光熔融数字化导板技术辅助2例前牙钙化根管的治疗。术前使用锥形束CT(CBCT)扫描患者上颌牙,建立三维牙体硬组织根管系统模型;制取患者上颌印模,三维扫描仪扫描模型,整合CBCT及三维扫描数据,通过Mimics 19.0及3-matic 11.0软件设计开髓路径,使用钴铬合金激光熔融法打印导板,在根管导板引导下开髓及打通钙化段根管,完成根管治疗。测量术前开髓设计路径和术后实际路径的位置和角度偏差。结果2例患牙均获得较好的治疗效果。病例1的开髓角度偏差为1.77°,钻基底偏差为0.403~0.497 mm,钻尖端偏差为0.433~0.537 mm。病例2的角度偏差为3.26°,钻基底偏差为0.183~0.347 mm,钻尖端偏差为0.310~0.463 mm。结论钴铬合金激光熔融根管导板辅助建立根管通道是治疗钙化根管的有效方法,可作为钙化根管治疗的新策略。

Objective The aim of this study is to treat calcified root canal and assess the accuracy of guided endodontics using laser melting templates.Methods Two cases with calcified anterior teeth were treated with laser melting templates.Cone beam computed tomography(CBCT)was used to scan the maxillary teeth of patients before surgery to establish the root canal system model.The maxillary impression of the patient was made and it was scanned by a 3D scanner.The CBCT scans were matched with surface scans of plaster model.Mimics 19.0 and 3-matic 11.0 software were used to design the virtual planning to access cavities.The templates were produced by laser melting 3D printing.Access cavity was prepared under the guidance of laser melting template.Then the deviations of planned and prepared cavities in three dimensions and angle were measured.Results The two teeth obtained satisfactory results.The first case had a angle deviation of 1.77°,a drilling base deviation of 0.403-0.497 mm,and a tip of 0.433-0.537 mm.The second case had a angle deviation of 3.26°,a drill base deviation of 0.18-0.347 mm,and a tip of 0.310-0.463 mm.Conclusion Laser melting template-guided endodontics is an effective technique for the treatment of calcified root canal and can be used as a new strategy for the treatment of calcified canal.