三维数字化仿真设计与实现技术在前牙美学修复中的应用

Application of three-dimensional digital simulated design and implementation in esthetic rehabilitation

目的探索三维数字化仿真设计与实现技术在前牙美学修复中的应用路线,评价其临床应用效果。方法选择2017年12月至2019年6月于北京大学口腔医学院·口腔医院修复科就诊、需行前牙美学修复的患者30例,应用随机数表法随机分为两组,每组15例。试验组男性4例,女性11例,年龄(36.0±10.5)岁;对照组男性6例,女性9例,年龄(32.0±6.7)岁。试验组采用三维数字化仿真设计技术进行修复效果的术前三维数字化仿真预测,并根据患者意见修改修复体形态,患者对预测效果满意后,用数字化技术复制修复体形态设计至最终修复体,并用数控切削技术制作全瓷修复体。对照组采用二维数字化设计进行修复效果预测,技师参考二维预测图片,雕刻修复体蜡型并用热压铸技术制作全瓷修复体。患者采用视觉模拟评分法(visual analogue scales,VAS)对数字化设计效果的仿真度、数字化设计效果与实际修复效果的相似度进行评分,并对修复体进行患者满意度分级评价;由1名不知患者分组情况且具有高级职称的口腔修复医师参考改良美国公共健康服务标准,对两组修复体质量进行评价。结果成功建立前牙美学修复三维数字化仿真设计和实现技术流程。试验组患者对数字化设计效果仿真度的VAS评分[(8.5±0.5)分]显著高于对照组[(7.2±0.7)分](P<0.01),对数字化设计效果与实际修复效果相似度的VAS评分[(9.6±0.3)分]显著高于对照组[(7.0±0.9)分](P<0.01)。试验组修复体患者满意度分级显著好于对照组(P<0.05)。两组修复体质量在外形准确性、边缘密合性和表面光滑性上的医师评价差异均无统计学意义(P>0.05)。结论在前牙美学修复中应用三维数字化仿真设计和实现技术,可在术前进行三维数字化仿真设计和修复效果预测,设计效果可精准转移至最终修复体,能有效促进医患交流,提高患者对美学修复效果的满意度。

Objective To explore and evaluate a three-dimensional(3D)digital simulated design and implementation technique in esthetic rehabilitation.Methods Thirty patients with esthetic deficiency,who came to the Department of Prosthodontics,Peking University School and Hospital of Stomatology from December 2017 to July 2019,were recruited and randomly assigned into 2 groups.Four males and 11 females which were(36.0±10.5)years old in the experimental group,6 males and 9 females which were(32.0±6.7)years old in the control group,were enrolled.In the experimental group,3D digital simulated design was used to predict the post-treatment effect;and the final restorations were designed duplicating from the pre-treatment digital design confirmed by the patient and milled.In the control group,the final restorations were manufactured by the dental technician according to the design of two-dimensional(2D)digital smile design.The simulation degree of digital design and the similarity between preoperative design and postoperative rehabilitation were scored by the patients with visual analogue scales(VAS)in both groups;and the satisfaction rate to the restorations was evaluated by the patients.The quality of the restorations was accessed by a prosthodontist who did not know the grouping of patients according to the modified criteria of United States Public Health Service(USPHS).Results Three-dimensional digital simulated design and implementation technique was successfully established.The VAS score on the simulation degree of digital design in the experimental group(8.5±0.5)was higher than that in the control group(7.2±0.7)(P<0.01);the VAS score on the similarity between preoperative design and postoperative rehabilitation in the experimental group(9.6±0.3)was higher than that in the control group(7.0±0.9)(P<0.01).The satisfaction rate of the patients to the restorations was significantly higher in the experimental group than in the control group(P<0.05).There was no significant difference of the quality of the restorations between the two groups on the anatomic form,the marginal adaption and the surface quality(P>0.05).Conclusions Three-dimensional digital simulated design and implementation technique can help achieving 3D digital simulated design before treatment and duplication to the final restorations,and can improve the patients′satisfaction in esthetic rehabilitation.