三维打印个性化钛网在美学区牙槽骨缺损骨增量中应用的效果评估

Assessment of the clinical effect regarding three-dimensional printing individualized titanium mesh for bone augmentation in the esthetic area

目的对三维打印个性化钛网在美学区骨增量中的临床应用效果进行评价。方法选择2018年1月至2020年6月于重庆医科大学附属口腔医院种植科行个性化钛网骨增量治疗的患者43例,男性21例,女性22例,年龄(30.1±5.8)岁。根据患者术前锥形束CT数据,将43例患者按骨缺损类型分为水平骨缺损(14例)、垂直骨缺损(15例)及水平-垂直联合骨缺损(14例)3组。综合患者骨量及美学要求设计个性化钛网并进行三维打印。术中以1∶1比例混合自体骨与异种骨颗粒,联合可注射富血小板纤维蛋白及个性化钛网进行骨增量手术。所有患者于术后1、3、6个月复查,观察是否出现钛网暴露;术后6个月评估骨增量效果;种植体植入并修复后评估患者粉白美学指数。结果术后仅1例患者出现钛网早期暴露,未见明显感染。与术前相比,各组患者术后即刻骨量均显著高于术前[术前水平骨缺损组骨宽度、垂直骨缺损组骨高度、水平-垂直联合骨缺损组骨宽度和骨高度分别为(3.27±0.13)、(17.41±0.46)、(3.76±0.24)、(14.37±0.89) mm;术后即刻分别为(5.25±0.15)、(26.10±0.55)、(6.35±0.29)、(22.52±0.90) mm,P<0.01];与术后即刻相比,术后6个月未见明显骨吸收[分别为(5.14±0.14)、(25.67±0.52)、(6.13±0.26)、(22.35±0.89) mm,P>0.05]。3组患者粉白美学指数评分均较高。结论个性化钛网修复美学区骨缺损效果显著,种植修复后可获得优异的美学效果。

Objective To evaluate the clinical effect of three-dimensional(3D)printing individualized titanium mesh for ridge augmentation in the esthetic zone.Methods Forty-three patients were treated with personalized titanium mesh bone augmentation from Department of Oral Implantology,Stomatological Hospital of Chongqing Medical University from January,2018 to June,2020.According to the preoperative cone-beam CT(CBCT)data,the 43 patients[male:21,female:22,aged(30.1±5.8)years]were divided into three groups according to the Seibert classification as horizontal,vertical and horizontal-vertical classes(sample size:14,15,14).Then,comprehensively the bone mass and esthetic requirements were taken into account to design and accordingly fabricate the 3D printing individualized titanium mesh.During the surgical process,autologous bone and xenogeneic bone substitutes were mixed at a 1∶1 ratio,combined with injectable platelet-rich fibrin(i-PRF)and individualized titanium mesh for ridge augmentation.All patients were recalled at 1,3,and 6 months post-operation to observe the mesh exposure;the clinical effect of ridge augmentation was evaluated 6 months post-operation.After the implant placement and final restoration,the pink esthetic score(PES)/white esthetic score(WES)were evaluated.Results Only one patient experienced early mesh exposure,and no obvious infection was observed.The bone gain regarding three types of bone defects was significantly higher immediately post-operation compared to pre-operation(horizontal,vertical and horizontal-vertical bone defect measured as(3.27±0.13),(17.41±0.46),(3.76±0.24),(14.37±0.89)mm pre-operation,respectively;and(5.25±0.15),(26.10±0.55),(6.35±0.29),(22.52±0.90)mm immediately post-operation,P<0.01).There was no obvious bone resorption 6 months post-operation[outcomes for horizontal,vertical and horizontal-vertical bone defect measured as(5.14±0.14),(25.67±0.52),(6.13±0.26),(22.35±0.89)mm,P>0.05].The PES/WES scores of all patients were interpreted as"excellent".Conclusions The 3D printing individualized titanium mesh is effective in repairing bone defects in the esthetic zone,and produces credible esthetic outcomes after implantation and final restoration.