数字化设计与3D打印在自体牙移植术的应用

Application of digital design combined with 3D⁃printing technologies in dental autotransplantation

目的探讨术前数字化设计结合3D打印供体牙模型及受区牙槽窝模型辅助自体牙移植术的效果。方法收集12例因牙折或牙槽骨广泛吸收而无法保留的第一或第二磨牙,将其锥形束CT数据导入Mim⁃ics数字化设计软件中,选取匹配度最高的第三磨牙作为供体牙,3D打印出供体牙及受区牙槽窝模型进行术前模拟移植术。术中在供体牙模型引导下进行受区牙槽窝及供体牙的预备,将供体牙移植于受区。术后3、6、12个月复查锥形束CT评估骨重建及牙周膜状况。结果12例患者均选择根尖孔已完全闭合的第三磨牙作为供体牙即刻移植于磨牙区。7例受区牙槽窝术前存在感染,其中1例因受区患牙感染致牙槽骨广泛吸收。12例手术短期恢复良好,均完成12个月以上随访,其中11例移植牙成功,能正常行使咀嚼功能,1例在术后14个月时出现牙根吸收。结论数字化设计结合3D打印技术能够辅助匹配最合适的供体牙,术前完成受区牙槽窝精准预备,减少供体牙在体外的暴露时间和移植到牙槽窝内的试放次数,有助于自体牙移植成功。

Objective To evaluate the therapeutic effect of dental autotransplantation with the application of digital design combined with 3D printing of donor tooth models and recipient alveolar fossa model preoperatively.Methods Twelve cases that could not be retained due to tooth fracture or extensive absorption of alveolar bone were recruited in the study.Cone⁃beam computed tomography(CBCT)data were imported into Mimics software for digital design,and the best⁃matched third molar was selected as the donor tooth.Replicas of the donor teeth and the recipient socket were printed out with three⁃dimensional(3D)printing technologies as a simulation model for recipient tooth socket prepara⁃tion.During tooth autotransplantation,preparation of the recipient tooth socket and the donor tooth were guided by the 3D⁃printed replicas sequentially.Then,the donor tooth was implanted into the recipient tooth pocket.Patients were fol⁃lowed up at 3,6 and 12 months after the operation,with CBCT examination to evaluate the status of bone reconstruction and periodontal ligaments at each time point.Results Twelve patients were transplanted with an autogenous third mo⁃lar with the apical foramen completely closed.Among them,7 patients had alveolar fossa infection before the operation of which 1 had extensive resorption of the alveolar bone due to the infection.All 12 patients recovered well after the op⁃eration and were followed up for at least 12 months.In total,11 caseswere successful in tooth autotransplantation with normal mastication,and 1 case had root resorption 14 months postoperation.Conclusion Digital design combined with 3D printing technology can assistin the selection of thebest⁃matched donor tooth and preparation of the recipient socket before tooth transplantation proceduresand reduce the extra⁃alveolar exposure time of the donor tooth and num⁃ber of trial placementsintothe alveolar fossa.Thus,this combined strategy can effectively improve the outcome of dental autotransplantation.