3D打印个性化钛网引导种植区骨再生的临床并发症研究

Clinical study on complications of bone regeneration guided by 3D printed personalized titanium mesh in implanting area

目的基于3D打印个性化钛网技术,探讨一种改良式引导骨再生技术对降低骨愈合期并发症发生率的效果评价。方法选择2019年9月—2021年7月于大连医科大学附属第一医院口腔科就诊,种植区剩余牙槽骨量严重不足的9例患者(9个植骨区域,24个缺牙位点),年龄(45.6±8.0)岁,所有患者术前以修复和生物学为导向,模拟植入种植体,并设计和3D打印制作个性化钛网。术中在个性化钛网的轮廓基础之上将植骨材料进行1 mm的过量充填,表面覆盖可吸收性胶原膜以固定植骨材料,完成9例患者的引导骨再生手术。观察9例患者术后愈合期植骨部位是否有切口裂开、钛网暴露、周围软组织感染以及“假骨膜”的形成。结果①1例患者术后出现暂时性颏部皮肤麻木,6个月时缓解,9个月时麻木感基本消失;②术后14 d,2例患者在拆线时创缘裂开约2 mm,仅有可吸收性胶原膜暴露,无钛网暴露及感染,术后1个月复诊时软组织愈合;③在术后1~9个月随访中,所有患者均未见软组织裂开、钛网暴露及感染等并发症发生;④拆除钛网后所有移植骨表面未见明显纤维结缔组织即“假骨膜”的形成。结论应用3D打印个性化钛网技术引导种植区骨再生时,采用一种过量骨粉植入联合可吸收性胶原膜的覆盖,能双重隔离钛网与黏膜的直接接触,可以有效减少切口裂开、钛网暴露以及感染等并发症。

Objective To evaluate the effect of a modified guided bone regeneration technique on reducing the incidence of complications during bone healing based on 3D printing personalized titanium mesh technology.Methods From September 2019 to July 2021,9 patients aged 45.6±8.0 with severe residual alveolar bone deficiency(9 bone graft areas and 24 denture sites)were enrolled in the Department of Stomatology,the First Affiliated Hospital of Dalian Medical University.Implants were simulated in the software guided by prosthetics and biology,then the personalized titanium mesh was designed and manufactured by 3D printing.Intraoperatively,the bone graft material was overfilled with 1 mm based on the profile of the personalized titanium mesh,and then the absorbable collagen membrane was covered on the surface to fix the bone graft material.Guided bone regeneration surgery was completed for 9 patients.During postoperative healing,9 patients were observed for incision dehiscing,titanium mesh exposure,surrounding soft tissue infection and the formation of“pseudoperiosteum”at the bone graft site.Results ①Temporary skin numbness in mental region occurred in 1 of 9 patients,which was relieved at the 6^(th) month and almost disappeared at the 9^(th) month.②14 days after surgery,two patients were found to have wound edge dehashes of about 2 mm during suture removal,and only absorbable collagen membrane was exposed,but titanium mesh was not exposed,and no infection occurred.The soft tissue healed at the follow-up visit 1 month after surgery.③During the follow-up of 1 to 9 months after surgery,no complications such as soft tissue dehiscing,titanium mesh exposure and infection were observed in all patients.④No obvious formation of fibrous connective tissue,namely“pseudoperiosteum”,was observed on the surface of all grafts after the titanium mesh was removed.Conclusion In the application of 3D printed personalized titanium mesh technology to guide bone regeneration,an excessive bone graft implantation combined with absorbable collagen membrane covering can double isolate the direct contact between titanium mesh and mucous membrane,and can effectively reduce complications such as incision dehashes,titanium mesh exposure and infection.