三维打印个性化托盘在唇腭裂新生儿术前鼻牙槽塑形治疗取模中的应用研究

Application study of three-dimensional printing individualized tray in impression taken of presurgical nasoalveolar molding for newborn with cleft lip and palate

目的探讨三维(3D)打印个性化托盘在唇腭裂新生儿术前鼻牙槽塑形治疗(PNAM)取模中的应用效果。方法回顾性分析2015年6月至2020年12月中国医科大学附属口腔医院收治的唇腭裂患儿临床资料,根据托盘的制备方法分为传统托盘组和3D打印个性化托盘组。通过3D打印个性化托盘取印模,与调改传统托盘所取印模进行对比,包括:(1)印模缺陷(直径>1 mm的气泡及托盘暴露)数目;(2)印模质量,分为优(1分)、良(2分)、合格(3分)、不合格(4分);(3)印模完整性和清晰度,由3名高年资正畸医生采用视觉模拟评分法(VAS)进行评价。采用SPSS 23.0软件进行统计学分析,数据以M(Q1,Q3)表示,组间比较采用秩和检验。结果共纳入22例患儿,其中传统托盘组7例,男3例,女4例,出生后3~28 d;3D打印个性化托盘组15例,男10例,女5例,出生后4~26 d。所有患儿在进行唇裂修复术前结束治疗,其中传统托盘组平均治疗时间131 d,3D打印个性化托盘组为137 d。(1)印模缺陷数目:传统托盘组印模存在较多的气泡及托盘暴露,缺陷数目为6(5,7)个,3D打印个性化托盘组印模缺陷数目[2(1,2)个]明显减少(P<0.05)。(2)印模质量:传统托盘组印模质量以合格为主,评分为3(2,3)分,3D打印个性化托盘组印模质量以良为主,评分为2(2,2)分(P<0.01)。(3)印模完整性:3D打印托盘组印模完整性整体评价VAS评分明显好于传统托盘组(P<0.05);分项评价表明除前庭沟外,3D打印托盘组其他部位完整性均明显好于传统托盘组(P<0.05或P<0.01)。印模清晰度:3D打印托盘组印模清晰度整体评价VAS评分明显高于传统托盘组(P<0.01);分项评价项目中除上唇系带外,其他各方面比较差异均有统计学意义(P<0.05或P<0.01)。结论3D打印个性化托盘所取印模质量更好、完整性和清晰度更高。

Objective To study the application of three-dimensional(3D)printed individualized tray in impression taken of presurgical nasoalveolar molding(PNAM)for newborn with cleft and palate.Methods The newborns with unilateral/bilateral cleft lip and palate treated with PNAM during 2015 to 2020 in School and Hospital of Stomatology,China Medical University,were chosen.Their clinical materials were retrospectively analyzed.Maxillary impressions taken by 3D printed individualized trays were compared with those taken by modified traditional tray.The indexes were evaluated including the numbers of defects(bubbles with diameter>1 mm and exposure of tray)in each impression;the impression quality grade(perfect 1,good 2,qualified 3 and unqualified 4),and the integrity and legibility of impressions[evaluated by 3 orthodontists using visual analog scale(VAS)].The date was analyzed by SPSS 23.0.Rank-sum test was used for comparison between groups.Results A total of 22 patients were included.There were 7 patients(3 males,4 females,3-28 days old)in modified traditional tray group and 15 patients(10 males,5 females,4-26 days old)in 3D printed individualized trays group.All patients finished the PNAM treatment before repairment of cleft lip.The average treatment duration were 136 days with 131 days in modified traditional tray group and 137 days in 3D printed individualized trays group.(1)The impressions made by conventional method had more defects[6(5,7)]than those made by 3D printed individualized trays[2(1,2)](P<0.05).(2)The impression taken by modified traditional tray was mainly qualified[3(2,3)scores]and that taken by 3D printed individualized tray exhibited higher grade[good,2(2,2)scores](P<0.01).(3)Compared with modified traditional tray group,the scores of VAS on integrity of impression taken by 3D printed individualized tray were significantly high(P<0.05).Itemized evaluation showed that the integrity scores on all positions except vestibular sulcus had significant difference between groups(P<0.05 or P<0.01).The scores of VAS on legibility of impression taken by 3D printed individualized tray were significantly higher than those taken by modified traditional tray(P<0.05).As for itemized evaluation,legibility scores on all positions except upper frenum had significant difference between groups(P<0.05 or P<0.01).Conclusions The impression taken by 3D printing individualized tray has higher quality,integrity and legibility.