张口受限患者的数字化修复1例及文献回顾

Digital repair for a patient with limited mouth opening:a case report and literature review

目的探讨因系统性硬皮病导致的特殊张口受限(小口畸形)患者取模困难时准确得到其口内模型的方法。方法本研究遵循医学伦理,并获得患者知情同意。对1例肯氏Ⅰ类下颌牙列缺损的硬皮病张口受限患者应用以数字化技术为主导,结合传统印模方式的分段印模方案。根据其本身的左、右下颌牙列制作个别托盘后进行分段式取模,同时口内扫描取得上、下颌软硬组织形态数据。在获得各部分模型后,对下颌模型进行扫描和数字对齐,形成最终的牙列模型,并借助CAD/CAM技术设计制作最终的可摘局部义齿,同时结合文献对张口受限患者可摘局部义齿修复诊疗进行回顾分析。结果义齿固位良好,获得了良好的修复效果,患者对该义齿的咀嚼效率等功能行使均满意。文献复习结果表明,数字化技术结合传统印模方法,利用计算机进行拟合可以准确地得到患者口内模型,为后续修复做好基础工作。然而患者下颌牙列前段无牙时该流程误差可能较大,仍需要进一步完善。结论以数字化技术为主导,结合传统印模方式的分段印模方案用于修复张口受限患者的牙列缺损效果良好,患者就医体验、满意度高,值得临床推广。

Objective To explore an accurate method to obtain an intraoral model of patients with specific limited mouth opening(microstomia)due to systemic scleroderma.Methods This study followed medical ethics,and informed consent has been obtained from patients.A case of Ken's Type I mandibular dentition defect scleroderma with limited mouth opening was addressed with digital technology as the leading method combined with the traditional impression method of segmental impression.Individual trays were made based on the patient's left and right mandibular dentition,and segmented molds were obtained.Simultaneously,intraoral scanning was performed to obtain the morphological data of both the soft and hard tissues of the upper and lower mandibles.After each part of the model was obtained,the mandibular model was scanned and digitally aligned to form the final denture model,and the final removable partial denture was designed and made by computer aided design/computer aided manufacturing(CAD/CAM)technology.At the same time,combined with the literature,the diagnosis and treatment of removable partial denture in patients with limited mouth opening were retrospectively analyzed.Results The denture was well retained and achieved a good repair effect.The patients expressed satisfaction with the mastication efficiency and other functions of the denture.The findings of the literature review show that the integration of digital technology with the traditional impression method,along with computer fitting,can accurately obtain the patient's oral model and facilitate successful follow-up repairs.However,when the anterior mandibular dentition of the patient is absent,the margin of error is increased in this procedure,which deserves further exploration.Conclusion Utilizing digital technology as the leading method,combined with the traditional impression method of segmental impression,for the repair of dental defects in patients with limited mouth opening,has proven to be effective.Thus,patients report a positive medical experience with high satisfaction,indicating that this approach is worthy of clinical promotion.