目的探讨空心环钻与数字化手术导板联合应用于制备自体牙移植受植窝洞的有效性及准确性。方法从2022年5—8月就诊于广州医科大学附属口腔医院颌面外科的患者中招募了16例磨牙缺失并接受自体牙移植修复的患者,实验对象采用随机数字表方...目的探讨空心环钻与数字化手术导板联合应用于制备自体牙移植受植窝洞的有效性及准确性。方法从2022年5—8月就诊于广州医科大学附属口腔医院颌面外科的患者中招募了16例磨牙缺失并接受自体牙移植修复的患者,实验对象采用随机数字表方法分为自由手组和导板组,每组8例。导板组用锥形束CT(CBCT)和口内扫描系统进行扫描,将结果导入Mimics 21.0,分析受体部位区域选择供体牙,模拟供体牙的植入以确定植入位置。设计基于空心环钻的数字化导板导向套,并生成数字化导板。自由手组按照常规自体牙移植手术流程,术中采用3D打印供牙模型试植,自由手预备窝洞。术后对患者重新进行CBCT扫描,使用Geomagic Control X匹配并对术前设计牙齿位置与术后实际牙齿位置进行比较。结果自体牙移植术后1年的随访中,两组的移植牙均成功愈合。导板组备洞时间为(323±50)s,自由手组为(522±91)s,两者相比差异有统计学意义(t=5.394,P<0.001)。导板组3D供牙试植次数(2.9±0.8)次,自由手组3D供牙试植次数(4.1±1.2)次,两者相比差异有统计学意义(t=2.357,P=0.034)。导板组术前术后牙齿的三维位置对比分析,显示牙体长轴的角度偏差为(9.0±5.5)°,3D偏差显示牙齿中心点的偏差为(1.0±0.6)mm,根尖偏差为(2.1±1.1)mm,移植牙相对于术前设计牙齿位置偏差较小。结论通过使用新方法,自体牙移植备洞时间缩短,过程可靠精确,深度可控,备洞流程简化,备洞过程中空心环钻取出骨块可用于自体牙移植牙槽骨缺损的骨移植,自体骨愈合效果好,节约成本。展开更多
Purpose: To describe a surgical technique using an artificial anterior chamber to facilitate harvest of Descemet’ s membrane (DM) and endothelium for corneal endothelial cell transplantation. Design: Laboratory inves...Purpose: To describe a surgical technique using an artificial anterior chamber to facilitate harvest of Descemet’ s membrane (DM) and endothelium for corneal endothelial cell transplantation. Design: Laboratory investigation. Methods: Corneoscleral buttons of seven human donor eyesweremounted endothelial side up on an artificial anterior chamber. Keeping the endothelial side with its usual concavity, a manual trephination was made on the posterior surface with a 9.0- mm trephine, inside the Schwalbe line and just past the DM in depth. The chamber was filled with air, causing the endothelial side of the donor cornea to assume a convex configuration. The DM along with its endothelium was separated from the posterior stroma using a blunt cyclodialysis spatula. Drops of trypan blue 0.3% and alizarin red S 0.2% (n=6) were applied. The stained DMs were examined under a light microscope and photographed to calculate the percentage of endothelial cell damage. Histology was done on the unstained cornea. Results: The DM carrying endothelium was successfully removed from the posterior stroma in all seven eyes. Although the DM appears to be very friable, all samples were removed in toto without rupture. Vital staining showed amean endothelial cell loss of 8.46% (standard deviation (SD) 6.9). Direct light microscopy demonstrated the preservation of endothelial cell morphology. Conclusions: This technique appears to be a safe and straight for wardmethod to harvest DM for endothelial cell transplantation. Further studies are underway to determine the optimal method of insertion of the obtained healthy DM with endothelial cells through small corneal incisions.展开更多
文摘目的探讨空心环钻与数字化手术导板联合应用于制备自体牙移植受植窝洞的有效性及准确性。方法从2022年5—8月就诊于广州医科大学附属口腔医院颌面外科的患者中招募了16例磨牙缺失并接受自体牙移植修复的患者,实验对象采用随机数字表方法分为自由手组和导板组,每组8例。导板组用锥形束CT(CBCT)和口内扫描系统进行扫描,将结果导入Mimics 21.0,分析受体部位区域选择供体牙,模拟供体牙的植入以确定植入位置。设计基于空心环钻的数字化导板导向套,并生成数字化导板。自由手组按照常规自体牙移植手术流程,术中采用3D打印供牙模型试植,自由手预备窝洞。术后对患者重新进行CBCT扫描,使用Geomagic Control X匹配并对术前设计牙齿位置与术后实际牙齿位置进行比较。结果自体牙移植术后1年的随访中,两组的移植牙均成功愈合。导板组备洞时间为(323±50)s,自由手组为(522±91)s,两者相比差异有统计学意义(t=5.394,P<0.001)。导板组3D供牙试植次数(2.9±0.8)次,自由手组3D供牙试植次数(4.1±1.2)次,两者相比差异有统计学意义(t=2.357,P=0.034)。导板组术前术后牙齿的三维位置对比分析,显示牙体长轴的角度偏差为(9.0±5.5)°,3D偏差显示牙齿中心点的偏差为(1.0±0.6)mm,根尖偏差为(2.1±1.1)mm,移植牙相对于术前设计牙齿位置偏差较小。结论通过使用新方法,自体牙移植备洞时间缩短,过程可靠精确,深度可控,备洞流程简化,备洞过程中空心环钻取出骨块可用于自体牙移植牙槽骨缺损的骨移植,自体骨愈合效果好,节约成本。
文摘Purpose: To describe a surgical technique using an artificial anterior chamber to facilitate harvest of Descemet’ s membrane (DM) and endothelium for corneal endothelial cell transplantation. Design: Laboratory investigation. Methods: Corneoscleral buttons of seven human donor eyesweremounted endothelial side up on an artificial anterior chamber. Keeping the endothelial side with its usual concavity, a manual trephination was made on the posterior surface with a 9.0- mm trephine, inside the Schwalbe line and just past the DM in depth. The chamber was filled with air, causing the endothelial side of the donor cornea to assume a convex configuration. The DM along with its endothelium was separated from the posterior stroma using a blunt cyclodialysis spatula. Drops of trypan blue 0.3% and alizarin red S 0.2% (n=6) were applied. The stained DMs were examined under a light microscope and photographed to calculate the percentage of endothelial cell damage. Histology was done on the unstained cornea. Results: The DM carrying endothelium was successfully removed from the posterior stroma in all seven eyes. Although the DM appears to be very friable, all samples were removed in toto without rupture. Vital staining showed amean endothelial cell loss of 8.46% (standard deviation (SD) 6.9). Direct light microscopy demonstrated the preservation of endothelial cell morphology. Conclusions: This technique appears to be a safe and straight for wardmethod to harvest DM for endothelial cell transplantation. Further studies are underway to determine the optimal method of insertion of the obtained healthy DM with endothelial cells through small corneal incisions.
