基于三维冠根整合模型在无托槽隐形矫治中的临床疗效研究

doi:10.13591/j.cnki.kqyx.2023.02.006

摘要/Abstract

摘要：

目的通过建立一种冠根融合的三维模型,评估无托槽隐形矫治器在非拔牙病例中前牙区的临床效果,为临床应用提供指导。方法收集2020年12月—2021年12月在徐州市口腔医院正畸科就诊患者11例,利用Maestro 3D Dental Studio排牙软件设计矫治方案,获取患者矫治结束预期三维模型,并通过锥形束CT、口内扫描、三维重建软件建立患者术后模型,在Geomagic Studio 2014中进行牙冠与牙根数据的配准,在3-matic中对比治疗后实际模型与治疗前预测模型前牙的转矩与轴倾度的差异。结果前牙的实际转矩角均小于治疗前的预测角度,其中侧切牙的实现率最高达到了77.55%,中切牙最低为60.70%;前牙的实际轴倾角也同样小于治疗前的预测角度,其中中切牙实现率最高达到了81.49%,尖牙最低为74.95%。结论基于三维重建及口内扫描技术结合的冠根整合数字化模型,在评估隐形矫治器疗效方面具有优势。在隐形矫治非拔牙病例中,前牙区小范围的移动效率较高。

关键词: 数字化模型, 冠根融合, 无托槽隐形矫治, 临床疗效

Abstract:

Objective To evaluate the clinical effect of clear aligners in the anterior region in non-extraction cases by establishing a three-dimensional model of crown-root fusion to guide clinical application. Methods Eleven patients visiting the orthodontic department of Xuzhou Stomatological Hospital from December 2020 to December 2021 were collected, and the orthodontic plan was designed using Maestro 3D Dental Studio scheduling software to obtain the expected three-dimensional model of the patient's orthodontic treatment result. CBCT, intraoral scan, and 3D reconstruction software were used to create a postoperative model of the patient. The crown and root data were aligned in Geomagic Studio 2014, and differences in torque and axial inclination between the actual model after treatment and the predicted model of the anterior teeth before treatment were compared in 3-matic. Results The actual torque angles of the anterior teeth were all smaller than the predicted angles before treatment, with the highest realization rate of 77.55% for lateral incisors and the lowest of 60.70% for central incisors; the actual axial inclination angles of the anterior teeth were also smaller than the predicted angles before treatment, with the highest realization rate of 81.49% for central incisors and the lowest of 74.95% for cuspids. Conclusion A digital model of crown-root integration based on a combination of 3D reconstruction and intraoral scanning techniques is advantageous in assessing the efficacy of clear aligners. In non-extraction cases with clear aligner, the efficiency of movement is higher for small areas of the anterior region.

Key words: digital model, crown-root integration, clear aligner, clinical efficacy

中图分类号:

R783.5

杨锦涛,范典,苏明,单丹妮,郑芃芃,陈红嫣,杨新宇,张良. 基于三维冠根整合模型在无托槽隐形矫治中的临床疗效研究[J]. 口腔医学, 2023, 43(2): 125-129.

YANG Jintao,FAN Dian,SU Ming,SHAN Danni,ZHENG Pengpeng,CHEN Hongyan,YANG Xinyu,ZHANG Liang. Study on clinical efficacy of a 3D model based on crown-root integration in clear aligners[J]. Stomatology, 2023, 43(2): 125-129.

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参考文献 26

[1]	徐小红, 张阳, 张梦男, 等. 成年拔牙患者隐形矫治牙齿移动效率的三维测量分析[J]. 口腔生物医学, 2021, 12(4):252-256.
[2]	Zhou XW, Gan YZ, Xiong J, et al. A method for tooth model reconstruction based on integration of multimodal images[J]. J Healthc Eng, 2018, 2018: 4950131.
[3]	邹晨, 邹道星, 艾毅龙. 口内三维扫描结合CBCT建立数字化模型的研究[J]. 口腔医学研究, 2019, 35(9):902-905. doi: 10.13701/j.cnki.kqyxyj.2019.09.020
[4]	李苏娜, 张怡, 魏青, 等. 三维冠根整合数字化模型在口腔临床中的应用研究[J]. 中国实用口腔科杂志, 2021, 14(1):53-58. doi: 0.19538/j.kq.2021.01.011
[5]	林雪芬, 宁楠, 马驰, 等. 偏颌患者虚拟排牙的根骨关系研究[J]. 口腔医学, 2022, 42(3):235-240.
[6]	侯瑜琳, 赵一姣, 王勇, 等. 基于数字化技术的正畸诊断性排牙中牙根位置初探[J]. 中华口腔医学杂志, 2015, 50(10):631-635.
[7]	Lim SW, Moon RJ, Kim MS, et al. Construction reproducibility of a composite tooth model composed of an intraoral-scanned crown and a cone-beam computed tomography-scanned root[J]. Korean J Orthod, 2020, 50(4):229-237. doi: 10.4041/kjod.2020.50.4.229
[8]	Andrews LF. The six keys to normal occlusion[J]. Am J Orthod, 1972, 62(3):296-309. doi: 10.1016/s0002-9416(72)90268-0 pmid: 4505873
[9]	黄秀珍, 葛孟柯, 段培佳, 等. 转矩的历史来源及测量方法[J]. 广东牙病防治, 2015, 23(9):501-504.
[10]	Simon M, Keilig L, Schwarze J, et al. Treatment outcome and efficacy of an aligner technique: Regarding incisor torque, premolar derotation and molar distalization[J]. BMC Oral Health, 2014, 14: 68. doi: 10.1186/1472-6831-14-68
[11]	Kim BC, Lee CE, Park W, et al. Integration accuracy of digital dental models and 3-dimensional computerized tomography images by sequential point- and surface-based markerless registration[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010, 110(3):370-378. doi: 10.1016/j.tripleo.2010.03.036 pmid: 20591700
[12]	Noh H, Nabha W, Cho JH, et al. Registration accuracy in the integration of laser-scanned dental images into maxillofacial cone-beam computed tomography images[J]. Am J Orthod Dentofacial Orthop, 2011, 140(4):585-591. doi: 10.1016/j.ajodo.2011.04.018
[13]	Sheng Y, Guo HM, Bai YX, et al. Dehiscence and fenestration in anterior teeth : Comparison before and after orthodontic treatment[J]. J Orofac Orthop, 2020, 81(1):1-9. doi: 10.1007/s00056-019-00196-4 pmid: 31646344
[14]	赵志河. 数字化正畸中前牙转矩设计的比较[J]. 国际口腔医学杂志, 2021, 48(1):1-6.
[15]	Lee RJ, Ko J, Park J, et al. Accuracy and reliability of the expected root position setup on clinical decision making of root position at midtreatment[J]. Am J Orthod Dentofacial Orthop, 2019, 156(4):566-573. doi: 10.1016/j.ajodo.2019.03.018
[16]	Rossini G, Parrini S, Castroflorio T, et al. Efficacy of clear aligners in controlling orthodontic tooth movement: A systematic review[J]. Angle Orthod, 2015, 85(5):881-889. doi: 10.2319/061614-436.1 pmid: 25412265
[17]	Haouili N, Kravitz ND, Vaid NR, et al. Has Invisalign improved? A prospective follow-up study on the efficacy of tooth movement with Invisalign[J]. Am J Orthod Dentofacial Orthop, 2020, 158(3):420-425. doi: 10.1016/j.ajodo.2019.12.015
[18]	Kravitz ND, Kusnoto B, BeGole E, et al. How well does Invisalign work? A prospective clinical study evaluating the efficacy of tooth movement with Invisalign[J]. Am J Orthod Dentofacial Orthop, 2009, 135(1):27-35. doi: 10.1016/j.ajodo.2007.05.018
[19]	陈佳君, 薛超然, 王沛棋, 等. 正畸治疗中利用锥形束CT测量牙根位置方法的研究进展[J]. 口腔疾病防治, 2022, 30(10):740-745. doi: 10.12016/j.issn.2096-1456.2022.10.009
[20]	金作林. 无托槽隐形矫治技术对于不同错牙合畸形的分级诊治[J]. 实用口腔医学杂志, 2021, 37(6):733-738.
[21]	赵志河. 基于治疗方案和牙移动方式的无托槽隐形矫治难度评估[J]. 国际口腔医学杂志, 2022, 49(4):373-379.
[22]	Weir T. Clear aligners in orthodontic treatment[J]. Aust Dent J, 2017, 62: 58-62.
[23]	袁惠芳. 成人无托槽隐形矫治牙齿移动效率的三维模型重叠测量研究[D]. 郑州: 郑州大学, 2019.
[24]	Grünheid T, Loh C, Larson BE. How accurate is Invisalign in nonextraction cases? Are predicted tooth positions achieved?[J]. Angle Orthod, 2017, 87(6):809-815. doi: 10.2319/022717-147.1 pmid: 28686090
[25]	郑伟龙, 原工杰. 隐形矫治器控制牙齿移动可预测性的研究进展[J]. 口腔医学研究, 2016, 32(10):1103-1105. doi: 10.13701/j.cnki.kqyxyj.2016.10.026
[26]	马艳宁, 金作林. 无托槽隐形矫治器的发展现状[J]. 实用口腔医学杂志, 2022, 38(4):537-540.

牙位	n	预测转矩	实际转矩	P	平均实现率/%
中切牙	14	5.10±2.36	2.73±1.47	0.002^**	60.70
侧切牙	12	4.30±2.87	2.80±2.10	0.046^*	77.55
尖牙	10	4.00±2.57	2.50±1.71	0.010^*	65.99

牙位	n	预测轴倾	实际轴倾	P	平均实现率/%
中切牙	7	2.68±1.49	2.35±1.45	0.001^**	81.49
侧切牙	9	1.83±0.64	1.40±0.56	0.009^**	77.62
尖牙	6	2.21±0.79	1.60±0.52	0.003^**	74.95