›› 2020, Vol. 40 ›› Issue (4): 324-329.

• 临床研究 • 上一篇    下一篇

CAD/CAM在腓骨瓣-种植体功能性修复下颌骨缺损的临床应用

王凌1,柳兆刚1,田宏伟1,唐振华1,周宇1,陈旭兵2   

  1. 1. 阜阳市人民医院
    2. 安徽省阜阳市人民医院 口腔科
  • 收稿日期:2019-09-30 修回日期:2019-12-11 出版日期:2020-04-28 发布日期:2020-04-28
  • 通讯作者: 陈旭兵 E-mail:wljfyyz@sohu.com
  • 作者简介:介绍信协议收

Clinical application of CAD/CAM in functional reconstruction of mandible defect with fibula flap-implant

  • Received:2019-09-30 Revised:2019-12-11 Online:2020-04-28 Published:2020-04-28

摘要: 目的 观察计算机辅助设计和计算机辅助制造(CAD/CAM)在单层腓骨肌(皮)瓣移植-种植体功能性修复下颌骨缺损的临床应用。方法:对9例因下颌骨病变导致下颌骨节段性缺损的患者进行数据分析,利用(CAD/CAM)技术,设计腓骨塑形为后期种植修复牙列缺损创造有利的骨性条件,结合快速成型技术,制作手术导板,并在重建后的实体模型上预成型重建钛板。其中5例术后一年完成种植修复。修复完成后6、12个月对患者面形、开口度/型、颞下颌关节、咬合功能及种植体周围软组织、骨组织进行随访观察,并进行种植体边缘骨水平测量。结果:9例腓骨瓣全部成活。术中在手术导板引导下,截骨及腓骨塑形顺利,耗时减少。5例完成种植修复的患者,种植术后6、12个月随访,患侧面形丰满,两侧对称,开口度3.1~3.9 mm。种植体周围软组织颜色正常无明显种植体周围龈炎。咬合关系及咀嚼功能无异常。CBCT示种植体周围骨组织无明显吸收。结论:CAD/CAM能更精确的指导腓骨塑形同时为后期腓骨种植修复牙列缺损创造有利的骨性条件。

关键词: 探讨计算机辅助设计和计算机辅助制造(CAD/CAM), 单层腓骨肌(皮)瓣, 种植修复, 锥束计算机体层摄影术, 种植体边缘骨水平测量

Abstract: Objective  To observe the clinical application of computer aided design and computer aided manufacturing (CAD/CAM) in the functional reconstruction of mandible defects with fibular musculocutaneous flap transplantation. Methods The data of 9 patients with mandibular segmental defect resulting from mandibular lesion were analyzed. (CAD/CAM) technology was used to design fibula shaping to create favorable bone conditions for dental implant repair. The surgical guide plate was made by rapid prototyping. The titanium plate was reconstructed by preforming on the reconstructed solid model. Among them, 5 patients completed the implantation and restoration one year after surgery. The patients' facial shape, mouth width/type, temporomandibular joint, occlusal function, peri-implant soft tissue and bone tissue were followed up and observed. Bone level at the edge of the implant was measured 6 to 12 months after the restoration. Result All the flaps survived in 9 cases. Under the guidance of the surgical guide plate, the osteotomy and fibula were shaped smoothly and the time consumption was reduced. The 5 patients who completed the implantation and restoration were followed up at 6 and 12 months after the implantation. The patients showed full lateral shape, bilateral symmetry, and mouth width of 3.1-3.9mm. The soft tissue color around the implant was normal without obvious gingivitis around the implant. The occlusal relationship and masticatory function were normal. CBCT showed that there was no obvious absorption of bone tissue around the implant.Conclusion CAD/CAM can guide the shaping of fibula more accurately and create favorable bone conditions for the reconstruction of dental defects.

Key words: computer aided design and computer aided manufacturing (CAD/CAM), Single fibula muscle flap, implant restoration, Cone-beam computer tomography, Bone level at the edge of implant

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