3D咬合板的临床应用与精确性评价

中国口腔颌面外科杂志 ›› 2014, Vol. 12 ›› Issue (4): 311-317.

3D咬合板的临床应用与精确性评价

李玥, 曾融生, 郑广森

中山大学附属口腔医院·
光华口腔医学院口腔颌面外科,广东省口腔医学重点实验室,广东广州 510055

收稿日期:2014-02-26 出版日期:2014-07-10 发布日期:2014-08-20
通讯作者: 曾融生,Tel:020-83862627,E-mail:rszeng@yahoo.ca
作者简介:李玥（1986-）,女,硕士,E-mail:liyue_dentist@163.com
基金资助:
国家自然科学基金（81070818）; 广东省科技计划项目（2011B061300051）

Assessment of the reliability and accuracy of 3D occlusal splints

LI Yue, ZENG Rong-sheng, ZHENG Guang-sen.

Department of Oral and Maxillofacial Surgery, Guanghua School and Hospital of Stomatology, Sun Yat-Sen University;
Guangdong Provincial Key Laboratory of Stomatology. Guangzhou 510055, Guangdong Province, China

Received:2014-02-26 Online:2014-07-10 Published:2014-08-20
Supported by:
Supported by National Natural Science Foundation of China (81070818) and Science and Technology Plan Project of Guangdong Province (2011B061300051)

摘要/Abstract

摘要： 目的以传统咬合板为参照,评价3D咬合板的临床可靠性;通过手术前、后三维头影测量,评价3D咬合板的精确性。方法：选择颅颌面畸形患者15例,术前制作传统咬合板,使用Mimics 10.01软件在锥形束CT（CBCT）重建三维模型上进行虚拟手术及3D咬合板设计,并由 Objet Eden260V^TM 3D Printer打印3D咬合板。术中先后使用3D咬合板和传统咬合板,统计3D咬合板的成功率。术后1周复查CBCT,进行三维头影测量。手术前、后分别进行3次重复定点测量,使用SPSS13.0软件包和MedCalc13.1.2软件对数据进行统计学分析。结果：15例3D咬合板的成功率为100%,三维头影测量的24个线距测量值和24个面角测量值在虚拟手术与实际手术间无显著差异（P>0.05）。线距测量值具有良好的一致性,角度测量值一致性欠佳。结论：3D咬合板具有一定的临床适用性,但其精确性有待提高。

关键词: 正颌外科, 3D咬合板, 三维头影测量, 精确性

Abstract: PURPOSE: To estimate the reliability of 3D occlusal splints compared with traditional occlusal splints, and to evaluate the accuracy of 3D occlusal splints through 3D cephalometry. METHODS: Fifteen patients with maxillofacial deformity were involved in this experiment. Traditional occlusal splints were made pre-operatively, and virtual surgery was performed on 3D maxillofacial model. Then 3D occlusal splints were printed by Objet Eden260V^TM 3D Printer. During the actual surgery, both splints were used to check the fitness of 3D occlusal splints. Cone-beam CT was taken 1 week after surgery. 3D cephalometry was repeated 3 times for both virtual and actual surgery. SPSS13.0 software package and MedCalc13.1.2 software were used for statistical analysis. RESULTS: All the 3D occlusal splints were successfully used in the surgery, and no significant difference was found between virtual surgery and actual surgery (P>0.05). Good consistency was obtained in distances rather than in angles. CONCLUSIONS: Three-dimensional occlusal splints were qualified clinically with the accuracy to be improved in future.

Key words: Orthognathic surgery, Three-dimensional occlusal splint, Three-dimensional cephalometry, Accuracy

中图分类号:

R782.2

李玥, 曾融生, 郑广森. 3D咬合板的临床应用与精确性评价[J]. 中国口腔颌面外科杂志, 2014, 12(4): 311-317.

LI Yue, ZENG Rong-sheng, ZHENG Guang-sen.. Assessment of the reliability and accuracy of 3D occlusal splints[J]. China J Oral Maxillofac Surg, 2014, 12(4): 311-317.

参考文献

[1] Kapila S, Conley RS, Harrell WE Jr. The current status of cone beam computed tomography imaging in orthodontics [J]. Dentomaxillofac Radiol, 2011, 40(1): 24-34.
[2] Tucker S, Cevidanes LH, Styner M, et al. Comparison of actual surgical outcomes and 3-dimensional surgical simulations [J]. J Oral Maxillofac Surg, 2010, 68(10): 2412-2421.
[3] Metzger MC, Hohlweg-Majert B, Schwarz U, et al. Manufacturing splints for orthognathic surgery using a three-dimensional printer [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2008,105(2): e1-7.
[4] Goiato MC, Santos MR, Pesqueira AA, et al. Prototyping for surgical and prosthetic treatment[J]. J Craniofac Surg,2011,22(3): 914-917.
[5] Hassan B, van der Stelt P, Sanderink G. Accuracy of three-dimensional measurements obtained from cone beam computed tomography surface-rendered images for cephalometric analysis: influence of patient scanning position[J]. Eur J Orthod,2009,31(2): 129-134.
[6] Titiz I, Laubinger M, Keller T, et al. Repeatability and reproducibility of landmarks a three-dimensional computed tomography study [J]. Eur J Orthod, 2012, 34(3): 276-286.
[7] Ludlow JB, Gubler M, Cevidanes L, et al. Precision of cephalometric landmark identification: cone-beam computed tomography vs conventional cephalometric views [J]. Am J Orthod Dentofacial Orthop, 2009, 136(3): 312.e1-10.
[8] Olmez H, Gorgulu S, Akin E, et al. Measurement accuracy of a computer-assisted three-dimensional analysis and a conventional two-dimensional method [J]. Angle Orthod, 2011, 81(3): 375-382.
[9] Gateno J, Xia JJ, Teichgraeber JF. Effect of facial asymmetry on 2-dimensional and 3-dimensional cephalometric measurements[J]. J Oral Maxillofac Surg, 2011, 69(3): 655-662.
[10] 张晓芸, 许天民. 应用锥束计算机体层摄影术评价颅颌面的不对称 [J]. 北京大学学报（医学版）, 2013, 45(1): 156-161.
[11] Aboul-Hosn Centenero S, Hern&#x0dbc0;&#x0dd61;ndez-Alfaro F. 3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results - our experience in 16 cases [J]. J Craniomaxillofac Surg, 2012, 40(2): 162-168.
[12] Zamora N, Cibri&#x0dbc0;&#x0dd61;n R, Gandia JL, et al. A new 3D method for measuring cranio-facial relationships with cone beam computed tomography(CBCT) [J]. Med Oral Patol Oral Cir Bucal,2013,18(4): e706-713.
[13] Zamora N, Llamas JM, Cibri&#x0dbc0;&#x0dd61;n R, et al. Cephalometric measurements from 3D reconstructed images compared with conventional 2D images [J].Angle Orthod, 2011, 81(5): 856-864.
[14] Zamora N, Llamas JM, Cibri&#x0dbc0;&#x0dd61;n R, et al. A study on the reproducibility of cephalometric landmarks when undertaking a three-dimensional (3D) cephalometric analysis [J].Med Oral Patol Oral Cir Bucal, 2012, 17(4): e678-688.
[15] 傅民魁. 口腔正畸学[M]. 第5版. 北京: 人民卫生出版社, 2009: 76-79.
[16] Ellis E 3rd. Accuracy of model surgery: evaluation of an old technique and introduction of a new one [J]. J Oral Maxillofac Surg, 1990, 48(11): 1161-1167.
[17] Damstra J, Fourie Z, Huddleston Slater JJ, et al. Reliability and the smallest detectable difference of measurements on 3-dimensional cone-beam computed tomography images [J]. Am J Orthod Dentofacial Orthop, 2011, 140(3): e107-114.