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中华口腔医学研究杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 234 -240. doi: 10.3877/cma.j.issn.1674-1366.2021.04.007

病例分析

上下颌牙列缺失应用数字化技术制作复制义齿修复一例
王兵1, 国丹妮2, 衡墨笛1, 国丽丽1, 周永胜2, 潘韶霞2,()   
  1. 1. 北京大学口腔医学院·口腔医院义齿加工中心 100081
    2. 北京大学口腔医学院·口腔医院修复科,国家口腔医学中心 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室 口腔数字医学北京市重点实验室 国家卫生健康委口腔医学计算机应用工程技术研究中心 100081
  • 收稿日期:2021-06-17 出版日期:2021-08-01
  • 通信作者: 潘韶霞

Fabrication of duplicate dentures using digital technique for an edentulous patient: A case report

Bing Wang1, Danni Guo2, Modi Heng1, Lili Guo1, Yongsheng Zhou2, Shaoxia Pan2,()   

  1. 1. Dental Laboratory, Peking University School and Hospital of Stomatology, Beijing 100081, China
    2. Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2021-06-17 Published:2021-08-01
  • Corresponding author: Shaoxia Pan
  • Supported by:
    Sub-project of the National Key R & D Program of China(2020YFC2009005-02); Program for New Clinical Techniques Therapies of Peking University and School and Hospital of Stomatology(PKUSSNCT-20G03); Program for New Clinical Techniques Therapies of Peking University and School and Hospital of Stomatology(PKUSSNCT-19B03)
引用本文:

王兵, 国丹妮, 衡墨笛, 国丽丽, 周永胜, 潘韶霞. 上下颌牙列缺失应用数字化技术制作复制义齿修复一例[J]. 中华口腔医学研究杂志(电子版), 2021, 15(04): 234-240.

Bing Wang, Danni Guo, Modi Heng, Lili Guo, Yongsheng Zhou, Shaoxia Pan. Fabrication of duplicate dentures using digital technique for an edentulous patient: A case report[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2021, 15(04): 234-240.

目的

报道1例应用数字化技术制作上下颌复制义齿病例,探讨数字化复制义齿制作流程及临床应用效果。

方法

患者,女,54岁,2020年8月就诊于北京大学口腔医院修复科,旧义齿戴用7年因基托裂纹要求重新制作全口义齿。口内检查上下颌牙列缺失,剩余牙槽嵴轻至中度吸收,右上前牙前庭沟处缝龈瘤,旧义齿磨光面形态可。软组织调整后,利用模型扫描仪获取旧义齿完整表面形态信息,五轴数控切削复制旧义齿蜡型,重新确定垂直距离、颌位关系及丰满度,硅橡胶翻制初模型,模型上架,更换蜡牙为人工牙,临床试排牙验证颌位关系,边缘整塑制取闭口式印模,灌制终模型,装胶压盒,热处理,制作复制义齿,临床戴牙完成修复治疗,患者填写义齿满意度视觉模拟评分量表(VAS)。

结果

复制义齿顺利就位,固位力及稳定性好,少量调实现平衡,美观效果好。复查无压痛,义齿咀嚼功能良好。复制义齿VAS评分在总体满意度、易清洁性、发音能力、舒适、美观及嚼碎功能等6个方面均高于97,固位力及稳定性VAS评分达96。

结论

对于长时间戴用旧义齿无不适、义齿外形满意可复制的患者,利用数字化技术获取旧义齿表面形态,制作复制义齿,实现3次临床就诊完成全口义齿修复,可减少临床就诊次数、简化操作步骤、优化修复效果、提高患者满意度。

Objective

To report a case of fabrication of duplicate dentures using digital technique for an edentulous patient, and to investigate the workflow and clinical efficacy of this method.

Methods

A fifty-four-year old edentulous female with complete dentures which had been worn for seven years and suffered from fissures in the maxilla denture base was recruited. The patient visited the Department of Prosthodontics, Peking University School and Hospital of Stomatology in August 2020. Intraoral examination revealed slightly absorbed residual alveolar ridge and epulis fissuratum at the vestibular sulcus of upper right anterior teeth. After tissue conditioning, a model scanner (3-Shape) was used to obtain the complete surface morphological information of the existing dentures. The generated STL file from this technique represented a digital duplicate of the scanned dentures. A set of wax-up duplicate dentures were milled by a five-axis CNC equipment. The occlusal relationship and fullness were re-determined after wax-up try-in. The initial models reproduced with silicone rubber and jaw relationship were transferred to an articulator. After wax teeth replaced with artificial teeth, the occlusal relationship was verified. After border molding, the wax-up was used to take a close-mouth impression. The final models were poured using plater. The duplicate dentures were completed after installing the plastic to the press box and heating. The patient′s satisfaction was measured using the visual analogue scale (VAS) after denture delivery.

Results

The restoration treatment was completed. The duplicate dentures with good retention and stability, and proper extension of the base edge got good aesthetics and high patient′s satisfaction. Occlusal balance was achieved by a bit of adjustment. Follow-up visit, the patient had no tenderness, good chewing function and good aesthetic effect. The VAS scores of this patient on the digital duplicate dentures showed high satisfaction. Each score of general satisfaction, cleaning, ability to speak, comfort, aesthetics and ability to chew up was higher than nighty-seven. The other two aspects of retention and stability got not less than 96 scores.

Conclusions

The digital technology could be used to fabricate duplicate dentures for edentulous patient who wore complete dentures for a long time without discomfort to reduce clinical visits, simplify the procedures and improve clinical outcomes and patient′s satisfaction.

图1 患者口腔检查情况 A:上颌剩余牙槽嵴轻度吸收,上前牙区唇侧及颧突处骨突;B:上下颌牙列缺失,上下颌间距离适中,黏膜无红肿、弹性可;C:下颌剩余牙槽嵴中度吸收,唾液分泌正常
图2 患者旧义齿检查情况 A:旧义齿完整,基托磨光面形态可;B:上颌义齿基托可见裂纹(白色箭头所示),延伸至唇侧基托;C:人工牙重度磨耗,下颌义齿基托边缘伸展不足;D:右上唇侧基托过度伸展且密合性欠佳,右上前牙前庭沟处缝龈瘤
图3 患者旧义齿美学效果不佳 A:垂直距离下降;B:11人工牙轴向远中倾斜,牙中线偏斜,平面歪斜;C:上唇丰满度不足
图4 患者口内软组织调整 A:调改旧义齿右上前牙唇侧基托前,前庭沟处缝龈瘤(白色箭头所示);B:调改旧义齿唇侧基托4周后,缝龈瘤消失
图5 数字化技术复制上下颌旧义齿形态 A~B:硅橡胶翻制初模型,检查模型完整清晰,完成模型修整;C~D:旧义齿复位至模型,使用3Shape D2000模型扫描仪扫描获取表面形态信息,再次扫描硅橡胶模型获取义齿组织面形态信息,使用数字化设计软件完成义齿边缘拼接及修整,获取旧义齿表面形态完整复制STL文件;E~F:使用五轴数控机床切削制作上下颌旧义齿蜡型
图7 初模型上架,更换蜡牙为人工牙
图8 闭口式终印模制取 A~B:使用重体硅橡胶材料完成上下颌蜡型边缘整塑;C~D:使用轻体硅橡胶材料完成上下颌闭口式印模制取
图9 复制义齿顺利戴牙 A:上颌正中平衡;B:上下颌复制义齿就位顺利,基托边缘合适;C:下颌正中平衡
图10 复制义齿美学效果良好 A:上颌人工牙切缘位于息止颌位上唇下缘约2 mm;B:复制义齿切缘曲线与下唇上缘形态协调,平面无歪斜,美学效果明显改善;C:恢复上唇丰满度
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