萎缩无牙颌患者数字化种植即刻修复工作流程

doi:10.12016/j.issn.2096-1456.2020.12.001

摘要/Abstract

摘要：

萎缩无牙颌由于颌骨解剖条件因素给修复重建带来了巨大挑战,种植支持式全口固定义齿修复因为可以很好地恢复患者咀嚼功能和美观效果而广受推崇。然而,萎缩无牙颌种植即刻功能重建手术要求高,修复治疗程序复杂,往往很难达到理想治疗效果。数字化辅助萎缩无牙颌种植即刻修复功能重建的工作流程对于无牙颌患者和种植修复医生都具有重要意义。本文结合临床病例总结了数字化辅助萎缩无牙颌种植即刻修复功能重建的工作流程,通过数字化手段进行辅助诊断、设计、植入、即刻修复重建和最终修复,可优化种植手术和即刻修复工作流程,提高萎缩无牙颌种植即刻修复的精度,减少大量植骨需要,获得更高的患者满意度,实现“修复导向,以终为始”的无牙颌种植修复理念,精准、微创、高效地恢复患者的美观和咀嚼功能,具有较高的临床推广应用价值。

关键词: 萎缩无牙颌, 骨量不足, 种植修复, 数字化工作流程, 即刻功能重建, 数字化导板, 数字化印模, 数字化微笑设计, 以修复为导向, CAD/CAM材料

Abstract:

Rehabilitation and reconstruction of atrophic edentulous predicament represents significant challenges for implant dentists due to the anatomical conditions of the edentulous jaw. Implant-supported fixed complete dental prostheses represent a scientifically and clinically validated treatment for recovering patients, masticatory function and esthetic effect. However, the highly demanding implant surgical techniques and complex rehabilitation procedures for immediate functional reconstruction make it difficult to achieve the desired treatment outcomes. The application of digital and CAD/CAM technology in various stages of the treatment process is logical for patients and dentists. This article summarizes the workflow of digital-assisted implantation with immediate functional reconstruction of atrophic edentulous combined with a clinical case. Digital-assisted diagnosis, design, implantation, immediate reconstruction and final rehabilitation can optimize the implant surgery and immediate rehabilitation workflow, improve the accuracy of implant-supported immediate functional reconstruction, reduce the demand for a large amount of bone graft, and achieve higher patient satisfaction. The “prosthetic-oriented, begin with the end in mind” concept of edentulous jaw implant prosthetics can accurately and efficiently restore the patient,s beauty and chewing function in a minimally invasive manner, and is worthy of clinical promotion.

Key words: atrophic edentulous jaw, bone insufficiency, implant restoration, digital workflow, immediate functional reconstruction, digital surgical guide, digital impression, digital smile design, prosthodontic oriented, CAD/CAM material

中图分类号:

R783.4

顾新华. 萎缩无牙颌患者数字化种植即刻修复工作流程[J]. 口腔疾病防治, 2020, 28(12): 749-758.

GU Xinhua. Digital workflow of immediate implant-supported restoration for atrophic edentulous patients[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2020, 28(12): 749-758.

图/表 8

图1 患者种植前口内照及X线检查照片

Figure 1 Intraoral images and X-ray examination images before implant surgery a： intraorthodontic image of removable partial denture before implant surgery; b： intraorthodontic image before implant surgery; c：maxillary occlusal image before implant surgery; d： panoramic image before implant surgery; e： CBCT indicated an inverted impacted tooth located on the apical side of 21 and 22

图2 标记并采集患者口内数字化信息

Figure 2 Mark and collect intraoral digital information of the patient a&b: 4 mark points were diffusely made by fluid resin on the mucosa of the edentulous area and remaining teeth; c: light curing finished; d&e: collection of digital intraoral information; f: intraoral digital information of the patient was obtained

图3 数字化预排牙

Figure 3 Digital teeth prearrangement a: merge the intraoral scan of soft tissue and occlusion status with CBCT bone tissue information; b: virtual dentition reconstruction

图4 数字化种植设计

Figure 4 Digital implant design a： implant plan design （implanting Straumann BLT 3.3 mm × 10 mm is planned for 12 and 22, and obliquely implanting BLT 4.1 mm × 14 mm is planned for 15 and 25）; b： temporary denture design; c-f： a digital-assisted plan was selected for each implant abutment transgingival height, angle and direction

图5 利用数字回切技术设计并制作支架,完成即刻修复义齿,3D打印研究模型、手术导板

Figure 5 Designing and manufacturing of the frame using digital cut-back technology, temporary denture, 3D printed research model and surgical guide a&b: digital design of enhanced bracket; c: fabrication of CAD/CAM resin wax pattern; d: fabrication of cobalt-chromium bracket; e: 3D printed research model, surgical guide and temporary denture

图6 数字化辅助的种植手术、即刻修复和术后影像评估

Figure 6 Digital-assisted implant surgery, immediaterestoration and image evaluation a: preparation of implant hole with a surgical guide during the surgery; b: the prefabricated temporary denture was worn and relined with self-curing resin immediately after implant surgery; c: panoramic image after implant surgery and fixation with abutments; d: matching diagram of 15, 12, 22 and 25 CBCT implant positions after implant surgery (dark green) and preoperative digital design (white)

表1 种植术后CBCT检查种植体与术前数字化设计偏差

Table 1 Deviations of the implants between postoperative CBCT implants and preoperative digital design

Implant position	Deviations of different parts of implant
Implant position	Cervical（mm）	Apex（mm）	Space angle（°）
12	1.6	1.3	2.0
15	0	0	0
22	2.0	2.2	5.4
25	0.7	0.8	2.0

图7 种植术后6个月复诊行最终修复

Figure 7 Revisits for final restoration 6 months after implant surgery a: digital images 6 months after implant surgery; b: making impression; c: taking the bite record; d: transferring the jaw position; e: the CAD/CAM-fabricated integrated pure titanium bracket was tried on; f: the implant supported fixed permanent restoration was completed; g&h: comparison of screw channel positions before and after surgery

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