CBCT重建下3D打印技术对青少年正畸治疗的应用效果及美学评价

邱勇 宋艳

[摘要]目的：探討锥形束CT（CBCT）和3D打印技术运用于青少年正畸治疗的效果及其对外观的影响。方法：选取2016年3月-2018年8月笔者医院就诊的46例接受正畸治疗的青少年患者为研究对象，根据随机数字表法分为观察组和对照组，每组23例。观察组：行CBCT检查，通过Mimics软件将患者的CBCT数据转化成计算机辅助设计（CAD）模型，在软件上模拟牙齿移动、设计个体化舌侧正畸托槽。将文件转化成STL文件后导入3D打印机，制成个体化舌侧托槽;对照组：正畸治疗给予常规舌侧托槽与粘接。记录两组正畸治疗前和治疗后6个月的临床效果、舒适度、拥挤度、Bolton值、微笑相、正面相测量值和并发症发生率。结果：观察组托槽脱落例数显著少于对照组（P<0.05）;治疗后，观察组鼻唇角、颏沟倾角、上唇长、上唇厚均大于对照组（P<0.05），而两组H角、面型角、下唇长、下唇厚比较均无明显差异（P>0.05）;治疗后，观察组GI和SBI均小于对照组（P<0.05）;观察组舒适度高于对照组（P<0.05）;治疗后，观察组上、下列牙拥挤度、前牙Bolton值和全牙Bolton值均小于对照组（P<0.05）;观察组W2/W1和W3/W2低于对照组（P<0.05），且C2/L1和C3/L1高于对照组（P<0.05）;观察组并发症发生率显著小于对照组（P<0.05）。结论：在青少年正畸治疗中，应用CBCT和3D打印技术制作个体化的舌侧托槽可取得良好的临床效果，托槽固定位置准确、不易脱落，对牙龈损伤程度较轻，患者侧貌美观可得到明显的改善。

[关键词]锥形束CT;3D打印;正畸治疗;正畸托槽

Abstract： Objective  To explore the effect of cone beam CT（CBCT）combined with 3D printing technology on teenagers orthodontic treatment and its influence on appearance. Methods  46 adolescent patients treated with orthodontic treatment from March 2016 to August 2018 in our hospital were divided into experimental group and control group by random number table method，23 patients in each group. Experimental group underwent CBCT，transforming patients CBCT date into computer aided design（CAD）model，simulating teeth movement and designing individuation lingual orthodontic brackets on the software. Making individuation lingual orthodontic brackets by sending to 3D printer after transforming document to STL format. Using routine lingual orthodontic brackets and its sticking on patients in the control group. Clinical effect、degree of comfort、the degree of dental crowding、the Bolton ratios、smile analysis、frontal photographs and the incidence of complication. Results The number of bond failure in the experimental group was lower than that in the control group（P<0.05）.After treatment，improvement of CU and WU4 in the experimental group were higher than those in the control group（P<0.05）.There were no statistical difference between the control group and the experimental group in the WU3、WU5、WL3、etc（P>0.05）.After treatment，GI and SBI in the experimental group were lower than those in the control group（P<0.05）. Degree of comfortin the experimental group was higher than that in the control group（P<0.05）.After treatment，the degree of dental crowding of the maxillary and mandibular teeth、the Bolton ratios of front teeth and overall teeth in the experimental group were lower than those in the control group（P<0.05）.After treatment，nasolabial angle、Pog′B′-FH、the length of upper lip、the thickness of lower lip in the experimental group were higher than those in the control group（P<0.05），there were no statistical difference between the control group and the experimental group in the H angle、G-Sn-Pos、the length and thickness of lower lip（P>0.05）.The incidence of complication in the experimental group was lower than that in the control group（P>0.05）.Conclusion  Using CBCT and 3D printing to make individuation lingual orthodontic brackets in teenagers orthodontic treatment can obtain obvious clinical effect.The adhesive position of brackets were accurate and them abscission difficultly，the extent of gingival injury is relatively minor，and patients profile can be improved.

Key words： CBCT; 3D printing; orthodontic treatment; orthodontic brackets

随着口腔正畸治疗技术的不断发展，及其展现出的明显效果，使得越来越多的人有了正畸治疗的需求。儿童期和青春期是正畸治疗的黄金时期，青少年是正畸矫正的主要群体之一[1]。然而正畸过程往往会给患者带来一定的烦扰，比如：口腔清洁困难、口腔溃疡、牙周组织受刺激和托槽脱落等[2]。优化托槽设计、改善正畸治疗体验、减少矫正器对日常生活的干扰是口腔医生的关注焦点之一。锥形束CT（Cone Beam Computed Tomography ，CBCT）是锥形束投照计算机重组断层影像设备[3-4]。与传统的二维影像学不同，可从三维的角度反映各个牙齿与骨骼之间的关系，它的出现推动了口腔医学的发展。而3D打印是一种以数字模型为基础[5-6]，应用相应材料来构造所需物体的技术，近年来不断活跃于医学的各个领域中。为……