关于牙体预备里的数字追问——从目测经验类比到数字引导

doi:10.7518/hxkq.2021.01.002

华西口腔医学杂志 ›› 2021, Vol. 39 ›› Issue (1): 9-19.doi: 10.7518/hxkq.2021.01.002

关于牙体预备里的数字追问——从目测经验类比到数字引导

于海洋()

口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院修复科，成都 610041

收稿日期:2020-09-01 修回日期:2020-12-07 出版日期:2021-02-01 发布日期:2021-03-02
通讯作者: 于海洋 E-mail:yhyang6812@scu.edu.cn
作者简介:于海洋，教授，博士，E-mail：yhyang6812@scu.edu.cn。于海洋，教授、博士生导师、一级临床专家。擅长显微美学修复、数字种植修复等。现任中华口腔医学会修复专委会候任主任委员，口腔修复国家临床重点专科负责人，四川大学口腔医学技术专业负责人，修复Ⅱ科主任。国际牙医师学院院士，教育部新世纪优秀人才；四川省有突出贡献的专家；《华西口腔医学杂志》、Bone Research副主编。参与制订国家及行业标准6项；研究成果获教育部自然科学一等奖，教学成果获国家教学成果二等奖等。主编规划教材《口腔固定修复学》、《口腔医学美学》以及专著《数字引导式显微修复学》、《引导式精准植入术》、《口腔微距摄影速成》等29部。提出了目标修复体空间TRS数论、美学修复形-色-心三要素四维辩证论，发明了iTRS系列导板（备牙、种植、转移、粘接等）、定深孔显微牙体预备术、实测引导种植术、E-clasp等多项临床技术方案；研发的多项软件及医疗器械产品已经成功转化临床。
基金资助:
四川省科技计划重点研发项目(2020YFS0040)

Questions about the numerical value and quantitative data transfer of tooth preparation—from experience guidance to digital guidance

Yu Haiyang()

State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China

Received:2020-09-01 Revised:2020-12-07 Online:2021-02-01 Published:2021-03-02
Contact: Yu Haiyang E-mail:yhyang6812@scu.edu.cn
Supported by:
Key Research and Development Project of Sichuan Province Science and Technology Plan(2020YFS0040)

摘要/Abstract

摘要：

不同修复方式及材料选择、拟预备牙体本身条件等都会对牙体预备手术产生影响。为了牙体保存、活髓保护及牙周健康等共识理念的实现，牙体预备量总体越少越好已成共识。支撑其实现的条件一是备选修复材料的综合性能进步、材料所需承载空间有效减少；二是预备量和形的数字化分析及实测技术的出现，使得导板下备牙量与修复空间全程实测核查成为可能，预备手术的引导方式也从凭借个人经验累积的目测徒手操作，发展到了采用数字引导联合显微操作进行等。这些进展也标志着精准的、可全程实测核查的引导式修复学的形成。本文将从数字化修复、引导式口腔修复及显微修复技术的视角，对牙体预备的数值要求与数量关系转移展开数字追问；并从测量四要素对现有数值要求做论证评价，指出统一测量方法、研发百微米、十微米级及角度的测量工具将是解决数据可信度的重点；同时也对牙体预备量的引导方式进行归纳梳理，进一步解读了为什么目测经验类比为逻辑基础的当前主流修复技术基础无法有效支撑数字化修复的原委，强烈呼吁尽快打造口腔修复的数字基础。

关键词: 牙齿预备, 目标修复体空间, 导板, 显微口腔修复学, 引导式口腔修复学, 数字化口腔修复学

Abstract:

Tooth preparation is a common operation in dental clinical practice. This procedure is irreversible and invasive from the point of view of tooth preservation. Conditions of the abutment tooth, treatment methods, and restoration materials for target restoration affect tooth preparation. To achieve the goals of tooth tissue preservation, dental pulp protection, and periodontal health, dentistry professionals agreed on the importance of minimizing the amount of tooth reduction. The foundations for realizing this consensus are as follows. First, the available restoration materials with improved comprehensive performance need less target restoration space. Next, teeth can be prepared under a digital guide, and the real-time measurement of restoration space can be verified due to the invention of digital technologies for the analysis of the quantity and shape of the prepared tooth and tooth measurement. Moreover, guiding methods for preparation have been developed from freehand operation under the naked eye based on accumulated personal experience to digital-guidance jointing microscope. These innovations indicate the creation of a prototype of guided prosthodontics that is precise and applies real-time measurement throughout the process of tooth preparation. From the perspective of the evolution of digital, guided, and micro prosthodontics, this article raised seven questions about the numerical value and quantitative data transfer of tooth preparation and evaluated the authenticity of existing numerical requirements from the perspective of the four elements of measurement. Identifying unified measuring methods and developing measuring tools with a precision of hundred or ten microns will be the key to solving the problem about the authenticity of numerical measurement. Furthermore, this paper summarizes the methods of how to control tooth reduction and explains in depth why the currently dominant tooth preparation technology, which is based on empiricism, cannot effectively achieve the goals in digital prosthodontics. Therefore, we strongly call for rebuilding the digital foundation of prosthodontic treatment immediately.

Key words: tooth preparation, target restoration space, guide, micro prosthodontics, guided prosthodontics, digital prosthodontics

中图分类号:

R 783.3

于海洋. 关于牙体预备里的数字追问——从目测经验类比到数字引导[J]. 华西口腔医学杂志, 2021, 39(1): 9-19.

Yu Haiyang. Questions about the numerical value and quantitative data transfer of tooth preparation—from experience guidance to digital guidance[J]. West China Journal of Stomatology, 2021, 39(1): 9-19.

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全冠	前牙预备所需最小空间			后牙预备所需最小空间
全冠	切缘	唇颊侧	肩台	面	肩台
金属	-	-	-	1.0	0.5
金属烤瓷	1.5~2.0	1.5	1.0~1.2	2.0	1.0~1.2
玻璃陶瓷	1.5	1.0~1.2	1.0	1.5	1.0
传统氧化锆	1.5~2.0	1.5	1.0~1.2	2.0	1.0
高透氧化锆	1.5	1.0~1.2	0.8~1.0	1.5	0.5

瓷贴面	唇侧预备所需最小空间			颈部边缘预备所需最小空间
瓷贴面	切1/3	中1/3	颈1/3	颈部边缘预备所需最小空间
长石质瓷	0.1	0.1	0.1	0.1
压铸玻璃陶瓷	0.4	0.3	0.3	0.3
切削玻璃陶瓷	0.7	0.6	0.4	0.4
陶瓷树脂复合材料	0.3	0.3	0.2	0.2

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Questions about the numerical value and quantitative data transfer of tooth preparation—from experience guidance to digital guidance

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