激光熔融数字化导板技术辅助钙化根管的治疗

doi:10.7518/hxkq.2020.05.009

华西口腔医学杂志 ›› 2020, Vol. 38 ›› Issue (5): 525-531.doi: 10.7518/hxkq.2020.05.009

激光熔融数字化导板技术辅助钙化根管的治疗

张婷¹^,²(), 陈度³, 苗雷英¹^,², 谢思静¹^,², 汤旭娜¹^,²^,⁴()

^1. 南京大学医学院附属口腔医院,南京市口腔医院牙体牙髓病科,南京 210000
^2. 南京大学医学院附属口腔医院,南京市口腔医院中心实验室,南京 210000
^3. 南京大学医学院附属口腔医院,南京市口腔医院修复科,南京 210000
^4. 计算机软件新技术国家重点实验室（南京大学）,南京 210000

收稿日期:2020-01-17 修回日期:2020-03-15 出版日期:2020-10-01 发布日期:2020-10-14
通讯作者: 汤旭娜 E-mail:zhangting7700@163.com;xunatang@126.com
作者简介:张婷,硕士,E-mail：zhangting7700@163.com
基金资助:
南京市医学科技发展资金项目(YKK16157);南京市科技计划项目(201715040);南京大学计算机软件新技术国家重点实验室资助项目(KFKT2018B16);科教强卫工程江苏省青年医学人才(QNRC2016120);江苏省青年医学人才资助项目(2017)

Guided endodontic access of calcified root canal by laser melting templates

Zhang Ting¹^,²(), Chen Du³, Miao Leiying¹^,², Xie Sijing¹^,², Tang Xuna¹^,²^,⁴()

^1. Dept. of Cariology and Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, China
^2. Central Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, China
^3. Dept. of Prosthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, China
^4. State Key Lab. for Novel Software Technology, Nanjing University, Nanjing 210000, China

Received:2020-01-17 Revised:2020-03-15 Online:2020-10-01 Published:2020-10-14
Contact: Tang Xuna E-mail:zhangting7700@163.com;xunatang@126.com
Supported by:
Nanjing Medical Science and Technique Development Foundation(YKK16157);Nanjing Foundation for Development of Science and Technology(201715040);Project of State Key Lab. for Novel Software Technology(Nanjing University)(KFKT2018B16);Project of Invigorating Health Care through Science, Technology and Education Jiangsu Provincial Medical Youth Talent(QNRC2016120);Jiangsu Provincial Medical Youth Talent(2017)

摘要/Abstract

摘要： 目的利用激光熔融数字化导板技术获得钙化根管治疗的新方法,并评估其准确性。方法采用激光熔融数字化导板技术辅助2例前牙钙化根管的治疗。术前使用锥形束CT（CBCT）扫描患者上颌牙,建立三维牙体硬组织根管系统模型;制取患者上颌印模,三维扫描仪扫描模型,整合CBCT及三维扫描数据,通过Mimics 19.0及3-matic 11.0软件设计开髓路径,使用钴铬合金激光熔融法打印导板,在根管导板引导下开髓及打通钙化段根管,完成根管治疗。测量术前开髓设计路径和术后实际路径的位置和角度偏差。结果 2例患牙均获得较好的治疗效果。病例1的开髓角度偏差为1.77°,钻基底偏差为0.403~0.497 mm,钻尖端偏差为0.433~0.537 mm。病例2的角度偏差为3.26°,钻基底偏差为0.183~0.347 mm,钻尖端偏差为0.310~0.463 mm。结论钴铬合金激光熔融根管导板辅助建立根管通道是治疗钙化根管的有效方法,可作为钙化根管治疗的新策略。

关键词: 引导根管治疗, 激光熔融导板, 钙化根管, 锥形束CT

Abstract:

Objective The aim of this study is to treat calcified root canal and assess the accuracy of guided endodontics using laser melting templates. Methods Two cases with calcified anterior teeth were treated with laser melting templates. Cone beam computed tomography (CBCT) was used to scan the maxillary teeth of patients before surgery to establish the root canal system model. The maxillary impression of the patient was made and it was scanned by a 3D scanner. The CBCT scans were matched with surface scans of plaster model. Mimics 19.0 and 3-matic 11.0 software were used to design the virtual planning to access cavities. The templates were produced by laser melting 3D printing. Access cavity was prepared under the guidance of laser melting template. Then the deviations of planned and prepared cavities in three dimensions and angle were measured. Results The two teeth obtained satisfactory results. The first case had a angle deviation of 1.77°, a drilling base deviation of 0.403-0.497 mm, and a tip of 0.433-0.537 mm. The second case had a angle deviation of 3.26°, a drill base deviation of 0.18-0.347 mm, and a tip of 0.310-0.463 mm. Conclusion Laser melting template-guided endodontics is an effective technique for the treatment of calcified root canal and can be used as a new strategy for the treatment of calcified canal.

Key words: guided endodontics, laser melting templates, calcified root canal, cone beam computed tomography

中图分类号:

R781.05

张婷, 陈度, 苗雷英, 谢思静, 汤旭娜. 激光熔融数字化导板技术辅助钙化根管的治疗[J]. 华西口腔医学杂志, 2020, 38(5): 525-531.

Zhang Ting, Chen Du, Miao Leiying, Xie Sijing, Tang Xuna. Guided endodontic access of calcified root canal by laser melting templates[J]. West China Journal of Stomatology, 2020, 38(5): 525-531.

图/表 4

图 1

图 2

表 1

表 2

参考文献 25

[1]	Mello-Moura AC, Santos AM, Bonini GA , et al. Pulp calcification in traumatized primary teeth—classification, clinical and radiographic aspects[J]. J Clin Pediatr Dent, 2017,41(6):467-471. doi: 10.17796/1053-4628-41.6.9 URL pmid: 28937901
[2]	Delivanis HP, Sauer GJ . Incidence of canal calcification in the orthodontic patient[J]. Am J Orthod, 1982,82(1):58-61. doi: 10.1016/0002-9416(82)90547-4 URL pmid: 6961778
[3]	Karteva E, Manchorova N, Petrova N , et al. Effect of ageing and endodontic treatment on the thermal stability of human dentin[J]. Biomed Mater Eng, 2019,30(2):145-156. doi: 10.3233/BME-191040 URL pmid: 30741663
[4]	Langeland K, Dowden WE, Tronstad L , et al. Human pulp changes of iatrogenic origin[J]. Oral Surg Oral Med Oral Pathol, 1971,32(6):943-980. doi: 10.1016/0030-4220(71)90183-6 URL pmid: 4942993
[5]	Oginni AO, Adekoya-Sofowora CA, Kolawole KA . Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision[J]. Dent Traumatol, 2009,25(6):620-625. doi: 10.1111/j.1600-9657.2009.00819.x URL pmid: 19917027
[6]	van der Meer WJ, Vissink A, Ng YL , et al. 3D Computer aided treatment planning in endodontics[J]. J Dent, 2016,45:67-72. doi: 10.1016/j.jdent.2015.11.007 URL pmid: 26627596
[7]	Matherne RP, Angelopoulos C, Kulild JC , et al. Use of cone-beam computed tomography to identify root canal systems in vitro[J]. J Endod, 2008,34(1):87-89. doi: 10.1016/j.joen.2007.10.016 URL pmid: 18155501
[8]	Krastl G, Zehnder MS, Connert T , et al. Guided endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology[J]. Dent Traumatol, 2016,32(3):240-246. doi: 10.1111/edt.12235 URL pmid: 26449290
[9]	Zehnder MS, Connert T, Weiger R , et al. Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location[J]. Int Endod J, 2016,49(10):966-972. doi: 10.1111/iej.12544 URL pmid: 26353942
[10]	Connert T, Zehnder MS, Amato M , et al. Microguided endodontics: a method to achieve minimally invasive access cavity preparation and root canal location in mandibular incisors using a novel computer-guided technique[J]. Int Endod J, 2018,51(2):247-255. doi: 10.1111/iej.12809 URL pmid: 28665514
[11]	Fonseca Tavares WL , Diniz Viana AC, de Carvalho Machado V, et al. Guided endodontic access of calcified anterior teeth[J]. J Endod, 2018,44(7):1195-1199. doi: 10.1016/j.joen.2018.04.014 URL pmid: 29941111
[12]	林捷, 林珍香, 郑志强 , 等. 根管导板技术辅助冠修复后磨牙的根管治疗[J]. 实用口腔医学杂志, 2018,34(5):648-651.
	Lin J, Lin ZX, Zheng ZQ , et al. Endodontic treatment of the molars following crown restoration by using endodontic guide technique[J]. J Pract Stomatol, 2018,34(5):648-651.
[13]	Bürklein S, Schäfer E . Minimally invasive endodontics[J]. Quintessence Int, 2015,46(2):119-124. doi: 10.3290/j.qi.a33047 URL pmid: 25500587
[14]	Opal S, Garg S, Dhindsa A , et al. Minimally invasive clinical approach in indirect pulp therapy and healing of deep carious lesions[J]. J Clin Pediatr Dent, 2014,38(3):185-192.
[15]	Ruddle CJ . Endodontic triad for success: the role of minimally invasive technology[J]. Dent Today, 2015, 34(5): 76, 78-80. URL pmid: 26470575
[16]	承清, 夏文薇 . 三维打印导板在牙体牙髓专业领域中的研究和应用[J]. 中华口腔医学杂志, 2019,54(1):67-70.
	Cheng Q, Xia WW . Research and application of three-dimensional printed template in endodontics[J]. Chin J Stomatol, 2019,54(1):67-70.
[17]	Zubizarreta-Macho Á, Ferreiroa A, Agustín-Panadero R , et al. Endodontic re-treatment and restorative treatment of a dens invaginatus type Ⅱ through new technologies[J]. J Clin Exp Dent, 2019,11(6):e570-e576. doi: 10.4317/jced.55840 URL pmid: 31346380
[18]	封琼, 王一舟, 黄雨婷 , 等. 精准微创根管治疗: 3D导板指引下的钙化根管疏通术[J]. 口腔医学研究, 2017,33(4):427-431.
	Feng Q, Wang YZ, Huang YT , et al. Negotiation of calcified root canal under guidance of 3D guides: precise minimally invasive root canal treatment[J]. J Oral Sci Res, 2017,33(4):427-431.
[19]	El Kholy K, Janner SF, Schimmel M , et al. The influence of guided sleeve height, drilling distance, and drilling key length on the accuracy of static computer-assisted implant surgery[J]. Clin Implant Dent Relat Res, 2019,21(1):101-107. doi: 10.1111/cid.12705 URL pmid: 30589502
[20]	Han T, Kundu S, Nag A , et al. 3D printed sensors for biomedical applications: a review[J]. Sensors (Basel), 2019,19(7):E1706.
[21]	Lu YJ, Wu SQ, Gan YL , et al. Microstructure, mechanical property and metal release of As-SLM CoCrW alloy under different solution treatment conditions[J]. J Mech Behav Biomed Mater, 2015,55:179-190. doi: 10.1016/j.jmbbm.2015.10.019 URL pmid: 26590910
[22]	Koutsoukis T, Zinelis S, Eliades G , et al. Selective laser melting technique of Co-Cr dental alloys: a review of structure and properties and comparative analysis with other available techniques[J]. J Prosthodont, 2015,24(4):303-312. doi: 10.1111/jopr.12268 URL pmid: 26129918
[23]	Schneider D, Marquardt P, Zwahlen M , et al. A systematic review on the accuracy and the clinical outcome of computer-guided template-based implant dentistry[J]. Clin Oral Implants Res, 2009,20(Suppl 4):73-86. doi: 10.1111/clr.2009.20.issue-s4 URL
[24]	李晋蒙, 欧国敏 . 计算机辅助设计种植导板精确性及其影响因素[J]. 华西口腔医学杂志, 2017,35(1):93-98.
	Li JM, Ou GM . Accuracy of computer-guided implant placement and influencing factors[J]. West China J Stomatol, 2017,35(1):93-98.
[25]	Buchgreitz J, Buchgreitz M, Mortensen D , et al. Guided access cavity preparation using cone-beam computed tomography and optical surface scans—an ex vivo study[J]. Int Endod J, 2016,49(8):790-795. doi: 10.1111/iej.12516 URL pmid: 26201367

项目	角度偏差/°	钻基底偏差/mm			钻尖端偏差/mm
项目	角度偏差/°	近远中向	颊舌向	冠根向	近远中向	颊舌向	冠根向
平均值	1.770	0.403	0.463	0.497	0.433	0.493	0.537
最小值	1.550	0.390	0.450	0.490	0.420	0.480	0.520
最大值	1.980	0.410	0.480	0.500	0.420	0.500	0.550
标准差	0.215	0.012	0.015	0.006	0.015	0.012	0.015

项目	角度偏差/°	钻基底偏差/mm			钻尖端偏差/mm
项目	角度偏差/°	近远中向	颊舌向	冠根向	近远中向	颊舌向	冠根向
平均值	3.260	0.247	0.347	0.183	0.347	0.463	0.310
最小值	3.210	0.230	0.330	0.180	0.330	0.450	0.300
最大值	3.320	0.260	0.360	0.190	0.360	0.480	0.320
标准差	0.056	0.015	0.015	0.006	0.015	0.015	0.010

激光熔融数字化导板技术辅助钙化根管的治疗

Guided endodontic access of calcified root canal by laser melting templates

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 25

相关文章 15

编辑推荐

Metrics

本文评价

[1]	刘晓琳, 任群, 白九平, 康培, 任贵云, 李向军, 冯晓伟. 基于锥形束CT的1 138颗多生牙影像学特征分析[J]. 华西口腔医学杂志, 2023, 41(6): 671-677.
[2]	李璐欣, 刘红红, 陈佳, 张志宏, 桑潇, 张莉丽, 王元天. 数字化方法测量种植体周围骨嵴上软组织高度可行性分析[J]. 华西口腔医学杂志, 2023, 41(4): 426-433.
[3]	景兵帅, 石冰, 郑谦, 李承浩. 牙槽突裂髂骨松质骨植骨术的效果及影响因素分析[J]. 华西口腔医学杂志, 2023, 41(3): 284-289.
[4]	李成蹊, 宋卫健. 上颌侧切牙Ⅱ型和ⅢA型双牙内陷根管治疗1例[J]. 华西口腔医学杂志, 2023, 41(2): 232-236.
[5]	袁婧, 余思静, 游梦, 张琼, 叶玲, 高波. 上颌侧切牙年轻恒牙牙中牙伴根尖周炎的牙髓血运重建治疗1例[J]. 华西口腔医学杂志, 2022, 40(6): 716-720.
[6]	鄢梨, 周茂强, 邱嘉旋. 颞下颌关节盘前移位患者关节骨形态与矢状向关节盘位置的关系[J]. 华西口腔医学杂志, 2022, 40(4): 414-421.
[7]	蔡娉娉, 陈熹, 江亦, 卢兆杰, 林捷, 郑志强. 导板与显微镜辅助拆除纤维桩的精确度比较[J]. 华西口腔医学杂志, 2022, 40(3): 297-302.
[8]	江晓娴, 茅传青, 赖永圳, 卢萌, 王承勇, 蔡志宇, 陈伟辉. 替牙期牙槽突裂患者行块状髂骨植骨术的初步疗效分析[J]. 华西口腔医学杂志, 2022, 40(3): 303-308.
[9]	高羽轩, 汪鎏, 傅裕杰, 杨帆, 张岚, 黄定明. 数字化导板引导技术辅助微创治疗前牙钙化根管[J]. 华西口腔医学杂志, 2022, 40(1): 111-122.
[10]	袁志瑶, 邹习宏, 戴霖霖, 敖慧芝, 李厚轩. 上颌第一磨牙牙根折裂的临床特征分析[J]. 华西口腔医学杂志, 2021, 39(5): 555-559.
[11]	郭美玲, 黄臻, 王宠, 王予江. 双侧下颌骨升支矢状劈开截骨后退术对骨性Ⅲ类错牙合患者颞下颌关节症状及髁突位置影响的锥形束CT研究[J]. 华西口腔医学杂志, 2020, 38(5): 519-524.
[12]	胡爽, 李春梅, 张帅源, 秦硕, 解晨露, 牛志兴, 孙明磊. 口腔修复膜和β-磷酸三钙治疗颌骨囊肿术后骨缺损的临床价值[J]. 华西口腔医学杂志, 2020, 38(5): 541-545.
[13]	施雄, 李生娇, 周剑萍, 张利. 低剂量锥形束CT扫描可行性的实验研究[J]. 华西口腔医学杂志, 2020, 38(4): 415-418.
[14]	郭彪, 路荣建. 口腔矫治器治疗不同垂直骨面型的骨性Ⅱ类错畸形伴阻塞性睡眠呼吸暂停综合征患者上气道形态变化的锥形束CT分析[J]. 华西口腔医学杂志, 2020, 38(4): 419-424.
[15]	赵海燕, 王楠, 丁一, 郑海英, 钱君荣. 锥形束CT在上颌磨牙根分叉病变诊断中的准确性分析[J]. 华西口腔医学杂志, 2020, 38(3): 270-273.