CN102415916A - Correction method for preventing excessive stress concentration of teeth roots and jaws in process of orthodontic treatment - Google Patents

Correction method for preventing excessive stress concentration of teeth roots and jaws in process of orthodontic treatment Download PDF

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CN102415916A
CN102415916A CN 201110217007 CN201110217007A CN102415916A CN 102415916 A CN102415916 A CN 102415916A CN 201110217007 CN201110217007 CN 201110217007 CN 201110217007 A CN201110217007 A CN 201110217007A CN 102415916 A CN102415916 A CN 102415916A
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correction
teeth
roots
jaws
process
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CN 201110217007
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Chinese (zh)
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厉松
曾晓雁
王振林
田杰
白玉兴
郭宏铭
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首都医科大学附属北京口腔医院
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61CDENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C7/00Orthodontics, i.e. obtaining or maintaining the desired position of teeth, e.g. by straightening, evening, regulating, separating, or by correcting malocclusions
    • A61C7/002Orthodontic computer assisted systems

Abstract

The invention relates to a correction method for preventing excessive stress concentration of teeth roots and jaws in the process of orthodontic treatment, belonging to the technical field of orthodontics of teeth. The correction method comprises the following steps of: establishing an automatic-matching 3D (three dimensional) integrated tooth-jaw model; carrying out stepwise virtual correction on the 3D integrated tooth-jaw model; applying 3D finite-element analysis to determine the dynamic change of stress distribution of the teeth roots and the jaws in the whole process of the virtual correction and guarantee that the stress of the teeth roots and the jaws in correction is in the safety range; and manufacturing a clinical correction device by a fast laser forming technology. By the individualized correction device designed and manufactured by a computer in an auxiliary manner, the positions and the routes of movement of the teeth roots can be controlled. By expression and verification, the correction method can duplicate the condition of virtual correction in actual treatment, realizes good position relation among the teeth roots, the teeth and the jaws in the correction process, and is beneficial to reducing and eliminating absorption of the teeth roots and the alveolar bones due to excessive stress concentration in the process of orthodontic treatment and reducing and avoiding recurrence after correction.

Description

防止正畸治疗过程中牙根和颌骨应力过度集中的矫治方法 The method of treatment to prevent the orthodontic treatment and root and excessive stress concentration maxillary

技术领域 FIELD

[0001] 本发明属于牙齿正畸技术领域,特别涉及一种防止正畸治疗过程中牙根和颂骨应力过度集中的矫治方法。 [0001] The present invention belongs to the technical field of orthodontics, more particularly to a method of orthodontic treatment during the treatment of root and bone to prevent excessive concentration of stress Chung.

背景技术 Background technique

[0002] 牙根吸收是正畸治疗的常见并发症之一,近年来的研究表明正畸治疗后牙根吸收甚至高达41. 6%,很多研究都表明正畸牙根吸收是伴随正畸治疗的常见现象,防止正畸治疗中牙根吸收是迫切需要解决的难题。 [0002] root resorption is a common complication of orthodontic treatment, recent studies have shown that root resorption after orthodontic treatment and even as high as 41.6 percent, many studies have shown that orthodontic root resorption is a common phenomenon associated with orthodontic treatment to prevent root resorption during orthodontic treatment is an urgent need to solve the problem. 正畸治疗牙根吸收的根本原因与牙齿移动过程中根尖应力过度集中有关,应力过度集中的原因,是牙根与颂骨在正畸治疗过程的位置关系不良造成的:例如前牙内收牙根靠近颂骨骨皮质会引起牙根吸收。 Orthodontic treatment and root resorption of the root causes of tooth movement apical stress related to excessive concentration due to excessive concentration of stress is the root of the mandible in poor positional relationship between orthodontic treatment caused: for example, received praise in the root near the front teeth cortical bone can cause root resorption. 但是如何准确判断牙根在颂骨内的安全移动范围,以及如何精确控制牙根在颂骨内的安全移动,这些问题目前文献中尚未见报道。 But how accurately determine the root within safe range of movement of the mandible, as well as how to root precise control of the security to move within the mandible, these problems have not been reported in the current literature.

[0003] 由于正畸牙根吸收是发生在三维方向上,传统的X片不能够准确观察。 [0003] Since the orthodontic root absorption occurs in three dimensions, the conventional X ray can not be accurately observed. 目前锥形束计算机断层扫描(cone beam computed tomography,CBCT)越来越广泛的应用于牙科,由于CBCT能够生成较高精度,与真实解剖机构1 : 1的三维图像,且放射剂量小,这对正畸牙根吸收的研究产生了巨大影响。 Currently cone-beam computed tomography (cone beam computed tomography, CBCT) is widely applied to dental CBCT can be generated due to the high precision, with the real anatomy mechanism 1: a three-dimensional image, and a small radiation dose, which Research orthodontic root resorption had a tremendous impact. CBCT扫描虽然可以获得详尽的硬组织图像,但是分辨率最高的CBCT图像也只有0. Imm左右的精度,不能精确的显示牙齿的形状或精确的咬合关系, 因此不能用基于CBCT的数字化模型制作临床矫治器(间接粘接托盘,个体化托槽,无托槽隐形矫治器)。 CBCT scan can be obtained although a detailed image hard tissue, but the highest resolution CBCT images, only about 0. Imm accuracy can not show the precise shape of the teeth or precise occlusion, and therefore can not be based on digital modeling CBCT clinical appliance (indirect bonding tray, individual brackets, no brackets invisible appliance). 它们的制作还必须依赖用激光或机构光扫描石膏模型建立的数字化牙冠模型,其精度可以达到0. 02mm甚至更高。 They must also rely on the production of a laser or optical scanning means plaster model of the digital model of the crown, its accuracy can reach 0. 02mm or even higher. 要在虚拟矫治和数字化排牙中应用包括牙根和颂骨的牙颂模型,并输出临床矫治器,就必须将基于CBCT的数字化模型和基于激光或机构光扫描数字化牙冠模型进行整合。 To apply the virtual appliance and digitized row of teeth in dental Chung model includes a root and the maxilla, and outputs the clinical appliance, it must be digitized model CBCT laser or institution optical scanning digital crown model performed based on integration.

[0004] 三维有限元分析是一种常用的应力分析方法,但是建模需应用放射剂量较大的CT,在放射剂量较低的CBCT没有广泛应用的情况下,目前尚不能在临床上对患者正畸治疗过程中牙根和颂骨进行动态的应力分析;另外一方面,目前虽然可以将牙根和颂骨纳入虚拟排牙,针对正畸治疗后牙根和颂骨位置关系进行控制,但是正畸牙根吸收是发生在正畸过程中,如何在整个正畸治疗过程中保证牙根和颂骨都没有应力过度集中,以往的技术尚不能完全解决。 [0004] Finite Element Analysis is a commonly used method of stress analysis, but the model should be applied a larger radiation dose CT, at a lower radiation dose CBCT widely without a case, the patient is not yet in the clinical orthodontic treatment and root maxilla and dynamic stress analysis; the other hand, although the current may be incorporated into the maxilla and root virtual row of teeth, for controlling the positional relationship between the root and the maxilla orthodontic treatment, the orthodontic root absorption occurs in the orthodontic process, how to ensure that throughout the course of orthodontic treatment and root maxilla are not excessive concentration of stress, the conventional technology is not yet fully resolved.

发明内容 SUMMARY

[0005] 本发明针对上述问题,公开了一种防止正畸治疗过程中牙根和颂骨应力过度集中的矫治方法。 [0005] The present invention addresses the above problems, there is disclosed a method of preventing orthodontic treatment during the treatment of bone and tooth root stress concentration over Chung.

[0006] 该方法具有以下步骤: [0006] The method has the steps of:

[0007] (1)建立自动配准3D整合牙颂模型: [0007] (1) the establishment of automatic registration teeth Chung 3D integration model:

[0008] (1. 1)取硅橡胶印取患者牙齿模型,并用石膏灌制,然后进行激光或结构光扫描, 获得数字化的牙冠;[0009] (1.2)对患者面部拍摄锥束计算机断层扫描图片,用软件重建出颂骨及全牙模型; [0008] (1.1) take the silicone rubber plate taking dental model of the patient, and gypsum irrigation system, and the laser or structured light scanning, obtaining digitized crown; [0009] (1.2) on the patient's face captured cone beam computed tomography pictures, software to reconstruct the mandible and the whole tooth model;

[0010] (1. 3)用逆向工程软件把激光或者结构光扫描成的牙冠与锥束计算机断层扫描重建的颂骨以及全牙模型自动配准后,切除重叠部分的牙冠,获得的3D整合牙颂模型包括激光或者结构光扫描的牙冠和锥束计算机断层扫描重建的牙根与颂骨; [0010] (1.3) with or reverse engineering software structure of the laser light is scanned with the crown mandible reconstruction of computed tomography and full cone beam dental model automatically after registration, the overlapping portions of the cut crown, obtained Chung 3D dental model integrated structure comprising a laser or optical scanning of the crown and the root cone beam tomography reconstruction mandible computer;

[0011] (¾在3D整合牙颂模型上进行分步虚拟矫治: [0011] (¾ for stepwise integration virtual 3D dental appliance in Chung Model:

[0012] (2. 1)在自动配准的3D整合牙颂模型上通过锥束计算机断层扫描和三维有限元分析确定牙根在颂骨内的安全移动范围,移动标准为:牙根的外表面离开皮质骨内表面0. 5mm以上,其中牙根的根尖离开皮质骨内表面Imm以上;每个牙根的外表面均离开其它牙的牙根外表面0. 5mm以上,每个牙根的根尖均离开其他牙的牙根外表面Imm以上;牙根的外表面离开弹性模量大于1 X IO4MPa的高密度结构表面0. 5mm以上,牙根的根尖离开弹性模量大于1 X IO4MPa的高密度结构表面Imm以上; [0012] (2.1) integrated on the 3D tooth model Chung automatic registration by cone beam tomography and three-dimensional finite element computer analysis to determine the range of safe movement in the root of the mandible, the mobile criteria: the outer surface of the tooth root leave the inner surface of the cortical bone than 0. 5mm, wherein the root apical surface away from the inner cortical bone Imm above; outer surface of each tooth root are away from the outer surface of the root of the other teeth 0. 5mm or more, away from each other are root apical the outer surface of the tooth root Imm above; away from the outer surface of the root of the elastic modulus of greater than 1 X IO4MPa high density 0. 5mm above the surface structure, leaving the root apical elastic modulus in a high density 1 X IO4MPa Imm above structure surface;

[0013] (2. 2)将三维牙颂整合模型上的每颗牙齿均分割成可以在三维方向移动牙齿,针对不同矫治器件分别进行分步虚拟矫治; [0013] (2.2) of each tooth on the three-dimensional teeth model integration Chung average cut into the teeth may be moved in three dimensions, by fractional treatment device for different virtual appliance, respectively;

[0014] (3)三维有限元动态应力分析: [0014] (3) dynamic finite element stress analysis:

[0015] (3. 1)将虚拟矫治过程中每一步整合牙颂模型上的牙根部分应用Mimics和Geomagic软件建立牙根_牙周膜_牙槽骨模型,并利用三维有限元分析软件Ansys划分网格和加载载荷; [0015] (3.1) the virtual integration of the treatment process each step of the root portion and Geomagic software applications Mimics Chung model tooth root _ _ periodontal alveolar bone model and three-dimensional finite element analysis software Ansys Meshing and loading load cell;

[0016] (3. 2)根据步骤(2. 2)的分步虚拟矫治计划设定牙根移动的位置和路线,整个过程中保证牙根应力最大不超过lOMPa,颂骨应力最大不超过2MPa ;虚拟矫治结果以矫治计划和Andrews新六要素标准确定,同时满足无牙根不平行、无牙根外露,即无骨开裂和骨开窗的情况; [0016] (3.2) moved position and set the root line in accordance with step (2.2) of the virtual treatment planning step, the whole process to ensure the root does not exceed the maximum stress Lompa, does not exceed the maximum bone stress Chung 2MPa; virtual treatment results and treatment plans Andrews new six elements to determine the standard, while meeting the non-root non-parallel, non-root exposure, that is not the case of bone and bone cracking the window;

[0017] (4)通过激光快速成形技术制作临床矫治装置。 [0017] (4) Clinical technical production rapid prototyping laser treatment apparatus.

[0018] 所述步骤(3.¾中,牙根应力进一步为最大不超过5MPa,颂骨应力进一步为最大不超过IMPa。 [0018] The step (3.¾, the root does not exceed the maximum stress of 5 MPa is more, Chung further stress the bone does not exceed a maximum IMPa.

[0019] 所述步骤(2. 2)中,所述矫治器件包括间接粘接托盘、个体化的唇、舌侧托槽、个体化的弓丝和无托槽隐形矫治器。 [0019] The step (2.2), the treatment device comprises an indirect bonding tray, individual lips, lingual bracket, the archwire individualized and no bracket invisible appliance.

[0020] 所述使用间接粘接托盘和个体化托槽的虚拟矫治分为以下5步: [0020] The use of indirect bonding trays and individual virtual treatment brackets divided into the following five steps:

[0021] 排齐平整初期:患者初始治疗时,使用0. 014英寸钛镍弓丝,弓丝未平整; [0021] Early aligned formation: the initial treatment of patients, the use of 0.014 inches nickel titanium archwire archwire unformed;

[0022] 排齐平整后期:使用0. 022X0. 016英寸TMA弓丝,弓丝未平整; [0022] aligned flat late: use 0. 022X0 016 Yingcun TMA arch wire arch wire is not smooth;.

[0023] 关闭间隙初期:使用0.022X0. 016英寸不锈钢弓丝,弓丝完全平整,但没有移动牙齿关闭间隙; Early [0023] Close the gap: use 0.022X0 016 inch stainless steel archwire, archwire completely flat, but there is no movement of teeth to close the gap;.

[0024] 关闭间隙后期:使用0.022X0. 016英寸不锈钢弓丝,移动牙齿关闭完成牙弓内所有间隙; [0024] Close the gap late: Use 0.022X0 016 inch stainless steel archwire, moving close to complete all gaps in the tooth arch;.

[0025] 治疗完成期。 [0025] completion of the treatment period.

[0026] 所述使用无托槽隐形矫治器的虚拟矫治分为20-30步,每一步牙齿的移动量在0. 2mm以内。 [0026] The use of non-bracket invisible appliance into a virtual treatment steps 20-30, the amount of movement for each step within the tooth 0. 2mm.

[0027] 本发明的有益效果为: [0027] Advantageous effects of the present invention are:

[0028] 通过虚拟矫治在治疗前就设定牙根在颂骨中移动的位置和路线,对整个实际正畸治疗过程进行模拟和控制,防止牙根和颂骨在正畸治疗中的应力过度集中,并通过先进技术将虚拟矫治转化为实际矫治,CAD/CAM的矫治装置(间接粘接托盘,个体化托槽,无托槽隐形矫治器)包含防止牙根和颂骨应力过度集中的信息,为防止正畸治疗中由于应力过度集中引起的牙根和牙槽骨吸收提供了解决方法,同时也可以避免正畸治疗后牙根不平行、 牙根外露(骨开裂和骨开窗)等副作用造成的牙周损伤和复发等风险。 [0028] by treatment before the treatment on the virtual root is set in movement and position of the mandible route simulation and the actual control of the entire orthodontic treatment, the root and to prevent stress in the maxilla excessive concentration of orthodontic treatment, and by treatment of advanced technology into practical virtual appliance, CAD / CAM apparatus of the appliance (indirect bonding tray, individual brackets, no brackets invisible appliance) comprises a root and bone to prevent information Chung excessive concentration of stress, to prevent positive Since the treatment of abnormal excessive stress concentration caused by root resorption of alveolar bone and provides a solution, but also avoid the orthodontic treatment is not parallel to the root, root exposure (bone and bone window cracking) and other side effects and damage caused by periodontal recurrence risk.

附图说明 BRIEF DESCRIPTION

[0029] 图1为本发明的流程图; [0029] FIG. 1 is a flowchart of the present invention;

[0030] 图2为激光扫描获得的牙冠模型; [0030] FIG. 2 is a crown obtained by laser scanner;

[0031] 图3 (a)和图3 (b)分别为CBCT重建获得的牙根和颂骨模型; [0031] FIG. 3 (a) and 3 (b), respectively the root and the maxilla model reconstructed CBCT obtained;

[0032] 图4为将激光扫描模型和CBCT模型整合后的3D牙颂模型; [0032] FIG. 4 is a 3D model of the dental laser scanning Chung model and model integration CBCT;

[0033] 图5 (a)和图5 (b)分别为牙根和颂骨动态应力分析 [0033] FIG. 5 (a) and 5 (b), respectively the root and the maxilla dynamic stress analysis

[0034] 图6为牙根在虚拟矫治各阶段应力分析示意图; [0034] FIG. 6 is a schematic view of the virtual root analyze each stage stress treatment;

[0035] 图7为虚拟矫治最后一步的排牙模型;图7(a)为牙根平行度示意图;图7(b)为牙根与颂骨位置关系示意图。 [0035] FIG. 7 is a final step the virtual row of teeth correction model; Parallelism schematic root 7 (a) is; FIG. 7 (b) and the root schematic positional relationship of the mandible.

具体实施方式 detailed description

[0036] 本发明提供了一种防止正畸治疗过程中牙根和颂骨应力过度集中的矫治方法,下面结合附图和具体实施方式对本发明做进一步说明。 [0036] The present invention provides a method of preventing orthodontic treatment during the treatment of bone and tooth root stress concentration over Chung, The present invention will be further described in conjunction with the accompanying drawings and specific embodiments.

[0037] 本发明所述方法的流程如图1所示: [0037] The process of the present invention, the method shown in Figure 1:

[0038] (1)制取数字化的牙列模型:用硅橡胶取患者印模,然后用高强度的石膏灌制模型,然后把牙合模型进行激光或机构光扫描获得数字化的牙合模型,如图2所示,其精确度较高。 [0038] (1) Preparation of digital dentition model: patients taking an impression of silicone rubber, and then with plaster irrigation system model of high strength, then the occlusal model laser or means light obtained by scanning occlusal digital model, such as As shown in FIG. 2, its high accuracy.

[0039] (2)重建颂骨以及牙根:拍摄患者颂面部CBCT,存为dicom格式文件,用Mimics软件根据牙齿与颂骨的密度不同而设置不同的阈值,选择合适的阈值将牙齿图像和颂骨图像分别分割三维重建,如图3(a)和图3(b)所示。 [0039] (2) reconstruction of the mandible and the root: shoot patients Chung face the CBCT, saved as dicom format, using Mimics software provided different threshold values ​​depending on the density of teeth and mandible, select the appropriate threshold tooth image and Chung bone reconstruction image is divided, as shown in FIG 3 (a) and 3 (b) shown in FIG.

[0040] (3)用逆向工程软件把激光或者结构光扫描成的牙冠与CBCT重建的牙冠自动配准后,将CBCT图像的牙冠部分切割掉,保留的CBCT牙根和颂骨的图像与扫描模型的牙冠图像合并,获得的3D整合牙颂模型包括激光或者结构光扫描的牙冠和CBCT重建的牙根与颂骨,如图4所示。 [0040] (3) reverse engineering software with a laser or structured light scanning and CBCT into crown crown reconstruction after automatic registration, the crown portion CBCT images cut off, retained root CBCT image and maxilla combined with scanning the image crown model, 3D integration Chung model dental crown and including the obtained reconstructed CBCT root mandible with a laser or structured light scanning, as shown in FIG.

[0041] (4)在自动配准的3D整合牙颂模型上通过锥束计算机断层扫描和三维有限元分析确定牙根在颂骨内的安全移动范围,移动标准为:牙根的外表面离开皮质骨内表面0. 5mm以上,其中牙根的根尖离开皮质骨内表面Imm以上;每个牙根的外表面均离开其它牙的牙根外表面0. 5mm以上,每个牙根的根尖均离开其他牙的牙根外表面Imm以上;牙根的外表面离开弹性模量大于1 X IO4MPa的高密度结构表面0. 5mm以上,牙根的根尖离开弹性模量大于1 X IO4MPa的高密度结构表面Imm以上。 [0041] (4) on a 3D integrated dental Chung model automatic registration by cone beam tomography and three-dimensional finite element computer analysis secure movement range of the root within the mandible, the mobile criteria: the outer surface of the root leaving cortical bone 0. 5mm above the inner surface, wherein the apical root from the surface within the cortical bone Imm above; root outer surface of each other are away from the outer surface of the tooth root 0. 5mm or more, away from each other are root apical tooth Imm above the outer root surface; the outer surface of the root exiting the elastic modulus greater than 1 X IO4MPa high density 0. 5mm above the surface structure, leaving the root of the modulus of elasticity in the apical 1 X IO4MPa high density structure than the surface Imm.

[0042] (5)在3D整合牙颂模型上针对间接粘接托盘、个体化托槽或无托槽隐形矫治器分别进行分步虚拟矫治:在三维牙颂整合模型上运用软件,将每颗牙齿分割成可以在三维方向移动牙齿,然后按照治疗计划进行分步虚拟矫治在动态虚拟矫治整个过程中保证牙根最大应力不超过IOMpa (实际应用中最好不超过为5Mpa);颂骨最大应力不超过2MPa(实际应用中最好不超过IMpa); [0042] (5) respectively on the integration of 3D dental model for indirect bonding tray Chung, no individual brackets or bracket invisible appliance virtual appliance step: application software integration in three-dimensional dental Chung model, each tablet may move the teeth into the tooth in three-dimensional directions, then step treatment according to the treatment plan to ensure the virtual root does not exceed the maximum stress IOMpa (preferably no more than a practical application is of 5Mpa) dynamic virtual treatment in the whole process; the maximum stress of not mandible than 2MPa (preferably no more than a practical application of IMPA);

[0043] 对于间接粘接托盘和个体化托槽的虚拟矫治分为以下5步: [0043] For a virtual appliance indirect bonding trays and individual brackets divided into the following five steps:

[0044] 排齐平整初期:患者未治疗时,使用0. 014英寸钛镍弓丝,弓丝未平整; [0044] Early aligned formation: untreated patients, using 0.014 inches nickel titanium archwire archwire unformed;

[0045] 排齐平整后期:使用0. 022X0. 016英寸TMA弓丝,弓丝未平整; [0045] aligned flat late: use 0. 022X0 016 Yingcun TMA arch wire arch wire is not smooth;.

[0046] 关闭间隙初期:使用0.022X0. 016英寸不锈钢弓丝,弓丝完全平整,但没有移动牙齿关闭间隙; Early [0046] Close the gap: use 0.022X0 016 inch stainless steel archwire, archwire completely flat, but there is no movement of teeth to close the gap;.

[0047] 关闭间隙后期:使用0.022X0. 016英寸不锈钢弓丝,移动牙齿关闭完成牙弓内所有间隙; [0047] Close the gap late: Use 0.022X0 016 inch stainless steel archwire, moving close to complete all gaps in the tooth arch;.

[0048] 治疗完成期。 [0048] completion of the treatment period.

[0049] 对于无托槽隐形矫治器的虚拟矫治分为20-30步,每一步牙齿的移动量在0. 2mm 以内。 [0049] For a virtual appliance without bracket invisible appliance into 20-30 steps, each step the amount of movement of the teeth within 0. 2mm.

[0050] (6)对牙根和颂骨进行动态应力分析:将虚拟矫治每一步整合牙颂模型上的牙根部分应用Mimics和Geomagic软件建立牙根-牙周膜-牙槽骨模型,并保存为三维有限元分析软件Ansys可以识别的格式,然后确定材料参数,划分网格和加载(10N*mm),如图5所 [0050] (6) and the root of the maxilla dynamic stress analysis: the virtual integration of the root portion of each step of treatment with Mimics Chung model on a dental root establishment and Geomagic software - periodontal ligament - alveolar bone model, and save it as a three-dimensional Ansys finite element analysis software may identify a format, and then determining the material parameters, meshing and loading (10N * mm), as shown in FIG 5

7J\ ο 7J \ ο

[0051] (7)通过三维有限元分析设定牙根移动的位置和路线:应用三维有限元分析确定虚拟矫治整个过程中牙根和颂骨应力分布的动态变化,如果有应力过度集中的情况(牙根最大等效应力大于5Mpa,或者牙槽骨最大等效应力大于IMpa)则重新调整虚拟矫治牙根移动的位置和路线,保证牙根和颂骨应力在虚拟矫治各阶段都在安全范围内,如图6所示。 [0051] (7) set by the finite element analysis of the root line and moved position: 3D finite element analysis to determine the virtual appliance dynamic change during the whole root and bone stress distribution Chung, if there is an excessive concentration of the stress (root is greater than the maximum equivalent stress of 5Mpa, alveolar bone or greater than the maximum equivalent stress of IMPA) readjust the root virtual appliance moved position and routes, to ensure root and bone stress Chung various stages in the virtual treatment in a safe range, 6 Fig.

[0052] 虚拟矫治最后结果:根据矫治计划和Andrews新六要素(包括颂骨)标准完成虚拟矫治最后一步排牙模型。 [0052] Virtual Appliance final result: a standard virtual appliance complete treatment plan based on the new Andrews and six elements (including the mandible) The final step tooth arrangement model. 同时要求无牙根不平行,如图7(a),无牙根外露,如图7(b)。 No root while not parallel, as shown in FIG 7 (a), no root exposure, FIG. 7 (b). 关于Andrews新六要素的内容请参见:张珂,白丁=Andrews 口颂面协调六要素在侧貌美学中的应用.国际口腔医学杂志,2010,37½) :P236-239 ;Andrews LF : The six elements of orofacial harmony[J]. Andrews J Orthod Orofac Harmony,2000,1(1) :13_22。 Content on the new six elements Andrews, see: Zhang Ke, commoner = Andrews opening song, coordinated application of international medical journal in the six elements of Learning in the beautiful side of the mouth, 2010,37½): P236-239; Andrews LF:. The six elements of orofacial harmony [J] Andrews J Orthod Orofac Harmony, 2000,1 (1):. 13_22.

[0053] (8)通过激光快速成形技术制作临床矫治装置: [0053] (8) making clinical rapid prototyping laser treatment apparatus:

[0054] 间接粘接托盘的制作:在虚拟矫治最后一步的模型上用三维绘图软件绘制全尺寸个体化舌侧或唇侧弓丝,用个体化弓丝定位虚拟舌侧或唇侧托槽,然后把含有定位好的托槽的整合模型的每个牙的坐标回到原来的错合状态,在错合模型上用软件生成虚拟间接粘接托盘,用激光快速成型技术输出实物转移托盘,转移托盘和个体化弓丝包含牙根移动位置和路线的信息。 [0054] Production of indirect bonding tray: at the last step of the model of the virtual full-size drawing individualized treatment lingual or labial side of the archwire three-dimensional graphics software, virtual lingual or labial side of the bracket with the archwire positioning individual, then the coordinates of each tooth comprising integrated model bracket good positioning groove back to the original malocclusion state, generating a virtual indirect bonding tray on malocclusion software model, rapid prototyping technology with laser output physical transfer tray, transfer pallets and individual arch wire root contains information mobile location and route.

[0055] 个体化托槽的制作:在虚拟矫治最后一步的模型上生成个体化托槽底版和绘制全尺寸个体化舌侧或唇侧弓丝,用个体化弓丝定位绘制好的托槽体,然后用软件将托槽底板与托槽体合并完成个体化托槽计算机辅助设计。 [0055] Production of individual brackets: generating individual tray bottom plate and the full-size drawing individualized lingual or labial side of the archwire in a virtual model on the last treatment step, the bracket body with good drawing individualized positioning archwire and then the bottom bracket software bracket body of the bracket merger individual computer-aided design. 用选区激光熔化技术(selective laser metling,SLM)将虚拟的个体化托槽直接输出为实物托槽,个体化托槽和个体化弓丝包含牙根移动位置和路线的信息。 Melting technology (selective laser metling, SLM) with Selective Laser output virtual direct individual brackets for the physical brackets, individual brackets and archwire comprising individual movement position information and routes root.

[0056] 个体化弓丝的制作:根据CAD模型采用机械手或手工弯制个体化弓丝。 [0056] archwire individualized production: The CAD model using a robot hand or the individual archwire bending.

[0057] 无托槽隐形矫治器的制作:按照治疗计划将虚拟矫治分为20-30步,进一步可以更细致的分为50步,保证每一步牙根和颂骨应力在安全范围,通过激光快速成形制作每一步的牙列模型(光固化模型),在光固化模型上真空压膜得到与虚拟矫治步骤相对应的无托槽隐形矫治器。 [0057] No bracket invisible appliance production: virtual appliance in accordance with the treatment plan will be divided into 20-30 steps further divided into 50 more detailed steps to ensure that every step of the root and bone stress Chung in a safe range, laser fast making each step forming dentition model (model photocuring), on the model of the photocurable film vacuo to give the corresponding virtual treatment step without bracket invisible appliance.

[0058] 临床应用效果:应用本发明所述方法制成的矫治器完成的临床病例,所有矫治牙齿发生牙根吸收(指治疗后原有牙根形态或者牙根长度改变)的比例在10%以内,所有发生牙根吸收的牙齿其吸收量在2mm以内;治疗后无牙根不平行(相邻牙齿牙根角度在15° 以内),无牙根外露于颂骨。 [0058] The clinical effect: The rate of the appliance case is made by the application method of the present invention is completed, all the dental treatment root resorption occurs (refer to the original root form or after treatment altered root length) is less than 10% of all tooth root absorption occurs within the volume which is absorbed 2mm; no non-parallel to the root (the adjacent tooth root angle within 15 °), no root exposure to the mandible after treatment.

Claims (5)

  1. 1.防止正畸治疗过程中牙根和颂骨应力过度集中的矫治方法,其特征在于,具有以下步骤:(1)建立自动配准3D整合牙颂模型:(1. 1)取硅橡胶印取患者牙齿模型,并用石膏灌制,然后进行激光或结构光扫描,获得数字化的牙冠;(1.2)对患者面部拍摄锥束计算机断层扫描图片,用软件重建出颂骨及全牙列模型;(1. 3)用逆向工程软件把激光或者结构光扫描成的牙冠与锥束计算机断层扫描重建的颂骨以及全牙列模型自动配准后,切除重叠部分的牙冠,获得的3D整合牙颂模型包括激光或者结构光扫描的牙冠和锥束计算机断层扫描重建的牙根与颂骨;(2)在3D整合牙颂模型上进行分步虚拟矫治:(2. 1)在自动配准的3D整合牙颂模型上通过锥束计算机断层扫描和三维有限元分析确定牙根在颂骨内的安全移动范围,移动标准为:牙根的外表面离开皮质骨内表面0. 5mm 以上,其 1. A method to prevent the orthodontic treatment during the treatment of bone and tooth root stress concentration over Chung, comprising the steps of: (1) establishing automatic registration dental 3D integration Chung model: (1 1) taking printing takes silicone rubber dental model of the patient, and gypsum irrigation system, and the laser or structured light scanning, to obtain the digitized crown; (1.2) on the patient's face captured cone beam computed tomography images, using software to reconstruct the mandible and full dentition model; (1 after. 3), or reverse engineering software structure of the laser light scanned with the crown cone beam tomographic reconstruction computer edentulous maxilla model and automatic registration, the overlapping portion of the cut crown, the obtained integrated 3D dental Chung model includes a laser or optical scanning of the crown structure and the cone beam tomographic reconstruction root computer and mandible; (2) for stepwise integration of a virtual 3D dental appliance in Chung model: (. 21) in the automatic registration of 3D Chung model by integration of dental tomography and cone beam computer finite element analysis secure root within the range of movement of the mandible, the mobile criteria: the outer root surface away from the inner surface of the cortical bone than 0. 5mm, which 中牙根的根尖离开皮质骨内表面Imm以上;每个牙根的外表面均离开其它牙的牙根外表面0. 5mm以上,每个牙根的根尖均离开其他牙的牙根外表面Imm以上;牙根的外表面离开弹性模量大于1 X IO4MPa的高密度结构表面0. 5mm以上,牙根的根尖离开弹性模量大于1 X IO4MPa的高密度结构表面Imm以上;(2. 2)将三维牙颂整合模型上的每颗牙齿均分割成可以在三维方向移动牙齿,针对不同矫治器分别进行分步虚拟矫治;(3)三维有限元动态应力分析:(3. 1)将虚拟矫治过程中每一步整合牙颂模型上的牙根部分应用Mimics和Geomagic 软件建立牙根-牙周膜-牙槽骨模型,并利用三维有限元分析软件Ansys划分网格和加载载荷;(3.2)根据步骤(2.¾的分步虚拟矫治计划设定牙根移动的位置和路线,整个过程中保证牙根应力最大不超过lOMPa,颂骨应力最大不超过2MPa ;虚拟矫治结果以矫治计划和 And root apical away from the inner surface of the cortical bone Imm above; outer surface of each tooth root are away from the outer surface of the root of the other teeth than 0. 5mm, each of the root apical are away from the outer root surface of teeth other than Imm; root away from the outer surface of the elastic modulus for high density surface structure of 1 X IO4MPa 0. 5mm or more, leaving the root apical elastic modulus greater than 1 X IO4MPa high density structure surface Imm above; (. 22) three-dimensional dental Chung each tooth on average cut into integration model tooth may be moved in three dimensions, by fractional treatment for different virtual appliance, respectively; (3) dynamic stress finite element analysis: (3 1.) the virtual treatment process each step root portion and integrated with Mimics software Geomagic Chung model a dental root - periodontal ligament - alveolar bone model, and the three-dimensional finite element analysis software Ansys meshing and loading load; (3.2) according to step (2.¾ of step by step virtual treatment plan set the root location and movement of the line, the whole process to ensure maximum root stress of not more than lOMPa, Chung does not exceed the maximum bone stress 2MPa; virtual treatment plan and treatment results Andrews新六要素标准确定,同时满足无牙根不平行、无牙根外露;(4)通过激光快速成形技术制作临床矫治装置。 Andrews new criteria to determine six elements, no root satisfies not parallel, non-root exposure; (4) the clinical treatment technology produced by rapid prototyping laser apparatus.
  2. 2.根据权利要求1所述的防止正畸治疗过程中牙根和颂骨应力过度集中的矫治方法, 其特征在于,所述步骤(3.¾中,牙根应力进一步为最大不超过5MPa,颂骨应力进一步为最大不超过IMPa。 The treatment method of orthodontic treatment during root and the bone of the excessive concentration of stress Chung prevent claim 1, wherein said step (3.¾, the root does not exceed the maximum stress of 5 MPa is more, mandible further stress does not exceed the maximum IMPa.
  3. 3.根据权利要求1所述的防止正畸治疗过程中牙根和颂骨应力过度集中的矫治方法, 其特征在于,所述步骤(2.¾中,所述矫治器包括间接粘接托盘、个体化托槽和无托槽隐形矫治器。 The treatment method of orthodontic treatment during root and the bone of the excessive concentration of stress Chung prevent claim 1, wherein said step (2.¾, the appliance comprises an indirect bonding tray, individual None of brackets and bracket invisible appliance.
  4. 4.根据权利要求3所述的防止正畸治疗过程中牙根和颂骨应力过度集中的矫治方法, 其特征在于,所述使用间接粘接托盘和个体化托槽的虚拟矫治分为以下5步:排齐平整初期:患者初始治疗时,使用0. 014英寸钛镍弓丝,弓丝未平整;排齐平整后期:使用0. 022X0. 016英寸TMA弓丝,弓丝未平整;关闭间隙初期:使用0. 022X0. 016英寸不锈钢弓丝,弓丝完全平整,但没有移动牙齿关闭间隙;关闭间隙后期:使用0. 022X0. 016英寸不锈钢弓丝,移动牙齿关闭完成牙弓内所有间隙;治疗完成期。 The treatment method of orthodontic treatment during root and the bone of the excessive concentration of stress Chung prevent claim 3, wherein said indirect bonding trays and individual virtual bracket 5 divided into the following treatment steps : initial formation aligned: the initial treatment of patients, the use of 0.014 inches nickel titanium archwire archwire unformed; post-aligned formation: 0. 022X0 016 inch using TMA archwire archwire unformed; initial gap closed. : use 0. 022X0 016 inch stainless steel arch wire, the arch wire completely flat, but there is no tooth movement to close the gap; the gap close late: use 0. 022X0 016 inch stainless steel arch wire, complete tooth movement to close all gaps in the arch; treatment. completion date.
  5. 5.根据权利要求3所述的防止正畸治疗过程中牙根和颂骨应力过度集中的矫治方法, 其特征在于,所述使用无托槽隐形矫治器的虚拟矫治分为20-30步,每一步牙齿的移动量在0. 2mm以内。 The treatment method of orthodontic treatment during root and the bone of the excessive concentration of stress Chung prevent claim 3, wherein said bracket without the use of invisible virtual appliance into the appliance 20-30 steps, each the amount of movement of the teeth in one step within 0. 2mm.
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CN105596091A (en) * 2016-03-14 2016-05-25 四川大学 Navigation device for root canal treatment and making method thereof
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