CN108618854B - Digital design and manufacturing method of guide plate for root tip operation - Google Patents

Digital design and manufacturing method of guide plate for root tip operation Download PDF

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CN108618854B
CN108618854B CN201711026327.6A CN201711026327A CN108618854B CN 108618854 B CN108618854 B CN 108618854B CN 201711026327 A CN201711026327 A CN 201711026327A CN 108618854 B CN108618854 B CN 108618854B
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guide plate
root tip
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cbct
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CN108618854A (en
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王祖华
彭俐
孙玉春
梁宇红
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Peking University School of Stomatology
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61CDENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C1/00Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
    • A61C1/08Machine parts specially adapted for dentistry
    • A61C1/082Positioning or guiding, e.g. of drills
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61CDENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C19/00Dental auxiliary appliances
    • A61C19/06Implements for therapeutic treatment
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61CDENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C5/00Filling or capping teeth
    • A61C5/40Implements for surgical treatment of the roots or nerves of the teeth; Nerve needles; Methods or instruments for medication of the roots

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  • Health & Medical Sciences (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Epidemiology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Animal Behavior & Ethology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Dentistry (AREA)
  • Surgery (AREA)
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  • Engineering & Computer Science (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Neurosurgery (AREA)
  • Dental Tools And Instruments Or Auxiliary Dental Instruments (AREA)

Abstract

The invention relates to a digital design manufacturing method of a root tip operation guide plate, which comprises the following steps: 1) acquiring soft and hard tissue data in the mouth of a patient through oral CBCT scanning, and reconstructing a CBCT model in three dimensions; 2) carrying out intraoral 3D optical scanning to obtain a three-dimensional digital image of information of teeth and a mucous membrane surface of a patient; 3) the CBCT model is combined with the three-dimensional optical scanning model to accurately reconstruct a target tissue; 4) 3D model design of the guide plate for the root tip operation is carried out by applying reverse engineering software; 5) through 3D printing, a guide plate is manufactured according to the 3D root tip operation guide plate model. The invention combines CBCT three-dimensional image and intraoral 3D scanning, accurately positions the excision length, angle, depth and range of root tip lesion by computer aided design, and utilizes 3D printing to manufacture a root tip operation guide plate, thereby realizing accurate control of the operation, reducing the operation risk, reducing the operation difficulty to the utmost extent and improving the operation efficiency.

Description

Digital design and manufacturing method of guide plate for root tip operation
Technical Field
The invention relates to a guide plate for a root tip operation, in particular to a digital design and manufacturing method of the guide plate for the root tip operation.
Background
The microscopic apical operation is increasingly widely developed in China, and the affected teeth which are still difficult to cure after a large amount of conventional root canal treatment or are difficult to implement by non-operative retreatment under the condition that restorations such as piles, crowns and the like exist are saved. However, how to accurately position the root tip and accurately remove the root tip and protect adjacent important tissue structures is an important link for ensuring the success of the operation. But the operation still depends on the experience of the operator, and the judgment and guidance of objective means are lacked.
The computer aided design combined with the three-dimensional image is widely applied to the implantation operation, so that an operator can be accurately guided to complete the implantation of the implant, the operation risk is reduced, and the implantation survival rate is improved to a certain extent. However, the accuracy and the using effect of the surgical guide plate are only reported in few foreign cases if the surgical guide plate can be used for the root tip surgery. Compared with the implant operation, the approach of the root tip operation is different, the operation space is narrow, and the treatment mode of the tooth root and the protection of the surrounding important tissue structure need to be fully considered in the operation. Therefore, the design and manufacture of the surgical guide plate are significantly different from the design and manufacture of the implant surgery, and the design and manufacture of the surgical guide plate are very important.
Disclosure of Invention
The invention aims to provide a digital design and manufacturing method of a root tip operation guide plate, which combines CBCT three-dimensional images and intraoral 3D scanning, accurately positions the cutting length, angle, depth and the range of root tip pathological changes through computer aided design, and utilizes 3D printing to manufacture the root tip operation guide plate, thereby realizing the accurate control of the operation, reducing the operation risk, reducing the operation difficulty to the maximum extent and improving the operation efficiency.
In order to achieve the purpose, the invention has the following technical scheme:
the invention discloses a digital design manufacturing method of a root tip operation guide plate, which comprises the following steps:
1) acquiring soft and hard tissue data in the mouth of a patient through oral CBCT scanning, and reconstructing a CBCT model in three dimensions;
2) carrying out intraoral 3D optical scanning to obtain a three-dimensional digital image of information of teeth and a mucous membrane surface of a patient;
3) the CBCT model is combined with the three-dimensional optical scanning model to accurately reconstruct a target tissue;
4) 3D model design of the guide plate for the root tip operation is carried out by applying reverse engineering software;
5) through 3D printing, a guide plate is manufactured according to the 3D root tip operation guide plate model.
Introducing oral CBCT scanning data in the step 1) into CT three-dimensional reconstruction software, and firstly respectively performing three-dimensional reconstruction to obtain an initial three-dimensional entity image model containing alveolar bone contour, affected teeth and root tip lesion areas; and then trimming by using reverse engineering software geogenic studio, reserving a target range including the affected tooth and at least one half of adjacent teeth on both sides of the affected tooth, and generating three CBCT three-dimensional reconstruction models including alveolar bone contour, the affected tooth and apical lesion.
And 2), extending a scanning head on the intraoral 3D optical scanner into the mouth of the patient, and uniformly scanning the surface of the intraoral target range of the patient so as to obtain a three-dimensional digital image of the information of the surfaces of the affected teeth, the two adjacent teeth and the corresponding mucous membrane of the patient.
The step 3) further comprises the following steps of introducing the CBCT three-dimensional reconstruction model and the intraoral three-dimensional optical scanning digital image into a reverse engineering software geographic studio together for region registration: fixing a CBCT three-dimensional reconstruction alveolar bone contour model, and aligning the CBCT three-dimensional reconstruction alveolar bone contour model with a common crown part in an intraoral three-dimensional optical scanning digital image; the gap between the two is the soft tissue space.
Wherein, the 3D model design of the guide plate for the root tip operation by using reverse engineering software in the step 4) specifically comprises the following steps:
A. in the reverse engineering software geomagic studio, the following contents of a CBCT three-dimensional reconstruction model of the affected teeth are established: a sagittal plane is formed in the middle; the axial surface a is positioned in the crown of the apical point, and the distance between the axial surface a and the apical point is the excision length of the apical point and is generally 3 mm; the coronal plane b is positioned on the labial side or the buccal side of the coronal plane of the long axis of the overteeth, and the distance between the coronal plane of the long axis of the overteeth is more than 10 mm; the coronal plane c is positioned on the lingual side or the palatal side of the coronal plane passing through the long axis of the tooth and is tangent to the root plane cut by the axial plane a;
B. the incision scope of the root tip operation guide plate is positioned, and the characteristic curve is firstly positioned: the intersection line of the axial surface a and the intraoral three-dimensional optical scanning digital image is marked as a curve 1; the projection boundary of the root tip lesion on the three-dimensional optical scanning digital image along the normal direction of the coronal plane is marked as a curve m; the mid-proximal sagittal plane tangent to the apical lesion is marked as a plane d, the mid-distal sagittal plane is marked as a plane e, the intersection line of the plane d and the three-dimensional optical scanning digital image is marked as a curve n, the intersection line of the plane e and the three-dimensional optical scanning digital image is marked as a curve p, and a closed curve with a larger area and surrounded by the curve 1, the curve m, the curve n and the curve p is the incision range of the apical surgical guide plate; then, removing a part surrounded by the closed curve on the three-dimensional optical scanning digital image to obtain a root tip operation guide plate incision;
C. determining the outer boundary of the guide plate for the root tip operation on the intraoral three-dimensional optical scanning digital image, wherein the range needs to ensure that the guide plate covers the lesion of the root tip and simultaneously gives consideration to the positioning channel, the retention property and the stability of the guide plate; thus, obtaining the preliminary outline of the root tip surgical guide plate;
D. aiming at the preliminary outline of the root tip surgical guide plate with the selected external boundary and the cut, filling the junction between the teeth and the gum, the dents of the teeth and the tooth gaps in the target range so as to facilitate the guide plate to be in place;
E. thickening the outer surface by 1.0-3.0mm according to the initial contour of the guide plate for the root tip operation to obtain an initial guide plate;
F. further thickening the outer surface of the initial guide plate near the notch range by 1.0-5.0mm to obtain a first middle guide plate; secondly, cutting the first middle guide plate by a coronal surface b, and reserving a part of the inner side surface of the first middle guide plate; closing the intersecting surfaces to obtain a second intermediate guide plate;
G. at present, a gap with the thickness of soft tissue exists between the middle guide plate II and the bone surface, reverse engineering software is used for processing the inner side surface of the middle guide plate II, a plurality of spherical-like bulges are formed near the incision range, and the middle guide plate II and the alveolar bone contour surface in the CBCT three-dimensional reconstruction model reach a plurality of point-like contacts; and finally finishing the design of the 3D model of the root tip surgical guide plate.
Wherein, the step 5) specifically comprises the following steps: and printing the designed root tip operation guide plate 3D model by using a portable strip polylactic acid material by using a 3D printer.
The invention has the advantages that:
the invention combines CBCT three-dimensional image and intraoral 3D scanning, accurately positions the excision length, angle, depth and range of root tip lesion by computer aided design, and utilizes 3D printing to manufacture a root tip operation guide plate, thereby realizing accurate control of the operation, reducing the operation risk, reducing the operation difficulty to the utmost extent and improving the operation efficiency.
Drawings
FIG. 1 is a functional block diagram of a method of making a digital 3D root tip surgical guide of the present invention;
FIG. 2 is a schematic three-dimensional digital image of the corresponding alveolar bone surface and mucosal surface of the affected tooth, the diseased area of the apical root, the affected tooth and the bilateral adjacent teeth according to the present invention;
FIG. 3 is a schematic three-dimensional digital image of the corresponding mucosal surfaces of an affected tooth, a diseased area of a root tip, an affected tooth and bilateral adjacent teeth according to the present invention;
FIG. 4 is a schematic view of the intermediate guide of the present invention once in place;
FIG. 5 is a schematic view of the surgical guide with the tip in place.
In the figure, 1, three-dimensional optical scanning digital image; 2. a soft tissue space; 3. alveolar bone contours; 4. affected teeth; 5. a coronal plane b; 6. a root tip lesion area; 7. the median sagittal plane; 8. an axial surface a; 9. a coronal plane c; 10. a curve n; 11. curve p: 12. a guide plate notch; 13. a first middle guide plate; 14. a guide plate for a root tip operation; 15. a spheroidal protrusion.
Detailed Description
The following examples are intended to illustrate the invention but are not intended to limit the scope of the invention.
Referring to fig. 1-5, in an embodiment of the present invention, a digital design and manufacturing method of a root tip surgical guide plate includes the following steps:
1) acquiring soft and hard tissue data in the mouth of a patient through oral CBCT scanning, and reconstructing a CBCT model in three dimensions;
2) carrying out intraoral 3D optical scanning to obtain a three-dimensional digital image of information of teeth and a mucous membrane surface of a patient;
3) the CBCT model is combined with the three-dimensional optical scanning model to accurately reconstruct a target tissue;
4) 3D model design of the guide plate for the root tip operation is carried out by applying reverse engineering software;
5) through 3D printing, a guide plate is manufactured according to the 3D root tip operation guide plate model.
Introducing oral CBCT scanning data in the step 1) into CT three-dimensional reconstruction software, and firstly respectively performing three-dimensional reconstruction to obtain an initial three-dimensional entity image model containing alveolar bone contour, affected teeth and root tip lesion areas; and then trimming by using reverse engineering software geogenic studio, reserving a target range including the affected tooth and at least one half of adjacent teeth on both sides of the affected tooth, and generating three CBCT three-dimensional reconstruction models including alveolar bone contour, the affected tooth and apical lesion.
And 2), extending a scanning head on the intraoral 3D optical scanner into the mouth of the patient, and uniformly scanning the surface of the intraoral target range of the patient so as to obtain a three-dimensional digital image of the information of the surfaces of the affected teeth, the two adjacent teeth and the corresponding mucous membrane of the patient.
The step 3) further comprises the following steps of introducing the CBCT three-dimensional reconstruction model and the intraoral three-dimensional optical scanning digital image into a reverse engineering software geographic studio together for region registration: fixing a CBCT three-dimensional reconstruction alveolar bone contour model, and aligning the CBCT three-dimensional reconstruction alveolar bone contour model with a common crown part in an intraoral three-dimensional optical scanning digital image; the gap between the two is the soft tissue space.
Wherein, the 3D model design of the guide plate for the root tip operation by using reverse engineering software in the step 4) specifically comprises the following steps:
A. in the reverse engineering software geomagic studio, the following contents of a CBCT three-dimensional reconstruction model of the affected teeth are established: a sagittal plane is formed in the middle; the axial surface a is positioned in the crown of the apical point, and the distance between the axial surface a and the apical point is the excision length of the apical point and is generally 3 mm; the coronal plane b is positioned on the labial side or the buccal side of the coronal plane of the long axis of the overteeth, and the distance between the coronal plane of the long axis of the overteeth is more than 10 mm; the coronal plane c is positioned on the lingual side or the palatal side of the coronal plane passing through the long axis of the tooth and is tangent to the root plane cut by the axial plane a;
B. the incision scope of the root tip operation guide plate is positioned, and the characteristic curve is firstly positioned: the intersection line of the axial surface a and the intraoral three-dimensional optical scanning digital image is marked as a curve 1; the projection boundary of the root tip lesion on the three-dimensional optical scanning digital image along the normal direction of the coronal plane is marked as a curve m; the mid-proximal sagittal plane tangent to the apical lesion is marked as a plane d, the mid-distal sagittal plane is marked as a plane e, the intersection line of the plane d and the three-dimensional optical scanning digital image is marked as a curve n, the intersection line of the plane e and the three-dimensional optical scanning digital image is marked as a curve p, and a closed curve with a larger area and surrounded by the curve 1, the curve m, the curve n and the curve p is the incision range of the apical surgical guide plate; then, removing a part surrounded by the closed curve on the three-dimensional optical scanning digital image to obtain a root tip operation guide plate incision;
C. determining the outer boundary of the guide plate for the root tip operation on the intraoral three-dimensional optical scanning digital image, wherein the range needs to ensure that the guide plate covers the lesion of the root tip and simultaneously gives consideration to the positioning channel, the retention property and the stability of the guide plate; thus, obtaining the preliminary outline of the root tip surgical guide plate;
D. aiming at the preliminary outline of the root tip surgical guide plate with the selected external boundary and the cut, filling the junction between the teeth and the gum, the dents of the teeth and the tooth gaps in the target range so as to facilitate the guide plate to be in place;
E. thickening the outer surface by 1.0-3.0mm according to the initial contour of the guide plate for the root tip operation to obtain an initial guide plate;
F. further thickening the outer surface of the initial guide plate near the notch range by 1.0-5.0mm to obtain a first middle guide plate; secondly, cutting the first middle guide plate by a coronal surface b, and reserving a part of the inner side surface of the first middle guide plate; closing the intersecting surfaces to obtain a second intermediate guide plate;
G. at present, a gap with the thickness of soft tissue exists between the middle guide plate II and the bone surface, reverse engineering software is used for processing the inner side surface of the middle guide plate II, a plurality of spherical-like bulges are formed near the incision range, and the middle guide plate II and the alveolar bone contour surface in the CBCT three-dimensional reconstruction model reach a plurality of point-like contacts; and finally finishing the design of the 3D model of the root tip surgical guide plate.
Wherein, the step 5) specifically comprises the following steps: and printing the designed root tip operation guide plate 3D model by using a portable strip polylactic acid material by using a 3D printer.
As described above, the present invention can be more fully realized. The above description is only a reasonable embodiment of the present invention, and the scope of the present invention includes but is not limited to the above description, and any insubstantial modifications of the technical solution of the present invention by those skilled in the art are included in the scope of the present invention.

Claims (5)

1. A digital design and manufacturing method of a root tip surgical guide plate is characterized by comprising the following steps:
1) acquiring soft and hard tissue data in the mouth of a patient through oral CBCT scanning, and reconstructing a CBCT model in three dimensions;
2) carrying out intraoral 3D optical scanning to obtain a three-dimensional digital image of information of teeth and a mucous membrane surface of a patient;
3) accurately reconstructing a target tissue by combining the CBCT model and the three-dimensional digital image;
4) 3D model design of the guide plate for the root tip operation is carried out by applying reverse engineering software;
5) manufacturing a guide plate according to the 3D root tip operation guide plate model through 3D printing;
the 3D model design of the guide plate for the root tip operation by using reverse engineering software in the step 4) specifically comprises the following steps:
A. in the reverse engineering software geomagic studio, the following contents of a CBCT three-dimensional reconstruction model of the affected teeth are established: a sagittal plane is formed in the middle; the axial surface a is positioned in the crown of the apical point, the distance between the axial surface a and the apical point is the length of the excision of the apical point, and the length is 3 mm; the coronal plane b is positioned on the labial side or the buccal side of the coronal plane of the long axis of the overteeth, and the distance between the coronal plane of the long axis of the overteeth is more than 10 mm; the coronal plane c is positioned on the lingual side or the palatal side of the coronal plane passing through the long axis of the tooth and is tangent to the root plane cut by the axial plane a;
B. the incision scope of the root tip operation guide plate is positioned, and the characteristic curve is firstly positioned: the intersection line of the axial surface a and the intraoral three-dimensional digital image is marked as a curve 1; the projection boundary of the apical lesion on the three-dimensional digital image along the normal direction of the coronal plane is marked as a curve m; the mid-proximal sagittal plane tangent to the root tip lesion is marked as a plane d, the mid-distal sagittal plane is marked as a plane e, the intersection line of the plane d and the three-dimensional digital image is marked as a curve n, the intersection line of the plane e and the three-dimensional digital image is marked as a curve p, and a closed curve surrounded by the curve 1, the curve m, the curve n and the curve p is the incision range of the root tip surgical guide plate; then, removing a part surrounded by the closed curve on the three-dimensional digital image to obtain a root tip operation guide plate incision;
C. determining the outer boundary of the guide plate for the root tip operation on the intraoral three-dimensional digital image, wherein the range needs to ensure that the guide plate covers the lesion of the root tip and simultaneously has the positioning channel, the retention property and the stability; thus, obtaining the preliminary outline of the root tip surgical guide plate;
D. aiming at the preliminary outline of the root tip surgical guide plate with the selected external boundary and the cut, filling the junction between the teeth and the gum, the dents of the teeth and the tooth gaps in the target range so as to facilitate the guide plate to be in place;
E. thickening the outer surface by 1.0-3.0mm according to the initial contour of the guide plate for the root tip operation to obtain an initial guide plate;
F. further thickening the outer surface of the initial guide plate near the notch range by 1.0-5.0mm to obtain a first middle guide plate; secondly, cutting the first middle guide plate by a coronal surface b, and reserving a part of the inner side surface of the first middle guide plate; closing the intersecting surfaces to obtain a second intermediate guide plate;
G. at present, a gap with the thickness of soft tissue exists between the middle guide plate II and the bone surface, reverse engineering software is used for processing the inner side surface of the middle guide plate II, a plurality of spherical-like bulges are formed near the incision range, and the middle guide plate II and the alveolar bone contour surface in the CBCT three-dimensional reconstruction model reach a plurality of point-like contacts; and finally finishing the design of the 3D model of the root tip surgical guide plate.
2. The method of claim 1, wherein the method comprises the steps of:
importing oral CBCT scanning data in the step 1) into CT three-dimensional reconstruction software, and firstly respectively performing three-dimensional reconstruction to obtain an initial three-dimensional entity image model containing alveolar bone contour, affected teeth and root tip lesion areas; and then trimming by using reverse engineering software geogenic studio, reserving a target range including the affected tooth and at least one half of adjacent teeth on both sides of the affected tooth, and generating three CBCT three-dimensional reconstruction models including alveolar bone contour, the affected tooth and apical lesion.
3. The method of claim 1, wherein the method comprises the steps of:
and in the step 2), a scanning head on the intraoral 3D optical scanner is stretched into the mouth of the patient, and the surface of the intraoral target range of the patient is uniformly scanned, so that three-dimensional digital images of the information of the affected teeth, the two adjacent teeth and the corresponding mucous membrane surface of the patient are obtained.
4. The method of claim 1, wherein the method comprises the steps of:
the step 3) further comprises the following steps of introducing the CBCT three-dimensional reconstruction model and the intraoral three-dimensional digital image into reverse engineering software geographic studio together for region registration: fixing a CBCT three-dimensional reconstruction alveolar bone contour model, and aligning the CBCT three-dimensional reconstruction alveolar bone contour model with a common crown part in an intraoral three-dimensional digital image; the gap between the two is the soft tissue space.
5. The method of claim 1, wherein the method comprises the steps of:
the step 5) specifically comprises the following steps: and printing the designed root tip operation guide plate 3D model by using a portable strip polylactic acid material by using a 3D printer.
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