WO2017193981A1 - 一种口腔修复体cad/金属3d自动化加工方法 - Google Patents

一种口腔修复体cad/金属3d自动化加工方法 Download PDF

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Publication number
WO2017193981A1
WO2017193981A1 PCT/CN2017/084052 CN2017084052W WO2017193981A1 WO 2017193981 A1 WO2017193981 A1 WO 2017193981A1 CN 2017084052 W CN2017084052 W CN 2017084052W WO 2017193981 A1 WO2017193981 A1 WO 2017193981A1
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metal
cad
dental prosthesis
processing
dental
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PCT/CN2017/084052
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French (fr)
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高勃
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中国人民解放军第四军医大学
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C13/00—Dental prostheses; Making same
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C13/00—Dental prostheses; Making same
    • A61C13/0003—Making bridge-work, inlays, implants or the like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C13/00—Dental prostheses; Making same
    • A61C13/0003—Making bridge-work, inlays, implants or the like
    • A61C13/0004—Computer-assisted sizing or machining of dental prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C13/00—Dental prostheses; Making same
    • A61C13/0003—Making bridge-work, inlays, implants or the like
    • A61C13/0006—Production methods
    • A61C13/0018—Production methods using laser
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C13/00—Dental prostheses; Making same
    • A61C13/0003—Making bridge-work, inlays, implants or the like
    • A61C13/0006—Production methods
    • A61C13/0019—Production methods using three dimensional printing

Definitions

  • the invention belongs to the technical field of dental prosthesis, and particularly relates to a new CAD/metal 3D automatic processing method for dental prosthesis, which combines the existing oral CAD system with metal 3D printing technology to achieve rapid and personalized production of metal oral cavity. Prosthesis.
  • CAD Computer aided design
  • CAM Computer Aided Manufacturing
  • CAD/CAM systems At present, more than 10 kinds of CAD/CAM systems have been introduced, which can be used to make inlays, veneers, full crowns, partial crowns, fixed bridges, implant bridges, etc.
  • the oral CAD/CAM system usually consists of three parts: data acquisition (digital impression), computer aided design (CAD), and computer aided production (CAM).
  • CAD computer aided design
  • CAM computer aided production
  • CNC milling machines are an important component.
  • Prosthetic machining uses a CNC milling machine to control the milling method to remove excess material to obtain a restoration that meets the shape, size and surface roughness requirements.
  • This technology is essentially in the category of material removal, which is called "subtraction" in the field.
  • the Cerec system was developed and gradually refined by the German SIEMENS Dental Division, now the German SIRONA Dental Equipment GmbH. Its product line includes CerecI, CerecII and CerecIII as well as Cerec in Lab. Cerec III is the Cerec III system born in 2000. The system is based on the Windows platform. The cutting system and the image acquisition system work independently. The software system has also been greatly improved, making the Cerec III system capable of making inlays, onlays, veneers. , partial crown and full crown. However, the Cerec III software system can only be designed on the plane, and it is difficult to display the overall shape of the restoration. The Cerec 3D system was first exhibited at the Hinman Dental Congress in Atlanta, USA in March 2003.
  • Cerec 3D software system has added 3D design software such as FrameWork to realize the repair of all-ceramic fixed bridge.
  • Sirona introduced the Cerec in Lab system, which was specially designed for the lab. It uses a laser scanning system to collect dental data. The restoration is made faster, has a wider range of applications, and can be used with higher intensity. Alumina, zirconia ceramic materials.
  • the Celay system was designed by the Zurich School of Dentistry and first exhibited in Kunststoff in 1990 and is now produced by the Swiss company Mikroma.
  • the system is not a CAD/CAM system in a complete sense.
  • the principle is similar to a small key copying machine. It consists of two parts, a contact sensor and a micro-milling machine.
  • the sensor head is “read” in the mouth or on the model.
  • Hard surface wax or resin restoration surface shape data, and the data is simultaneously transmitted to the milling machine to simultaneously process the porcelain restoration.
  • the system is simple in composition and low in automation. When working, you must first make a temporary restoration in the mouth or on the model as a source of information for obtaining data.
  • the Celay system mainly utilizes alumina alumina machinable ceramic processing.
  • the inlay or onlay of the occlusal surface can also process the base crown of the full crown or fixed bridge.
  • the Procera system is a Swedish system and was introduced to the market in 1993 by Nobel Biocare.
  • the system now uses Procera Piccolo or a more advanced Procera Forte scanner to collect data on the dental model.
  • the physician designs the prosthesis with Procera Lofrwore 2.0 software and transmits the data over the Internet to the four production centers designated by the Procera system. (Stockholm, Sweden; Fair Lawn, NJ, USA; Karlskoga, Sweden; Tokyo, Japan) Perform processing of the restoration.
  • the processing center can be directly processed into the final zirconia and alumina all-ceramic crown bridge according to the doctor's requirements, or it can be processed into zirconia and alumina substrates to be post-posted and then surface-mounted porcelain.
  • the Procera system can also be used in the field of planting.
  • the Procera system can cut a single tooth abutment of pure titanium or zirconia, which can be used to personalize the height, angle and edge shape of the abutment; the Procera system can also cut a plant made of pure titanium or zirconia. It can provide up to 14 units of plantation bridges with excellent biocompatibility, excellent strength and aesthetics.
  • the Cercon system scans the data on the dental model with the Cercon Eye Scanner 3D laser and transmits it to the Cercon Art CAD section to design the restoration.
  • the design information is then passed to the Cercon Brain section to cut the restoration or pass the information through the Internet. Passed to the production center in York to process the restoration. So for some small dental clinics or mechanic centers, you can buy only the Cercon Art CAD part of the Cercon system (which already includes the Cercon Eye Scanner scanner), which reduces costs.
  • Cercon Art CAD provides a sophisticated design of the edges and faces of the restoration.
  • the Cercon system is based on zirconia structural ceramics and can be used to make post cores, implant abutments, full crowns and fixed bridges.
  • the Lava system was launched in 2002 by 3M, USA, by Lava Scan, Lava CAD, Lava Form, Lava Therm and other components. Firstly, the non-contact 3D optical scanning system was used to collect the data on the dental model. The physician used Lava Design 4.0 software to design the prosthesis. After the completion, the base crown was obtained by cutting the pre-sintered zirconia ceramic block, and the average per unit crown was needed. 35 minutes. After the cutting is completed, the crown base crown is completely sintered, and then the surface porcelain is added on the surface. Compared to the Vita colorimetric system, the Lava zirconia base crown has 7 color choices, and the veneer porcelain has 16 color choices. Therefore, the restoration made by the Lava system has the closest color and light transmission to natural teeth. It is suitable for the repair of fixed bridges with 3 ⁇ 4 units for single crown and front and back teeth.
  • the Everest system was introduced to the market in 2002 by the German company Kavo.
  • the system consists of four components: Everest scan, Everest engine, Everest therm, and Everest elements.
  • the Everest scan data scanning system (using a CCD camera) collects data on the dental model.
  • the operator uses ENERGY CAD software to perform 3D design on the restoration, and then the CAM part is on the X, Y, Z, A, and B axes. Perform a machining of the restoration. Therefore, the restoration made by the Everest system has good processing precision and clear anatomy.
  • the Everest system can process a wide range of materials, including zirconia, alumina, pure titanium, glass ceramics, gold, resins, etc., for implants, veneers, inlays, onlays, single crowns and fixed bridges.
  • the open system is an "assembled" CAD/CAM system that has appeared on the market in recent years. Its data acquisition system, CAD system, and CAM system can be assembled and assembled by different companies. There are two options for the more mature open systems on the market today:
  • the advantages of open systems are: the materials that can be processed are more Wide range, production costs are also cheaper.
  • Rapid Prototyping/Rapid Prototyping Manufacturing is an advanced manufacturing technology developed in the late 1980s.
  • the technology combines computer-aided design (CAD), computer-aided manufacturing (CAM), computer numerical control (CNC), precision servo drive, laser and materials science into one, adopting the idea of discrete-stack stacking, basic idea Yes: Any 3D part can be thought of as the superposition of many 2D planar contours along a certain coordinate.
  • RP technology cannot directly produce metal restorations to meet the needs of oral restoration.
  • Rapid Manufacturing a combination of RP technology and laser coating technology, used a pre-laying or simultaneous powder feeding method to deposit powder materials layer by layer by laser. Components. The formed parts have excellent physical and chemical properties and are not limited by complicated structures.
  • RP technology and RM technology are essentially additive production, that is, "addition”.
  • SLM selective laser melting
  • EBM Electro Beam Melting
  • the former mainly produces cobalt-chromium alloy crown bridges, crown bridge bases or removable partial denture brackets. In the manufacture of metal implants.
  • Bennett used the MCP Realizer device based on SLM technology to make base crowns, fixed crowns and fixed bridges of cobalt-chromium alloy and stainless steel.
  • the crown shape was good after fabrication.
  • French scholar Nadine applied and developed the Phenix SLM system to design and manufacture the base crown of nickel-chromium alloy. The shape and precision of the base crown were good. After the porcelain was melted, the porcelain crown was very good. Color matching and edge suitability.
  • the complete denture has a complex shape and the materials of the dentures are diverse.
  • the CAD/CAM study of the complete denture is relatively lagging.
  • Gao Bo the Fourth Military Medical University of the Chinese People's Liberation Army, designed the maxillary half-metal base denture through the Surfacer software, and used the laser stereo forming technology to initially process the upper half base.
  • 2008 and 2009 Gao Bo of the Fourth Military Medical University of the Chinese People's Liberation Army published a laser rapid prototyping of a complete denture with a maxillary titanium substrate.
  • Lasers Med Sci (2010) 25:309–315, Rapid Prototyping Journal Volume15 ⁇ Number2 ⁇ 2009 ⁇ 133 ⁇ 136, and its suitability research, clinical test results show that its production accuracy needs to be improved.
  • CAD/CAM technology in the oral field has greatly improved the repair efficiency, shortened the patient treatment cycle, reduced the patient's pain and reduced the labor intensity of the technician, and made the dental prosthesis revolutionized.
  • the current CAD/CAM system is mainly used in the field of fixed repair, but the main reason for the lack of application in removable partial dentures and full dentures is the inherent limitations of CAD/CAM system cutting. Sexuality not only causes waste of materials, but also makes the type of restoration produced by a single type, and it is impossible to cut the composite of the composite material.
  • the metal 3D printing technology can replace the traditional CAD/CAM system cutting manufacturing technology, which is called the oral CAD/metal 3D printing system, it will be able to better expand the indications and repairs of the dental prosthesis. Body mass.
  • the present invention aims to provide a new method for processing a dental prosthesis, which combines the existing dental CAD system with metal 3D printing technology to achieve rapid personalized production.
  • Metal dental prosthesis combines the existing dental CAD system with metal 3D printing technology to achieve rapid personalized production.
  • a dental prosthesis CAD/metal 3D automated processing method characterized in that the method uses a composite system consisting of an optical scanning and computer aided design system, a CAD assisting system and a selective laser cladding machine to process the oral prosthesis, specifically including the following step:
  • Step one routinely complete the three-dimensional shape scan of the patient's intraoral or extraoral plaster model and establish a data model consistent with the oral missing condition;
  • Step 2 according to the design principle of the dental prosthesis, adopting the CAD auxiliary system to complete the design and manufacture of the oral prosthesis, and the output data format is the STL format compatible with the selective laser cladding machine;
  • Step 3 The selective laser cladding machine uses the metal powder material formed by SLM to discretize the three-dimensional data model of the dental prosthesis obtained in step two into two-dimensional plane data, and performs two-dimensional plane contour data processing according to a preset sequence.
  • the layers are stacked and the metal powder material is formed by cladding to obtain a metal dental restoration.
  • Step 4 Baking or baking porcelain on the metal dental prosthesis to complete the preparation of the dental prosthesis.
  • the selective laser cladding machine described in the third step is formed by laminating the deposited metal powder material in a vacuum inert gas processing chamber, and the metal powder material is laid on the metal substrate, and the thickness of the single layer is based on different metal powder materials.
  • the characteristics and processing accuracy depend on the specific molding steps as follows:
  • the laser beam is formed by cladding the metal powder according to a two-dimensional plane profile
  • step (2) carry out the second layering, scrape the surface of the powder bed with a scraper, and then re-form the single layer of the new layer according to the steps (1) and (2).
  • step (3) After repeated lamination, after single-pass cladding molding, the un-clad powder and the support structure are removed to obtain a metal dental prosthesis.
  • the step 2 further includes: the CAD assisting system is designed to connect the metal bracket and the artificial tooth in the computer aided design of the dental prosthesis, and the retaining structure is designed to promote the combination of gold and porcelain or baking, and the retaining structure includes solid. A microbead, a retention microsphere, or a honeycomb structure that increases the bonding area.
  • the dental restoration includes:
  • the dental prosthesis CAD/metal 3D automated processing method of the present invention is innovative:
  • an appropriate amount of silver ion powder can be blended to achieve the purpose of antibacterial without affecting bone bonding.
  • the metal joint and the artificial tooth are connected to design a special retention structure that is beneficial to enhance the combination of gold and porcelain or baking: such as retaining microbeads, retaining microspheres, or increasing the bonding area.
  • Honeycomb structure, etc. through the metal 3D printing to produce a special structure of the metal bracket that meets the design requirements, thereby improving the bonding force of the plastic or ceramic and the metal bracket while reducing the breakage rate of the ceramic or plastic while the metal bracket is baked or baked. It is beneficial for the oral prosthesis to perform normal functions for a long time.
  • the composite system consisting of the optical scanning and computer aided design system, the CAD assisting system and the selective laser cladding machine in the method of the invention can be placed on a mobile vehicle, such as a car or a ship, which is equivalent to a flowing denture. Digital processing plant.
  • FIG. 1 is a structural block diagram of a composite system comprising an optical scanning and computer aided design system, a CAD assisting system, and a selective laser cladding machine according to the present invention
  • FIG. 2 is a structural view of a metal oral prosthesis prepared by taking a removable partial denture TC4 stent as an example
  • Figure 3 is a picture of the form of the special structure of the joint of the prosthetic metal bracket and the ceramic or plastic;
  • Figure 4 is a picture of a removable partial denture TC4 metal bracket finished with metal 3D printing
  • Figure 5 is a partial special structure display picture of the removable partial denture TC4 metal bracket
  • Figure 6 is a porcelain or baking photo of a removable partial denture TC4 metal sticking frame
  • the present invention provides a novel oral prosthetic processing method for processing an oral prosthesis using a composite system consisting of an optical scanning and computer aided design system, a CAD assist system, and a selective laser cladding machine.
  • the composite system consists of three parts. The first part is an optical scanning and computer-aided design system to complete the digital model collection of the dental prosthesis. The second part is the CAD auxiliary system of the dental prosthesis to complete the configuration of the oral prosthesis. Computer Aided Design. The third part is a miniaturized selective laser cladding machine that acts as a metal 3D printing machine.
  • the CAD data of the designed dental restoration is formed by metal powder cladding. Specifically, the following steps are included:
  • Step one routinely complete the three-dimensional shape scan of the patient's intraoral or extraoral plaster model and establish a data model consistent with the oral missing condition;
  • Step 2 according to the design principle of the dental prosthesis, adopting the CAD auxiliary system to complete the design and manufacture of the oral prosthesis, and the output data format is the STL format compatible with the selective laser cladding machine;
  • Step 3 The selective laser cladding machine uses the metal powder material formed by SLM to discretize the three-dimensional data model of the dental prosthesis obtained in step two into two-dimensional plane data, and performs two-dimensional plane contour data processing according to a preset sequence. Cumulative layer by layer, cladding and depositing metal powder material to form gold Is a dental prosthesis;
  • Step 4 Baking or baking porcelain on the metal dental prosthesis to complete the preparation of the dental prosthesis.
  • the above metal dental prosthesis comprises: 1. a personalized metal post core, a metal crown bridge, a porcelain crown bridge base, a removable partial denture metal bracket, and a full denture metal base;
  • the step 2 further includes: the CAD assisting system is designed to connect the metal bracket and the artificial tooth in the computer aided design of the dental prosthesis, and is designed to enhance the gold-porcelain or bake-molded retention structure, and the retention structure includes the retention structure.
  • the CAD assisting system is designed to connect the metal bracket and the artificial tooth in the computer aided design of the dental prosthesis, and is designed to enhance the gold-porcelain or bake-molded retention structure, and the retention structure includes the retention structure.
  • Microbeads, retention microspheres, or honeycomb structures that increase the bond area to increase the adhesion of ceramic or plastic to metal stents.
  • TC4 powder spherical powder, particle size 15-53 microns (Carpenter, USA);
  • a two-patient oral gypsum model was prepared, and one was made according to the traditional lost wax casting method and worn to the patient.
  • Another digital model that enables the optical scanning and computer-aided design system to obtain a plaster model, using 3shape's removable partial denture design software to complete the CAD design of the removable partial denture TC4 stent ( Figure 2), it is emphasized that at 14 The 15 and 16 edentulous areas were designed to design a special retention microbead structure (Fig. 3), and then the metal 3D printing was performed on the selective laser cladding machine to produce a removable local alloy denture TC4. Bracket ( Figure 4).
  • a picture showing the local special structure of the removable partial denture TC4 metal bracket is shown in Fig. 5.
  • the print production parameters are 400W fiber laser, the single layer is 60 microns thick, and the scan path is linear fill + outer contour scan.
  • the selective laser cladding machine functions as a metal 3D printing, and the cladding TC4 powder molding is performed in a vacuum inert gas processing chamber, and the TC4 powder material is spread on the metal substrate, and the single layer is laid.
  • the specific molding steps are as follows:
  • the laser beam is formed by cladding the metal powder according to a two-dimensional plane profile
  • step (2) carry out the second layering, scrape the surface of the powder bed with a scraper, and then re-form the single layer of the new layer according to the steps (1) and (2).
  • step (3) After repeated lamination, after single-pass cladding molding, the un-clad powder and support structure are removed, and the removable local alloy denture TC4 stent can be obtained.
  • the preparation of the dental prosthesis was completed by baking or baking the special structure of the removable local alloy denture TC4 stent and the artificial tooth (Fig. 6).
  • personalized post cores, crown bridges, Porcelain crown bridge base, removable partial denture bracket or full denture base; or individual implants, implants of the upper structure of the implant, personalized abutments and other oral prostheses are automatically processed.
  • an appropriate amount of silver ion powder can be incorporated to achieve the purpose of both antibacterial and osseointegration.
  • the composite system consisting of the optical scanning and computer aided design system, the CAD assisting system and the selective laser cladding machine used in the method of the present invention can be placed on a mobile vehicle, such as a car or a ship, which is equivalent to a flowing denture.
  • Digital processing plants provide patients with more convenient services.

Abstract

一种口腔修复体自动化加工方法，该方法采用光学扫描和计算机辅助设计系统、CAD辅助系统和选择性激光熔覆机组成的复合系统加工口腔修复体，该方法将现有的口腔CAD系统与金属3D打印技术相结合，达到快速个性化制作金属口腔修复体，可以改变传统的种植体及其上部结构的制作方式，由数控切削加工变为金属3D打印加工，加工效率提高，还可以实现个性化制作，必要时还可以和数控切削辅助加工两种加工方式有机结合起来，达到金属3D打印与数控切削的结合，改变原有的种植体及其上部结构的制作方式。

Description

一种口腔修复体CAD/金属3D自动化加工方法 技术领域
本发明属于口腔修复体技术领域，具体涉及一种新的口腔修复体CAD/金属3D自动化加工方法，该方法将现有的口腔CAD系统与金属3D打印技术相结合，达到快速个性化制作金属口腔修复体。
背景技术
计算机辅助设计(Computer aided design，CAD)与计算机辅助制作(Computer aided manufacture，CAM)技术，融合了数学、光学、电子学、计算机图像识别与处理、自动控制与自动化加工等多学科的知识与技术，在20世纪70年代被广泛应用于工业自动化和航空航天领域。1983年，法国Duret研制的第一台牙科CAD/CAM系统样机在法国问世；1985年在法国国际牙医学术会议上Duret教授利用该设备制作出首个后牙瓷全冠体并成功地用于患者口腔，使得CAD/CAM用于口腔医学领域成为现实。在进入上世纪90年代后，随着现代光电子技术、计算机技术图像分析处理技术等的进一步发展，越来越多的牙科CAD/CAM系统问世。目前，已有10余种CAD/CAM系统问世，可制作嵌体、贴面、全冠、部分冠、固定桥、种植体桥架等。而在可摘局部义齿及全口义齿仍处于研究阶段，并没有成熟的系统。口腔CAD/CAM系统通常由数据采集(数字化印模)、计算机辅助设计(CAD)、计算机辅助制作(CAM)三部分子系统组成。一门新兴的口腔修复技术开始形成，CAD/CAM系统使口腔修复学跨入了现代高科技领域。
1、主要CAD/CAM系统
目前商业化的口腔CAD/CAM系统中，数控铣床是重要的组成部分之一。 修复体加工采用数控铣床控制铣削方式，用以切除多余材料，以获得符合形状、尺寸和表面粗糙度要求的修复体。该技术本质上属于去材制作范畴，即本领域所称的“减法”。
1.1 Cerec系统
Cerec系统由德国西门子公司(SIEMENS)牙科部，即现在的德国西诺德(SIRONA)牙科设备有限公司开发并逐步得到完善。其产品系列包括有CerecⅠ、CerecⅡ和CerecⅢ以及Cerec in Lab。CerecⅢ是2000年诞生的CerecⅢ系统，该系统基于Windows平台，切削系统与图象采集系统各自独立工作，软件系统也有了极大的提高，使得该CerecⅢ系统可以制作嵌体、高嵌体、贴面、部分冠和全冠。但是CerecⅢ软件系统也只能在平面上进行设计，很难显示修复体的整体形态。2003年3月在美国亚特兰大的Hinman牙科大会上Cerec 3D系统首次展出，它在设计修复体时可引入了多维视角，可以从三维的角度直观评价修复体以及基牙的形态。Cerec 3D软件系统加入了FrameWork等3D设计软件，实现了全瓷固定桥的修复。2002年Sirona公司推出了Cerec in Lab系统，是专门为技工室所设计的，它使用激光扫描系统收集牙颌数据，修复体制作速度更快，适用范围更广，并且可以使用更高强度的二氧化铝、二氧化锆陶瓷材料。
1.2 Celay系统
Celay系统由苏黎世牙学院设计并于1990年在慕尼黑第一次展出，现由瑞士Mikroma公司生产。该系统不是完全意义上CAD/CAM系统，其原理类似于一个小型钥匙复制机，由两部分组成，接触式传感器和微型铣床，传感头“读”出在口内或代型上制作的具有一定硬度的蜡或树脂修复体表面外形数据，并将数据同时传递到铣床上，同步加工出瓷修复体。该系统组成简单，自动化程度很低。工作时，必须先在口内或者代型上制作一个临时修复体，作为获取数据的信息源。Celay系统主要利用二氧化铝可切削陶瓷加工具有 牙合面形态的嵌体或高嵌体，还可以加工全冠或固定桥的基底冠。
1.3 Procera系统
Procera系统为瑞典系统，由Nobel Biocare公司于1993年推向市场。现在，该系统利用Procera Piccolo或者更加先进的Procera Forte扫描仪收集牙颌模型上数据，医师通过Procera Lofrwore 2.0软件对修复体进行设计，完毕后将数据通过互联网传送至Procera系统指定的4个生产中心(Stockholm，Sweden；Fair Lawn，NJ，USA；Karlskoga，Sweden；Tokyo，Japan)进行修复体的加工。加工中心可根据医师要求直接加工成最终的氧化锆、氧化铝全瓷冠桥，也可只加工成氧化锆、氧化铝基底待邮回后再进行表面饰瓷。Procera系统除可以用于制作天然牙牙冠外，还可以用于种植领域。Procera系统可以切削制作纯钛或氧化锆的单牙基台，其可以对基台的高度、角度和边缘线的形态外形进行个性化设计；Procera系统还可以切削制作纯钛或氧化锆的种植桥，其最多可以提供14个单位的种植桥，拥有极好的生物相容性、卓越的强度和美学效果。
1.4 Cercon系统
Cercon系统通过Cercon Eye Scanner 3维激光扫描牙颌模型上数据，传输给Cercon Art CAD部分对修复体进行设计，然后将设计好的信息传递给Cercon Brain部分对修复体进行切削加工或者将信息通过互联网传递到位于York的制作中心对修复体进行加工制作。因此对于一些小型牙科诊所或者技工中心可以仅购买Cercon系统的Cercon Art CAD部分(已经包含了Cercon Eye Scanner扫描仪)，从而降低成本。Cercon Art CAD可以对修复体边缘、合面进行精细的设计。Cercon系统以二氧化锆结构陶瓷为加工对象，可制作桩核、种植体基台、全冠和固定桥。
1.5 Lava系统
Lava系统由美国3M公司于2002年推出，由Lava Scan、Lava CAD、 Lava Form、Lava Therm等部分组成。首先利用非接触式3D光扫描系统收集牙颌模型上数据，医师利用Lava Design 4.0软件进行修复体设计，完成后首先通过切削预烧结的二氧化锆瓷块获得基底冠，平均每单位牙冠需要35分钟。切削完成后对牙冠基底冠进行完全烧结，再在其表面加饰面瓷。对照Vita比色系统，Lava二氧化锆基底冠有7种颜色选择，饰面瓷有16种颜色选择，因此Lava系统制作的修复体拥有最接近天然牙的色泽和透光性，该系统主要适用于适于单冠和前后牙3～4单位固定桥的修复。
1.6 Everest系统
Everest系统统由德国Kavo公司于2002年推向市场。该系统由Everest scan，Everest engine，Everest therm，Everest elements四个构件组成。首先由Everest scan数据扫描系统(使用CCD相机)采集牙颌模型上数据，操作者利用ENERGY CAD软件对修复体进行3维设计，然后CAM部分在X、Y、Z、A、B五个轴上进行切削加工修复体。因此Everest系统制作的修复体具有良好的加工精度以及清晰的解剖结构。Everest系统可加工的材料非常广泛，包括氧化锆、氧化铝、纯钛、玻璃陶瓷、金、树脂等，可制作种植体、贴面、嵌体、高嵌体、单冠和固定桥。
1.7开放式系统
开放式系统是近年来市场上出现的“组装”型CAD/CAM系统，其数据采集系统、CAD系统、CAM系统可由不同的公司制作后组装形成。目前市场上比较成熟的开放式系统有两种方案：
1)3Shape牙科专用扫描仪+CAD软件+德国数控车床，其可以加工所有品牌的氧化锆、塑料，不受品牌的限制；
2)3Shape牙科专用扫描仪+CAD软件+美国3D system蜡型机，在制作完蜡型后可以包埋铸造金属也可以进行全瓷冠的制作。
和其他CAD/CAM系统相比，开放式系统的优点在于：能加工的材料更加 广泛，制作成本也更加低廉。
2、增材制造的CAD/CAM系统
上述数控车床无法切削具有复杂结构(如带有中空结构)的修复体以及切削过程中造成材料的浪费等成为口腔修复先进制造技术中急需解决的关键问题。快速成型技术，简称RP或RPM技术(Rapid Prototyping/Rapid Prototyping Manufacturing)，是20世纪80年代末发展起来的一项先进制造技术。该技术将计算机辅助设计(CAD)，计算机辅助制造(CAM)，计算机数字控制(CNC)，精密伺服驱动，激光和材料科学等先进科学集于一体，采取离散-叠层堆积的思想，基本构思是：任何三维零件都可以看作是许多二维平面轮廓沿某一坐标方相叠加而成。但RP技术不能直接制作金属修复体以满足口腔修复的需要。20世纪90年代末由RP技术和激光涂覆技术相结合建立的快速制造技术(Rapid Manufacturing，RM)采用预置铺粉或者同步送粉的方式由激光将粉末材料逐层熔覆堆积得到三维实体零件。其制作的成形件具有优秀理化性能，且不受复杂结构的限制。RP技术和RM技术从本质上说均属于增材制作，即“加法”。高勃于2003年申请了“口腔金属修复体的激光立体成形方法”中国发明专利，2005年获得授权，ZL03134316.3。目前，金属修复体的3D打印成型主流为SLM(selective laser melting)和EBM(Electron Beam Melting)方法，前者主要打印制作钴铬合金冠桥、冠桥基底或者可摘局部义齿支架，后者主要用于金属植入体的制作。
2.1在固定修复中的应用
2004年Bennett采用基于SLM技术的MCP Realizer设备分别制作了钴铬合金和不锈钢材料的基底冠、固定冠和固定桥，制作后的牙冠外型良好。2005年，法国学者Nadine应用自己研发的Phenix SLM系统设计并制作了镍铬合金的基底冠，制成的基底冠外形、精度均良好，熔覆烤瓷后，制作的烤瓷牙冠具有非常好的颜色匹配性和边缘适合性。
2.2在可摘局部义齿中的应用
2006年Williams等通过CAD/CAM技术在SLM Realizer 2机器上制作了可摘局部义齿的钴铬合金支架。国内吴琳等初步实现了对肯氏Ⅱ类牙列缺损模型的计算机辅助设计，并用激光快速成形机加工出可摘局部义齿支架的树脂铸型。2009年诸森阳等对肯氏Ⅰ类牙列缺损可摘局部义齿支架进行了计算机辅助设计与制作。
2.3在全口义齿中的应用
全口义齿形态复杂，且组成义齿的材料多样，全口义齿CAD/CAM研究相对滞后。中国人民解放军第四军医大学高勃等通过Surfacer软件，设计出上颌半口金属基托义齿，并利用激光立体成形技术初步加工出上半口基托。2008、2009年，中国人民解放军第四军医大学高勃发表了激光快速成形制作全口义齿上颌纯钛基板的论著Lasers Med Sci(2010)25:309–315，Rapid Prototyping Journal Volume15·Number2·2009·133～136，并对其适合性进行了研究，临床测试结果显示其制作精度有待提高。
3、传统CAD/CAM在临床应用中的局限和发展方向
CAD/CAM技术在口腔领域的应用大大提高了修复效率，缩短了患者治疗周期，减少了患者的痛苦并且降低了技师的劳动强度，使得口腔修复学取得了革命性的发展。但在临床应用过程中还存在以下问题：目前CAD/CAM系统主要应用于固定修复领域，而在可摘局部义齿以及全口义齿中没有应用的主要原因是CAD/CAM系统的切削加工固有的局限性，不单造成材料的浪费，也使得制作的修复体种类单一，不能切削加工复合材料的修复体。
综上所述，如果能将金属3D打印技术替代传统CAD/CAM系统的切削制造技术，姑且称之为口腔CAD/金属3D打印系统，将能更好地拓展口腔修复体制作的适应证和修复体质量。
发明内容
针对上述现有技术存在的缺陷或不足，本发明的目的在于，提供一种新的口腔修复体加工方法，该方法将现有的口腔CAD系统与金属3D打印技术相结合，达到快速个性化制作金属口腔修复体。
为了实现上述任务，本发明采取如下的技术解决方案：
一种口腔修复体CAD/金属3D自动化加工方法，其特征在于，该方法采用光学扫描和计算机辅助设计系统、CAD辅助系统和选择性激光熔覆机组成的复合系统加工口腔修复体，具体包括下列步骤：
步骤一，常规完成患者口内或者口外石膏模型的三维外形扫描并建立与口腔缺牙情况一致的数据模型；
步骤二，根据口腔修复体的设计原则，采用CAD辅助系统完口腔成修复体的构型设计与制作，输出数据格式为选择性激光熔覆机兼容的STL格式；
步骤三，选择性激光熔覆机以SLM成型的金属粉末材料，将步骤二得到的口腔修复体CAD三维数据模型，离散成二维平面数据，按照预设的顺序进行二维平面轮廓数据加工，逐层累加，熔覆堆积金属粉末材料成型，得到金属口腔修复体。
步骤四，在金属口腔修复体上烤塑或者烤瓷，完成口腔修复体的制作。
其中步骤三中所述的选择性激光熔覆机熔覆堆积金属粉末材料成型是在真空惰性气体加工仓内，将金属粉末材料铺于金属基板上，单层铺粉厚度为依据不同金属粉末材料的特性和加工精度而定，具体成型步骤如下：
(1)将金属粉末置于粉床之上，升温至合适的温度；
(2)步骤(1)结束后激光光束按照二维平面轮廓将金属粉末熔覆成形；
(3)步骤(2)结束后，进行第二次铺粉，用刮板将粉床表面刮平，然后重新按照步骤(1)、步骤(2)顺序进行新一层的单道熔覆成型；经反复铺粉，单道熔覆成型后，去除未曾熔覆的粉末和支撑结构，即可得到金属口腔修复体。
所述的步骤二中进一步包括：CAD辅助系统在口腔修复体计算机辅助设计时，将金属支架与人工牙连接处设计利于增进金瓷结合或者烤塑结合的固位结构，这些固位结构包括固位微珠、固位微球、或者增大粘接面积的蜂窝状结构。
所述的口腔修复体包括：
(1)、个性化的桩核、冠桥、烤瓷冠桥基底、可摘局部义齿支架或全口义齿基托；或者
(2)、个性化种植体、种植体上部结构的桥架、个性化基台。
本发明的口腔修复体CAD/金属3D自动化加工方法，创新之处在于：
1、改变传统的种植体及其上部结构的制作方式，由数控切削加工变为金属3D打印加工，加工效率极大提高，还可以实现个性化制作，必要时还可以和数控切削辅助加工两种加工方式有机结合起来，各取所长，达到金属3D打印与数控切削的完美结合，颠覆原有的种植体及其上部结构的制作方式。
2、在种植体3D打印过程中，可掺入适量的银离子粉末，达到既抗菌，又不影响骨结合的目的。
3、在CAD设计时，将金属支架与人工牙连接处设计特殊的利于增进金瓷结合或者烤塑结合的固位结构：如固位微珠、固位微球、或者增大粘接面积的蜂窝状结构等，通过金属3D打印制作出符合设计要求的金属支架特殊结构，从而在金属支架烤塑或者烤瓷的同时，提高塑料或陶瓷与金属支架的结合力，降低陶瓷或者塑料的破损率，利于口腔修复体长期稳定地行使正常功能。
4、采用本发明方法中的光学扫描和计算机辅助设计系统、CAD辅助系统、选择性激光熔覆机组成的复合系统，可安放在流动交通工具上，例如车、船，相当于一个流动的义齿数字化加工厂。
附图说明
图1是本发明采用的光学扫描和计算机辅助设计系统、CAD辅助系统、选择性激光熔覆机组成的复合系统结构框图；
图2是以可摘局部义齿TC4支架为例制备的金属口腔修复体结构图；
图3是修复体金属支架与陶瓷或者塑料连接处特殊结构的形式图片；
图4是金属3D打印完成的可摘局部义齿TC4金属支架图片；
图5是可摘局部义齿TC4金属支架局部特殊结构展示图片；
图6是可摘局部义齿TC4金属支粘贴架烤瓷或者烤塑照片；
以下结合附图和实施例对本发明作进一步的详细说明。
具体实施方式
参见图1，本发明给出一种新的口腔修复体加工方法，该方法采用光学扫描和计算机辅助设计系统、CAD辅助系统和选择性激光熔覆机组成的复合系统加工口腔修复体。该复合系统包括三部分，第一部分为光学扫描和计算机辅助设计系统,用以完成口腔修复体的数字化模型的采集；第二部分为口腔修复体的CAD辅助系统，以完成口腔修复体构型的计算机辅助设计。第三部分为小型化的选择性激光熔覆机，该选择性激光熔覆机充当了金属3D打印的角色，将设计完成的口腔修复体的CAD数据用金属粉末熔覆堆积成型。具体包括下列步骤：
步骤一，常规完成患者口内或者口外石膏模型的三维外形扫描并建立与口腔缺牙情况一致的数据模型；
步骤二，根据口腔修复体的设计原则，采用CAD辅助系统完口腔成修复体的构型设计与制作，输出数据格式为选择性激光熔覆机兼容的STL格式；
步骤三，选择性激光熔覆机以SLM成型的金属粉末材料，将步骤二得到的口腔修复体CAD三维数据模型，离散成二维平面数据，按照预设的顺序进行二维平面轮廓数据加工，逐层累加，熔覆堆积金属粉末材料成型，得到金 属口腔修复体；
步骤四，在金属口腔修复体上烤塑或者烤瓷，完成口腔修复体的制作。
上述金属口腔修复体包括：1、个性化的金属桩核、金属冠桥、烤瓷冠桥基底、可摘局部义齿金属支架、全口义齿金属基托；
2、个性化种植体、种植体上部结构的桥架、个性化基台等；
所述步骤二中进一步包括：CAD辅助系统在口腔修复体计算机辅助设计时，将金属支架与人工牙连接处设计利于增进金瓷结合或者烤塑结合的固位结构，这些固位结构包括固位微珠、固位微球、或者增大粘接面积的蜂窝状结构，以增加陶瓷或者塑料与金属支架的结合力。
以下是发明人给出的一种口腔修复体中较为复杂的可摘局部义齿的制作的详细全过程：
1、材料与设备
1.1 SLM所需材料及设备
选择性激光熔覆机(EOSINT M280，EOS公司，德国)；
TC4粉末，球形粉，粒径15-53微米(卡本特公司，美国)；
光学扫描和计算机辅助设计系统(DWOS，Dental Wings公司，加拿大)。
1.2其他材料与设备
康特“水魔方”硅橡胶印模材(康特齿科集团，瑞士)；
超硬石膏(湖北贝诺齿科材料有限公司)。
1.3病例选择和基牙预备
选取以男性患者，年龄56岁，左上颌前磨牙和第一磨牙缺失，不能行种植和固定义齿修复，自愿行传统的维他灵金属支架式可摘局部义齿修复。
可摘局部义齿设计参见图2，为牙支持式的可摘局部义齿，13、17、23、27作为基牙，放置合支托，唇颊侧设计卡环，宽后腭杆为大连接体。完成临床基牙预备。
1.4可摘局部义齿支架的计算机辅助设计和3D打印
制取两付患者口腔石膏模型，一付按照传统的失蜡铸造方法制作完成并给患者佩戴。另一付使光学扫描和计算机辅助设计系统获得石膏模型的数字化模型，用3shape公司的可摘局部义齿设计软件完成可摘局部义齿TC4支架的CAD设计图(图2)，需要强调的是在14、15、16缺牙区设计出设计出增加结合力的特殊固位微珠结构(图3)，随后以该数据在选择性激光熔覆机上进行金属3D打印，制作出可摘局部合金义齿TC4支架(图4)。可摘局部义齿TC4金属支架局部特殊结构展示图片如图5所示。打印制作参数是400W光纤激光，单层铺粉厚度为60微米，扫描路径为线性充填+外轮廓扫描。
本实施例中，选择性激光熔覆机充当了金属3D打印的角色，其熔覆堆积TC4粉末成型是在真空惰性气体加工仓内，将TC4粉末材料铺于金属基板上，单层铺粉厚度为依据不同金属粉末材料的特性和加工精度而定，具体成型步骤如下：
(1)将金属粉末(TC4粉末)置于粉床之上，升温至合适的温度；
(2)步骤(1)结束后激光光束按照二维平面轮廓将金属粉末熔覆成形；
(3)步骤(2)结束后，进行第二次铺粉，用刮板将粉床表面刮平，然后重新按照步骤(1)、步骤(2)顺序进行新一层的单道熔覆成型；经反复铺粉，单道熔覆成型后，去除未曾熔覆的粉末和支撑结构，即可得到可摘局部合金义齿TC4支架。
1.5可摘局部合金义齿TC4支架烤塑或烤瓷
在可摘局部合金义齿TC4支架与人造牙连接处特殊结构上烤塑或烤瓷，完成口腔修复体的制作(图6)。
需要说明的是，以上的实施例是帮助本领域的技术人员理解本发明，本发明不限于上述实施例，按照本发明的方法，还可以对个性化的桩核、冠桥、 烤瓷冠桥基底、可摘局部义齿支架或全口义齿基托；或者个性化种植体、种植体上部结构的桥架、个性化基台等各种口腔修复体的自动进行加工。在种植体3D打印过程中，可掺入适量的银离子粉末，达到既抗菌，又不影响骨结合的目的。
当然，本发明方法中采用的光学扫描和计算机辅助设计系统、CAD辅助系统和选择性激光熔覆机组成的复合系统，可安放在流动交通工具上，例如车、船，相当于一个流动的义齿数字化加工厂，为患者提供更便捷的服务。

Claims (4)

  1. 一种口腔修复体CAD/金属3D自动化加工方法，其特征在于，该方法采用光学扫描和计算机辅助设计系统、CAD辅助系统和选择性激光熔覆机组成的复合系统加工口腔修复体，具体包括下列步骤：
    步骤一，常规完成患者口内或者口外石膏模型的三维外形扫描并建立与口腔缺牙情况一致的数据模型；
    步骤二，根据口腔修复体的设计原则，采用CAD辅助系统完口腔成修复体的构型设计与制作，输出数据格式为选择性激光熔覆机兼容的STL格式；
    步骤三，选择性激光熔覆机以SLM成型的金属粉末材料，将步骤二得到的口腔修复体CAD三维数据模型，离散成二维平面数据，按照预设的顺序进行二维平面轮廓数据加工，逐层累加，熔覆堆积金属粉末材料成型，得到金属口腔修复体；
    步骤四，在金属口腔修复体上烤塑或者烤瓷，完成口腔修复体的制作。
  2. 如权利要求1所述的方法，其特征在于，所述的口腔修复体包括：
    (1)、个性化的桩核、冠桥、烤瓷冠桥基底、可摘局部义齿支架或全口义齿基托；或者
    (2)、个性化种植体、种植体上部结构的桥架、个性化基台。
  3. 如权利要求1所述的方法，其特征在于，步骤三中所述的选择性激光熔覆机熔覆堆积金属粉末材料成型是在真空惰性气体加工仓内，将金属粉末材料铺于金属基板上，单层铺粉厚度为依据不同金属粉末材料的特性和加工精度而定，具体成型步骤如下：
    (1)将金属粉末置于粉床之上，升温至合适的温度；
    (2)步骤(1)结束后激光光束按照二维平面轮廓将金属粉末熔覆成形；
    (3)步骤(2)结束后，进行第二次铺粉，用刮板将粉床表面刮平，然 后重新按照步骤(1)、步骤(2)顺序进行新一层的单道熔覆成型；经反复铺粉，单道熔覆成型后，去除未曾熔覆的粉末和支撑结构，即可得到金属口腔修复体。
  4. 如权利要求1所述的方法，其特征在于，所述步骤二中进一步包括：CAD辅助系统在口腔修复体计算机辅助设计时，将金属支架与人工牙连接处设计利于增进金瓷结合或者烤塑结合的固位结构，这些位结构包括固位微珠、固位微球、或者增大粘接面积的蜂窝状结构。
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