WO2018090579A2 - Procédé de réparation de liaison fixe-mobile concurrente - Google Patents

Procédé de réparation de liaison fixe-mobile concurrente Download PDF

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Publication number
WO2018090579A2
WO2018090579A2 PCT/CN2017/084055 CN2017084055W WO2018090579A2 WO 2018090579 A2 WO2018090579 A2 WO 2018090579A2 CN 2017084055 W CN2017084055 W CN 2017084055W WO 2018090579 A2 WO2018090579 A2 WO 2018090579A2
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WIPO (PCT)
Prior art keywords
metal
abutment
configuration
removable partial
crown
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PCT/CN2017/084055
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English (en)
Chinese (zh)
Inventor
高勃
刘一帆
王伟娜
于海
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中国人民解放军第四军医大学
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Publication of WO2018090579A2 publication Critical patent/WO2018090579A2/fr

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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
    • 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
    • A61C13/0019—Production methods using three dimensional printing
    • 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
    • A61C13/01—Palates or other bases or supports for the artificial teeth; 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
    • A61C13/08—Artificial teeth; Making same
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C2204/00—Features not otherwise provided for

Definitions

  • the invention belongs to the technical field of oral prosthetics, and particularly relates to a simultaneous fixed-activity joint repairing method, which combines the existing dental CAD/CAM system with metal 3D printing technology, and organically combines the respective numerical control processing methods. Play to the extreme.
  • CAD Computer aided design
  • CAM Computeraidedmanufacture
  • 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 part of the current commercial dental CAD/CAM system. one.
  • the prosthesis is machined using a CNC milling method that uses a cutting tool to remove excess material to obtain a restoration that meets the shape, size, and surface roughness requirements.
  • This technology is essentially a category of material removal, namely "subtraction.”
  • the Cerec system was developed by the German Ministry of Dental Engineering (SIEMENS), now the German SIRONA Dental Equipment Co., Ltd. Its product line includes CerecI, CerecII and CerecIII as well as CerecinLab. Among them: CerecIII was born in 2000, Cerec III system is based on Windows platform, the cutting system and image acquisition system work independently, and the software system has been greatly improved, which makes the Cerec III system can make inlays, onlays, veneers and parts. 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 Cerec3D system was first exhibited at the Hinman Dental Congress in Atlanta, USA in March 2003.
  • Cerec3D software system has added 3D design software such as FrameWork to realize the repair of all-ceramic fixed bridge.
  • Sirona introduced the Cerec inLab 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.
  • Celay system mainly uses aluminum oxide machinable ceramic processing
  • An inlay or onlay with a occlusal shape can also process the base crown of a full crown or fixed bridge.
  • the Procera system is a Swedish system and was introduced to the market in 1993 by Nobel Biocare. Now, the system uses Procera Piccolo or a more advanced ProceraForte scanner to collect data on the dental model.
  • the physician designs the prosthesis through ProceraLofr worn 2.0 software, and after the design is completed, the data is transmitted to the four production centers designated by the Procera system via the Internet ( Swiss, Sweden; FairLawn, NJ, USA; Karlskoga, Sweden; Tokyo, Japan).
  • 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 through the CerconEyeScanner 3D laser and transmits it to the CerconArtCAD section to design the restoration.
  • the transmitted information is then passed to the CerconBrain section to cut the restoration or pass the information over the Internet to York.
  • the production center processes the restoration. Therefore, for some small dental clinics or technician centers, you can purchase only the CerconArt CAD part of the Cercon system (which already includes the CerconEyeScanner scanner), thus reducing costs.
  • CerconArtCAD provides a fine design for the edges of the prosthesis and the occlusal surface.
  • 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 in the United States, by Lava Scan, LavaCAD, LavaForm, LavaTherm and other components. Firstly, the non-contact 3D optical scanning system was used to collect the data on the dental model. The physician used LavaDesign4.0 software to design the prosthesis. After 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: Everestscan, Everest engine, Everesttherm, and Everest elements.
  • the Everestscan data scanning system (using a CCD camera) collects the data on the dental model.
  • the operator uses the ENERGYCAD software to design the prosthesis in three dimensions, and then the CAM part is cut on the X, Y, Z, A, and B axes. Prosthesis. 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:
  • Rapid prototyping technology referred to as RP or RPM technology (RapidPrototyping/RapidPrototypingManufacturing) 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.
  • the Rapid Manufacturing Technology which was established by the combination of RP technology and laser coating technology, used a laser to deposit the powder material layer by layer by means of pre-laying or simultaneous powder feeding. 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”.
  • Bennett used the MCPRealizer 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 PhenixSLM system developed by herself.
  • the base crown of nickel-chromium alloy has a good shape and precision of the base crown.
  • the porcelain crown After hand-clad porcelain, the porcelain crown has very good color matching and edge suitability.
  • the complete denture has a complex shape and various materials for the denture.
  • the current full denture CAD/CAM research 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.
  • Gao Bo of the Fourth Military Medical University of the Chinese People's Liberation Army published a series of laser rapid prototyping complete dentures of pure titanium substrates: LasersMedSci (2010) 25:309–315; RapidPrototypingJournalVolume15, Number2, 2009, 133–136 And the suitability of its research, clinical test results show that its production accuracy needs to be improved.
  • the method adopts an optical scanning measuring instrument or a contact scanning measuring instrument, a computer aided design software for a dental prosthesis, a CAD/CAM/SLM-3D printing composite system composed of a miniaturized metal 3D printer and a numerically controlled milling machine to prepare a dental prosthesis.
  • the oral prosthesis is composed of a composite material restoration, the base or the bracket part is metal, and the metal surface is ceramic or plastic; from the repair type, it is a porcelain or baked crown bridge, and the removable partial denture .
  • the data format is 3D printer compatible STL format
  • the C structure data is input into the CNC cutting machine tool, and the dental ceramic or plastic blank obtained by the national medical certification is selected, and the artificial tooth data configuration matching the upper part of the B configuration is cut out, which is referred to as the E configuration;
  • the metal substrate or stent is a removable partial denture metal stent for removable partial dentures; for a porcelain or roast crown bridge is the metal base of the crown bridge.
  • the above CAD/CAM/SLM-3D printing composite system can be placed on a mobile vehicle such as a vehicle or a ship, which is equivalent to a mobile denture digital processing factory.
  • the method greatly improves the automatic production efficiency of the oral metal prosthesis, especially the complex dental prosthesis, and rids the complicated process of the traditional hand-made dental prosthesis, improves the quality and stability of the prosthesis, and achieves rapid, precise and personalized production. purpose.
  • the present invention aims to provide a simultaneous fixed-activity joint repair method, which combines the numerical control cutting technology and the metal 3D printing technology in the existing dental CAD/CAM system.
  • each of the CNC machining methods is combined to give full play to their respective strengths, and their respective advantages are maximized, and complex restorations can be repaired simultaneously, quickly, accurately and individually.
  • a simultaneous fixed-activity joint repairing method characterized in that the method uses a scanning measuring instrument to acquire relevant three-dimensional topographic data of oral soft and hard tissues and reconstructs into a digital model, in the number On the model, the fixed prosthesis of the removable partial denture abutment and the design of the removable partial denture on the removable partial denture were completed by computer aided design software of the dental prosthesis, followed by CNC milling machine and miniaturized SLM-metal 3D printer. The prosthesis is prepared synchronously, and the removable partial denture can be repaired simultaneously with the fixed restoration of the abutment and the dentition defect.
  • the reconstruction is a digital model consistent with the condition of the oral cavity and the abutment, referred to as the A model;
  • the C1 configuration data is input into the 3D printer, the metal powder material conforming to the national medical material license is selected, and the corresponding metal substrate or bracket is fabricated by the selective laser melting technology (SLM) 3D printing process, and is completed by a conventional laboratory process.
  • SLM selective laser melting technology
  • the D structure is first bonded or glued to the corresponding abutment in the patient's mouth.
  • the E1, E2, and E3 structures are for patient wear.
  • the abutment of the dentition defect patient is a natural tooth, a post core, a sleeve crown or an implant abutment;
  • the abutment tooth condition is a crown bridge, a veneer, an inlay or a sleeve.
  • Indications for crown restoration; the restoration of the abutment is fixed, including crown, veneer, inlay or telescopic crown repair.
  • the removable partial denture of the present invention may be a composite material restoration from the material composition, the base or the bracket portion is a metal, the ceramic or resin attached to the metal surface, or a metal material restoration, the artificial The teeth and the stent are both metal; the metal substrate or stent is a metal stent of a removable partial denture for a removable partial denture; and a metal base for the crown bridge for a porcelain or baked crown bridge.
  • the CAD/CAM and SLM-3D metal printing composite system can be placed on a mobile vehicle (such as a vehicle or a ship), which is equivalent to a mobile denture digital processing factory.
  • the simultaneous fixed-activity combined repair method of the present invention is a new method for simultaneous repair of dental prosthesis by using CAD/CAM and SLM-3D printing technology for patients with dentition defect and fixed restoration of abutment.
  • the innovation lies in: integrated design, simultaneous processing, especially for fixed denture restoration and removable denture restoration, which can realize simultaneous restoration, artificial tooth configuration matching with abutment and metal base or branch structure type (such as removable part)
  • the denture bracket is designed separately before and after the same time.
  • the CNC cutting subtracted material manufacturing, called subtraction
  • 3D printing technology additive manufacturing, called addition
  • the method greatly improves the repair efficiency of the patient in this clinical type, greatly reduces the number of clinical visits of the patient, and significantly shortens the chair-side operation time of the patient at the time of the treatment; and gets rid of the cumbersome process of the traditional hand-made dental prosthesis, improves the quality of the prosthesis and Stability, to achieve fast, accurate, personalized repair purposes, better meet the urgent needs of the majority of patients with missing teeth.
  • FIG. 1 is a schematic view of a simultaneous fixed-activity joint repair method of the present invention
  • Figure 2 is a photograph of the selected standard plaster model
  • Figure 3 is an abutment generation of a digital model in software
  • Figure 4 is a CAD design drawing of the corresponding all-ceramic crown of the abutment
  • Figure 5 is the original position of the corresponding all-ceramic crown of the abutment on its digitized model and form a new model
  • Figure 6 is a CAD design of a TC4 alloy stent for a removable partial denture
  • Figure 7 is a computer aided design of artificial teeth on a TC4 alloy bracket
  • Figure 8 is a zirconia ceramic crown produced by numerical control cutting
  • Figure 9 is a 3D printed TC4 alloy bracket
  • Figure 10 is a photograph of a plaster model and a zirconia all-ceramic crown assembly
  • Figure 11 is a photograph of a TC4 alloy stent and a zirconia ceramic joint assembly
  • Figure 12 is a picture of the final restoration effect.
  • the applicant uses an optical scanning measuring instrument or a contact scanning measuring instrument, a computer aided design software for a dental prosthesis, a miniaturized metal 3D printer, and a CNC milling machine to form a CAD/CAM digital workflow. It is mainly composed of three parts. The first is an optical scanning measuring instrument or a contact scanning measuring instrument. The scanning digital model is completed by scanning the plaster model, the impression made in the mouth, and directly scanning the soft and hard tissues in the mouth. Computer-aided design software for dental prosthesis, computer-aided design of dental prosthesis configuration; third, miniaturized metal 3D printer and CNC milling machine, 3D printer will print metal substrate or bracket CAD data with metal powder Forming, the metal powder meets the national medical licensing standards. CNC cutting ceramics, resins, and metals are also subject to national medical licensing standards.
  • the abutment of the patient with dentition defect is a natural tooth, a post core, a sleeve crown or an implant base.
  • Table the tooth condition of the abutment is the indication for crown bridge, veneer, inlay or telescopic crown restoration; the restoration of the abutment is fixed repair, including crown bridge, veneer, inlay or telescopic crown repair .
  • the removable partial denture may be a composite material restoration from a material composition, the base or the bracket portion thereof being a metal, a ceramic or resin attached to the metal surface, or a metal material restoration, the artificial tooth and the bracket All of the metals; the metal substrate or bracket is a metal stent for removable partial dentures for removable partial dentures; for metal or bases of the crown bridges.
  • the prepared prosthesis is worn by the patient in clinical practice, thus realizing the rapid and simultaneous completion of the fixed restoration of the abutment and the removable denture of the dentition defect.
  • the CAD/CAM and SLM-3D metal printing composite system can be placed on a mobile vehicle (such as a vehicle or a ship), which is equivalent to a mobile denture digital processing factory.
  • the scanner scans the relevant soft and hard tissues in the mouth of the patient with dentition defect, or scans the corresponding impression or its cast gypsum model obtained by conventional methods to obtain its three-dimensional shape and reconstruct it into the condition of tooth missing and abutment.
  • a consistent digital model referred to as the A model;
  • the CAD/CAM/SLM-metal 3D printing composite method (system) consists of three parts.
  • the first is an optical scanning measuring instrument or a contact scanning measuring instrument. By scanning the plaster model, the impression made in the mouth, and directly scanning the soft and hard inside the mouth. Organize and other methods to complete the collection of oral digital models;
  • the second is The computer aided design software of the dental prosthesis completes the configuration design of the removable partial denture metal base or stent and the computer aided design of the corresponding artificial dental configuration thereon.
  • the third is a miniaturized metal 3D printer and a CNC milling machine. The 3D printer prints the designed metal substrate or bracket CAD data with metal powder, and the metal powder meets the national medical license standard.
  • the prepared dental prosthesis is composed of a composite material restoration, the base or the bracket part is metal, and the metal surface is ceramic or plastic; from the repair type, it is a porcelain or baked crown bridge, and the removable partial denture . Finally, the plastic or ceramic artificial tooth is assembled and bonded on the metal substrate or the bracket, thus completing the rapid preparation of the dental restoration;
  • the 3D printer discretizes the three-dimensional data model of the C1 or C2 configuration into two-dimensional plane data, and uses the selective laser melting technology (SLM) to perform two-dimensional plane contour data processing in a preset order, layer by layer, and melting.
  • SLM selective laser melting technology
  • a metal stent is formed by covering a metal powder material. The specific process is:
  • the metal powder material is laid on the metal substrate, and the thickness of the single layer is determined according to the characteristics and processing precision of the different metal powder materials, and the specific steps are as follows:
  • step (1) the laser beam is melted into a metal powder according to a two-dimensional plane profile
  • step (2) After the end of 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, remove the powder and support structure that have not been clad, and then obtain Metal substrate or bracket, and the preparation of the removable partial denture by the conventional laboratory process, referred to as E1 structure; or directly by the process, the metal removable partial denture integrated with the artificial tooth and the bracket, referred to as E2 structure;
  • the C3 configuration can also be used to fabricate a new composite removable partial denture through the CAD/CAM/SLM-metal 3D printing composite system, referred to as the E3 structure;
  • the D structure is first bonded to the corresponding abutment in the patient's mouth. After completion, the E1, E2, and E3 structures can be worn by the patient.
  • the inventor only gives a complicated process of repairing the abutment and repairing the removable partial denture in the dental prosthesis, as follows:
  • CAD/CAM system Premium 4820, WIELAND, Germany
  • machinable zirconia block Ertron, China
  • a standard gypsum model is selected, in which the right premolar second premolar and the first molar are missing, and the second molar is missing, in order to avoid dissimilar metal interference with the removable partial denture metal stent in the edentulous region,
  • the enamel crown is repaired, and the occlusal support is reserved for the near middle teeth.
  • the tooth preparation has been carried out according to the requirements of the all-ceramic crown.
  • the tooth-supported removable partial denture is prepared in the edentulous area, 14, 17, 24, 27
  • the TC4 alloy bracket is designed with a snap ring on the cheekbone side of the base tooth, and the upper jaw is provided with a wide joint of the wide jaw.
  • TC4 alloy bracket Artificial teeth (artificial teeth).
  • the STL format data 1 and 3 of the artificial tooth CAD configuration were input to a dental CNC milling machine, and a zirconia crown was produced by cutting (Fig. 8).
  • the STL format data 2 was printed on a 3D printer using a selective laser melting technique (SLM) to produce a TC4 alloy holder (Fig. 9).
  • SLM selective laser melting technique
  • the printing parameters are 400W fiber laser, the thickness of the single layer is 60 microns, and the scanning path is linear filling + outer contour scanning.
  • the zirconia crown is bonded to the 17 tooth preparation (Fig. 10), and the zirconia double crown is bonded to the corresponding position of the removable partial denture TC4 alloy bracket (Fig. 11) to become a new composite removable partial denture.
  • the removable partial denture is then worn into the corresponding position on the model, and the fixed restoration of the abutment and the removable partial denture restoration in the edentulous region are completed simultaneously (Fig. 12).

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  • Health & Medical Sciences (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Dentistry (AREA)
  • Epidemiology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Manufacturing & Machinery (AREA)
  • Dental Prosthetics (AREA)
  • Dental Tools And Instruments Or Auxiliary Dental Instruments (AREA)
PCT/CN2017/084055 2016-11-18 2017-05-12 Procédé de réparation de liaison fixe-mobile concurrente WO2018090579A2 (fr)

Applications Claiming Priority (2)

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CN201611025836.2A CN106580496B (zh) 2016-11-18 2016-11-18 一种同期行固定-活动联合修复方法
CN201611025836.2 2016-11-18

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