3D打印技术在上颌Le Fort Ⅰ型截骨术中的应用

目的:探讨3D打印技术制作的定位导板在上颌Le Fort Ⅰ型截骨术中的应用效果。方法:选择牙颌面畸形患者8例,男4例,女4例;年龄18~32岁,平均24.6岁。所有患者术前均行头颅CT扫描,将CT数据导入Mimics16.0,重建出上颌骨和下颌骨的三维模型,用3-matic 9.0设计定位导板,在上颌Le Fort I型截骨线的上方骨壁厚的位置选4个点作为标志点,利用这4个标志点来定位上颌骨术后的位置,设计好后采用光敏树脂用三维打印机打印制作,在术中应用。结果:所有患者均采用新的方法行正颌手术,上颌骨模拟位置和术后实际位置绝对差异的平均值小于1 mm,患者对术后美学效果均满意。结论:初步的结果显示此技术定位上颌骨精确,可在临床应用。     

上颌骨ＬeFortI型截骨术式应用及并发症的探讨

目的：对全上颌骨水平向骨切开术(total horizontal maxillary osteotomy)既上颌骨ＬeFortＩ型截骨术的不同术式,对术中及术后可能出现发并发症进行探讨,方法：对５３例先天性发育、外伤等原因造成的颌骨畸形,行单颌或双颌同期上颌骨ＦeFortＩ型截骨。结果：术中无异常骨裂,牙体,牙髓损伤等并发症,上颌骨ＬeFortＩ型截骨术式可稍有改变,术前应充分计术中及术后的各种并发症,并制订相应的预防措施,以确保手术安全。     

3D打印技术在双侧下颌升支矢状劈开截骨术中的应用

目的 探讨3D打印技术制作的截骨导板在双侧下颌升支矢状劈开截骨术（BSSO）中的应用效果。方法 选择32例（男17例,女15例,年龄19~35岁,平均23.5岁）下颌发育不良的患者为研究对象,进行BSSO（Hunsuck模式,64侧）,所有患者术前均进行锥形束CT（CBCT）扫描并建立下颌骨3D模型,使用3D打印技术制作下颌骨升支内侧水平骨切口截骨导板。64侧手术分别由年轻主治医师或具有丰富正颌手术经验的专家（主任医师）使用或不使用截骨导板来完成,对各组完成下颌升支内侧水平骨切口的时间进行计时。术后复查CBCT并按照LSS（lingual split scale）分类来评估手术效果。结果 术后所有患者口内切口均一期愈合,无严重并发症。各组完成下颌升支内侧水平骨切口时间的差异有统计学意义（F=30.059,P<0.05）,其中主治医师不使用导板组的手术用时明显高于其他3组（P<0.05）,其余各组两两比较无明显差异（P>0.05）。尽管所有64侧手术均按照标准方式进行,仅有59.38%（38/64）的骨折线遵循标准Hunsuck骨劈开线,21.88%（14/64）骨折线累及下颌神经管,其余18.75%（12/64）是其他方式。经列联表分析和Fisher确切概率法检验发现,截骨导板的使用影响舌侧骨劈开线的方式（P<0.05）。结论 3D打印技术制作的截骨导板能够帮助年轻医师更快更好地完成BSSO。     

高位LeFortⅠ型截骨术

作者介绍了一种高位ＬｅＦｏｒｔＩ型截骨术。该术式将ＬｅＦｏＩｔＩ型截骨线上移至眶下神经管水平，并延伸到颧骨根部，对于矫正上颌后缩畸形伴有颧骨区和鼻旁区平坦不足的患者收到了较好的治疗效果。文内提出了手术适应证和外科操作，讨论了与手术有关的问题，并附２例报告。     

LeFort I 型截骨术在陈旧性上颌骨骨折中的临床应用

目的：探讨LeFortⅠ型截骨术在陈旧性上颌骨骨折中的临床应用。方法：对30例陈旧性上颌骨骨折患者采用LeFortⅠ型截骨术进行治疗，考察其咬合关系等恢复情况。结果：28例患者咬合关系及咀嚼功能恢复满意；2例患者咀嚼功能恢复不理想，考虑为咬合平面的改建没有达到神经-肌肉的平衡。结论：LeFonⅠ型截骨术是治疗陈旧性上颌骨骨折一种较好的方法。     

上颌骨Le FortⅠ型截骨术常见并发症及其可能原因

ＬｅＦｏｒｔⅠ型截骨术是按ＬｅＦｏｒｔⅠ型骨折线截骨,使上颌骨折断下降,整体移动上颌骨,矫正其各方向的畸形,同时也可于上颌骨的鼻侧面将其分割成若干块,改变上颌牙弓的宽度及平面的弧度,以矫正上下牙弓的不调。各种结果均证明,该手术是安全可靠的。但由于种种原因,常发生一些并发症,甚至严重并发症。本文综述了ＬｅＦｏｒｔⅠ截骨降下术常见的并发症,并对其可能的原因进行了讨论,为临床上防止其发生提供一点参考。１－对牙髓血供的影响：上颌骨及牙髓的血供主要来自颌内动脉及其分支,截骨后必定产生影响。Ｂｅｌｌ［３］的…     

LeFortⅠ型截骨上颌前移术后对鼻尖高度和鼻翼宽度的影响

本文研究了上颌ＬｅＦｏｒｔＩ型截骨前移后鼻翼宽度及鼻尖高度的变化，作者发现术后鼻翼宽度有明显增加而鼻尖高度则略有降低，这种变化与上颌前移的距离成相关关系。     

基于锥形术CT数字化建模的3D打印牙颌模型制作及精确度研究

目的 基于锥形术CT（CBCT）数据构建患者数字化模型,应用3D打印技术制作牙颌实体模型并评估其精确度。方法 通过Mimics 10.01软件处理正畸临床患者CBCT数据,并结合Geomagic studio三维软件制作牙颌数字化模型,导入MakerBot Replicator2X型3D打印机中,采用熔融沉积技术（FDM）制作聚乳酸材料的上下颌实体模型。比较3D打印模型与传统石膏模型的牙冠近远中径、牙弓长度和宽度及后牙牙尖三角嵴长度测量值。结果 3D打印牙颌模型和传统石膏模型的测量数据经配对样本t检验,无统计学差异（P>0.05）。结论 采用CBCT构建数字化模型具有可行性,能够简化正畸检查流程、实现患者牙颌状况的数字化存储。采用3D打印制作牙颌模型精确度良好,可用于正畸临床。     

3D打印在第三磨牙自体移植中的临床研究

目的:探讨锥形束CT(cone-beam computed tomography,CBCT)联合3D打印制作的个性化牙模型在上、下颌第三磨牙移植修复缺失磨牙病例中的临床疗效.方法:收集2017年5月—2019年4月在温州医科大学附属口腔医院上、下颌第一或第二磨牙缺失并需拔除第三磨牙的46例病例(52颗牙).按照手术方式...     

Effect of maxillary surgical movement on nasal cavity and maxillary sinus dimensions and function after Le Fort I osteotomy

This study was designed to evaluate the effects of different maxillary movements performed in Le Fort I surgery on the anatomy of the nasal cavity and maxillary sinus, occurrence of rhinosinusitis, and nasal airflow. Patients were divided into three groups: group I underwent pure advancement, group II underwent advancement with yaw rotation, and group III underwent advancement with impaction movements. All evaluations were performed using pre- and postoperative computed tomography images and surveys. Twenty-eight patients were enrolled. The mean pre- and postoperative nasal air volumes in group I were 22.74 ± 6.32 cm³ and 25.17 ± 6.19 cm³, respectively, showing a significant increase (P = 0.041). The mean pre- and postoperative maxillary sinus air volumes were 33.94 ± 13.72 cm³ and 26.28 ± 14.12 cm³ in group II and 35.29 ± 9.58 cm³ and 28.65 ± 8.42 cm³ in group III, respectively, showing significant reductions (P = 0.028 and P = 0.007, respectively). For all movements, the occurrence of septum deviation and nasal airflow impairment was not statistically significant. Pure maxillary advancement movement enhanced nasal cavity air volume. The yaw rotation movement significantly increased quantitative clinical rhinosinusitis symptoms. The risk of airflow impairment following Le Fort I surgery is low.     

Validity of three-dimensional computed tomography measurements for Le Fort I osteotomy

The purpose of this study was to test the precision and accuracy of three-dimensional (3D) linear measurements for Le Fort I osteotomy, obtained from multi-slice computed tomography (MSCT) and cone beam computed tomography (CBCT) scans. The study population consisted of 11 dried skulls submitted to 64-row MSCT and CBCT scans. Three-dimensional reconstructed images (3D-CT) were generated, and linear measurements (n = 11) based on anatomical structures and landmarks of interest for Le Fort I osteotomy were performed independently by two oral and maxillofacial radiologists, twice each, using Vitrea software; this allows true 3D measurement on 3D-CT images. The results demonstrated no statistically significant differences between the inter-examiner and intra-examiner analyses, and physical and true 3D linear measurements using MSCT and CBCT images. Regarding examiner accuracy, no statistically significant differences were found for the comparisons among the physical and the MSCT and the CBCT linear measurements by either examiner. For examiners 1 and 2, the analysis intra-examiner correlation coefficient ranged from 0.87 to 0.96 and 0.82 to 0.98, respectively, using MSCT, and from 0.84 to 0.98 and 0.80 to 0.98, respectively, using CBCT, indicating almost perfect agreement for all analyses performed. 3D linear measurements obtained from MSCT and CBCT images were considered precise and accurate for Le Fort I osteotomy and thus accurate and helpful for Le Fort I osteotomy planning.     

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目的 探讨面部不对称畸形患者的三维仿真头模术前设计对其术中上颌骨截骨的指导意义。方法 选择中国医科大学口腔医学院口腔颌面外科2007年1月至2009年1月收治的18例面部不对称畸形患者。所有患者畸形明显并且均伴有竖直方向牙合平面的倾斜。术前制作三维头模,精确测量之后在模型上模拟截断上颌骨,评价截骨的位置及截骨量,再将得到的数据应用到手术中行上颌骨截骨,术后6个月评价手术效果。结果 18例患者手术顺利,无严重并发症出现。所有患者术后效果满意,牙合平面均水平,面部对称。结论 通过三维头模模拟截骨得出的数据可用于精确指导术中的截骨,对于术中上颌骨截骨的位置及截骨量的确定具有重要的指导意义。     

Maxillary osteotomy complications in piezoelectric surgery compared to conventional surgical techniques: a systematic review

A systematic review was conducted to investigate the available evidence on maxillary complications related to piezoelectric and conventional surgery. Seven databases were searched. A total of 996 maxillary osteotomies were analysed, 864 performed with conventional tools and 132 with a piezoelectric device. One hundred and fifty-six complication events were reported. The complications, in descending order of overall prevalence, were as follows: neurosensory disturbance (64.7%), haemorrhage (8.3%), oroantral communication (7.7%), soft tissue injury (7.7%), tooth injury (5.1%), infection (3.2%), osteonecrosis (1.9%), and permanent nerve injury (1.3%). Among the complications, the results showed the highest prevalence for neurosensory disturbance, and haemorrhage was the most reported complication and the second most prevalent complication. A three-fold meta-analysis was performed. Using GRADEpro, the level of evidence was determined for each complication. The current low level of evidence suggests that piezoelectric bone surgery reduces critical and important complications during maxillary osteotomy procedures, such as neurosensory disturbance, haemorrhage, oroantral communication, tooth injury, and permanent nerve injury. However, an effective comparison between the two techniques was difficult to perform with the current available literature. Due to the small sample sizes in the piezoelectric surgery studies, caution should be exercised when considering almost non-existent reported complications.     

超声骨刀在上颌窦侧壁开窗提升种植术中的临床应用

目的：评价超声骨刀在上颌窦侧壁开窗提升牙种植术中应用的临床效果。方法：15例上颌后牙缺失患者,术前CBCT检查牙槽嵴顶距上颌窦底的骨量高度为3．0～6．5 mm,采用超声骨刀行上颌窦侧壁开窗提升术并同期植入19颗种植体,术后即刻CBCT观察上颌窦底黏膜、窦内情况及种植体植入情况,术后3天随访观察有无上颌窦黏膜破裂并发症状。结果：15例中无1例出现上颌窦黏膜破裂,术后CBCT检查所有患者上颌窦窦底黏膜提升成功,无上颌窦底黏膜破损者,无患者出现上颌窦内液体渗出堆积。术后3天内随访,均无鼻腔出现血性分泌物或骨粉等异物排出现象。结论：采用超声骨刀行上颌窦侧壁开窗提升牙种植术,可以大大减少种植手术的时间,降低了手术并发症的风险。     

Palatal osteotomy with vestibuloplasty for the treatment of severe maxillary atrophy: a new twist on an old technique

Nowadays, upper denture instability secondary to severe maxillary atrophy is treated, in most cases, with dental implants. However, a significant number of patients cannot afford this procedure. Palatal bone deepening through a U-shaped osteotomy has been described previously. The procedure increases retention by improving the suction effect of the palate and prevents anteroposterior and lateral movement of the denture. By combining this procedure with a secondary epithelialization vestibuloplasty, the labial aspect of the ridge is also extended and it does not require a skin graft. This article describes a modification of the palatal vault osteotomy through the presentation of a case.     

Anatomical characteristics of maxillary sinus septa visualized by cone beam computed tomography

Proper implant positioning in the posterior region of the edentulous maxilla commonly requires sinus floor elevation. Maxillary sinus septa increase the risk of membrane perforation during sinus floor elevation. The purpose of this retrospective, cone beam computed tomography (CBCT)-based study was to examine the frequency, number, location, and orientation of antral septa in the maxillary sinus. Further, possible associated factors were assessed. Measurements were performed on CBCT scans of 301 patients (602 sinuses). The data were analysed statistically with respect to patient age, sex, and dentition type. One or more septa were detected in 117 patients (38.9%). A total of 188 septa were found in the 602 sinuses (31.2%). Septa were most often coronally oriented (53.2%), followed by sagittal (24.5%) and transverse (22.3%) orientations. Septa were most often found in the region of the first and second molar (37.2%), followed by the posterior region of the third molar (33.0%) and the anterior region of the premolars and canines (29.8%). A significant association was found between edentulism and the presence of septa. For edentulous patients, the septa were most often transversally oriented. Maxillary sinus septa are encountered in every third patient. This may have an influence on the performance of sinus floor elevation.