口内数字化印模技术在口腔种植中的应用现状与研究进展

近年来,数字化技术在口腔种植领域迅速发展,口内数字化印模技术作为数字化流程中的重要部分也受到越来越多的关注。与传统印模技术相比,口内数字化印模在临床操作效率、患者就诊体验、模型储存等方面表现出明显优势,同时也面临着数据拼接处理精度不足、软组织还原度低等问题。该文针对口腔种植修复中口内数字化印模技术的发展、特点及其应用现状与研究进展进行综述,以期进一步指导其临床应用。     

口内数字化印模扫描重复性的研究

目的：通过研究口内数字化扫描仪多次扫描的重复性来评价其扫描精度。方法：根据原始研究模型上牙备后基牙的分布不同分为5小组（1.右侧上颌中切牙为牙备后形态,余牙完整;2.右侧上颌第一磨牙为牙备后形态,余牙完整;3.右侧上颌中切牙和尖牙为牙备后形态,上颌侧切牙缺失,余牙完整;4.右侧上颌7颗牙齿为牙备后形态,左半侧完整;5.上颌全部牙齿为牙备后形态）。实验组中,每一小组的研究模型均用TRIOS口内扫描仪10次;对照组中,每一小组的研究模型先分别翻制10副石膏模型,再用3Shape口外扫描仪扫描。实验组和对照组分别得到扫描生成的50个STL三维图像文件,将总共100个STL文件通过Geomagic Studio 12软件进行处理和分析来评价两组扫描的重复性和精度。结果：实验组（口内组）3D标准偏差分别是第1小组：13.33μm,第2小组：7.0μm,第3小组：16.33μm,第4小组：41.56μm,第5小组：88.44μm。对照组的3D标准偏差分别是第1小组：14.89μm,第2小组：8.67μm,第3小组：24.33μm,第4小组：14.22μm,第5小组：12.67μm。实验组和对照组的3D标准偏差在第2,3,4,5小组中有统计学差异（P〈0.05）。结论：口内数字化印模扫描精度随着牙弓扫描范围增大而降低,其在扫描范围小于半个牙弓时表现出的精度符合临床要求;而口外台式扫描仪在扫描任意范围牙弓时均表现出较好的精度。     

种植修复口内扫描印模精度的影响因素

在种植修复领域中,随着数字化技术逐渐推广,口内扫描印模因其简捷高效、舒适度高、便于医患交流的优势,临床应用日益广泛。但是在实际应用中,口内扫描印模的精度会受到多种因素的影响,包括扫描技术、牙列和种植体的情况、辅助标记和材料以及环境等,进而导致精度的降低,限制其适用性;应用于牙齿缺失较多的患者时可能会精度不足,建议当种植体数量多、间距大时谨慎使用口内扫描,不要过度拧紧扫描杆,尽量维持合适的环境条件。本文回顾近期相关研究文献,对种植修复中口内扫描印模精度的影响因素进行综述。     

种植修复数字化口内印模及其精度的影响因素

数字化口内印模技术已经是临床常用的印模方式,并被用于种植修复领域.基于数字化的种植修复口内印模技术相较于传统种植修复取模具有许多优势,该文介绍数字化种植印模技术流程和分类,并对相关文献中口内扫描仪及种植扫描杆相关因素对种植数字化印模精度的影响进行综述分析,以期为临床应用提供指导.     

口内扫描数字化印模对固定修复临床应用效果的Meta分析

目的 系统评价口内扫描数字化印模(IDI)技术对固定修复的临床应用效果.方法 计算机检索Medline(Ovid)、EMBASE、Cochrane Central Register of Controlled Trials以及中国知网(CNKI)数据库关于IDI对口腔固定修复治疗临床效果的随机对照试验(RCT),各数据...     

数字化口腔修复(2)——数字化印模

义齿采用数字化的加工方法,有助于提高修复体质量,改善护理质量,并为患者提供最佳就诊体验.数字化印模易于储存,不占空间,且无需消毒,极大地避免了气泡、裂痕和收缩变形的发生.随着新技术的迅猛发展,优化数字化印模的操作,降低数字化印模的成本,将有助于其发展.     

Cavicide消毒液对口腔硅橡胶印模的消毒效果

目的 探讨Cavicide消毒液对口腔硅橡胶印模消毒效果及尺寸稳定性的影响。方法 将加成型硅橡胶印模材料制成55 mm×30 mm×10 mm大小、表面光滑平整的试样,单面划一条标记线段,表面涂布失去活性的15％牛血清以模拟口腔唾液,用无菌棉签分别涂布金黄色葡萄球菌、血链球菌和白色念珠菌3种细菌悬液0.5 ml/100 cm³,随机分成5组,一组不加任何消毒剂（对照组）,其他4组实验组分别为二氧化氯浸泡组、戊二醛浸泡组、cavicide浸泡组和cavicide喷涂组,比较分析各组抑菌率,并在显微镜下测量标记线段的长度变化。结果 对3种细菌抑菌率的结果显示： Cavicide浸泡组抑菌率最高,Cavicide喷涂组抑菌率次之,与其他2实验组比较差异有统计学意义（P<0.05）。二氧化氯浸泡组与戊二醛浸泡组之间差异无统计学意义（P>0.05）; Cavicide浸泡组和喷涂组标记线段长度几乎未见变化,组间差异无统计学意义（P>0.05）,二氧化氯浸泡组和戊二醛浸泡组标记线段长度明显变长,与Cavicide浸泡组和喷涂组比较,差异有统计学意义（P<0.05）。结论 Cavicide消毒液对口腔硅橡胶印模消毒效果较好,具有较高的抑菌率,且对口腔硅橡胶印模尺寸稳定性影响小,值得临床推广应用。     

CS3600■口扫数字化印模技术与传统硅橡胶印模技术在磨牙全瓷冠修复中的比较

目的:比较数字化口内直接印模技术与传统精细硅橡胶印模技术在磨牙全瓷冠修复中的效果。方法:研究选取2019年10月~2020年1月于华中科技大学同济医学院附属同济医院口腔修复科行磨牙全瓷单冠修复治疗的患者32例,共计36颗患牙。实验组18颗患牙采用CS3600^■口内扫描仪制取数字化印模,对照组18颗患牙采用传统硅橡胶印模技术制取印模。记录两组取模时间、戴牙时间及患者舒适度,修复完成2个月参照改良美国公共卫生署(USPHS)标准对修复体进行评价。结果:实验组取模时间更短、取模更舒适;制作的修复体戴牙时间更短、修复体边缘适合性更好(P<0.05)。结论:在磨牙全瓷冠的修复治疗中,CS3600^■口内扫描技术在取模时间、取模舒适度、戴牙时间和修复体边缘适合性等方面都优于传统硅橡胶印模技术。     

基于口内数字化印模制作的全瓷单冠的适合性研究

目的 检测基于口内数字化印模制作的全瓷单冠的适合性,为口内数字化印模在牙体缺损中的临床应用提供数据参考。方法 选择右下第一磨牙全冠树脂标准预备模型作为实验对象,实验组采用口内扫描法,对照组使用传统硅橡胶印模翻制石膏模型,再通过口外扫描仪扫描石膏模型,两组分别扫描10次。通过数字切削加工技术制作全瓷冠共20个。利用硅橡胶薄膜法测量内冠的内部适合性和边缘适合性。结果 实验组的全瓷单冠在近中边缘（49.04±19.71）μm、近中轴转角（210.52±55.65）μm、面中点（313.34±83.97）μm的适合性优于对照组[近中边缘（80.08±31.76）μm、近中轴转角（371.14±104.62）μm、面中点（441.60±171.21）μm],差异有统计学意义（P<0.05）,而其余位点实验组[近中轴面中点（126.51±35.29）μm,远中轴转角（281.09±95.22）μm,远中轴面中点（94.65±23.81）μm,远中边缘（80.99±37.85）μm]与对照组[近中轴面中点（114.48±23.23）μm,远中轴转角（379.19±149.39）μm,远中轴面中点（109.06±31.45）μm,远中边缘（81.64±24.57）μm]之间的差异无统计学意义（P>0.05）。结论 采用口内扫描法制作的全瓷单冠其适合性可满足临床要求。     

数字化印模在无牙颌中应用的研究进展

数字化印模是一种高效、便捷的新兴印模技术,近年来在固定冠、种植牙,可摘局部义齿中都展现了良好的准确度以及临床疗效,同时简化了临床诊疗的繁琐流程,提高了患者舒适度.无牙颌印模制取一直是临床诊疗的关键与难点,数字化印模在无牙颌患者修复中的应用逐渐增多.该文将从无牙颌数字化印模的分类、准确度研究以及临床扫描策略进行综述,为无...     

口内三维扫描技术临床应用精度的研究进展

口内三维扫描技术发展迅速,精度不断提高,已被广泛应用于口腔医学领域。在单冠修复、三单位固定桥以及单枚种植体上部修复方面,口内三维扫描仪的扫描精度可满足临床要求;但在跨度过大的固定修复领域,其扫描精度仍存在不足。由于光学扫描原理的局限,目前临床难以通过口内三维扫描仪直接获取功能整塑后的软组织形态,口内三维扫描技术尚存在技术瓶颈。本文通过回顾和总结常见口内三维扫描仪对口腔软硬组织的扫描精度,分析口内三维扫描技术的临床适用性及局限性,以期为临床决策提供参考。     

Comparison of intraoral scanning and conventional impression techniques using 3-dimensional superimposition

PURPOSE

The aim of this study is to evaluate the appropriate impression technique by analyzing the superimposition of 3D digital model for evaluating accuracy of conventional impression technique and digital impression.

MATERIALS AND METHODS

Twenty-four patients who had no periodontitis or temporomandibular joint disease were selected for analysis. As a reference model, digital impressions with a digital impression system were performed. As a test models, for conventional impression dual-arch and full-arch, impression techniques utilizing addition type polyvinylsiloxane for fabrication of cast were applied. 3D laser scanner is used for scanning the cast. Each 3 pairs for 25 STL datasets were imported into the inspection software. The three-dimensional differences were illustrated in a color-coded map. For three-dimensional quantitative analysis, 4 specified contact locations(buccal and lingual cusps of second premolar and molar) were established. For twodimensional quantitative analysis, the sectioning from buccal cusp to lingual cusp of second premolar and molar were acquired depending on the tooth axis.

RESULTS

In color-coded map, the biggest difference between intraoral scanning and dual-arch impression was seen (P<.05). In three-dimensional analysis, the biggest difference was seen between intraoral scanning and dual-arch impression and the smallest difference was seen between dual-arch and full-arch impression.

CONCLUSION

The two- and three-dimensional deviations between intraoral scanner and dual-arch impression was bigger than full-arch and dual-arch impression (P<.05). The second premolar showed significantly bigger three-dimensional deviations than the second molar in the three-dimensional deviations (P>.05).     

Torsion and linear accuracy in intraoral scans obtained with different scanning principles

PurposeFew investigations have examined the production of single restorations using intraoral scanners (IOS). Data on full-arch scans are rare, and data regarding torsion within the entire arch are very sparsely reported. Therefore, the aim of this study was to examine the deviations of torsion and linear distances in full-arch scans of three IOS based on different scanning principles.MethodsA cobalt-chrome-molybdenum alloy master model (CCMM) with four hemispheres was fabricated by laser sintering. The CCMM was digitized using a laboratory scanner (ATOS-Core/GOM) and scanned with three IOS (Omnicam/Sirona(OC); True Definition/3M(TD); TriosII/Cara-Version/Kulzer(TR)). All scan data were exported in a standard STL-file format and were analyzed with GOM Inspect software (V7.5/GOM). Torsion between the right and left side of the arch and linear accuracy (trueness and precision) were evaluated. After normality was confirmed, all data were subjected to parametric statistical analyses.ResultsThe torsion ranged from 0.07 ± 0.03°(OC) to 0.29 ± 0.14°(TD). Pairwise comparisons showed significant differences between the OC and TD scanners and between the TR and TD scanners. The linear distances ranged from 6 ± 5 μm(OC) to 298 ± 317 μm(TD). Significant differences were observed among all investigated IOS (p = 0.05).ConclusionsAlthough the highest torsion was observed for the TD scanner, it is still not clear whether the differences between the IOS are related to the scanning principle or to the scanning algorithm. Due to the high clinical relevance of full-arch restorations, future studies should consider torsion. Regarding linear accuracy, no general difference related to the scanning principles of the IOSs was observed.     

全口牙列口内扫描的精确性与可重复性分析

目的:通过比较全口牙列传统石膏模型和数字化模型的线性测量数据,评估口腔扫描系统的精确性与可重复性.方法:由5位志愿者构成传统模型组(对照组)与口内扫描组(实验组).对志愿者进行传统硅橡胶取模、石膏灌制后,采用Trios Ortho口内扫描仪(3 Shape公司)对志愿者分别于8点、13点、18点进行全口牙列口内扫描,为期15 d.采用电子游标卡尺测量石膏模型,Simplant软件测量口内扫描图像.由经过专业培训的测试者分别于上午8点、13点、18点进行测量,重复15 d.采用SAS 11.0软件包中的配对t检验进行实验组与对照组组间数据的精确性比较,可重复性研究则为在实验组组间进行单因素方差分析.结果:精确性研究中,志愿者1的参数23L有显著差异(P＜0.01),5位志愿者的其他所有参数均无显著差异(P＞0.05).可重复性研究中,5位志愿者各参数之间均无显著差异(P＞0.05).结论:全口口内直接数字化扫描的精确性与可重复性较高.     

Titanium dioxide-based scanning powder can modulate cell activity of oral soft tissue - Insights from in vitro studies with L929 cells and periodontal fibroblasts

PurposeTo reveal the impact of titanium dioxide-based scanning powder for intraoral digital impression on the biological activity of oral fibroblasts.MethodsMurine L929 cells and human periodontal ligament (PDLF) and gingival fibroblasts (GF) were treated with ten-fold serial dilutions of scanning powder and the corresponding conditioned medium (filtrate of overnight incubation of powder in medium) starting with 30 mg/ml. Bicinchoninic acid protein assay, formazan- and resazurin-based toxicity assays, live/dead and annexin V/propidium iodide (PI) staining and immunoassays for interleukin (IL)-6 and IL-8 were performed. Powder composition was analyzed using energy dispersive X-ray spectroscopy (EDS).ResultsFormazan and resazurin conversion was lesser in L929 cells than PDLF and GF in the presence of scanning powder. Induction of cell death was caused by 30 mg/ml of powder in L929 cells but not in PDLF and GF. No pronounced impact of the conditioned medium was seen in cytotoxicity assays or live/dead-, and annexin V/PI staining. In PDLF and GF IL-6 expression was increased by the powder, while there was a decrease in IL-8. Powder particles did not deplete protein from medium. EDS showed a heterogeneous mixture consisting predominantly of titanium dioxide.ConclusionsScanning powder decreased cell activity and induced cell death in L929 cells at high concentrations. Human oral fibroblasts showed an increase in IL-6 levels but more resistance to the cytotoxicity of the powder. Within the limitations of an in vitro study our results suggest that proper cleaning after scanning is of clinical relevance to avoid potential unwanted effects of the powder.     

Accuracy of 14 intraoral scanners for the All-on-4 treatment concept: a comparative in vitro study

PURPOSEThis in vitro study aimed to evaluate the accuracy of 14 different intraoral scanners for the All-on-4 treatment concept.MATERIALS AND METHODSFour implants were placed in regions 13, 16, 23, and 26 of an edentulous maxillary model that was poured with scannable Type 4 gypsum to imitate the All-on-4 concept. The cast was scanned 10 times for each of 14 intraoral scanners (Primescan, iTero 2, iTero 5D, Virtuo Vivo, Trios 3, Trios 4, CS3600, CS3700, Emerald, Emerald S, Medit i500, BenQ BIS-I, Heron IOS, and Aadva IOS 100P) after the polyether ether ketone scanbody was placed. For the control group, the gypsum model was scanned 10 times with an industrial scanner. The first of the 10 virtual models obtained from the industrial model was chosen as the reference model. For trueness, the data of the 14 dental scanners were superimposed with the reference model; for precision, the data of all 14 scanners were superimposed within the groups. Statistical analyses were performed using the Kolmogorov-Smirnov, Shapiro-Wilks, and Dunn’s tests.RESULTSPrimescan showed the highest trueness and precision values (P < .005), followed by the iTero 5D scanner (P < .005).CONCLUSIONSome of these digital scanners can be used to make impressions within the All-on-4 concept. However, the possibility of data loss due to artifacts, reflections, and the inability to combine the data should be considered.