数字化设计与3D打印在自体牙移植术的应用

目的探讨术前数字化设计结合3D打印供体牙模型及受区牙槽窝模型辅助自体牙移植术的效果。方法收集12例因牙折或牙槽骨广泛吸收而无法保留的第一或第二磨牙,将其锥形束CT数据导入Mimics数字化设计软件中,选取匹配度最高的第三磨牙作为供体牙,3D打印出供体牙及受区牙槽窝模型进行术前模拟移植术。术中在供体牙模型引导下进行受区牙槽窝及供体牙的预备,将供体牙移植于受区。术后3、6、12个月复查锥形束CT评估骨重建及牙周膜状况。结果 12例患者均选择根尖孔已完全闭合的第三磨牙作为供体牙即刻移植于磨牙区。7例受区牙槽窝术前存在感染,其中1例因受区患牙感染致牙槽骨广泛吸收。12例手术短期恢复良好,均完成12个月以上随访,其中11例移植牙成功,能正常行使咀嚼功能,1例在术后14个月时出现牙根吸收。结论数字化设计结合3D打印技术能够辅助匹配最合适的供体牙,术前完成受区牙槽窝精准预备,减少供体牙在体外的暴露时间和移植到牙槽窝内的试放次数,有助于自体牙移植成功。     

计算机辅助设计联合3D打印应用于自体牙移植

目的:评价计算机辅助设计下,3D打印技术应用于自体牙移植术的临床疗效分析.方法:选取2016年5月～2019年5月31例患者,从年龄、性别、受区情况、供体牙发育情况、移植时间、模型制备时间、牙槽窝制备时间、供牙离体时间、供牙牙根与牙槽窝的平均距离、移植手术评分和移植牙成功率等角度进行分析.结果:实验组和对照组牙槽窝预备...     

数字化技术辅助异位阻生尖牙自体牙移植1例

自体牙移植术是指将天然牙从一个位置移植到同一个体的另一位置的手术过程,可有效恢复患者的美观和咀嚼功能,是替代缺牙的可行方法。但因缺乏技术规范,成功率不易保障。不同牙位自体牙移植的存活率与成功率存在差异,尖牙的自体牙移植预后最差。应用数字化技术辅助自体牙移植术,可降低手术难度,减少牙周膜损伤,提高移植牙的成功率。本文报告1例牙瘤导致下颌尖牙异位阻生的自体移植病例。     

自体牙移植术大鼠动物模型的建立

［摘要］ 目的 建立自体牙移植术的标准化大鼠动物模型,并分析其优缺点。方法 选取5周龄SD大鼠,全麻下先后拔除左上第三磨牙（供牙）和左上第二磨牙（患牙）。预备左上第二磨牙牙槽窝后将供牙放入其中试植,调整方向和咬合后进行树脂粘接固定。术后进行口内愈合情况、影像学及组织学检查。结果 大鼠可以接受自体牙移植手术操作。术后8周口内移植牙固定良好,术区软组织无红肿。组织HE染色可见移植牙牙根和牙槽骨初步愈合,CT显示有少量成骨。该模型具有实验周期较短、成本较低、可重复性较好、以及可以接受多种类型的检查和检测的优点。其缺点包括：个体偏小,实验操作空间小,精细化程度要求较高,以及有些操作不能彻底进行或无法完成。结论 大鼠可以用于自体牙移植术标准动物模型。     

自体牙移植的研究进展

自体牙移植是将健康无功能的牙移植到同一个体的另一拔牙窝或手术预备的牙槽窝中,从而恢复缺失牙的一种治疗方法。随着研究的深入,自体牙移植技术日渐成熟,但大量的临床病例和随访结果显示成功率参差不齐。为了掌握术前、术中、术后的操作要点,提高移植成功率,本文对自体牙移植近几年的文献进行回顾,为临床医生行牙移植提供指导与参考。     

自体牙移植术规范化操作流程中国专家共识

自体牙移植术是指将牙从一个位置移植到同一个体的另一位置的手术过程,常见的是将埋伏、阻生、错位或异位萌出牙转移到其他需要拔牙部位或缺牙部位的牙槽窝内,或手术制备的牙槽窝内。作为生物相容性最好的修复方式,自体牙移植可以用天然牙恢复牙列缺失、维持牙槽骨的骨量,恢复受牙区正常的牙周组织和牙本体感受,达到“变废为宝”的目的。目前国内外尚缺乏一个公认的、具有可操作性的自体牙移植术的规范化操作流程（包括适应证、禁忌证、术前检查、术前准备、手术步骤、术后治疗及医嘱等）。为了进一步规范自体牙移植术的临床应用,我们结合该领域专家的操作经验,制订了自体牙移植术的规范化操作流程,以期提高自体牙移植术的成功率。     

种植技术在自体牙移植的临床研究

目的：探讨牙种植技术在自体牙移植中的应用方法,评价其临床效果。方法：对20颗牙进行自体移植,其中,埋伏阻生牙移植16颗,前磨牙移植前牙缺失区4颗,应用Frialit-2种植工具完成移植窝制备,将埋伏牙或前磨牙完整拔出后移植于缺牙区,同期植入自体骨.托槽弓丝固定6周,移植4周后进行根管治疗。结果：经1～6年的随访,20颗移植牙均未发现牙根吸收松动等并发症。结论：应用种植技术实施自体牙移植具有去骨精确,骨损伤小,成功率高的优点,临床效果肯定。     

人工骨用于自体牙移植2年临床效果分析

目的探讨3种人工骨在自体牙移植中应用的临床效果及影响因素。方法选择年龄16～54岁．第一或第二磨牙缺失或残根．口腔内同时有能完整拔出无功能的第三磨牙患者96例,患牙103颗,分A、B、C3组。拔出供牙,体外根管预备充填,拔除患牙,制备受牙区牙槽窝,植入供牙后,根周骨腔分别填塞BAM、Bio—Oss和PerioGlas人工骨,缝合、结扎固定,术后6、12和24个月复查、观察临床效果并记录牙周指数。结果3组牙移植术后6个月因松动A组拔出2颗,B组和c组各拔除1颗：术后1～2年复查A组再拔除3颗,C组拔除1颗;3组其余移植牙各项牙周指数无明显差异．咀嚼功能基本正常。结论3种人工骨用于自体牙移植临床效果接近,2年复查牙周指数无明显差异。     

自体牙移植在正畸临床上的应用

自体牙移植术是将自体牙完整摘出,移植于自身其他部位的缺牙处,是治疗缺牙的方法之一。本文对自体牙移植术在口腔正畸方面的供牙选取、适应证以及移植牙成活的影响因素等进行了综述。     

对过大牙槽窝行自体牙移植的动物实验研究

目的研究对受区过大牙槽窝行自体牙移植的方法。方法3只Beagle犬的18颗切牙作为供体牙,分为3组,分别植入到前磨牙区已预备好,近远中向比牙根宽2mm的牙槽窝中。再生组提前7d预备受区,利用再生组织充填;骨材料组使用瑞安生骨替代物充填;对照组不做处理。术后3月大体观察、拍X片和组织学检测比较3组的预后。结果所有移植牙均健康存活,无松动脱落。再生组示牙周膜再生,牙骨质和牙槽骨表面无吸收。骨材料组牙根发生炎症性吸收,有新骨生成。对照组牙根发生表面吸收。结论再生组织可以促进牙周再生,并减少牙根表面吸收;瑞安生骨替代物的使用有助于移植牙的稳定和存活,但其对牙周再生的作用尚待进一步研究。     

Simulation of postoperative occlusion and direction in autotransplantation of teeth: application of computer-aided design and digital surgical templates

Autotransplantation of teeth requires optimisation of both occlusion and direction to ensure minimal injury to the dental crown and the alveolar bone. We describe a method that could simulate postoperative occlusion and direction of the donor tooth by using CAD and digital surgical templates, and evaluate the postoperative effect in five patients who had teeth autotransplanted. Computed tomographic data were imported into ProPlan CMF 3.0 software, the donor tooth was simulated to replace the recipient site according to the position of the occlusion and alveolar bone, and a digital template was designed to guide preparation of the socket. A computer-aided, rapid prototyped, tooth was used to match the socket and, finally, an occlusal template was designed to ensure that the donor tooth was in the simulated position. We compared the position of the tooth in the simulation with its postoperative position using ProPlan CMF 3.0 software. In this way it was possible to simulate and guide the donor tooth accurately to the recipient site. At six-month follow up all teeth had survived successfully. Given the efficiency and precision of placement and the success, we conclude that CAD can successfully help to simulate occlusion and direction in autotransplantation of teeth while simplifying the procedure.     

Clinical application of 3D technology for tooth autotransplantation: A case report

This report presents two cases of tooth autotransplantation using cone‐beam computed tomography (CBCT), the three‐dimensional (3D) simulation dental planning software and a computer‐aided rapid prototyping (CARP) model. Two hopeless teeth of adult patients were replaced as their third molar teeth. Before deciding the autotransplantation, diagnostic CBCT images were acquired and imported to SimPlant software. The SimPlant dental program was used for surgical simulation prior to autotransplantation, which created 3D images of the available donor teeth and recipient site tooth and superimposed the images to display their morphological similarity. Efficient modification of the recipient socket was designed preoperatively. The CARP model of the donor tooth was prepared as a substitute for the donor tooth that would be fit into the new recipient socket during bone preparation. Autotransplantation was favourably performed in 5–6 min. Transplanted teeth healed up without clinical abnormality. The postoperative follow‐up time was up to 6 years.     

Accuracy and surgical feasibility of a CBCT‐based stereolithographic surgical guide aiding autotransplantation of teeth: in vitro validation

Summary The aims of this study were to determine the accuracy of a 3D computer model and stereolithographic (STL) replica when compared to the real tooth and to develop a cone beam computed tomography (CBCT)‐based planning technique including surgical guide fabrication. A STL surgical guide and a tooth replica were fabricated using SimPlant Pro 12.1. To validate this process, tooth segmentation and replica design were prepared for comparison to an optical scan of the corresponding tooth. For surgical intervention, a dry dentate mandible was scanned using a Scanora CBCT and the donor tooth was segmented. The donor tooth was repositioned, and two guides were designed. These tooth replica and guides were used in socket preparation of the dry mandible. The 3D computer model of the segmented teeth and related STL models showed satisfactory results with an acceptable accuracy. The surfaces were within 0·25 mm distance, but in some areas up to 2·5 mm deviation were seen. The results showed that 79% of the points was between 0·25 and ?0·25 mm, 3% was overestimated (>0·25 mm) and 18% was underestimated (in vivo planning of CBCT‐based autotransplantation.     

Virtual Simulation of Autotransplantation Using 3-dimensional Printing Prototyping Model and Computer-assisted Design Program

This case report describes an innovative virtual simulation method using a computer-aided rapid prototyping (CARP) model and a computer-aided design (CAD) program for autotransplantation of an immature third molar.A compromised left mandibular second molar (#18) was extracted and replaced by autotransplantation using an immature left mandibular third molar (#17). In order to minimize the surgical time and injury to the donor tooth, a virtual 3-dimensional (3D) rehearsal surgery was planned. Cone-beam computed tomographic images were taken to fabricate the 3D printing CARP model of the donor tooth and tentative extraction socket. Subsequently, both CARP models were scanned with an intraoral scanner (CEREC Omnicam; Dentsply Sirona, Bensheim, Germany) followed by superimposition and virtual simulation of osteotomy preparation of the recipient alveolus using the CAD analysis program. During the surgery, the extraction socket was precisely prepared according to the predetermined location and dimensions via virtual simulation rehearsal surgery using CAD analysis. The donor tooth was atraumatically transplanted into the prepared socket. The follow-up examination revealed that the root developed with a normal periodontal ligament and lamina dura.Virtual simulation using a 3D printing CARP model and a CAD program could be clinically useful in autotransplantation of an immature third molar by ensuring an atraumatic and predictable surgery.     

Use of computer-aided three-dimensional prototyping to surgically assist in tooth autotransplantation

Autotransplantation is a surgical technique in which a donor tooth belonging to the same individual is repositioned into a surgically prepared socket or site of previous tooth extraction. It is beneficial in patients with teeth affected by agenesis, trauma, significant caries, and in teeth in a non-restorable condition or prognostically poor due to other pathology. It is particularly useful in paediatric patients, as properly transplanted teeth have a vital periodontium that allows for continuous growth and functional adaptation leading to preservation of the alveolar ridge. Technological advances in rapid prototyping combined with three-dimensional (3D) computed tomography (CT) have the ability to revolutionise autotransplantation. Preoperative planning for atraumatic extraction of the donor tooth and precise preparation of the recipient site with a rapid prototyped surgical template of the donor tooth considerably reduces the extra-alveolar time, and also reduces manipulation of the root sheath and periodontal ligament, and related trauma. This case series demonstrates the efficient and successful autotransplantation of various types of teeth with the use of a rapid prototyped surgical template produced from 3D CT. The use of this technology is expected to refine the surgical technique and improve treatment outcomes.     

Treatment of an avulsed maxillary permanent central incisor by autotransplantation of a primary canine tooth

Aim  To present a case in which an avulsed permanent maxillary central incisor was replaced by autotransplantation of a primary canine tooth.
Summary  The present case describes transplantation of a primary canine tooth into the space left by an avulsed permanent maxillary central incisor after a delay of several days. After root canal treatment, the primary canine tooth was extracted and placed into the prepared socket. To provide better adaptation of the donor tooth, the recipient alveolar site was remodeled using surgical burs. Semi-rigid splinting was maintained for 15 days. The crown of the primary canine was reshaped with composite resin and with an interim prosthesis, preventing movement of the lateral incisor tooth into the space of the transplanted canine. After 24-month follow-up the autotransplanted primary canine showed ankylosis but the tooth was in an acceptable state. The use of permanent tooth autotransplantation has been well documented. However a literature search revealed only one case report on the autotransplantation of primary teeth.
Key learning points • Long term results of primary tooth autotransplantation are scarce but the procedure in this case report could be considered as a temporary space maintainer for the treatment of a patient with a lost permanent incisor under 10 years of age.
• Success of primary tooth autotransplantation may be affected by several factors, such as case selection, extra oral time, surgical and endodontic procedures.     

A 3D printed surgical analogue to reduce donor tooth trauma during autotransplantation

Surgical trauma and prolonged extra-alveolar exposure of the donor tooth’s root sheath are both complicating factors during tooth autotransplantation surgery. This case report describes a 12-year-old female patient who underwent surgical transplantation of a maxillary second premolar to a central incisor site. A three-dimensional printed analogue of the donor tooth was fabricated from a cone beam (CBCT) scan of the tooth in order to minimise the extra-oral (exposure) time and frequency of trial insertions of the donor tooth into the recipient socket. The laboratory and clinical aspects of this novel technique are described.     

Impacted Maxillary Canine with Curved Apex: Three-Dimensional Guided Protocol for Autotransplantation

IntroductionMaxillary canines play a crucial role in dental and facial aspect, arch expansion, and efficient occlusion. When surgical exposure measures cannot be executed or the patient does not agree to take the treatment, autotransplantation should be considered. The aim of this case report was to describe a novel surgical technique using virtually planned three-dimensional (3D)-printed templates for guided apicoectomy and guided drilling of the recipient site for autotransplantation of an impacted maxillary canine with a curved apex.MethodsA 42-year-old man complaining of pain and increased mobility in the maxillary left primary canine came to the clinic. Autotransplantation of the impacted canine was completed using altered methods from guided implant surgery to manufacture 3D-printed templates. After a full-thickness mucoperiosteal flap elevation, the surgical template for the guided osteotomy and apicoectomy was inserted. This 3D-printed guide allowed the clinician to perform a quick and precise removal of the curved apex, providing an atraumatic extraction of the impacted canine throughout the cyst. Three further 3D surgical guides for implant burs and a 3D replica tooth were printed to modify the recipient socket. After the final position, the tooth was semi-rigid splinted to the adjacent teeth.ResultsFollow-up at 2 years showed complete regeneration of the palatal defect and remodeling of the bone surrounding the maxillary canine.ConclusionsDigitally planned procedures can facilitate the complex execution of an autotransplantation, reducing the treatment chair time and the morbidity for the patient as well as increasing the predictability of the result.