全程数字化夜磨牙保护(牙合)垫的制作和初步应用

目的:建立一套夜磨牙保护牙合垫的全程数字化设计制作流程,并将其初步应用于临床,观察其临床效果。方法:选取需要通过佩戴牙合垫缓解夜磨牙症的患者24名,使用随机数表法分为两组,实验组使用口内扫描仪获取患者的上下牙列数字印模和抬高后的咬合关系,采用计算机辅助设计软件(computer aided design, CAD)进行数字化设计,将设计数据导入计算机辅助制作软件(computer aided manufacturing, CAM)进行切削;对照组通过真空压膜法制作传统软牙合垫。将两种方法制作的牙合垫分别让两组患者进行口内试戴,应用T-scan Ⅲ咬合分析系统分析佩戴两种牙合垫后的牙合接触特征,并由患者对牙合垫的固位、美观与咬合舒适度进行评分,采用IBM SPSS 20.0软件进行Mann-Whitney双侧检验,P<0.05为差异有统计学意义。结果:成功建立了夜磨牙保护牙合垫的全程数字化设计制作流程。临床应用发现,两组患者对两种牙合垫的固位评价差异无统计学意义(Z=-0.538,P=0.590), 实验组的美观评分(Z=2.038,P=0.042)与咬合舒适度评分(Z=-2.579,P=0.010)均高于对照组,差异有统计学意义。T-scan结果显示,正中咬合时,对照组仅有双侧第二磨牙区存在牙合接触,而实验组可与下颌全牙列接触,前后牙合力均匀。结论:全程数字化设计制作的夜磨牙保护牙合垫改良了咬合设计,极大地简化和优化了牙合垫的制作流程,节约了医疗资源,有益环保,能够更加便捷、高效地为患者服务。

Preliminary clinical application of complete digital workflow of design and manufacturing occlusal splint for sleep bruxism

Objective: To establish a complete workflow of digital design and manufacturing occlusal splint for sleep bruxism, which can be preliminarily applied in clinical use, thus observe the clinical efficacy. Methods: Twenty-four patients with sleep bruxism were recruited in the study and randomly divi-ded into two groups by using random number tables. Digital-occlusal-splint (experimental group) treatment plan and traditional-occlusal-splint (control group) treatment plan were carried out for each group, respectively. For experimental group, digital models of patients’ both dental arches and the occlusion relationship after elevation were captured using an intraoral scanner. The occlusal splint was carried out by computer aided design/computer aided manufacturing (CAD/CAM), including splint designing and milling. For control group, the traditional soft occlusal splint was fabricated by vacuum laminator. The two kinds of occlusal splints were tried in the patients from each group, and the occlusal contacts were tested respectively by T-scan analysis system, which recorded the changes of occlusal indicators in the two groups. The retention, appearance and occlusal comfort degree were evaluated by the two groups of patients. Mann-Whitney test was performed with IBM SPSS 20.0 software, and bilateral test was performed. P<0.05 was considered to be statistically significant. Results: The complete workflow of digital design and manufacturing occlusal splint was successfully established. During the clinical use, there was no statistical difference in the retention evaluation of two kinds of occlusal splints between the two groups of patients (Z=-0.538, P=0.590). The appearance score (Z=2.038, P=0.042) and the occlusal comfort score (Z=-2.579, P=0.010) of the experimental group were higher than those of the control group, with statistically significant differences. The T-scan analysis results showed that only the second molar on both sides of the traditional occlusal splint had occlusal contact in intercupsal position, while the digital occlusal splint had stable and bilaterally balanced contact between the maxillary and mandibular teeth. Furthermore, the occlusal force was uniformly distributed in the experimental group. Conclusion: The complete workflow of digital occlusal splint improves the occlusal design, greatly simplifies and optimizes the traditional process of making occlusal splint. This new method is resource-saving and environmental-friendly, and it is able to serve patients more conveniently and efficiently.