计算机辅助设计与制作一体化聚醚醚酮可摘局部义齿不同形态组件的适合性评价
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摘要
目的:评价用聚醚醚酮(polyetheretherketone,PEEK)制作可摘局部义齿不同形态组件的适合性。方法:选取已进行基牙预备的下颌牙列缺损超硬石膏标准模型进行三维扫描,获得牙列缺损数字模型,联合牙科计算机辅助设计软件与逆向工程软件分别设计13个完整的可摘局部义齿,用计算机辅助制作技术制作PEEK一体化可摘局部义齿,在超硬石膏模型上试戴。用硅橡胶印模材复制义齿各组件与模型之间的间隙,采用三维偏差分析法测量牙合支托、基托和大连接体处的间隙大小,通过单因素方差分析、配对t检验分别比较各组件之间以及各组件内部的间隙差异是否有统计学意义。结果:PEEK一体化可摘局部义齿在超硬石膏模型上就位良好。单因素方差分析表明牙合支托、基托和大连接体处间隙的差异有统计学意义(P<0.01)。牙合支托处平均间隙[(84.3±23.6)μm]大于基托[(32.5±27.8)μm]和大连接体处[(49.9±47.0)μm](P<0.01),但均满足临床需求;基托与大连接体处间隙差异无统计学意义(P>0.05)。游离端与非游离端基托处平均间隙为(25.1±55.3)μm和(41.5±17.7)μm,两者差异无统计学意义(P>0.05)。远离缺牙间隙牙合支托与靠近缺牙间隙牙合支托的平均间隙为(80.8±42.1)μm和(86.1±29.8)μm,两者差异无统计学意义(P>0.05)。结论:数字化设计的全组件可摘局部义齿可用PEEK切削为一体化可摘局部义齿,该义齿不同形态组件均有良好的适合性,有良好的应用前景。
Objective: To explore a novel method for fabricating removable partial dentures( RPDs)using polyetheretherketone( PEEK) by computer-aided design and computer-aided manufacturing( CAD/CAM) technologies and to evaluate their fits for different assemblies in vitro. Methods: A standard stone cast of mandibular partial edentulous jaw was scanned using a lab scanner. Based on the digital cast,thirteen complete RPDs were designed combing dental CAD software and reverse engineering software,and then fabricated using PEEK by milling machine. Fits of assemblies were evaluated quantitatively by measuring the spaces between RPDs and casts. The gaps between RPDs and stone casts in different assemblies were duplicated using light-body silicone impression material and then measured using threedimensional( 3 D) digital analysis methods in virtue of a dedicated software. Statistically,one-way analysis of variance( ANOVA) was used to compare the difference of gaps among assemblies in different shapes such as occlusal rest,denture base,and major connector. Paired-samples t test was used to compare the gaps difference for the similar shape assemblies in different areas. Results: One-piece PEEK RPDs were successfully designed and fabricated by CAD/CAM,and all the RPDs were well-seated on stone casts. The gaps between occlusal rests and casts [( 84. 3 ± 23. 6) μm] were significantly larger than those of denture bases [( 32. 5 ± 27. 8) μm] and major connectors [( 49. 9 ± 47. 0) μm],which meant that the fits of denture bases and major connectors were better than that of occlusal rests. However,the fits of all assemblies could be accepted clinically. For the similar shape assemblies in different areas,there were no significantly differences for gaps between distal extension denture bases [( 25. 1 ± 55. 3)μm]and non-extensive denture bases [( 41. 5 ± 17. 7) μm]. The gaps of occlusal rests adjacent and nonadjacent to the edentulous space were( 86. 1 ± 29. 8) μm and( 80. 8 ± 42. 1) μm respectively and there were no significantly difference between them either. These results implied that different locations had no apparent effect on the fits of assemblies. Conclusion: With the computer-aided design and computer-aided manufacturing technology,PEEK can be used to fabricate one-piece removable partial dentures. And all assemblies of the one-piece PEEK RPDs showed satisfying fits in vitro,indicating a promising clinical application in the future.
Objective: To explore a novel method for fabricating removable partial dentures( RPDs)using polyetheretherketone( PEEK) by computer-aided design and computer-aided manufacturing( CAD/CAM) technologies and to evaluate their fits for different assemblies in vitro. Methods: A standard stone cast of mandibular partial edentulous jaw was scanned using a lab scanner. Based on the digital cast,thirteen complete RPDs were designed combing dental CAD software and reverse engineering software,and then fabricated using PEEK by milling machine. Fits of assemblies were evaluated quantitatively by measuring the spaces between RPDs and casts. The gaps between RPDs and stone casts in different assemblies were duplicated using light-body silicone impression material and then measured using threedimensional( 3 D) digital analysis methods in virtue of a dedicated software. Statistically,one-way analysis of variance( ANOVA) was used to compare the difference of gaps among assemblies in different shapes such as occlusal rest,denture base,and major connector. Paired-samples t test was used to compare the gaps difference for the similar shape assemblies in different areas. Results: One-piece PEEK RPDs were successfully designed and fabricated by CAD/CAM,and all the RPDs were well-seated on stone casts. The gaps between occlusal rests and casts [( 84. 3 ± 23. 6) μm] were significantly larger than those of denture bases [( 32. 5 ± 27. 8) μm] and major connectors [( 49. 9 ± 47. 0) μm],which meant that the fits of denture bases and major connectors were better than that of occlusal rests. However,the fits of all assemblies could be accepted clinically. For the similar shape assemblies in different areas,there were no significantly differences for gaps between distal extension denture bases [( 25. 1 ± 55. 3)μm]and non-extensive denture bases [( 41. 5 ± 17. 7) μm]. The gaps of occlusal rests adjacent and nonadjacent to the edentulous space were( 86. 1 ± 29. 8) μm and( 80. 8 ± 42. 1) μm respectively and there were no significantly difference between them either. These results implied that different locations had no apparent effect on the fits of assemblies. Conclusion: With the computer-aided design and computer-aided manufacturing technology,PEEK can be used to fabricate one-piece removable partial dentures. And all assemblies of the one-piece PEEK RPDs showed satisfying fits in vitro,indicating a promising clinical application in the future.
引文
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[3]Panayotov IV,Orti V,Cuisinier F,et al.Polyetheretherketone(peek)for medical applications[J].J Mater Sci Mater Med,2016,27(7):118.
[4]Najeeb S,Zafar MS,Khurshid Z,et al.Applications of polyetheretherketone(peek)in oral implantology and prosthodontics[J].J Prosthodont Res,2016,60(1):12-19.
[5]Costa-Palau S,Torrents-Nicolas J,Brufau-de Barbera M,et al.Use of polyetheretherketone in the fabrication of a maxillary obturator prosthesis:a clinical report[J].J Prosthet Dent,2013,112(3):680-682.
[6]Zoidis P,Papathanasiou I,Polyzois G.The use of a modified polyetheretherketone(peek)as an alternative framework material for removable dental prostheses.A clinical report[J].J Prosthodont,2015,25(7):580-584.
[7]Tannous F,Steiner M,Shahin R,et al.Retentive forces and fatigue resistance of thermoplastic resin clasps[J].Dent Mater,2012,28(3):273-278.
[8]Frank RP,Brudvik JS,Leroux B,et al.Relationship between the standards of removable partial denture construction,clinical acceptability,and patient satisfaction[J].J Prosthet Dent,2000,83(5):521-527.
[9]Stern MA,Brudvik JS,Frank RP.Clinical evaluation of removable partial denture rest seat adaptation[J].J Prosthet Dent,1985,53(5):658-662.
[10]Dunham D,Brudvik JS,Morris WJ,et al.A clinical investigation of the fit of removable partial dental prosthesis clasp assemblies[J].J Prosthet Dent,2006,95(4):323-326.
[11]Ye H,Ning J,Li M,et al.Preliminary clinical application of removable partial denture frameworks fabricated using computeraided design and rapid prototyping techniques[J].Int J Prosthodont,2017,30(4):348-353.
[12]Luthardt RG,Bornemann G,Lemelson S,et al.An innovative method for evaluation of the 3-D internal fit of CAD/CAM crowns fabricated after direct optical versus indirect laser scan digitizing[J].Int J Prosthodont,2004,17(6):680-685.
[13]Rantanen T,Eerikinen E.Accuracy of the palatal plate of removable partial dentures,and influence of laboratory[J].Dent Mater,1986,2(1):28-31.
[2]Han J,Wang Y,Lu P.A preliminary report of designing removable partial denture frameworks using a specifically developed software package[J].Int J Prosthodont,2010,23(4):370-375.
[3]Panayotov IV,Orti V,Cuisinier F,et al.Polyetheretherketone(peek)for medical applications[J].J Mater Sci Mater Med,2016,27(7):118.
[4]Najeeb S,Zafar MS,Khurshid Z,et al.Applications of polyetheretherketone(peek)in oral implantology and prosthodontics[J].J Prosthodont Res,2016,60(1):12-19.
[5]Costa-Palau S,Torrents-Nicolas J,Brufau-de Barbera M,et al.Use of polyetheretherketone in the fabrication of a maxillary obturator prosthesis:a clinical report[J].J Prosthet Dent,2013,112(3):680-682.
[6]Zoidis P,Papathanasiou I,Polyzois G.The use of a modified polyetheretherketone(peek)as an alternative framework material for removable dental prostheses.A clinical report[J].J Prosthodont,2015,25(7):580-584.
[7]Tannous F,Steiner M,Shahin R,et al.Retentive forces and fatigue resistance of thermoplastic resin clasps[J].Dent Mater,2012,28(3):273-278.
[8]Frank RP,Brudvik JS,Leroux B,et al.Relationship between the standards of removable partial denture construction,clinical acceptability,and patient satisfaction[J].J Prosthet Dent,2000,83(5):521-527.
[9]Stern MA,Brudvik JS,Frank RP.Clinical evaluation of removable partial denture rest seat adaptation[J].J Prosthet Dent,1985,53(5):658-662.
[10]Dunham D,Brudvik JS,Morris WJ,et al.A clinical investigation of the fit of removable partial dental prosthesis clasp assemblies[J].J Prosthet Dent,2006,95(4):323-326.
[11]Ye H,Ning J,Li M,et al.Preliminary clinical application of removable partial denture frameworks fabricated using computeraided design and rapid prototyping techniques[J].Int J Prosthodont,2017,30(4):348-353.
[12]Luthardt RG,Bornemann G,Lemelson S,et al.An innovative method for evaluation of the 3-D internal fit of CAD/CAM crowns fabricated after direct optical versus indirect laser scan digitizing[J].Int J Prosthodont,2004,17(6):680-685.
[13]Rantanen T,Eerikinen E.Accuracy of the palatal plate of removable partial dentures,and influence of laboratory[J].Dent Mater,1986,2(1):28-31.