数字化三维技术在正畸诊疗中的应用进展
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摘要
口腔正畸学研究的是颅、颌、面三者在三维结构上之间的位置关系。传统的检查方法已不能满足现代正畸的诊断与治疗。随着数字化技术及相关学科的快速发展,医师对错?畸形的诊断、方案的设计及预防治疗均发生了变化。三维数字化技术的发展使医师有机会在此基础上模拟正颌手术,构建三维气道结构、预测治疗前后软硬组织的变化及数字化模型的推广应用。三维数字化技术具有效率高、精度高,可视化及可操作性高等优点,为个性化正畸治疗提供了有效手段,增加了评测的客观性。
The object of orthodontics research is three-dimensional positional relationships of cranial,maxillofacial,and facial structures. Traditional examination methods can not satisfy the diagnosis and treatment of modern orthodontics. With the rapid development of digital technology and related disciplines,doctors have changed the diagnosis,treatment design and prevention of malocclusion. The development of three-dimensional digital technology has enabled doctors to simulate orthognathic surgery on this basis,construct a three-dimensional airway structure,predict changes in soft and hard tissue before and after treatment,and promote the application of digital models. The research shows that the three-dimensional digital technology has the advantages of high efficiency,high precision,high visualization and operability,which provides an effective means for individualized orthodontic treatment and increases the objectivity of evaluation.
The object of orthodontics research is three-dimensional positional relationships of cranial,maxillofacial,and facial structures. Traditional examination methods can not satisfy the diagnosis and treatment of modern orthodontics. With the rapid development of digital technology and related disciplines,doctors have changed the diagnosis,treatment design and prevention of malocclusion. The development of three-dimensional digital technology has enabled doctors to simulate orthognathic surgery on this basis,construct a three-dimensional airway structure,predict changes in soft and hard tissue before and after treatment,and promote the application of digital models. The research shows that the three-dimensional digital technology has the advantages of high efficiency,high precision,high visualization and operability,which provides an effective means for individualized orthodontic treatment and increases the objectivity of evaluation.
引文
[1]杨洋,郭磊,郭卫星.数字医学三维成像技术在原发性肝癌治疗中的应用[J/CD].中华肝脏外科手术学电子杂志,2019,8(1):14-17.
[2]高晓辉,吴晶,王邦康,等.正畸牙移动的形象化目标分析法及临床应用[J].北京口腔医学,2001,9(3):117-119.
[3]Harrell WE Jr,Hatcher DC,Bolt RL.In search of anatomic truth:Three-dimensional modeling and the future of orthodontics[J].Am J Orthod Dentofacial Orthop,2003,122(3):325-330.
[4]Adams GL,Gansky SA,Miller AJ,et al.Comparison between traditional 2-dimensional cephalometry and a 3-dimensional approach on human dry skulls[J].Am J Orthod Dentofacial Orthop,2004,126(5):397-409.
[5]Schulze D,Heiland M,Blake F,et al.Evaluation of quality of reformatted images from two cone-beam computed tomographic systems[J].J Craniomaxillofac Surg,2005,33(1):19-23.
[6]秦化祥.头颅侧位片2D和CBCT 3D头影测量的可靠性及精确度比较[J].温州医学院学报,2011,41(5):421-430.
[7]Moshiri M,Scarfe WC,Hilgers ML,et al.Accuracy of linear measurements from imaging plate and lateral cephalometric imagesderived from cone-beam computed tomography[J].Am J Orthod Dent ofacial Orthop,2007,132(4):550-560.
[8]张翼.CBCT与传统二维X线片头影测量的比较研究[D].贵阳:贵阳医学院,2012.
[9]李斯斯.正常人2D与CBCT-3D头影测量可靠性的对比研究[D].贵州:遵义医学院,2016.
[10]刘怡.浅谈三维头影测量中的一些技术问题[J].中华口腔医学杂志,2016,51(6):331-335.
[11]许晓岑,房莉,曾飞煌,等.口腔正畸中3种常用头影测量技术的对比研究[J].口腔医学研究,2014,30(4):348-351.
[12]van Vlijmen OJ,Berge SJ,Swennen GR,et al.Comparison of cephalometric radiographs obtained from cone-beam computed tomography scans and conventional radiographs[J].J Oral Maxillofac Surg,2009,67(1):92-97.
[13]Ricketts RM.Planning treatment on the basis of the facial pattern and an estimate of its growth[J].Am JOrthod,1957,27:14-37.
[14]Asakawa S,Al-Musaallam T,Handelman CS.Nonextraction treatment of a ClassⅡdeepbite malocclusion with severe mandibular crowding:Visualized treatment objectives for selecting treatment options[J].Am J Orthod Dentofacial Orthop,2008,133(2):308-316.
[15]李冰.计算机Ricketts分析系统及静态VTO矫治设定系统的建立[D].西安:第四军医大学,2009.
[16]刘杰.两种不同VTO分析方法的比较分析[D].福州:福建医科大学,2013.
[17]卢钰,王增全.可视治疗目标对错患者软组织变化预测的临床研究[J].广西医科大学学报,2010,27(2):227-229.
[18]Peterman RJ,Jiang S,Johe R,et al.Accuracy of Dolphin visual treatment objective(VTO)prediction software on classⅢpatients treated with maxillary advancement and mandibular setback[J].Prog Orthod,2016,17(1):19.
[19]Toepel-Sievers C,Fischer-Brandies H.Validity of the ComputerAssisted Cephalometric Growth prognosis VTO(Visual Treatment Objective)According to Ricketts[J].J Orofac Orthop,1999,94(3):185-194.
[20]Enciso R,Shigeta Y,Nguyen M,et al.Comparison of Cone-Beam CT Incidental Findings between Moderate/Severe Obstructive Sleep Apnea patients and Mild/Normal patients[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2012,114(3):373-381.
[21]陈科名,杨崇实,邓锋.不同矢状骨面型错畸形患者气道大小形态的CBCT研究[J].口腔医学研究,2012,28(1):54-57.
[22]任少春,门海艳,李洪发.成人骨性Ⅱ类错口咽气道形态的CBCT研究[J].天津医科大学学报,2017,23(4):364-368.
[23]杨彩霞,李骋.青少年Ⅱ类骨面型非拔牙矫治后上气道结构变化的三维研究[J].口腔医学研究,2017,33(10):1118-1122.
[24]Li L,Liu H,Cheng H,et al.CBCT evaluation of the upper airway morphological changes in growing patients of classⅡdivision 1malocclusion with mandibular retrusion using twin block appliance:Acomparative research[J].PLo S One,2014,9(4):e94378.
[25]Di Carlo G,Polimeni A,Melsen B,et al.The relationship between upper airways and craniofacial morphology studied in 3D.ACBCT study[J].Orthod Craniofac Res,2015,18(1):1-11.
[26]Weissheimer A,Menezes LM,Koerich L,et al.Fast three-dimensional superimposition of cone beam computed tomography for orthopaedics and orthognathic surgery evaluation[J].Int J Oral Maxillofac Surg,2015,44(9):1188-1196.
[27]Jayaratne YS,Zwahlen RA.The Oropharyngeal Airway in Young Adults with Skeletal ClassⅡand ClassⅢDeformities:A 3-DMorphometric Analysis[J].PLo S One,2016,11(2):e0148086.
[28]Wen X,Wang X,Qin S,et al.Three-dimensional analysis of upper airway morphology in skeletal Class Ill patients with and without mandi-bular asymmetry[J].Angle Orthod,2017,87(4):526-533.
[29]李晅,许衍,罗薇,等.基于CBCT青春期骨性Ⅱ类患者上气道结构分析[J].山西医科大学学报,2014,45(7):637-641.
[30]常琳.下颌前伸止鼾器治疗轻、中度OSAHS患者前后上气道的CBCT研究[D].昆明:昆明医科大学,2017.
[31]张郁,李永明,安志彬.口腔矫治器对OSAHS患者咽腔气流及上气道壁形变影响的研究[J].河北医药,2017,39(19):2915-2918.
[32]Schwarz R.New cephalometric method and apparatus and its application to orthodontia[J].Int J Orthod Oral Surg Radiol,1925,11(10):910-928.
[33]Broadbent BH.A new x-ray technique and its application to orthodontia[J].Angle Orthod,1931,1:45.
[34]Mankovich NJ,Curtis DA,Kagawa T,et al.Comparison of computer-based fabrication of alloplastic cranial implants with conventional techniques[J].Prosthet Dent,1986,55(5):606-609.
[35]Hemmy DC.Wire mesh for cranial vault reconstruction[J].Plast Reconstr Surg,1987,79(2):306-307.
[36]Robinson RC,Holm RL.Orthognathic surgery for patients with maxillofacial deformities[J].AORN J,2010,92(1):28-49,50-52.
[37]Mavili ME,Canter HI,Saglam-Aydinatay B,et al.Use of three dimensional medical modeling methods for precise planning of orthognathic surgery[J].J Craniofac Surg,2007,18(4):740-747.
[38]Cintra O,Grybauskas S,Vogel CJ,et al.Digital platform for planning facial asymmetry orthodontic-surgical treatment preparation[J].Dental Press J Orthod,2018,23(3):80-93.
[39]Janakiraman N,Feinberg M,Vishwanath M,et al.Integration of3-dimensional surgical and orthodontic technologies with orthognathic"surgery-first"approach in the management of unilateral condylar hyperplasia[J].Am J Orthod Dentofacial Orthop,2015,148(6):1054-1066.
[40]谭新颖,胡敏,刘昌奎,等.数字化虚拟手术设计辅助正颌外科手术12例临床分析[J].上海口腔医学,2014,23(3):322-327.
[41]张文斌,沈国芳.导航手术在颅颌面外科的应用及误差控制[J].中国口腔颌面外科杂志,2012,10(2):170-173.
[42]Dai J,Tang M,Xin P,et al.Accurate movement of jaw segment in virtual 3D orthognathic surgery[J].J Craniofac Surg,2014,25(2):e140-143.
[43]商洪涛,史雨林,白石柱,等.骨性Ⅲ类面形患者数字化正颌外科治疗[J].中国美容整形外科杂志,2016,27(12):713-716.
[44]Redmond WR.Digital models:A new diagnostic tool[J].J Clin Orthod,2001,35(6):386-387.
[45]Fleming PS,Marinho V,Johal A.Orthodontic measurements on digital study models compared with plaster models:A systematic review[J].Orthod Craniofac Res,2011,14(1):1-16.
[46]Sousa MV,Vasconcelos EC,Janson G,et al.Accuracy and reproducibility of 3-dimensional digital model measurements[J].Am JOrthod Dentofacial Orthop,2012,142(2):269-273.
[47]Anh JW,Park JM,Chun YS,et al.A comparison of the precision of three-dimensional images acquired by 2 digital intraoral scanners:Effects of tooth irregularity and scanning direction[J].Korean J Orthod,2016,46(1):3-12.
[48]Seelbach P,Brueckel C,Wostmann B.Accuracy of digital and conventional impression techniques and workflow[J].Clin Oral Invest,2013,17(7):1759-1764.
[49]Mack S,Bonill T,English JD,et al.Accuracy of 3-dimensional curvilinear measurements on digital models with intraoral scanners[J].Am J Orthod Dentofacial Orthop,2017,152(3):420-425.
[50]Flugge TV,Schlager S,Nelson K,et al.Precision of intraoral digital dental impressions with i Tero and extraoral digitization with the i Tero and a model scanner[J].Am J Orthod Dentofacial Orthop,2013,144(3):471-478.
[51]Im J,Cha JY,Lee KJ,et al.Comparison of virtual and manual tooth setups with digital and plaster models in extraction cases[J].Am J Orthod Dentofacial Orthop,2014,145(4):434-442.
[2]高晓辉,吴晶,王邦康,等.正畸牙移动的形象化目标分析法及临床应用[J].北京口腔医学,2001,9(3):117-119.
[3]Harrell WE Jr,Hatcher DC,Bolt RL.In search of anatomic truth:Three-dimensional modeling and the future of orthodontics[J].Am J Orthod Dentofacial Orthop,2003,122(3):325-330.
[4]Adams GL,Gansky SA,Miller AJ,et al.Comparison between traditional 2-dimensional cephalometry and a 3-dimensional approach on human dry skulls[J].Am J Orthod Dentofacial Orthop,2004,126(5):397-409.
[5]Schulze D,Heiland M,Blake F,et al.Evaluation of quality of reformatted images from two cone-beam computed tomographic systems[J].J Craniomaxillofac Surg,2005,33(1):19-23.
[6]秦化祥.头颅侧位片2D和CBCT 3D头影测量的可靠性及精确度比较[J].温州医学院学报,2011,41(5):421-430.
[7]Moshiri M,Scarfe WC,Hilgers ML,et al.Accuracy of linear measurements from imaging plate and lateral cephalometric imagesderived from cone-beam computed tomography[J].Am J Orthod Dent ofacial Orthop,2007,132(4):550-560.
[8]张翼.CBCT与传统二维X线片头影测量的比较研究[D].贵阳:贵阳医学院,2012.
[9]李斯斯.正常人2D与CBCT-3D头影测量可靠性的对比研究[D].贵州:遵义医学院,2016.
[10]刘怡.浅谈三维头影测量中的一些技术问题[J].中华口腔医学杂志,2016,51(6):331-335.
[11]许晓岑,房莉,曾飞煌,等.口腔正畸中3种常用头影测量技术的对比研究[J].口腔医学研究,2014,30(4):348-351.
[12]van Vlijmen OJ,Berge SJ,Swennen GR,et al.Comparison of cephalometric radiographs obtained from cone-beam computed tomography scans and conventional radiographs[J].J Oral Maxillofac Surg,2009,67(1):92-97.
[13]Ricketts RM.Planning treatment on the basis of the facial pattern and an estimate of its growth[J].Am JOrthod,1957,27:14-37.
[14]Asakawa S,Al-Musaallam T,Handelman CS.Nonextraction treatment of a ClassⅡdeepbite malocclusion with severe mandibular crowding:Visualized treatment objectives for selecting treatment options[J].Am J Orthod Dentofacial Orthop,2008,133(2):308-316.
[15]李冰.计算机Ricketts分析系统及静态VTO矫治设定系统的建立[D].西安:第四军医大学,2009.
[16]刘杰.两种不同VTO分析方法的比较分析[D].福州:福建医科大学,2013.
[17]卢钰,王增全.可视治疗目标对错患者软组织变化预测的临床研究[J].广西医科大学学报,2010,27(2):227-229.
[18]Peterman RJ,Jiang S,Johe R,et al.Accuracy of Dolphin visual treatment objective(VTO)prediction software on classⅢpatients treated with maxillary advancement and mandibular setback[J].Prog Orthod,2016,17(1):19.
[19]Toepel-Sievers C,Fischer-Brandies H.Validity of the ComputerAssisted Cephalometric Growth prognosis VTO(Visual Treatment Objective)According to Ricketts[J].J Orofac Orthop,1999,94(3):185-194.
[20]Enciso R,Shigeta Y,Nguyen M,et al.Comparison of Cone-Beam CT Incidental Findings between Moderate/Severe Obstructive Sleep Apnea patients and Mild/Normal patients[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2012,114(3):373-381.
[21]陈科名,杨崇实,邓锋.不同矢状骨面型错畸形患者气道大小形态的CBCT研究[J].口腔医学研究,2012,28(1):54-57.
[22]任少春,门海艳,李洪发.成人骨性Ⅱ类错口咽气道形态的CBCT研究[J].天津医科大学学报,2017,23(4):364-368.
[23]杨彩霞,李骋.青少年Ⅱ类骨面型非拔牙矫治后上气道结构变化的三维研究[J].口腔医学研究,2017,33(10):1118-1122.
[24]Li L,Liu H,Cheng H,et al.CBCT evaluation of the upper airway morphological changes in growing patients of classⅡdivision 1malocclusion with mandibular retrusion using twin block appliance:Acomparative research[J].PLo S One,2014,9(4):e94378.
[25]Di Carlo G,Polimeni A,Melsen B,et al.The relationship between upper airways and craniofacial morphology studied in 3D.ACBCT study[J].Orthod Craniofac Res,2015,18(1):1-11.
[26]Weissheimer A,Menezes LM,Koerich L,et al.Fast three-dimensional superimposition of cone beam computed tomography for orthopaedics and orthognathic surgery evaluation[J].Int J Oral Maxillofac Surg,2015,44(9):1188-1196.
[27]Jayaratne YS,Zwahlen RA.The Oropharyngeal Airway in Young Adults with Skeletal ClassⅡand ClassⅢDeformities:A 3-DMorphometric Analysis[J].PLo S One,2016,11(2):e0148086.
[28]Wen X,Wang X,Qin S,et al.Three-dimensional analysis of upper airway morphology in skeletal Class Ill patients with and without mandi-bular asymmetry[J].Angle Orthod,2017,87(4):526-533.
[29]李晅,许衍,罗薇,等.基于CBCT青春期骨性Ⅱ类患者上气道结构分析[J].山西医科大学学报,2014,45(7):637-641.
[30]常琳.下颌前伸止鼾器治疗轻、中度OSAHS患者前后上气道的CBCT研究[D].昆明:昆明医科大学,2017.
[31]张郁,李永明,安志彬.口腔矫治器对OSAHS患者咽腔气流及上气道壁形变影响的研究[J].河北医药,2017,39(19):2915-2918.
[32]Schwarz R.New cephalometric method and apparatus and its application to orthodontia[J].Int J Orthod Oral Surg Radiol,1925,11(10):910-928.
[33]Broadbent BH.A new x-ray technique and its application to orthodontia[J].Angle Orthod,1931,1:45.
[34]Mankovich NJ,Curtis DA,Kagawa T,et al.Comparison of computer-based fabrication of alloplastic cranial implants with conventional techniques[J].Prosthet Dent,1986,55(5):606-609.
[35]Hemmy DC.Wire mesh for cranial vault reconstruction[J].Plast Reconstr Surg,1987,79(2):306-307.
[36]Robinson RC,Holm RL.Orthognathic surgery for patients with maxillofacial deformities[J].AORN J,2010,92(1):28-49,50-52.
[37]Mavili ME,Canter HI,Saglam-Aydinatay B,et al.Use of three dimensional medical modeling methods for precise planning of orthognathic surgery[J].J Craniofac Surg,2007,18(4):740-747.
[38]Cintra O,Grybauskas S,Vogel CJ,et al.Digital platform for planning facial asymmetry orthodontic-surgical treatment preparation[J].Dental Press J Orthod,2018,23(3):80-93.
[39]Janakiraman N,Feinberg M,Vishwanath M,et al.Integration of3-dimensional surgical and orthodontic technologies with orthognathic"surgery-first"approach in the management of unilateral condylar hyperplasia[J].Am J Orthod Dentofacial Orthop,2015,148(6):1054-1066.
[40]谭新颖,胡敏,刘昌奎,等.数字化虚拟手术设计辅助正颌外科手术12例临床分析[J].上海口腔医学,2014,23(3):322-327.
[41]张文斌,沈国芳.导航手术在颅颌面外科的应用及误差控制[J].中国口腔颌面外科杂志,2012,10(2):170-173.
[42]Dai J,Tang M,Xin P,et al.Accurate movement of jaw segment in virtual 3D orthognathic surgery[J].J Craniofac Surg,2014,25(2):e140-143.
[43]商洪涛,史雨林,白石柱,等.骨性Ⅲ类面形患者数字化正颌外科治疗[J].中国美容整形外科杂志,2016,27(12):713-716.
[44]Redmond WR.Digital models:A new diagnostic tool[J].J Clin Orthod,2001,35(6):386-387.
[45]Fleming PS,Marinho V,Johal A.Orthodontic measurements on digital study models compared with plaster models:A systematic review[J].Orthod Craniofac Res,2011,14(1):1-16.
[46]Sousa MV,Vasconcelos EC,Janson G,et al.Accuracy and reproducibility of 3-dimensional digital model measurements[J].Am JOrthod Dentofacial Orthop,2012,142(2):269-273.
[47]Anh JW,Park JM,Chun YS,et al.A comparison of the precision of three-dimensional images acquired by 2 digital intraoral scanners:Effects of tooth irregularity and scanning direction[J].Korean J Orthod,2016,46(1):3-12.
[48]Seelbach P,Brueckel C,Wostmann B.Accuracy of digital and conventional impression techniques and workflow[J].Clin Oral Invest,2013,17(7):1759-1764.
[49]Mack S,Bonill T,English JD,et al.Accuracy of 3-dimensional curvilinear measurements on digital models with intraoral scanners[J].Am J Orthod Dentofacial Orthop,2017,152(3):420-425.
[50]Flugge TV,Schlager S,Nelson K,et al.Precision of intraoral digital dental impressions with i Tero and extraoral digitization with the i Tero and a model scanner[J].Am J Orthod Dentofacial Orthop,2013,144(3):471-478.
[51]Im J,Cha JY,Lee KJ,et al.Comparison of virtual and manual tooth setups with digital and plaster models in extraction cases[J].Am J Orthod Dentofacial Orthop,2014,145(4):434-442.