CN111281577A - Positioning device for root tip surgical operation and preparation method thereof - Google Patents
Positioning device for root tip surgical operation and preparation method thereof Download PDFInfo
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Abstract
The invention relates to the field of dental equipment, in particular to a positioning device for a root tip surgical operation and a preparation method thereof. In order to reduce the risk of the root tip surgical operation, improve the treatment quality and make the long-term prognosis develop better, the invention provides a positioning device for the root tip surgical operation, wherein the side surface of the outer edge of a supporting plate is an outward convex cambered surface; the positioning plate is positioned on the top surface of the supporting plate and close to the side surface of the outer edge of the supporting plate, and a positioning through groove is formed in the positioning plate and is close to or positioned at a positioning end, far away from the supporting plate, of the positioning plate; the positioning accessory is clamped in the positioning through groove and is provided with a positioning guide through hole penetrating through the inner wall and the outer wall of the positioning accessory; when the tooth-cutting device is used, the supporting plate is positioned between the upper tooth and the lower tooth of a patient, the positioning accessory is pressed on an affected tooth, and the positioning guide through hole is positioned at the cutting position of the root tip of the affected tooth. The positioning device for the root tip surgical operation can reduce the operation risk, improve the treatment quality and be beneficial to the development of the long-term prognosis.
Description
Technical Field
The invention relates to the field of dental equipment, in particular to a positioning device for a root tip surgical operation and a preparation method thereof.
Background
Root canal therapy is the preferred treatment for chronic periapical inflammation, however, when root canal therapy fails and is not suitable for root canal retreatment or root canal retreatment fails, or there is a serious anatomical variation in the affected tooth, or a definite diagnosis by exploratory surgery is required, etc., surgical methods for promoting healing of periapical disease by scraping off periapical diseased tissue and excising the infected apical tip, treating the stump of the apical tip, and depositing calcific substances by the organization of blood clots, including apical excision, apical scraping and apical inverted filling, are often employed as the methods of apical surgery.
When the periapical lesions which can not be cured by partial root canal therapy and retreatment are treated by using the apical surgery, the bone removal amount and the excision length of the root tip of the affected tooth during the operation are determined according to the structure, the direction, the depth and the periapical lesion conditions of the affected tooth root, and in the operation process, the size of the bone removal amount, the excision length of the root tip of the affected tooth and the damage degree of soft and hard tissues of the root tip area have great influence on the quality of the treatment of the apical surgery and the long-term prognosis. Therefore, when the periapical lesions are treated by using the apical surgery, the cutting length and angle of the affected tooth root tip need to be accurately positioned, but at present, the structure, direction, depth and periapical lesions of the affected tooth root are generally preliminarily known by the Cone beam CT (CBCT for short), and the cutting length and angle of the affected tooth root tip cannot be accurately positioned, so that the apical surgery operation has certain risks, and the treatment quality and the long-term prognosis are influenced to be well developed.
Disclosure of Invention
In order to reduce the risk of the root tip surgical operation, improve the treatment quality and make the prognosis develop well in the long term, the invention provides a positioning device for the root tip surgical operation, which comprises a supporting plate, a positioning plate and a positioning accessory, wherein the side surface of the outer edge of the supporting plate is an outward convex cambered surface; the positioning plate is positioned on the top surface of the supporting plate and close to the outer edge side surface of the supporting plate, a positioning through groove is formed in the positioning plate, and the positioning through groove is close to or positioned at a positioning end, far away from the supporting plate, of the positioning plate; the positioning accessory is clamped in the positioning through groove and is provided with a positioning guide through hole penetrating through the inner wall and the outer wall of the positioning accessory; when the tooth-cleaning device is used, the supporting plate is positioned between the upper tooth and the lower tooth of a patient, the inner wall of the positioning accessory is pressed on an affected tooth, and the positioning guide through hole on the positioning accessory is positioned at the cutting position of the root tip of the affected tooth.
When the root tip surgical operation is carried out on the affected tooth of a patient, a supporting plate in the positioning device for the root tip surgical operation is placed between the upper tooth and the lower tooth of the patient, and the inner wall of the positioning end of the positioning plate is attached to the affected tooth gum of the patient; then, removing bone tissues through the positioning through groove by using a bone removal tool so as to expose the tooth root of the affected tooth; then the positioning accessory is inserted into the positioning through groove, the inner wall of the positioning accessory is pressed against the affected tooth of the patient, and the affected tooth root tip is cut off by the long-handle split drill inserted into the positioning guide through hole, so that the affected tooth root tip is cut off. Thus, when the positioning device for the apical surgery is used for carrying out the apical surgery on the affected tooth of a patient, the bone removing range can be limited through the positioning through groove on the positioning plate, so that the bone removing amount is reduced; the position, direction, degree of depth and the angle of excision of the split drill of long handle are injectd to the location direction through-hole on the accessible location accessory to accurate excision suffers from the tooth root tip, reduces the destruction to the soft and hard tissue in root tip district when excising the root tip of suffering from the tooth. Therefore, when the positioning device for the root tip surgical operation is used for performing the root tip surgical operation on the affected tooth of a patient, the bone removing amount can be effectively reduced, the affected tooth root tip can be accurately cut, the damage to soft and hard tissues in the affected tooth root tip area can be reduced, the risk of the root tip surgical operation can be reduced, the treatment quality can be improved, and the long-term prognosis can be favorably developed.
Preferably, the positioning guide through hole is a counter bore, and the aperture of the positioning guide through hole at the outer wall of the positioning fitting is larger than the aperture of the positioning guide through hole at the inner wall of the positioning fitting. Therefore, the cutting depth of the long-handle split drill can be controlled by adjusting the depth of the positioning guide through hole in the sinking groove on the outer wall of the positioning accessory according to needs, and the long-handle split drill is prevented from damaging a patient due to too deep depth in the cutting process, so that the treatment and the long-term prognosis are influenced to be developed.
Preferably, the support plate is a ring sector plate. Like this, can avoid backup pad and patient's tongue to interfere each other, influence the location effect of locating plate and location accessory. Furthermore, limiting grooves for accommodating tooth tips are arranged on the top surface and the bottom surface of the supporting plate. Therefore, when in use, the tooth tips of the patient can be clamped in the limiting grooves, and the situation that the supporting plate is displaced in the operation process to influence the operation treatment quality is avoided.
Preferably, the positioning device further comprises a supporting projection, and the supporting projection is located on a positioning end of the positioning plate far away from the supporting plate. Therefore, when in use, the lip of the patient can be supported by the supporting lug, and the situation that the lip of the patient obstructs the operation and affects the treatment quality is avoided.
Preferably, the positioning fitting is made of a titanium alloy material. The positioning accessory has good wear resistance, can reduce possible wear errors and further improves the accuracy of the operation.
In addition, the invention also provides a preparation method of the positioning device for the root tip surgical operation, which comprises the following steps:
step S1: acquiring a dentition model of a patient in a plaster model scanning or oral scanning mode;
step S2: performing annular digital projection on the head of a patient by using cone-beam CT equipment to obtain a CBCT image of the affected tooth of the patient, and determining the position, the property, the degree and the range of periapical lesions of the affected tooth, the change of peripheral alveolar bones and whether an adjacent important anatomical structure is affected by the affected tooth according to the CBCT image; importing the CBCT image into a Mimics Research software, distinguishing soft tissues, bone tissues and tooth bodies in the CBCT image by using a threshold segmentation method, and establishing a three-dimensional reconstruction model of a periapical disease bone destruction area of an affected tooth of a patient;
step S3: introducing the dentition model and the CBCT image into a Geomagic Studio software, segmenting the upper jaw bone and the lower jaw bone in the CBCT image by using the Geomagic Studio software, registering and fusing the jaw bone where the affected teeth of the patient are located and the dentition model, and reconstructing to obtain a jaw bone-dentition three-dimensional model of the patient;
step S4: introducing the periapical disease bone destruction area three-dimensional reconstruction model and the jaw bone-dentition three-dimensional model into Freefom Plus software, measuring the maximum diameter and volume of periapical lesions of the affected teeth of the patient, the distance between the periapical lesions and an important anatomical structure, the length of the dental crowns and the length of the dental roots by using the Freefom Plus software, and establishing a visualized three-dimensional model of the periapical lesions;
step S5; determining the outer edge size and the outer edge side surface of a supporting plate in the positioning device to select an outward convex cambered surface according to the outer edges of the upper and lower dental crowns in the jaw-dentition three-dimensional model; determining the shape and the size of a positioning plate in the positioning device and the position of the positioning plate on the supporting plate according to the visual three-dimensional model of the periapical lesion; determining the position and the size of a positioning through groove on the positioning plate, the shape and the size of a positioning accessory arranged in the positioning through groove and the position, the size and the direction of a positioning guide through hole on the positioning accessory according to the visual three-dimensional model of the periapical lesion;
step S6: inputting the shape and size of the positioning device determined in step S5 into a 3D printer, and printing by the 3D printer to obtain the positioning device.
When the positioning device for the apical surgery is prepared by the preparation method of the positioning device for the apical surgery, the dentition model of the patient obtained by adopting a plaster model scanning or oral scanning mode has high precision, so that the dentition model can be registered and fused with the obtained CBCT graph to establish a high-precision jaw-dentition three-dimensional model, and further the outer edge size and the outer edge side shape of the supporting plate in the positioning device for the apical surgery can be accurately determined according to the outer edges of the upper and lower dental crowns in the jaw-dentition three-dimensional model; after the CBCT image of the patient affected tooth is projected by the cone-beam CT equipment, the morphological structure of the root canal can be clearly observed from CBCT images of the patient affected tooth dissected from different angles and layers, the change of the periapical lesion position, the property, the degree and the range and the peripheral alveolar bone and whether the adjacent important anatomical structures are affected are determined, a three-dimensional reconstruction model of the periapical disease bone destruction zone of the patient affected tooth is conveniently established, and the operation range during operation treatment is conveniently determined; the maximum diameter and the volume of the periapical lesion of the affected tooth of the patient, the distance between the periapical lesion and an important anatomical structure, the length of the dental crown and the length of the dental root are measured according to the three-dimensional reconstruction model of the periapical disease bone destruction area and the jaw-dentition three-dimensional model, so that a visual three-dimensional model of the periapical lesion can be established, the shape, the size and the position of a positioning plate, the arrangement position and the size of a positioning through groove on the positioning plate, the shape and the size of a positioning accessory arranged in the positioning through groove and the position, the size and the direction of a positioning guide through hole on the positioning accessory can be accurately determined according to the visual three-dimensional model of the periapical lesion, so that medical personnel can accurately remove the affected tooth tip by matching the positioning device for the tip surgical operation prepared by using the preparation method with a long-handle split drill to reduce the bone removal amount during the root tip removal, reduce the damage to the soft and hard tissues in the apical area when the affected tooth apical is cut.
Preferably, in step S1, when the dentition model of the patient is obtained by a plaster model scanning manner, the dentition impression of the patient is firstly prepared by 3M ESPE silicone rubber impression material, then the dentition plaster model of the patient is obtained by a plaster filling manner, and finally the dentition plaster model is obtained by scanning the dentition plaster model by using a 3Shape laser scanner; when the dentition model of the patient is obtained in an oral scanning mode, a 3shape Trios intraoral scanner is adopted to scan and obtain the dentition model of the patient. When the dentition model of the patient is acquired by adopting the two modes, the accuracy of the acquired dentition model can be further improved.
Preferably, in the step S2, the threshold value for segmenting the CBCT image by using the threshold segmentation method is set to 226-3071 HU. Thus, the threshold used when the CBCT image is segmented by the threshold segmentation method is set to 226-3071HU, namely the bone tissue threshold, so that tissues with obvious gray value difference in the CBCT image, such as soft tissues, bone tissues and tooth bodies, can be easily segmented conveniently and quickly, and further, the jaw-dentition three-dimensional model of a patient can be quickly and accurately reconstructed.
Preferably, in the step S5, the shape and size of the inner rim of the support plate of the ring segment plate are determined according to the inner rims of the upper and lower dental crowns in the three-dimensional model of the jaw-dentition; and determining the positions and the sizes of the limiting grooves for accommodating the tooth tips on the top surface and the bottom surface of the supporting plate according to the crowns of the upper and lower teeth in the jaw-dentition three-dimensional model. Thus, when the 3D printer is used to print the positioning device for apical surgery, the support plate can be printed as a ring-segment shaped plate and the stop grooves formed to accommodate the cusps of the patient's teeth can be printed on the top and bottom surfaces of the support plate.
Drawings
FIG. 1 is a schematic view of a positioning device for apical surgery according to the present invention;
FIG. 2 is a schematic view of the FIG. 1 positioning device with the positioning attachment removed;
FIG. 3 is a schematic view of the FIG. 2 apex surgical positioning apparatus at another angle.
Detailed Description
The following will explain the positioning device for root tip surgery and the method for manufacturing the same in detail with reference to fig. 1 to 3.
As shown in fig. 1 to 3, the positioning device for the root tip surgical operation of the present invention includes a support plate 1, a positioning plate 2, a positioning fitting 3, and a support projection 4. Wherein, the outer edge side surface 11 of the supporting plate 1 is an outer convex cambered surface so as to be placed in the oral cavity of a patient and positioned between the upper and lower teeth of the patient when in use. Preferably, the support plate 1 is a ring sector plate. Therefore, the tongue of the supporting plate 1 and the patient can be prevented from interfering with each other, and the positioning effect of the positioning plate 2 and the positioning fitting part 3 can be prevented from being influenced. Preferably, the top surface 12 and the bottom surface (not shown) of the support plate 1 are provided with a retaining groove (not shown) for receiving the cusp of the tooth. Therefore, when in use, the tooth tips of the patient can be clamped in the limiting grooves, and the situation that the supporting plate 1 is displaced in the operation process to influence the operation treatment quality is avoided.
The locating plate 2 is located on the top surface 12 of the supporting plate 1 and close to the outer edge side surface 11 of the supporting plate 1, a locating through groove 21 is formed in the locating plate 2, and the locating through groove 21 is close to or located at a locating end, far away from the supporting plate 1, of the locating plate 2. Preferably, the positioning plate 2 is an arc-shaped plate so that the inner wall 22 of the positioning plate 2 is attached to the jawbone surface where the affected teeth of the patient are located when the positioning plate is used, and the phenomenon that the treatment effect is affected by shaking or dislocation during the operation is avoided.
The positioning fitting 3 is clamped in the positioning through groove 21 of the positioning plate 2, and the positioning fitting 3 is provided with a positioning guide through hole 32 penetrating through an inner wall (not shown) and an outer wall 31 of the positioning fitting 3. Preferably, the positioning guide through hole 32 is a counter bore, and the aperture of the positioning guide through hole 32 at the outer wall 31 of the positioning fitting 3 is larger than the aperture of the positioning guide through hole 32 at the inner wall of the positioning fitting 3. Therefore, the cutting depth of the long-handle split drill can be controlled by adjusting the depth of the sinking groove of the positioning guide through hole 32 at the outer wall 31 of the positioning accessory 3 according to requirements, and the long-handle split drill is prevented from damaging a patient due to too deep depth in the cutting process, so that the treatment and the long-term prognosis are influenced and developed. Preferably, the positioning fitting 3 is made of a titanium alloy material. The positioning fitting 3 has good wear resistance, can reduce possible wear errors and further improves the accuracy of the operation.
The supporting projection 4 is located on the positioning end of the positioning plate 2 away from the supporting plate 1. Thus, when in use, the supporting lug 2 can be used for supporting the lips of a patient, and the lips of the patient are prevented from obstructing the operation and influencing the treatment quality.
During the use, backup pad 1 is placed in the patient's oral cavity and is located between patient's the upper and lower tooth, and location accessory 3 is located the location on locating plate 2 and leads to the groove 21 in and supports and press on the sick tooth, and the location guide through-hole 32 on the location accessory 3 is located the excision position department of sick tooth root tip. When the root tip surgical operation is carried out on the affected tooth of a patient, the supporting plate 1 in the positioning device for the root tip surgical operation is firstly placed between the upper tooth and the lower tooth of the patient, and the inner wall of the positioning end of the positioning plate 2 is attached to the affected tooth gum of the patient; then, removing bone tissues through the positioning through grooves 21 by using a bone removal tool to expose the roots of the affected teeth; then the positioning fittings 3 are inserted into the positioning through grooves 21, the inner walls of the positioning fittings 3 are pressed against the affected teeth of the patient, and the affected tooth root tips are cut off by using the long-handle split drills inserted into the positioning guide through holes 32, so that the affected tooth root tips are cut off. Thus, when the positioning device for the root tip surgical operation is used for performing the root tip surgical operation on the affected tooth of a patient, the bone removing range can be limited through the positioning through grooves 21 on the positioning plate 2, so that the bone removing amount is reduced; the cutting position, direction, depth and angle of the long-handle split drill can be accurately limited through the positioning guide through hole 32 on the positioning accessory 3, so that the affected tooth root tip can be accurately cut, and the damage to soft and hard tissues in the root tip area during cutting of the affected tooth root tip can be reduced. Therefore, when the positioning device for the root tip surgical operation is used for performing the root tip surgical operation on the affected tooth of a patient, the bone removing amount can be effectively reduced, the affected tooth root tip can be accurately cut, the damage to soft and hard tissues in the affected tooth root tip area can be reduced, the risk of the root tip surgical operation can be reduced, the treatment quality can be improved, and the long-term prognosis can be favorably developed.
When the positioning device for the root tip surgical operation is prepared, the specific preparation method is as follows:
first, a dentition model of a patient is acquired by way of a plaster model scan or oral scan. Preferably, when the dentition model of the patient is obtained in a plaster model scanning mode, firstly, the dentition impression of the patient is prepared by using a 3M ESPE silicon rubber impression material, then, the dentition plaster model of the patient is obtained in a plaster filling mode, and finally, the dentition plaster model of the patient is obtained by scanning the dentition plaster model by using a 3Shape laser scanner; when the dentition model of the patient is obtained in an oral scanning mode, a 3shape Trios intraoral scanner is adopted to scan and obtain the dentition model of the patient. When the dentition model of the patient is acquired by adopting the two modes, the accuracy of the acquired dentition model can be further improved.
Then, the cone beam CT equipment is adopted to carry out annular digital projection on the head of the patient to obtain a CBCT image of the affected tooth of the patient, the position, the property, the degree and the range of periapical lesion of the affected tooth, the change of the peripheral alveolar bone and whether the adjacent important anatomical structures are affected by the affected tooth are determined according to the CBCT image, the CBCT image is introduced into a Mimics Research software, soft tissues, bone tissues and tooth bodies in the CBCT image are distinguished by a threshold segmentation method, and a three-dimensional reconstruction model of the periapical disease bone destruction zone of the affected tooth of the patient is established. Preferably, the threshold value for segmenting the CBCT image by the threshold segmentation method is set to 226-3071 HU. Thus, the threshold used when the CBCT image is segmented by the threshold segmentation method is set to 226-3071HU, namely the bone tissue threshold, so that tissues with obvious gray value difference in the CBCT image, such as soft tissues, bone tissues and tooth bodies, can be easily segmented conveniently and quickly, and further, the jaw-dentition three-dimensional model of a patient can be quickly and accurately reconstructed. The micsresearch software can be preferably 19.0 and later 19.0 versions. In addition, for adjacent structures with similar gray values which are difficult to distinguish by a threshold segmentation method in a CBCT image, image segmentation tools such as 3D magnetic lasso, morphological operation, Boolean operation, cavity filling, mask editing, multi-layer editing and mask three-dimensional editing can be selected for local fine adjustment, so that the accuracy of the reconstructed three-dimensional model of the jaw bone-dentition of the patient is further improved.
And then, introducing the obtained dentition model and the CBCT image of the patient into a Geomagic Studio software, segmenting the upper jaw bone and the lower jaw bone in the CBCT image by using the Geomagic Studio software, registering and fusing the jaw bone where the affected teeth of the patient are located and the dentition model, and reconstructing to obtain a jaw bone-dentition three-dimensional model of the patient. When the affected tooth of the patient is the upper tooth, registering and fusing the maxilla of the patient and the dentition model of the patient; and when the affected tooth of the patient is the lower tooth, registering and fusing the lower jaw bone of the patient and the dentition model of the patient.
Then, a three-dimensional reconstruction model of a periapical disease bone damaged area and a jaw bone-dentition three-dimensional model are introduced into Freefom Plus software, the Freefom Plus software is utilized to measure the maximum diameter and the volume of periapical lesions of the affected teeth of a patient, the distance between the periapical lesions and an important anatomical structure, the length of a dental crown, the length of a tooth root and the length of a tooth root supported by alveolar bone, and a visual three-dimensional model of the periapical lesions is established. In addition, the maximum diameter and the volume of the periapical lesions of the affected teeth of the patient are measured, and the method can be used for evaluating the range of the periapical lesions of the affected teeth of the patient; the distance between the periapical lesion of the affected tooth of the patient and the important anatomical structures (maxillary sinus and incisor tube) is measured, so that the method can be used for evaluating the risk of performing surgical operation on the affected tooth of the patient and reminding operation in the operation, and the operation risk is reduced; the length of the dental crown, the length of the dental root and the length of the dental root supported by the alveolar bone of the patient are measured, and the root-crown ratio of the affected tooth of the patient can be obtained by utilizing the combined analysis of the length of the dental crown and the length of the dental root, and the post-operation root-crown ratio is calculated, so that the retention value of the affected tooth of the patient is evaluated.
Finally, determining the outer edge size of the supporting plate 1 and the outer edge side surface 11 of the supporting plate in the positioning device for the apical surgery according to the outer edges of the crowns of the upper and lower teeth in the jaw-dentition three-dimensional model; determining the shape and the size of a positioning plate 2 in a positioning device for the apical surgery and the position of the positioning plate 2 on a support plate 1 according to a visual three-dimensional model of periapical lesions; the position and the size of the positioning through groove 21 on the positioning plate 2, the shape and the size of the positioning accessory 3 arranged in the positioning through groove 21 and the position, the size and the direction of the positioning guide through hole 32 on the positioning accessory 3 are determined according to the visual three-dimensional model of the periapical lesion. The shape and size of the positioning device for the root tip surgery are input into a 3D printer, and the positioning device for the root tip surgery is obtained by printing through the 3D printer. Preferably, the shape and the size of the inner edge of the supporting plate 1 of the ring sector plate are determined according to the inner edges of the upper and lower dental crowns in the jaw-dentition three-dimensional model; the position and size of the limiting grooves (not shown in the drawings) for receiving the cusps of the teeth on the top and bottom surfaces of the support plate 1 are determined according to the crowns of the upper and lower teeth in the jaw-dentition three-dimensional model. Thus, when printing the positioning device for the apical surgery using a 3D printer, the support plate 1 may be printed as a ring-shaped sector plate, and the spacing grooves for receiving the cusps of the patient's teeth may be formed by printing on the top and bottom surfaces of the support plate 1. In specific implementation, in a visual three-dimensional model of periapical lesions, after the crown part in the jaw-dentition three-dimensional model is used for carrying out undercut removing operation, a supporting plate 1 is established through a stretching function; a positioning plate 2 with an inner wall jointed with the bone surface of the jaw bone where the affected tooth of the patient is positioned is formed through a protruding function; establishing contour projection of periapical lesions on the cortical surface of the bone in a visual three-dimensional model of the periapical lesions, establishing a bone-removing guide part, namely the shape (shape and size) of a positioning through groove 21 according to the boundary of the contour projection, and forming a positioning accessory 3 at the positioning through groove by utilizing a protruding function; the long axis of the affected tooth of the patient is determined in a visualized three-dimensional model of the periapical lesion, and as the diameter of the long-handle split drill for removing the bone is 1mm, and the cutting length of the root tip is generally 3mm, a plane perpendicular to the long axis of the affected tooth of the patient is made at a position 2mm away from the root tip, so that the position, the size and the direction of the positioning guide through hole on the positioning accessory 3 are determined by utilizing the plane. In order to ensure the root tip cutting effect, the positioning guide through hole 32 is set to be a counter bore, and the bore diameter of the positioning guide through hole 32 at the outer wall 31 of the positioning fitting 3 is larger than the bore diameter of the positioning guide through hole 32 at the inner wall of the positioning fitting 3, so that the cutting depth of the long-handle split drill can be controlled by adjusting the depth of a counter bore of the positioning guide through hole 32 at the outer wall 31 of the positioning fitting 3 according to needs, and the long-handle split drill is prevented from damaging a patient due to too deep depth in the cutting process, and the treatment and the prognosis are prevented from being well developed. In addition, on the location end of locating plate 2 keeping away from backup pad 1, can set up support lug 4 to utilize support lug 4 to support patient's lip, avoid patient's lip to hinder the operation and go on, influence treatment quality. Preferably, the thickness of the support protrusions 4 may be set to 7mm to facilitate supporting the lips of the patient.
When the positioning device for an apical surgery is prepared by the method for preparing a positioning device for an apical surgery of the present invention:
the patient dentition model obtained by adopting a plaster model scanning or oral scanning mode has high precision, so that the model can be registered and fused with the obtained CBCT graph to establish a high-precision jaw-dentition three-dimensional model, and further the outer edge size and the outer edge side shape of a supporting plate in the positioning device for the apical surgery can be accurately determined according to the outer edges of the upper and lower dental crowns in the jaw-dentition three-dimensional model;
after the CBCT image of the patient affected tooth is projected by using cone-beam CT equipment, the morphological structure of the root canal of the patient affected tooth can be clearly observed from CBCT images of the patient affected tooth dissected from different angles and layers, the change of the position, the property, the degree and the range of periapical lesion and the peripheral alveolar bone is determined, whether the adjacent important anatomical structures are affected or not is determined, a three-dimensional reconstruction model of the periapical disease bone destruction zone of the patient affected tooth is conveniently established, and the operation range when the operation treatment is adopted is conveniently determined;
the maximum diameter and the volume of the periapical lesion of the affected tooth of the patient, the distance between the periapical lesion and an important anatomical structure, the length of the dental crown and the length of the dental root are measured according to the three-dimensional reconstruction model of the periapical disease bone destruction area and the jaw-dentition three-dimensional model, so that a visual three-dimensional model of the periapical lesion can be established, the shape, the size and the position of the positioning plate 2 on the supporting plate 1, the setting position and the size of the positioning through groove 21 on the positioning plate 2, the shape and the size of the positioning accessory 3 arranged in the positioning through groove 21 and the position, the size and the direction of the positioning guide through hole 32 on the positioning accessory 3 can be accurately determined according to the visual three-dimensional model of the periapical lesion, so that medical personnel can accurately excise the affected tooth tip by matching the positioning device for the apical surgery prepared by using the preparation method, reduce the bone removal amount when the affected tooth root tip is cut off, and reduce the damage to the soft and hard tissues in the root tip area when the affected tooth root tip is cut off.
Claims (10)
1. A positioning device for a root tip surgical operation is characterized by comprising a supporting plate, a positioning plate and a positioning accessory, wherein the side surface of the outer edge of the supporting plate is an outer convex cambered surface; the positioning plate is positioned on the top surface of the supporting plate and close to the outer edge side surface of the supporting plate, a positioning through groove is formed in the positioning plate, and the positioning through groove is close to or positioned at a positioning end, far away from the supporting plate, of the positioning plate; the positioning accessory is clamped in the positioning through groove and is provided with a positioning guide through hole penetrating through the inner wall and the outer wall of the positioning accessory; when the tooth-cleaning device is used, the supporting plate is positioned between the upper tooth and the lower tooth of a patient, the inner wall of the positioning accessory is pressed on an affected tooth, and the positioning guide through hole on the positioning accessory is positioned at the cutting position of the root tip of the affected tooth.
2. The positioning device for root tip surgery of claim 1, wherein the positioning guide through hole is a counter bore, and a hole diameter of the positioning guide through hole at an outer wall of the positioning fitting is larger than a hole diameter of the positioning guide through hole at an inner wall of the positioning fitting.
3. The root tip surgical positioning apparatus of claims 1 or 2, wherein the support plate is a ring segment plate.
4. The apical surgical positioning apparatus of claim 3, wherein the support plate has stop grooves on the top and bottom surfaces thereof for receiving the cusps of the teeth.
5. The root tip surgical positioning apparatus of claim 1 or 2, further comprising a support protrusion located on a positioning end of the positioning plate away from the support plate.
6. The root tip surgical positioning apparatus of claim 1 or 2, wherein the positioning fitting is made of a titanium alloy material.
7. A method of making a positioning device for use in an apical surgical procedure, the method comprising the steps of:
step S1: acquiring a dentition model of a patient in a plaster model scanning or oral scanning mode;
step S2: performing annular digital projection on the head of a patient by using cone-beam CT equipment to obtain a CBCT image of the affected tooth of the patient, and determining the position, the property, the degree and the range of periapical lesions of the affected tooth, the change of peripheral alveolar bones and whether an adjacent important anatomical structure is affected by the affected tooth according to the CBCT image; importing the CBCT image into a Mimics Research software, distinguishing soft tissues, bone tissues and tooth bodies in the CBCT image by using a threshold segmentation method, and establishing a three-dimensional reconstruction model of a periapical disease bone destruction area of an affected tooth of a patient;
step S3: introducing the dentition model and the CBCT image into a Geomagic Studio software, segmenting the upper jaw bone and the lower jaw bone in the CBCT image by using the Geomagic Studio software, registering and fusing the jaw bone where the affected teeth of the patient are located and the dentition model, and reconstructing to obtain a jaw bone-dentition three-dimensional model of the patient;
step S4: introducing the periapical disease bone destruction area three-dimensional reconstruction model and the jaw bone-dentition three-dimensional model into Freefom Plus software, measuring the maximum diameter and volume of periapical lesions of the affected teeth of the patient, the distance between the periapical lesions and an important anatomical structure, the length of the dental crowns and the length of the dental roots by using the Freefom Plus software, and establishing a visualized three-dimensional model of the periapical lesions;
step S5; determining the outer edge size and the outer edge side surface of a supporting plate in the positioning device to select an outward convex cambered surface according to the outer edges of the upper and lower dental crowns in the jaw-dentition three-dimensional model; determining the shape and the size of a positioning plate in the positioning device and the position of the positioning plate on the supporting plate according to the visual three-dimensional model of the periapical lesion; determining the position and the size of a positioning through groove on the positioning plate, the shape and the size of a positioning accessory arranged in the positioning through groove and the position, the size and the direction of a positioning guide through hole on the positioning accessory according to the visual three-dimensional model of the periapical lesion;
step S6: inputting the shape and size of the positioning device determined in step S5 into a 3D printer, and printing by the 3D printer to obtain the positioning device.
8. The method for preparing a positioning device for a root tip surgical operation according to claim 7, wherein in the step S1, when the dentition model of the patient is obtained by the plaster model scanning method, firstly, the dentition impression of the patient is prepared by 3M ESPE silicone rubber impression material, then the dentition plaster model of the patient is obtained by the plaster cast method, and finally, the dentition model is obtained by scanning the dentition plaster model by using a 3Shape laser scanner; when the dentition model of the patient is obtained in an oral scanning mode, a 3shape Trios intraoral scanner is adopted to scan and obtain the dentition model of the patient.
9. The method for preparing a positioning device for root tip surgery as recited in claim 8, wherein in the step S2, the threshold value for segmenting the CBCT image by using the threshold segmentation method is set to be bone 226 and 3071 HU.
10. The method for preparing a positioning device for an apical surgical operation according to claim 7, wherein in the step S5, the shape and size of the inner edge of the support plate of the ring-segment plate are determined according to the inner edges of the upper and lower dental crowns in the three-dimensional model of the jaw-dentition; and determining the positions and the sizes of the limiting grooves for accommodating the tooth tips on the top surface and the bottom surface of the supporting plate according to the crowns of the upper and lower teeth in the jaw-dentition three-dimensional model.
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| CN202010190443.7A CN111281577A (en) | 2020-03-18 | 2020-03-18 | Positioning device for root tip surgical operation and preparation method thereof |
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Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN111803235A (en) * | 2020-08-11 | 2020-10-23 | 中南大学 | Periodontal accelerated osteogenesis auxiliary orthodontic treatment surgical guide plate system and forming method thereof |
| CN113749681A (en) * | 2021-11-10 | 2021-12-07 | 极限人工智能(北京)有限公司 | Tool for evaluating CBCT machine image precision |
-
2020
- 2020-03-18 CN CN202010190443.7A patent/CN111281577A/en active Pending
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN111803235A (en) * | 2020-08-11 | 2020-10-23 | 中南大学 | Periodontal accelerated osteogenesis auxiliary orthodontic treatment surgical guide plate system and forming method thereof |
| CN113749681A (en) * | 2021-11-10 | 2021-12-07 | 极限人工智能(北京)有限公司 | Tool for evaluating CBCT machine image precision |
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