CN114831755A - Manufacturing and using method of lower alveolar nerve displacement surgical guide plate and surgical guide plate - Google Patents
Manufacturing and using method of lower alveolar nerve displacement surgical guide plate and surgical guide plate Download PDFInfo
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- CN114831755A CN114831755A CN202210379291.4A CN202210379291A CN114831755A CN 114831755 A CN114831755 A CN 114831755A CN 202210379291 A CN202210379291 A CN 202210379291A CN 114831755 A CN114831755 A CN 114831755A
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
- A61C8/0089—Implanting tools or instruments
- A61C8/009—Implanting tools or instruments for selecting the right implanting element, e.g. templates
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- A—HUMAN NECESSITIES
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- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C19/00—Dental auxiliary appliances
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
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Abstract
The invention discloses a lower alveolar nerve displacement surgical guide plate and a manufacturing and using method thereof, wherein the manufacturing method comprises the following steps: constructing a three-dimensional model before an oral cavity operation; reconstructing a three-dimensional model of a lower alveolar neural tube on the three-dimensional model before the oral operation; moving the reconstructed three-dimensional model of the lower alveolar neural tube to the buccal side for a certain distance according to the direction of nerve displacement required; respectively shifting and stretching the shifted three-dimensional model of the lower alveolar neural tube to the coronal direction and the root direction by a certain length, and then subtracting the neural tube model before shifting by Boolean operation to form a guide groove model; designing a tooth-supported guide plate or a mucous membrane-supported guide plate exposing the position of the guide groove; connecting the guide groove model and the tooth-supporting guide plate or the mucous membrane-supporting guide plate into a whole to be used as the surgical guide plate; alveolar nerve displacement operation baffle under 3D printed oral cavity planting. The invention is beneficial to reducing the clinical operation difficulty of the inferior alveolar nerve displacement operation, improving the accuracy of the operation and reducing the trauma of the operation.
Description
Technical Field
The invention relates to the technical field of medical treatment, in particular to a lower alveolar nerve displacement operation guide plate and a manufacturing and using method thereof.
Background
With the development of the surface treatment technology of materials, the oral implantology is more mature, and patients receive the treatment of implanted teeth more and more. With the improvement of everyone's surgery, more and more middle aged and elderly people start to receive planting treatment instead of traditional full dentures because planting can provide better comfort, chewing efficiency and aesthetic property.
However, the situation that the bone quantity is insufficient in the lower jaw posterior dental area is often caused, particularly the bone height in the vertical direction is insufficient, the implant height in the posterior dental area is insufficient due to the fact that a complete denture is worn for many years or the implant repair is carried out timely without conditions, alveolar bones are continuously absorbed and shrunk after the teeth are lost, and the implant operation cannot be carried out due to the fact that the implant height in the posterior dental area is insufficient and the implant operation is close to the lower alveolar neural tube.
The most clinically used method for this situation is autologous bone augmentation, but many patients are older, and autologous bone augmentation is traumatic and unsuitable for older patients. In this case, if implant treatment is desired, only inferior alveolar nerve displacement surgery is performed.
The inferior alveolar nerve displacement operation is to perform implantation treatment after the alveolar bone is exposed by flap turning, estimate the shape and position of the inferior alveolar nerve according to the position of the mental foramen and the CBCT image, open a window on the bone wall on the buccal side, take out a bone block, expose a nerve canal, pull out the nerve canal and perform implantation treatment. The lower alveolar nerve displacement operation has small wound, is suitable for cases with more lower jaw bone absorption and higher lower alveolar nerve, but has higher technical sensitivity, and needs to master the oral maxillofacial anatomy and rich clinical experience, so that the operation is difficult to popularize.
Disclosure of Invention
The technical problem to be solved by the invention is as follows: the lower alveolar nerve displacement operation guide plate has high sensitivity, is judged and operated based on the experience of doctors, has high difficulty and low popularization rate, and solves the problems.
The invention is realized by the following technical scheme:
a manufacturing method of a lower alveolar nerve displacement surgical guide plate comprises the following steps: step1, constructing a three-dimensional model before an oral cavity operation; step2, reconstructing a three-dimensional model of a lower alveolar neural tube on the three-dimensional model before the oral surgery; step3, moving the reconstructed lower alveolar neural tube three-dimensional model to the buccal side for a certain distance according to the direction of nerve displacement required; step4, respectively extending the displaced three-dimensional model of the lower alveolar neural tube to the coronal direction and the root direction in a shifting way for a certain length, and then subtracting the neural tube model before shifting by Boolean operation to form a guiding groove model for guiding the bone wall to be ground and windowed; step4, designing a tooth-supporting guide plate or a mucous membrane-supporting guide plate, wherein the guide plate exposes the position of the guide groove; step5, connecting the guide groove model and the tooth-supporting guide plate or the mucous membrane-supporting guide plate into a whole to complete the design of the alveolar nerve displacement surgical guide plate under the oral implantation; Step6.3D prints alveolar nerve displacement operation baffle under the oral implantation.
The invention provides an operation guide plate for alveolar nerve displacement operation under oral implantation, which is based on a digitization technology, a three-dimensional modeling and a three-dimensional reconstruction technology, accurately calculates and analyzes the position and the shape of the alveolar nerve in a computer, simulates the optimal operation process and the position of a bone wall windowing, including the direction, the position, the angle and the range of the bone wall windowing, and then designs a guiding device in the computer, namely the lower alveolar nerve displacement operation guide plate.
The method for manufacturing a surgical guiding apparatus for turning over the implanted gum according to claim 1, further preferably, 2. the method for manufacturing the surgical guiding apparatus for turning over the implanted gum according to claim 1, wherein Step1 comprises the Step of constructing a pre-oral three-dimensional model based on data information including a bone model, gingivitis dentition data and soft tissue gum information.
More preferably, Step1 specifically comprises the following steps: step11, shooting CBCT, and constructing a jaw bone model of the patient; step12. intraoral scanning to obtain dentition and gingival data of a patient; step13, matching jaw bone models and dentition and gingiva data based on natural teeth; step14, obtaining information of soft tissue gingiva; and step15, constructing a preoperative three-dimensional model of the oral cavity based on the information.
More preferably, Step1 specifically comprises the following steps: step11. manufacturing a radioactive diagnosis guide plate; step12. put the radioactive diagnosis guide plate into the patient's mouth and take CBCT; step13, taking a radioactive diagnosis guide plate separately to take a CBCT; step14, three-dimensionally reconstructing the two CBCT data, and matching the two CBCT data models according to the blocking point positions on the radioactive diagnosis guide plate; step15, measuring the distance from the bottommost end of the tissue surface of the radioactive diagnosis guide plate to the alveolar bone, and acquiring the height of soft tissue; and step16, constructing a preoperative three-dimensional model of the oral cavity based on the information.
Further preferably, in Step2, a three-dimensional model of the lower alveolar neural tube is three-dimensionally reconstructed based on the CBCT mandibular low density image.
Further preferably, Step2 further includes the Step of performing a fine adjustment on the three-dimensional reconstructed model of the inferior alveolar nerve tube according to the CBCT slice image examination.
Further preferably, at Step3, the distance traveled by the three-dimensional model of the inferior alveolar neural tube is determined based on the working length of the tool used for bone wall removal and windowing.
More preferably, in Step4, the three-dimensional model of the inferior alveolar neural tube is stretched 2mm to 4mm in a shift from the coronal direction to the root direction.
A lower alveolar nerve displacement surgical guide plate is obtained by the manufacturing method of the lower alveolar nerve displacement surgical guide plate.
The use method of the lower alveolar nerve displacement surgical guide plate is characterized in that the guide plate is obtained by adopting the manufacturing method of the lower alveolar nerve displacement surgical guide plate; the method comprises the following steps:
carrying out flap turning on the gingival mucosa of an operation area; the lower alveolar nerve displacement operation guide plate is worn into the mouth of a patient and reset through the residual healthy natural teeth or the mucosa adsorption force; when in design, a tool used for grinding and windowing the bone wall is selected to grind bone tissues along the guide groove of the operation guide plate or cut and take down bone blocks along the guide groove, and the set depth is ground to be just flush with the surface of the guide groove; the lower alveolar nerve tube is pulled out, and then the implantation operation is carried out.
The invention has the following advantages and beneficial effects:
the surgical guide plate provided by the invention can be used for indicating the position of the lower alveolar nerve, guiding the processes of windowing and grinding the bone wall, accurately grinding the bone covering the buccal surface of the nerve and exposing the nerve, thereby completing the displacement of the nerve. The technology combines the three-dimensional reconstruction technology, the 3D printing technology, the three-dimensional modeling technology, the medical image technology and other technologies, obtains the accurate position of the neural tube in a computer, and gives the position design of the virtual neural tube and plans the range, the depth, the angle and the like of the windowing of the bone wall, thereby guiding the inferior alveolar nerve displacement operation.
The surgical guide plate provided by the invention can enable the alveolar nerve displacement operation under oral implantation to be simpler and quicker, reduce the technical sensitivity and the requirements on experience, complete the surgical planning before the operation, position the nerves, and directly perform bone wall windowing in the operation through the surgical guide plate, thereby saving the clinical operation time.
The surgical guide plate provided by the invention is more accurate and minimally invasive in inferior alveolar nerve displacement surgery, the position of the inferior alveolar nerve can be accurately obtained through CBCT reconstruction, and then the surgery and the positioning are guided by the surgical guide plate, so that the amount of bone tissues removed by windowing is reduced, the inflammatory reaction after the surgery is reduced, the success rate of the implantation surgery is increased, and the comfort level of a patient is improved.
The application of the invention can popularize the inferior alveolar nerve displacement operation under the assistance of the digital technology and the guide plate guiding technology, and can realize the implantation treatment under the condition of minimally invasive bone grafting of the inferior maxilla under the condition of insufficient bone mass.
The method is based on a digitization technology, a 3D printing technology and a medical image technology, the alveolar nerve displacement operation under oral implantation is changed from a traditional empirical mode to a digitization mode, and preparation is made for a future operation robot technology.
Drawings
The accompanying drawings, which are included to provide a further understanding of the embodiments of the invention and are incorporated in and constitute a part of this application, illustrate embodiment(s) of the invention and together with the description serve to explain the principles of the invention. In the drawings:
FIG. 1 is a schematic diagram of data matching between CBCT and the mouth scan model in example 1.
FIG. 2 is a schematic diagram of a three-dimensional model of the alveolar neural tube under three-dimensional modeling of example 1.
FIG. 3 is a schematic diagram showing the displacement of the three-dimensional model of the lower alveolar neural tube in example 1.
FIG. 4 is a schematic view of a dental support guide designed based on an oral scan model according to example 1.
FIG. 5 is a schematic view of a model of a guide groove of embodiment 1; the two models in the figure represent models at different angles.
FIG. 6 is a schematic view of the guide groove model of example 1 connected to a dental backup guide as a whole.
FIG. 7 is a schematic view of the lower alveolar nerve displacement surgical guide of example 1; the four models in the figure represent the lower alveolar nerve displacement surgical guide at different angles.
Detailed Description
In order to make the objects, technical solutions and advantages of the present invention more apparent, the present invention is further described in detail below with reference to examples and accompanying drawings, and the exemplary embodiments and descriptions thereof are only used for explaining the present invention and are not meant to limit the present invention.
Example 1
The embodiment provides a method for manufacturing a lower alveolar nerve displacement surgical guide plate, which is designed for a single tooth implantation case and comprises the following specific steps:
step1, shooting CBCT and constructing a jaw bone model of the patient.
Step2. intraoral scan the patient's dentition and gingival data are obtained.
Step3. matching jaw bone model and dentition gingival data based on natural teeth.
And Step4, measuring the distance from the gum to the alveolar bone, and acquiring the height of soft tissue, namely the thickness of the cut gum when the valve is turned over.
And step5, constructing a preoperative three-dimensional model of the oral cavity based on the information.
Step6, reconstructing a three-dimensional model of a lower alveolar neural canal based on the CBCT mandibular low-density image; and checking the modeling condition of the three-dimensional reconstructed lower alveolar neural tube according to the CBCT slice image, and performing fine adjustment.
Step7, selecting a lathing needle with scale marks of 10mm as a tool for windowing the wall of the operative bone; the reconstructed three-dimensional model of the inferior alveolar neural canal was moved 10mm buccally in the direction in which nerve displacement was desired.
And Step8, respectively stretching the three-dimensional model of the moved lower alveolar neural tube to the coronal direction and the root direction in a shifting way by 3mm, and then subtracting the neural tube model before shifting by Boolean operation to form a guiding groove model for guiding the bone wall to be ground and windowed.
Step9. design a dental supported guide based on intraoral scan data, where the dental supported guide is to expose the guide slot.
And Step 10, connecting the guide groove model and the tooth-supporting guide plate into a whole to complete the design of the alveolar nerve displacement surgical guide plate under the oral implantation.
Step 11.3D prints alveolar nerve and shifts operation baffle under the oral implantation.
The use method of the lower alveolar nerve displacement surgical guide plate manufactured in the embodiment comprises the following steps: putting the alveolar nerve displacement operation guide plate under the cavity implantation into the mouth of a patient through the remaining healthy natural teeth and resetting; grinding bone tissues along a guide groove of a guide plate by using a machine needle selected during design, wherein a scale mark with the grinding depth of 10mm is just flush with the surface of the guide groove, and a lower alveolar neural tube is exposed; the lower alveolar nerve tube is pulled out, and then the implantation operation is carried out.
Example 2
The embodiment provides a method for manufacturing a lower alveolar nerve displacement surgical guide plate, which is designed aiming at an edentulous jaw full-mouth implantation case and comprises the following specific steps:
step1. manufacture the radioactive diagnosis guide plate.
Step2. a radioactive diagnostic guide was put into the patient's mouth and CBCT was taken.
Step3. radioactive diagnosis guide plate was taken alone for CBCT.
And step4, three-dimensionally reconstructing the two CBCT data, matching the two CBCT data models according to the blocking point positions on the radioactive diagnosis guide plate, and three-dimensionally reconstructing the formed diagnostic radioactive guide plate.
And step5, measuring the distance from the lowest end of the tissue surface of the radioactive diagnosis guide plate to the alveolar bone, and acquiring the height of the soft tissue.
And step6, constructing a preoperative three-dimensional model of the oral cavity based on the information.
And step7, three-dimensionally reconstructing a three-dimensional model of the lower alveolar neural tube based on the CBCT mandibular low-density image, checking the three-dimensionally reconstructed lower alveolar neural tube modeling condition according to the CBCT slice image, and performing fine adjustment.
And Step8, selecting a lathing needle with 10mm scale marks as a tool for windowing the wall of the operation bone, and moving the reconstructed three-dimensional model of the lower alveolar neural tube 10mm to the buccal side direction in which nerve displacement is needed.
And step9, respectively shifting and stretching the moved three-dimensional model of the lower alveolar neural tube to the coronal direction and the root direction by 3mm, and then subtracting the neural tube model before shifting by Boolean operation to form a guiding groove model.
And Step10, connecting the guide groove model and the radioactive diagnosis guide plate three-dimensional reconstruction model into a whole, and cutting and removing the part of the radioactive diagnosis guide plate blocking the guide groove to complete the design of the alveolar nerve displacement operation guide plate under the oral implantation.
Step11.3D prints alveolar nerve displacement operation baffle under the oral implantation.
The use method of the lower alveolar nerve displacement surgical guide plate manufactured in the embodiment comprises the following steps: carrying out flap turning on the gingival mucosa of an operation area; resetting through the mucosa adsorption force and wearing the lower alveolar nerve displacement operation guide plate into the mouth of a patient and resetting; grinding bone tissues along a guide groove of the surgical guide plate by using a lathe needle which is selected during design, wherein the grinding depth is 10mm, and a scale mark is just flush with the surface of the guide groove to expose a lower alveolar neural tube; the lower alveolar nerve tube is pulled out, and then the implantation operation is carried out.
The above-mentioned embodiments are intended to illustrate the objects, technical solutions and advantages of the present invention in further detail, and it should be understood that the above-mentioned embodiments are merely exemplary embodiments of the present invention, and are not intended to limit the scope of the present invention, and any modifications, equivalent substitutions, improvements and the like made within the spirit and principle of the present invention should be included in the scope of the present invention.
Claims (10)
1. A manufacturing method of a lower alveolar nerve displacement surgical guide plate is characterized by comprising the following steps:
step1, constructing a three-dimensional model before an oral cavity operation;
Step2, reconstructing a three-dimensional model of a lower alveolar neural tube on the three-dimensional model before the oral operation;
step3, moving the reconstructed lower alveolar neural tube three-dimensional model to the buccal side for a certain distance according to the direction of nerve displacement required;
step4, respectively extending the displaced three-dimensional model of the lower alveolar neural tube to the coronal direction and the root direction in a shifting way for a certain length, and then subtracting the neural tube model before shifting by Boolean operation to form a guiding groove model for guiding the bone wall to be ground and windowed;
step4, designing a tooth-supporting guide plate or a mucous membrane-supporting guide plate, wherein the guide plate exposes the position of the guide groove;
step5, connecting the guide groove model and the tooth-supporting guide plate or the mucous membrane-supporting guide plate into a whole to complete the design of the alveolar nerve displacement surgical guide plate under the oral implantation;
Step6.3D prints alveolar nerve displacement operation baffle under the oral implantation.
2. The method as claimed in claim 1, wherein Step1 comprises constructing a pre-oral three-dimensional model based on data information including bone model, gingivitis dentition data and soft tissue gingival information.
3. The method for manufacturing the inferior alveolar nerve displacement surgical guide according to claim 2, wherein Step1 specifically comprises the following steps:
Step11, shooting CBCT, and constructing a jaw bone model of the patient;
step12, intraoral scanning to obtain dentition and gingival data of a patient;
step13, matching jaw bone models and dentition and gingiva data based on natural teeth;
step14, obtaining information of soft tissue gingiva;
and step15, constructing a preoperative three-dimensional model of the oral cavity based on the information.
4. The method for manufacturing the inferior alveolar nerve displacement surgical guide according to claim 2, wherein Step1 specifically comprises the following steps:
step11. manufacturing a radioactive diagnosis guide plate;
step12. put the radioactive diagnosis guide plate into the patient's mouth and take CBCT;
step13, taking a radioactive diagnosis guide plate separately to take a CBCT;
step14, three-dimensionally reconstructing the two CBCT data, and matching the two CBCT data models according to the rejection point positions on the radioactive diagnosis guide plate;
step15, measuring the distance from the bottommost end of the tissue surface of the radioactive diagnosis guide plate to the alveolar bone, and acquiring the height of soft tissue;
and step16, constructing a preoperative three-dimensional model of the oral cavity based on the information.
5. The method for manufacturing a lower alveolar nerve displacement surgical guide plate according to claim 1, wherein in Step2, a three-dimensional model of a lower alveolar nerve tube is three-dimensionally reconstructed based on a CBCT mandibular low-density image.
6. The method as claimed in claim 1, wherein Step2 further comprises checking the three-dimensional reconstructed model of the inferior alveolar nerve canal according to the CBCT slice image and performing the fine tuning.
7. The method of claim 1, wherein the Step3 is performed such that the distance the three-dimensional model of the inferior alveolar neural canal moves is determined according to the working length of the tool used for grinding and windowing the bone wall.
8. The method for manufacturing a lower alveolar nerve displacement surgical guide according to claim 1, wherein in Step4, the three-dimensional model of the lower alveolar nerve canal is extended by 2mm to 4mm in a manner of being deviated in the coronal direction and the root direction, respectively.
9. A lower alveolar nerve displacement surgical guide obtained by the method for manufacturing a lower alveolar nerve displacement surgical guide according to any one of claims 1 to 8.
10. A method for using a lower alveolar nerve displacement surgical guide plate, wherein the guide plate is obtained by the manufacturing method of the lower alveolar nerve displacement surgical guide plate according to any one of claims 1 to 8; the method comprises the following steps:
Flap-turning is carried out on the gingival mucosa of the operation area;
the lower alveolar nerve displacement operation guide plate is worn into the mouth of a patient and reset through the residual healthy natural teeth or the adsorption force of mucous membranes;
when in design, a tool used for grinding and windowing the bone wall is selected to grind bone tissues along the guide groove of the operation guide plate or cut and take down bone blocks along the guide groove, and the set depth is ground to be just flush with the surface of the guide groove;
the lower alveolar nerve tube is pulled out, and then the implantation operation is carried out.
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| Application Number | Priority Date | Filing Date | Title |
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| CN202210379291.4A CN114831755A (en) | 2022-04-12 | 2022-04-12 | Manufacturing and using method of lower alveolar nerve displacement surgical guide plate and surgical guide plate |
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| CN202210379291.4A CN114831755A (en) | 2022-04-12 | 2022-04-12 | Manufacturing and using method of lower alveolar nerve displacement surgical guide plate and surgical guide plate |
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN117582306A (en) * | 2023-10-20 | 2024-02-23 | 青岛牙秘书医疗科技有限公司 | Tooth root type tooth implantation method utilizing oral cavity CBCT image |
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2022
- 2022-04-12 CN CN202210379291.4A patent/CN114831755A/en active Pending
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN117582306A (en) * | 2023-10-20 | 2024-02-23 | 青岛牙秘书医疗科技有限公司 | Tooth root type tooth implantation method utilizing oral cavity CBCT image |
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