引导牙髓病学：牙髓通路腔的三维规划和模板辅助制备
1Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel UZB,University of Basel, 2Center for Dental Imaging, University Center for Dental Medicine,University of Basel, 3Department of Conservative Dentistry and Periodontology,University Hospital of Würzburg
Summary
引导牙髓病学描述了一种用于入路腔准备的模板辅助方法。该过程需要锥形束计算机断层扫描和表面扫描以生成模板。内置的套筒将钻头引导至目标点。这允许在钙化牙齿中制备微创牙髓通路腔。
Abstract
牙髓管闭塞（PCO）通常是牙齿创伤的结果，例如脱位损伤。即使牙本质叠加是重要牙髓的征兆，牙髓炎或根尖周炎也可能长期发展。根管治疗患有严重PCO和牙髓或根尖周病变的牙齿对于全科医生甚至设备齐全的牙髓专家来说都是具有挑战性的。为了确保检测钙化的根管并避免牙齿结构过度丧失或牙根穿孔，几年前引入了使用模板的静态导航（“引导牙髓学”）。一般工作流程包括使用锥形束计算机断层扫描 （CBCT） 的三维成像、数字表面扫描以及在规划软件中将两者叠加。接下来是通道腔的虚拟规划，并设计一个模板，将钻头引导到所需的目标点。为此，必须以钻头尖端到达钙化根管孔口的方式放置钻头的真实比例虚拟图像。一旦使用计算机辅助设计和计算机辅助制造（CAD / CAM）或3D打印机制造了模板，就可以在临床上进行导管腔的准备。出于研究目的，术后CBCT图像可用于量化所执行的通路腔的准确性。这项工作旨在介绍静态引导牙髓学技术从成像到临床实施。
Introduction
牙髓管闭塞 （PCO） 是重要牙髓的体征，通常在牙齿创伤1 后观察到，或作为对龋齿、修复手术2 或重要牙髓治疗3 等刺激的反应。当没有临床或影像学病理体征时，不需要根管治疗。然而，从长远来看，剩余的牙髓组织可能会发展为病理4。在存在牙髓或根尖病变的临床或影像学体征的情况下，非手术根管治疗将是牙齿保护的首选治疗方法。
为了获得根管治疗的成功结果，准备足够的通路腔至关重要。需要根管治疗的PCO牙齿很难治疗，即使对于专门从事牙髓学领域的牙医也是如此5。试图定位钙化的根管可能会导致牙齿结构的大量损失，从而削弱甚至穿孔。这降低了牙齿的预后，并且可能需要拔牙6。
由于基于模板的（静态）导航已经成功地用于口腔种植学，因此几年前在文献中首次描述了其在牙髓病学中的应用7。从那时起，许多病例报告和研究已经证明了模板辅助牙髓通路腔准备在PCO8，9病例中的益处。
这项工作的目的是介绍使用引导牙髓病学引导入路腔准备的技术。出于研究目的，在术后CBCT扫描后可以进行治疗评估（确定计划和执行的通路腔之间的角度和空间偏差），本文也将对此进行介绍。
Protocol
进行这项研究不需要批准或同意，因为患者数据的使用不适用。在这项研究中，使用了来自上颌骨模型的DICOM数据，该模型由提取的，去识别的人牙组成。由于与本研究无关的原因，拔牙。 1. 虚拟接入腔规划 启动数字规划程序。 右键单击 专家 以选择高级模式。 右键单击“ 新建 ”以打开新案例。 选择包含…
Representative Results
图10A 显示了在模板辅助通路腔制备中颊管后，第一上颌磨牙中制备的牙髓通路腔的咬合视图。 图10B 显示了在准备腭和颊沟通路腔后插入三个牙髓手锉以确认根管检测成功。将术后CBCT数据与术前计划数据匹配后，虚拟钻头放置生成有关偏差的信息（图11A）。这里，角度偏差为 0.7°，钻头底部的 3D 偏差为 0.74 mm 3D 偏差，钻头尖端?…
Discussion
模板辅助通路腔制剂在牙髓病学中的引入，为PCO牙齿的非手术牙髓治疗带来了巨大的进步。传统的通路腔准备可能非常耗时5 ，并且在严重PCO的情况下容易出错。 体外 研究和临床病例报告证明了引导牙髓病学方法的可行性，在根管检测方面产生了令人满意的结果，并且计划和执行的通路腔之间的总体偏差较低8。然而，引导牙髓病的实施应仅限于传统的?…
Divulgaciones
The authors have nothing to disclose.
Acknowledgements
没有。
Materials
| Accuitomo 170 | Morita Manufacturing | NA | CBCT machine |
| coDiagnostiX | Dental Wings Inc | Version 10.4 | Planning software, which is mainly intended for implant surgery. Endodontic access cavities can be planned by adding the utlized bur to the implant database |
| Endoseal drill | Atec Dental GmbH | NA | Carbide bur, which is used for the guided access cavity preparation |
| StecoGuide Endo-Sleeve | steco-system-technik | REF M.27.28.D100L5 | Sleeves, which are inserted into the fabricated template |
| TRIOS 3 | 3Shape A/S | NA | Surface scanner |
| P30 | Straumann | NA | 3D Printer |
| P pro Surgical Guide Clear | Straumann | NA | Light-curing resin for the additive manufacturing |
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Citar este artículo
Leontiev, W., Connert, T., Weiger, R., Dagassan-Berndt, D., Krastl, G., Magni, E. Guided Endodontics: Three-Dimensional Planning and Template-Aided Preparation of Endodontic Access Cavities. J. Vis. Exp. (183), e63781, doi:10.3791/63781 (2022).