阅读说明：本技术 治疗颞下颌关节盘可复性前移位的再定位咬合板的制作方法及再定位咬合板 (Manufacturing method of repositioning bite plate for treating recoverable anterior displacement of temporomandibular joint disc and repositioning bite plate ) 是由 张智玲 刘浩 李瑞欣 陈春霞 严颖彬 于 2019-11-14 设计创作，主要内容包括：本发明公开了3D打印的治疗颞下颌关节盘移位的咬合板的制作方法,包括以下步骤：(1)患者下颌髁突位置,记录并固定位置；(2)拍摄患者的颅颌面,得到患者锥形束CT数据；(3)重建出患者上下颌骨部分,根据患者眶耳平面将患者头位摆正；(4)在三维绘制软件中选取骨组织CT值、牙齿及颌面区域,对患者的颌面数据进行三维重建；(5)在三维绘制软件中重建患者颌面三维模型；(6)去除颌面三维模型的干扰部分；(7)将颌面三维模型导入3D打印机配套软件；(8)设计牙合垫的上颌部分及下颌部分；(9)用3D打印机打印出来,完成牙合垫制作。咬合板的内侧形成的凸起,使得下牙被咬合板的下颌凸起阻挡而不能后退,使得患者的下颌保持前伸状态,以治疗颞下颌关节盘可复性前移位。(The invention discloses a method for manufacturing a 3D printed occlusal plate for treating temporomandibular joint disc displacement, which comprises the following steps: (1) recording and fixing the position of the mandibular condyle of the patient; (2) shooting the craniomaxillofacial surface of a patient to obtain the CT data of the patient cone beam; (3) reconstructing the upper and lower jaw parts of the patient, and righting the head of the patient according to the orbital-ear plane of the patient; (4) selecting a bone tissue CT value, a tooth and a maxillofacial region from three-dimensional drawing software, and performing three-dimensional reconstruction on maxillofacial data of a patient; (5) reconstructing a patient jaw face three-dimensional model in three-dimensional drawing software; (6) removing an interference part of the jaw face three-dimensional model; (7) importing the jaw face three-dimensional model into the matched software of the 3D printer; (8) designing an upper jaw part and a lower jaw part of the occlusal pad; (9) and printing by using a 3D printer to finish the manufacture of the occlusal pad. The protrusion formed on the inner side of the bite plate prevents the lower teeth from receding due to the protrusion of the mandible of the bite plate, so that the mandible of the patient is kept in a protrusive state to treat the reversible anterior displacement of the temporomandibular joint disc.)

1. A method of making a repositionable bite plate for treating reversible anterior displacement of a temporomandibular joint disc, comprising the steps of:

(1) the patient normally opens the mouth to enable the lower jaw of the patient to extend forwards and close the mouth, and the position of the lower jaw condylar process is recorded and fixed under the condition that the lower jaw extends forwards and is in contact with teeth;

(2) utilizing the cone beam CT to shoot the craniomaxillofacial area under the mandibular condylar position in the step (1) of the patient to obtain the cone beam CT data of the patient;

(3) importing the patient cone beam CT data into three-dimensional drawing software, reconstructing upper and lower jaw parts of a patient, and correcting the head of the patient according to the orbital-ear plane of the patient;

(4) importing the patient cone beam CT data into three-dimensional drawing software, selecting a bone tissue CT value, a tooth and a maxillofacial region in the CT data in the three-dimensional drawing software, and performing three-dimensional reconstruction on the maxillofacial data of the patient;

(5) reconstructing a patient jaw face three-dimensional model in three-dimensional drawing software according to the selected area in the step (4);

(6) removing the interference part of the jaw face three-dimensional model reconstructed in the step (5);

(7) importing the reconstructed patient jaw face three-dimensional model into the 3D printer matching software;

(8) in the 3D printer matching software, designing an occlusal splint according to the introduced reconstructed patient maxillofacial three-dimensional model, and designing an upper jaw part and a lower jaw part of the occlusal splint to enable an upper dentition to be matched with the upper maxillofacial dentition part and a lower dentition to be matched with the lower maxillofacial dentition part so as to form the designed occlusal splint;

(9) and (4) printing the occlusal plate designed in the step (8) by using a 3D printer to finish the manufacturing of the occlusal plate.

2. The method of manufacturing according to claim 1, wherein: in the step (1), the mandibular condyle position is determined by, when the patient opens the mouth, making the mandibular joints on both sides or one side bounce and reaching the maximum opening degree, extending and closing the mandible to the position where the incisal edges or cusps of the upper and lower teeth are in point contact, opening the mouth again and closing the mouth to reciprocate the mandibular joints protrusive position, and after no bounce occurs on the mandibular joints on both sides or one side, if the bounce still occurs, continuing to extend and adjust the mandibular position until the mandibular joint sounds disappear, i.e. determining the mandibular condyle position, and recording and fixing the position by using the occlusal wax.

3. The method of manufacturing according to claim 1, wherein: in the step (6), the step of removing the interference part of the reconstructed jaw face three-dimensional model is to perform fuzzy processing on the bottom surface of the lower upper dentition according to the condition of the lower dentition.

4. The method of manufacturing according to claim 1, wherein: in the step (8), when the upper jaw part is designed, the upper dentition forms an occlusal plate structure with a trepanning for wrapping the tooth body, the inner bottom surface of the trepanning of the occlusal plate is completely consistent with the upper dentition, and the outer bottom surface of the occlusal plate is a bottom surface which is effectively occluded with the lower dentition; when the lower jaw part is designed, a bulge for preventing the lower anterior teeth from retreating is formed in the lingual area of the lower jaw anterior teeth, and the bulge is tightly attached to the lingual side of the lower anterior teeth.

5. The method of manufacturing according to claim 4, wherein: when the upper jaw part and the lower jaw part are designed in the step (8), at least 2 pairs of continuous symmetrical molars are reserved, and the molars at two sides are connected with a connecting plate with the middle matched with the upper jaw shape to form an occlusal plate connected by the connecting plate; or, in design, all the upper dentition teeth are reserved to form the occlusal splint of the whole dentition.

6. The method of manufacturing according to claim 1, wherein: in the step (6), after the interference part of the reconstructed maxillofacial three-dimensional model is removed, the three-dimensional models of the upper jaw and the lower jaw are separated.

7. The method of manufacturing according to claim 7, wherein: in the step (9), the upper jaw part and the lower jaw part which are respectively designed are combined to form a complete bite plate.

8. A repositionable bite plate for treating reversible anterior displacement of a temporomandibular joint disc made according to the method of manufacture of any one of claims 1 to 7 including dental occlusal sleeves of at least 2 pairs of successive symmetrical molars fitted to the upper dentition, the dental occlusal sleeves on either side being connected by a connecting plate, wherein: the tooth occlusion sleeve is characterized in that tooth placing holes are correspondingly formed in the occlusion sleeve, the connecting plates are arranged on the inner side and the outer side, the shapes of the inner side connecting plate and the outer side connecting plate are consistent with the inner side and the outer side of the top of an upper jaw or an upper dentition, the shape of the inner side bottom surface of the tooth occlusion sleeve is consistent with the shape of the upper dentition bottom surface, the outer side bottom surface of the tooth occlusion sleeve is effectively occluded with a lower dentition, each tooth occlusion sleeve is communicated with each other, and a protrusion facing to the lower teeth is formed on one side of the inner side of.

9. The repositioned bite plate of claim 8, wherein: the shape of the lip side surface and the top of the bulge is attached to the tongue side surface and the occlusal surface of the lower front tooth so as to prevent the lower jaw dentition and the jaw from retreating and keep the lower jaw of a patient in a forward extending state when the patient wears the bite-block, the thickness of the bulge from the middle to the two sides is gradually reduced, the tail ends of the two sides of the bulge are gradually reduced until the tail ends of the two sides of the bulge are flush with the bottom of the bite-block, when the bite-block is worn, the lower edge of the bulge does not cross the bulge on the lower front tongue side, and the bulge does not enter the undercut area on the lower front.

10. The repositioned bite plate of claim 9, wherein: the length of the bulge is 20mm-80mm, and the height of the bulge is 2mm-10 mm.

Technical Field

The invention belongs to the technical field of oral medical instruments, and particularly relates to a manufacturing method of a repositioning occlusal plate for treating reducible anterior displacement of a temporomandibular joint disc and the repositioning occlusal plate.

Background

Anterior displacement of the temporomandibular joint disc (ADD) is a common clinical condition in stomatology, which means that when the cusps are dislocated, the joint disc is displaced forward beyond its normal position (the posterior border of the joint disc is located above or slightly behind the crest of the lateral crest of the condylar process). According to whether the disc-condyle relationship can be recovered to be normal during opening, ADD is divided into reducible and irreducible anterior displacement, namely in the opening process, a disc-condyle position relation person with the joint disc capable of rebounding backwards to recover to be normal is called reducible anterior displacement of the disc; when the condyle slides forward and downward, the articular disc can not rebound backward and still is in a forward displacement state, which is called the irreversible disc forward displacement. Patients with ADD can have pain, rebound and abnormal jaw movement in temporomandibular joint (TMJ) areas, and when ADD occurs, particularly in the growth and development stage of teenagers, jaw development is affected, and if the ADD is not treated in time, mandibular retroversion or deviation is easily caused, and secondary dentogorofacial deformity is caused.

Treatment of reversible anterior displacement of the temporomandibular joint disc is mainly achieved in a conservative manner, usually by treatment with education, medication, physical therapy, occlusal plates or by surgical approaches such as joint cavity lavage, arthroscopic reduction, open surgery, etc. At present, the conservative treatment is effective by wearing an anterior mandibular repositioning bite plate (ARS), which can eliminate the symptoms of bounce and twistlock immediately, and Magnetic Resonance Imaging (MRI) also confirms that the articular disc can be well repositioned.

The existing occlusal plate model is designed in a broad spectrum according to the conditions of most patients, the occlusal design is single, when doctors perform specific operation, the occlusal plate treatment has the problems of complex treatment procedure, inaccurate manufacture, multiple times of repeated diagnosis of the patients and the like, and the occlusal plate is generally required to be ground for multiple times according to the conditions of the patients; moreover, the occlusal plate cannot completely solve the clinical problem of anterior displacement of various temporomandibular joint discs due to single occlusion design.

With the development of the digitization technology and the 3D printing technology, the field of applying the digitization technology and the 3D printing technology in clinic is more and more, the digitization technology and the 3D printing technology can be applied to more accurately and rapidly prepare an individualized model or prosthesis according to the self condition of a patient, and the prepared model and prosthesis have high inosculation and good prognosis effect and do not need to be adjusted repeatedly because of individuation.

Therefore, there is a need for a bite plate and a method for manufacturing the same that can solve the problems of single design of the bite plate, complicated procedure of the treatment process, and inaccurate manufacture of the bite plate in the above-mentioned technical problems.

Disclosure of Invention

The invention aims to provide a manufacturing method of a repositioning occlusal plate for treating the reducible anterior displacement of a temporomandibular joint disc, which has the advantages of simple structure, simple and convenient treatment procedure, diversified design of the occlusal plate, high accuracy of the occlusal plate and better prognosis effect.

The technical scheme of the invention is as follows:

a method of making a repositionable bite plate for treating reversible anterior displacement of a temporomandibular joint disc, comprising the steps of:

(1) the patient normally opens the mouth to enable the lower jaw of the patient to extend forwards and close the mouth, and the position of the lower jaw condylar process is recorded and fixed under the condition that the lower jaw extends forwards and is in contact with teeth;

(2) utilizing the cone beam CT to shoot the craniomaxillofacial area under the mandibular condylar position in the step (1) of the patient to obtain the cone beam CT data of the patient;

(3) importing the patient cone beam CT data into three-dimensional drawing software, reconstructing upper and lower jaw parts of a patient, and correcting the head of the patient according to the orbital-ear plane of the patient;

(4) importing the patient cone beam CT data into three-dimensional drawing software, selecting a bone tissue CT value, a tooth and a maxillofacial region in the CT data in the three-dimensional drawing software, and performing three-dimensional reconstruction on the maxillofacial data of the patient;

(5) reconstructing a patient jaw face three-dimensional model in three-dimensional drawing software according to the selected area in the step (4);

(6) removing the interference part of the jaw face three-dimensional model reconstructed in the step (5);

(7) importing the reconstructed patient jaw face three-dimensional model into the 3D printer matching software;

(8) in the 3D printer matching software, designing an occlusal splint according to the introduced reconstructed patient maxillofacial three-dimensional model, and designing an upper jaw part and a lower jaw part of the occlusal splint to enable an upper dentition to be matched with the upper maxillofacial dentition part and a lower dentition to be matched with the lower maxillofacial dentition part so as to form the designed occlusal splint;

(9) and (4) printing the occlusal plate designed in the step (8) by using a 3D printer to finish the manufacturing of the occlusal plate.

In the above technical solution, in the step (1), the mandibular condyle position is determined by, when the patient opens his mouth, making the bilateral or unilateral mandibular joint pop and make the maximum opening, extending the mandible forward and closing the mouth to a position where the incisal edges or cusps of the upper and lower teeth are in point contact, opening the mouth again and closing the mouth to reciprocate the mandibular forward position, and after the bilateral or unilateral mandibular joint pop does not occur, if the bilateral or unilateral mandibular joint pop still occurs, continuing to extend the mandible position until the mandibular joint pop disappears, that is, determining the mandibular condyle position, and recording and fixing the position with an occlusal wax.

In the above technical solution, in the step (6), the bottom surface of the lower upper dentition is blurred according to the condition of the lower dentition after the interference part of the reconstructed maxillofacial three-dimensional model is removed.

In the above technical solution, in the step (8), when the maxilla portion is designed, the upper dentition forms an occlusal plate structure with a socket hole that wraps the tooth body, an inner bottom surface of the socket hole of the occlusal plate completely coincides with the upper dentition, and an outer bottom surface of the occlusal plate is a bottom surface that is effectively occluded with the lower dentition; when the lower jaw part is designed, a bulge for preventing the lower anterior teeth from retreating is formed in the lingual area of the lower jaw anterior teeth, and the bulge is tightly attached to the lingual side of the lower anterior teeth.

In the above technical solution, when the upper jaw part and the lower jaw part are designed in the step (8), at least 2 pairs of continuous symmetrical molars are retained, and the molars at both sides are connected by a connecting plate whose middle part is matched with the upper jaw shape to form an occlusal splint connected by the connecting plate; or, in design, all the upper dentition teeth are reserved to form the occlusal splint of the whole dentition.

In the above technical solution, in the step (6), after removing the interference part of the reconstructed maxillofacial three-dimensional model, the three-dimensional models of the maxilla and the mandible are separated.

In the above technical solution, in the step (9), the upper jaw part and the lower jaw part which are respectively designed are combined to form a complete bite plate.

The invention also aims to provide a repositioning occlusal plate for treating the reducible anterior shift of a temporomandibular joint disc, which is manufactured based on the manufacturing method, and comprises at least 2 pairs of tooth occlusal sleeves of continuous symmetrical molars, wherein the tooth occlusal sleeves on two sides are connected through connecting plates, tooth placing holes are correspondingly arranged in the occlusal sleeves, the connecting plates are arranged on the inner side and the outer side, the shapes of the inner connecting plate and the outer connecting plate are consistent with the inner side and the outer side of the top of the upper jaw or the upper dentition, the shape of the inner bottom surface of the tooth occlusal sleeve is consistent with the shape of the upper dentition teeth, the outer bottom surface of the tooth occlusal sleeve is effectively occluded with the lower dentition, each tooth occlusal sleeve is communicated with each other, and a bulge facing to the lower teeth is formed on one surface of the inner side of the occlusal.

In the above technical solution, the shape of the protrusion is matched with the shape of the anterior dental area of the mandibular dental arch, the shapes of the labial surface and the top of the protrusion are fitted with the lingual surface and the occlusal surface of the lower anterior teeth to block the mandibular dentition and the jaw bone from receding and keep the lower jaw of the patient in a protrusive state when wearing the bite-block, the thickness of the protrusion gradually decreases from the middle to both sides, and the ends of both sides of the protrusion gradually decrease until they are flush with the bottom of the bite-block.

In the technical scheme, the length of the protrusion is 20mm-80mm, and the height of the protrusion is 2mm-10 mm.

In the technical scheme, the thickness of the bottom surface of the tooth occlusion sleeve is 1.5mm-5mm, and the thickness of the side surface and/or the connecting plate is 1.5mm-5mm, so that the effective separation of the upper jaw and the lower jaw can be ensured, and the material loss of the side surface can be reduced.

In the above technical solution, the bite plate includes 2 pairs of continuous symmetrical molar bite sleeves, specifically two pairs of continuous symmetrical molar bite sleeves of the first molar and the second molar, and this arrangement ensures stability of the structural configuration on the premise of minimum bite sleeve arrangement.

In the technical scheme, the inner connecting plate is anastomosed to the inner part or the upper part of the upper jaw by 1.5-5mm at the base part of the dentition, and the upper part of the upper jaw of the outer connecting plate is anastomosed by 1.5-5mm at the base part of the dentition so as to ensure the stability of the occlusal plate during the nesting.

The invention has the advantages and positive effects that:

1. the protrusion formed on the inner side of the occlusal plate enables the lower teeth to be blocked by the mandibular protrusion of the occlusal plate and not to retreat, the side surface of the lower front tooth tongue of the patient is tightly attached to the protrusion of the occlusal plate when the patient wears the dental articulator, and the lower jaw of the patient keeps a protrusive state to treat anterior displacement of the temporomandibular joint disc.

2. The conical beam CT data are shot under the mandibular protrusion state of a patient, the occlusal plate is designed according to the CT data of each patient, so that the occlusal plate has individuality, and the maxillofacial data of the patient do not need to be scanned for many times, so that the occlusal plate has high inosculation performance and strong pertinence, does not need repeated debugging of doctors, and is simple and convenient to use.

Drawings

Fig. 1 is a schematic view of the overall front view of the bite plate with total dentition repositioning of the present invention;

fig. 2 is a schematic view of the overall front view of the bite plate with total dentition repositioning of the present invention;

fig. 3 is a schematic view of the overall structure of the inventive bite plate with total dentition repositioning;

fig. 4 is a schematic view of a longitudinal cross-section of the bite plate of the present invention with total dentition repositioning;

fig. 5 is a schematic view of the overall underview of the partially dentition repositioned bite plate of the present invention;

fig. 6 is a side view overall schematic of the partially dentition repositioning bite plate of the present invention;

fig. 7 is a schematic view of the upper jaw portion of the repositioned bite plate of the present invention in three-dimensional rendering software;

fig. 8 is a schematic view of the mandibular portion of the repositioned bite plate of the present invention in three-dimensional rendering software.

In the figure:

1. tooth occlusion sleeve 2, protrusion 3 and outer side connecting plate

4. Placing hole 5 and inner connecting plate

Detailed Description

The present invention will be described in further detail with reference to specific examples. It should be understood that the specific embodiments described herein are merely illustrative of the invention and are not intended to limit the scope of the invention in any way.