阅读说明：本技术 一种用于改良骨皮质切开的工具制作方法 (Method for manufacturing tool for improving cortex lycii cutting ) 是由 江凌勇 瞿然奕 汪席均 王旭东 何东明 姜腾飞 于 2020-12-11 设计创作，主要内容包括：本发明涉及一种用于改良骨皮质切开的工具制作方法,包括以下步骤：设计截骨引导板：根据治疗方案中上颌后牙压低量设计根方骨皮质切除宽度、根据压低牙位确定近远中虚拟截骨线位置及骨皮质切除长度,明确所述虚拟截骨线及骨皮质切除部位打印上颌左右、颊腭侧截骨引导板；设计颧种植钛板：根据患者CT所示上颌骨形态于颧牙槽嵴处设计颧种植钛板；设计铸造横腭杆：通过患者上下牙列及腭穹隆超硬石膏模型或口内扫描数据依照具体垂直向控制方案设计铸造横腭杆；使用三维打印的方式将设计好的截骨引导板、颧种植钛板和铸造横腭杆制作成实物。本发明能够减轻病人的创伤和经济负担。(The invention relates to a method for manufacturing a tool for improving the cortex lycii cutting, which comprises the following steps: designing an osteotomy guide plate: designing a root cortex resection width according to the maxillary posterior tooth depression in a treatment scheme, determining a near-far middle virtual osteotomy line position and a cortical bone resection length according to the depressed tooth position, and definitely printing maxillary left and right and cheek-palate side osteotomy guide plates at the virtual osteotomy line and cortical bone resection positions; designing a zygomatic planting titanium plate: designing a zygomatic implant titanium plate at the zygomatic alveolar ridge according to the maxillary morphology shown by the CT of the patient; designing a cast cross palate rod: designing and casting a cross palatal bar according to a specific vertical control scheme through the super-hard gypsum model of the upper dentition, the lower dentition and the palatine fornix or intraoral scanning data of a patient; and manufacturing the designed osteotomy guide plate, the zygomatic implanting titanium plate and the cast cross palatal bar into a real object by using a three-dimensional printing mode. The invention can reduce the trauma and the economic burden of the patient.)

1. A method of making a tool for improving cortical bone dissection, comprising the steps of:

(1) designing an osteotomy guide plate: designing a root cortex resection width according to the maxillary posterior tooth depression in a treatment scheme, determining a near-far middle virtual osteotomy line position and a cortical bone resection length according to the depressed tooth position, and definitely printing maxillary left and right and cheek-palate side osteotomy guide plates at the virtual osteotomy line and cortical bone resection positions;

(2) designing a zygomatic planting titanium plate: designing a zygomatic implant titanium plate at the zygomatic alveolar ridge according to the maxilla form shown by the CT of the patient, wherein the zygomatic implant titanium plate extends towards the fitting direction to design an integrally printed traction hook to match with a cast cross palatal bar to press down posterior teeth and adducted anterior teeth;

(3) designing a cast cross palate rod: designing and casting a cross palatal bar according to a specific vertical control scheme through the super-hard gypsum model of the upper dentition, the lower dentition and the palatine fornix or intraoral scanning data of a patient; preparing a low-pressure tooth casting belt with a mesh-shaped laminating surface, welding a buccal tube or a bracket on the buccal side, connecting the palate side through a transverse palate rod with the width of 3mm, and connecting the two sides of the casting belt close to the gum area in a dovetail way at a distance of 1-2mm from the gum; enough space for pressing down is reserved at the bottom of the palatal pole 4-5mm away from the palatal cap;

(4) and manufacturing the designed osteotomy guide plate, the zygomatic implanting titanium plate and the cast cross palatal bar into a real object by using a three-dimensional printing mode.

2. The method for making a tool for improving cortical bone dissection according to claim 1, wherein the virtual osteotomy line in the proximal and distal ends of step (1) is in the shape of an inverted trapezoid.

3. The method for making a tool for improving cortical bone dissection according to claim 1, wherein the zygomatic titanium plate designed in step (2) includes 2-3 holes.

4. The method for making a tool for improving cortical bone dissection according to claim 1, wherein the distance from the bottom end of the retractor hook to the upper posterior buccal cusp in step (2) is 6-8 mm.

5. The method for making a tool for improving cortical bone dissection according to claim 1, wherein said step (3) of designing a cast palate beam according to a specific vertical control scheme from the patient's super hard gypsum models of upper and lower dentitions and palatal vault or intraoral scan data, comprises:

(31) preparing upper and lower dentition models of a patient by using alginate impression materials and superhard gypsum;

(32) acquiring a digital three-dimensional model of upper and lower dentitions of a patient through a scanner;

(33) acquiring a full cranium spiral CT shot when a patient is in a jaw position before an operation, reconstructing cranio-maxillofacial bone tissues of the patient into a digital three-dimensional model through software with a function of digitally reconstructing Dicom data in a three-dimensional manner, and naming the model as an E1 model;

(34) matching the digital three-dimensional models of the upper and lower dentitions to the corresponding dentition positions of the E1 model through software with the functions of 'registration' and 'alignment', and replacing the upper and lower dentitions on the E1 model by the digital three-dimensional models of the upper and lower dentitions, and naming the obtained model as an E2 model;

(35) designing a bone cutting line and preparing to remove the position and the bone mass of the cortical bone according to the individual condition of the patient on the E2 model;

(36) designing zygomatic implant titanium plates and traction hooks at zygomatic alveolar ridges on both sides of the maxilla according to the E2 model, and designing retention screw holes on a digital three-dimensional model of the left and right osteotomy guide plates of the maxilla;

(37) the cross palatal bar was designed for a specific tooth position according to the treatment protocol.

Technical Field

The invention relates to the technical field of auxiliary medical instruments, in particular to a manufacturing method of a tool for improving cortex lycii cutting.

Background

Aiming at the defects that patients with osseous II high angles often need to apply orthognathic surgery to separate the upper jaw and the lower jaw and move the upper jaw and the lower jaw to establish stable occlusion relation, but the surgery has the disadvantages of large trauma, easy relapse, limited movement amount, high cost and the like, and many patients are forbidden.

Disclosure of Invention

The technical problem to be solved by the invention is to provide a tool manufacturing method for improving the cortex lycii cutting, which can reduce the trauma and the economic burden of a patient.

Aiming at patients with high angle of bone type II and orthognathic operation indication, a treatment mode that bilateral maxillary posterior cheek and palate improved cortex incising, bilateral maxillary cheek and palate implanted titanium plates are implanted and matched with a cast transverse palate rod to press down maxillary posterior teeth is designed to achieve vertical control. The treatment mode optimizes the case that the face shape and occlusion can be improved only through orthognathic surgery originally into an operable operation mode under local anesthesia, has certain popularization significance and universality, correspondingly reduces the trauma and economic burden of patients, creates conditions for minimally invasive and efficient orthodontic treatment, and uses tools in all links, such as an osteotomy guide plate, a titanium plate traction hook, a cast cross palate rod and the like, are completely customized by three-dimensional digital printing.

The technical scheme adopted by the invention for solving the technical problems is as follows: a method for making a tool for improving cortical bone dissection is provided, comprising the steps of:

(1) designing an osteotomy guide plate: designing the resection width of the cortex of the radicular bone according to the reduction amount of the posterior maxillary tooth in a treatment scheme, determining the position of a near-far middle virtual osteotomy line and the resection length of the cortex of the bone according to the reduction tooth position, and definitely printing maxillary left and right, cheekbasal side osteotomy guide plates on the virtual osteotomy line and the cortex of the bone resection part;

(2) designing a zygomatic planting titanium plate: designing a zygomatic implant titanium plate at the zygomatic alveolar ridge according to the maxilla form shown by the CT of the patient, wherein the zygomatic implant titanium plate extends towards the fitting direction to design an integrally printed traction hook to match with a cast cross palatal bar to press down posterior teeth and adducted anterior teeth;

(3) designing a cast cross palate rod: designing and casting a cross palatal bar according to a specific vertical control scheme through the super-hard gypsum model of the upper dentition, the lower dentition and the palatine fornix or intraoral scanning data of a patient; preparing a low-pressure tooth casting belt with a mesh-shaped laminating surface, welding a buccal tube or a bracket on the buccal side, connecting the palate side through a transverse palate rod with the width of 3mm, and connecting the two sides of the casting belt close to the gum area in a dovetail way at a distance of 1-2mm from the gum; enough space for pressing down is reserved at the bottom of the palatal pole 4-5mm away from the palatal cap;

(4) and manufacturing the designed osteotomy guide plate, the zygomatic implanting titanium plate and the cast cross palatal bar into a real object by using a three-dimensional printing mode.

The virtual osteotomy line in the step (1) is in an inverted trapezoid shape.

The zygomatic planting titanium plate designed in the step (2) comprises 2-3 holes.

In the step (2), the distance from the bottom end of the traction hook to the upper posterior buccal cusp is 6-8 mm.

In the step (3), a transverse palate rod is designed and cast according to a specific vertical control scheme through the super-hard gypsum model or intraoral scanning data of the upper dentition, the lower dentition and the palatal vault of the patient, and the method specifically comprises the following steps:

(31) preparing upper and lower dentition models of a patient by using alginate impression materials and superhard gypsum;

(32) acquiring a digital three-dimensional model of upper and lower dentitions of a patient through a scanner;

(33) acquiring a full cranium spiral CT shot when a patient is in a jaw position before an operation, reconstructing cranio-maxillofacial bone tissues of the patient into a digital three-dimensional model through software with a function of digitally reconstructing Dicom data in a three-dimensional manner, and naming the model as an E1 model;

(34) matching the digital three-dimensional models of the upper and lower dentitions to the corresponding dentition positions of the E1 model through software with the functions of 'registration' and 'alignment', and replacing the upper and lower dentitions on the E1 model by the digital three-dimensional models of the upper and lower dentitions, and naming the obtained model as an E2 model;

(35) designing a bone cutting line and preparing to remove the position and the bone mass of the cortical bone according to the individual condition of the patient on the E2 model;

(36) designing zygomatic implant titanium plates and traction hooks at zygomatic alveolar ridges on both sides of the maxilla according to the E2 model, and designing retention screw holes on a digital three-dimensional model of the left and right osteotomy guide plates of the maxilla;

(37) the cross palatal bar was designed for a specific tooth position according to the treatment protocol.

Advantageous effects

Due to the adoption of the technical scheme, compared with the prior art, the invention has the following advantages and positive effects: the tools used in the invention for improving each link of the cortex lycii incision, such as the osteotomy guide plate, the titanium plate traction hook, the cast cross palate rod and the like, are all customized in a three-dimensional digital printing way, so that the case of improving the surface form and occlusion through the orthognathic surgery is optimized into an operable operation form under local anesthesia, and the wound and the economic burden of a patient are correspondingly reduced.

Detailed Description

The invention will be further illustrated with reference to the following specific examples. It should be understood that these examples are for illustrative purposes only and are not intended to limit the scope of the present invention. Further, it should be understood that various changes or modifications of the present invention may be made by those skilled in the art after reading the teaching of the present invention, and such equivalents may fall within the scope of the present invention as defined in the appended claims.

Aiming at patients with high angle of bone type II and orthognathic operation indication, a treatment mode that bilateral maxillary posterior cheek and palate improved cortex incising, bilateral maxillary cheek and palate implanted titanium plates are implanted and matched with a cast transverse palate rod to press down maxillary posterior teeth is designed to achieve vertical control. The treatment mode is used for preoperatively preparing a flap incision with personalized design, an osteotomy guide plate, a zygomatic titanium plate and a cast cross palatal bar

The personalized flap-turning incision is specifically designed as follows: the coronal part of the gingival flap is provided with an inner oblique incision along the gingival margin line to turn over a full-thickness flap, the root part of the gingival flap is provided with a half-thickness flap so as to be beneficial to improving the mobility of the gingival flap, and the mucosa flap is stopped at the corresponding buccal side of the tooth root and is projected about 5mm from the root (specifically determined according to the upper jaw back teeth depression and the cortical bone cutting amount). The gingival flap extends to a tooth position respectively in the mesial-distal direction so as to ensure that the cortical bone in the operative region is exposed without tissue barrier completely, and the gingival papilla is protected to have complete morphological structure in flap operation.

Designing an osteotomy guide plate: the resection width of the cortex of the radicular bone is designed according to the maxillary posterior tooth depression in the treatment scheme, and the virtual osteotomy line position in the near and far directions and the resection length of the cortex of the bone are determined according to the depressed tooth position. The virtual osteotomy line in the distal and proximal directions forms an inverted trapezoid to ensure that the posterior teeth are vertically pressed into the anterior teeth without inverted concave resistance. And (3) clearly printing maxillary left and right and cheekbone side osteotomy guide plates at the virtual osteotomy line and the cortical bone resection part.

Designing a zygomatic planting titanium plate: according to the shape of the maxilla shown by a patient CT, a zygomatic implant titanium plate (2-3 holes are designed at the zygomatic alveolar ridge (the impedance center is as close to the posterior maxillary area as possible) is designed, the zygomatic implant titanium plate extends towards the fitting direction, 2-3 traction hooks are integrally printed to match with a cast palatal bar to press down the posterior teeth and the anterior adducted teeth, and the bottom end of each traction hook is 6-8mm away from the upper posterior buccal tip.

Designing a cast cross palate rod: the casting cross palatine bar is designed according to a specific vertical control scheme through the super hard plaster model of the upper dentition, the lower dentition and the palatine fornix or intraoral scanning data of a patient. Preparing a low-pressure tooth casting belt with a mesh-shaped laminating surface, welding a buccal tube or a bracket on the buccal side, connecting the palate side through a transverse palate rod with the width of 3mm, and connecting the two sides of the casting belt close to the gum area in a dovetail way at a distance of 1-2mm from the gum; enough space for depressing is reserved at the bottom of the transverse palate rod 4-5mm away from the palate cover. The method comprises the following specific steps:

(1) preparing upper and lower dentition models of a patient by using alginate impression materials and superhard gypsum;

(2) acquiring a digital three-dimensional model of upper and lower dentitions of a patient through a scanner, and recording and storing the dentition and occlusion relation in an STL format;

(3) acquiring a full cranium spiral CT (1.25mm thick) shot when a patient is in a jaw position before an operation, reconstructing cranio-maxillofacial bone tissues of the patient into a digital three-dimensional model through software with a function of digitally reconstructing Dicom data in a three-dimensional manner, naming the model as an E1 model and storing the model in an STL format;

(4) matching the digital three-dimensional models of the upper and lower dentitions obtained in the step (2) to the corresponding dentition positions of the E1 model through software with the functions of 'registration' and 'alignment', replacing the upper and lower dentitions on the E1 model with the digital three-dimensional models of the upper and lower dentitions, and naming the obtained model as an E2 model and storing the model in an STL format;

(5) designing a osteotomy line (a body surface projection of the osteotomy line, namely a flap incision) and a position and a bone mass for preparing to remove cortical bone on the E2 model obtained in the step 4 according to the individual condition of the patient;

(6) designing a titanium plate and a traction hook at the maxillary bilateral zygomatic alveolar ridges according to the E2 model obtained in the step 4, and designing a fixing screw hole on a digital three-dimensional model of the maxillary left and right osteotomy guide plate;

(7) the cross palatal bar was designed for a specific tooth position according to the treatment protocol.

The designed osteotomy guide plate, zygomatic implantation titanium plate and cast cross palate rod are made into a real object by using a three-dimensional printing mode: printing the designed osteotomy guide plate into a real object by using a three-dimensional printing material through a three-dimensional printing rapid prototyping method; printing the cheeks planting titanium plate and the traction hook which are designed by using titanium alloy through three-dimensional printing to manufacture a real object; and manufacturing the cast cross palate bar into a real object by using titanium alloy casting or printing.

The using method comprises the following steps: the patient tries to wear the cast cross palate bar in the mouth before the operation treatment to confirm the fitting degree so as to ensure the normal adhesion after the operation.

The retroalveolar nerve and palatal macropore block anesthesia is gone up in the operation, and according to the flap operation of treatment scheme line, correspond the upper jaw and cut the bone guide plate and settle and coincide and fix with patient's last dentition, use supersound osteotome to get rid of the guide plate slot and correspond alveolar bone surface cortex of bone and accomplish and correspond the cortex of bone and cut. The implant position of the zygomatic titanium plate is determined by the guide plate fixing screw hole, the titanium plate is implanted after the guide plate is taken out, and the incisal margin is intermittently sutured after each operation area is finished.

And (3) adjusting and stirring light-cured glass ions after the operation to bond and cast the cross palate rod, and starting to reduce and pull from a cheek planting titanium plate traction hook to a cheek side cheek pipe of a casting part or a bracket rubber hanging chain after the operation for one circle.