CN102415916A - Correction method for preventing excessive stress concentration of teeth roots and jaws in process of orthodontic treatment - Google Patents
Correction method for preventing excessive stress concentration of teeth roots and jaws in process of orthodontic treatment Download PDFInfo
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Abstract
The invention relates to a correction method for preventing excessive stress concentration of teeth roots and jaws in the process of orthodontic treatment, belonging to the technical field of orthodontics of teeth. The correction method comprises the following steps of: establishing an automatic-matching 3D (three dimensional) integrated tooth-jaw model; carrying out stepwise virtual correction on the 3D integrated tooth-jaw model; applying 3D finite-element analysis to determine the dynamic change of stress distribution of the teeth roots and the jaws in the whole process of the virtual correction and guarantee that the stress of the teeth roots and the jaws in correction is in the safety range; and manufacturing a clinical correction device by a fast laser forming technology. By the individualized correction device designed and manufactured by a computer in an auxiliary manner, the positions and the routes of movement of the teeth roots can be controlled. By expression and verification, the correction method can duplicate the condition of virtual correction in actual treatment, realizes good position relation among the teeth roots, the teeth and the jaws in the correction process, and is beneficial to reducing and eliminating absorption of the teeth roots and the alveolar bones due to excessive stress concentration in the process of orthodontic treatment and reducing and avoiding recurrence after correction.
Description
Technical field
The invention belongs to the orthodontic technical field, particularly a kind of correcting method that prevents root of the tooth and jawbone stress concentrations in the orthodontic treatment process.
Background technology
Root resorption is one of common complication of orthodontic treatment; Research in recent years shows behind the orthodontic treatment root resorption even up to 41.6%; A lot of researchs show that all just abnormal root resorption is a common phenomenon of following orthodontic treatment, prevent that root resorption is a difficult problem that presses for solution in the orthodontic treatment.Tip of a root stress concentrations is relevant in the basic reason of orthodontic treatment root resorption and the tooth moving process; The reason of stress concentrations is that root of the tooth and jawbone concern bad causing in the position of orthodontic treatment process: for example receive root of the tooth in the labial teeth and can cause root resorption near the jawbone cortical bone.But how accurately to judge the safe movement scope of root of the tooth in jawbone, and how accurately to control the safe movement of root of the tooth in jawbone, do not appear in the newspapers as yet in the present document of these problems.
Because just abnormal root resorption is to occur on the three-dimensional, traditional X sheet can not accurately be observed.Present cone beam computed tomography (cone beam computed tomography; CBCT) more and more widely be applied to dentistry; Because CBCT can generate degree of precision; With 1: 1 3-D view of real anatomy mechanism, and radiological dose is little, and this research that aligns abnormal root resorption has produced tremendous influence.Though CBCT scanning can obtain detailed sclerous tissues's image; But the CBCT image that resolution is the highest also has only the precision about 0.1mm; The shape or the accurate occluding relation that can not show tooth accurately; Therefore can not use based on the digital model of CBCT and make clinical appliance (indirect bonding pallet, individuation bracket, the stealthy appliance of no bracket).Their making also must rely on the digitized corona model of setting up with laser or mechanism's photoscanning plaster model, and its precision can reach 0.02mm even higher.To in virtual orthodontic treatment and digitized row tooth, application comprise the dentognathic model of root of the tooth and jawbone, and export clinical appliance, just must integrate based on the digital model of CBCT with based on laser or mechanism's photoscanning digitized corona model.
Three-dimensional finite element analysis is a kind of stress analysis method commonly used; But modeling needs the bigger CT of application of radiation dosage; Do not have under the situation of extensive use at the lower CBCT of radiological dose, still can not carry out dynamic stress analysis to root of the tooth and jawbone in patient's orthodontic treatment process clinically at present; In addition on the one hand; Though can include root of the tooth and jawbone in virtual row's tooth at present; Control to root of the tooth behind the orthodontic treatment and jawbone position relation; But just abnormal root resorption is to occur in the just abnormal process, how to guarantee in whole orthodontic treatment process that root of the tooth and jawbone all do not have stress concentrations, and technology in the past still can not solve fully.
Summary of the invention
The present invention is directed to the problems referred to above, disclose a kind of correcting method that prevents root of the tooth and jawbone stress concentrations in the orthodontic treatment process.
This method has following steps:
(1) set up autoregistration 3D and integrate dentognathic model:
(1.1) get the silicone rubber seal and get patient's tooth model, and record, carry out the scanning of laser or structured light then, obtain digitized corona with Gypsum Fibrosum;
(1.2) patient's face is taken cone-beam computed tomography picture, go out jawbone and full dental cast with software rebuild;
(1.3) behind the jawbone and full dental cast autoregistration that corona that is scanned into laser or structured light with reverse engineering software and cone-beam computed tomography are rebuild; The corona of excision lap, the 3D of acquisition are integrated dentognathic model and are comprised the corona of laser or structured light scanning and root of the tooth and the jawbone that the cone-beam computed tomography is rebuild;
(2) on 3D integration dentognathic model, carry out the substep virtual orthodontic treatment:
(2.1) on the 3D of autoregistration integration dentognathic model, confirm the safe movement scope of root of the tooth in jawbone through cone-beam computed tomography and three-dimensional finite element analysis; Mobile standard is: the outer surface of root of the tooth leaves more than the cortical bone inner surface 0.5mm, and wherein the tip of a root of root of the tooth leaves more than the cortical bone inner surface 1mm; The outer surface of each root of the tooth all leaves more than the root of the tooth outer surface 0.5mm of other tooth, and the tip of a root of each root of the tooth all leaves more than the root of the tooth outer surface 1mm of other teeth; The outer surface of root of the tooth leaves elastic modelling quantity greater than 1 * 10
4More than the high density structures surface 0.5mm of MPa, the tip of a root of root of the tooth leaves elastic modelling quantity greater than 1 * 10
4More than the high density structures surface 1mm of MPa;
(2.2) every tooth three-dimensional tooth jaw being integrated on the model is divided into and can moves tooth at three-dimensional, rescues device to difference and carries out the substep virtual orthodontic treatment respectively;
(3) the three-dimensional finite element dynamic stress is analyzed:
(3.1) each step is integrated on the dentognathic model in the virtual orthodontic treatment process root of the tooth certain applications Mimics and Geomagic software are set up root of the tooth-periodontal membrane-alveolar bone model, and utilize three-dimensional finite element analysis software Ansys to divide grid and loaded load;
(3.2) set position and the route that root of the tooth moves according to the substep virtual orthodontic treatment plan of step (2.2), guarantee in the whole process that root of the tooth stress maximum is no more than 10MPa, jawbone stress maximum is no more than 2MPa; The virtual orthodontic treatment result confirms to rescue plan and the new six key element standards of Andrews, satisfies not parallel, the no root of the tooth of no root of the tooth simultaneously and exposes, and does not promptly have the situation of bone cracking and fenestration;
(4) through the clinical orthotic device of laser fast forming fabrication techniques.
In the said step (3.2), root of the tooth stress is further for maximum is no more than 5MPa, and jawbone stress further is no more than 1MPa for maximum.
In the said step (2.2), saidly rescue the arch wire of lip that device comprises indirect bonding pallet, individuation, linguoplate groove, individuation and do not have the stealthy appliance of bracket.
The virtual orthodontic treatment of indirect bonding pallet of said use and individuation bracket is divided into following 5 steps:
Come into line the smooth initial stage: during patient's initial therapy, use 0.014 inch titanium nickel arch wire, arch wire is not smooth;
Come into line the smooth later stage: use 0.022 * 0.016 inch TMA arch wire, arch wire is not smooth;
The closing gap initial stage: use 0.022 * 0.016 inch rustless steel arch wire, arch wire is smooth fully, but does not move the tooth closing gap;
The closing gap later stage: use 0.022 * 0.016 inch rustless steel arch wire, it is gapped that mobile tooth is closed the interior institute of completion dental arch;
The treatment completion phase.
The virtual orthodontic treatment that said use does not have the stealthy appliance of bracket is divided into the 20-30 step, and the amount of movement of each step tooth is in 0.2mm.
Beneficial effect of the present invention is:
Before treatment, just set position and the route that root of the tooth moves through virtual orthodontic treatment in jawbone; Whole actual orthodontic treatment process is simulated and controlled; Prevent root of the tooth and the jawbone stress concentrations in orthodontic treatment; And virtual orthodontic treatment is converted into actual rescuing through advanced technology; The orthotic device of CAD/CAM (indirect bonding pallet, individuation bracket, the stealthy appliance of no bracket) comprises the information that prevents root of the tooth and jawbone stress concentrations; Because root of the tooth and frontal resorption that stress concentrations causes provide solution, also can avoid that root of the tooth behind the orthodontic treatment is not parallel simultaneously, root of the tooth exposes periodontal that (bone cracking and fenestration) wait side effect to cause and damage and recur equivalent risk for preventing in the orthodontic treatment.
Description of drawings
Fig. 1 is a flow chart of the present invention;
The corona model that Fig. 2 obtains for laser scanning;
Fig. 3 (a) and Fig. 3 (b) are respectively CBCT and rebuild root of the tooth and the jawbone model that obtains;
Fig. 4 is with the 3D dentognathic model behind laser scanning model and the CBCT model integration;
Fig. 5 (a) and Fig. 5 (b) are respectively root of the tooth and the analysis of jawbone dynamic stress
Fig. 6 is that root of the tooth is at each stage stress analysis sketch map of virtual orthodontic treatment;
Fig. 7 is row's dental cast of virtual orthodontic treatment final step; Fig. 7 (a) is a root of the tooth depth of parallelism sketch map; Fig. 7 (b) is that root of the tooth and jawbone position concern sketch map.
The specific embodiment
The invention provides a kind of correcting method that prevents root of the tooth and jawbone stress concentrations in the orthodontic treatment process, the present invention is further specified below in conjunction with the accompanying drawing and the specific embodiment.
The flow process of the method for the invention is as shown in Figure 1:
(1) produce digitized dental arch model: get patient's die with silicone rubber, record model with high-intensity Gypsum Fibrosum then, carry out laser to occlusion cast then or mechanism's photoscanning obtains digitized occlusion cast, as shown in Figure 2, its degree of accuracy is higher.
(2) rebuild jawbone and root of the tooth: take the facial CBCT of patient's jaw; Save as the dicom formatted file; According to the density of tooth and jawbone is different different threshold values is set with Mimics software; Select appropriate threshold that dental imaging and jawbone image are cut apart three-dimensional reconstruction respectively, shown in Fig. 3 (a) and Fig. 3 (b).
(3) behind the corona autoregistration that corona that is scanned into laser or structured light with reverse engineering software and CBCT rebuild; The crown portion branch of CBCT image is cut away; The corona image of the CBCT root of the tooth that keeps and the image of jawbone and scan model merges; The 3D that obtains integrates dentognathic model and comprises the corona of laser or structured light scanning and root of the tooth and the jawbone that CBCT rebuilds, and is as shown in Figure 4.
(4) on the 3D of autoregistration integration dentognathic model, confirm the safe movement scope of root of the tooth in jawbone through cone-beam computed tomography and three-dimensional finite element analysis; Mobile standard is: the outer surface of root of the tooth leaves more than the cortical bone inner surface 0.5mm, and wherein the tip of a root of root of the tooth leaves more than the cortical bone inner surface 1mm; The outer surface of each root of the tooth all leaves more than the root of the tooth outer surface 0.5mm of other tooth, and the tip of a root of each root of the tooth all leaves more than the root of the tooth outer surface 1mm of other teeth; The outer surface of root of the tooth leaves elastic modelling quantity greater than 1 * 10
4More than the high density structures surface 0.5mm of MPa, the tip of a root of root of the tooth leaves elastic modelling quantity greater than 1 * 10
4More than the high density structures surface 1mm of MPa.
(5) be directed against indirect bonding pallet, individuation bracket on the 3D integration dentognathic model or do not having the stealthy appliance of bracket and carry out the substep virtual orthodontic treatment respectively: on three-dimensional tooth jaw integration model, using software; Every tooth is divided into and can moves tooth at three-dimensional, carry out the substep virtual orthodontic treatment according to treatment plan then and rescue in the whole process at dynamic virtual and guarantee that the root of the tooth maximum stress is no more than 10Mpa (preferably be no more than in the practical application and be 5Mpa); The jawbone maximum stress is no more than 2MPa (preferably being no more than 1Mpa in the practical application);
Virtual orthodontic treatment for indirect bonding pallet and individuation bracket is divided into following 5 steps:
Come into line the smooth initial stage: when the patient does not treat, use 0.014 inch titanium nickel arch wire, arch wire is not smooth;
Come into line the smooth later stage: use 0.022 * 0.016 inch TMA arch wire, arch wire is not smooth;
The closing gap initial stage: use 0.022 * 0.016 inch rustless steel arch wire, arch wire is smooth fully, but does not move the tooth closing gap;
The closing gap later stage: use 0.022 * 0.016 inch rustless steel arch wire, it is gapped that mobile tooth is closed the interior institute of completion dental arch;
The treatment completion phase.
Virtual orthodontic treatment for the stealthy appliance of no bracket is divided into the 20-30 step, and the amount of movement of each step tooth is in 0.2mm.
(6) root of the tooth and jawbone are carried out the dynamic stress analysis: root of the tooth certain applications Mimics and Geomagic software that each step of virtual orthodontic treatment is integrated on the dentognathic model are set up root of the tooth-periodontal membrane-alveolar bone model; And save as the form that three-dimensional finite element analysis software Ansys can discern; Confirm material parameter then; Divide grid and loading (10Nmm), as shown in Figure 5.
(7) set position and the route that root of the tooth moves through three-dimensional finite element analysis: the dynamic change of root of the tooth and jawbone stress distribution in the whole process of virtual orthodontic treatment is confirmed in the applying three-dimensional finite element analysis; If the situation of stress concentrations is arranged, and (the root of the tooth maximum equivalent is greater than 5Mpa; Perhaps the alveolar bone maximum equivalent is greater than 1Mpa) then readjust position and route that the virtual orthodontic treatment root of the tooth moves; Guarantee root of the tooth and jawbone stress each stage of virtual orthodontic treatment all in safety range, as shown in Figure 6.
Virtual orthodontic treatment end product: accomplish virtual orthodontic treatment final step row dental cast according to rescuing plan and new six key elements of Andrews (comprising jawbone) standard.Require no root of the tooth not parallel simultaneously, like Fig. 7 (a), no root of the tooth exposes, like Fig. 7 (b).Content about new six key elements of Andrews sees also: Zhang Ke, the illiterate person: Andrews mouth jaw face is coordinated the application of six key elements in side has attractive appearance. international stomatology magazine, 2010,37 (2): P236-239; Andrews LF:The six elements of orofacial harmony [J] .Andrews J Orthod Orofac Harmony, 2000,1 (1): 13-22.
(8) through the clinical orthotic device of laser fast forming fabrication techniques:
The making of indirect bonding pallet: on the model of virtual orthodontic treatment final step, draw full-scale individuation tongue side or lip side arch wire with three-dimensional drawing software; Locate virtual tongue side or lip side bracket with the individuation arch wire; Get back to original misfit state to the coordinate of each tooth of the integration model that contains the bracket of having good positioning then; On the misfit model, generate virtual indirect bonding pallet with software; Export transfer tray in kind with rapid laser-shaping technique, transfer tray and individuation arch wire comprise the information of root of the tooth shift position and route.
The making of individuation bracket: on the model of virtual orthodontic treatment final step, generate individuation bracket negative and draw full-scale individuation tongue side or lip side arch wire; Draw good supporter groove with individuation arch wire location, with software bracket base and supporter groove are merged the computer-aided design of completion individuation bracket then.(selective laser metling SLM) is directly output as bracket in kind with virtual individuation bracket, and individuation bracket and individuation arch wire comprise the information of root of the tooth shift position and route with the precinct laser fusion technology.
The making of individuation arch wire: adopt mechanical hand or the manual individuation arch wire that bends according to cad model.
The making of the stealthy appliance of no bracket: virtual orthodontic treatment is divided into the 20-30 step according to treatment plan; Further can finerly be divided into for 50 steps; Guarantee that each step root of the tooth and jawbone stress are in safety range; Make the dental arch model (photocuring model) in each step through laser fast forming, vacuum film pressing obtains and the stealthy appliance of the corresponding no bracket of virtual orthodontic treatment step on the photocuring model.
Clinical application effect: the clinical case that the appliance that application the method for the invention is processed is accomplished; All rescue the ratio of tooth generation root resorption (referring to that treatment original root of the tooth form in back or root length change) in 10%, and all its absorbtivity of tooth of root resorption take place in 2mm; Treatment back no root of the tooth not parallel (adjacent teeth root of the tooth angle is in 15 °), no root of the tooth exposes to jawbone.
Claims (5)
1. prevent the correcting method of root of the tooth and jawbone stress concentrations in the orthodontic treatment process, it is characterized in that having following steps:
(1) set up autoregistration 3D and integrate dentognathic model:
(1.1) get the silicone rubber seal and get patient's tooth model, and record, carry out the scanning of laser or structured light then, obtain digitized corona with Gypsum Fibrosum;
(1.2) patient's face is taken cone-beam computed tomography picture, go out jawbone and full dental arch model with software rebuild;
(1.3) behind the jawbone and full dental arch model autoregistration that corona that is scanned into laser or structured light with reverse engineering software and cone-beam computed tomography are rebuild; The corona of excision lap, the 3D of acquisition are integrated dentognathic model and are comprised the corona of laser or structured light scanning and root of the tooth and the jawbone that the cone-beam computed tomography is rebuild;
(2) on 3D integration dentognathic model, carry out the substep virtual orthodontic treatment:
(2.1) on the 3D of autoregistration integration dentognathic model, confirm the safe movement scope of root of the tooth in jawbone through cone-beam computed tomography and three-dimensional finite element analysis; Mobile standard is: the outer surface of root of the tooth leaves more than the cortical bone inner surface 0.5mm, and wherein the tip of a root of root of the tooth leaves more than the cortical bone inner surface 1mm; The outer surface of each root of the tooth all leaves more than the root of the tooth outer surface 0.5mm of other tooth, and the tip of a root of each root of the tooth all leaves more than the root of the tooth outer surface 1mm of other teeth; The outer surface of root of the tooth leaves elastic modelling quantity greater than 1 * 10
4More than the high density structures surface 0.5mm of MPa, the tip of a root of root of the tooth leaves elastic modelling quantity greater than 1 * 10
4More than the high density structures surface 1mm of MPa;
(2.2) every tooth three-dimensional tooth jaw being integrated on the model is divided into and can moves tooth at three-dimensional, carries out the substep virtual orthodontic treatment respectively to different appliances;
(3) the three-dimensional finite element dynamic stress is analyzed:
(3.1) each step is integrated on the dentognathic model in the virtual orthodontic treatment process root of the tooth certain applications Mimics and Geomagic software are set up root of the tooth-periodontal membrane-alveolar bone model, and utilize three-dimensional finite element analysis software Ansys to divide grid and loaded load;
(3.2) set position and the route that root of the tooth moves according to the substep virtual orthodontic treatment plan of step (2.2), guarantee in the whole process that root of the tooth stress maximum is no more than 10MPa, jawbone stress maximum is no more than 2MPa; The virtual orthodontic treatment result confirms to rescue plan and the new six key element standards of Andrews, satisfies not parallel, the no root of the tooth of no root of the tooth simultaneously and expose;
(4) through the clinical orthotic device of laser fast forming fabrication techniques.
2. the correcting method that prevents root of the tooth and jawbone stress concentrations in the orthodontic treatment process according to claim 1; It is characterized in that; In the said step (3.2), root of the tooth stress is further for maximum is no more than 5MPa, and jawbone stress further is no more than 1MPa for maximum.
3. the correcting method that prevents root of the tooth and jawbone stress concentrations in the orthodontic treatment process according to claim 1 is characterized in that, in the said step (2.2), said appliance comprises indirect bonding pallet, individuation bracket and do not have the stealthy appliance of bracket.
4. the correcting method that prevents root of the tooth and jawbone stress concentrations in the orthodontic treatment process according to claim 3 is characterized in that, the virtual orthodontic treatment of indirect bonding pallet of said use and individuation bracket is divided into following 5 steps:
Come into line the smooth initial stage: during patient's initial therapy, use 0.014 inch titanium nickel arch wire, arch wire is not smooth;
Come into line the smooth later stage: use 0.022 * 0.016 inch TMA arch wire, arch wire is not smooth;
The closing gap initial stage: use 0.022 * 0.016 inch rustless steel arch wire, arch wire is smooth fully, but does not move the tooth closing gap;
The closing gap later stage: use 0.022 * 0.016 inch rustless steel arch wire, it is gapped that mobile tooth is closed the interior institute of completion dental arch;
The treatment completion phase.
5. the correcting method that prevents root of the tooth and jawbone stress concentrations in the orthodontic treatment process according to claim 3; It is characterized in that; The virtual orthodontic treatment that said use does not have the stealthy appliance of bracket is divided into the 20-30 step, and the amount of movement of each step tooth is in 0.2mm.
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