- 期刊
以傳統方式或3D列印精準化的牙齦切除術治療嚴重牙齦纖維瘤病：病例系列
Conventional or 3D Printing-Precisionized Gingivectomy for Severe Gingival Fibromatosis: A Case Series
摘要
研究目的：牙齦纖維瘤病（Gingival fibromatosis），可分為遺傳性（hereditary）或是偶發性（idiopathic），其盛行率在過去的研究介於1:175000至1:750000之間，是罕見的牙周相關疾病。本篇研究的目標為使用傳統方式，或利用3D列印技術預先設計手術導板輔助進行牙齦切除手術，針對兩者的優缺點及適應症做初步的探討評估。材料與方法：本篇病例系列報告包含兩個病患，均屬於嚴重的牙齦纖維瘤病。其中一位使用傳統的牙齦切除術進行治療，另一位則是先利用錐狀束電腦斷層、模型掃瞄及3D列印的技術，將病患口內狀況重組成3D模型，再設計出手術導板以輔助手術中切線的設計。結果：不論是使用傳統或是3D列印輔助的方式，都能達到一定的術後結果。然而，在特別嚴重的牙齦纖維瘤病的患者身上，牙冠可能大部分或全部被過度生長的牙齦覆蓋，事先使用3D列印重現牙齦跟牙齒的關係並製作手術導板，能有效縮短手術的時間，並且達到更精準的切線設計，對美觀區的術後結果有更好的預測性。結論：傳統的牙齦切除術能減少病患的花費以及技工時間，但若在特別嚴重及美觀區的案例上，利用電腦輔助設計及3D列印技術預先製作手術導板，可以有效地減少手術時間及增加精準度。
並列摘要
Gingival fibromatosis is a rare condition with prevalence from 1:175,000 to 1:750,000. It can be divided to hereditary or idiopathic type, and the treatment of choice for severe cases is usually gingivectomy. This case series aims to discuss about the advantages, disadvantages and indications between conventional and 3D printing-assisted gingivectomy. Materials and Methods: This case series demonstrates two cases of severe gingival fibromatosis. The first patient was treated with conventional gingivectomy. The other patient had cone beam computerized tomography and dental impression first. A 3D reconstruction model was printed after combining the images from both hard and soft tissue. Finally, a surgical guide was made on the 3D printing model to assist the surgery. Results: Regardless of using conventional or 3D printing-assisted methods, acceptable postoperative results can be achieved. However, in severe gingival fibromatosis, the teeth may be mostly or completely covered by enlarged gingiva. Using 3D printing technique to reproduce the relationship between the gingiva and the teeth as well as making surgical guide in advance can effectively shorten the surgical time and achieve more precise outcome. The esthetic outcome can also be more predictable. Conclusion: The conventional gingivectomy can be less laboratory time and financial cost for the patient. Whereas in severe cases, using computer-aided design and 3D printing technique to assist the surgery can greatly reduce the operation time and increase the accuracy, especially in the esthetic zone.