Using Virtual Surgery with 3D Printing Guiding Stent Applied in Upper Dental Alveolar Bone and Lower Jaw Bone Fracture Patient-A Case Report

Facial trauma involving the jaws and teeth due to accident is common and requires plenty of time for reconstruction. With the assistance of digital dentistry, including radiographic technology, intraoral scanner, 3-dimensional (3D) software, and 3D printer, the entire treatment process can be performed more rapidly and precisely. Therefore, virtual surgery and 3D printing guides are novel methods in digital dentistry to rebuild a traumatic jaw, and improve occlusal function and esthetic profile. A 21-year-old male suffered from accidental trauma and was presented with loss of consciousness, malocclusion and laceration as arriving to the emergency room. After physical and radiographic examination, avulsion of the upper left central incisor, crown fracture with pulpal involvement of the upper right incisor, and right subcondylar and left parasymphysis fractures were diagnosed. Computerized tomography, cone-beam computerized tomography, and an intraoral scan standard tessellation language (STL) file were integrated using Materialise 3-matic software to simulate the patient's bone and teeth condition, and the virtual surgery was planned at the same time. Open reduction-internal fixation with immediate dental implantation were performed under general anesthesia. Occlusion and condylar height were recovering well at 3-month follow-up and dental implant prosthetics would be delivered a few months later. Reconstruction of facial trauma using a 3D printed surgical stent to assist open reduction and internal fixation and immediate dental implantation can allow for complex reconstruction at one time. We describe successful use of digital dentistry techniques in a case of accidental facial trauma.

關鍵字

Digital dentistry ； 3D software ； 3D printing ； Immediate dental implant ； Open reduction and internal fixation (ORIF)

並列摘要

在台灣因意外導致牙齒、齒槽骨與顎骨的顏面創傷十分常見，重建成本高昂及耗費時間。隨著數位牙科的發展，包括數位影像、口內掃描機、3D數位軟體和3D列印機皆能使治療過程更精準，並縮短治療時間。所以虛擬手術與3D列印導板是創傷患者的顎骨骨折重建、咬合功能恢復和輪廓美學修正的新模式。本病例為21歲男性，因車禍創傷轉診到急診室，伴隨意識喪失、咬合不正和顏面多處撕裂傷。狀況穩定後，臨床及影像檢查診斷為左側上顎正中門齒外傷脫落、右側上顎正中門齒牙冠斷裂深及牙根，下顎骨右側髁突及左側副聯合區骨折。經3D數位軟體的輔助下，重組電腦斷層、錐狀束電腦斷層和口腔掃描機的STL影像檔案，成功模擬出患者最佳的骨骼和牙齒狀況，且在數位模擬下完成虛擬手術與列印手術導引板。接著於全身麻醉下完成開放性骨折復位手術、上下顎間固定手術和即拔即種植牙植骨手術，過程順利，術後穩定且無併發症。在三個月回診追蹤時，我們發現患者的咬合位置及髁突高度恢復良好，後續將安排完成植體假牙。運用術前虛擬手術及列印3D手術導引板，可大幅縮短骨折復位手術與植牙植骨手術時間和約診次數。此病例提供了應用數位牙科技術成功重建顏面創傷患者之治療經驗。

並列關鍵字

數位牙科； 3D軟體； 3D列印；立即植牙；開放性骨復位手術

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