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颅骨成形术的快速成型技术:病例系列

Rapid prototyping technology for cranioplasty: A case series.

作者信息

Thakur Ashish, Chauhan Dushyant, Viswambaran M, Yadav R K, Sharma Dhruv

机构信息

Department of Prosthodontics and Crown and Bridge, Army Dental Centre R and R, New Delhi, India.

出版信息

J Indian Prosthodont Soc. 2019 Apr-Jun;19(2):184-189. doi: 10.4103/jips.jips_295_18.

Abstract

Cranial vault defects may be acquired or congenital in origin. Rehabilitation of these patients often poses challenge to the operating team and prosthodontist. Polymethylmethacrylate is a commonly used alloplastic graft material which is used for the fabrication of cranial prosthesis. Nowadays, with the advancement in the bioengineering, custom-made template and cranial prosthesis can be made by rapid prototyping technology (RPT) by patient three-dimensional (3D) computed tomography (CT) scan images. This series of two cases explained two different techniques for the rehabilitation of the patient with frontotemporoparietal cranial defect. Case 1 had a history of cerebrovascular accident, followed by decompression craniotomy which led to frontotemporoparietal defect of the left side. This defect area was associated with the cerebrospinal fluid accumulation which made delineation of underlying bony margins difficult and interfered with conventional impression procedures. Case 2 had a road traffic accident which led to intracerebral hemorrhage followed by decompression craniotomy which resulted in frontotemporoparietal defect of the right side. The patient had a poor neuromuscular control which impedes with the upright posture of the head during impression making of the defect area. Therefore, these cases were planned to rehabilitate by RPT. In these techniques, the prosthesis was made using custom-made skull template produced by RPT, using the data of 3D-CT scan images. This technique resulted in the prosthesis with good esthetics and better fit of the prosthesis. The contours of the prosthesis were replicated in the same manner as compared to the contralateral side. RPT is an additive manufacturing technology which is now used in the field of dentistry too. This technique is easy to use; fabricate prosthesis with high precision is less time-consuming and has fewer chances of error.

摘要

颅盖缺损可能是后天获得性的或先天性的。对这些患者进行修复往往给手术团队和口腔修复医生带来挑战。聚甲基丙烯酸甲酯是一种常用的异体移植材料,用于制作颅骨假体。如今,随着生物工程的进步,可以通过快速成型技术(RPT)利用患者的三维(3D)计算机断层扫描(CT)图像制作定制模板和颅骨假体。这一系列的两个病例阐述了修复额颞顶颅骨缺损患者的两种不同技术。病例1有脑血管意外病史,随后进行了减压开颅手术,导致左侧额颞顶缺损。该缺损区域伴有脑脊液积聚,使得难以勾勒出下方的骨边缘,并干扰了传统的印模程序。病例2发生道路交通事故,导致脑出血,随后进行了减压开颅手术,造成右侧额颞顶缺损。患者神经肌肉控制能力差,在对缺损区域进行印模时妨碍头部保持直立姿势。因此,计划通过RPT对这些病例进行修复。在这些技术中,利用3D-CT扫描图像数据,通过RPT制作的定制颅骨模板来制作假体。该技术制作出的假体具有良好的美观效果且贴合度更好。假体的轮廓与对侧以相同方式复制。RPT是一种增材制造技术,现在也应用于牙科领域。该技术易于使用;制造精度高的假体耗时少且出错几率小。

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