Department of Community Dentistry, Semmelweis University, Szentkirályi utca 40. 1088 Budapest, Hungary.
Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv 64239, Israel,; Goldschleger School of Dental Medicine, Sackler School of Medicine, Tel-Aviv University, Tel Aviv 39040, Israel.
J Dent. 2022 Nov;126:104295. doi: 10.1016/j.jdent.2022.104295. Epub 2022 Sep 15.
This case series aimed to assess the feasibility of a custom-made decompression appliance fabricated using a digital workflow to decompress odontogenic cysts. Additionally, the treated cysts were assessed for volumetric changes.
A three-dimensional (3D) reconstruction software (CoDiagnostiX version 10.4) was used to obtain the master cast STL (Standard Tessellation Language) file by placing a customized virtual implant to create a recess for the tube of the decompression device. The decompression appliance was planned using Dental Wings Open Software (DWOS). Following rapid prototyping, the tube of the appliance was perforated using round burs. In cases where the appliances were designed to replace teeth, denture teeth were added using the conventional workflow. The appliances were delivered on the day of the cystostomy. Following decompression, cyst enucleation was performed. Cyst volume was assessed by manual segmentation of pre- and post-operative cone-beam computed tomography (CBCT) reconstructions using slice-by-slice boundary drawing with a scissors tool in the 3DSlicer 4.10.2 software. Percentage of volume reduction was calculated as follows: volume reduction/pre-operative volume × 100.
Six odontogenic cysts in six patients (5 male, 1 female; age 40 years, range: 15-49 years) with a pre- and post-operative cyst volume of 5597 ± 3983 mm and 2330 ± 1860 mm respectively (p < 0.05) were treated. Percentage of volume reduction was 58.84 ± 13.22 % following a 6-month-long decompression period.
The digital workflow described in this case series enables the delivery of decompression appliances at the time of cystostomy, thus effectively reducing the volume of odontogenic cysts. The resulting bone formation established a safe zone around the anatomical landmarks; therefore, during enucleation surgery, complications to these landmarks can be avoided.
本病例系列旨在评估使用数字工作流程制造的定制减压器械治疗牙源性囊肿的可行性,并评估治疗后囊肿的体积变化。
使用三维(3D)重建软件(CoDiagnostiX 版本 10.4),通过放置定制虚拟植入物以创建减压装置管的凹槽,获得主铸型 STL(标准网格语言)文件。使用 Dental Wings Open Software(DWOS)规划减压器械。快速原型制作后,使用圆锯片在器械管上穿孔。如果设计的器械用于替代牙齿,则使用传统工作流程添加假牙牙。在囊肿造口术当天交付器械。减压后进行囊肿切除术。使用 3DSlicer 4.10.2 软件中的剪刀工具在逐层边界绘制,手动分割术前和术后锥形束计算机断层扫描(CBCT)重建,评估囊肿体积。体积减少百分比计算如下:体积减少/术前体积×100。
6 名患者(5 名男性,1 名女性;年龄 40 岁,范围:15-49 岁)的 6 个牙源性囊肿,术前和术后囊肿体积分别为 5597 ± 3983mm 和 2330 ± 1860mm(p<0.05)。减压 6 个月后,体积减少百分比为 58.84 ± 13.22%。
本病例系列中描述的数字工作流程可在囊肿造口术时交付减压器械,从而有效减小牙源性囊肿的体积。由此产生的骨形成在解剖学标志周围建立了一个安全区域;因此,在囊肿切除术手术中,可以避免这些标志的并发症。