Zhu J Y, Wang J J, Wang Y X, Yang J W, Jiang T
Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.
Beijing WeCare Digital Technology Co., Ltd, Beijing 100076, China.
Zhonghua Kou Qiang Yi Xue Za Zhi. 2023 Jan 9;58(1):50-56. doi: 10.3760/cma.j.cn112144-20220507-00243.
To investigate the influence of light and heavy bite force on the mandibular movement trajectories, and the influence of bite force on virtual occlusal pre-adjustment of digital full crown. From October 2021 to March 2022, 10 postgraduate volunteers (3 males and 7 females, aged 22-26 years) were recruited from Peking University School and Hospital of Stomatology. Maxillary and mandibular digital models of the participants were obtained by intraoral scanning. Jaw relations were digitally transferred under heavy bite force and mandibular movement trajectories under light and heavy bite force were recorded by jaw motion analyser. Three mandibular markers were chosen, namely the mesial proximal contact point of the central incisor (incisal point) and the mesial buccal cusp tips of the bilateral first molars. The three-dimensional displacements of the markers under two kinds of bite force in the intercuspal position (ICP), the sagittal projection of the three-dimensional displacements in the protrusive edge-to-edge position, and the coronal projection of the three-dimensional displacements in the lateral edge-to-edge position of upper and lower posterior teeth were measured. Single-sample -test was used to compare the three-dimensional displacements and the corresponding sagittal projection and coronal projection with 0, respectively. The left maxillary central incisor and left mandibular first molar were virtually prepared by the reverse engineering software. Then dental design software was used to design digital full crown using the copy method. The mandibular movement trajectories under light and heavy bite force were separately used to guide virtual occlusal pre-adjustment. The three-dimensional deviations (mean deviations and root mean square) between the lingual surface of the left maxillary central incisor or the occlusal surface of the left mandibular first molar and that of the natural tooth before preparation were calculated (light bite force group and heavy bite force group), and the differences between the two groups were compared by the paired -test. Under the two kinds of bite force, the three-dimensional displacements of the markers in the ICP were (0.217±0.135), (0.210±0.133) and (0.237±0.101) mm, respectively; the sagittal projection of the three-dimensional displacements of the markers in the protrusive edge-to-edge position were (0.204±0.133), (0.288±0.148) and (0.292±0.136) mm, respectively; the coronal projection of the three-dimensional displacements of the mesial buccal cusp tips of the bilateral first molars in the lateral edge-to-edge position were (0.254±0.140) and (0.295±0.190) mm, respectively. The differences between the above displacements and 0 were statistically significant (<0.05). The results of occlusal pre-adjustment showed that the mean deviations of the lingual surface of the left maxillary central incisor in the light and heavy bite force groups were (0.215±0.036) and (0.195±0.041) mm (=3.95, =0.004), respectively. The mean deviations of the occlusal surface of the left mandibular first molar were (0.144±0.084) and (0.100±0.096) mm (=0.84, =0.036), respectively. Both the light and heavy bite force have an influence on the mandibular movement trajectories. Virtual occlusal pre-adjustment of prostheses with mandibular movement trajectories under heavy bite force can obtain morphology of lingual or occlusal surfaces closer to the natural teeth before preparation.
探讨轻、重咬合力对下颌运动轨迹的影响,以及咬合力对数字化全冠虚拟咬合预调整的影响。2021年10月至2022年3月,从北京大学口腔医学院招募10名研究生志愿者(男3名,女7名,年龄22 - 26岁)。通过口内扫描获取参与者的上颌和下颌数字化模型。在重咬合力下进行颌位关系的数字化转移,并用颌运动分析仪记录轻、重咬合力下的下颌运动轨迹。选取三个下颌标志点,即中切牙近中邻接点(切缘点)和双侧第一磨牙近中颊尖。测量两种咬合力下标志点在牙尖交错位(ICP)的三维位移、前伸对刃位三维位移的矢状面投影以及上下后牙侧方对刃位三维位移的冠状面投影。采用单样本t检验分别将三维位移及其相应的矢状面投影和冠状面投影与0进行比较。利用逆向工程软件对左上颌中切牙和左下颌第一磨牙进行虚拟预备。然后使用牙科设计软件采用复制法设计数字化全冠。分别用轻、重咬合力下的下颌运动轨迹来指导虚拟咬合预调整。计算左上颌中切牙舌面或左下颌第一磨牙咬合面与预备前天然牙相应面之间的三维偏差(平均偏差和均方根)(轻咬合力组和重咬合力组),并采用配对t检验比较两组之间的差异。在两种咬合力下,标志点在ICP的三维位移分别为(0.217±0.135)、(0.210±0.133)和(0.237±0.101)mm;标志点在前伸对刃位三维位移的矢状面投影分别为(0.204±0.133)、(0.288±0.148)和(0.292±0.136)mm;双侧第一磨牙近中颊尖在侧方对刃位三维位移的冠状面投影分别为(0.254±0.140)和(0.295±0.190)mm。上述位移与0之间的差异具有统计学意义(P<0.05)。咬合预调整结果显示,轻、重咬合力组左上颌中切牙舌面的平均偏差分别为(0.215±0.036)和(0.195±0.041)mm(t = 3.95,P = 0.004)。左下颌第一磨牙咬合面的平均偏差分别为(0.144±0.084)和(0.100±0.096)mm(t = 0.84,P = 0.036)。轻、重咬合力均对下颌运动轨迹有影响。利用重咬合力下的下颌运动轨迹对修复体进行虚拟咬合预调整可获得更接近预备前天然牙舌面或咬合面的形态。