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一种使用锥形束计算机断层扫描（CBCT）和3D打印技术诊断和治疗下颌侧切牙罕见舌侧窝内陷病例的新方法。

A Novel Diagnostic and Treatment Approach to an Unusual Case of Dens Invaginatus in a Mandibular Lateral Incisor Using CBCT and 3D Printing Technology.

作者信息

LaLonde Lindsey, Askar Mazin, Paurazas Susan

机构信息

Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA.

出版信息

Dent J (Basel). 2024 Apr 13;12(4):107. doi: 10.3390/dj12040107.

DOI:10.3390/dj12040107
PMID:38668019
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11048744/
Abstract

BACKGROUND

This case report demonstrates the use of three-dimensional (3D) models produced from a cone beam computed tomographic (CBCT) volume to develop a treatment strategy for a rare type of dens invaginatus (DI) in a mandibular incisor.

METHODS

A patient with DI Type IIIa presented for endodontic treatment. Following CBCT evaluation, the complex morphologic nature of the invagination required additional diagnostic tools for treatment planning. The fabrication of 3D models provided clarity regarding the treatment strategy. Treatment involved intracanal medication with calcium hydroxide Ca(OH), nonsurgical root canal therapy (NS-RCT) of the main canal, and endodontic surgery for the DI anomaly using mineral trioxide aggregate (MTA), bone graft, and platelet-rich fibrin (PRF) membrane.

RESULTS

The use of 3D models provided an invaluable guide for proper treatment. Complicating factors were diagnosed and planned for accordingly.

CONCLUSIONS

It is difficult to appreciate the anatomical complexity, the extent, and the nature of the invagination of rare Type III DI morphology. CBCT imaging and 3D models played a critical role in the pre-treatment planning to ensure a predictable outcome. A 3D model is recommended as a diagnostic tool in treating complex cases where the DI morphology is wide, oblique, or the foraminal opening is irregular.

摘要

背景

本病例报告展示了利用锥形束计算机断层扫描（CBCT）容积数据生成的三维（3D）模型，为下颌切牙罕见类型的牙内陷（DI）制定治疗策略。

方法

一名IIIa型牙内陷患者前来接受牙髓治疗。经CBCT评估后，牙内陷复杂的形态需要额外的诊断工具来进行治疗规划。3D模型的制作使治疗策略更加清晰。治疗包括根管内使用氢氧化钙（Ca(OH)）、主根管的非手术根管治疗（NS-RCT），以及使用三氧化矿物凝聚体（MTA）、骨移植和富血小板纤维蛋白（PRF）膜对牙内陷异常进行牙髓手术。

结果

3D模型的使用为恰当的治疗提供了宝贵的指导。对复杂因素进行了诊断并相应地制定了计划。

结论

罕见的III型牙内陷形态的牙内陷的解剖复杂性、范围和性质难以识别。CBCT成像和3D模型在治疗前规划中发挥了关键作用，以确保可预测的结果。对于牙内陷形态广泛、倾斜或孔口不规则的复杂病例，建议将3D模型作为诊断工具。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/d8f819c48847/dentistry-12-00107-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/2ccb5986cb89/dentistry-12-00107-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/621c9ded3aac/dentistry-12-00107-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/1d14a95cbbe1/dentistry-12-00107-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/3162718ed428/dentistry-12-00107-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/c13ba27ba613/dentistry-12-00107-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/47a5f57c5d85/dentistry-12-00107-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/d76b28dbf2c6/dentistry-12-00107-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/18ce2c326af7/dentistry-12-00107-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/d8f819c48847/dentistry-12-00107-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/2ccb5986cb89/dentistry-12-00107-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/621c9ded3aac/dentistry-12-00107-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/1d14a95cbbe1/dentistry-12-00107-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/3162718ed428/dentistry-12-00107-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/c13ba27ba613/dentistry-12-00107-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/47a5f57c5d85/dentistry-12-00107-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/d76b28dbf2c6/dentistry-12-00107-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/18ce2c326af7/dentistry-12-00107-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93d6/11048744/d8f819c48847/dentistry-12-00107-g009.jpg

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Int J Environ Res Public Health. 2022 Jun 29;19(13):7966. doi: 10.3390/ijerph19137966.
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A Novel Approach to Repositioning and Stabilization of a Luxated Tooth With Displacement Using a 3D Printed Guide.一种使用 3D 打印导板重新定位和稳定脱位牙的新方法。
J Endod. 2022 Jul;48(7):936-942. doi: 10.1016/j.joen.2022.03.014. Epub 2022 Apr 8.
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Outcome Assessment of Teeth with Necrotic Pulps and Apical Periodontitis Treated with Long-term Calcium Hydroxide.
长期氢氧化钙治疗牙髓坏死和根尖周炎的疗效评估。
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Unusual Location of Dens Invaginatus Causing a Difficult-to-Diagnose Pulpal Involvement.畸形中央尖导致牙髓病变位置异常，诊断困难。
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Treatment of peri-invagination lesion and vitality preservation in an immature type III dens invaginatus: a case report.治疗未完全萌出牙型 III 度齿内陷的围囊内病变和保存活力：一例报告。
BMC Oral Health. 2020 Jan 30;20(1):29. doi: 10.1186/s12903-020-1008-x.
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Successful management of a case of true radicular dens invaginatus using platelet-rich fibrin and guided tissue regeneration.使用富血小板纤维蛋白和引导组织再生技术成功治疗一例真性根侧内陷病例。
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