Dr Andrew Ip

Andrew Ip博士

Mon. 26. August 2024

周一。2024年8月26日

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The digitisation of dentistry has unlocked many potential applications in modern clinical and technical practice. 3D printing is becoming an increasingly popular and effective part of that equation. Gone are the days where it seemed like you needed a PhD to operate a 3D printer. Chairside dental 3D printing has become extremely cost-effective and simple to learn, and there are many dentistry-specific systems known to be highly consistent, accurate, precise and reliable..

牙科的数字化已经在现代临床和技术实践中释放了许多潜在的应用。3D打印正在成为这一等式中越来越受欢迎和有效的一部分。似乎需要博士学位才能操作3D打印机的日子一去不复返了。椅旁牙科3D打印已变得非常经济高效且易于学习，并且已知许多牙科专用系统具有高度一致性，准确性，精确性和可靠性。。

Dental technology has allowed us to create excellent provisional restorations, cost-effective dentures, same-day or even same-appointment night guards, and more! However, the beauty of 3D printing is that applications are only limited by your imagination, restrictions in design software and the materials currently available on the market.

牙科技术使我们能够创建出色的临时修复体、经济高效的假牙、同一天甚至同一预约的夜班警卫等等！然而，3D打印的美妙之处在于，应用程序仅受您的想象力、设计软件的限制以及目前市场上可用的材料的限制。

It gives the clinician and technician the opportunity to let their creativity run rampant, all while improving the patient experience. In this case report, I will share how CAD software and CAM hardware can create a predictable and innovative provisional implant restoration which satisfies not only the patient but also the clinician and dental designer–technician..

它让临床医生和技术人员有机会发挥创造力，同时改善患者体验。在本案例报告中，我将分享CAD软件和CAM硬件如何创建可预测和创新的临时种植修复体，不仅满足患者，而且满足临床医生和牙科设计师-技师的要求。。

Initial situation

“The beauty of 3D printing is that applications are only limited by your imagination.”

“3D打印的美妙之处在于，应用程序只受你的想象力的限制。”

A male patient presented in our dental office with a severely broken maxillary right first premolar (tooth #14) that had been designated for extraction a number of years before. The tooth immediately distal (tooth #15) was also in need of substantial dental treatment (Figs. 1 & 2). The patient had hypertension that was controlled with anti-hypertensive medication, but was otherwise medically fit.

。紧邻远端的牙齿（牙齿#15）也需要大量的牙齿治疗（图1和2）。该患者患有通过抗高血压药物控制的高血压，但在其他方面身体健康。

He intended to have the colour of his anterior teeth improved, but wished to address the issues on his maxillary right side first..

他打算改善前牙的颜色，但希望先解决上颌骨右侧的问题。。

Tooth #14 was deemed unrestorable, and so it was decided to extract the tooth (Figs. 3 & 4), wait for bony healing and replace it with an implant with a provisional restoration. During the healing process, endodontic therapy would be performed on tooth #15. After bony integration, implant #14 would be restored with a screw-retained direct-to-implant zirconia crown, and tooth #15 would also be restored with a complete zirconia crown.

牙齿#14被认为是不可修复的，因此决定拔除牙齿（图3和4），等待骨愈合，并用临时修复的植入物替代。。在骨整合后，植入物#14将用直接保留的螺钉修复以植入氧化锆冠，并且牙齿#15也将用完整的氧化锆冠修复。

A deliberately lighter shade would be chosen, factoring in the patient’s long-term desire to improve the colour of his teeth..

考虑到患者改善牙齿颜色的长期愿望，将选择故意较浅的色调。。

Fig. 2: Pre-op situation, showing the maxillary right first premolar with a poor restorative prognosis.

图2：术前情况，显示上颌右第一前磨牙的修复预后较差。

Fig. 3: Initial periapical radiograph.

图3：初始根尖周X光片。

Fig. 4: Post-extraction site.

图4：提取后部位。

Fig. 5: Surgical guide design on 3Shape Implant Studio.

图5:3Shape Implant Studio上的手术指南设计。

Implant planning

植入计划

Two months after tooth #14 had been extracted, a CBCT scan (GO, NewTom) and intra-oral scan (Medit i700 wireless) were performed, and the two data sets were merged on 3Shape Implant Studio in order to plan the patient’s case (Fig. 5). The use of surgical guides has been shown to enhance accuracy and precision for many users.1.

拔牙后两个月，进行CBCT扫描（GO，NewTom）和口内扫描（Medit i700 wireless），并将两个数据集合并到3Shape Implant Studio上，以计划患者的情况（图5）。手术指南的使用已被证明可以提高许多用户的准确性和精确度。

A tissue-level matrix implant (4.1 × 8.0 mm; TRI Dental Implants) was digitally positioned in order to design the surgical guide, based on parameters already preloaded on the extensive 3Shape Implant Studio library. A pilot guide was designed in this case, as it has been shown to produce similarly accurate results in comparison with fully guided systems.2 The surgical guide was printed out of V-Print SG (VOCO) on the MAX UV (Asiga) in 50 μm layers and was autoclaved after complete processing..

根据广泛的3Shape implant Studio库中已经预装的参数，对组织级基质植入物（4.1×8.0 mm；TRI-Dental Implants）进行数字定位，以设计手术指南。在这种情况下，设计了一个试验指南，因为与全引导系统相比，它可以产生类似的准确结果。2手术指南是在MAX UV（Asiga）上以50μm的层用V-Print SG（VOCO）打印出来的，并在完成处理后进行高压灭菌。。

Provisional restoration design

临时修复设计

Based on the implant plan, a two-piece provisional restoration was designed using the same software (Figs. 6 & 7). The abutment portion would be printed in a clear splint material (KeySplint Hard, Keystone Industries) and highly polished for optimum transparency. This would allow for visibility of the healing process.

根据植入计划，使用相同的软件设计了两件式临时修复体（图6和7）。基台部分将采用透明夹板材料（KeySplint Hard，Keystone Industries）印刷，并进行高度抛光以获得最佳透明度。这将允许愈合过程的可见性。

To reduce the amount of polishing required, the abutment would be printed in 50 μm layers to diminish the appearance of the layers and using the UltraGLOSS material tray (Asiga; Fig. 8)..

为了减少所需的抛光量，桥台将印刷成50μm的层，以减少层的外观，并使用超高光材料托盘（Asiga；图8）。。

Fig. 6: Provisional restoration design on 3Shape Implant Studio.

图6:3Shape Implant Studio的临时修复设计。

Fig. 7: Abutment design on 3Shape Implant Studio.

。

Fig. 8: Printing the temporary abutments out of KeySplint Hard on the MAX UV using the UltraGLOSS material tray.

图8：使用UltraGLOSS材料托盘在MAX UV上打印临时基台。

Fig. 9: Veneer, facial aspect.

图9：贴面，面部外观。

Fig. 10: Veneer, fitting surface.

图10：贴面，配合面。

Fig. 11: Veneers nested and supported on Composer 2.0 (Asiga).

图11：在Composer 2.0（Asiga）上嵌套和支撑的单板。

A separate facial veneer would be bonded to this abutment and would be printed in a restorative resin (saremco print CROWNTEC, SAREMCO Dental) to satisfy the aesthetic concerns of the patient. Two retentive slots would be incorporated into the abutment and veneer to ensure proper fixation during the bonding process (Figs. 9–11).

将单独的面部贴面粘合到该基台上，并将其印刷在修复性树脂（saremco print CROWNTEC，saremco Dental）中，以满足患者的美学需求。两个固位槽将被纳入基台和贴面中，以确保在粘合过程中正确固定（图9-11）。

Prior to final polymerisation in the Otoflash G171 (two 2,000 flashes; NK-Optik), the two pieces would be bonded together using the splint resin as a cementing agent (Figs. 12–14)..

在Otoflash G171（两个2000 flash；NK Optik）中进行最终聚合之前，将使用夹板树脂作为粘合剂将两片粘合在一起（图12-14）。。

Fig. 12: Abutments printed.

图12：打印的桥台。

Fig. 13: Veneers printed.

图13：印刷的单板。

Fig. 14: AI3D–Dentiq provisional restorations assembled and fully processed.

图14:AI3D–Dentiq临时修复体组装并完全处理。

Implant placement and provisionalisation

种植体植入和临时化

The fit of the surgical guide was confirmed, and the patient was anaesthetised locally (Fig. 15). A small full-thickness flap was raised, and a guided osteotomy was performed. The implant was inserted to a 45 N cm torque. The prefabricated two-piece provisional restoration was torqued in to 15 N cm and was confirmed to be out of occlusion.

确认了手术指南的适合性，并对患者进行了局部麻醉（图15）。抬起一个小的全层皮瓣，并进行引导截骨术。植入物以45 N cm的扭矩插入。将预制的两件式临时修复体扭转至15 N cm，并确认其已脱离咬合。

Two 4-0 PROLENE sutures (Ethicon) were used to close the flap (Figs. 16–19)..

使用两条4-0 PROLENE缝线（Ethicon）闭合皮瓣（图16-19）。。

Endodontic therapy was commenced on tooth #15 in the meantime. The sutures were removed 14 days later, and the patient reported uneventful postoperative healing at this stage.

同时在15号牙齿上开始牙髓治疗。缝合线在14天后被移除，患者报告在此阶段术后愈合顺利。

Fig. 15: Surgical guide in situ.

。

Fig. 16: Guided osteotomy.

图16：引导截骨术。

Fig. 17: Provisional restoration in place after implant placement.

图17：植入后的临时修复。

Fig. 18: Post-op situation.

图18：术后情况。

Fig. 19: Post-op situation, occlusal aspect.

图19：术后情况，咬合方面。

Fig. 20: Situation after four months of healing.

图20：愈合四个月后的情况。

Fig. 21: Situation after removal of the provisional restoration.

图21：拆除临时修复后的情况。

Fig. 22: Zirconia crowns in situ.

图22：原位氧化锆冠。

Fig. 23: Zirconia crowns in situ, occlusal aspect.

图23：原位氧化锆冠，咬合方面。

Fig. 24: Final periapical radiograph, showing the good fit and no excess cement.

图24：最终的根尖周X光片，显示出良好的配合，没有多余的水泥。

Figs. 25a–f: Situation at each step of treatment.

图25a–f：治疗每个步骤的情况。

Implant and tooth restoration

种植体和牙齿修复

A waiting period of four months allowed adequate osseointegration of the implant (Fig. 20). The endodontic treatment of tooth #15 had been completed in the meantime, and the tooth had been prepared for a complete zirconia crown. Removal of the implant provisional restoration revealed a natural soft-tissue profile and an improved soft-tissue contour without the need for additional soft- or hard-tissue augmentation (Fig. 21)..

四个月的等待期允许植入物充分的骨整合（图20）。同时完成了牙齿#15的牙髓治疗，牙齿已经准备好了完整的氧化锆冠。移除种植体临时修复体显示出自然的软组织轮廓和改善的软组织轮廓，而不需要额外的软组织或硬组织增强（图21）。。

Secondary impression was taken digitally with an intra-oral scanner and the relevant scan body. Definitive restorations were designed on exocad and milled in-house on CRAFT 5X (DOF) out of EVEREST Multilayer AT zirconia (Shade A3; UNC International). A deliberately lighter shade was chosen by the patient, as he intended to have the appearance of his other maxillary teeth improved.

用口内扫描仪和相关扫描体以数字方式拍摄二次印象。最终的修复体是在exocad上设计的，并在氧化锆（Shade A3；UNC International）的珠穆朗玛峰多层膜的CRAFT 5X（DOF）上进行内部研磨。。

The implant crown was torqued in to 35 N cm, and the crown was cemented to tooth #15 using G-CEM ONE cement (GC Dental; Figs. 22–24)..

将种植体牙冠扭转至35 N cm，并使用G-CEM ONE水泥（GC Dental；图22-24）将牙冠粘合到牙齿#15上。。

Conclusion

结论

Digital dentistry and novel techniques can help produce excellent and effective results. Improvements in the software and physical workflow have meant that the clinician’s and the technician’s work are not only more streamlined and straightforward but also enjoyable (Fig. 25). A more-than-satisfactory outcome was achieved for the patient.

数字牙科和新技术可以帮助产生出色而有效的结果。软件和物理工作流程的改进意味着临床医生和技术人员的工作不仅更加简化和直接，而且令人愉快（图25）。患者取得了非常令人满意的结果。

What made all this possible was the novel and innovative tissue-level matrix implant connection, which lacks any sharp corners or edges, allowing for direct-to-implant milled and printed restorations. Overall, 3D printing and software can unlock numerous applications to improve not only the patient outcomes but also the operator experience.

使这一切成为可能的是新颖而创新的组织水平基质-种植体连接，它没有任何尖角或边缘，可以直接植入铣削和印刷的修复体。。

It will be truly exciting to see the innovations that lie ahead..

看到未来的创新真的很令人兴奋。。

Acknowledgements

致谢

I would like to acknowledge Jeroen Klijnsma of Dentiq Dental Services for the implant planning and surgical guide design.

我要感谢Dentiq牙科服务公司的Jeroen Klijnsma在植入物规划和手术指南设计方面的贡献。

Editorial note:

编辑注释：

This article was published in 3D printing–international magazine of dental printing technology, No. 1, 2024.

这篇文章发表在3D打印-国际牙科打印技术杂志，2024年第1期。

References

参考文献

Scherer U, Stoetzer M, Ruecker M, Gellrich NC, von See C. Template-guided vs. non-guided drilling in site preparation of dental implants. Clin Oral Investig. 2015 Jul;19(6):1339–46. doi: 10.1007/s00784-014-1346-7.

Scherer U，Stoetzer M，Ruecker M，Gellrich NC，von See C.牙种植体现场准备中的模板引导与非引导钻孔。临床口腔调查。2015年7月；19（6）：1339-46。doi:10.1007/s00784-014-1346-7。

Kühl S, Zürcher S, Mahid T, Müller-Gerbl M, Filippi A, Cattin P. Accuracy of full guided vs. half-guided implant surgery. Clin Oral Implants Res. 2013 Jul;24(7):763–9. doi: 10.1111/j.1600-0501.2012.02484.x.

Kühl S，Zürcher S，Mahid T，Müller-Gerbl M，Filippi A，Cattin P.全引导与半引导种植手术的准确性。Clin Oral Implants Res.2013年7月；24（7）：763-9。doi:10.1111/j.1600-0501.2012.02484.x。

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Thu. 5 September 202411:00 am EST (New York)

星期四。202411年9月5日美国东部时间上午11:00（纽约）

Exploring future opportunities of dental treatment planning driven by AI

探索人工智能驱动的牙科治疗计划的未来机会

Dr. Alex Sanders

Alex Sanders博士

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Sat. 7 September 2024 3:00 am EST (New York)

2024年9月7日星期六美国东部时间凌晨3:00（纽约）

WATERLASE AESTHETIC CROWN LENGTHENING. STEP-BY-STEP GUIDE/ اطالة التاج التجميلي باستخدام الليزر المائي. خطوة بخطوة

Waterlase Aesthetic Crown Lengthening。STEP-BY-STEP GUIDE/使用水激光延长化妆品冠。一步一步

Dr. Salah Almethin DDS, Ms.

错了，阿尔梅辛博士，女士。

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