Name: guided endodontics: three-dimensional planning and template-aided preparation of endodontic access cavities
Uploaded: 2022-05-24T14:00:00
Description: Watch this Scientific Journal Video about Guided Endodontics: Three-Dimensional Planning and Template-Aided Preparation of Endodontic Access Cavities at JoVE.com

进行这项研究不需要批准或同意，因为患者数据的使用不适用。在这项研究中，使用了来自上颌骨模型的DICOM数据，该模型由提取的，去识别的人牙组成。由于与本研究无关的原因，拔牙。
1. 虚拟接入腔规划
<ol><li>启动数字规划程序。</li>
	<li>右键单击 专家 以选择高级模式。</li>
	<li>右键单击“ 新建 ”以打开新案例。</li>
	<li>选择包含...

<ol>
	<li>Andreasen, F. M., Zhijie, Y., Thomsen, B. L., Andersen, P. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Occurrence+of+pulp+canal+obliteration+after+luxation+injuries+in+the+permanent+dentition.">Occurrence of pulp canal obliteration after luxation injuries in the permanent dentition.</a> Endodontics &amp; Dental Traumatology. 3 (3), 103-115 (1987).</li><li>Fleig, S., Attin, T., Jungbluth, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Narrowing+of+the+radicular+pulp+space+in+coronally+restored+teeth.">Narrowing of the radicular pulp space in coronally restored teeth.</a> Clinical Oral Investigation. 21 (4), 1251-1257 (2016).</li><li>Linu, S., Lekshmi, M. S., Varunkumar, V. S., Sam Joseph, V. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+outcome+following+direct+pulp+capping+using+bioceramic+materials+in+mature+permanent+teeth+with+carious+exposure:+A+pilot+retrospective+study.">Treatment outcome following direct pulp capping using bioceramic materials in mature permanent teeth with carious exposure: A pilot retrospective study.</a> Journal of Endodontics. 43 (10), 1635-1639 (2017).</li><li>Robertson, A., Andreasen, F. M., Bergenholtz, G., Andreasen, J. O., Noren, J. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+of+pulp+necrosis+subsequent+to+pulp+canal+obliteration+from+trauma+of+permanent+incisors.">Incidence of pulp necrosis subsequent to pulp canal obliteration from trauma of permanent incisors.</a> Journal of Endodontics. 22 (10), 557-560 (1996).</li><li>Kiefner, P., Connert, T., ElAyouti, A., Weiger, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+calcified+root+canals+in+elderly+people:+a+clinical+study+about+the+accessibility,+the+time+needed+and+the+outcome+with+a+three-year+follow-up.">Treatment of calcified root canals in elderly people: a clinical study about the accessibility, the time needed and the outcome with a three-year follow-up.</a> Gerodontology. 34 (2), 164-170 (2017).</li><li>Cvek, M., Granath, L., Lundberg, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Failures+and+healing+in+endodontically+treated+non-vital+anterior+teeth+with+posttraumatically+reduced+pulpal+lumen.">Failures and healing in endodontically treated non-vital anterior teeth with posttraumatically reduced pulpal lumen.</a> Acta Odontologica Scandinavica. 40 (4), 223-228 (1982).</li><li>Zehnder, M. S., Connert, T., Weiger, R., Krastl, G., Kuhl, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guided+endodontics:+accuracy+of+a+novel+method+for+guided+access+cavity+preparation+and+root+canal+location.">Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location.</a> International Endodontic Journal. 49 (10), 966-972 (2016).</li><li>Moreno-Rabi&#233;, C., Torres, A., Lambrechts, P., Jacobs, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+applications,+accuracy+and+limitations+of+guided+endodontics:+a+systematic+review.">Clinical applications, accuracy and limitations of guided endodontics: a systematic review.</a> International Endodontic Journal. 53 (2), 214-231 (2020).</li><li>Buchgreitz, J., Buchgreitz, M., Bj&#248;rndal, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guided+root+canal+preparation+using+cone+beam+computed+tomography+and+optical+surface+scans+-+an+observational+study+of+pulp+space+obliteration+and+drill+path+depth+in+50+patients.">Guided root canal preparation using cone beam computed tomography and optical surface scans - an observational study of pulp space obliteration and drill path depth in 50 patients.</a> International Endodontic Journal. 52 (5), 559-568 (2019).</li><li>Dula, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=SADMFR+guidelines+for+the+use+of+cone-beam+computed+tomography/+digital+volume+tomography.">SADMFR guidelines for the use of cone-beam computed tomography/ digital volume tomography.</a> Swiss Dental Journal. 124 (11), 1169-1183 (2014).</li><li>Ender, A., Zimmermann, M., Mehl, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+of+complete-+and+partial-arch+impressions+of+actual+intraoral+scanning+systems+in+vitro.">Accuracy of complete- and partial-arch impressions of actual intraoral scanning systems in vitro.</a> International Journal of Computerized Dentistry. 22 (1), 11-19 (2019).</li><li>Krug, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guided+endodontics:+a+comparative+in+vitro+study+on+the+accuracy+and+effort+of+two+different+planning+workflows.">Guided endodontics: a comparative in vitro study on the accuracy and effort of two different planning workflows.</a> International Journal of Computerized Dentistry. 23 (2), 119-128 (2020).</li><li>Chen, L., Lin, W. S., Polido, W. D., Eckert, G. J., Morton, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy,+reproducibility,+and+dimensional+stability+of+additively+manufactured+surgical+templates.">Accuracy, reproducibility, and dimensional stability of additively manufactured surgical templates.</a> The Journal of Prosthetic Dentistry. 122 (3), (2019).</li><li>Tahir, N., Abduo, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+in+vitro+evaluation+of+the+effect+of+3D+printing+orientation+on+the+accuracy+of+implant+surgical+templates+fabricated+by+desktop+printer.">An in vitro evaluation of the effect of 3D printing orientation on the accuracy of implant surgical templates fabricated by desktop printer.</a> Journal of Prosthodontics. , (2022).</li><li>Torres, A., Lerut, K., Lambrechts, P., Jacobs, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guided+endodontics:+Use+of+a+sleeveless+guide+system+on+an+upper+premolar+with+pulp+canal+obliteration+and+apical+periodontitis.">Guided endodontics: Use of a sleeveless guide system on an upper premolar with pulp canal obliteration and apical periodontitis.</a> Journal of Endodontics. 47 (1), 133-139 (2021).</li><li>Dong, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+of+in+vitro+mandibular+volumetric+measurements+from+CBCT+of+different+voxel+sizes+with+different+segmentation+threshold+settings.">Accuracy of in vitro mandibular volumetric measurements from CBCT of different voxel sizes with different segmentation threshold settings.</a> BMC Oral Health. 19 (1), 206 (2019).</li><li>Oh, S. -. M., Lee, D. -. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+the+accuracy+of+postoperative+analysis+methods+for+locating+the+actual+position+of+implants:+An+in+vitro+study.">Validation of the accuracy of postoperative analysis methods for locating the actual position of implants: An in vitro study.</a> Applied Sciences. 10 (20), 7266 (2020).</li><li>Connert, T., Weiger, R., Krastl, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Present+status+and+future+directions+-+Guided+endodontics.">Present status and future directions - Guided endodontics.</a> International Endodontic Journal. , (2022).</li></ol>

模板辅助通路腔制剂在牙髓病学中的引入，为PCO牙齿的非手术牙髓治疗带来了巨大的进步。传统的通路腔准备可能非常耗时5 ，并且在严重PCO的情况下容易出错。 体外 研究和临床病例报告证明了引导牙髓病学方法的可行性，在根管检测方面产生了令人满意的结果，并且计划和执行的通路腔之间的总体偏差较低8。然而，引导牙髓病的实施应仅限于传统的?...

牙髓管闭塞 （PCO） 是重要牙髓的体征，通常在牙齿创伤1 后观察到，或作为对龋齿、修复手术2 或重要牙髓治疗3 等刺激的反应。当没有临床或影像学病理体征时，不需要根管治疗。然而，从长远来看，剩余的牙髓组织可能会发展为病理4。在存在牙髓或根尖病变的临床或影像学体征的情况下，非手术根管治疗将是牙齿保护的首选治疗方法。 
为了获得根管治疗的成功结果，准备足够的通路腔至关重要。需要根管治疗的PCO牙齿很难治疗，即使对于专门从事牙髓学领域的牙医也是如此5。试图定位钙化的根管可能会导致牙齿结构的大量损失，从而削弱甚至穿孔。这降低了牙齿的预后，并且可能需要拔牙6。
由于基于模板的（静态）导航已经成功地用于口腔种植学，因此几年前在文献中首次描述了其在牙髓病学中的应用7。从那时起，许多病例报告和研究已经证明了模板辅助牙髓通路腔准备在PCO8，9病例中的益处。 
这项工作的目的是介绍使用引导牙髓病学引导入路腔准备的技术。出于研究目的，在术后CBCT扫描后可以进行治疗评估（确定计划和执行的通路腔之间的角度和空间偏差），本文也将对此进行介绍。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Accuitomo 170</td>
			<td>Morita Manufacturing</td>
			<td>NA</td>
			<td>CBCT machine</td>
		</tr>
		<tr>
			<td>coDiagnostiX</td>
			<td>Dental Wings Inc</td>
			<td>Version 10.4</td>
			<td>Planning software, which is mainly intended for implant surgery. Endodontic access cavities can be planned by adding the utlized bur to the implant database</td>
		</tr>
		<tr>
			<td>Endoseal drill</td>
			<td>Atec Dental GmbH</td>
			<td>NA</td>
			<td>Carbide bur, which is used for the guided access cavity preparation</td>
		</tr>
		<tr>
			<td>StecoGuide Endo-Sleeve</td>
			<td>steco-system-technik</td>
			<td>REF M.27.28.D100L5</td>
			<td>Sleeves, which are inserted into the fabricated template</td>
		</tr>
		<tr>
			<td>TRIOS 3</td>
			<td>3Shape A/S</td>
			<td>NA</td>
			<td>Surface scanner</td>
		</tr>
		<tr>
			<td>P30</td>
			<td>Straumann</td>
			<td>NA</td>
			<td>3D Printer</td>
		</tr>
		<tr>
			<td>P pro Surgical Guide Clear</td>
			<td>Straumann</td>
			<td>NA</td>
			<td>Light-curing resin for the additive manufacturing</td>
		</tr>
	</tbody>
</table>

guided endodontics: three-dimensional planning and template-aided preparation of endodontic access cavities

牙髓管闭塞（PCO）通常是牙齿创伤的结果，例如脱位损伤。即使牙本质叠加是重要牙髓的征兆，牙髓炎或根尖周炎也可能长期发展。根管治疗患有严重PCO和牙髓或根尖周病变的牙齿对于全科医生甚至设备齐全的牙髓专家来说都是具有挑战性的。为了确保检测钙化的根管并避免牙齿结构过度丧失或牙根穿孔，几年前引入了使用模板的静态导航（“引导牙髓学”）。一般工作流程包括使用锥形束计算机断层扫描 （CBCT） 的三维成像、数字表面扫描以及在规划软件中将两者叠加。接下来是通道腔的虚拟规划，并设计一个模板，将钻头引导到所需的目标点。为此，必须以钻头尖端到达钙化根管孔口的方式放置钻头的真实比例虚拟图像。一旦使用计算机辅助设计和计算机辅助制造（CAD / CAM）或3D打印机制造了模板，就可以在临床上进行导管腔的准备。出于研究目的，术后CBCT图像可用于量化所执行的通路腔的准确性。这项工作旨在介绍静态引导牙髓学技术从成像到临床实施。

图10A 显示了在模板辅助通路腔制备中颊管后，第一上颌磨牙中制备的牙髓通路腔的咬合视图。 图10B 显示了在准备腭和颊沟通路腔后插入三个牙髓手锉以确认根管检测成功。将术后CBCT数据与术前计划数据匹配后，虚拟钻头放置生成有关偏差的信息（图11A）。这里，角度偏差为 0.7°，钻头底部的 3D 偏差为 0.74 mm 3D 偏差，钻头尖端?...

Watch this Scientific Journal Video about Guided Endodontics: Three-Dimensional Planning and Template-Aided Preparation of Endodontic Access Cavities at JoVE.com

Guided Endodontics: Three-Dimensional Planning and Template-Aided Preparation of Endodontic Access Cavities

引导牙髓病学描述了一种用于入路腔准备的模板辅助方法。该过程需要锥形束计算机断层扫描和表面扫描以生成模板。内置的套筒将钻头引导至目标点。这允许在钙化牙齿中制备微创牙髓通路腔。

引导牙髓病学：牙髓通路腔的三维规划和模板辅助制备

Pulp canal obliterations (PCO) are often a consequence of dental trauma, such as luxation injuries. Even though dentin apposition is a sign of vital pulp, ...

具有严重弹出管钙化和根尖病变的牙齿可能非常难以常规治疗。模板引导访问准备是一种可靠的技术，可以保护牙齿。使用基于模板的方法进行多余的型腔制备是微创的，并且可以由经验不足的操作员完成访问。首先，启动数字规划程序。右键单击专家以选择高级模式。右键单击“新建”以打开一个新案例。选择包含 DICOM 图像数据的文件夹以将图像数据导入软件。如有必要，请调整霍恩斯菲尔德单位阈值以获得最佳可视化效果。单击“创建数据集”以完成数据导入。通过左键单击上颌骨或下颌骨来选择计划类型并命名计划。单击编辑分割以开始图像分割过程。通过左键单击左上角框中的轴向来选择轴视图。单击密度测量以测量周围非无线电组状态下的高无线电组齿面。计算两种密度之间的平均值。将下限阈值设置为确定的平均值。点击 3D 重建。使用泛滥填充工具分割牙列，并根据需要命名分割。通过单击关闭模块完成细分。通过选择“添加”来添加模型扫描，然后单击“对象”，然后单击“模型扫描”。 从数字表面扫描导入 STL 文件。 选择“与其他对象对齐”。选择执行的分段。在 3D 视图中选择三个不同的匹配点，用于数据集、分割和表面扫描中的地标配准。验证所有飞机上的注册是否正确并完成注册。将牙髓钻头导入植入物的数据库。添加植入物以计划根管的通道。将钻头和所需的角度定位到所需的深度，并在所有平面上进行验证。将相应的套筒添加到钻头中。 选择对象，然后单击添加，然后单击手术指南以根据需要设计模板。将模板导出为 STL 文件并使用 3D 打印机制造。检查模板在牙列上的贴合度。检查袖子在模板中的贴合度。在检修腔部位标记搪瓷。染料可以在毛刺的尖端使用。在通路腔部位去除牙釉质，而无需使用模板或牙髓钻。改用钻石钻头，直到牙本质暴露出来。将含有模板的套筒放在牙弓上。将钻头插入用于计划的手机中。在模板引导下进行通道腔准备。使用术前锥形束计算机断层扫描设置创建术后图像数据。开始新的案例规划。将图像数据模拟导入术前计划。单击编辑细分。将下限阈值设置为为术前数据计算的确定平均值。使用泛洪填充工具分割牙列。通过单击关闭模块完成细分。打开术前计划。选择“计划”，然后单击“治疗评估”。选择术后体积数据集。加载正确的术后数据集并选择生成的分割。通过选择三个不同的区域进行地标配准，对齐术前和术后锥形束计算机断层扫描数据。验证所有平原中的正确注册并完成注册。将虚拟牙髓钻头放在执行的通路腔准备方向上，并检查所有平面。在模板化通路腔制备中颊管插入三个牙髓内切后，第一上颌磨牙中制备的牙髓通路腔的咬合视图证实了在准备腭和颊远通腔后成功检测根管。将术后锥形束计算机断层扫描数据与术前计划数据相匹配后，虚拟钻头放置生成有关偏差的信息。这里的角度偏差是0.7度，钻头底部的3D偏差为0.74毫米，钻头尖端的3D偏差为0.87毫米。在此程序之后，可以启用内陷的牙髓治疗，去除手动三出口骨料或纤维柱。

Research

JoVE Journal

Medicine

Quantification of Breast Cancer Cell Invasiveness Using a Three-dimensional (3D) Model

Quantification of Breast Cancer Cell Invasiveness Using a Three-dimensional 3D Model

乳腺癌细胞侵袭定量使用三维（3D）模型

It is now well known that the cellular and tissue microenvironment are critical regulators influencing tumor initiation and progression. Moreover, the ...

科研

医学

Three-dimensional Co-culture Model for Tumor-stromal Interaction

对于肿瘤基质相互作用的三维共培养模式

Cancer progression (initiation, growth, invasion and metastasis) occurs through interactions between malignant cells and the surrounding tumor stromal ...

Three-Dimensional (3D) Tumor Spheroid Invasion Assay

Three-Dimensional 3D Tumor Spheroid Invasion Assay

三维（3D）肿瘤球体侵袭试验

Invasion of surrounding normal tissues is generally considered to be a key hallmark of malignant (as opposed to benign) tumors. For some cancers in ...

Three-dimensional Alginate-bead Culture of Human Pituitary Adenoma Cells

人垂体腺瘤细胞的三维海藻酸钠珠文化

A three-dimensional culture method is described in which primary pituitary adenoma cells are grown in alginate beads. Alginate is a polymer derived from ...

Radiation Planning Assistant - A Streamlined, Fully Automated Radiotherapy Treatment Planning System

放射规划助理-一个流线型的全自动放疗治疗计划系统

The Radiation Planning Assistant (RPA) is a system developed for the fully automated creation of radiotherapy treatment plans, including volume-modulated ...

Three-Dimensional Printing of a Complex Aortic Anomaly

复杂主动脉异常的三维打印

Complex congenital aortic anomalies include diverse types of malformations that may be clinically asymptomatic or present with respiratory or esophageal ...

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty (PVP)

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty PVP

三维打印指南模板辅助皮椎间盘（PVP）

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The ...

Three-Dimensional Collagen Matrix Scaffold Implantation as a Liver Regeneration Strategy

三维胶原基质支架植入作为肝脏再生策略

Liver diseases are the leading cause of death worldwide. Excessive alcohol consumption, a high-fat diet, and hepatitis C virus infection promote fibrosis, ...

Digital Hybrid Model Preparation for Virtual Planning of Reconstructive Dentoalveolar Surgical Procedures

用于重建牙槽外科手术虚拟规划的数字混合模型制备

Virtual, hybrid three-dimensional (3D) model acquisition is presented in this article, utilizing the sequence of radiographic image segmentation, spatial ...

Sample Preparation for Computed Tomography-based Three-dimensional Visualization of Murine Hind-limb Vessels

基于计算机断层扫描的小鼠后肢血管三维可视化的样品制备

Blood vessels are complex networks with tree-like structures, and vascular networks are essential for maintaining both circulation and maintaining organ ...