【作者】 王欢；

【导师】 伍军；

【作者基本信息】 南昌大学 ， 口腔医学（专业学位）， 2025， 硕士

【摘要】 目的:比较CBCT上颌骨重叠法与上颌数字化模型腭部区域重叠法在评估青少年非拔牙矫治患者上颌牙齿三维移动中的差异,为临床提供一定参考。方法:按纳排标准选取南昌大学附属口腔医院正畸科采用非拔牙矫治的青少年患者30例(年龄10-14岁,平均年龄12.5±1.3岁),收集患者治疗前、后的锥形束计算机断层扫描(cone beam computed tomography,CBCT)和上颌数字化模型(maxillary digital model,MDM)数据。将治疗前、后的CBCT数据导入Amira 3D软件,以硬腭区域为重叠区域,进行CBCT上颌骨体素重叠,将重叠后的CBCT数据三维重建为pre-CBCT表面模型和post-CBCT表面模型,组装为M1模型。将M1模型、治疗前上颌数字化模型(pre-MDM)和治疗后上颌数字化模型(post A-MDM)导入Geomagic Wrap软件,以上颌牙列临床牙冠区域为重叠区域,将pre-CBCT表面模型与pre-MDM、post-CBCT表面模型与post A-MDM分别进行表面重叠,组装为M2模型。将M2模型与治疗后上颌数字化模型(post B-MDM)再次导入Geomagic Wrap软件,以第三腭皱襞内侧2/3及其远中腭穹窿区域为重叠区域,将post B-MDM与M2模型中pre-MDM进行表面重叠,导出为包含pre-MDM、post A-MDM及post B-MDM的M3模型。将M3模型导入Blender软件,以pre-MDM为参考建立测量坐标系,分别测量基于CBCT上颌骨重叠法装配的post A-MDM和基于上颌数字化模型腭部区域重叠法装配的post B-MDM中上颌双侧中切牙、尖牙及第一磨牙的位置坐标(X、Y、Z)、轴倾角、转矩角以及模型倾斜角(R-YZ、R-XZ、R-XY)。间隔2周后,由本实验者和第二名实验者分别再次测量post A-MDM和post B-MDM中上颌双侧中切牙、尖牙及第一磨牙的位置坐标(X、Y、Z)。通过SPSS软件,统计分析post A-MDM和post B-MDM中上颌双侧中切牙、尖牙及第一磨牙的位置坐标(X、Y、Z)、轴倾角、转矩角以及模型倾斜角(R-YZ、R-XZ、R-XY)测量值的差异,并使用组内相关系数(intraclass correlation coefficient,ICC)检验两种三维影像重叠方法的可重复性。结果:1、在CBCT上颌骨重叠法与上颌数字化模型腭部区域重叠法的可重复性检验中,对于上颌双侧中切牙、尖牙及第一磨牙的位置坐标(X、Y、Z),实验者内和实验者间的ICC值均大于0.99(P<0.001)。2、对于上颌双侧中切牙、尖牙及第一磨牙位置坐标(X、Y、Z)、轴倾角、转矩角以及模型倾斜角(R-YZ、R-XZ、R-XY),CBCT上颌骨重叠法与上颌数字化模型腭部区域重叠法测量值的差异均无统计学意义(P>0.05)。结论:CBCT上颌骨重叠法与上颌数字化模型腭部区域重叠法用于评估青少年非拔牙矫治患者上颌牙齿三维移动的效果无显著差异,且两种三维影像重叠方法的可重复性均极高。更多还原

【Abstract】 Objective:This study aims to compare CBCT maxillary superimposition and palatal superimposition of maxillary digital model in evaluating three-dimensional tooth movement of the maxillary dentition in non-extraction orthodontic adolescent patients,thereby providing some referencre for clinical practice.Method:Following the inclusion and exclusion criteria,30 adolescent patients(aged10-14 years,mean age 12.5±1.3 years)undergoing non-extraction orthodontic treatment at the Orthodontic Department of Affiliated Stomatological Hospital of Nanchang University,were selected.Pre-treatment and post-treatment cone beam computed tomography(CBCT)and maxillary digital model(MDM)data were acquired.The pre-treatment CBCT and post-treatment CBCT data were imported into Amira 3D software for voxel-based maxillary superimposition using the hard palate as the reference region.Then,the superimposed CBCT data were three-dimensionally reconstructed into pre-CBCT surface models and post-CBCT surface models,which were assembled into the M1 model.The M1 model and pre-treatment maxillary digital models(pre-MDM)and post-treatment maxillary digital models(post A-MDM)were imported into Geomagic Wrap software,where surface superimposition was performed between the pre-CBCT surface model and pre-MDM,as well as between the post-CBCT surface model and post A-MDM,using the clinical crown region of the maxillary dentition as the reference area.The resulting overlapped datasets were then assembled into the M2 model.The M2model and the post-treatment maxillary digital model(post B-MDM)were re-imported into Geomagic Wrap software.Surface superimposition was performed between post B-MDM and the pre-MDM within the M2 model,using the medial 2/3of the third palatal rugae and the distal palatal vault region as the reference area.The resulting overlapped dataset was exported as the M3 model,incorporating pre-MDM,post A-MDM,and post B-MDM.The M3 model was then imported into Blender software,where a measurement coordinate system was established with pre-MDM as the reference.Three-dimensional coordinates(X,Y,Z),tip,torque of maxillary bilateral central incisors,canines,first molars,and model inclination angle(R-YZ,R-XZ,R-XY)were measured for both post A-MDM based on CBCT maxillary superimposition and post B-MDM based on palatal superimposition of maxillary digital model.After two weeks interval,the measurement of three-dimensional coordinates(X,Y,Z)of maxillary bilateral central incisors,canines,first molars for post A-MDM and post B-MDM were independently repeated by the principal examiner and a second examiner.SPSS was used to statistically analyze differences in the three-dimensional coordinates(X,Y,Z),tip,torque of maxillary bilateral central incisors,canines,first molars,and model inclination angle(R-YZ,R-XZ,R-XY)between post A-MDM and post B-MDM.The intraclass correlation coefficient(ICC)was used to assess the reproducibility of the two three-dimensional image superimposition methods.Result:1.In the reproducibility assessment of CBCT maxillary superimposition and palatal superimposition of maxillary digital model,the intra-examiner and inter-examiner ICC values for the three-dimensional coordinates(X,Y,Z)of maxillary bilateral central incisors,canines,and first molars all exceeded 0.99(P<0.001).2.There were no statistically significant differences between CBCT maxillary superimposition and palatal superimposition of maxillary digital model in measuring the three-dimensional coordinates(X,Y,Z),tip,torque of maxillary bilateral central incisors,canines,first molars,and model inclination angle(R-YZ,R-XZ,R-XY)(P>0.05).Conclusion:CBCT maxillary superimposition and palatal superimposition of maxillary digital model showed no significant differences in evaluating three-dimensional movement of maxillary teeth in adolescent non-extraction orthodontic patients.Additionally,both three-dimensional image superimposition methods demonstrating excellent reproducibility.更多还原