외상, 구강암, 선천적 요인 등에 의한 구강 결손시 음식물의 섭취, 흡입성 폐렴 방지, 안모 지지를 위하여 치과용 obturator가 제작된다. 그러나 기존의 전통적인 인상 채득 방법을 이용한 obturator제작 시, 제작 과정에서 술자와 환자, 기공사 모두 번거로운 과정을 거쳐야 하며, 환자는 악안면 보철 치료가 가능한 치과 보철 전문의가 있는 병원을 찾아 방문해야 하는 어려움이 있다. 그러나, 3D printing을 포함한 CAD-CAM 기술을 이용하면 비교적 간단하게 hollow obturator를 제작할 수 있고, 보철 전문의가 없는 지역에서도, 지역 치과의사와 멀리 떨어져 있는 보철 전문의 간의 협진을 통해 수월한 치료가 가능할 수 있다. 본 연구에서는 한국의 상악 구개 결손 환자들의 치료를 위해, 일본에서 obturator를 디자인하고 한국에서 3D printing하여 성공적으로 obturator를 제작하였고, 더불어 원격 치료의 가능성을 확인하였기에 보고하는 바이다.
외상, 구강암, 선천적 요인 등에 의한 구강 결손시 음식물의 섭취, 흡입성 폐렴 방지, 안모 지지를 위하여 치과용 obturator가 제작된다. 그러나 기존의 전통적인 인상 채득 방법을 이용한 obturator제작 시, 제작 과정에서 술자와 환자, 기공사 모두 번거로운 과정을 거쳐야 하며, 환자는 악안면 보철 치료가 가능한 치과 보철 전문의가 있는 병원을 찾아 방문해야 하는 어려움이 있다. 그러나, 3D printing을 포함한 CAD-CAM 기술을 이용하면 비교적 간단하게 hollow obturator를 제작할 수 있고, 보철 전문의가 없는 지역에서도, 지역 치과의사와 멀리 떨어져 있는 보철 전문의 간의 협진을 통해 수월한 치료가 가능할 수 있다. 본 연구에서는 한국의 상악 구개 결손 환자들의 치료를 위해, 일본에서 obturator를 디자인하고 한국에서 3D printing하여 성공적으로 obturator를 제작하였고, 더불어 원격 치료의 가능성을 확인하였기에 보고하는 바이다.
The use of an obturator prosthesis for patients with maxillary defects is a common treatment method to improve their oral function and achieve esthetic satisfaction. However, due to various difficulties and complexities, conventional methods for fabricating dental obturators continue to pose a chall...
The use of an obturator prosthesis for patients with maxillary defects is a common treatment method to improve their oral function and achieve esthetic satisfaction. However, due to various difficulties and complexities, conventional methods for fabricating dental obturators continue to pose a challenge for dentists and patients, as well as laboratory technicians. CAD-CAM technologies may make it simple to fabricate maxillofacial prostheses including hollow obturators, which could improve comfort for clinicians by reducing burdensome manipulations. In addition, patients without a specialist in their vicinity will be able to be treated via cooperation between a nearby general practitioner and a distant prosthodontist. The aim of this clinical report is to investigate the possibility of using digitally fabricated maxillofacial prostheses that can be designed in one location, and manufactured in another in clinical situations.
The use of an obturator prosthesis for patients with maxillary defects is a common treatment method to improve their oral function and achieve esthetic satisfaction. However, due to various difficulties and complexities, conventional methods for fabricating dental obturators continue to pose a challenge for dentists and patients, as well as laboratory technicians. CAD-CAM technologies may make it simple to fabricate maxillofacial prostheses including hollow obturators, which could improve comfort for clinicians by reducing burdensome manipulations. In addition, patients without a specialist in their vicinity will be able to be treated via cooperation between a nearby general practitioner and a distant prosthodontist. The aim of this clinical report is to investigate the possibility of using digitally fabricated maxillofacial prostheses that can be designed in one location, and manufactured in another in clinical situations.
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문제 정의
Design data were sent back to Korea to fabricate obturators, which were delivered to the patients. The purpose of this study is to explore the application of CAD-CAM technology in maxillofacial prosthetic treatment and to identify the possibilities of providing remote dental service via cooperation among distant clinicians.
제안 방법
In this clinical report, both patients’ maxillary defects were successfully restored with 3D printed obturators that were designed in Japan and fabricated in Korea. The obturators were fabricated successfully using a CAD-CAM process that can reduce the time-consuming and complex procedures and relatively simple manipulations.
The completed new obturator adjusted was delivered, patient’s comfort and esthetics as well as speech were evaluated (Figs 4B and 4C).
The patient’s jaw relationship and occlusal vertical dimension were registered using an occlusal wax rim. The maxillary master cast and the opposing complete denture, as well as the interocclusal record of the occlusal rim, were scanned using a desktop scanner (Identica Blue, Medit Corp, Seoul, Korea).
Speech and language assessment was conducted in the Speech and Phonetic Evaluation Center of Ewha Womans University Mokdong Hospital by U-TAP (Urimal test of articulation and phonation) method.9The patient was asked to read 30 Korean words with and without the obturator, and the accuracy of the individual phonemes of each word was evaluated for consonants and vowels. This evaluation showed that the accuracy of consonants was 67.
The patients were observed during the clinical check periods at 1 and 4 weeks and informed to return for checkups at 6-months intervals. For both patients, the obturators worked well through 6 month of follow-up, but long-term follow-up is needed to confirm these results.
Using a DLP-based printer (Bio 3D W11, NextDent, Soesterberg, Netherlands), the bases of the obturator (tis sue part and polishing part) and artificial teeth were printed with 3D printable PMMA (NextDent Base, NextDent C&B, NextDent, Soesterberg, Netherlands) (Figs 7B, 7C, and 7D).
대상 데이터
A 26-year-old Korean woman with an uncomfortable maxillary obturator visited Ewha Womans University Mokdong Hospital. The patient presented with a history of mucoepidermoid carcinoma on the right maxilla for which she had undergone a hemimaxillectomy approximately 5 years ago.
A 90-year-old Korean woman with an ill-fitting maxillary obturator was referred to the Department of Prosthodontics in Ewha Womans University Mokdong Hospital. The patient presented with a history of squamous cell carcinoma on the left maxilla for which she had undergone a hemimaxillectomy approximately 10 years ago (Fig.
These patients’ data which were obtained in Korea were sent to the department of removable prosthodontics in Tsurumi University, Japan where they were used for new obturator designs. Design data were sent back to Korea to fabricate obturators, which were delivered to the patients. The purpose of this study is to explore the application of CAD-CAM technology in maxillofacial prosthetic treatment and to identify the possibilities of providing remote dental service via cooperation among distant clinicians.
The metal framework was built with cobalt-chrome (Co-Cr) powder (EOS CobaltChrome, EOS GmbH, Krailling, Germany) using an additive manufacturing machine (MetalSys 250, WinforSys, Yongin, Korea) (Fig. 7A). Support structures were removed and finishing and polishing accomplished in the same manner as conventionally manufactured frameworks.
A 90-year-old Korean woman with an ill-fitting maxillary obturator was referred to the Department of Prosthodontics in Ewha Womans University Mokdong Hospital. The patient presented with a history of squamous cell carcinoma on the left maxilla for which she had undergone a hemimaxillectomy approximately 10 years ago (Fig. 1). She asked for a new obturator with better stability and comfort.
The patient’s CT data (.dcm) and all the scan data (.stl) were sent to Japan for the design of a new obturator.
The patient’s computed tomography images (DICOM file) and model scan data (stereolithography, STL) obtained in Korea were sent to Tsurumi University in Japan.
성능/효과
9 The patient was asked to read 30 Korean words with and without the obturator, and the accuracy of the individual phonemes of each word was evaluated for consonants and vowels. This evaluation showed that the accuracy of consonants was 67.44% without the obturator but 100% with the obturator (Table 1). In addition, the obturator enhanced the resonance of the oral and nasal cavities when the patient was evaluated with a nasometer.
후속연구
Laboratory work such as adjusting and polishing the metal framework and bonding the printed teeth to the base was inevitable. Further development is expected to overcome these limitations, possibly allowing all steps, including digital surveying, prosthesis design and prosthesis manufacture, to be accomplished using only intraoral scanned data, without requiring a stone model. If these were to be realized, true remote dental service would be possible.
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