[논문]가상환자 데이터세트를 기반으로 악관절과 심미를 고려한 진단 및 치료계획 수립

이수영; 강동휘; 이도연; 김희철

doi:10.15522/jkaed.2021.30.2.71

[국내논문] 가상환자 데이터세트를 기반으로 악관절과 심미를 고려한 진단 및 치료계획 수립
From TMJ to 3D Digital Smile Design with Virtual Patient Dataset for diagnosis and treatment planning 원문보기

Journal of the Korean Academy of Esthetic Dentistry = 대한심미치과학회지, v.30 no.2, 2021년, pp.71 - 90

이수영 (오복만세치과) , 강동휘 (행복나눔부부치과) , 이도연 (닥터플란트치과) , 김희철 (더블유화이트치과)

초록
AI-Helper

가상 환자 데이터 세트는 단일 환자로부터 획득한 구강스캔 안면스캔 전신스캔 하악운동경로데이터 등 다양한 소스의 진단 데이터를 하나의 3차원 좌표계로 정렬한 데이터의 집합이다. 치과의사는 가상 환자 데이터 세트를 사용하여 효과적으로 치료 계획을 수립하고 다양한 치료 계획을 가상공간상에서 시뮬레이션 할 수 있으며, 가상 환자 데이터 세트에서 환자의 미소를 디자인 후 그 결과를 시뮬레이션하고 최적의 치료결과를 선택할 수 있다. 가상공간에서 선택된 치료 계획은 3D 프린팅, 밀링, 사출 성형과 같은 제조 기술을 사용하여 환자에게 동일하게 전달될 수 있다. 이러 치료 계획의 전달은 임시 수복물 제작 및 환자의 구강 내에서 목업 확인을 통해 최종 보철물 제작으로 연결할 수 있다. 이와 같이 진단 데이터, 중첩 및 가공의 정확도가 보장된다면 3차원 가상공간 상에서 시뮬레이션된 3D 디지털 스마일 디자인을 실제 환자에게 정확하게 전달할 수 있다. 가상환자데이터세트의 임상적용방법으로 동기능적교합측정 검사를 통해 교합조정치료를 치료계획에서 배제할수 있는 의사결정방법과, 턱관절질환을 가지고 있는 청소년기 특발성 척추측만증 환자의 턱관절 치료전후 전신스캔 비교분석방법, 그리고 전악수복증례인 상하악 총의치환자 진료시 가상환자데이터세트에 기반한 교합평면분석 및 디지털심미분석방법을 제시하였다.

Abstract ▼ AI-Helper

The virtual patient dataset is a collection of diagnostic data from various sources acquired from a single patient into a coordinate system of three-dimensional visualization. Virtual patient dataset makes it possible to establish a treatment plan, simulate various treatment procedures, and create a treatment planning delivery device. Clinicians can design and simulate a patient's smile on the virtual patient dataset and select the optimal result from the diagnostic process. The selected treatment plan can be delivered identically to the patient using manufacturing techniques such as 3D printing, milling, and injection molding. The delivery of this treatment plan can be linked to the final prosthesis through mockup confirmation through provisional restoration fabrication and delivery in the patient's mouth. In this way, if the diagnostic data superimposition and processing accuracy during the manufacturing process are guaranteed, 3D digital smile design simulated in 3D visualization can be accurately delivered to the real patient. As a clinical application method of the virtual patient dataset, we suggest a decision-making method that can exclude occlusal adjustment treatment from the treatment plan through the digital occlusal pressure analysis. A comparative analysis of whole-body scans before and after temporomandibular joint treatment was suggested for adolescent idiopathic scoliosis patients with temporomandibular joint disease. Occlusal plane and smile aesthetic analysis based on the virtual patient dataset was presented when treating patients with complete dentures.

Keyword

표/그림 (28)

그림 Fig. 1. Seamless digital dentistry workflow with Virtual Patient Dataset
그림 Fig. 2. Virtual Patient Dataset with Bellus3D facial scan and Trios3 intraoral scanner.
그림 Fig. 3. A bite jig is essential to align low-resolution facial scan data and intraoral scan data.
그림 Fig. 4. No bite jig is required to superimpose the high-resolution facial scan data acquired by CMC handheld optical 3D scanner on the intraoral scan data.
그림 Fig. 5. Superimposition of a soft tissue CBCT scan and a photograph can generate full-color textured facial scan data
그림 Fig. 6. Moti Physio body posture analyzer
그림 Fig. 7. Moti Physio body posture analyzer can generate Moiré topography
그림 Fig. 8. CMC handheld optical scanner can generate Moiré topography
그림 Fig. 9. CMC handheld optical scanner can export whole-body color-textured 3D reconstruction data
그림 Fig. 10. Whole-spine X-ray showed the curvature of the spine.
그림 Fig. 12. Heavy occlusal pressure was shifted to the opposite side immediately after High-Velocity Low-Amplitude (HVLA) cervical manipulation
그림 Fig. 11. Heavy occlusal pressure on left side
그림 Fig. 13. Immediately after delivering the silicone splint, occlusal pressure analysis software showed the symmetry of the occlusal force distribution.
그림 Fig. 14. The X-ray image and soft tissue enhanced image processing showed curvature improvement of the cervical spine after 20 days from initial treatment.
그림 Fig. 15. Difference in shoulder, scapular, and pelvic height improved in adolescent idiopathic scoliosis patients' whole-body scan data
그림 Fig. 16. Superimposition of whole-body scan data
그림 Fig. 17. Centric tray, Frame Cut Back tray, and CDG tray
그림 Fig. 18. Impression scan with CEREC Primescan intraoral scanner: Lower jaw impression with frame cut back tray, Preliminary vertical dimension record with Centric tray, and Upper jaw impression with CDG tray
그림 Fig. 19. 3D bite plate CAD design with 3Shape Digital Denture module
그림 Fig. 20. 3D bite plate CAD design with Meshmixer
그림 Fig. 21. 3D printed 3D bite plate with Gnathometer CAD
그림 Fig. 22. Complete Denture CAD design with Virtual Patient Dataset
그림 Fig. 23. Face scan data and final impression scan data were aligned in 3DmeStudio SW using T-markers as reference data
그림 Fig. 25. Vertical dimension confirmation with Virtual Patient Datasets
그림 Fig. 24. 3shape in y-up axis and exocad in z-up axis coordinate system
그림 Fig. 26. Occlusal plane inclination simulation in Virtual Patient Dataset. A. Paralleled to Camper's plane B. Steep C. Flat D. Inverse occlusal plane
그림 Fig. 27. Definitive complete denture
그림 Fig. 28. Suction effect test for suction effective mandibular complete denture

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