Dental and Medical Problems

Dent Med Probl
Index Copernicus (ICV 2020) – 128.41
MEiN – 70 pts
CiteScore (2021) – 2.0
JCI – 0.5
Average rejection rate (2021) – 81.35%
ISSN 1644-387X (print)
ISSN 2300-9020 (online)
Periodicity – quarterly

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Dental and Medical Problems

2014, vol. 51, nr 1, January-March, p. 119–129

Publication type: clinical case

Language: English

Creative Commons BY-NC-ND 3.0 Open Access

An Individual Rapid Prototyping Attachment Used in Extrusion of Displaced and Transposed Maxillary Canine Tooth – Case Report

Zastosowanie diagnostyki 3D oraz szybkiego prototypowania w ortodoncji – opis własnej metody ekstruzji zatrzymanego kła

Adrian Strzecki1,A,B,C,D, Joanna Jabłońska-Zrobek1,C,E,F, Elżbieta Pawłowska1,A,E,F

1 Department of Orthodontics, Medical University of Lodz, Lodz, Poland

Abstract

Impacted or displaced maxillary canines are regarded as a significant clinical problem due to their esthetic and functional properties. The relatively high prevalence of such cases in the general population entails frequent management by practitioners. However, canine displacement combined with its transposition is a rare case that requires thorough diagnostic measures and an individually designed treatment plan. The purpose of this study is to present a methodology for management of a palatally displaced and transposed maxillary left canine based on cone-beam computed tomography (CBCT) imaging and rapid prototyping techniques. A 10-year old female patient with displaced and incompletely transposed upper left canine undergone thorough 3D orthodontic diagnostics involving creation of 3D anatomic STL models. Anatomic reconstructions were processed in rapid prototyping software and printed by means of 3D printing technology. Custom-designed attachment for orthodontic extrusion was milled from CoCr alloy on the basis of digital STL model accurately reflecting the anatomy of displaced canine. Despite difficult anatomic conditions, the tooth was successfully extruded with no complications regarding the adjacent teeth. CBCT is not only an efficient tool for multi-planar assessment of dental abnormalities and the facial skeleton, but it also allows for the creation of 3D models of the patient’s anatomy enabling the computer aided design individual treatment solutions.

Streszczenie

Stożkowa tomografia komputerowa (cone-beam computed tomography – CBCT) zyskuje coraz większe znaczenie w diagnostyce ortodontycznej. Możliwość uwidocznienia struktur twarzoczaszki w dowolnej projekcji pozwala na dogłębną ocenę anatomii także w przypadku asymetrycznych zaburzeń oraz dokładne określenie położenia zatrzymanych zębów. Ważnym poszerzeniem możliwości diagnostycznych skanu CBCT jest konwersja danych do postaci trójwymiarowej wizualizacji tkanek pacjenta. Tak otrzymany wirtualny model może służyć nie tylko do realistycznej oceny stosunków anatomicznych, ale przede wszystkim podlegać modyfikacjom umożliwiającym zindywidualizowanie postępowania terapeutycznego. W pracy przedstawiono przypadek 11-letniej pacjentki z zatrzymanym górnym lewym kłem. Na podstawie skanu CBCT przygotowano model 3D szczęki pacjentki oraz zatrzymanego zęba. Następnie z wykorzystaniem specjalistycznego oprogramowania stworzono wirtualny model zaczepu w taki sposób, aby stanowił idealny negatyw powierzchni podniebiennej mającego podlegać ekstruzji zęba. W kolejnym etapie wirtualny model przekształcono w prototyp z fotopolimeru, ten zaś zamieniono na stop chromokobaltowy w pracowni technicznej. Tak otrzymany zaczep charakteryzował się: wyprofilowaniem dopasowanym do powierzchni zęba pacjentki, zwiększeniem powierzchni adhezyjnej, znacznie poprawioną retencją w stosunku do standardowo stosowanych guziczków, co umożliwiło skrócenie czynności klinicznych oraz efektywną ekstruzję zatrzymanego kła.

Key words

canine displacement, dental transposition, rapid prototyping, cone-beam computed tomography

Słowa kluczowe

zatrzymane kły, transpozycja zębów, techniki szybkiego prototypowania, stożkowa tomografia komputerowa

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