3D打印支架义齿精度验证及临床适配性研究

doi:10.3760/cma.j.cn441417-20250626-21010

摘要/Abstract

摘要： 目的　探讨3D打印支架义齿的临床适配性与精度，验证3D打印技术在口腔修复中的应用价值。方法　采用前瞻性随机对照设计，纳入2022年1月至2024年6月天津医科大学总医院114例牙列缺失患者，按随机数字表法分为观察组与对照组各57例。观察组男28例、女29例，年龄（58.21±7.62）岁，缺失牙齿数（4.30±1.17）；对照组男29例、女28例，年龄（57.84±8.08）岁，缺失牙齿数（4.21±1.09）。观察组采用3D打印技术［数字化设计+选择性激光熔化（SLM）打印］制作义齿，对照组采用传统铸造工艺。评估两组边缘贴合度、基牙接触、咬合关系、佩戴稳定性及患者满意度。采用独立样本t检验、χ²检验进行统计学分析；多因素logistic回归分析术后1个月患者满意度的影响因素；通过Bootstrap法（5 000次抽样）检验支架贴合度在制作方式与满意度间的中介效应；采用线性混合效应模型分析重复测量数据。结果　术后1个月，观察组边缘贴合良好率高于对照组［87.72%（50/57）比71.93%（41/57）］，基牙接触优良率高于对照组［78.95%（45/57）比61.40%（35/57）］，咬合良好率［85.96%（49/57）］与稳定性达标率［84.21%（48/57）］均高于对照组［70.18%（40/57）、68.42%（39/57）］，患者满意度亦高于对照组（均P<0.05）。术后3个月观察组各指标仍优于对照组（均P<0.05），但6个月时差异缩小（均P>0.05）。logistic回归分析显示，3D打印工艺是提升患者满意度的核心因素（OR=3.467，P=0.004）。支架贴合度在3D打印工艺与满意度间起完全中介效应（P<0.05）。结论　3D打印支架义齿在早期临床适配性与精度方面优于传统铸造工艺，其优势通过数字化闭环控制与生物力学优化实现，为口腔修复向数据驱动型转型提供依据。

关键词: 3D打印技术, 可摘局部义齿, 金属支架, 临床适配性

Abstract:

Objective　To investigate the clinical adaptability and accuracy of 3D-printed denture frameworks and validate the application value of 3D printing technology in oral rehabilitation. Methods　A prospective randomized controlled design was adopted. A total of 114 patients with complete dentition loss at Tianjin Medical University General Hospital from January 2022 to June 2024 were included, and were randomly divided into an observation group and a control group, with 57 cases in each group. In the observation group, there were 28 males and 29 females, with an age of (58.21±7.62) years old and a number of missing teeth of (4.30±1.17); in the control group, there were 29 males and 28 females, with an age of (57.84±8.08) years old and a number of missing teeth of (4.21±1.09). The observation group used 3D printing technology [digital design + selective laser melting (SLM) printing] to manufacture the dentures, while the control group used the traditional casting process. The edge fit, abutment contact, occlusal relationship, wearing stability, and patients' satisfaction of the two groups were evaluated. Statistical analysis was conducted using the independent sample t test and χ² test; multivariate logistic regression analysis was used to analyze the influencing factors of patients' satisfaction one month after surgery; the mediating effect of framework fit between the production method and satisfaction was tested by the Bootstrap method (5 000 sampling); a linear mixed-effect model was used to analyze the repeated measurement data. Results　One month after surgery, the good rate of edge fit in the observation group was higher than that in the control group [87.72% (50/57) vs. 71.93% (41/57)], the excellent rate of abutment tooth contact was higher than that in the control group [78.95% (45/57) vs. 61.40% (35/57)], the rate of good occlusion [85.96% (49/57)] and the rate of reaching stability standards [84.21% (48/57)] were both higher than those in the control group [70.18% (40/57) and 68.42% (39/57)], and the patients' satisfaction was also higher than that in the control group (all P<0.05). Three months after surgery, the indicators of the observation group were still superior to those of the control group (all P<0.05), but the differences narrowed at 6 months (all P>0.05). Logistic regression analysis revealed that the 3D printing process was the key factor in enhancing the patients' satisfaction (OR=3.467, P=0.004). The framework fit served as a complete mediator between the 3D printing process and satisfaction (P<0.05). Conclusion　3D-printed denture frameworks exhibit significantly better early clinical adaptability and accuracy than traditional casting, achieve through digital closed-loop control and biomechanical optimization, thereby providing a basis for the transition of oral restoration toward data-driven approaches.

Key words: 3D printing technology, Removable partial dentures, Metal framework, Clinical applicability

马宏斌张雯怡金燕娇吴炜. 3D打印支架义齿精度验证及临床适配性研究[J]. 国际医药卫生导报, 2025, 31(21): 3570-3575.

Ma Hongbin, Zhang Wenyi, Jin Yanjiao, Wu Wei. Accuracy verification and clinical adaptability research of 3D printed dentures[J]. International Medicine and Health Guidance News, 2025, 31(21): 3570-3575.

参考文献

[1] 宋雨菲,程焕芝,范海霞,等.3D打印技术在口腔医学、颌面外科修复重建中的作用与优势[J].中国组织工程研究,2025,29(22):4823-4831. DOI:10.12307/2025.452.
[2] 宋世威,李风兰.支撑结构位置对3D打印全口义齿基托适合性的影响[J].实用口腔医学杂志,2023,39(5):584-589. DOI:10.3969/j.issn.1001-3733.2023.05.005.
[3] 钱飞,吴玉禄,刁晓鸥,等.数字化可摘局部义齿支架模型的建立与结构强度的有限元分析[J].实用口腔医学杂志,2022,38(1):97-101. DOI:10.3969/j.issn.1001-3733.2022.01.020.
[4] 李雪莲,徐超,吴亮颖.3D打印技术在牙周病伴牙列缺损修复治疗中的应用研究[J].现代科学仪器, 2024, 41(1):65-69.
[5] 王玉佳,孙甲璐,苟建重. Osteoset XR医用硫酸钙联合浓缩生长因子纤维蛋白膜在预防拔牙后牙槽骨吸收中的应用[J]. 国际医药卫生导报,2025,31(11):1875-1879. DOI:10.3760/cma.j.cn441417-20241206-11021.
[6] 曾河清,牟荣,余跃.SLM 3D打印技术与失蜡铸造技术在可摘局部义齿支架制作中的应用[J].海南医学,2024,35(8):1120-1123. DOI:10.3969/j.issn.1003-6350.2024.08.012.
[7] 国家卫生健康委员会医政医管局. 牙体缺损、牙列缺损与缺失修复诊疗指南(2022年版)[S].2022.
[8] Bennett GW. 3D printed trial denture store inforce prosthodontic concepts[J]. J Dent Educ, 2021, 85 Suppl 3:2032-2033. DOI:10.1002/jdd.12544.
[9] Prpić V, Schauperl Z, Ćatić A, et al. Comparison of mechanical properties of 3D-printed, CAD/CAM, and conventional denture base materials[J]. J Prosthodont, 2020, 29(6):524-528. DOI: 10.1111/jopr.13175.
[10] Sulaya K, B V S, Nayak VM. The science of printing and polishing 3D printed dentures[J]. F1000Res, 2025, 13:1266. DOI: 10.12688/f1000research.157596.2.
[11] Kihara H, Sugawara S, Yokota J, et al. Applications of three-dimensional printers in prosthetic dentistry[J]. J Oral Sci, 2021, 63(3):212-216. DOI: 10.2334/josnusd.21-0072.
[12] Liu YX, Yu SJ, Huang XY, et al. Primary exploration of the clinical application of 3D-printed complete dentures[J]. Int J Prosthodont, 2022, 35(6):809-814. DOI: 10.11607/ijp.7692.
[13] Oh KC, Yun BS, Kim JH. Accuracy of metal 3D printed frameworks for removable partial dentures evaluated by digital superimposition[J]. Dent Mater, 2022, 38(2):309-317. DOI: 10.1016/j.dental.2021.12.012.
[14] Greuling A, Matthies A, Eisenburger M. Fracture load of 4-unit interim fixed partial dentures using 3D-printed and traditionally manufactured materials[J]. J Prosthet Dent, 2023, 129(4):607.e1-607.e8. DOI: 10.1016/j.prosdent.2022.12.013.
[15] Lo Russo L, Guida L, Zhurakivska K, et al. Intaglio surface trueness of milled and 3D-printed digital maxillary and mandibular dentures: a clinical study[J]. J Prosthet Dent, 2023, 129(1):131-139. DOI: 10.1016/j.prosdent.2021.05.003.
[16] Park C, Kee W, Lim HP, et al. Combining 3D-printed metal and resin for digitally fabricated dentures: a dental technique[J]. J Prosthet Dent, 2020, 123(3):389-392. DOI: 10.1016/j.prosdent.2019.04.019.
[17] Yoshidome K, Torii M, Kawamura N, et al. Trueness and fitting accuracy of maxillary 3D printed complete dentures[J]. J Prosthodont Res, 2021, 65(4):559-564. DOI: 10.2186/jpr.JPR_D_20_00240.
[18] Poker BC, Oliveira VC, Macedo AP, et al. Evaluation of surface roughness, wettability and adhesion of multispecies biofilm on 3D-printed resins for the base and teeth of complete dentures[J]. J Appl Oral Sci, 2024, 32:e20230326. DOI: 10.1590/1678-7757-2023-0326.
[19] Emera RMK, Shady M, Alnajih MA. Comparison of retention and denture base adaptation between conventional and 3D-printed complete dentures[J]. J Dent Res Dent Clin Dent Prospects, 2022, 16(3):179-185. DOI: 10.34172/joddd.2022.030.
[20] Gao H, Yang Z, Lin WS, et al. The effect of build orientation on the dimensional accuracy of 3D-printed mandibular complete dentures manufactured with a multijet 3D printer[J]. J Prosthodont, 2021, 30(8):684-689. DOI: 10.1111/jopr.13330.
[21] Dimitrova M, Kazakova R, Vlahova A. Comparative study of the fracture resistance of 3D-printed and prefabricated artificial teeth for removable dentures[J]. Polymers (Basel), 2024, 16(23):3381. DOI: 10.3390/polym16233381.
[22] Hada T, Kanazawa M, Iwaki M, et al. Effect of printing direction on the accuracy of 3D-printed dentures using stereolithography technology[J]. Materials (Basel), 2020, 13(15):3405. DOI: 10.3390/ma13153405.
[23] Shen L, Yin C, Wei Z, et al. Computer design and three-dimensional finite element analysis of a new type of stand-alone bracket dentures[J]. Sustainable Civil Infrastructures, 2025:795-803. DOI:10.1007/978-3-031-72509-8_66.
[24] Numazaki K, Seiryu M, Yamauchi K, et al. Combined surgical-orthodontic and prosthetic treatment of apartially edentulous patient with skeletal Class III malocclusion[J]. Clinical and Investigative Orthodontics, 2023,82(3):11. DOI:10.1080/27705781.2023.2235738.
[25] Nakornnoi T, Srirodjanakul W, Chintavalakorn R, et al. The biomechanical effects of clear aligner trimline designs and extensions on orthodontic tooth movement: a systematic review[J]. BMC Oral Health, 2024, 24(1):1523. DOI: 10.1186/s12903-024-05274-7.