| Objectives: To explore the maximal incisal opening and influence factors on the mandible after decompression, using the technique of SLA to explore a simple, fast and efficient plug device production method,, and study on the feasibility of the surgical guide in Decompression and the feasibility of immediate prosthesis repair therapy after decompression.Methods: This study includes three experiments:1. We prospective analyzed 73 cases accorded with the inclusive criteria,who were treated as at the Department of Oral and Maxillofacial Surgery, Kunming Medical University affiliated oral hospital, From October 2015 to August 2016.Statistics of patients preoperative and postoperative six days of the maximal incisal opening and analyze its influence factors.2. Nine patients with mandibular cystic lesions were selected and performed 4-7 days after decompression. Firstly,we used the direct method to obtain mandibular cysts wax type, 3shape Trios laser scanner scanned wax type to obtain digital impression, and completed the wax type of three-dimensional reconstruction model.Secondly, the individual cyst plug model was fabricated with BEGO Varseo Wax resin based on the technique of SLA.3. Selected the two patients with mandibular cystic lesions need to decompression, in collaboration with the oral and maxillofacial surgeon, based on CBCT data and plaster model, Firstly, we designed and produced surgical guide before surgery. Secondly, we operated the simulations through the gypsum model and completed the production of cyst plug. Surgery was completed under the guidance of the surgical guide and immediate Prosthetic therapy.Result:1. The average value of the average maximal incisal opening in 73 cases is 39.58± 5.91mm before operation; The average minimum of the maximal incisal opening appeared first days after surgery,was 22.71 ± 5.13mm;On the sixth day after surgery,patients with limited mouth opening accounted for 31.14%,and 2.74% of the patients with moderate restriction of mouth opening, 27.40% of the patients with mild restriction of mouth opening; The single factor analysis, the maximal incisal opening of preoperative and operation site were correlated with the maximal incisal opening of postoperative.2. Nine patients with mandibular cystic lesions were selected after decompression, we used indirect digital impression combined with 3D printing to complete the cyst plug. It had no clasp and base device, but slim and smooth surface.The cyst plug and the Soft tissue had good marginal adaptation, it had a certain retention force, and could delay the soft tissue to close the cystic cavity, and exudat of cyst cavity could be drained out. This method was applicable to the operation location in retromolar tissue and in the vestibular area.3. Two patients with mandibular cystic disease were selected, and the surgical guide was made before operation. We performed surgical simulations on the gypsum model and production of the individual cyst plug. We completed the operation under the guidance of the surgical guide and immediate Prosthetic therapy after decompression. The claps had a retention and stability effect, base and mucosal contact without tenderness. The cyst plug could delay the soft tissue to close the cystic cavity, and exudat of cyst cavity could be drained out. The cyst plug could meet the clinical requirements. This method was suitable for decompression of tooth extraction.Conclusions:1. Some patients will be limited mouth opening after marsupialization, especially the operation location in retromolar tissue were higher in patients with mouth limited.,Which causes the difficulty in making cyst plug.2. Based on digital impression and 3D reconstruction, firstly, the digital model was made with wax type by using the 3 shape scanner. Secondly, a cyst plug model was finished based on the 3D model reconstruction. Thirdly, the individual cyst plug model was fabricated based on the technique of SLA. The fabrication of individual cyst plug with SLA was feasible. The whole progress was simple and efficient, and the products had good quality. This method was applicable to the operation location in retromolar tissue in patients with mouth limited, and the operation location in the vestibular area.3. Based on CBCT images data and plaster model , the oral and maxillofacial surgeon determined the surgical procedure. Firstly, we completed the design and production of the surgical guide. Secondly, we performed surgical simulations on the gypsum model and production of the individual cyst plug. Thirdly, we completed the operation under the guidance of the surgical guide and immediate Prosthetic therapy after decompression. The practical application value of this method in clinical and scientific research still needed further research to explore. |
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