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Application of digital technology in diagnosis and treatment of dental pulp d...

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发表于 2018-9-16 16:25:35 | 显示全部楼层 |阅读模式
Application of digital technology in diagnosis and treatment of dental pulp diseases
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 楼主| 发表于 2018-9-16 16:25:50 | 显示全部楼层
Digital technology of Stomatology refers to the technology that assists stomatologists to diagnose and treat oral diseases accurately, efficiently, automatically and intelligently by means of digital hardware or software. Digital technology is widely used in oral and maxillofacial surgery, prosthodontics, dental implants, orthodontics. There is no doubt that the diagnosis and treatment of dental pulpology has also developed into a digital era.

At present, the application of digital technology in dental prosthodontics is more mature, and brings revolutionary changes to dental prosthodontics. In endodontics, although the introduction of various digital technology and equipment makes the diagnosis and treatment of dental pulp diseases more intuitive, accurate and minimally invasive, its application and development is still relatively slow. At present, the main digital technologies used in dental pulpology are cone-beam computed to-mography (CBCT), microcomputed tomography (UCT), three-dimensional optical scanning (3D optical scanning), computer aided design (CAD). CAD, three-dimensional printing, computer aided diagnosis and analysis, and computer aided navigation system (CANS). This article summarizes the application of digital technology in the diagnosis and treatment of dental pulp diseases in recent years.
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 楼主| 发表于 2018-9-16 16:26:11 | 显示全部楼层
1. digital technology in the diagnosis of dental pulp diseases

The digitalization techniques used in the diagnosis of endodontics include CBCT, CT and 3D printing.

1.1CBCT

At present, CBCT has been proved to be a valuable assistant tool in the diagnosis of pulp diseases, such as showing the shape of root canal or diagnosing apical lesions. Transparent tooth staining is considered to be the gold standard for studying root canal morphology, but it is not suitable for clinical application. CBCT can achieve the same results as transparent tooth staining in diagnosing the number and shape of root canals because of its high spatial resolution. CBCT has the characteristics of non-invasive, stereoscopic, accurate and easy to perform. It has special advantages in the diagnosis of complex variant root canals. Combined with the use of micro-ultrasound technology, it can reduce the occurrence of root canal omission and improve the curative effect of root canal therapy. In addition, compared with apical radiographs, CBCT can determine the three-dimensional relationship between lesions and normal anatomical structures, which is particularly important in specific cases, such as lesions around important anatomical structures such as maxillary sinus and chin foramen, complex root canal structures such as type III or type IV tooth invagination, suspicious non-odontogenic lesions, and severe endogenous absorption. And external absorption, vertical root fracture. Previous studies have shown that CBCT plays an active role in assisting the diagnosis and treatment planning of difficult cases.

Recently, Yilmaz et al. developed a computer-aided diagnostic software based on three-dimensional images of CBCT. According to the expert's clinical, radiological and histopathological characteristics, it was found that the software could distinguish the apical cyst and odontogenic keratocyst (KCOT) with a high accuracy of over 94% and was computer-aided. The application of diagnosis in endodontics is of great significance. Of course, there are some limitations in the application of CBCT, mainly as follows: low resolution, about 125 microns, for showing the micro-structure of complex root canal system is still lacking; compared with apical film, CBCT radiation dose is larger, higher cost, root filling materials or metal materials radiation artifacts interference. Therefore, the European Association of Endodontics issued the application of CBCT in endodontics guidelines pointed out that the use of CBCT should follow the principle of rational use of low doses.

To sum up, CBCT is helpful for doctors to diagnose and plan the treatment of the teeth, and the diagnostic accuracy is high, but because of its low resolution, radiation dose and other limitations, doctors should master its indications in the pulp diagnosis, in order to better serve the clinical.
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 楼主| 发表于 2018-9-16 16:26:29 | 显示全部楼层
1.2 mu CT

Also known as micro CT or micro CT, it has been applied to the oral field since 1990s. As a digital technology, micro-CT has unique advantages in displaying and analyzing root canal morphology because of its high resolution (5-25 micron), good reproducibility and non-invasiveness.

At present, micro-CT is mainly used in vitro experiments, which can help clinicians understand the anatomical characteristics and parameters of complex root canal system qualitatively, quantitatively and visually, such as the classification of main canal, the curvature of root canal, the position of lateral branch canal, the position of apical foramen and apex, the position of narrow area of root canal, the thickness of dentin and root canal. Volume, root canal surface area and so on. However, due to the small field of vision, microscopic CT can not be directly applied to clinical examination. With the improvement of micro-CT technology and related analysis software, it is expected to be used in clinic, which will bring great convenience to the diagnosis of complex root canal system.

1.3 3D printing technology

3D printing technology is also known as computer-aided rapid prototyping (CARP) technology, is a series of additive processing of digital technology collectively. 3D printing technology can display the 3D data of CT more vividly and concretely. It has been used to diagnose the complex structure and special lesions of the root canal system since the beginning of the 21st century. Lee and others successfully printed out the mandibular first molars with three independent distal roots based on CT scan data, which laid the foundation for root canal therapy. In addition to being used in the diagnosis of complex root canal structures, 3D printed dental models can also be used as an auxiliary diagnostic tool for extracanal invasive absorption.

The exact location and size of the lesion can be easily and intuitively judged from the dental model. Compared with the extracted teeth, the size and location of the absorption area are basically the same, and the structure of the lesion can be further displayed by the serial sections of the dental model. Therefore, 3D printing technology can obtain more accurate three-dimensional models of the affected teeth without extraction, which is of great benefit to direct observation, diagnosis, treatment, and recording of clinical uncommon root anatomical structures. Existing studies have confirmed that the overall 3D deviation analysis results of the polylactic acid wax and CAD data printed by Lingtong-III printer are about 0.013 mm.

To sum up, rapid prototyping based on CT data is a more intuitive method to diagnose root canal morphology, but as a diagnostic method, its simplicity, feasibility and economic practicability need to be discussed.
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 楼主| 发表于 2018-9-16 16:26:48 | 显示全部楼层
2. application of digital technology in endodontic treatment

2.1 application of digital technology in routine root canal therapy

2.1.1 computer aided identification of root canal orifice

Correctly identifying the number and distribution of root canal orifice is the foundation and important link of root canal therapy. BrU llmann and others connected the software to the camera on the microscope and detected the root canal orifice in the shape of pulp hole on the image automatically by the minimum distance classification image recognition algorithm. The sensitivity could reach 90.1%. Although it could not replace the judgment of clinicians, it was very popular in clinical root canal therapy, doctor-patient communication and clinical teaching. Potential means of development.

2.1.2 determine work length

In root canal therapy, accurately determining the working length is the key to the success of root canal therapy. Christofzik et al. used computer-aided image analysis system to analyze and calculate the accuracy of two kinds of root canal length measuring instruments. The results showed that the digital image analysis and evaluation results of different root canal length measuring instruments were more objective. Therefore, computer-aided image technology can be used to objectively evaluate the accuracy of root canal length measuring instruments. Sex. On the other hand, some scholars directly use CBCT to measure the working length through in vitro experiments, and find that compared with the gold standard, CBCT measurement results are accurate and reliable. Therefore, the working length of the teeth measured by CBCT can be used as an effective supplement and verification for the root canal length measuring instrument.
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 楼主| 发表于 2018-9-16 16:27:14 | 显示全部楼层
2.1.3 computer aided identification of instrument deformation

Separation of instruments is one of the common complications in root canal therapy, which may affect the therapeutic effect. Separation of instruments is important for prevention, and in most cases, the use of nickel-titanium devices is difficult to see morphological changes with the naked eye. At present, the methods for observing the deformation of nickel titanium instruments are the microscope and scanning electron microscope. Some scholars have found that through AutoCAD computer software and stereoscopic microscope images can be found that vision or microscope can not detect the deformation of the instrument. Therefore, AutoCAD is expected to be the basis for developing computer image analysis program for chairside, which can be used to detect or evaluate whether the device has specific deformation, and whether it can continue to be used safely.

2.1.4 computer aided design improvement

With the development of digital technology, various high-resolution detection or image processing technologies are used to describe the three-dimensional information of objects. For example, surface information is obtained by optical scanning, internal information is obtained by CT scanning, 3D digital model is drawn by modeling software based on computer-aided laser scanning data. Based on the above technology, Nassef introduced a new method to construct a model of root canal file: using CT scanning and stereomicroscope to obtain the digital information of the file, including taper, pitch, cross-sectional design and other sophisticated features, to construct an intelligent 3D rotary file (IRDF) model in a piecewise form. This method is helpful to analyze, study and produce various types of file systems, in order to achieve the purpose of root canal cleaning and shaping, while reducing the occurrence of instrument separation, thus helping dentists to improve the treatment plan in complex root canals.

2.2 application of digital technology in the treatment of difficult dental pulp diseases

CBCT three-dimensional images can display calcification and curved root canals, malformed structures, separation of instruments and other difficult situations, but it is still not directly guide the treatment of pulp diseases. The location of related structures still depends on the clinical experience of the operator, and the operation still has certain risks. The introduction of digital guidance board and navigation technology makes the difficult root canal treatment more intuitive, precise and minimally invasive.

Treatment of calcified root canal guided by 2.2.1 computer aided design and manufacturing guide plate

The treatment of calcification and stenosis of the root canal is a difficult problem facing clinicians. With the assistance of CBCT, dental operating microscope and ultrasound technology, the success rate of treatment can be significantly improved, but still can not guarantee the successful dredging of all cases, there will still be lateral puncture, deviation, etc. or inevitably wear away too much tooth tissue. It affects the resistance of the affected teeth. On the other hand, the introduction of the digital pulping guide plate for calcified root canal, which was designed and manufactured by computer aided based on CBCT and optical scanning data, has shown its advantages in vitro experiment and clinical application. The results of in vitro pulping with the guide plate show that the average deviation of the end of the drill is 0.12-0.13 mm, the average angle deviation is 1.59 degrees, and the error is 1.59 degrees. It has nothing to do with different operators and saves treatment time to a great extent; clinical reports show that the computer-aided design and manufacture of open-pith guide plate can clearly locate calcified root canal, successfully avoid the occurrence of perforation and other complications, and obtain better clinical efficacy.
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 楼主| 发表于 2018-9-16 16:27:31 | 显示全部楼层
Localization and treatment of malformed structures assisted by 2.2.2 3D printing

Pulp treatment of malformed teeth is a challenge for clinicians. The presence of abnormal anatomical structures often leads to incomplete removal of infection, difficult to achieve tight sealing or complications of root canal therapy. The introduction of 3D printing technology enables doctors to analyze the structure of deformed teeth in advance, determine the treatment approach and treatment methods in vitro simulation, improve the accuracy of treatment, and expand the scope of tooth retention. Byun et al. realized root canal therapy of crooked and inverted teeth with the help of solid tooth model made by 3D printing technology and individualized jig, and avoided complications while curing the teeth. Similarly, Kfir and other techniques based on CBCT and 3D printing cured a case of large-area apical lesion of complex type III invaginated central incisor under the premise of preserving pulp vitality, and successfully achieved the preservation of the affected teeth.

2.2.3 digital navigation under taking and separating apparatus

Instrument separation is one of the most difficult complications in root canal therapy, especially when the separation part is below the curvature of root canal or beyond the apical foramen. Sukegawa et al. reported that by using a computer-aided navigation system and a stable and reproducible pad, the effect of mandibular mobility on the synchronization of preoperative and intraoperative imaging data was eliminated, and the important structures around the mandible were avoided. Finally, the separating instruments outside the apical foramen were safely and minimally removed. Computerized navigation system is a feasible method to solve the problem of instrument separation in root canal therapy. Compared with conventional X-ray and CBCT, it is more intuitive, accurate and controllable.

2.3 digital apical surgical guide

In apical surgery, it is necessary to locate the apex accurately, remove at least 3 mm apex along the vertical direction with the long axis of the tooth, and protect the important adjacent structures during the operation. Preoperative CBCT can be used to preliminarily understand and distinguish the structure of the root and the relationship between the root and adjacent tissues, but it can not directly locate the apex and control the length and angle of the apex excision. With the development of digital technology, computer-aided design based on optical scanning and CT scanning and 3D printed guide plate have been applied in apical surgery. Under the guidance of the guide plate, the size of the osteotomy, the length and angle of the apical excision were controlled. The complications such as perforation of maxillary sinus mucosa were avoided. The accuracy and efficiency of the apical operation were improved and the operation trauma was reduced.
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 楼主| 发表于 2018-9-16 16:39:38 | 显示全部楼层
3. summary

Digital technology is changing stomatology. Although the development and application of digital technology in dental pulpology is relatively slow, the introduction of digital technology and equipment in the diagnosis and treatment of dental pulp diseases shows the characteristics of intuition, accuracy and minimally invasive. This paper advances the digital technology in the diagnosis and treatment of dental pulp diseases. The conclusion is made. In digital assisted diagnosis, CBCT has obvious advantages in displaying root canal details or diagnosing apical lesions. Microscopic CT is helpful in displaying and analyzing root canal morphology because of its high resolution, good reproducibility and non-invasiveness. 3D printing technology has visual and accurate characteristics in diagnosing root canal morphology. In the treatment of dental pulp diseases, digital technology is mainly used for computer aided identification of root canal orifice, determination of root canal working length, identification of instrument deformation, aided improvement of instrument design, 3D printing aided malformation structure positioning and treatment, and digital guide board and navigation. In the treatment process, digital technology has shown superiority to traditional technology. The characteristics of operation.

Generally speaking, digital technology has obvious advantages in the diagnosis and treatment of dental pulp diseases, and has a good application prospect.
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