计算机辅助种植导航手术在上颌前磨牙区的应用

Clinical observations of flapless implant operation with implant navigation in the areas of maxillary premolar

背景:计算机辅助设计制造的手术导板辅助的不翻瓣种植导航能准确地将种植体植入到术前设计位置,在计算机制造的牙颌模型上手工制作的导板同样能够用在牙槽骨萎缩患者的种植修复中。目的:观察利用自制导板对骨宽度萎缩的上颌前磨牙缺失患者实施不翻瓣种植导航手术临床效果,评价此种方法的临床应用可行性。方法:8例可用骨宽度不充足的上颌前磨牙缺失并需要进行种植义齿修复患者共计10颗患牙,平均前磨牙区牙槽骨高度为(13.45±1.67)mm。通过颅颌面CT扫描、三维重建分析以及快速成型模型模拟手术分析,膜片热压成形方法制作手术导板,精确测量种植区域可用牙槽骨长度、宽度、高度及角度。结果与结论:种植导板固位力合适,取戴方便。与模型模拟手术比较,10颗缺失牙术后种植体植入位置准确,无上颌窦底黏膜穿通、骨壁侧穿、邻牙损伤等并发症,植入手术平均用时为(17.0±5.8)min。除1例患者因上颌窦黏膜下存有断根植入10mm长种植体外,其余患者种植体植入长度均>13mm。患者术后仅有轻度肿痛。植入后3～6个月行烤瓷冠修复。提示在种植手术导板的引导下,应用不翻瓣种植导航手术可将种植体准确植入到可用骨宽度不足的上颌前磨牙缺失患者术前预设计位置,表明其在牙槽骨萎缩、可用骨宽度不足患者治疗中具有较为明显的技术优势与广阔的应用前景。

BACKGROUND：CAD-CAM template-guided flapless implantation can ensure reliable transfer of preoperative computer-assisted planning into surgical practice.A new type of template-guided flapless implant placement using a CAM model-based planning procedure can also be used in sites with insufficient bone volume.OBJECTIVE：By observing the clinical results of flapless implant operation with implant navigation in the areas of maxillary premolar,which have relatively insufficient bone width,to evaluate the clinical feasibility of this method.METHODS：A total of eight patients who had lost 10 maxillary premolars were treated with the operations.The average height of premolar alveolar bone was（13.45±1.67） mm.By using craniofacial CT scan,three-dimensional reconstruction analysis and sham-operated analysis of rapid prototyping models,we obtained the accurate datum of the length,width,height and angle of the alveolar bone.RESULTS AND CONCLUSION：The surgical guides had sufficient retention which was easy to place and remove on the teeth.Compared with the sham-operated analysis of models,all the implants of the 10 teeth had been implanted accurately.The average operation time was（17.0 ± 5.8） minutes.Except for one patient who had a residual root under the mucosa of maxillary sinus,the length of the implants in the alveolar bone was all more than 13 mm,without the occurrence of penetration of mucosa of maxillary sinus,perforation of bone lamella and other complications.And all the patients only had mild swelling and pain.Ten porcelain crowns were placed 3 to 6 months later.With the guidance of guide plates,the implants can be accurately implanted into the insufficient bone by application of flapless implant operation.This method may have great technical advantages and broad prospects in curing the patients with alveolar bone atrophy and insufficient available bone.