不同引导方式对部分牙列缺损患者种植手术准确性的影响

Accuracy of different guiding templates for immediate implant placement in partially edentulous patients

目的比较先锋钻引导和全程引导方式对部分牙列缺损患者进行即刻种植手术的精确性。方法筛选2017年1月—2018年6月于杭州市萧山区中医院口腔科就诊并行即刻种植的牙列部分缺损患者45例(56颗种植体),按照随机数字表法分为PG组和FG组,PG组应用先锋钻引导手术,FG组应用全程引导手术,每组各28颗牙。术前行锥形束CT(CBCT)检查,采集数据,重建牙齿和颌骨模型,经过三维重建、模拟种植体3D图像设计并制作导板。分别应用先锋钻引导和全程引导进行植入体植入手术。术后再次拍摄CBCT并进行三维重建,比较两种引导方式植入体三维位置的精准度以及两种引导术后4周和24周时植入体的ISQ值和安全性。结果 56颗植入体全部在导板引导下顺利植入。FG组植入体植入后根尖总偏差(AGD)、角度偏差(AD)、冠方总偏差(CGD)、冠方侧向偏差(CLD)、冠方垂直偏差(CVD)、根尖侧向偏差(ALD)、根尖垂直偏差(AVD)均小于PG组(均P<0.01)。2组术后植入体安全性和术后4周、24周时ISQ值比较差异均无统计学意义(均P>0.05)。结论数字化外科导板为即刻种植手术的开展提供了良好的技术支持,全程引导手术比先锋钻引导手术具有更高的精准性,2种引导方式引导下植入体的安全性和稳定性相似。

Objective To compare the accuracy of pilot-drill guided and fully-guided immediate implant surgery in partially edentulous patients. Methods Forty-five partial edentulous patients(56 implants) in our hospital between January 2017 and June 2018 were randomly allocated to pilot-drill guided(PG) group(28 implants) and fully-guided(FG) group(28 implants) according to random number table. Cone beam CT(CBCT) was performed before the operation to collect data for three-dimensional reconstruction of teeth and jaw, simulation of implant 3 D image design and producing guiding templates. PG and FG were performed in the two groups respectively. After implant insertion, CBCT was performed again for three-dimensional reconstruction. The deviations of positions and angulations of the implants were determined and calculated. The safety and stability(ISQ) of the implant were investigated at 4 w and 24 w after the operation. Results All 56 implants were successfully implanted under the guidance of template. AGD, AD, CGD, CLD, CVD, ALD and AVD in FG group were all lower than those in the PG group(all P<0.01). There was no significant difference in the safety and ISQ value between the two groups at 4 and 24 weeks after the operation(all P>0.05). Conclusions Digital template can provide a good technical support for immediate implant surgery. A higher degree of accuracy can be achieved by fully-guided surgery in immediate implant surgery of partially edentulous patients. PG and FG surgery demonstrate a similar safety and stability.