动态实时导航在下颌后牙区跨下颌神经管种植中的临床应用研究

Clinical application of a dynamic navigation system to cross-mandibular canal implant placement surgery in the mandibular posterior areas

目的:探讨动态实时导航系统引导下颌后牙区跨下颌神经管种植的可行性。方法:将下颌后牙区牙槽骨严重萎缩患者CBCT数据导入动态实时导航系统中进行跨下颌神经管种植的设计,并在导航引导下进行种植体植入。将术后CBCT种植体三维影像位置信息导入到动态实时导航系统软件中,与术前设计的种植体位置进行融合比对,测量种植体的实际位置与术前设计位置的偏离情况,包括种植体颈部中心点和根尖部的偏差,种植体与下颌神经管的间距偏差,种植体角度偏差。结果:在动态实时导航系统指导下顺利植入11颗种植体,精准度测量显示种植体颈部偏差(1.1±0.4)mm,根尖部偏差(1.6±0.7)mm,种植体与下颌神经管的间距偏差(1.2±0.4)mm,角度偏差(3.2±1.1)°。未出现下牙槽神经损伤。修复后随访3~6个月,种植体稳定性良好,咀嚼功能恢复良好。结论:动态实时导航系统引导下颌后牙区跨下颌神经管种植精准、安全,避免下牙槽神经的损伤。

Objective:To explore the feasibility of cross-mandibular canal implant placement under the guidance of a dynamic navigation system in the severely atrophic mandibular posterior areas.Methods:Patients with severely atrophic mandibular posterior areas were prospectively recruited.Cross-mandibular canal implant placement was planned using CBCT data,and implants were placed using a dynamic navigation system.The planned-placed distance deviations at entry(entry deviation)points,exit(exit deviation)points,distance deviation between implant and mandibular canal(distance deviation),and angle deviation of axes(angle deviation)were measured on fused the preoperation CBCT images with the postoperation CBCT images.Results:Eleven implants were placed as planned in 9 patients.The entry deviation,exit deviation,distance deviation and angle deviation were(1.1±0.4)mm,(1.6±0.7)mm,(1.2±0.4)mm and(3.2±1.1)°,respectively.Implant positions deviated from planed slightly.Injury of the mandibular nerve does not occur in all cases.The implants were stable with good masticatory function 3~6 months after loading.Conclusion:A dynamic navigation system used for the placement of cross-mandibular canal implant in the mandibular posterior areas demonstrated a high level of accuracy with only minimal planned-placed deviations,avoiding any injury to nervous structures.