实测值引导的后牙种植基台的临床决策

Clinical decision making of implant abutment of posterior teeth guided by measured value

如何全程统筹好并且正确选择基台,是最终获得种植修复成功的关键一环。选择不当将出现各种机械及生物并发症,也可能出现反复更换上部结构,甚至无法进行上部修复等难题。究其原因可能与基台的选择高度依赖经验,全程统筹不足,缺乏贯彻始终的易于测量核查的数值要求有关。已有的数值要求,有些是术后测量才有的,对种植术前设计和术中核查校验的指导可及性差。而基于目标修复体空间(target restorative space,TRS)的分析设计及转移,结合测量学常规的要求,本文分别介绍了后牙TRS高度(vertical height of TRS,VTRS)及其测量方案,将TRS种植体平面高度(Implant level VTRS,I-VTRS,I)与软组织垂直厚度(Vertical soft tissue thickness,T)(术后即穿龈深度,gingival height,GH)的实测值作为基台遴选时的全程统筹和实测校对的主控变量,结合术前虚拟种植设计参数值和术后种植系统(implant system,S)愈合基台的尺寸以及术后种植体角度偏差(long axis of implant,L)实测,制定了二期种植上部修复各种基台选择的决策树,通过实测值引导实现了合理的种植修复方案比选。该决策方案的实测变量的英文首字母自由组合就成了LIGHTS字样,因此简称为Lights方案。整体上看该决策树简明便捷,可及性好。

How to properly plan the whole process and select the correct abutments is the key to the success of implant prosthodontics.Improper selection may lead to various mechanical and biological complications,as well as the possibility of repeated replacement of upper prosthesis,or even the failure of restoration.These complications mainly attribute to the fact that the selection of the abutment is highly dependent on experience,the insufficient overall planning,and the lack of measurable quantity index which could be implemented consistently.Some of the existing numerical requirements are only for postoperative measurement,and are poor in the accessibility of guidance for preoperative implant design and intraoperative verification.Base on the analysis,design and transference of TRS and requirements of conventional measurement,this paper defines the vertical-height of TRS(VTRS) and its measurement scheme.The implant level VTRS(I-VTRS,I),vertical soft tissue thickness(T)(postoperative-vertical soft tissue thickness,gingival height,GH) was used as the main control variable for the overall planning and measurement calibration during abutment selection,combined with preoperative virtual implant design parameter values,postoperative implant system(S) healing abutment size and measured valve of postoperative implant angle deviation(long axis of implant,L),making the decision tree for the selection of various abutment bases for the second stage of implant prosthodontics.Guided by the measured values,a reasonable plan for implant prosthodontics is realized.The control variables of this decision plan are freely combined to the word“LIGHTS”,referred as Lights plan.This decision tree which is simple and accessible can guide the selection of implant plans through the measured value.