分置式可测量种植导板在多颗前牙即刻种植即刻修复中的应用

Application of measurable surgical guides in immediate implant placement and immediate restoration

本文报道1例应用分置式可测量种植导板引导的即刻种植即刻修复技术,修复牙外伤所致的12-22牙缺失。术前根据咬合记录,在exoCAD软件中设计上部目标修复体空间轮廓位置,再通过口内和锥形束CT图像实测获得12-22牙位点近远中向、唇腭向和龈向分别在软硬组织水平的空间数据,在Bluesky Plan 4软件中设计比选4个正确种植位点,确认后设计并通过三维打印制作基于三向位置数值的可测量种植导板。术中使用3组可测量种植导板结合测量尺实测依次完成定点、半钻预备及轴向核查、全程预备及三向位置核查和种植体植入,之后再次实测核查种植位点。术后通过转移导板即刻戴入基于目标修复体空间和原天然牙穿龈形态设计、并于术前切削完成的临时修复体。经术后对比测量,种植入口点平均线性偏差为(0.57±0.17) mm,种植止点平均线性偏差为(0.82±0.27) mm,各植体平均角度偏差为(1.86±0.89)°,实现了12-22牙位点种植体的精准植入与同期的即刻修复。

This article reports a case of using immediate implant placement and immediate restoration combined with measurable implant surgical guides to restore compromised maxillary incisors caused by dental trauma.Target restoration was designed in the exoCAD software preoperatively,intraoral measurements were obtained in three directions,and the correct position of virtual implants was determined in BlueSky Plan 4.Afterward,measurable implant guides were designed and fabricated by 3D printing.Under the guidance of the measurable implant surgical guides and intraoperative measurement,the entry point was determined,the axial direction was verified when drilling to half the depth,and the 3D position was verified when drilling to total depth.Implants were inserted followed by verification once again.The temporary restoration,which was designed based on the target restoration and emergence profile of the original teeth and milled preoperatively,was connected to the implant immediately after surgery.Postoperative accuracy analysis showed that the mean linear deviations between the actual implant position and the pre-planned position were(0.57±0.17)mm at the entry point and(0.82±0.27)mm at the apex,and the mean angular deviation was(1.86±0.89)°,demonstrating that precise implant placement and immediate restoration were implemented.