动态实时导航辅助下颌后牙区牙槽骨骨量不足种植

Dynamic realtime navigation system assisted implant of insufficient alveolar bone in the mandibular posterior area

目的:评价动态实时导航辅助下颌后牙区牙槽骨骨量不足种植手术中的精准度及临床效果。方法:回顾分析2021年1—12月因下颌后牙缺失就诊于中山大学附属第一医院口腔科,且采用动态实时导航辅助植入的23例患者。将术前规划种植体数据和术后实际植入种植体锥形束CT数据导入动态导航精度验证软件,对术前设计与术后植入种植体的三维轴向信息进行误差分析,计算并报告实际种植体顶部、根尖部、角度和深度偏差。使用SPSS 23.0统计学软件,对动态实时导航引导种植体植入术后的精度偏差和植入深度进行数据处理。本研究为符合正态分布的计量资料,采用±s描述。结果:本次计算机辅助动态导航系统指导下完成下颌后牙区25颗种植体植入,获得了良好的初期稳定性,术后CBCT示种植体精确植入规划位置,规避了下牙槽神经及邻近重要解剖结构,未发生相关手术并发症。25颗种植体的总体顶部偏差为(0.23±0.11)mm,根尖部偏差为(0.45±0.29)mm,深度偏差为(0.33±0.32)mm,角度偏差为1.01°±0.65°。结论:动态实时导航辅助下颌后牙区骨量不足种植,可获得良好的植入精度和满意的临床效果。

Objective To evaluate the accuracy and clinical outcome of a realtime navigation system for the implant placement in insufficient alveolar bone in the mandibular posterior area.Methods In the study,23 patients with the loss of mandibular posterior teeth were retrospectively analyzed in department of stomatology,the First Affiliated Hospital of Sun Yat⁃sen University,from January 2021 to December 2021.Cone⁃beam computed tomography(CBCT)was performed by wearing registration devices,and the position of the implants was designed.Then implants were placed for each case with the aid of dynamic real⁃time navigation.The preoperative design scheme and the postoperative CBCT were imported into the dynamic navigation accuracy verification software.The differences of implant accuracy between the designed and the actually placed implants were analyzed,including the mean entry point,apex point and depth deviation as well as overall angular discrepancy.SPSS 23.0 statistical software was used to analyze the data on the accuracy deviation.The measurement data in this study were in accordance with normal distribution and were described by mean±standard deviation.Results In this study,25 implants were implanted in the mandibular posterior area under the guidance of a computer⁃aided dynamic navigation system,and good primary stability was obtained.Postoperative CBCT showed the precise implant planning position,avoiding the damage to nearby anatomical structures such as inferior alveolar nerve,and surgical complications.The mean entry point discrepancy of 25 implants was(0.23±0.11)mm,whereas the deviations at the apex point,in the depth and axis were(0.45±0.29),(0.33±0.32)mm and(1.01°±0.65°),respectively.Conclusion Implant placement in the insufficient alveolar bone in the mandibular posterior area can be achieved with high accuracy and predictable clinical outcome under the guidance of a realtime navigation system.