种植术区开口度新分类引导的种植引导方式临床决策

Clinical decision making of implant guidance methods guided by new classification of surgical area mouth opening

判断患者是否可以进行种植治疗或选择具体的种植引导方案时,不少医生忽视或者仅采用目测粗略估计患者的开口度,常导致在术中才发现开口度不足而无法完成植入或者角度受限勉强植入产生偏斜等不正确种植位点,进而诱发相关并发症。出现这类问题的主要原因还是术者缺乏对口内术区整体环境几何条件的准确分析与把控,术中出现了手术器械三维空间位阻而产生的。以往的开口度定义是患者大张口时上下中切牙切缘之间的距离,而种植位点可以在任一缺牙牙位,当位于后牙区时其开口度的具体测量方案不能简单等同于以往在前牙区的测量方法,而如何快速便捷地测量获得任一术区开口度的数值,并据此判断能否植入以及是否满足选定引导方式的开口度需求,就是本文讨论的重点。为了避免术区出现空间位阻影响种植治疗,本文介绍了种植术区开口度的新概念、新分类及相应的准确测量方案,并根据实测值建立了以开口度数值为引导的种植治疗引导方案决策树,为种植治疗术前设计提供了一种数量关系决策依据。

When selecting implant guidance methods or judging whether the patient can be implanted,many doctors ignore or only use visual inspection to estimate a patient’s mouth opening.This phenomenon often leads to failure to complete the implantation due to insufficient mouth opening or the deflection of the implant due to limited angle,resulting in the high incidence of corresponding complications.The main reason is that doctors lack accurate analysis and control of the overall geometric conditions of the intraoral surgical area,and three-dimensional position blocking of surgical instruments occurs during the operation.In the past,mouth opening was defined as the distance between the incisor edges of the upper and lower central incisors when the patient opens his mouth widely,and the implant area could be in any missing tooth position.When it is in the posterior tooth area,the specific measurement scheme of the mouth opening could not be simply equivalent to the previous measurement method in the anterior tooth area.However,how to measure quickly and conveniently the mouth opening of any surgical area to determine whether it could be implanted and meet the needs of the selected guidance method remains unclear.This paper introduces new concepts,establishes new classification and corresponding accurate measurement scheme of implant area,and establishes a decision tree of implant methods guided by the actually measured value.Results provide a quantitative basis for rational formulation and implementation of implant treatment.