牙支持式半程导板在种植手术中的精度研究

Study on the application of tooth-supported half guided surgical templates in implant surgery

目的:研究数字化牙支持式半程导板的安全性,探讨影响其精确性的因素。方法:选择50例2022年1~12月于上海市口腔医院修复科,行牙支持式半程手术导板辅助口腔种植术的患者,共种植成功65枚。使用3Shape软件测量和比对患者术后种植体的实际位点与术前设计的种植体虚拟位点的偏差,评估在使用牙支持式半程手术导板引导下的种植手术的精确度。结果:65枚种植体在轴向,颊舌向,近远中向的颈部偏差分别为(0.31±1.3)mm,(0.47±1.71)mm,(0.22±1.88)mm;根尖偏差:(0.35±1.82)mm,(0.45±2.33)mm,(0.09±2.33)mm;角度偏差:(5.7±4.01)°,(4.71±3.66)°;对照组(0.079 mm偏差值)与实验组种植体在三维方向上的种植偏差值无统计学意义(P>0.05)。单颗与多颗种植体颈部和根尖部在近远中向偏差<轴向偏差<颊舌向偏差,在颊舌向整体呈现颊向偏移,在近远中向略偏向近中。前牙种植体颈部偏差在三维方向上略小于后牙,但角度偏差略大于后牙,但前牙和后牙种植体的偏差无统计学意义(P>0.05)。结论:数字化牙支持式半程导板在辅助牙种植手术时,单颗/多颗,前牙/后牙种植体上不同位点之间偏差值均无统计学差异,且在2 mm安全范围内,数字化牙支持式半程导板对于保证手术精准开展具有重要临床意义。

Objective:To evaluate the safety of tooth-supported half guided templates using digital methods,and explore the factors affecting the accuracy of this templates.Methods:Fifty patients with dental implant assisted by tooth-supported half guided templates were included in the Prosthodontics Department of Shanghai Stomatological Hospital,from January to December 2022,with a total of 65 successful implants.Using 3Shape software to measure and compare the implant implantation of the actual location and design position between the deviation.Results:The cervical deviation of 65 implants,directions of the axial,buccal/lingual,mesial/distal was(0.31±1.3)mm,(0.47±1.71)mm,(0.22±1.88)mm,in apical deviation that of(0.35±1.82)mm,(0.45±2.33)mm,(0.09±2.33)mm,respectively,and in angle deviation that(5.7±4.01)°,(4.71±3.66)°.There was no significant difference between the deviation value of 0.079 mm in the control group and the implant deviation in the test group in the three directions(P>0.05).The cervical and apical deviation of single and multiple implants in the mesial/distal was lesser than that in the axial,and lesser than buccal/lingual direction.The overall deviation in the buccal/lingual direction was buccal,and the deviation in the mesial/distal direction was slightly biased to the mesial.The cervical deviation of implant anterior was slightly smaller than that of posterior in three directions,but the angle deviation was slightly larger than that of posterior teeth.There was no significant difference in the deviation between anterior and posterior implants(P>0.05).Conclusion:There was no significant difference in the deviation value between single/multiple implant or anterior/posterior implants,the deviation values of these sites all meet the safe range of the application of the guide plate(within 2 mm),which has clinical significance to ensure the accurate operation.