数字化导板引导下不同区域单颗牙种植的精确度分析

Analysis of accuracy of single tooth implants in different regions guided by digital guide plates

目的 探索数字化导板引导下,单颗牙缺失区域对种植体植入精确度的影响,并研究误差产生的原因以及可能的解决办法。方法 研究93例患者植入的132枚种植体。患者术前的口内扫描数据或传统取模数据与圆锥束计算机断层扫描(CBCT)数据结合,以3D打印手术导板引导种植体植入,术后通过CBCT测量种植体三维方向上与术前设计的偏移距离的误差绝对值,比较术前术后的误差。结果 前牙区缺失与后牙区缺失的植入误差之间差异无统计学意义(P>0.05),游离端缺失时在颊舌向及冠根向的误差高于前牙区及后牙区植入误差(P<0.001)。而在游离端缺失的病例中,通过使用传统取模仓扫数据制作的手术导板与使用口内扫描数据相比,冠根向的植入精确度明显更高(P<0.001)。结论 在数字化导板引导下,单颗牙种植的病例中游离端缺失病例的颊舌向和冠根向误差明显高于非游离端病例。而在游离端病例中,通过仓扫传统研究模型制作的数字化导板能降低游离端缺失位点的植入的误差。

Objective To explore the impact of single tooth loss area on implant accuracy guided by digital guide plate,and to study the causes of errors and possible solutions.Methods 132 implants implanted in 93 patients were studied.Patients'preoperative intraoral scanning data or traditional mold acquisition data were combined with CBCT data,and 3D printing surgical guide plate was used to guide implant implantation.After surgery,the absolute error value of the deviation distance between the three-dimensional direction of the implant and the preoperative design were measured by CBCT,and the errors before and after treatment were compared.Results There was no statistically significant difference in implant errors between anterior and posterior tooth loss(P>0.05),when distal-extension was missing,the errors in the buccal lingual and coronal root directions were higher than the implantation errors in the anterior and posterior tooth areas(P<0.001).However,in cases with distal-extension absence,the surgical guide plate made by traditional mold retrieval chamber scanning data had significantly higher implantation accuracy in the coronal root direction compared to that made by intraoral scanning data(P<0.001).Conclusion Among cases with single tooth implantation,the errors in the buccal lingual and coronal root directions of cases with distal-extension absence are significantly higher than cases without distal-extension absence under the guidance of the digital surgical plate.But in cases with distal-extension absence,the digital guide plate made by scanning the traditional research model can reduce the implantation error of the missing site at the distal-extension absence.