Optics‑guided Robotic System for Dental Implant Surgery

At present,dental implant surgery mainly relies on the clinical experience of the doctor and the assistance of preoperative medical imaging.However,there are some problems in dental implant surgery,such as narrow space,sight obstruction,inaccurate positioning,and high requirements of doctors’proficiency.Therefore,a dental implant robot system(DIRS)guided by optical navigation is developed in this study,with an x-shaped tool and an irregular pentagonal tracer are designed for spatial registration and needle tip positioning strategy respectively.The coordinate system of each unit in DIRS is unified through system calibration,spatial registration,and needle tip positioning strategy.Then the surgical path is planned on the computed tomography(CT)images in the navigation software before operation.The automatic positioning method and the auxiliary positioning method can be used in the operation to achieve accurate positioning and assist doctors to complete the operation.The errors of spatial registration,needle tip positioning strategy,and the overall accuracy of the system were evaluated respectively,and the results showed that they all met the needs of clinical surgery.This study preliminarily verified the feasibility of the precise positioning method for dental surgery robots and provided certain ideas for subsequent related research.

Prospects of 3D Printing Technology in Dental Medicine

With the continuous advancement of technology,the application of 3D printing technology in the field of dental medicine is becoming increasingly widespread.This article aims to explore the current applications and future potential of 3D printing technology in dental medicine and to analyze its benefits and challenges.It first introduces the current state of 3D printing technology in dental implants,crowns,bridges,orthodontics,and maxillofacial surgery.It then discusses the potential applications of 3D printing technology in oral tissue engineering,drug delivery systems,personalized dental prosthetics,and surgical planning.Finally,it analyzes the benefits of 3D printing technology in dental medicine,such as improving treatment accuracy and patient comfort,and shortening treatment times,while also highlighting the challenges faced,such as costs,material choices,and technical limitations.This article aims to provide a reference for professionals in the field of dental medicine and to promote the further application and development of 3D printing technology in this area.

Long-term clinical performance of flapless implant surgery compared to the conventional approach with flap elevation:A systematic review and meta-analysis

BACKGROUND The conventional implant approach involves flap elevation,which may result in increased soft tissue and bone loss and postoperative morbidity.The flapless surgical technique,aided by three-dimensional medical imaging equipment,is regarded as a possible alternative to the conventional approach to alleviate the above issues.Several studies have been performed regarding the role of flapless implant surgery.However,the results are inconsistent and there is no robust synthesis of long-term evidence to better inform surgeons regarding which type of surgical technique is more beneficial to the long-term prognosis of patients in need of implant insertion.AIM To compare the long-term clinical performance after flapless implant surgery to that after the conventional approach with flap elevation.METHODS PubMed,EMBASE,Cochrane Central Register of Controlled Trials,and grey literature databases were searched from inception to 23 September 2019.Randomised controlled trials (RCTs) and cohort studies comparing the long-term clinical performance after flapless implant surgery to that after the conventional approach over a follow-up of three years or more were induded.Meta-analyses were conducted to estimate the odds ratios (ORs) or mean differences (MDs) and their 95 To confidence intervals (CIs) between the long-term implant survival rate,marginal bone loss,and complication rate of the flapless and conventional groups.Subgroup analyses were carried out to account for the possible effects of the guided or free-hand method during flapless surgery.RESULTS Ten articles,including four RCTs and six cohort studies,satisfied the eligibility criteria and nine of them were inclded in the meta-analysis.There was no significant difference between the long-term implant survival rate [OR=1.30,95%CI (0.37,4.54),P=0.68],marginal bone loss [MD=0.01,95%CI (-0.42,0.44),P=0.97],and complication rate [OR=1.44,95%CI (0.77,2.68),P=0.25] after flapless implant surgery and the conventional approach.Moreover,subgroup analyses revealed that there was no statistically significant difference between the implant survival rate [guided:OR=1.52,95%CI (0.19,12.35),P=0.70];free-hand:n=1,could not be estimated),marginal bone loss [guided:MD=0.22,95%CI (-0.14,0.59),P=0.23;free-hand:MD=-0.27,95%CI (-1.10,0.57),P=0.53],or complication rate [guided:OR=1.16,95%CI (0.52,2.63),P=0.71;free-hand:OR=1.75,95%CI(0.66,4.63),P=0.26] in the flapless and conventional groups either with use of the surgical guide or by the free-hand method.CONCLUSION The flapless surgery and conventional approach had comparable clinical performance over three years or more.The guided or free-hand technique does not significantly affect the long-term outcomes of flapless surgery.

Extraordinary sneeze:Spontaneous transmaxillarytransnasal discharge of a migrated dental implant

This case report describes an extraordinary case of the spontaneous transmaxillary-transnasal discharge of a dental implant, which occurred during a sneeze. The patient was complained of symptoms of acute sinusitis. She underwent a computed tomography scan that revealed a dental implant dislocated in the maxillary sinus. Medical treatment based on antibiotics and mucolytics was administered to the patient in order to prepare her for endoscopic endonasal surgery. The implant was spontaneously discharged two days after during a sneeze. Mucociliary clearance in combination with a local osteolytic inflammatory process and mucolytics therapy are the likely causes of this unusual discharge.

“互联网+护理”模式在老年患者种植牙围手术期的应用及效果研究

目的研究“互联网+护理”模式在老年患者种植牙围手术期中的应用及其疗效。方法以2022年1月至2023年6月在南京医科大学附属口腔医院接受口腔种植手术的老年患者90例为研究对象,按随机数字表法分成对照组(45例)和观察组(45例),分别进行常规护理和“互联网+护理”模式护理。两组患者均进行半年的观察随访。比较两组患者视觉模拟评分法(VAS)评分、疼痛天数、红色美学指数(PES)评分、焦虑自评量表(SAS)评分。结果术后观察组患者VAS评分、疼痛天数、PES评分、SAS评分分别为(2.06±0.55)分、(3.11±1.32)d、(16.56±0.87)分、(31.07±6.45)分,对照组患者分别为(4.83±1.24)分、(4.12±2.21)d、(12.75±1.03)分、(39.27±9.79)分,两组比较差异有统计学意义(均P<0.05)。结论“互联网+护理”可以提高老年患者在围手术期和术后的心理承受度,减少患者焦虑,减轻患者疼痛,增加美观满意程度,值得临床推广应用。

口腔种植机器人的研究进展和应用现状

随着人工智能和数字化技术在口腔医学领域的发展,口腔种植机器人有效提高了牙种植手术的精确度,达到了以修复为导向的治疗目的,获得了长远的治疗效果。相比传统外科数字化种植技术,种植机器人结合了动态导航技术实时反馈手术信息、及时调整手术规划的优点,开发和运用6自由度机械臂,改变了传统种植的方式,有效避免了手部的震颤,达到了更加微创、安全和可预测的治疗效果。本文就种植机器人的组成结构、临床操作流程、国内外研究和应用现状及其优缺点进行综述,以期为种植机器人的临床使用提供参考。

自主式口腔种植机器人牙列缺损种植修复的临床回顾性研究

目的:回顾性分析自主式口腔种植机器人(ADIR)牙列缺损种植修复随访1年的临床疗效。方法:纳入20例自主式口腔种植机器人牙列缺损种植病例,分析术后种植体的肩部偏差、颈部偏差和角度偏差。测量并记录修复后即刻、修复后6、 12个月种植体边缘骨高度和种植体周围软组织情况。结果:20颗种植体的肩部偏差、根部偏差以及角度偏差分别是(0.34±0.11) mm,(0.34±0.15) mm,(0.82°±0.38°),且不同种植体直径和长度的对精度的影响无统计学意义(P>0.05)。随访期内,所有植体周围边缘骨高度稳定,均获得良好骨结合,种植体周围软组织情况良好。结论:ADIR在牙列缺损种植修复1年内应用效果良好,但仍需长期的随访研究验证。

口腔种植机器人的精度及应用现状

口腔种植修复已成为牙列缺损及牙列缺失患者的首选治疗方式。精准植入种植体不仅能有效避免损伤口腔重要解剖结构,对于精准修复及种植体长期稳定亦有重要意义。近年来,随着计算机技术的蓬勃发展,种植手术也逐渐实现智能化、现代化。口腔种植机器人具有稳定、精准、微创等优势,可实现种植手术的个性化、精准化、高效化。本文就口腔种植机器人的分类、精确度及其影响因素,应用范围等内容进行整理与探讨,以期为临床决策提供参考。

口腔种植机器人的应用现状与研究进展

种植修复是目前牙列缺损、缺失的首选治疗手段。由于口腔种植机器人具有高精度、高稳定性等优异性能,可为口腔种植术提供关键的技术支持,其开发与应用具有良好的发展前景,但目前国内口腔种植机器人的研究还相对较少,本研究对口腔种植机器人的开发历程、主要类型、信息数据采集方式、术中规划与注册、术中操作、优势与缺点以及新近研究进展等进行综述,以期为口腔种植医师提供参考。

老年口腔种植患者术后疼痛状况与术前疼痛敏感度和牙科畏惧的相关性分析

目的探讨老年口腔种植患者术后疼痛与术前疼痛敏感度、牙科畏惧的相关性。方法选取2023年7月至2024年2月南方医科大学口腔医院125例老年口腔种植患者,术前完成疼痛敏感度问卷和牙科畏惧调查,术后采用修订版面部表情疼痛量表、简明疼痛调查表分别评估疼痛强度及其影响。根据术后第1天最重疼痛评分将患者分为轻度(1~3分)、中度(4~6分)和重度(7~10分)疼痛组。采用Logistic回归分析、Spearman相关系数分别分析术后疼痛的影响因素及其与术前疼痛敏感度和牙科畏惧的相关性。结果患者术后6 h疼痛评分为4(2,6),术后第1天最重疼痛为6(4,8)分,第2天后降为轻度,至第7天基本无痛感。术后第1天疼痛对患者睡眠影响为2(0,5)分。术后第1天,最重疼痛为轻度、中度和重度的患者分别占13.6%、47.2%、39.2%,3组患者在疼痛敏感度、种植体植入颗数、手术方式、口服镇痛药方面比较,差异有统计学意义(P<0.05);种植体植入≥2颗、口服镇痛药是术后疼痛的影响因素(P<0.05)。术前疼痛敏感度和牙科畏惧与术后疼痛影响相关。结论老年口腔种植患者术后经历轻度至重度疼痛,术后第1天疼痛强度及对睡眠影响较重,疼痛强度受种植体植入颗数和口服镇痛药等因素影响。应关注术前疼痛敏感度偏高和牙科畏惧程度较重的患者,减少术后疼痛对患者的影响。

数字化导板引导的口腔种植修复术在牙列缺损患者中的应用效果

目的分析数字化导板引导的口腔种植修复术在牙列缺损患者中的应用效果。方法选取2021年5月至2022年4月南阳市口腔医院收治的96例牙列缺损患者,按随机数表法分为两组,各48例。对照组接受常规口腔种植修复术治疗,试验组接受数字化导板引导的口腔种植修复术。比较两组种植精准度、术后恢复情况、牙周健康指数[牙龈指数(GI)、菌斑指数(PLI)]、术后修复美学效果[红色美学评分(PES)、白色美学评分(WES)]及并发症发生率。结果与对照组比较,试验组颈部距离偏差、根尖部距离偏差、深度偏差、角度偏差小(P<0.05),术后疼痛持续时间、肿胀持续时间、饮食恢复正常时间短(P<0.05)。术后7 d与对照组比较,试验组GI、PLI指数低(P<0.05);术后7 d、术后6个月与对照组比较,试验组PES评分、WES评分高(P<0.05);试验组并发症发生率较对照组低(P<0.05)。结论数字化导板引导的口腔种植修复术应用于牙列缺损治疗中,可提升种植精准度和修复美学效果,缩短术后疼痛及肿胀持续时间,改善患者牙周健康,且术后并发症较少。

下颌神经管分支在下颌骨内的走行

目的 通过观察胶东地区成年人口腔锥形束CT(cone beam computed lomography, CBCT)结果,对下颌神经管的分支在下颌骨内走行进行分析统计,为口腔医学临床工作尤其是牙槽外科、口腔种植科操作提供准确的临床影像数据。方法 选取2021年12月到2022年1月期间在烟台市口腔医院拍摄CBCT影像且符合纳入标准的188例成年人(男性78人,女性110人,年龄18~59岁)患者的口腔CBCT数据,应用NNT图像系统分析观察,汇总统计分支发生率。结果 下颌神经管分支发生率为52.12%,侧别发生率为43.35%,其中Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ型的发生率分别为11.70%、9.30%、9.84%、6.38%、6.11%。男性和女性左侧和右侧下颌神经管分支的发生率的差异无统计学意义(P>0.05)。结论 CBCT相较于平片更能够清晰显示下颌神经管及其分支的解剖特征,对于牙槽外科及口腔种植科进行手术时,可以更细致进行术前设计,避免损伤神经分支。

口腔种植机器人在不同牙位植入精度研究

【目的】探究口腔种植机器人在不同牙位种植手术中的精度。【方法】按照标准纳入延期种植患者共5名、16颗种植体。按照标准的口腔种植机器人操作流程进行种植体窝洞预备及植入,术后拍摄CBCT,进而评估实际植入位点与设计位点之间的偏差,对不同牙位种植偏差进行统计分析。【结果】将16颗种植体按照牙位分为上颌及下颌牙位、前牙区及后牙区牙位和左侧及右侧牙位三类牙位,在该三类中植入点偏差(包括总偏差、横向偏差和深度偏差)、根尖点偏差(包括总偏差、横向偏差和深度偏差)和角度偏差中,仅有前牙区及后牙区植入点横向偏差具有统计学差异,其余均无统计学差异。【结论】口腔种植机器人辅助种植手术在不同牙位之间均有着良好的精准度,获得满意的临床效果。

口腔种植手术中微创技术与传统方法的应用效果对比

目的:在口腔种植手术中分别采用微创技术与传统方法,观察比较两者的应用效果。方法:将2022年1月至2023年12月晋江市安海医院口腔科收治并通过种植修复方式完成修复治疗的牙齿、牙列缺失患者100例作为试验对象,随机分为观察组和对照组,各50例。对照组行传统种植手术,观察组行微创种植手术,统计比较两组的手术时间、创口愈合时间、治疗费用、治疗效果、美观性及术后并发症发生率。结果:与对照组相比,观察组手术时间和创口愈合时间均更短,治疗费用更高,差异有统计学意义(P<0.05)。两组治疗总有效率均为94.00%,差异无统计学意义(P>0.05)。观察组种植修复后美观性评分(10.31±1.53)分,显著高于对照组的(8.12±1.67)分,差异有统计学意义(P<0.05)。观察组术后并发症发生率2.00%,显著低于对照组的12.00%,差异有统计学意义(P<0.05)。结论:在口腔种植手术中,采用微创技术比传统方法更能降低患者术后并发症发生率,提升种植体美观性,在临床上应用价值较高。

口腔种植机器人辅助手术与传统种植手术的护理配合比较

目的:探讨口腔种植机器人辅助种植手术与传统种植手术护理配合的不同,为临床口腔护士进行机器人手术护理配合提供参考。方法:分析总结南方医科大学口腔医院特诊中心2022年1月—2022年2月3例行口腔种植机器人辅助种植手术患者的围手术期护理配合流程,并与传统口腔种植手术护理配合进行对比。结果:与传统口腔种植手术护理配合相比,口腔种植机器人辅助手术在护士培训、术前准备、术中护理配合、术后处置等方面存在一定差异。结论:口腔种植机器人的应用与推广,为微创精准的术式提供了启示,改变了传统种植手术护理配合的方式,建议护士加强培训,建立相应的流程与规范,以便适应口腔机器人辅助种植技术日新月异的变化。

自主式口腔种植机器人术中常见故障及应对策略

目的:总结自主式口腔种植机器人术中常见故障并提出相应的应对策略,为临床操作提供参考。方法:回顾性分析2020年7月—2023年4月空军军医大学第三附属医院数字化口腔医学中心256例自主式口腔种植机器人手术中发生的器械故障及其原因,并提出解决方案。结果:在256例手术中,记录到31次器械故障,其中显示器黑屏4例(12.9%)、视觉相机识别异常12例(38.7%)、机械臂停止运动11例(35.5%),触控屏无反应4例(12.9%)。分析其原因,操作因素占比71.0%(22例)、设备因素占比22.5%(7例)、环境因素占比6.5%(2例)。临床医务人员和技术人员合作解决了术中器械故障,未对患者造成不良影响。结论:口腔种植机器人术中故障难以完全避免,通过总结常见故障并提出应对策略,能够帮助医护人员快速处理术中问题,保障手术顺利进行。

新型牙龈钳对种植牙手术患者牙龈修整边缘整齐度、美观度及术后恢复的影响

目的研究新型牙龈钳对种植牙手术患者牙龈修整边缘整齐度、美观度及术后恢复的影响。方法随机选取2020年12月至2022年12月进行种植牙手术的140例患者为研究对象,使用随机数字表法将其分为对照组(n=70)和观察组(n=70)。对照组使用手术刀修整牙龈,观察组使用新型牙龈钳修护牙龈。比较两组的修复后边缘整齐度、美观度、术后恢复情况、手术时间及满意度。结果观察组的修复后边缘整齐度、美观度、术后恢复优良率及满意度均高于对照组,差异具有统计学意义(P<0.05);观察组的手术时间短于对照组,差异具有统计学意义(P<0.05)。结论新型牙龈钳对种植牙手术患者牙龈修整边缘整齐度、美观度及术后恢复具有积极影响,且患者的满意度较高,值得在临床中进行推广和应用。

Simultaneous Upper and Lower Jaw Extractions, Autogenous Bone Augmentation and Temporary Implant Placement with Immediate Loading

Aims: We expanded the known technique for simultaneously augmenting an atrophic maxilla and placement of immediate provisional implants (IPI), followed by immediate loading by performing surgery in both jaws simultaneously. Feasibility of this new technique, implant survival and success were evaluated as well as prosthetic success. Materials and Methods: All patients undergoing simultaneous bone grafting and IPI placement with immediate loading at our institute between the 1st of June 2016 and the 30th of May 2018 were included and followed up for at least one year postoperatively. Results: 3 patients were followed for a mean period of 25.67 months (20 - 29 months). 33 IPIs were placed. All were immobile at second stage surgery without signs of infection. No provisional bridges were lost and no infections were noted. After second stage surgery, none of these 36 final dental implants were lost. There was some bone loss at one implant. In all patients, good functional and aesthetic results were obtained without any unforeseen complications. This renders the implant survival at 100% and the success rate at 97%. Conclusion: The technique is complex due to the intricate step-by-step process that is required and depends on a dedicated team to ensure a proper workflow. When performed correctly, the protocol shows good and predictable results.

数字化静态导板与种植机器人系统辅助无牙颌种植手术的精度分析

目的 评价数字化静态导板与种植机器人辅助无牙颌种植手术的精确性。方法 选择2021年5月-2022年10月于南京医科大学附属医院口腔种植科行种植手术的8例牙列缺失患者(共62枚植体),随机分为两组,第1组应用数字化静态导板行种植手术(n=31),第2组行种植机器人植入牙种植体手术(n=31)。术后比较两组种植体植入点、根尖点和角度偏差。结果 数字化静态导板组植入点偏差为0.98±0.21 mm,根尖点偏差为1.34±0.21 mm和角度偏差为3.20±0.67°;种植机器人组植入点偏差为0.49±0.25 mm,根尖点偏差为0.57±0.23 mm,角度偏差为1.95±0.82°。两组种植体的植入点、根尖点和角度偏差有统计学差异(P <0.05)。结论 与静态导板相比,种植机器人辅助无牙颌种植手术的精确性更高。

机器人系统辅助口腔种植手术精度的Meta分析

目的系统评价机器人系统辅助实施种植手术的精确性。方法计算机检索Pubmed、Embase、Cochranelibrary、中国知网、维普、万方、CBM数据库中机器人辅助下进行种植手术的研究,包括体外模型实验、动物实验和临床研究,检索时限为建库至2023年1月。主要结局指标为测量植入种植体位置与设计位置在三维方向上的误差,包括种植体颈部、种植体根尖及种植体轴向角度的误差大小。用Stata17.0对数据进行合并分析。亚组分析用于比较不同的研究设计、是否植入种植体和不同机器人系统的偏差。结果最终纳入14篇文献,其中模型实验有9项,临床研究3项,动物实验3项,共计705个植入位点。Meta分析结果显示,机器人辅助下种植手术在种植体颈部偏差为0.72 mm(95%CI:0.63~0.81,I^(2)=93.2%)、种植体根尖偏差为0.90mm(95%CI:0.76~1.03,I^(2)=95.7%)、种植体角度偏差为1.57°(95%CI:1.26~1.88,I^(2)=98.1%)。结论种植手术机器人已达到临床可接受的精度,现有研究大多数为模型实验,有待更多的临床研究来进一步丰富数据。