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随着数字化技术的发展和CBCT的普及,术前制作手术导板引导种植体植入,可以实现以修复为导向的精确植入,提高修复质量,减少手术创伤,节省时间,降低技术敏感性,特别是连续多牙缺失,无牙颌及牙槽骨条件较差的患者。但因患者个体差异、数字化信息采集技术、种植系统及导板设计软件、引导系统、制作方法、术中应用,甚至医生经验等因素的影响,可能发生误差,每个因素产生的误差逐步累积,影响最终手术导板的精确性,甚至不得不放弃导板改为自由手操作。本文就数字化种植手术导板的组成、虚拟设计与制作步骤、术中应用等相关因素进行综述,为数字化手术导板在临床的准确应用提供帮助。 相似文献
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目的 比较混合支持式和黏膜支持式数字化全程手术导板对全口种植位点精确性的影响。方法 22名无牙颌或潜在无牙颌患者共136枚种植体分为2组,混合支持式组(A组,72例)和黏膜支持式组(B组,64例)。测量实际植入与术前设计的种植体角度、颈部、根尖及深度的偏移。运用统计学方法分析影响种植体植入精确度的相关因素。结果 混合支持式组与黏膜支持式组与在种植体的角度、颈部、根尖及深度的差异有统计学意义(P <0.05)。不同支持方式在8 mm、10 mm、12 mm种植体的偏移差异有统计学意义(P <0.05)。结论 全程导板引导下的全口种植手术中,混合支持式导板精确度高于黏膜支持式导板,种植体植入深度影响种植体位置的精确性。 相似文献
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在计算机辅助种植外科中,数字化种植导板具有控制好种植体植入角度、方向,降低手术风险,减少手术时间,并可以实现不翻瓣种植术后即刻修复等优势,但仍存在精确度欠佳及由此产生一定的并发症等问题。本文就种植导板简介、计算机辅助种植外科研究现状、导板精确性评估及并发症分析进行综述,并总结其适应症,以期为临床医生在应用这项技术时提供参考。 相似文献
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目的 :评估利用数字化导板进行种植手术的精确度,探讨其在口腔种植中的优势和临床应用价值。方法 :选择2013年2月—2013年12月在上海交通大学医学院附属第九人民医院口腔外科行种植手术的60例牙列缺损患者,随机分为Ⅰ、Ⅱ2组,每组30例。术前均拍摄口腔颌面部锥形束CT,并利用Simplant软件规划手术方案。其中I组采用无种植导板辅助植入种植体;Ⅱ组利用快速成型技术制作数字化导板,辅助植入种植体。术后2组均拍摄口腔颌面部锥形束CT,利用Simplant软件将术前图像与术后图像进行配准融合,测量比较种植体实际位置与术前设计的差异。所得数据采用SPSS 18.0软件包进行统计学分析。结果 :Ⅰ组共植入52颗种植体,测量偏差为:顶部(2.07±0.51) mm(1.33~2.79 mm),根尖部(2.89±1.02) mm(1.51~4.43 mm),深度(0.78±0.33) mm(0.30~1.28 mm)和角度(8.84±4.64)°(3.29~16.21°);Ⅱ组共植入57颗种植体,测量偏差为:顶部(1.18±0.72) mm(0.12~2.35 mm),根尖部(1.43±0.74) mm(0.20~2.66 mm),深度(0.54±0.29) mm(0.20~1.07 mm)和角度(4.21±1.91)°(0.82~7.79°)。种植体植入的精确度在顶部、根尖部和角度有显著差异(P<0.01),而深度偏差无显著差异(P>0.05)。结论 :利用数字化导板辅助种植手术,可以更好地控制种植体植入的精确度,具有良好的应用前景。 相似文献
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随着现代口腔种植修复技术的发展,数字化种植导板能很好地控制种植体植入的角度、方向及深度,具有缩短手术时间、降低手术风险、可实现不翻瓣种植等优势,已被更多地应用于临床,同时仍存在制作过程复杂、成本较高、地域条件的差异、精确度欠佳等问题.本文对数字化种植导板制作、分类、精确性等方面进行综述,为口腔种植医生应用数字化口腔种植技术提供参考. 相似文献
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目的评价分析计算机辅助设计和制作种植导板应用于多牙缺失患者的种植术后误差。方法选择多牙缺失患者20例,采集CT数据,利用彩立方Tooth Implant软件进行数据分析,拟定植入位点及确定手术计划并制作最终导板。口内戴入导板,植入种植体,选用相应型号的即刻修复基台,术后48 h内戴入即刻修复体。并于术后拍摄CT,测量术前、术后种植体在颌骨内的深度、近远中向及唇舌向的倾斜角度,计算术后误差,3个月后完成最终义齿修复。于修复后3个月、6个月及1年后评价种植体存留率。结果 20例多牙缺失患者共植入139枚种植体,种植体植入位置精确性好,观察期内有2枚种植体脱落,其余137枚种植体牙周软组织健康,无种植体周围炎发生。结论应用计算机辅助设计和制作的种植导板对于提高种植手术的质量与精度具有重要意义,可以指导临床医生植入种植体时避免伤及重要解剖结构,即刻修复极大地改善了患者术后生活质量,但仍需进一步跟踪观察其长期应用效果。 相似文献
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目的 本项研究旨在探索榫卯连接式全程数字化组合导板在全口种植外科手术中应用的临床效果.方法 本项研究选取一位由于重度牙周炎导致全口上下颌牙槽骨吸收至根尖1/3,全口上下颌牙齿松动III度,要求全口种植修复的患者为研究对象.运用一项自主设计研发的榫卯连接式全程数字化组合导板,该导板利用榫卯式的连接,将定位导板、截骨导板、... 相似文献
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Jee-Ho Lee Ji-Man Park Soung-Min Kim Myung-Joo Kim Jong-Ho Lee Myung-Jin Kim 《The journal of advanced prosthodontics》2013,5(4):440-447
PURPOSE
Template-guided implant therapy has developed hand-in-hand with computed tomography (CT) to improve the accuracy of implant surgery and future prosthodontic treatment. In our present study, the accuracy and causative factors for computer-assisted implant surgery were assessed to further validate the stable clinical application of this technique.MATERIALS AND METHODS
A total of 102 implants in 48 patients were included in this study. Implant surgery was performed with a stereolithographic template. Pre- and post-operative CTs were used to compare the planned and placed implants. Accuracy and related factors were statistically analyzed with the Spearman correlation method and the linear mixed model. Differences were considered to be statistically significant at P≤.05.RESULTS
The mean errors of computer-assisted implant surgery were 1.09 mm at the coronal center, 1.56 mm at the apical center, and the axis deviation was 3.80°. The coronal and apical errors of the implants were found to be strongly correlated. The errors developed at the coronal center were magnified at the apical center by the fixture length. The case of anterior edentulous area and longer fixtures affected the accuracy of the implant template.CONCLUSION
The control of errors at the coronal center and stabilization of the anterior part of the template are needed for safe implant surgery and future prosthodontic treatment. 相似文献12.
《Journal of cranio-maxillo-facial surgery》2014,42(7):1530-1535
ObjectiveThis study investigates the usefulness of a navigation method using a reference frame directly fixed to the mandible compared to the stereolithographic (STL) surgical guide template method in dental implant surgery.Materials and methodsTwenty rapid prototyping (RP) mandibular models were divided into two groups. Simulation surgery was performed using SimPlant software for both groups. The actual dental implants were placed in the RP models using a real-time navigation system or the surgical guide template, which was fabricated based on STL data by a 3-dimensional printer. Positional implantation errors were measured by comparing the simulation surgery implant positions to the actual postoperative implant positions.ResultsThe vertical distance error of the top surface area in the first molar region was not significantly different between groups. Otherwise, the implantation method using real-time navigation showed greater errors except for the horizontal and vertical errors in the apical area of the canine region.ConclusionThe STL surgical guide template was associated with fewer errors than the real-time navigation method in dental implant surgery. 相似文献
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《International journal of oral and maxillofacial surgery》2014,43(1):85-92
Computer-aided implantology using a single fixed stereolithographic surgical guide involves a sequence of diagnostic and therapeutic events, and errors can creep in at different stages. Taken together, these can be termed the ‘total error’. A positioning of the surgical guide on the support surface different to that of the diagnostic template may generate an error that reoccurs with all the implants inserted, and this error can be termed the ‘guide positioning error’. The aim of the present study was to measure the deviation between the planned and inserted implants due to this guide positioning error, to evaluate if this error was statistically significant, and concurrently, to assess the influence of the type of arch (upper vs lower jaw) and mucosal thickness on the guide positioning error. Twenty-four subjects were treated and 172 implants inserted. Preoperative and postoperative computed tomography images were compared using Mimics software to determine the total error and guide positioning error. Quantitative data were described; the t-test and Pearson correlation coefficient were used. The guide positioning error was found to affect the accuracy, but was statistically significant only for global coronal deviation (P = 0.038). Arch of support and mucosa thickness did not affect the guide positioning error. 相似文献
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Wenjuan Zhou Zhonghao Liu Liansheng Song Chia-ling Kuo David M. Shafer 《Journal of Evidence》2018,18(1):28-40
Objectives
To systematically review the current dental literature regarding clinical accuracy of guided implant surgery and to analyze the involved clinical factors.Material and Methods
PubMed and Cochrane Central Register of Controlled Trials were searched. Meta-analysis and meta-regression analysis were performed. Clinical studies with the following outcome measurements were included: (1) angle deviation, (2) deviation at the entry point, and (3) deviation at the apex. The involved clinical factors were further evaluated.Results
Fourteen clinical studies from 1951 articles initially identified met the inclusion criteria. Meta-regression analysis revealed a mean deviation at the entry point of 1.25 mm (95% confidence interval [CI]: 1.22-1.29), 1.57 mm (95% CI: 1.53-1.62) at the apex, and 4.1° in angle (95% CI: 3.97-4.23). A statistically significant difference (P < .001) was observed in angular deviations between the maxilla and mandible. Partially guided surgery showed a statistically significant greater deviation in angle (P < .001), at the entry point (P < .001), and at the apex (P < .001) compared with totally guided surgery. The outcome of guided surgery with flapless approach indicated significantly more accuracy in angle (P < .001), at the entry point (P < .001), and at apex (P < .001). Significant differences were observed in angular deviation based on the use of fixation screw (P < .001).Conclusions
The position of guide, guide fixation, type of guide, and flap approach could influence the accuracy of computer-aided implant surgery. A totally guided system using fixation screws with a flapless protocol demonstrated the greatest accuracy. Future clinical research should use a standardized measurement technique for improved accuracy. 相似文献15.
目的分析翻瓣与不翻瓣种植手术的疗效对比,为临床合理选择种植手术方式提供依据。 方法分别检索PubMed、Cochrane Library、Web of Science和Embase等数据库,时间为数据库建库至2021年9月1日,以Dental impalnts、Surgical flaps、Surgery等主题词及其下位词,查找关于翻瓣与不翻瓣种植手术的相关文献,严格按照纳入、排除标准进行筛选,对纳入的文献进行质量评估,提取关于翻瓣与不翻瓣种植手术疗效相关的数据,包括共提取失败例数、手术时间、炎症、肿胀、改良菌斑指数(MPI)、牙龈出血指数(MSBI)、牙周袋深度(PD)、语言模拟疼痛评估量表(VAS)、种植体稳定性商数值(ISQ)、骨吸收、近中骨吸收、远中骨吸收、即刻负重近中骨吸收和即刻负重远中骨吸收等。采用RevMan 5.3软件计算疗效指标的比值比(OR)或均数差(MD)和95%置信区间(CI),采用StataSE 12.0软件对存在异质性的研究进行敏感性分析和发表偏倚检验。 结果共纳入24篇相关研究,报道含翻瓣种植手术1 124例,不翻瓣种植手术1 184例。研究结果显示,不翻瓣种植术后MSBI[OR = -0.12,95% CI(-0.22,-0.01),P = 0.03]、PD[OR = -0.21,95% CI(-0.25,-0.17),P<0.001]、VAS[OR = -0.39,95% CI(-0.60,-0.19),P = 0.000 2]、骨吸收[OR = -0.11,95% CI(-0.18,-0.03),P = 0.007]明显低于翻瓣种植手术,差异有统计学意义;失败例数、MPI、ISQ、即刻负重近中骨吸收、即刻负重远中骨吸收在翻瓣与不翻瓣种植手术均无明显差异(P>0.05)。 结论不翻瓣种植术后疼痛的发生明显低于翻瓣种植手术,负荷后牙龈出血、牙周袋深度和骨吸收明显低于翻瓣种植手术。临床工作中,应根据病例的软硬组织条件选择适当的种植手术方式,不翻瓣种植手术具有更大优势。 相似文献
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目的探讨放射定位标记模板技术在种植手术前三维影像分析中的作用和意义。方法应用空气压模技术制作标记有放射线阻射剂拟种植位点的放射模板,通过牙种植外科石膏模型,受试注塑模型、颅骨颌骨标本及临床种植病人颌骨的螺旋CT扫描,获取颌骨受植区域拟种植部位骨三维结构CT数据。结果确立的扫描平面即调整牙合平面与地面垂直(与X轴坐标线一致)能获得最佳侧断层图像;所有标记的CT模板均可在CT扫描后的轴位图像及颌重建侧断层和全景图像中清晰显现,且能达到准确的标定预种植位点。结论基于放射标记定位模板的评估方法可为种植外科前三维影像分析提供更为精确的手段,更有助于CAD/CAM种植外科定位导向模板的合理设计。 相似文献
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目的:通过CT扫描、计算机辅助设计和制造技术获得带有不同定位方式的通用型种植导板精度。方法:采用通用型导板进行种植,然后获取90颗种植体的术后位置数据,并按照黏膜支撑导板和牙支撑导板进行分类,最后将该数据与术前设计数据进行比较,并以种植体颈部、顶部、深度和角度误差进行描述。结果:牙支撑导板的平均颈部偏差为1.56 mm,顶部平均偏差1.78 mm,深度平均偏差1.1 mm,角度平均偏差2.96°;黏膜支撑导板平均颈部偏差1.71 mm,平均顶端偏差1.9 mm,深度平均深度偏差1.09 mm,角度平均偏差3.19°。结论:牙支持导板与黏膜导板相比,牙支持导板精度更高;与专用导板相比通用导板在颈部误差方面要偏大,而在深度、顶端和角度误差方面则没有显著差异。 相似文献
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后牙区牙种植手术导板准确性的初步研究 总被引:1,自引:0,他引:1
目的:减少种植定位的偏差,取得种植预期设计效果。方法:确定种植手术导板的厚度为4mm,孔径为2.3mm,计算其最大理论偏差;并根据从种植义齿(牙合)面到种植体顶端的距离,求得最大理论偏差。另通过在石膏模型上定位,测量种植体中心螺丝的中心出孔位置与手术导板中心出孔位置间的距离,求得实际偏差,由此比较理论偏差与实际偏差的大小。结果:后牙区种植手术导板实际偏差不明显,但游离组存在偏差的可能性较非游离组大。结论:种植手术导板是满足精确定位的前提,手术导板的固位影响手术导板的准确性。 相似文献
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目的:观察隧道开放式模板在牙种植手术中的作用。方法:对13例缺牙患者取模后灌制工作模型,雕蜡牙,恢复牙列的完整性,在蜡牙上制作开放式植入隧道;二次取模灌模型后,采用热压成型技术制作隧道开放式模板。手术时按隧道方向钻孔并植入种植体。结果:12例患者的工作模型及X线片显示,植入位置和方向与预定方向基本一致,并取得了较好的修复效果。结论:使用隧道开放式种植模板,能使术者较准确地把握牙种植体植入的位置与方向,制作简单,使用方便。 相似文献
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种植导板的制作及CAD-CAM技术的应用 总被引:2,自引:0,他引:2
在牙科种植技术的发展过程中,以修复体为指导的种植观念的出现克服了早期种植体植入后易出现位置不正的问题。CT扫描提供了关于植入区骨、软组织及相邻重要解剖结构的详细数据,医生在手术前能够在相关软件中参考种植体与修复体、邻牙及相邻重要解剖结构的关系,进行种植体类型、尺寸、植入位置、角度的设计,进一步设计并加工制作种植导板,以将电脑中的虚拟设计准确地转化到实际手术中。该技术在种植领域的应用缩短了手术时间、降低了手术难度、提高了种植修复效果。 相似文献