动态导航引导颧种植体植入的临床工作流程

由于颧骨骨量有限、周围解剖结构较复杂,颧种植体植入手术具有高度的技术敏感性。在临床上,动态导航系统的应用使医生能够在实时监控下完成扩孔和种植体植入,最大可能地降低手术风险,实现术前规划方案。但导航手术仍存在误差,如配准标记物类型、分布与数目会影响配准精度,继而对导航精度产生影响。导航手术精度的降低会引起严重的颧种植手术外科并发症。同时,术者对颧种植导航流程的熟悉程度和对导航手术的熟练程度也可能会对最终精度产生影响。本文总结了临床颧种植导航手术的具体流程,并对影响颧种植导航精度的相关因素做一总结。     

动态导航系统在口腔种植中的临床应用及展望

 动态导航系统可有效提高种植手术的精度，辅助实现以修复为导向的种植体植入，获得更加稳定的种植修复效果。根据定位光源的种类及位置，动态导航系统有不同的分类，其工作流程包括数据获取、数据处理和种植方案设计、标定和配准、手术实施及术后精度验证。动态导航系统的精度与静态导板系统相近，且其可有效弥补静态导板系统在临床应用中的诸多不足，适应证更广，对于在无牙颌种植、穿颧种植等复杂种植手术中的应用还具有独特的优势。而提高精度、简化装置及操作流程、提高导航软件的修复模块功能、加强在临床教学中的应用及降低价格等方面将是动态导航系统未来发展的主要方向。文章就动态导航系统在口腔种植中的临床应用及展望做一阐述。     

动态导航系统在口腔种植中的临床应用及展望

动态导航系统可有效提高种植手术的精度，辅助实现以修复为导向的种植体植入，获得更加稳定的种植修复效果。根据定位光源的种类及位置，动态导航系统有不同的分类，其工作流程包括数据获取、数据处理和种植方案设计、标定和配准、手术实施及术后精度验证。动态导航系统的精度与静态导板系统相近，且其可有效弥补静态导板系统在临床应用中的诸多不足，适应证更广，对于在无牙颌种植、穿颧种植等复杂种植手术中的应用还具有独特的优势。而提高精度、简化装置及操作流程、提高导航软件的修复模块功能、加强在临床教学中的应用及降低价格等方面将是动态导航系统未来发展的主要方向。文章就动态导航系统在口腔种植中的临床应用及展望做一阐述。     

计算机辅助动态导航技术在种植手术中的临床精度评价

目的 本研究利用计算机辅助动态导航系统进行种植外科手术,探索动态导航技术在种植手术中的应用精度,为实现精准、微创、高效的种植外科手术提供理论依据。方法 选取2017年6月至2019年12月期间在烟台市口腔医院接受计算机辅助动态导航种植外科手术的51例患者,共66枚种植体。术前佩戴合适的U型管拍摄CBCT,制取数字化印模,利用计算机辅助动态导航软件完成术前种植方案规划。在动态导航引导下完成种植体植入,术后拍摄CBCT获取种植体三维位置,测量每枚种植体的颈部距离误差、根方距离误差及轴向角度误差。结果 51枚种植体颈部距离误差为（0.61±0.17）mm(0.35～0.98mm),根方距离误差为（0.73±0.15）mm(0.50～0.99 mm),轴向角度误差为（3.32±1.55）°（0.43°～6.66°）。结论 计算机辅助动态导航系统引导的种植外科手术存在误差,各项误差在可允许的范围内,计算机辅助动态导航系统引导下的种植外科手术可广泛应用于术前流程规划、术中手术引导、术后精度分析等各个方面。     

动态导航系统在部分特殊种植病例中的应用研究进展

动态导航系统可以在锥形束CT(CBCT)提供的三维影像上实时定位种植手术中钻头与颌骨解剖结构的三维位置关系，从而引导种植医生在进行手术时，实现预定种植手术设计，且可据实况进行微调整，进一步提高种植精度。目前动态导航技术适用广泛(无牙牙合种植、穿颧、穿翼、跨神经管种植等特殊病例),备受广大口腔医务工作者的青睐。本文将从动态导航在特殊种植病例中应用时，其在种植位点实时把控、可视化暴露术区、缩短就诊周期等方面的优势以及未来的进展前沿做一阐述。     

牙种植动态导航配准方式对配准精度的影响

牙种植动态导航系统(DNS)是一种利用精确的红外定位技术,通过对三维数字影像的可视化操作,最终实现三维影像和实际解剖位置的精确融合,实时追踪手术器械的牙种植手术辅助系统,适用于牙种植手术的术前规划和精确的术中引导。影响DNS精确性的关键因素是实际术区解剖结构与其虚拟三维数字影像的精确配准,而不同配准方式的适应证、配准特点和配准精度等各不相同。本文对临床所应用的配准方式,包括骨标记物配准、咬合夹板配准、U型管配准、面部框架式配准、解剖标志点配准及无标记点配准进行介绍,并对影响配准误差的因素进行总结,以便临床医生更好地了解不同配准方式的特点,减少配准误差,达到精准种植的效果。     

计算机辅助动态导航技术在种植手术中的临床精度影响因素分析

目的 本研究利用计算机辅助动态导航技术引导进行种植外科手术,探索动态导航技术在种植手术中精度的影响因素,为实现精准、微创、高效的种植外科手术提供理论依据.方法 选取2018年6月至2020年12月期间在烟台市口腔医院接受计算机辅助动态导航种植外科手术的病例51例,共66颗种植体.在动态导航引导下完成种植体植入,术后拍摄...     

动态实时导航在口腔无牙颌种植中的研究进展

随着人口老龄化的日趋严重,牙列缺失患者数量逐年增长,传统全口活动义齿是牙列缺失修复的主要治疗手段之一,但因其体积较大,异物感强,初次佩戴有压痛,适应性差,且咀嚼效率相对较低,已经不能满足人们对于口腔健康的需求。目前,动态实时导航系统辅助种植术已突显优势,尤其是在无牙颌种植、颧种植修复及翼上颌区种植修复中的效果显著。基于动态实时导航系统的发展史、组成分类及精度影响因素等方面,本文系统综述了其在无牙颌患者中的工作流程及应用效果,以期为动态实时导航在口腔无牙颌中的临床应用提供参考。     

动态实时导航辅助下颌后牙区牙槽骨骨量不足种植

目的评价动态实时导航辅助下颌后牙区牙槽骨骨量不足种植手术中的精准度及临床效果。 方法回顾分析2021年1—12月因下颌后牙缺失就诊于中山大学附属第一医院口腔科，且采用动态实时导航辅助植入的23例患者。将术前规划种植体数据和术后实际植入种植体锥形束CT数据导入动态导航精度验证软件，对术前设计与术后植入种植体的三维轴向信息进行误差分析，计算并报告实际种植体顶部、根尖部、角度和深度偏差。使用SPSS 23.0统计学软件，对动态实时导航引导种植体植入术后的精度偏差和植入深度进行数据处理。本研究为符合正态分布的计量资料，采用 ±s描述。 结果本次计算机辅助动态导航系统指导下完成下颌后牙区25颗种植体植入，获得了良好的初期稳定性，术后CBCT示种植体精确植入规划位置，规避了下牙槽神经及邻近重要解剖结构，未发生相关手术并发症。25颗种植体的总体顶部偏差为（0.23 ± 0.11）mm，根尖部偏差为（0.45 ± 0.29）mm，深度偏差为（0.33 ± 0.32）mm，角度偏差为1.01° ± 0.65°。 结论动态实时导航辅助下颌后牙区骨量不足种植，可获得良好的植入精度和满意的临床效果。     

动态导航系统在口腔种植领域的发展和应用

动态导航系统在口腔种植领域逐渐开始使用,系统能够术前规划种植体植入路径,术中实时可视化追踪种植钻针,避开重要解剖结构,提高手术安全性.本文将简述动态导航系统的发展,组成原理和临床应用,针对不同导航系统辅助常规种植体植入的精度进行探讨,并介绍动态导航系统辅助颧骨种植体植入术的精准度,分析导致临床误差的各种因素.     

Navigated implantation after microsurgical bone transfer using intraoperatively acquired cone-beam computed tomography data sets

The use of a combination of intraoperative cone-beam computed tomography (CBCT) and a navigation system via a spinal software platform for the navigated implantation of oral implants after microsurgical bone transfer is described. Intraoperative data sets were generated using Arcadis Orbic 3D (Siemens, Medical Solutions, Erlangen, Germany) and immediately transferred to the VectorVision(2) navigation system (BrainLAB, Feldkirchen, Germany) via the NaviLink interface. In two patients who underwent microsurgical bone transfer for midfacial reconstruction, implants were placed using intraoperatively acquired CBCT data sets for planning and navigated insertion. In both cases, successful realization of the planned implant sites was achieved by the guidance of the drill, leading to rehabilitation of both patients. CBCT data generated by mobile systems are sufficient for the planning of implant position, and can be used for navigated insertion using tools originally developed for spinal surgery.     

Intraoperative computerized navigation for flapless implant surgery and immediate loading in the edentulous mandible

Computerized navigation surgery has evolved to facilitate minimally invasive procedures, the gold standard of surgery today. While flapless implant surgery may be clinically beneficial, it has generally been perceived as a blind procedure limited to straightforward cases that do not pose a risk of cortical plate perforation. The objective of this report is to describe a protocol for flapless implant placement in a completely edentulous mandible using computerized navigation surgery. The Image Guided Implantology system (IGI, DenX Advanced Dental Systems) is described. The IGI system provides real-time imaging of the dental drill and transforms flapless implant surgery into a fully monitored procedure. The highly accurate intraoperative navigation enables precise transfer of the detailed presurgical implant plan to the patient. This is particularly valuable in edentulous jaws lacking any indication of the dental arch. The accurate positioning of the implants, based on the presurgical digital plan, allows fabrication of a provisional fixed prosthesis before the implant surgery for immediate postoperative loading. This innovative protocol can enhance prosthodontic-driven placement of implants in a fully monitored flapless surgery.     

Navigated vs. conventional implant insertion for maxillary single tooth replacement

Abstract Introduction: Computer-guided navigation has proven a valuable tool in several surgical disciplines. During oral implant placement, its application is intended to accomplish optimal implant localization and to reduce the risk of damage to adjacent structures. The aim of this study was to compare the precision limits of conventional vs. navigated implant insertion in practice. Materials and methods: In cast models of the maxilla, implants were inserted to replace the left central incisor (n = 40) and the right canine (n = 40); each of those were inserted either conventionally (n = 20) or navigated (n = 20). Implant position, angulation and insertion depth were calculated from computer tomography scans of the implants that were connected to an index abutment of 40 cm length. Results: The variations of implant positions were reduced for implants that were inserted by navigation (P < 0.05). In both the axial and the transversal plane, the variations of implant angulations were reduced for implants that were inserted by a navigation protocol (P < 0.05). The variations of insertion depth were less (P < 0.05) when the implants were placed by navigation in comparison with conventional insertion procedures. Conclusions: Given the experimental conditions, although they tried to mimic a clinical situation, no final conclusions can be drawn. The in vitro application of a navigation system resulted in an improved precision of insertion surgery regarding the position, angulation and depth of an implant. Clinical studies will have to prove if routine image guidance will result in superior surgical outcome.     

Computer-aided placement of endosseous oral implants in patients after ablative tumour surgery: assessment of accuracy

The objective of this study was to evaluate the feasibility and accuracy of a novel surgical computer-aided navigation system for the placement of endosseous implants in patients after ablative tumour surgery. Pre-operative planning was performed by developing a prosthetic concept and modifying the implant position according to surgical requirements after high-resolution computed tomography (HRCT) scans with VISIT, a surgical planning and navigation software developed at the Vienna General Hospital. The pre-operative plan was transferred to the patients intraoperatively using surgical navigation software and optical tracking technology. The patients were HRCT-scanned again to compare the position of the implants with the pre-operative plan on reformatted CT-slices after matching of the pre- and post-operative data sets using the mutual information-technique. A total of 32 implants was evaluated. The mean deviation was 1.1 mm (range: 0-3.5 mm). The mean angular deviation of the implants was 6.4 degrees (range: 0.4 degrees - 17.4 degrees, variance: 13.3 degrees ). The results demonstrate, that adequate accuracy in placing endosseous oral implants can be delivered to patients with most difficult implantologic situations.     

动态导航技术对口腔种植精准度影响的Meta分析

目的    评估动态导航技术辅助口腔种植体植入的精准度以及相关影响因素。方法    计算机检索PubMed、Web of Science、Cochrane Library数据库和中国知网（CNKI）,检索日期截至2022-01-31。并手工检索纳入研究的参考文献作为补充,对动态导航在种植手术中种植体植入的精准度进行Meta分析。研究的主要结局指标为动态导航辅助下种植体植入位置与计划中位置的偏差。结果    14篇文献符合纳入标准,共纳入666颗在动态导航下行种植手术的种植体。Meta分析结果显示,种植体平均颈部偏差为1.01 mm（95%CI：0.84 ~ 1.17,I2 = 98.2%）,平均根尖偏差为1.25 mm（95%CI：0.92 ~ 1.58,I2 = 99.3%）,平均角度偏差为3.08°（95%CI：2.23 ~ 3.94,I2 = 99.5%）。Meta回归分析结果显示,导航下种植区域在上颌骨和下颌骨之间的精准度（颈部、根尖、角度偏差）差异无统计学意义（P值分别为0.830、0.711、0.301）;在研究设计为模型研究和临床研究的种植精准度（颈部、根尖、角度偏差）差异无统计学意义（P 值分别为 0.212、0.133、0.128）。结论    动态导航下进行种植手术是一种相对安全且高效的手术操作方法,但需要更多的高质量研究对精准度差异的影响因素进一步分析证明。     

计算机辅助设计制造牙种植导板的应用及形变分析

目的：自主研发软件计算机辅助设计和制造（CAD／CAM）牙种植导板应用于牙种植手术,并对其进行手术前后的形变分析。方法：通过制作诊断性活动义齿,运用锥形束CT对其进行扫描,采集数据,利用自主研发的设计软件进行导板设计,应用三维打印快速成型技术完成导板的制作,在CAD／CAM导板指导下进行牙种植手术。术前、术后分别采用激光扫描仪进行导板的三维扫描,应用逆向工程软件进行术前、术后导板的三维配准,分析导板的形变情况。结果：成功植入8颗种植体。术前、术后导板平均形变量为0．132mm,最大形变量为1．037mm。结论：自主研发CAD／CAM牙种植导板具有良好的准确性和稳定性。