下颌磨牙区种植体同下颌神经管间距的临床分析

目的探讨下颌磨牙区种植体同下颌神经管之间的安全间距的范围。方法选择临床上种植体末端同下颌神经管距离小于2 mm的12例患者15颗种植体(包括软组织水平和骨水平种植体)测算出其种植体末端同下颌神经管之间的实际距离。记录种植体植入期间下牙槽神经有无阳性体征。结果 15例种植体末端距离下颌神经管上缘平均距离为(0.94±0.50)mm(0.24~1.52 mm)。12例患者中有1例患者出现短期下颌神经感觉麻木。结论在回顾分析了下牙槽神经损伤、下颌骨感染、种植体周围炎、逆行性种植体周围炎等可能出现的问题后,结合本研究实际情况,我们考虑种植体末端同下颌神经管之间的安全距离可小于2 mm。     

The use of lipiodol in spiral tomography for dental implant imaging

Preoperative radiographic assessment is mandatory for the meticulous treatment planning and successful placement of implants. The precise topographical evaluation of selected implant sites, apart from the most straightforward cases, requires tomographic examination with the use of diagnostic radiographic templates. The incorporation of various radiopaque materials such as barium sulphate and lead foil as radiographic markers had not been entirely satisfactory. A new contrast medium, Lipiodol ethiodized oil (Laboratoire Guerbet, Paris, France), can easily be mixed with the monomer of autopolymerizing acrylic resin. The resultant acrylic template has several advantages. The tomographic images (Scanora; Soredex Orion Corporation, Helsinki, Finland) are radiographically homogenous and show the contour of the future prosthesis, the angulation of the planned implant, and the thickness of the soft tissue. In addition, the radiopaque template is optically transparent (with a slight yellow tint), which facilitates good visibility of surgical sites when the template is modified to become the surgical guide for implant placement. This transparent template can be further modified for implant position registration at the time of surgery. Because this multipurpose template is simple to construct and inexpensive, it can be recommended for routine use in implant dentistry.     

CT-based dental imaging for implant planning and surgical guidance

CT-based dental imaging for implant planning and surgical guidance carries both clinical and radiographic information for implant positioning as far as trajectory, depth and distribution. The significance of accurate planning and surgical guidance as it pertains to critical anatomical landmarks, such as the mandibular canal, maxillary sinus and adjacent teeth, cannot be overstated. This case report describes a systematic approach to the planning and surgical placement of a single, implant-supported crown, using CT-based dental imaging for implant planning and surgical guidance. The simple steps result in the accurate transfer of critical radiographic information to the surgical site.     

跨下颌神经管种植在萎缩下颌后牙区的应用

目的：探讨在下颌后牙缺失骨高度严重不足时,采用超声上颌窦内提升骨刀制备种植窝,进行偏颊侧跨下牙槽神经种植的可行性。方法：11例下颌后牙缺失患者,牙槽嵴顶至下颌神经管上缘距离3.2-5.5mm,按照手术导板偏颊侧倾斜角度,常规制备种植窝至下颌神经管上端1mm处,再用超声内提升骨刀头从已备种植床中央向下方跨过下牙槽神经继续备洞至植入长度,共植入种植体25颗;术中及术后当天密切观察种植床出血及下唇感觉,负载后1、3、6、9、12个月定期复查。结果：术中均未损伤下牙槽神经;观察期间种植体稳固无一脱落,种植体周围牙龈组织健康,种植体周围未见骨低密度影,负载后12月种植体边缘骨高度与刚负载时边缘骨高度差异无统计学上意义;咀嚼功能恢复满意。结论：应用超声上颌窦内提升骨刀,进行跨下颌神经管种植是一种安全、简单、可靠的修复下颌后牙缺失骨高度严重不足的方法,可避免使用传统的外置法植骨、牵张成骨术、下牙槽神经移位术。     

Cone beam computerized tomography-based dental imaging for implant planning and surgical guidance, Part 1: Single implant in the mandibular molar region

Computerized tomography (CT)-based dental imaging for implant planning and surgical guidance carries both restorative information for implant positioning, as far as trajectory and distribution, and radiographic information, as far as depth and proximity to critical anatomic landmarks such as the mandibular canal, maxillary sinus, and adjacent teeth. This case report describes a systematic approach to the planning and surgical placement of a single implant-supported crown, utilizing CT-based dental imaging for implant planning and surgical guidance. The simple steps result in the accurate transfer of critical radiographic information to the surgical site.     

下磨牙区种植体尖端与下颌管间安全距离的探讨

目的:探讨下颌磨牙区植入的种植体尖端与下牙槽神经管上缘之间的安全距离。方法:用游标卡尺测量23例患者全景片中的30颗下颌磨牙区种植体长度,除以对应的种植体实际长度,计算全景片中下颌磨牙区垂直放大率(vertical magnification factor,MF);选择种植体尖端至下牙槽神经管上缘间距离小于2mm的8例患者的全景片,测量片中12颗种植体尖端至下牙槽神经管上缘间的距离,除以对应种植体的垂直放大率,计算其实际距离;记录该8例患者有无下唇和(或)颏部感觉异常。结果:①全景片中下颌磨牙区垂直放大率为1.27±0.02;②12颗种植体尖端距下牙槽神经管上缘之间的距离为(1.19±0.33)mm(0.69～1.89mm);③8例接受种植体植入的患者,无一例出现下唇或颏部感觉异常。结论:下颌磨牙区植入种植体的尖端与下颌管上缘之间保存完整的骨壁,是防止损伤下牙槽神经的最关键因素之一。     

下颌神经管CT扫描及在下颌后牙种植中的应用

目的：探讨下颌神经管CT扫描的技术原理、应用效果及在下颌后牙种植中的临床意义。方法：应用GE螺旋CT对18例下颌骨按照自定设计方案进行扫描及图像后处理分析。结果：下颌神经管经过一套系统的观察得到详尽的显示和精确的测量。结论：规范、有序的下颌神经管扫描方案简单易行,能够很好地显示下颌神经管走行方向及其与周围结构的关系,对下颌后牙种植术前手术方案的制定具有重要的临床意义,其程序可在放射科固化。     

Displacement of a root form implant into the mandibular canal

An unusual complication associated with the placement of osseointegrated root form implants is presented. Discussion of this complication focuses on treatment planning and anatomic considerations in the posterior mandible that impact the viability of implant placement. Vital structures in this location, including the mandibular canal, are often obscured on routine panoramic radiography. Tomograms of the maxilla or mandible can provide data on cortical plate thickness, location of vital structures, and the presence of large medullary spaces, information that will decrease the incidence of implant complications.     

不同测量方法对种植术区垂直骨量的临床评价

目的：应用不同方法对种植标记物垂直向失真率的测量,对拟种植区域骨量进行正确评价。方法：在普通X线胶片上应用直接测量和间接数字化图像的计算机辅助测量法对已知长度的种植体进行测量,并与在直接数字化全景片（DR）上标记物测量的结果进行失真率对比,了解3种测量方法之间失真率的差异。结果：普通胶片应用直接测量法得到不同区域垂直向失真率大于间接数字化图像的计算机辅助测量结果,而在DR上测量得出的误差率明显小于前者。结论：应用全景片进行种植术前检查及骨量评估中,DR测量结果较普通胶片直接测量和间接数字化图像的计算机辅助测量计算出的失真率更小,数据更接近真实值,可为临床种植术前及术后评估提供可靠依据．     

Application of CT imaging for dental implant simulation

Accurate diagnosis and exact treatment planning are very important for successful implant treatment. Pretreatment examination and simulations using CT can be especially effective information sources, and diagnosis by CT imaging before treatment substantially enhances the security and safety of the treatment plan. New interactive CT software (SIM/Plant) which enables diagnosis of bone morphology and quality, and also implant simulation on a personal computer through multiplanar reformation of CT images, has been developed. Stereolithography models (SLMs) are reproduced anatomical morphological models of an individual patient's bone structure from the information obtained by the CT scan, and is fabricated out of light cure resin. In this article, SLMs and SIM/Plant for simulation of various examinations and diagnosis incorporating CT information are described, and their features are introduced.     

螺旋CT三维成像对下颌神经管走向的研究

目的通过螺旋CT探讨下颌神经管与下颌骨的实际位置关系。方法利用螺旋CT对正常青年人,进行下颌骨的横断面连续薄层扫描,并进行多平面重建后,测量并计算正常人群中下颌神经管在下颌骨中的实际位置及走行方向。结果下颌骨多平面重建的冠状位CT图像能清楚显示下颌神经管的位置及走向。①在垂直方向下颌神经管距下颌骨下缘的距离小于距牙槽嵴顶的距离,在第二磨牙区距离下颌骨下缘最近。②在颊舌方向,颏孔至第一磨牙间,下颌神经管距颊侧骨板的距离小于距舌侧骨板的距离。自第二磨牙向后,下颌神经管距颊侧骨板的距离大于距舌侧骨板的距离。③下颌神经管的走行方向在颊舌方向,下颌神经管总体走行是由舌侧逐渐向颊侧倾斜达颏孔,越近磨牙后区距离舌侧骨板越近,越近颏孔距离颊侧骨板越近。在走行高度上,在第三磨牙区由上向下走行。自第二磨牙开始下颌神经管逐渐由下向上走行达颏孔。结论螺旋CT通过多平面重建后,可以准确测量并计算出下颌神经管在下颌骨中的三维空间位置,利用螺旋CT对下颌神经管的位置和走行进行研究是可行的。     

口腔种植计算机术前规划系统的建立与应用

目的：建立口腔颌面计算机术前规划软件系统并进行初步应用。方法：将患者的三维CT数据输入计算机,经空间几何算法、计算机图形学方法及专用语言处理和分析,建立颅颌面骨三维可视化模型,并以Visual C＋＋ 6.0和Visualization Toolkit（VTK）（Kitware）为平台,开发牙列缺损、缺失以及颌骨缺损后应用计算机进行术前评估和种植体植入模拟的应用软件系统。结果：根据临床各种功能需求,建立了针对口腔种植和颅颌面缺损种植修复的系统规划程序。结论：该系统能够实现口腔种植和颌骨缺损种植的术前评估以及各种类型种植体的植入设计与修复,为临床种植提供指导,并为后续基于CT数据的精确导向奠定了基础。