动态实时导航在口腔种植领域中的临床应用及新进展

动态实时导航系统引导下的口腔种植手术是计算机辅助种植外科的一种。医生可以在术前通过导航系统的内部软件合理规划理想的植体位置,并在导航系统的引导下将术前设计准确转移到术中,术中医生可以实时观察到手机钻针在术区牙槽骨内的位置并及时作出调整。目前导航系统在临床的应用越来越广泛,尤其是在前牙美学区病例和在术区解剖条件较为复杂的牙列缺损病例中使用较多。但是动态实时导航系统的临床使用流程较为复杂,包括佩戴配准装置拍摄CBCT、以修复为导向的种植体三维位置设计、术中标定、术中配准、在导航引导下进行扩孔和种植体植入等。应用时需考量的因素和细节较多,包括种植体位置设计、追踪装置的坚固固定、配准误差、按照导航引导的稳定扩孔等。本文从种植手术导航系统的临床应用与工作流程、临床应用的效果及特点等方面进行述评,并介绍动态实时导航系统在口腔种植领域的应用新进展,包括无牙颌种植导航手术和导航引导下的穿颧种植手术。进一步提高种植手术导航的精度、简化使用流程将会是未来导航系统的发展方向。

Clinical application and new progress of dynamic navigation system in the field of oral implantology

Currently,computer?aided implant surgeries include implant placement surgery under the guidance of a dynamic navigation system.With the use of software inherent in the navigation system,doctors can make a preoperative plan including the ideal position of the implant.Then the plan can be accurately transferred to the surgery,during which the real?time condition of the drill and its relationship with the surgical region will be visualized by the surgeon and the drill can be adjusted in a timely manner.Currently the dynamic navigation system is increasingly widely uti?lized,especially in cases of esthetic zones or surgical sites with important anatomical structures.However,the clinical workflow of the navigation system is complicated,including CBCT taken after the registration device placement,pros?thetic?driven 3D design,calibration,registration,navigated borehole preparation and implant placement surgery.Many details should be considered when the device is applied,including implant position design,fixation of the tracking de?vice,registration,and stable borehole preparation under the guidance of dynamic navigation.Therefore,this article intro?duces the dynamic navigation system into the clinical workflow and evaluates,the effects of the application and the clini?cal features.The new progress of the navigation system in the field of implantology is demonstrated at the same time,in?cluding navigated surgery in fully edentulous arches and in the zygomatic zone.Further improvements in the navigation system in terms of the accuracy and simplification of the workflow are needed in the future.