数字化手术导板在口腔即刻种植中的临床应用
|
摘要
目的:研究和评估数字化种植导板在口腔即刻种植中的应用效果。方法:选择2015年1月~2016年12月于云南省一院口腔中心就诊的患者22例,这些患者口腔内有1个或者数个牙根无法保留需行种植修复,在种植数字化导板引导下不翻瓣于拔除牙根同期植入植体,收集患者影像学资料并对比分析种植体实际植入位置和预设位置之间的偏差,进行系统性研究。分别测量术后即刻和术后半年永久性修复时的边缘骨水平,永久修复完成后第2天以及1年以后随访时软组织指数并进行统计学分析。结果:共39颗种植体纳入本研究,28例患者均无种植体脱落现象,植入种植体的角度偏差为(3.25±1.6)°,位置偏差(0.54±0.38)mm,深度偏差(0.51±0.38)mm;术后半年种植体颊侧垂直向骨吸收(1.3±0.6)mm,舌侧垂直向骨吸收为(0.3±0.2)mm,改良出血指数(mBI)为(0.91±0.45),探诊深度(PD)为(2.05±0.3)mm;随访时39颗种植体的mBI为(1.18±0.72),PD为(2.10±0.2)mm。随访时mBI较术后半年时有所降低,且差异有统计学意义(P<0.05)。结论:在即刻种植中应用数字化导板,可以固定种植钻针,引导种植体按照预设位置精确植入,保证种植修复的效果。在组织稳定性和美学效果的稳定性方面还需要长期的临床观察。
Objective:To evaluate the application effect of digital surgical guide in immediate implantation.Methods:Twenty-two patients were included in this study from January 2015 to January 2017.Thirty-two implants were placed precisely with the assist of surgical guide plates.Imagining materials was collected to measure the deviation between the virtual and actual implant position.The crest bone level,M-T bone width,and the soft tissue index at the immediate postoperative or after one year were measured and analyzed.Results:The implant angel deviation was(3.25±1.6)degree,the position deviation was(0.54±0.38)mm,and the length deviation was(0.51±0.38)mm.The difference showed statistical significance.After six months,the vertical bone resorption was(1.3±0.6)mm and M-T bone resorption at alveolar crest was(0.8±0.3)mm.The index of soft tissue mBI was(0.91±0.45),and the PD was(2.05±0.3)mm.After one year follow-up,the mBI was(1.18±0.72),and the PD was(2.10±0.2)mm.The difference of mBi showed statistical significance.Conclusion:The application of surgical guide plates is beneficial to immediate implantation.
Objective:To evaluate the application effect of digital surgical guide in immediate implantation.Methods:Twenty-two patients were included in this study from January 2015 to January 2017.Thirty-two implants were placed precisely with the assist of surgical guide plates.Imagining materials was collected to measure the deviation between the virtual and actual implant position.The crest bone level,M-T bone width,and the soft tissue index at the immediate postoperative or after one year were measured and analyzed.Results:The implant angel deviation was(3.25±1.6)degree,the position deviation was(0.54±0.38)mm,and the length deviation was(0.51±0.38)mm.The difference showed statistical significance.After six months,the vertical bone resorption was(1.3±0.6)mm and M-T bone resorption at alveolar crest was(0.8±0.3)mm.The index of soft tissue mBI was(0.91±0.45),and the PD was(2.05±0.3)mm.After one year follow-up,the mBI was(1.18±0.72),and the PD was(2.10±0.2)mm.The difference of mBi showed statistical significance.Conclusion:The application of surgical guide plates is beneficial to immediate implantation.
引文
[1]Iasella JM,Greenwell H,Miller RL,et al.Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant sitedevelopment:A clinical and histologic study in humans[J].J Periodontol,2003,74(7)∶990-999
[2]Cannizzaro G,Leone M,Esposito M.Immediate functionalloading of implants placed with flapless surgery in the edentulous maxilla:1-year follow-up of a single cohort study[J].Int J Oral Maxillofac Implants,2007,22(1)∶87-95
[3]Van Assche N,Vercruyssen M,Coucke W,et al.Accuracy of computer-aided implant placement[J].Clin Oral Implants Res,2012,23(Suppl 6)∶112-123
[4]Lee CY,Ganz SD,Wong N,et al.Use of cone beamcomputed tomography and a laser intraoral scanner invirtual dental implant surgery:part 1[J].Implant Dent,2012,21(4)∶265-271
[5]夏婷,施斌.上颌单前牙即刻种植修复和延期种植修复的美学效果比较[J].口腔医学研究,2016,32(1)∶50-54
[6]Chen St,Wilson TG Jr,Hammerle CH.Immediate or early placement of implant following tooth extraction:review of biologic basis,clinical procedures and outcomes[J].Int.J Oral Maxillofac Implants,2004,19(suppl)∶12-25
[7]Sarment DP,Sukovic P,Clinthorne N:Accuracy of implant placement with stereolithographic surgical guide[J].Int J O-ral Maxillofac Implants,2003,18(5)∶571-577
[8]Widmann G,Widmann R,Widmann E,Jaschke W,Bale RJ:In vitro accuracy of a novel registration and targeting technique for image guided template production[J].Clin Oral Implants Res,2005,16(4)∶502-508
[9]Van Assche N,Van Steenberghe D,Guerrero ME,et al.Accuracy of implant placement based on pre-surgical planning of three-dimensional cone-beam images:apilot study[J].J Clin Periodontol,2007,34(9)∶816-821
[10]Turbush SK,Turkyilmaz I.Accuracy of three different types of stereolithographic surgical guide in implant placement:an in vitro study[J].J Prosthet Dent,2012,108(3)∶181-188
[11]Schropp L,Wenzel A,Kostopoulos L,et al.Bone healing and softtissue contour changes following single-tooth extraction:A clinical and radiographic 12-month prospective study[J].Int J Periodontics Restorative Dent,2003,23(4)∶313-323
[12]Botticelli D,Berglundh T,Lindhe J.Hard tissue alterations following immediate implant placement in extraction sites[J].J Clin Periodontol,2004,31(7)∶820-828
[13]Caneva M,Salata L A,De Souza,et al.Influence of implant positioning in extraction sockets on osseointegration:histomorphometric analyses in dogs[J].Clin Oral Implants Res,2010,21(1)∶43-49
[14]Brun JB.In vivo response to biomechanical loading at the bone/dental-implant interface[J].Adv Dent Res,1999,13(1)∶99-119
[15]Pirker W,Kocher A.Immediate,non-submerged,rootanalogue zirconia implants placed into single-rooted extraction sockets:2-year follow-up of a clinical study[J].Int J Oral Maxillofac Surg,2009,38(11)∶1127-1132
[16]Blanco J,Nu1ez V,Aracil L.Ridge alterations following immediate implant placement in the dog:Flap versus flapless surgery[J].J Clin Periodontol,2008,35(7)∶640-648
[2]Cannizzaro G,Leone M,Esposito M.Immediate functionalloading of implants placed with flapless surgery in the edentulous maxilla:1-year follow-up of a single cohort study[J].Int J Oral Maxillofac Implants,2007,22(1)∶87-95
[3]Van Assche N,Vercruyssen M,Coucke W,et al.Accuracy of computer-aided implant placement[J].Clin Oral Implants Res,2012,23(Suppl 6)∶112-123
[4]Lee CY,Ganz SD,Wong N,et al.Use of cone beamcomputed tomography and a laser intraoral scanner invirtual dental implant surgery:part 1[J].Implant Dent,2012,21(4)∶265-271
[5]夏婷,施斌.上颌单前牙即刻种植修复和延期种植修复的美学效果比较[J].口腔医学研究,2016,32(1)∶50-54
[6]Chen St,Wilson TG Jr,Hammerle CH.Immediate or early placement of implant following tooth extraction:review of biologic basis,clinical procedures and outcomes[J].Int.J Oral Maxillofac Implants,2004,19(suppl)∶12-25
[7]Sarment DP,Sukovic P,Clinthorne N:Accuracy of implant placement with stereolithographic surgical guide[J].Int J O-ral Maxillofac Implants,2003,18(5)∶571-577
[8]Widmann G,Widmann R,Widmann E,Jaschke W,Bale RJ:In vitro accuracy of a novel registration and targeting technique for image guided template production[J].Clin Oral Implants Res,2005,16(4)∶502-508
[9]Van Assche N,Van Steenberghe D,Guerrero ME,et al.Accuracy of implant placement based on pre-surgical planning of three-dimensional cone-beam images:apilot study[J].J Clin Periodontol,2007,34(9)∶816-821
[10]Turbush SK,Turkyilmaz I.Accuracy of three different types of stereolithographic surgical guide in implant placement:an in vitro study[J].J Prosthet Dent,2012,108(3)∶181-188
[11]Schropp L,Wenzel A,Kostopoulos L,et al.Bone healing and softtissue contour changes following single-tooth extraction:A clinical and radiographic 12-month prospective study[J].Int J Periodontics Restorative Dent,2003,23(4)∶313-323
[12]Botticelli D,Berglundh T,Lindhe J.Hard tissue alterations following immediate implant placement in extraction sites[J].J Clin Periodontol,2004,31(7)∶820-828
[13]Caneva M,Salata L A,De Souza,et al.Influence of implant positioning in extraction sockets on osseointegration:histomorphometric analyses in dogs[J].Clin Oral Implants Res,2010,21(1)∶43-49
[14]Brun JB.In vivo response to biomechanical loading at the bone/dental-implant interface[J].Adv Dent Res,1999,13(1)∶99-119
[15]Pirker W,Kocher A.Immediate,non-submerged,rootanalogue zirconia implants placed into single-rooted extraction sockets:2-year follow-up of a clinical study[J].Int J Oral Maxillofac Surg,2009,38(11)∶1127-1132
[16]Blanco J,Nu1ez V,Aracil L.Ridge alterations following immediate implant placement in the dog:Flap versus flapless surgery[J].J Clin Periodontol,2008,35(7)∶640-648