计算机辅助设计+自制外科导板在种植牙中的应用研究
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摘要
研究背景近年来,导航技术在口腔种植领域得到了较大的发展。牙种植术要求术者充分利用现有的骨量植人种植体,达到修复所需的最佳位置,同时尽最大可能避免各种副损伤,化解手术风险。但目前临床应用的种植技术远未达到上述要求,因此,口腔种植领域应用外科导航技术,能够较好满足种植外科和修复的精确要求,具有良好的临床应用前景。计算机辅助外科(computer-assisted surgery,CAS)与无翻瓣术相结合可使患者所受创伤最小化;CAS与即刻修复技术相结合可以使义齿修复制作周期最短化(如Teeth in hour);计算机辅助设计(computer-assisted desiga,CAD)与规范化临床操作相结合可以使种植医师所担负的风险最低化;CAD在美学区的三维定位使外科医生与修复医生术前融洽沟通的程度最大化,使种植修复简单化。可是,目前国内CAS或CAD技术并不如想象中那样普及应用,要想实现“微创”和“即刻修复”都需要依赖外科导板与之相配合。目前临床上所应用的外科导板要么制作过于简单,只是在石膏模型或原有义齿上制作,并不能起到精确导航的作用;要么采用国外制作的导板,如Noble Guide或比利时Materialize的经过快速原型机制做出的导板,但其昂贵的价格和较长的制作周期并不能让大多数患者享用,从而限制了这一技术的推广。目的本课题通过对采用计算机辅助设计+自制外科导板法的患者术前、术后CT三维数据进行对比测量,评价此方法在临床种植牙技术中的应用价值,探索研制能够普及应用的外科导板,以利计算机导航技术的全面推广。材料和方法1.拍摄CT,用Simplant软件进行术前设计2.依据设计结果,制作出导向环导板3.术后拍摄CT,与术前设计的CT数据进行对比分析。结果1.对采用计算机辅助设计+单导板法进行配对t检验统计分析,术前与术后在垂直方向上的偏差均数为0.62±1.41mm,P＜0.05,有统计学意义;颊舌方向上偏差为9.44±8.51度,p＜0.05,有统计学意义,修复时可用铸造基台调整就位道。2.对患者采用计算机辅助设计+无翻瓣术进行种植,大大减轻对患者的创伤,节省了手术的时间。结论1.计算机导航下的自制外科导板符合临床应用要求,确实起到了三维方向上的导航作用。2.采用无翻瓣术的牙种植术,对患者创伤小,手术时间短,术后并发症少。
Background In recently years , computer navigation has been used in medical area especially in implantology. Implants were placed in the jaw bone precisely to achieve the best position from the prosthesis , meanwhile , minimally invasion should be considered in the procedure. However, the position of the implants has decisive effect on the final results in terms of mastication, phonation, and esthetics. In order to achieve a predicable treatment outcome, a comprehensive diagnostic work - up of the planed implant positions and then precisely transferring to the implant surgery is a paramount before surgery. Image guided navigation surgery or stereographic surgical guide by technique are developed for this purpose. There are many software and hardware designed by different companies available in the market nowadays such as Nobel guide and Materealize guide. But this technique has been restricted rapidly to develop by expensive price and long time to made in the laboratory . Purpose In this study, we used a simulated dental cast model to test the precision between the planned pre—operative implant position and the actual placed implant position using metal tube guided surgical templates. The radiographic examination and analysis of the implant position were performed with CT and Simplant software respectively. Methods Thirteen patients ranging from 20 to 73 years were recruited from Inner Mongolia Hospital, thirty—four implants were placed. The 2. 2 diameter pilot guide drill was used to create a precise, minimally invasion initial penetration through the mucosa and into bone . The parameters evaluated were depth from mucosal margin to bone crest . implant position including depth and angulation in the bone. From the preoperation and postoperation CT image, for 34 implants placed in 13 patients , the data was statisticed by SPSS 16. 0 software. Results 1. Data obtained from this study shows that the depth and angulation in panoramic is perfect : the depth deflexion mean is 0.62mm, P<0.05; the angulation in cross sectional deflexion mean is 9.44 degree to the designation of pre - operation , P< 0.05, angulation abutment can adjust the dental prosthetic restoration to a correct occlusion relationship. 2. This article presents a technique for dental implants in a flapless approach that utilizes the tracking technology of a computerized navigation system. Conclusion 1. The preoperative planning of implant position could be predictably transferred to the operative field using metal tube guided surgical template. Using the techniques described in our study, the implant could be placed as accurately as other commercialized products like Simplant Surgical Guide 2. The results of this study demonstrate that following diagnostic treatment planning criteria, flapless surgery using a minimally invasive technique is a predictable procedure. The benefits of this procedure are lessened surgical time; minimal changes in crestal bone levels, probing depth, and inflammation; perceived minimized bleeding; and lessened postoperative discomfort.
Background In recently years , computer navigation has been used in medical area especially in implantology. Implants were placed in the jaw bone precisely to achieve the best position from the prosthesis , meanwhile , minimally invasion should be considered in the procedure. However, the position of the implants has decisive effect on the final results in terms of mastication, phonation, and esthetics. In order to achieve a predicable treatment outcome, a comprehensive diagnostic work - up of the planed implant positions and then precisely transferring to the implant surgery is a paramount before surgery. Image guided navigation surgery or stereographic surgical guide by technique are developed for this purpose. There are many software and hardware designed by different companies available in the market nowadays such as Nobel guide and Materealize guide. But this technique has been restricted rapidly to develop by expensive price and long time to made in the laboratory . Purpose In this study, we used a simulated dental cast model to test the precision between the planned pre—operative implant position and the actual placed implant position using metal tube guided surgical templates. The radiographic examination and analysis of the implant position were performed with CT and Simplant software respectively. Methods Thirteen patients ranging from 20 to 73 years were recruited from Inner Mongolia Hospital, thirty—four implants were placed. The 2. 2 diameter pilot guide drill was used to create a precise, minimally invasion initial penetration through the mucosa and into bone . The parameters evaluated were depth from mucosal margin to bone crest . implant position including depth and angulation in the bone. From the preoperation and postoperation CT image, for 34 implants placed in 13 patients , the data was statisticed by SPSS 16. 0 software. Results 1. Data obtained from this study shows that the depth and angulation in panoramic is perfect : the depth deflexion mean is 0.62mm, P<0.05; the angulation in cross sectional deflexion mean is 9.44 degree to the designation of pre - operation , P< 0.05, angulation abutment can adjust the dental prosthetic restoration to a correct occlusion relationship. 2. This article presents a technique for dental implants in a flapless approach that utilizes the tracking technology of a computerized navigation system. Conclusion 1. The preoperative planning of implant position could be predictably transferred to the operative field using metal tube guided surgical template. Using the techniques described in our study, the implant could be placed as accurately as other commercialized products like Simplant Surgical Guide 2. The results of this study demonstrate that following diagnostic treatment planning criteria, flapless surgery using a minimally invasive technique is a predictable procedure. The benefits of this procedure are lessened surgical time; minimal changes in crestal bone levels, probing depth, and inflammation; perceived minimized bleeding; and lessened postoperative discomfort.
引文
[1]BranemarkPI,HanssonBO,AdellR,etal Osseointegrated implants in the treatment of the edentulous jaw Experience from a 10 year period Scand J PlastReconstr Surg Suppl,1977,16:130-132
[2]IasellaJM,GreenwellH,MillerRL,etal Ridge preservation with freeze dried bone allograft and a collagenmemhrane compared to extractional one for implant site development:a clinical and histologic study in humans J Periodontol,2003,74:990-999
[3]ShanamanRH The use of guided tissue regeneration to facilitate ideal prosthetic placement of implants Int J Periodontics Restorative Dent,1992,12:256-265
[4]HigginbottomF,BelserU,JohnJD,etal Prosthetic management of implants in the esthetic zone Int J Oral Maxillofacial Implants,2004,19:62-72
[5]AlbrektssonT,ZarbG,WorthingtonP,etal The long term efficacy of currently used dental implants:a review and proposed criteria of success Int J OralMaxillofac Implants,1986,1:11-25
[6]BlockMS,KentJN Placement of endosseous implants into tooth extraction sites J OralMaxillofac Surg,1991,49:1269-1276
[7]Gomez RomanG,SchulteW,d'HoedtB,etal The Frialit 2 implant system:five year clinical experience in single tooth and immediately postextraction applications Int J OralMaxillofac Implants,1997,12:299-309
[8]H mmerleCH,ChenST,WilsonTGJr,etal Consensus statements and recommended clinical procedures regarding the placement of implants in extraction sockets Int J OralMaxillofac Implants,2004,19:26-28
[9]NemcovskyCE,ArtziZ,MosesO Rotated palatal flap in immediate implant procedures Clinical evaluation of 26 consecutive cases Clin Oral Implants Res,2000,11:83-90
[10]Szmukler MonclerS,SalamaH,ReingewirtzY,etal Timing of loading and effect of micromotionon bone dental implant interface:review of experimental literature J BiomedMaterRes,1998,43:192-203
[11]MortonD,JaffinR,WeberHP Immediate restoration and loading of dental implants:clinical considerations and protocols IntJ OralMaxillofac Implants,2004,19Suppl:103-108
[12]SethiA,KausT,SochorP The use of angulated abutments in implant dentistry:five year clinical results of an ongoing prospective study IntJ oralMaxillofac Implants,2000,15:801-810
[13]BelserUC,Mericske SternR,BernardJP,etal Prosthetic management of the partially dentate patient with fixed implant restorations ClinOralImplants Res,2000,11Suppl:126-145
[14]B roadbent J M Chewing and occlusal function FunctOrthod,2000,17:34-39
[15]BuserD,SchenkRK,SteinemannS,etal Influence of surfacec haraete ristic sonbone integration of titanium implants A histomorphometric study in miniature pigs JBiomedMaterRes,1991,25:889-902
[16]LiD,LiuB,WuJ,etal Bone interface of dental implants cytologically influenced by a rnodifieds and blasted surface:a preliminary in vitro study ImplantDent,2001,10:132-138
[17]CochranDL,BuserD,tenBruggenkateCM,etal The use of reduced healing times on ITI implants with as and blasted and acid etched(SLA) surface:early results from clinical trials on ITI SLA implants ClinOralImplantsRes,2002,13:144-153
[18]NedirR,BischofM,BriauxJM,etal A 7 year life table analysis from aprospective study on ITI implants with special emphasis on the use of short implants Results from aprivate practice ClinOralImplantsRes,2004,15:150-157
[19]Schlondorff G.Computer- assisted surgery:historical remarks.Comput Aided surg,1998,3:150-152
[20]冷斌,王贻宁,程勇。曲面断层与螺旋CT在牙种植应用中的对比研究[J]。中华口腔医学杂志,2002.37(5):339
[1]Wanschitz F,Birkfellner W,Watzinger F,et al.Evaluation of accuracy of computer-aided intraoperative positioning of
[2]endosseous oral implants in the edentulous mandible[J].Clin Oral Implants Res,2002,13(1):59-64
[3]Wagner A,Wanschitz F,Birkfellner W,et al.Computer aided placement of endosseous oral implants in patients after ablative tumour surgery:assessment of accuracy[J].Clin Oral Implants Res,2003,14(3):340-348
[4]Meyer U,Wiesmann HP,Runte C,et al.Evaluation of accuracy of insertion of dental implants and prosthetic treatment by computeraided navigation in minipigs[J].Br J Oral Maxillofac Surg,2003,41(2):102-108
[5]Brief J,Edinger D,Hassfeld S,et al.Accuracy of image-guidedimplantology[J].Clinical Oral Implants Research,2005,16(4):495-501
[6]Rosenfeld AL,Mandelaris GA,Tardieu PB.Prosthetically directed implant placement using computer software to ensure precise placement and predictable prosthetic outcomes.Part 1:diagnostics,imaging,and collaborative accountability[J].Int JPeriodontics Restorative Dent,2006,26(3):215-221
[7]Tardieu PB,Vrielinck L,Escolano E,et al.Computer assisted implant placement:scan template,simplant,surgiguide,and SAFE system[J].Int J Periodontics Restorative Dent,2007,27(2):141-149
[8]黄远亮.现代牙种植外科计划Ⅲ.基于CT图像的计算机辅助牙种植外科定位导向模板制作与应用[J].口腔颌面外科杂志 2003,13(1):59-61
[9]王远勤,王臻,吕杰,等.三维重建技术在口腔虚拟种植导航定位中应用的方法学研究[J].中国口腔种植学杂志,2005,10(3):114-117
[10]陈晓军,阎士举,吴轶群,等.基于VTK的口腔种植手术导航系统的图像配准[J].计算机工程,2007,13(1):23-26
[11]Garg AK.Implant surgical templates in implant dentistry:Nobel- Guide Dent[J].Implantol Update,2007,18(4):25-28
[12]Brief J,Hassfeld S,Sonnenfeld U,et al.Computer- guided insertion of dental implants-a clinical evaluation[J].InternationalCongress Series,2001,1230:739-747
[13]Boyes- Varley JG,Howes DG,Lownie JF,et al.Surgical modifications to the Br" nemark zygomaticus protocol in the treatment of the severely resorbed maxilla:a clinical report[J].Int J Oral Maxillofac Implants,2003,18(2):232-237
[14]van Steenberghe D,Malevez C,Van Cleynenbreugel J,et al
[15]Accuracy of drilling guides for transfer from three dimensional CT- based planning to placement of zygoma implants in human cadavers[J].Clin Oral Implants Res,2003,14(1):131-136
[16]张诗雷,张志愿,沈国芳.计算机及三维导航技术辅助外科手术的应用进展.[J]2004,2(3):187-189
[17]Xiaojun C,Yanping L,Yiqun W,et al.Computer- aided oral implantology:methods and applications [J].J Med Eng Tech nol,2007,31,31(6):459-467
[18]Port P.Robots,navigation,telesurgery:state of the art and market overview[J].Z Orthop lhre Grenzgeb.2002,140(2):218-231
[19]Selesnick SH,Kacker A.Image-guided surgical navigation in otology and neurotology[J].Am J Otol,1999,20(5):188-693
[20]Gybels J,Suetens P.Image- guided surgery[J],verb k Acad Geneeskd Belg,1997,59(1):39-57
[21]Wang T,tian Z,Robotic stereotactic neurosurgery system research[J].Int Med Dev,1997,3(9):30-35
[22]Siessegger M,Schneider BT,Mischkowske RA,et al.Use of an image-guided navigation system in dental implant surgery in anatomically complex operation sites[J].Craniomaxillofac Surg,2001,29(5):276-281
[23]Siessegger M.Image guided surgical navigation for removal of foreign bodies in the head and neck[J].J Cranionmaxillofac Surg.2001,29(6):321-325
[24]Nolte LP,Visarius H.Computer-assisted fixation of spinal implants[J].J Image Guid Surg,1995,1:88-93
[25]Vrielinck L,Politis C,Schepers S,Pauwels M,Naert I.Image-based planning and clinical validation of zygoma and pterygoid implant placement in patients with severe bone atrophy using customized drill guides.Preliminary results from a prospective clinical follow-up study.Int.J Oral Maxillofac Surg 2003;32:7-14
[26]Hirsch J-M,Henry P,Andreasson L et al.A clinical Evaluation of the Zygoma Fixture.One -year follow-up at 16 clinics.J Oral Maxillofac Surg 2004;9(Suppl):22-29
[27]Calandriello R,Tomatis M,Rangert N,Gottlow J.Immediate function of tilted implants in the atrophic posterior maxilla.Clin Oral Impl Res 2004;15:1xxi
[28]Priest G.Predictability of soft tissue form around single-tooth implant restorations.Int J Periodontics Restorative Dent,2003,23(1):19-27
[29]Fortin T,Bosson JL,Isidori M,Blanchet E.Effect of flapless surgery on pain experienced in implant placement using an image-guided system.Int J Oral Maxillofac Implants,2006,21(2):298-304
[30]Cannizzaro G,Leone M,Esposito M.Immediate functional loading of implants placed with flapless surgery in the edentulous maxilla:1-year follow-up of a single cohort study.Int J Oral Maxillofac Implants,2007,22(1):87-95
[31]Tamaki Nakano,So ju Eguchi,al.Immediate loading of Implants in a completely Edentulous Maxilla Using Flapless Surgery.Prosthodontic Research and Practice,2007,6(1):57-62
[32]Becker W,Wikesjo UM,Sennerby L,al.Histologic evaluation of implants following flapless and flapped surgery:a study in canines.J Periodontol,2006,77(10):171-172
[33]Cardaropoli G,Lekholm U,Wennstrom JL.Tissue alterations at implant-supported singletooth replacements:a 1-year prospective study.Clin Oral Implants Res,2006,17(2):165-171
[34]Priest G.Predictability of soft tissue form around single-tooth implant restorations.Int J Periodontics Restorative Dent,2003,23(1):19-27
[35]Camelo LD,Camara JR.Flapless implant surgery:a 10-year clinical retrospective analysis.Int J Oral Maxillofac Implants.2002 Mar-Apr;17(2):271-6
[36]Jeong SM,Choi BH,Li J.Flapless implant surgery:an experimental study.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2007 Jul;104(1):24-8
[37]Tamaki Nakano,Soju Eguchi,Kunihiro Hisada.Immediate Loading of Implants in a Completely Edentulous Maxilla Using Flapless Surgery.Prosthodontic Research & Practice Vol.6(2007) 1:.57-62
[38]Oh TJ,Shot well J,Billy E,Byun HY,Wang HL.Flapless implant surgery in the esthetic region:advantages and precautions.Int J Periodontics Restorative Dent.2007 Feb;27(1):27-33
[39]Becker W,Goldstein M,Becker BE,Sennerby L Minimally invasive flapless implant surgery:a prospective multicenter study.Clin Implant Dent Relat Res。2005;7 Suppl 1:S21-7
[40]Tel Aviv,G? teborg,Tucson.Minimally invasive flapless implant surgery:A prospective muhicenter study.Clinical Implant Dentistry and Related Research,2005,7(1):21-27
[41]Fortin T,Champleboux G,Bianchi S,al.Precision of transfer of preoperative planning for oral implants based on cone-beam CT-scan images through a robotic drilling machine.Clin Oral Implants Res,2002 Dec,13(6):651-6
[42]Fortin T,Isidori M,al.An image- guided system- drilled surgical template and trephine guide pin to make treatment of completely edentulous patients easier:a clinical report on immediate loading.Clin Implant Dent Relat Res,2004:6(2):111-9
[43]Casap N,Tarazi E,al.Intraoperative computerized navigation for flapless implant surgery and immediate loading in the edentulous mandible.Int J Oral Maxillofac Implants,2005,Jan-Feb,20(1):92-8
[44]Fortin T,Bosson JL,Isidori M,Blanchet E.Effect of flapless surgery on pain experienced in implant placement using an image-guided system.Int J Oral Maxillofac Implants,2006,21(2):298-304
[45]Cannizzaro G,Leone M,Esposito M.Immediate functional loading of implants placed with flapless surgery in the edentulous maxilla:1-year follow-up of a single cohort study.Int J Oral Maxillofac Implants,2007,22(1):87-95
[46]Tamaki Nakano,So ju Eguchi,al.Immediate loading of Implants in a completely Edentulous Maxilla Using Flapless Surgery.Prosthodontic Research and Practice,2007,6(1):57-62
[2]IasellaJM,GreenwellH,MillerRL,etal Ridge preservation with freeze dried bone allograft and a collagenmemhrane compared to extractional one for implant site development:a clinical and histologic study in humans J Periodontol,2003,74:990-999
[3]ShanamanRH The use of guided tissue regeneration to facilitate ideal prosthetic placement of implants Int J Periodontics Restorative Dent,1992,12:256-265
[4]HigginbottomF,BelserU,JohnJD,etal Prosthetic management of implants in the esthetic zone Int J Oral Maxillofacial Implants,2004,19:62-72
[5]AlbrektssonT,ZarbG,WorthingtonP,etal The long term efficacy of currently used dental implants:a review and proposed criteria of success Int J OralMaxillofac Implants,1986,1:11-25
[6]BlockMS,KentJN Placement of endosseous implants into tooth extraction sites J OralMaxillofac Surg,1991,49:1269-1276
[7]Gomez RomanG,SchulteW,d'HoedtB,etal The Frialit 2 implant system:five year clinical experience in single tooth and immediately postextraction applications Int J OralMaxillofac Implants,1997,12:299-309
[8]H mmerleCH,ChenST,WilsonTGJr,etal Consensus statements and recommended clinical procedures regarding the placement of implants in extraction sockets Int J OralMaxillofac Implants,2004,19:26-28
[9]NemcovskyCE,ArtziZ,MosesO Rotated palatal flap in immediate implant procedures Clinical evaluation of 26 consecutive cases Clin Oral Implants Res,2000,11:83-90
[10]Szmukler MonclerS,SalamaH,ReingewirtzY,etal Timing of loading and effect of micromotionon bone dental implant interface:review of experimental literature J BiomedMaterRes,1998,43:192-203
[11]MortonD,JaffinR,WeberHP Immediate restoration and loading of dental implants:clinical considerations and protocols IntJ OralMaxillofac Implants,2004,19Suppl:103-108
[12]SethiA,KausT,SochorP The use of angulated abutments in implant dentistry:five year clinical results of an ongoing prospective study IntJ oralMaxillofac Implants,2000,15:801-810
[13]BelserUC,Mericske SternR,BernardJP,etal Prosthetic management of the partially dentate patient with fixed implant restorations ClinOralImplants Res,2000,11Suppl:126-145
[14]B roadbent J M Chewing and occlusal function FunctOrthod,2000,17:34-39
[15]BuserD,SchenkRK,SteinemannS,etal Influence of surfacec haraete ristic sonbone integration of titanium implants A histomorphometric study in miniature pigs JBiomedMaterRes,1991,25:889-902
[16]LiD,LiuB,WuJ,etal Bone interface of dental implants cytologically influenced by a rnodifieds and blasted surface:a preliminary in vitro study ImplantDent,2001,10:132-138
[17]CochranDL,BuserD,tenBruggenkateCM,etal The use of reduced healing times on ITI implants with as and blasted and acid etched(SLA) surface:early results from clinical trials on ITI SLA implants ClinOralImplantsRes,2002,13:144-153
[18]NedirR,BischofM,BriauxJM,etal A 7 year life table analysis from aprospective study on ITI implants with special emphasis on the use of short implants Results from aprivate practice ClinOralImplantsRes,2004,15:150-157
[19]Schlondorff G.Computer- assisted surgery:historical remarks.Comput Aided surg,1998,3:150-152
[20]冷斌,王贻宁,程勇。曲面断层与螺旋CT在牙种植应用中的对比研究[J]。中华口腔医学杂志,2002.37(5):339
[1]Wanschitz F,Birkfellner W,Watzinger F,et al.Evaluation of accuracy of computer-aided intraoperative positioning of
[2]endosseous oral implants in the edentulous mandible[J].Clin Oral Implants Res,2002,13(1):59-64
[3]Wagner A,Wanschitz F,Birkfellner W,et al.Computer aided placement of endosseous oral implants in patients after ablative tumour surgery:assessment of accuracy[J].Clin Oral Implants Res,2003,14(3):340-348
[4]Meyer U,Wiesmann HP,Runte C,et al.Evaluation of accuracy of insertion of dental implants and prosthetic treatment by computeraided navigation in minipigs[J].Br J Oral Maxillofac Surg,2003,41(2):102-108
[5]Brief J,Edinger D,Hassfeld S,et al.Accuracy of image-guidedimplantology[J].Clinical Oral Implants Research,2005,16(4):495-501
[6]Rosenfeld AL,Mandelaris GA,Tardieu PB.Prosthetically directed implant placement using computer software to ensure precise placement and predictable prosthetic outcomes.Part 1:diagnostics,imaging,and collaborative accountability[J].Int JPeriodontics Restorative Dent,2006,26(3):215-221
[7]Tardieu PB,Vrielinck L,Escolano E,et al.Computer assisted implant placement:scan template,simplant,surgiguide,and SAFE system[J].Int J Periodontics Restorative Dent,2007,27(2):141-149
[8]黄远亮.现代牙种植外科计划Ⅲ.基于CT图像的计算机辅助牙种植外科定位导向模板制作与应用[J].口腔颌面外科杂志 2003,13(1):59-61
[9]王远勤,王臻,吕杰,等.三维重建技术在口腔虚拟种植导航定位中应用的方法学研究[J].中国口腔种植学杂志,2005,10(3):114-117
[10]陈晓军,阎士举,吴轶群,等.基于VTK的口腔种植手术导航系统的图像配准[J].计算机工程,2007,13(1):23-26
[11]Garg AK.Implant surgical templates in implant dentistry:Nobel- Guide Dent[J].Implantol Update,2007,18(4):25-28
[12]Brief J,Hassfeld S,Sonnenfeld U,et al.Computer- guided insertion of dental implants-a clinical evaluation[J].InternationalCongress Series,2001,1230:739-747
[13]Boyes- Varley JG,Howes DG,Lownie JF,et al.Surgical modifications to the Br" nemark zygomaticus protocol in the treatment of the severely resorbed maxilla:a clinical report[J].Int J Oral Maxillofac Implants,2003,18(2):232-237
[14]van Steenberghe D,Malevez C,Van Cleynenbreugel J,et al
[15]Accuracy of drilling guides for transfer from three dimensional CT- based planning to placement of zygoma implants in human cadavers[J].Clin Oral Implants Res,2003,14(1):131-136
[16]张诗雷,张志愿,沈国芳.计算机及三维导航技术辅助外科手术的应用进展.[J]2004,2(3):187-189
[17]Xiaojun C,Yanping L,Yiqun W,et al.Computer- aided oral implantology:methods and applications [J].J Med Eng Tech nol,2007,31,31(6):459-467
[18]Port P.Robots,navigation,telesurgery:state of the art and market overview[J].Z Orthop lhre Grenzgeb.2002,140(2):218-231
[19]Selesnick SH,Kacker A.Image-guided surgical navigation in otology and neurotology[J].Am J Otol,1999,20(5):188-693
[20]Gybels J,Suetens P.Image- guided surgery[J],verb k Acad Geneeskd Belg,1997,59(1):39-57
[21]Wang T,tian Z,Robotic stereotactic neurosurgery system research[J].Int Med Dev,1997,3(9):30-35
[22]Siessegger M,Schneider BT,Mischkowske RA,et al.Use of an image-guided navigation system in dental implant surgery in anatomically complex operation sites[J].Craniomaxillofac Surg,2001,29(5):276-281
[23]Siessegger M.Image guided surgical navigation for removal of foreign bodies in the head and neck[J].J Cranionmaxillofac Surg.2001,29(6):321-325
[24]Nolte LP,Visarius H.Computer-assisted fixation of spinal implants[J].J Image Guid Surg,1995,1:88-93
[25]Vrielinck L,Politis C,Schepers S,Pauwels M,Naert I.Image-based planning and clinical validation of zygoma and pterygoid implant placement in patients with severe bone atrophy using customized drill guides.Preliminary results from a prospective clinical follow-up study.Int.J Oral Maxillofac Surg 2003;32:7-14
[26]Hirsch J-M,Henry P,Andreasson L et al.A clinical Evaluation of the Zygoma Fixture.One -year follow-up at 16 clinics.J Oral Maxillofac Surg 2004;9(Suppl):22-29
[27]Calandriello R,Tomatis M,Rangert N,Gottlow J.Immediate function of tilted implants in the atrophic posterior maxilla.Clin Oral Impl Res 2004;15:1xxi
[28]Priest G.Predictability of soft tissue form around single-tooth implant restorations.Int J Periodontics Restorative Dent,2003,23(1):19-27
[29]Fortin T,Bosson JL,Isidori M,Blanchet E.Effect of flapless surgery on pain experienced in implant placement using an image-guided system.Int J Oral Maxillofac Implants,2006,21(2):298-304
[30]Cannizzaro G,Leone M,Esposito M.Immediate functional loading of implants placed with flapless surgery in the edentulous maxilla:1-year follow-up of a single cohort study.Int J Oral Maxillofac Implants,2007,22(1):87-95
[31]Tamaki Nakano,So ju Eguchi,al.Immediate loading of Implants in a completely Edentulous Maxilla Using Flapless Surgery.Prosthodontic Research and Practice,2007,6(1):57-62
[32]Becker W,Wikesjo UM,Sennerby L,al.Histologic evaluation of implants following flapless and flapped surgery:a study in canines.J Periodontol,2006,77(10):171-172
[33]Cardaropoli G,Lekholm U,Wennstrom JL.Tissue alterations at implant-supported singletooth replacements:a 1-year prospective study.Clin Oral Implants Res,2006,17(2):165-171
[34]Priest G.Predictability of soft tissue form around single-tooth implant restorations.Int J Periodontics Restorative Dent,2003,23(1):19-27
[35]Camelo LD,Camara JR.Flapless implant surgery:a 10-year clinical retrospective analysis.Int J Oral Maxillofac Implants.2002 Mar-Apr;17(2):271-6
[36]Jeong SM,Choi BH,Li J.Flapless implant surgery:an experimental study.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2007 Jul;104(1):24-8
[37]Tamaki Nakano,Soju Eguchi,Kunihiro Hisada.Immediate Loading of Implants in a Completely Edentulous Maxilla Using Flapless Surgery.Prosthodontic Research & Practice Vol.6(2007) 1:.57-62
[38]Oh TJ,Shot well J,Billy E,Byun HY,Wang HL.Flapless implant surgery in the esthetic region:advantages and precautions.Int J Periodontics Restorative Dent.2007 Feb;27(1):27-33
[39]Becker W,Goldstein M,Becker BE,Sennerby L Minimally invasive flapless implant surgery:a prospective multicenter study.Clin Implant Dent Relat Res。2005;7 Suppl 1:S21-7
[40]Tel Aviv,G? teborg,Tucson.Minimally invasive flapless implant surgery:A prospective muhicenter study.Clinical Implant Dentistry and Related Research,2005,7(1):21-27
[41]Fortin T,Champleboux G,Bianchi S,al.Precision of transfer of preoperative planning for oral implants based on cone-beam CT-scan images through a robotic drilling machine.Clin Oral Implants Res,2002 Dec,13(6):651-6
[42]Fortin T,Isidori M,al.An image- guided system- drilled surgical template and trephine guide pin to make treatment of completely edentulous patients easier:a clinical report on immediate loading.Clin Implant Dent Relat Res,2004:6(2):111-9
[43]Casap N,Tarazi E,al.Intraoperative computerized navigation for flapless implant surgery and immediate loading in the edentulous mandible.Int J Oral Maxillofac Implants,2005,Jan-Feb,20(1):92-8
[44]Fortin T,Bosson JL,Isidori M,Blanchet E.Effect of flapless surgery on pain experienced in implant placement using an image-guided system.Int J Oral Maxillofac Implants,2006,21(2):298-304
[45]Cannizzaro G,Leone M,Esposito M.Immediate functional loading of implants placed with flapless surgery in the edentulous maxilla:1-year follow-up of a single cohort study.Int J Oral Maxillofac Implants,2007,22(1):87-95
[46]Tamaki Nakano,So ju Eguchi,al.Immediate loading of Implants in a completely Edentulous Maxilla Using Flapless Surgery.Prosthodontic Research and Practice,2007,6(1):57-62