数字化导板引导下全口种植即刻负重可行性与精准度的研究

doi:10.13591/j.cnki.kqyx.2022.04.012

摘要/Abstract

摘要： 目的探究数字化导板引导下全口种植即刻负荷的可行性,根据影像学数据评价导板引导的种植精准度,探讨可能影响植体位置精度的相关因素。方法按照准入排除标准,收集2017年至2019年使用数字化导板引导下的全口种植即刻负重固定修复患者16例(98枚植体),跟踪随访患者评价长期的临床修复效果。利用CBCT数据测量30颗植体实际位置与设计位置在三维空间上的偏差,评估植入精准度。运用统计学方法分析精准度相关因素。结果种植体1年留存率98.98%(97/98),红色美学评分(PES)(9.53±1.68)分,白色美学评分(WES)(7.05±1.10)分,患者满意度为(9.15±0.84)分。种植体颈部偏差量为(1.40±1.07) mm,根部偏差量为(1.54±1.13) mm,深度偏差量为(1.10±1.09) mm,角度偏差量为4.41°±2.68°。不同品牌植体的偏差值存在显著差异,种植时机、手术导板支持方式、放射导板制作方式、牙位未对植入精准度造成显著影响。结论数字化全口种植固定修复是一种临床效果好、可重复性高的牙列缺失治疗方案,值得应用和推广。

关键词: 牙种植, 数字化种植, 全口种植, 牙列缺失

Abstract: Objective To explore the feasibility of static digital guided surgery with immediate loading in edentulous patients, to evaluate the accuracy of guided implant surgery based on cone-beam computed tomography (CBCT) data, and to discuss factors that may affect accuracy. Methods Sixteen cases where 98 implants were placed into partially and totally edentulous patients from 2017 to 2019 were collected. All surgeries were assisted by digital surgical guide and immediately loaded. Patients were followed up to record survival rate and long-term function of implants. The three-dimensional deviations of 30 actual implants from their designed position were measured based on CBCT data, which aimed to evaluate accuracy. Statistical methods were employed to analyze accuracy related factors. Results The 1-year implant survival rate was 98.98% (97/98); the pink esthetic score (PES) was (9.53±1.68) points; the white esthetic score (WES) was (7.05±1.10) points, and the patient satisfaction was (9.15±0.84) points. 3D deviation at entry was (1.40±1.07) mm, and at apex was (1.54±1.13) mm. Depth deviation was (1.10±1.09) mm, and angle deviation was 4.41°±2.68°. There were significant differences in implants′ deviations among different brands. Timing of implant placement, the supporting mode of surgical guide, the manufacturing method of guide and tooth position did not significantly affect the accuracy of implantation. Conclusion Digital guided implant surgery with immediate loading is a stable and highly repeatable clinical procedure for edentulous patients, which is worthy of application and promotion.

Key words: dental implant, computer-assisted implant surgery, full-arch implant, edentulous

中图分类号:

R783.4

柳麟翔, 唐丽琴, 于美娜, 袁月, 董岩. 数字化导板引导下全口种植即刻负重可行性与精准度的研究[J]. 口腔医学, 2022, 42(4): 345-348.

LIU Linxiang, TANG Liqin, YU Meina, YUAN Yue, DONG Yan. Feasibility and accuracy of static computer-assisted full-arch implant surgery with immediate loading[J]. Stomatology, 2022, 42(4): 345-348.

参考文献

[1] 贾胜男, 林野. 不同的种植修复方式对无牙颌剩余牙槽骨改建的影响[J]. 口腔医学研究, 2021, 37(7):598-601.
[2] Tahmaseb A, Wu V, Wismeijer D,et al. The accuracy of static computer-aided implant surgery:A systematic review and meta-analysis[J]. Clin Oral Implants Res, 2018, 29(Suppl 16):416-435.
[3] Al Yafi F, Camenisch B, Al-Sabbagh M. Isdigital guided implant surgery accurate and reliable?[J]. Dent Clin North Am, 2019, 63(3):381-397.
[4] D'haese J, Ackhurst J, Wismeijer D, et al. Current state of the art of computer-guided implant surgery[J]. Periodontol 2000, 2017, 73(1):121-133.
[5] Tahmaseb A, Wismeijer D, Coucke W,et al. Computer technology applications in surgical implant dentistry:A systematic review[J]. Int J Oral Maxillofac Implants, 2014, 29(Suppl):25-42.
[6] Olofsson H, Ulander EL, Gustafson Y, et al. Association between socioeconomic and health factors and edentulism in people aged 65 and older-a population-based survey[J]. Scand J Public Heal, 2018, 46(7):690-698.
[7] Joda T, Ferrari M, Gallucci GO, et al. Digital technology in fixed implant prosthodontics[J]. Periodontol 2000, 2017, 73(1):178-192.
[8] Moreno A, Giménez B, Özcan M,et al. A clinical protocol for intraoral digital impression of screw-retained CAD/CAM framework on multiple implants based on wavefront sampling technology[J]. Implant Dent, 2013, 22(4):320-325.
[9] Menini M, Setti P, Pera F,et al. Accuracy of multi-unit implant impression:Traditional techniques versus a digital procedure[J]. Clin Oral Investig, 2018, 22(3):1253-1262.
[10] Sadan A, Raigrodski AJ, Salinas TJ. Prosthetic considerations in the fabrication of surgical stents for implant placement[J]. Pract Periodontics Aesthet Dent, 1997, 9(9):1003-1011;quiz1012.
[11] Raigrodski AJ, Sadan A, Salinas TJ. Managing malrelated Arches and limited vertical space for implant-supported overdentures:A case report[J]. Pract Periodontics Aesthet Dent, 1998, 10(2):163-170;quiz172.
[12] 瞿利军, 赖红昌. Straumann种植体早期负荷与延迟负荷稳定性的比较研究[J]. 口腔医学, 2011, 31(8):476-479.
[13] Tealdo T, Menini M, Bevilacqua M,et al. Immediate versus delayed loading of dental implants in edentulous patients' maxillae:A 6-year prospective study[J]. Int J Prosthodont, 2014, 27(3):207-214.
[14] Salvi GE, Gallini G, Lang NP. Early loading (2 or 6 weeks) of sandblasted and acid-etched (SLA) ITI implants in the posterior mandible. A 1-year randomized controlled clinical trial[J]. Clin Oral Implants Res, 2004, 15(2):142-149.
[15] Song D, Zheng H, Huang Y,et al. Effect of the different implant protocols on peri-implant bone:A 6-month prospective study in beagle dogs[J]. Int J Artif Organs, 2017, 40(12):701-708.
[16] Turkyilmaz I, Tumer C, Ozbek EN, et al. Relations between the bone density values from computerized tomography, and implant stability parameters:A clinical study of 230 regular platform implants[J]. J Clin Periodontol, 2007, 34(8):716-722.
[17] Payne AG, Tawse-Smith A, Thompson WM, et al. Early functional loading of unsplinted roughened surface implants with mandibular overdentures 2 weeks after surgery[J]. Clin Implant Dent Relat Res, 2003, 5(3):143-153.
[18] Zhou WJ, Liu ZH, Song LS, et al. Clinical factors affecting the accuracy of guided implant surgery-A systematic review and meta-analysis[J]. J Evid Based Dent Pract, 2018, 18(1):28-40.
[19] Wismeijer D, Joda T, Flügge T,et al. Group 5 ITI consensus report:Digital technologies[J]. Clin Oral Implants Res, 2018, 29(Suppl 16):436-442.
[20] Smitkarn P, Subbalekha K, Mattheos N,et al. The accuracy of single-tooth implants placed using fully digital-guided surgery and freehand implant surgery[J]. J Clin Periodontol, 2019, 46(9):949-957.