骨质情况对计算机辅助设计种植导板应用精确性的影响分析

doi:10.13591/j.cnki.kqyx.2024.07.005

摘要/Abstract

摘要：

目的针对拟种植区骨质较差的患者应用计算机辅助设计种植导板并评估其精确性,以探讨种植体周不同骨质对植入精度的影响。方法对29例符合纳入标准、骨质相对较差的单牙种植患者相关临床数据进行回顾性分析。术前使用3Shape Implant Studio软件设计种植方案并制作数字化导板,全程引导下完成种植体植入,并记录植入扭力和ISQ值,以评价种植体初期稳定性。借助术后CBCT影像逆向构建种植体实际植入位置,结合术前设计方案,评价种植体植入的三维偏差,分析术前设计和术后种植体周围骨质情况。结果本研究中在骨质较差患者中全程应用数字化导板,除3枚种植体外,其余种植体初期稳定性均≥20 N·cm;种植体实际植入颈部偏差为(0.94±0.59)mm,根尖部偏差为(1.40±0.81)mm,角度偏差为4.10°±2.99°,骨质对角度偏差影响更大,具有统计学意义(P<0.05);种植体体部1/3周围D3类骨质占比越高,其颈部、根尖和角度偏差越小,而D5类骨质占比越高,植入偏差越大。结论针对骨质较差的患者,在以修复为导向的前提下,通过计算机辅助设计增加种植体周D3类骨质占比,采用全程数字化导板引导植入,可提高种植体初期稳定性;导板应用过程中需关注骨质对种植体角度偏差的影响。

关键词: 牙种植, 计算机辅助设计与制作, 精度, 手术导板

Abstract:

Objective To explore the influence of different bone quality around the implant on the implantation accuracy, the computer-aided design of implant guide plate was used for patients with poor bone quality to evaluate its accuracy. Methods Retrospective analysis of relevant clinical data from 29 single-tooth implant patients with relatively poor bone quality meeting inclusion criteria was conducted. Using 3Shape Implant Studio software, implant plans were designed and fully guided digital templates were fabricated before surgery. Implantation was guided by the templates throughout, with torque and ISQ values recorded to evaluate the initial stability of the implant. Postoperative implant positions were reconstructed using CBCT images, and the three-dimensional deviation of implant placement was evaluated in conjunction with the preoperative design. Bone quality around the implants was also recorded and analyzed before and after surgery. Results In this study, digital guide plates were used in patients with poor bone quality, and the initial stability of implants was ≥ 20 N·cm except for three cases. In cases of poor bone quality, the accuracy of the fully guided digital templates was as follows: cervix deviation (0.94±0.59)mm, apex deviation (1.40±0.81)mm and angle deviation 4.10°±2.99°. Bone quality had a greater impact on angle deviation (P<0.05). The higher the proportion of D3 bone was around the implant body 1/3, the smaller the deviation of neck, apex and angle was, while the higher the proportion of D5 bone, the greater the deviation of implantation. Conclusion For patients with poor bone quality, under the premise of restoration-oriented, the proportion of D3 bone around the implant can be increased by computer-aided design, and the initial stability of the implant can be improved by guiding the implantation with digital guide plate. Attention should be paid to the influence of bone on the angle deviation of implant during the application of guide plate.

Key words: dental implant, computer-assisted design and fabrication, precision, surgical template

中图分类号:

R783.4

钱雨馨, 李建, 张建兰, 张施璇, 顾洋乾, 路萌萌, 汤春波. 骨质情况对计算机辅助设计种植导板应用精确性的影响分析[J]. 口腔医学, 2024, 44(7): 508-514.

QIAN Yuxin, LI Jian, ZHANG Jianlan, ZHANG Shixuan, GU Yangqian, LU Mengmeng, TANG Chunbo. Analysis of the impact of bone quality on the accuracy of computer-aided design of implant guide plate[J]. Stomatology, 2024, 44(7): 508-514.

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项目	骨质分类		P
项目	D4、D3b(HU<600)	D2(颈部D4)	P
位置			0.030
上颌	11	0
下颌	10	8
性别			0.257
男	9	6
女	12	2
植入扭矩/(N·cm)	25.24±5.63	28.13±3.91	0.196
ISQ	63.80±7.80	67.46±6.06	0.243

种植体尺寸 (直径×长度)	种植体数量	植入扭矩/(N·cm)	ISQ
4.0 mm×8.5 mm	1	23.00	57.70
4.0 mm×10.0 mm	3	25±5.57	60.67±2.52
4.0 mm×11.5 mm	1	30.00	63.90
4.5 mm×7.0 mm	5	17.80±4.38	58.28±8.02
4.5 mm×8.5 mm	9	28.56±1.94	68.41±6.42
4.5 mm×10.0 mm	9	28.11±4.37	67.32±7.57
5.0 mm×7.0 mm	1	28.00	62.80

差异源	植入扭矩		ISQ
差异源	F	P	F	P
直径	2.279	0.126	2.190	0.136
长度	4.280	0.016	2.607	0.077

骨质分类	颈部偏差/mm	根尖部偏差/mm	角度偏差/°
D4、D3b(HU<600)	0.99±0.60	1.53±0.82	4.74±2.27
D2(颈部D4)	0.80±0.60	1.05±0.67	2.27±1.08
P	0.467	0.150	0.045

种植体尺寸 (直径×长度)	颈部偏差/mm	根尖部偏差/mm	角度偏差/°
4.0 mm×8.5 mm	0.51	1.17	4.61
4.0 mm×10.0 mm	1.08±0.32	2.64±0.54	9.16±2.14
4.0 mm×11.5 mm	0.77	0.84	1.86
4.5 mm×7.0 mm	1.40±1.08	1.60±1.10	5.72±4.34
4.5 mm×8.5 mm	1.02±0.48	1.37±0.59	3.06±1.47
4.5 mm×10.0 mm	0.67±0.34	1.09±0.62	2.91±1.86
5.0 mm×7.0 mm	0.49	0.50	2.46