牙-骨联合支持式CAD/CAM种植手术模板的临床应用  

Clinical Application of Bone and Tooth-supported CAD/CAM Surgical Templates for Placement of Dental Implants in Jaw

作　　者：黄远亮[1] 吴伟恂[1] 黄兰[1] 陈卫东[1] 陈晓军[2] 王成焘[2] 

机构地区：[1]同济大学附属东方医院口腔科 [2]上海交通大学生命质量与制造研究所

出　　处：《中国口腔种植学杂志》2009年第2期7-8,共2页Chinese Journal of Oral Implantology

摘　　要：目的:口腔种植体植入位置的正确性与精确性以及方向与深度问题的把握,一直为临床口腔种植外科领域关注的问题。本研究在基于CT影像颌骨三维解剖结构分析的基础上,研究适合国人的计算机辅助设计与制作(CAD/CAM)的口腔种植外科手术模板系统,旨在探讨个体化设计的牙-骨联合支持式CAD/CAM种植手术模板的临床应用效果。材料与方法:应用Philips Brilliance64层螺旋CT机、CHEU-DENTAL Biostar空气压模机、SPS600B激光快速原型机并借助Advantage-Dentascan AW4.0软件、ez-DICOM程序、PRO/E及在Visual C++6.0程序设计语言编程下的CISPlan牙种植软件,先后完成研究包括:基于螺旋CT受植颌骨三维结构分析;②CAD/CAM牙种植外科手术定位导向模板的设计;③12例末端游离缺失患者种植的临床应用及评价。结果:该辅助软件系统均能满足涉及三维重建、图像分割、图像显示、图像融合等方面的图像处理功能与医学图像的三维可视化,系统可以直接读取DICOM格式、JPG格式和BMP格式的图像数据,实现颌骨CT数据多平面重建与浏览包括轴位、侧断层、全景及受植颌骨三维结构图像的任意剖面的显示。在仿生下颌骨上应用RP技术制作的3、5、10mm三种不同高度的种植外科导向模板进行13mm长度种植体模拟种植的结果提示,5mm以上厚度模板能将植入位点误差控制在1mm以内,角度误差在3度以内。该研究成果为临床研究提供了可靠的实验依据,并为种植外科医生术中准确与精确植入牙种植体提供了安全保障。12例末端游离缺失患者种植外科临床应用效果显示:牙-骨联合支持式CAD/CAM光敏树脂手术模板能满足手术便利、准确、精确与安全的需要。讨论:经临床种植病人初步应用,牙-骨联合支持式CAD/CAM种植手术模板具有如下优点:将骨支持与牙支持方式结合起来,研制出以模板的骨支持为基础并辅以激光扫描获得的Objective:Recently,novel CAD/CAM techniques of stereolithographic rapid prototyping have been developed to build surgical template in an attempt to improve precision of implant placement.The purpose of this study was to compare the accuracy of a bone-borne stereolithographic surgical template to that of a tooth-bone-borne surgical guide.Materials and Methods:CT scanning of partial edentulous jaw were performed for 12 patients using a CT scanner with high isotropic spatial resolution(Philip Brilliance 64).The planning for 3 or 4 implants on lateral distal extension edentulous areas was performed using a new developed interactive software system.One surgeon performed osteotomies on the maxilla and mandible of all patients;bone-borne surgical templates were used for 6 of the patients,and tooth-bone-borne surgical guides were used for remaining six patients.Each maxilla or mandible was then CT scanned,and a registration method was applied to match it to the initial planning.Measurements included distance between planned implants and actual osteotmies.Results:The results indicated a nearly perfect match and stable between the tooth-bone-born templates and receptor sites.The average distances between planned implants and the actual osteotomy was 0.8mm at the entrance and 1.2mm at the apex when the bone-borne guide was used.The same measurements were reduced to 0.5mm and 0.8mm when the tooth-bone-borne guide was used.Conclusions:This novel approach may be advantageous once available in dental offices.Based on the presurgical planning transferred to the surgical reality with tooth-bone-borne stereolithographic template,the cases can then be completed with complete confidence.Resulting clinical benefits over only bone-borne surgical templates are discussed.

关 键 词：联合支持式 手术模板 种植外科 口腔种植 牙种植体 牙支持式 压模机 模板系统 种植体植入 光敏树脂 

分 类 号：R783[医药卫生—口腔医学]