动态导航技术辅助无牙颌种植精度分析  

Accuracy of dental implant placement in fully edentulous patients using a dynamic navigation system

作　　者：陶宝鑫 蓝耕良 黄伟[1] 王凤[2] 沈意涵 吴轶群[1] TAO Baoxin;LAN Kengliang;HUANG Wei;WANG Feng;SHEN Yihan;WU Yiqun(Department of Second Dental Center, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine,College of Stomatology, Shanghai Jiao Tong University,National Center for Stomatology,National Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology,Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences,Shanghai 201999,China;Department of Oral Implantology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine,College of Stomatology, Shanghai Jiao Tong University,National Center for Stomatology,National Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology,Research Unit of Oral and Maxillofacial Regenerative Medicine,Chinese Academy of Medical Sciences,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院口腔第二门诊部,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,中国医学科学院口腔颌面再生医学创新单元,上海201999 [2]上海交通大学医学院附属第九人民医院口腔种植科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,中国医学科学院口腔颌面再生医学创新单元,上海200011

出　　处：《上海交通大学学报（医学版）》2022年第9期1353-1360,共8页Journal of Shanghai Jiao tong University:Medical Science

基　　金：申康医院发展中心促进市级医院临床技能与临床创新能力三年行动计划(SHDC2020CR3049B);上海交通大学“交大之星”计划医工交叉研究基金(YG2021QN72);中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-037);上海交通大学医学院附属第九人民医院口腔医学研究型学科基金(KQYJXK2020);黄浦区产业扶持基金(XK2020014);上海市高水平地方高校创新团队(SHSMU-ZLCX20212402)。

摘　　要：目的·针对动态导航技术辅助无牙颌种植的种植体植入精度进行分析。方法·回顾性分析2020年12月至2022年1月期间于上海交通大学医学院附属第九人民医院口腔第二门诊部接受动态导航辅助种植修复的9例无牙颌患者,其中男性8例、女性1例,包括5例无牙下颌及4例无牙上颌患者,年龄(48.78±15.25)岁;共计57枚种植体,其中动态导航下植入种植体56枚,自由手植入1枚。将术前规划的种植路径与术后实际种植体的锥形束CT数据融合,测量和记录种植规划路径和实际种植体之间的三维入口偏差、出口偏差和角度偏差。根据种植体植入颌位,将种植体分为上颌组和下颌组;根据种植体植入位置(以中线划分),将种植体分为左侧组和右侧组;根据种植体植入位置(前牙区或后牙区),将种植体分为前牙区组和后牙区组。采用近似t检验或Mann-Whitney U检验分析各组之间种植体精度的差异。结果·56枚动态导航下植入的种植体三维入口偏差的中位数(下四分位数,上四分位数)为1.06(0.54,1.54)mm,出口偏差为1.11(0.51,1.56)mm,角度偏差为3.33°(1.77°,4.52°)。上颌组和下颌组的种植体的入口偏差、出口偏差及角度偏差差异均无统计学意义(P>0.05);左侧组和右侧组的种植体的入口偏差、出口偏差及角度偏差差异均无统计学意义(P>0.05);前牙区组和后牙区组的种植体的入口偏差及出口偏差差异均无统计学意义(P>0.05),但前牙区组与后牙区组角度偏差差异有统计学意义(P=0.029)。结论·动态导航系统辅助种植体植入可以在无牙颌患者中获得良好的植入精度。Objective·To study the accuracy of dental implant placement in fully edentulous patients using a dynamic navigation system. Methods·Nine fully edentulous patients [8 males and 1 female with the mean age of(48.78±15.25) years old], including 5 maxillae and 4 mandibles, from December 2020 to January 2022, in the Department of Second Dental Center, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine were included, where 56 implants were placed by a dynamic navigation system and 1 was by freehand. The preoperative plans and the postoperative cone-beam CT were fused, and the entry deviation, exit deviation and angle deviation between the planned and placed dental implants were measured and recorded. According to different jaws, the implants were divided into maxilla and mandible group, and the implants were split into left and right group according to their locations to the midline. The dental implants were classified into anterior and posterior group based on the placed location. The differences of the three deviations between different groups were analyzed by using approximate t test and Mann-Whitney U test.Results·The median(lower quartile, upper quartile) of entry deviation, exit deviation and angle deviation of dental implants were 1.06(0.54, 1.54) mm, 1.11(0.51, 1.56) mm and 3.33°(1.77°, 4.52°), respectively. No significant difference was found in the three deviations,irrespective of the different jaws(maxilla and mandible)(P>0.05) and implant locations(left and right side)(P>0.05). The angle deviation of the anterior implants was significantly higher than that of the posterior implants(P=0.029), but the entry deviation and exit deviation showed no significant difference between the anterior and posterior group(P>0.05). Conclusion·The dynamic navigation system can achieve acceptable accuracy of dental implant placement in the fully edentulous patients.

关 键 词：牙种植体 牙修复体 无牙颌 计算机辅助外科手术 

分 类 号：R782.12[医药卫生—口腔医学]