数字化种植导板手术的精确性:非手术因素分析及对策的专家共识  

Accuracy of digital guided implant surgery:expert consensus on nonsurgical factors and their treatments

作　　者：徐淑兰 李平 杨烁 李少冰 卢海宾 朱安棣 黄立舒 王劲茗[3] 徐世同 王丽萍[5] 汤春波[6] 周延民[7] 周磊 XU Shulan;LI Ping;YANG Shuo;LI Shaobing;LU Haibin;ZHU Andi;HUANG Lishu;WANG Jinming;XU Shitong;WANG Liping;TANG Chunbo;ZHOU Yanmin;ZHOU Lei(Dental implant Center,Stomatological Hospital,School of Stomatology,Southern Medical University,Guangzhou 510280,China;Macao Weiyu Dental Medical Center,Macao Special Administrative Region 999078,China;Department of Implantology,Guanghua School of Stomatology,Sun Yatsen University,Guangzhou 510000,China;Guangzhou Ruitai Dental Hospital,Guangzhou 510000,China;Department of Implantology,Affiliated Stomatological Hospital of Guangzhou Medical University,Guangzhou 510000,China;Dental implant Center,Affiliated Stomatological Hospital of Nanjing Medical University,Nanjing 210029,China;Dental implant Center,Hospital of Stomatological,Jilin University,Changchun 130021,China;Taikang Bybo Dental Group Co.,Ltd.,Guangzhou 510000,China)

机构地区：[1]南方医科大学口腔医院(口腔医学院)口腔种植中心,广东广州510280 [2]澳门威尔口腔医疗中心,中国澳门999078 [3]中山大学光华口腔医院口腔种植科,广东广州510000 [4]广州瑞泰口腔医院,广东广州510000 [5]广州医科大学附属口腔医院口腔种植科,广东广州510000 [6]南京医科大学附属口腔医院口腔种植中心,江苏南京210029 [7]吉林大学口腔医院口腔种植中心,吉林长春130021 [8]泰康拜博医疗集团有限公司,广东广州510000

出　　处：《口腔疾病防治》2024年第5期321-329,共9页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：广东省基础与应用基础研究基金(2021A1515111140,2021B1515120059);南方医科大学口腔医院科研培育项目(PY2021003,PY2020011);广州市科技项目(202102080148)。

摘　　要：计算机辅助静态导板引导种植手术的标准化流程包括术前检查、数据采集、计算机辅助设计、计算机辅助制作以及种植导板引导手术。其间每一环节产生的误差都可能导致误差的叠加效应,从而影响种植体植入的准确性。然而,临床医师往往关注于外科手术中的误差因素,却忽略了术前阶段的不规范操作导致种植手术产生不可逆转的误差。本文结合国内专家的临床实践与国内外研究进展,从种植导板手术术前检查、数据采集、导板设计、导板制作等方面,对种植导板手术的误差来源进行总结,并制定解决误差的策略,形成专家共识。①术前因素考量:术前应该根据患者口腔情况选择合适的种植导板类型,必要时选用固位螺钉辅助支持式导板;②规范数据采集流程:尽量采用锥形束CT与口外扫描法进行数据采集,建议选择小视野进行CBCT拍摄,同时保持患者头部固定,对于口内带有金属修复体的患者采用配准标记导板,并且合理控制口外扫描的环境温度与光照;③优化计算机辅助设计:建议选用手柄引导的种植系统与封闭式金属套筒,并通过标记物重叠的方式进行图像配准,另外,适当地设计固位螺钉、延伸导板的支持结构、增加导板引导段长度都是减少误差的可行方法;④改进计算机辅助制作:根据不同的打印技术设置最佳的打印参数,选择合适的打印后处理与灭菌方法也是至关重要的。The standardized workflow of computer⁃aided static guided implant surgery includes preoperative exami⁃nation,data acquisition,guide design,guide fabrication and surgery.Errors may occur at each step,leading to irrevers⁃ible cumulative effects and thus impacting the accuracy of implant placement.However,clinicians tend to focus on fac⁃tors causing errors in surgical operations,ignoring the possibility of irreversible errors in nonstandard guided surgery.Based on the clinical practice of domestic experts and research progress at home and abroad,this paper summarizes the sources of errors in guided implant surgery from the perspectives of preoperative inspection,data collection,guide de⁃signing and manufacturing and describes strategies to resolve errors so as to gain expert consensus.Consensus recom⁃mendation:1.Preoperative considerations:the appropriate implant guide type should be selected according to the pa⁃tient's oral condition before surgery,and a retaining screw⁃assisted support guide should be selected if necessary.2.Da⁃ta acquisition should be standardized as much as possible,including beam CT and extraoral scanning.CBCT performed with the patient’s head fixed and with a small field of view is recommended.For patients with metal prostheses inside the mouth,a registration marker guide should be used,and the ambient temperature and light of the external oral scan⁃ner should be reasonably controlled.3.Optimization of computer⁃aided design:it is recommended to select a handle⁃guided planting system and a closed metal sleeve and to register images by overlapping markers.Properly designing the retaining screws,extending the support structure of the guide plate and increasing the length of the guide section are methods to feasibly reduce the incidence of surgical errors.4.Improving computer⁃aided production:it is also crucial to set the best printing parameters according to different printing technologies and to choose the most appropriate postpro⁃cessing procedures.

关 键 词：数字化种植 种植导板手术 非手术因素 准确性 患者因素 数据采集 导板设计 导板制作 

分 类 号：R78[医药卫生—口腔医学]