动态导航引导下上颌无牙颌翼突种植的精准度分析  

Accuracy of pterygoid implant place with the aid of a dynamic navigation for edentulous maxilla

作　　者：覃梓健 孙思敏 郑悦 张森林 QIN Zi-jian;SUN Si-min;ZHENG Yue;ZHANG Sen-lin(Department of Stomatology,Affiliated Jiangning Hospital of Nanjing Medical University,Jiangsu Nanjing 211100,China)

机构地区：[1]南京医科大学附属江宁医院口腔科,江苏南京211100

出　　处：《临床口腔医学杂志》2024年第11期667-671,共5页Journal of Clinical Stomatology

摘　　要：目的:评估动态导航引导下对于上颌后牙区牙槽骨严重萎缩的上颌无牙颌患者进行翼突种植的精准度和安全性。方法:选取2022年9月~2023年12月在南京市江宁医院进行翼突种植的上颌无牙颌或上颌终末期牙列患者12例,每例在动态导航引导下植入2颗翼突种植体和2~4颗前部常规种植体。将术前设计方案和术后CBCT数据导入牙种植精准度验证软件,测量分析种植体的实际位置与术前设计位置的偏离情况,分析比较翼突种植体和前部常规种植体的精准度,观察局部出血和穿通上颌窦等种植并发症发生情况。在种植体初期稳定性均>35 N·cm的情况下,给予即刻固定义齿修复。3~6个月后,给予最终固定义齿修复。结果:翼突种植体的平均颈部、尖部、深度和角度偏差分别为0.81 mm、1.46 mm、0.85 mm和2.78°,前部常规种植体分别为0.79 mm、1.33 mm、0.83 mm和2.63°,两者之间无统计学差异。未出现术中出血和穿通上颌窦等种植并发症。其中1例患者有2颗前部常规种植体的初期稳定性未达到35 N·cm而未行临时即刻固定修复,3个月后完成固定义齿修复;余11例均完成临时即刻固定修复,3~6个月后完成最终固定义齿修复。随访4~16个月,无修复体松动或种植体脱落。结论:动态导航引导下上颌无牙颌翼突种植的精准度高、安全性好。Objective:To investigate the accuracy and safety of pterygoid implant place with the aid of a dynamic navigation for rehabilitation of the edentulous maxilla.Methods:Twelve participants,either completely edentulous or failing dentition in the maxillary arch and with severe atrophy of the posterior maxilla,were enrolled in the study between September 2022 and December 2023.Two pterygoid implants were seated in the pterygoid regions and 2~4 anterior standard implants were seated the anterior maxilla areas with the aid of a dynamic navigation for all participants.The accuracy of the implant placement was assessed by overlapping the pre-operative CBCT with planned implants and the post-operative CBCT with achieved implants.The accuracy of pterygoid implant placement was compared to that of anterior standard implant placement.The possible following post-surgery complications were recorded:post-operating hemorrhage and sinus perforation.The participant with primary stability>35 N·cm in all implants required a complete-arch immediate fixed prosthesis.After 3~6 months,a composite resin,titanium-reinforced definitive prosthesis was delivered to the patients.Results:A total of 12 patients(24 pterygoid implants and 44 anterior standard implants)were enrolled in the study for a full arch implant prosthetic rehabilitation,with the aid of the dynamic navigation system.Mean deviations between the planned and actual position for pterygoid implants were 0.81 mm at the coronal level,1.46 mm at the apical level,0.85 mm in depth,and 2.78 degrees of angular deviation,compared to 0.79 mm,1.33 mm,0.83 mm,2.63 degrees,respectively,for anterior standard implants,and there were no statistically differences in deviations between the pterygoid implants and the anterior standard implants.No post-operating hemorrhage and sinus perforation were observed for all participants.A complete-arch immediate fixed prosthesis was fulfilled in 11 patients with all implants achieving primary stability>35 N·cm,and one patient did not require a complete-a

关 键 词：上颌骨萎缩 上颌无牙颌 翼突种植 计算机辅助种植外科 动态导航 精准度 

分 类 号：R782.1[医药卫生—口腔医学]