【作者】 石磊；

【导师】 屈志国；

【作者基本信息】 内蒙古医学院 ， 口腔临床医学， 2009， 硕士

【摘要】 研究背景近年来,导航技术在口腔种植领域得到了较大的发展。牙种植术要求术者充分利用现有的骨量植人种植体,达到修复所需的最佳位置,同时尽最大可能避免各种副损伤,化解手术风险。但目前临床应用的种植技术远未达到上述要求,因此,口腔种植领域应用外科导航技术,能够较好满足种植外科和修复的精确要求,具有良好的临床应用前景。计算机辅助外科(computer-assisted surgery,CAS)与无翻瓣术相结合可使患者所受创伤最小化;CAS与即刻修复技术相结合可以使义齿修复制作周期最短化(如Teeth in hour);计算机辅助设计(computer-assisted desiga,CAD)与规范化临床操作相结合可以使种植医师所担负的风险最低化;CAD在美学区的三维定位使外科医生与修复医生术前融洽沟通的程度最大化,使种植修复简单化。可是,目前国内CAS或CAD技术并不如想象中那样普及应用,要想实现“微创”和“即刻修复”都需要依赖外科导板与之相配合。目前临床上所应用的外科导板要么制作过于简单,只是在石膏模型或原有义齿上制作,并不能起到精确导航的作用;要么采用国外制作的导板,如Noble Guide或比利时Materialize的经过快速原型机制做出的导板,但其昂贵的价格和较长的制作周期并不能让大多数患者享用,从而限制了这一技术的推广。目的本课题通过对采用计算机辅助设计+自制外科导板法的患者术前、术后CT三维数据进行对比测量,评价此方法在临床种植牙技术中的应用价值,探索研制能够普及应用的外科导板,以利计算机导航技术的全面推广。材料和方法1.拍摄CT,用Simplant软件进行术前设计2.依据设计结果,制作出导向环导板3.术后拍摄CT,与术前设计的CT数据进行对比分析。结果1.对采用计算机辅助设计+单导板法进行配对t检验统计分析,术前与术后在垂直方向上的偏差均数为0.62±1.41mm,P＜0.05,有统计学意义;颊舌方向上偏差为9.44±8.51度,p＜0.05,有统计学意义,修复时可用铸造基台调整就位道。2.对患者采用计算机辅助设计+无翻瓣术进行种植,大大减轻对患者的创伤,节省了手术的时间。结论1.计算机导航下的自制外科导板符合临床应用要求,确实起到了三维方向上的导航作用。2.采用无翻瓣术的牙种植术,对患者创伤小,手术时间短,术后并发症少。更多还原

【Abstract】 Background In recently years , computer navigation has been used in medical area especially in implantology. Implants were placed in the jaw bone precisely to achieve the best position from the prosthesis , meanwhile , minimally invasion should be considered in the procedure. However, the position of the implants has decisive effect on the final results in terms of mastication, phonation, and esthetics. In order to achieve a predicable treatment outcome, a comprehensive diagnostic work - up of the planed implant positions and then precisely transferring to the implant surgery is a paramount before surgery. Image guided navigation surgery or stereographic surgical guide by technique are developed for this purpose. There are many software and hardware designed by different companies available in the market nowadays such as Nobel guide and Materealize guide. But this technique has been restricted rapidly to develop by expensive price and long time to made in the laboratory . Purpose In this study, we used a simulated dental cast model to test the precision between the planned pre—operative implant position and the actual placed implant position using metal tube guided surgical templates. The radiographic examination and analysis of the implant position were performed with CT and Simplant software respectively. Methods Thirteen patients ranging from 20 to 73 years were recruited from Inner Mongolia Hospital, thirty—four implants were placed. The 2. 2 diameter pilot guide drill was used to create a precise, minimally invasion initial penetration through the mucosa and into bone . The parameters evaluated were depth from mucosal margin to bone crest . implant position including depth and angulation in the bone. From the preoperation and postoperation CT image, for 34 implants placed in 13 patients , the data was statisticed by SPSS 16. 0 software. Results 1. Data obtained from this study shows that the depth and angulation in panoramic is perfect : the depth deflexion mean is 0.62mm, P<0.05; the angulation in cross sectional deflexion mean is 9.44 degree to the designation of pre - operation , P< 0.05, angulation abutment can adjust the dental prosthetic restoration to a correct occlusion relationship. 2. This article presents a technique for dental implants in a flapless approach that utilizes the tracking technology of a computerized navigation system. Conclusion 1. The preoperative planning of implant position could be predictably transferred to the operative field using metal tube guided surgical template. Using the techniques described in our study, the implant could be placed as accurately as other commercialized products like Simplant Surgical Guide 2. The results of this study demonstrate that following diagnostic treatment planning criteria, flapless surgery using a minimally invasive technique is a predictable procedure. The benefits of this procedure are lessened surgical time; minimal changes in crestal bone levels, probing depth, and inflammation; perceived minimized bleeding; and lessened postoperative discomfort.更多还原