摘要
目的：评价计算机辅助设计制造、牙支持式种植外科手术导板在下颌后牙游离缺失伴垂直骨量不足患者中应用的可行性、精确度及临床效果。方法：选取下颌后牙种植区域垂直骨量小于8mm的患者3名（2名女性，1名男性），平均年龄45岁（44～46岁），共10个种植位点。术前进行计算机辅助下手术设计，快速成型技术（rapidprototyping，RP）制作手术导板，施行导板引导下种植手术，避开下牙槽神经，术后进行临床评估和影像学评估。结果：3名患者在手术导板引导下共植入10颗种植体，并完成种植体支持固定修复，至最后一次复查，种植修复体临床效果良好，随访期间未观察到下牙槽神经功能障碍症状。术后即刻进行锥形束计算机断层扫描（conebeamcorn—puterizedtomography，CBCT），确认种植体位置与下牙槽神经之间存在1．5—3．0mm的安全距离。进一步测量种植体实际植入位置与术前设计之间的偏差，种植体颈部偏移为（0．84-4-0．30）mm（0．31～1．24mm），根方偏移为（1．42±0．52）mm（0．52—2．36mm），角度偏移为7．65°±1．84°（4．43°～9．81°）。结论：对于下颌后牙游离缺失伴重度垂直骨量不足的种植修复疑难病例，计算机辅助、手术导板引导下种植术创伤相对小，缩短了疗程，避免了复杂植骨手术或高风险神经游离术，技术上可行，近期临床效果肯定，但需要严格把握适应征。
Objective ：To evaluate the applicability, accuracy and clinical outcome of the computer assisted design and computer assisted manufacture （CAD ＆ CAM） tooth-supported implant surgical guide in the mandibular free-end partially edentulous patients with insufficient vertical bone height. Methods： According to the inclusion criteria, 3 patients （2 women, and 1 man） with the mean age of 45 years （from 44 to 46 years） with 10 implant sites were involved in this study. With the help of computer- assisted-desigu software to plan and simulate the surgical strategies, the implant surgical guides were fabricated via the rapid prototyping technique, then the guided implant placement was implemented, finally the post-surgical evaluations were accomplished by the clinical and radiographic examinations. Results： Ten implants were placed in 3 mandibles via the surgical guides, and the implant supported non-split restorations were in place. All the implant restorations revealed good clinical function until the last review. No inferior alveolar nerve injury was detected by the clinical neurosensory test. The immediate post surgical CBCT was performed to confirm a safe distance of 1.5 to 3.0 mm between the implant apical and the nerve canal. The deviations between the planed and the actually placed implant were： coronal deviation （0.84 ±0.30） mm （0.31 -1.24 mm） ; apical deviation （1.42 ±0.52） mm （0.52 -2.36 mm） ; angular deviation 7.65 °± 1.84 °（4.43 °- 9.81 ° ）. Conclusion： In case of distal free-end partially edentulous with insufficient vertical bone height in the posterior mandibular region, computer assisted surgical design and guided surgery can offer a treatment option with minimal invasiveness and a shorter treatment period, and avoid the complicated bone augmentation procedure and the high risk of nerve transposition. This technique is clinically and technically feasible, but the cases using this technique should be strictly selected according to the indication.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2014年第2期294-298,共5页
Journal of Peking University:Health Sciences
关键词
计算机辅助设计
义齿
植入物支持
骨质吸收
颌
无牙
下颌骨
Computer-aided design
Dental prosthesis, implant-supported
Bone resorption
Jaw, edentulous
Mandible
