数字化全程外科导板在磨牙区即刻种植的应用

doi:10.12016/j.issn.2096-1456.2018.08.006

摘要/Abstract

摘要：

目的评估数字化全程外科导板在磨牙区即刻种植应用的临床效果。方法选择磨牙区即刻种植患者26例,术前拍摄CBCT和制取模型,通过计算机软件设计种植体的理想三维位置,其中对照组13例采用自由手操作完成即刻种植,试验组13例则通过制备数字化全程外科导板,在全程导板的引导下完成种植窝洞的预备及种植体的植入,均获得良好初期稳定性并进行间隙植骨,经过5~6个月骨结合后制备最终修复体。术后测量种植体三维位置的精准度以及修复后6个月的改良菌斑指数（modified plaque index, mPLI）、改良出血指数（modified sulcular bleeding index, mSBI）和探诊深度（probing depth, PD）。结果 26例患者顺利完成最终修复,对照组和试验组植体的最终三维位置顶端的垂直向误差分别为为（1.246 ± 0.072）mm和（0.628 ± 0.046）mm（t =26.078,P < 0.001）,水平向误差分别为（1.563 ± 0.086）mm和（0.546 ± 0.056）mm（t = 35.813,P < 0.001）;根端的垂直向误差分别为（1.352 ± 0.042）mm和（0.532 ± 0.030）mm（t = 57.021,P < 0.001）,水平向误差分别为（1.645 ± 0.076）mm和（0.625 ± 0.072）mm（t =35.086,P < 0.001）,差异具有统计学意义。试验组的mPLI值0.923 ± 0.760、mSBI值0.846 ± 0.689和PD值（3.460 ± 0.713）mm显著低于对照组mPLI值（1.769 ± 0.927,t = 2.546, P = 0.018）、mSBI值（1.692 ± 0.947, t = 22.605,P = 0.016）和PD值（4.579 ± 0.475）mm（t =4.709, P < 0.001）。结论数字化全程外科导板可以增加磨牙区即刻种植修复的精准度及种植体周健康。

关键词: 即刻种植, 磨牙区, 数字化外科导板, 三维位置, 精准度, 改良菌斑指数, 改良出血指数, 探诊深度

Abstract:

Objective To evaluate the clinical effect of a digital whole-process surgical guide for immediate implantation in the molar area. Methods Twenty-six patients with molar extraction plans were accepted for preoperative CBCT and model construction. Computer software was used to design the ideal three-dimensional position of the implant. The control group of 13 patients underwent immediate implantation with a free hand operation, whereas the experimental group of 13 patients underwent preparation and implant insertion under the guidance of a surgical guide. Bone grafting was performed, and a good initial stability was achieved. After 5 to 6 months, osseointegration was achieved, and the final restoration was delivered. After surgery, the accuracy of the three-dimensional position of the implants was measured, and at the 6 month return visit, the modified Plaque Index (mPLI), modified Sulcular Bleeding Index (mSBI) and probing depth (PD) were measured. Results In the control group and experimental group, the vertical errors at the top of the implants were 1.246 ± 0.072 mm and 0.628 ± 0.046 mm (t = 26.078, P < 0.001), respectively, and the horizontal errors were 1.563 ± 0.086 mm and 0.546 ± 0.056 mm (t = 35.813, P < 0.001), respectively; and the vertical errors at the root of the implants were 1.352 ± 0.042 mm and 0.532 ± 0.030 mm (t = 57.021, P < 0.001), respectively, and the horizontal errors were 1.645 ± 0.076 mm and 0.625 ± 0.072 mm (t = 35.086, P < 0.001), respectively. For the experimental group, the mPLI value was 0.923 ± 0.760, the mSBI value was 0.846 ± 0.689, and the PD value was 3.460 ± 0.713 mm, which were significantly lower than those of the control group. For the control group, the mPLI value was 1.769 ± 0.927 (t = 2.546, P = 0.018), the mSBI value was 1.692 ± 0.947 (t = 22.605, P = 0.016) and the PD value was (4.579 ± 0.475) mm (t = 4.709, P < 0.001). Conclusion A digital surgical guide plate can increase the precision of immediate implantation and the peri-implant health in the molar area.

Key words: Immediate implant placement, Molar area, Digital surgical guide, Three-dimensional position, Accuracy, Modified plaque index, Modified sulcular bleeding index, Probing depth

中图分类号:

R783.6

李少冰, 倪佳, 张雪洋, 黄雁红, 容明灯, 卢海宾. 数字化全程外科导板在磨牙区即刻种植的应用[J]. 口腔疾病防治, 2018, 26(8): 508-513.

Shaobing LI, Jia NI, Xueyang ZHANG, Yanhong HUANG, Mingdeng RONG, Haibin LU. Clinical application of a digital whole-process surgical guide plate for immediate implant placement in the molar area[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2018, 26(8): 508-513.

图/表 5

图1 软件设计种植体的正确三维位置及生成数字化全程外科导板 a：软件设计种植体的近远中向位置;b：软件设计种植体的颊舌向位置;c：生成的数字化外科导板。

Figure 1 Software-designed 3D position of the implant and digital surgical guide plate

图2 微创拔牙后数字化导板即刻种植 a：术前的口内照片;b：拔除患牙;c：检查拔牙窝;d：导板的准确就位;e：窝洞的预备;f：种植体的植入;g：种植体就位的情况;h：拔牙窝间隙植骨;i：术创关闭;j：种植体愈合的情况;k：基台就位;l：最终修复体就位。

Figure 2 Digital guide plate used in immediate implant placement after minimally invasive tooth extraction

图3 软件中匹配术前术后的 CBCT 影像并测量种植体计划植入位置与实际植入位置的误差 a：术后种植体的近远中方向位置;b：术中种植体的颊舌向位置;c：种植体三维位置误差的测量计算示意图。

Figure 3 Software matching between the preoperative and postoperative CBCT images and measurement of the deviation between the planned implant placement and the actual implant placement

表1 种植体三维位置精确度检查

Table 1 Inspection of the accuracy of the 3D positioning of the implants $\bar{x}$ ± s,mm

位置	对照组	试验组	t值	P值
顶端垂直向误差	1.246 ± 0.072	0.628 ± 0.046	26.078	< 0.001
顶端水平向误差	1.563 ± 0.086	0.546 ± 0.056	35.813	< 0.001
根端垂直向误差	1.352 ± 0.042	0.532 ± 0.030	57.021	< 0.001
根端水平向误差	1.645 ± 0.076	0.625 ± 0.072	35.086	< 0.001

表2 种植修复的mPLI、mSBI及PD比较

Table 2 Comparison of the modified plaque index, modified bleeding index and probing depth for the implantation restorations $\bar{x}$± s

指标	对照组	试验组	t值	P值
mPLI	1.769 ± 0.927	0.923 ± 0.760	2.546	0.018
mSBI	1.692 ± 0.947	0.846 ± 0.689	2.605	0.016
PD（mm）	4.579 ± 0.475	3.460 ± 0.713	4.709	< 0.001

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