Journal of Prevention and Treatment for Stomatological Diseases ›› 2020, Vol. 28 ›› Issue (6): 341-348.DOI: 10.12016/j.issn.2096-1456.2020.06.001

• Expert Forum • Previous Articles     Next Articles

Clinical application and new progress of dynamic navigation system in the field of oral implantology

MAN Yi(),ZHOU Nan,YANG Xingmei   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2019-10-18 Revised:2019-11-14 Online:2020-06-20 Published:2020-05-28
  • Contact: Yi MAN

动态实时导航在口腔种植领域中的临床应用及新进展

满毅(),周楠,杨醒眉   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院种植科,四川 成都(610041)
  • 通讯作者: 满毅
  • 作者简介:满毅,教授,四川大学华西口腔医院种植科主任,种植教研室主任,博士研究生导师。中华口腔医学会种植专业委员会常委,口腔数字化产业分会主任委员,ICOI中国分会(专家委员会)会长,四川省卫健委学术技术带头人后备人选,四川省口腔种植专业委员会主任委员;Clinical Implant Dentistry Related Research中文版副主编,Implant Dentistry编审委(Editorial reviewer board),《口腔疾病防治》编委;国际牙医师学院专家组成员(ICD fellow),国际种植学会专家组成员(ITI fellow)、国际种植牙专科医师学会专家组成员(ICOI Diplomate)。作为课题负责人负责国家重大研发计划子课题,国家自然科学基金面上项目和青年项目多项,发表SCI论文40余篇。
  • 基金资助:
    国家重点研发计划(2016YFC1102700)

Abstract:

Currently, computer-aided implant surgeries include implant placement surgery under the guidance of a dynamic navigation system. With the use of software inherent in the navigation system, doctors can make a preoperative plan including the ideal position of the implant. Then the plan can be accurately transferred to the surgery, during which the real-time condition of the drill and its relationship with the surgical region will be visualized by the surgeon and the drill can be adjusted in a timely manner. Currently the dynamic navigation system is increasingly widely utilized, especially in cases of esthetic zones or surgical sites with important anatomical structures. However, the clinical workflow of the navigation system is complicated, including CBCT taken after the registration device placement, prosthetic-driven 3D design, calibration, registration, navigated borehole preparation and implant placement surgery. Many details should be considered when the device is applied, including implant position design, fixation of the tracking device, registration, and stable borehole preparation under the guidance of dynamic navigation. Therefore, this article introduces the dynamic navigation system into the clinical workflow and evaluates, the effects of the application and the clinical features. The new progress of the navigation system in the field of implantology is demonstrated at the same time, including navigated surgery in fully edentulous arches and in the zygomatic zone. Further improvements in the navigation system in terms of the accuracy and simplification of the workflow are needed in the future.

Key words: dentition defect, oral implantology, esthetic zone, insufficient bone mass in posterior region, dental implant, computer-aided implant surgery, dynamic navigation, accuracy, precision medicine, digital, clinical application

摘要:

动态实时导航系统引导下的口腔种植手术是计算机辅助种植外科的一种。医生可以在术前通过导航系统的内部软件合理规划理想的植体位置,并在导航系统的引导下将术前设计准确转移到术中,术中医生可以实时观察到手机钻针在术区牙槽骨内的位置并及时作出调整。目前导航系统在临床的应用越来越广泛,尤其是在前牙美学区病例和在术区解剖条件较为复杂的牙列缺损病例中使用较多。但是动态实时导航系统的临床使用流程较为复杂,包括佩戴配准装置拍摄CBCT、以修复为导向的种植体三维位置设计、术中标定、术中配准、在导航引导下进行扩孔和种植体植入等。应用时需考量的因素和细节较多,包括种植体位置设计、追踪装置的坚固固定、配准误差、按照导航引导的稳定扩孔等。本文从种植手术导航系统的临床应用与工作流程、临床应用的效果及特点等方面进行述评,并介绍动态实时导航系统在口腔种植领域的应用新进展,包括无牙颌种植导航手术和导航引导下的穿颧种植手术。进一步提高种植手术导航的精度、简化使用流程将会是未来导航系统的发展方向。

关键词: 牙列缺损, 口腔种植, 前牙美学区, 后牙骨量不足, 计算机辅助种植外科, 动态导航, 精准医学, 数字化, 临床应用

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