数字化导板在口腔即刻种植中的临床应用观察
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摘要
目的探讨数字化导板在口腔即刻种植中的应用价值。方法选取32例牙列缺损患者,共43颗种植体,其中前牙28颗,后牙15颗。采集患者口内光学印模及CBCT的DICOM三维数据后,通过专业软件进行三维重建,获得口腔内软硬组织的数据。根据缺失牙与邻牙、对颌牙的位置关系模拟排牙,依照人工牙的方向和角度,在拟种植区域虚拟植入种植体,其中前牙以舌隆突作为植入位点,深度为牙槽嵴顶下1～2 mm;后牙以中央窝作为植入位点,深度为牙槽嵴顶下1 mm。再使用Simplant软件生成导板图像,将图像转为STL格式,进行3D打印。消毒导板后,在数字化导板的引导下即刻种植,观察术后相关指标。结果种植体植入后的角度偏差为(3.25±1.02)°,深度偏差为(0.52±0.25)mm。术后6个月,种植窝颊侧垂直向骨吸收为(1.32±0.25)mm;术后1年,43颗种植体中,有35颗种植体得以随访,与种植修复完成时相比,其探诊深度(PD)和改良出血指数(mBI)虽有所增高,但差异不显著(P> 0.05)。结论即刻种植中应用数字化导板,可引导种植体精确植入,确保种植效果,且种植体周围的软组织在修复后较为稳定,具有较大的推广价值。
Objective To explore the application value of digital guide in immediate dental implantation. Methods A total of32 patients with dentition defect were selected, and 43 implants, including 28 anterior teeth and 15 posterior teeth, were implanted.After the collection of the oral optical impression and CBCT DICOM 3 D data, 3 D reconstruction was carried out with professional software to obtain the data on oral soft and hard tissues. Tooth arrangement was simulated according to the positional relation between the missing tooth and the adjacent teeth and that between the missing tooth and jaw teeth. Implants were virtually implanted according to the direction and angle of artificial teeth. The cingulum was the implantation site and 1-2 mm below the alveolar crest the implantation depth for anterior teeth; the central fossa was the implantation site and 1 mm below the alveolar crest the implantation depth for posterior teeth. The guide image was generated with the software Simplant and was converted into STL format for 3 D printing. After disinfecting the guide, immediate dental implantation was carried out under the guidance of the digital guide. Relevant post-operative indicators were observed. Results The angular deviation after the implantation of implants was(3.25 ±1.02)° and the depth deviation(0.52±0.25)mm. Six months after the operation, the vertical bone resorption on the buccal side of the implant was(1.32 ±0.25)mm; one year after the operation, 35 of the 43 implants were followed up. Compared with the indicators upon the completion of the repair, the probing depth(PD) and the modified bleeding index(mBI) increased, but they showed no significant difference(P > 0.05). Conclusion The application of digital guide in immediate dental implantation can guide the accurate implantation of implants and ensure the effects of implantation. Besides, the soft tissues around the implants are stable after repair.Therefore, it is worthy of popularization.
Objective To explore the application value of digital guide in immediate dental implantation. Methods A total of32 patients with dentition defect were selected, and 43 implants, including 28 anterior teeth and 15 posterior teeth, were implanted.After the collection of the oral optical impression and CBCT DICOM 3 D data, 3 D reconstruction was carried out with professional software to obtain the data on oral soft and hard tissues. Tooth arrangement was simulated according to the positional relation between the missing tooth and the adjacent teeth and that between the missing tooth and jaw teeth. Implants were virtually implanted according to the direction and angle of artificial teeth. The cingulum was the implantation site and 1-2 mm below the alveolar crest the implantation depth for anterior teeth; the central fossa was the implantation site and 1 mm below the alveolar crest the implantation depth for posterior teeth. The guide image was generated with the software Simplant and was converted into STL format for 3 D printing. After disinfecting the guide, immediate dental implantation was carried out under the guidance of the digital guide. Relevant post-operative indicators were observed. Results The angular deviation after the implantation of implants was(3.25 ±1.02)° and the depth deviation(0.52±0.25)mm. Six months after the operation, the vertical bone resorption on the buccal side of the implant was(1.32 ±0.25)mm; one year after the operation, 35 of the 43 implants were followed up. Compared with the indicators upon the completion of the repair, the probing depth(PD) and the modified bleeding index(mBI) increased, but they showed no significant difference(P > 0.05). Conclusion The application of digital guide in immediate dental implantation can guide the accurate implantation of implants and ensure the effects of implantation. Besides, the soft tissues around the implants are stable after repair.Therefore, it is worthy of popularization.
引文
[1]芮宇欣,张波.数字化导板在上颌美学区即刻种植中的临床应用[J].实用医技杂志,2017,24(8):903-904.
[2]石磊,黄盛兴,刘慧凤,等.前牙区数字化即刻种植即刻修复病例报道及文献回顾[J].口腔疾病防治,2017,25(2):119-122.
[3]赵璟阳,樊林峰,王艳辉,等.数字化导板在口腔种植临床应用中的精确度评价[J].中国口腔颌面外科杂志, 2015, 13(6):508-514.
[4]郭秋云,白石柱,董瑜,等.结合三维激光扫描的CAD/CAM牙种植导板的临床精度评价[J].临床口腔医学杂志,2014,30(1):3-6.
[5]郭磊,杨倞,王远勤,等.上颌后牙区数字化导板引导下倾斜种植精确性研究[J].口腔疾病防治,2017,25(7):435-438.
[6] Soydan SS, Cubuk S, Oguz Y, et al. Are success and survival rates of early implant placement higher than immediate implant placement[J]? International Journal of Oral and Maxillofacial Surgery,2013,42(4):511-515.
[7] Chen ST, Buser D. Esthetic outcomes following immediate and early implant placement in the anterior maxilla-a systematic review[J]. International Journal of Oral&Maxillofacial Implants,2014, 29(Suppl 1):186.
[8]陈春艳,张力,鲍海宏,等.数字化导板和三维模型在儿童髁状突骨折重建中的应用[J].中国医科大学学报, 2016,45(2):171-174.
[2]石磊,黄盛兴,刘慧凤,等.前牙区数字化即刻种植即刻修复病例报道及文献回顾[J].口腔疾病防治,2017,25(2):119-122.
[3]赵璟阳,樊林峰,王艳辉,等.数字化导板在口腔种植临床应用中的精确度评价[J].中国口腔颌面外科杂志, 2015, 13(6):508-514.
[4]郭秋云,白石柱,董瑜,等.结合三维激光扫描的CAD/CAM牙种植导板的临床精度评价[J].临床口腔医学杂志,2014,30(1):3-6.
[5]郭磊,杨倞,王远勤,等.上颌后牙区数字化导板引导下倾斜种植精确性研究[J].口腔疾病防治,2017,25(7):435-438.
[6] Soydan SS, Cubuk S, Oguz Y, et al. Are success and survival rates of early implant placement higher than immediate implant placement[J]? International Journal of Oral and Maxillofacial Surgery,2013,42(4):511-515.
[7] Chen ST, Buser D. Esthetic outcomes following immediate and early implant placement in the anterior maxilla-a systematic review[J]. International Journal of Oral&Maxillofacial Implants,2014, 29(Suppl 1):186.
[8]陈春艳,张力,鲍海宏,等.数字化导板和三维模型在儿童髁状突骨折重建中的应用[J].中国医科大学学报, 2016,45(2):171-174.