先锋钻导航和全程导航导板在前牙不翻瓣即刻种植手术中的精确性比较

摘要

目的 比较先锋钻导航和全程导航导板进行不翻瓣即刻种植手术的精确性.方法 回顾性分析2014—2016年天津市口腔医院种植科47例门诊即刻种植患者(50颗种植体)的资料,分别在先锋钻导航系统(22颗)和全程导航系统(28颗)的引导下行种植手术.术前拍摄锥形束CT(CBCT)并制取模型,经过三维重建、模拟种植设计以及应用数字化快速成型技术制成导板.分别应用先锋钻导航和全程导航系统配合种植钻进行窝洞预备,最后进行种植体植入手术.术后再次拍摄CBCT并进行三维重建,比较两种导航系统引导下植入体的精确性.结果 50颗种植体全部应用导板顺利完成手术,1例在临时修复3个月后出现种植体黏膜炎,经处理后完成最终修复,其余病例均顺利完成最终修复,所有植体无松动、无脱落.全程导航系统引导下的种植体植入后颈部和根端偏差均小于先锋钻导航(P<0.01),但两者轴向角度偏差差异无统计学意义(P>0.05).结论 数字化外科导板可对前牙不翻瓣即刻种植技术的应用提供良好的技术支持,全程导航系统比先锋钻导航系统具有更高的精准性.%Objective To compare the operative precision between pioneer drilling guiding and full navigation guiding plates in the flapless immediate implantation. Methods Data of 50 immediate implants, which were implanted from 47 outpatients (50 implants) of Tianjin Stomatological Hospital from 2014 to 2016 were retrospectively analyzed. The patients were conducted on the pioneer drilling guiding system (22 implants) and full navigation guiding sytem (28 implants). The cone beam CT (CBCT) was preliminarily taken and modeled for each patient. All of the patients underwent implant surgery after making guiding plates by three-dimensional reconstruction, simulation planting design and the application of digital rapid prototyping technology. Cavity preparations were made by pioneer drilling and full navigation assisted with planting drills respectively to finish implantation. The post-operative CBCT was taken and performed the three-dimensional reconstruction. The implantation precision guiding by two systems were compared. Results All of the 50 immediate implants were successfully completed with the guiding plates. Implant mucositis appeared in one case after 3 months of temporary repair, and after the targeted therapy, the final repair was finished. The rest cases were finally completed. No implant was loose or fell off. The deviation was less in neck apex and root apex angle in full navigation group than that of pioneer drilling guiding group (P<0.01). But there was no significant difference in axial angle between the two groups after navigation and implantation (P>0.05). Conclusion The digital surgical guiding plates provide nice technical support for the application of the flapless immediate implantation. And the full navigation system has higher precision than that of the pioneer drilling navigation system.