数字化导板在多牙缺失种植中的临床应用研究

发布时间：2018-06-27 18:30

本文选题：计算机辅助设计 + 种植导板　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:应用彩立方Tooth Implant软件评估数字化外科导板用于多牙缺失种植手术中的精确度,探讨其在多牙缺失种植中的优势,为更好地应用数字化导板提供理论基础。方法:选择2015年1月至2016年10月,在青岛大学附属医院口腔种植科行种植手术的多牙缺失的患者20例,根据患者自身条件和意愿分为A、B两组,每组10例。术前均拍摄口腔颌面部锥形束CT(Cone-beam computed tomography,CBCT),将所得三维数据导入彩立方Tooth Implant软件,利用Tooth Implant软件分析数据,制定手术方案。其中A组患者不使用种植导板,依靠术者的临床经验直接植入种植体;B组采用快速成型技术(rapid prototyping,RP)制作数字化导板,术中辅助种植体的植入。术后两组患者再次拍摄CBCT,利用彩立方Tooth Implant软件将术前与术后图像进行配准比较,测量种植体实际位置与设计位置的误差值,用SPSS 18.0软件对所得数据进行统计学分析。结果:20例患者共植入87颗种植体。全部种植体骨结合良好,无松动脱落,未发现明显边缘骨吸收。A组种植体的实际位置与术前模拟的位置有一定差别,B组种植体的实际位置与模拟位置基本一致。A组共植入39颗种植体,肩部的测量误差为(2.11±0.39)mm(1.35-3.09)mm,底部的测量误差为(2.30±0.82)mm(1.55-4.96)mm,深度的测量误差值(0.72±0.39)mm(-0.88-1.23)mm,角度的测量误差值为(9.05±3.74)°(2.56-15.98)°;B组共植入48颗种植体,肩部的测量误差为(1.26±0.57)mm(0.17-2.38)mm,底部的测量误差为(1.56±0.57)mm(0.31-2.65)mm,深度的测量误差值为(0.52±0.37)mm(-1.03-1.34)mm,角度的测量误差值为(4.87±1.55)°(2.04-7.05)°。统计学分析得出结果:两组种植体在肩部、底部、深度和角度方面均有统计学差异(P0.05)。结论:1.多牙缺失患者在数字化导板引导下行种植手术,可以使种植体在颌骨中的三维位置更加精确,从而获得良好的修复效果,有广泛的应用前景和良好的应用价值。2.由于多牙缺失的患者解剖结构复杂,加之数字化导板的制作以及手术操作过程等原因,使用数字化导板时也存在一定的误差,因此不能随意或盲目使用,应在术前设计一定的安全距离,避免损伤重要的解剖结构。
[Abstract]:Objective: To evaluate the accuracy of digital surgical guide plate in the operation of multiple tooth loss implantation with color cube Tooth Implant software, and to explore its advantages in the cultivation of multi tooth deletion and provide a theoretical basis for better application of digital guide plate. Methods: selection from January 2015 to October 2016 in the oral implant Department of the Affiliated Hospital of Qiingdao University. 20 patients with multiple tooth loss were divided into A, B two and 10 cases in each group according to the patient's own conditions and wishes. Before operation, the conical bundles of oral and maxillofacial tract CT (Cone-beam computed tomography, CBCT) were taken. The three dimensional data were introduced into the color cube Tooth Implant software, and the Tooth Implant software was used to analyze the data and formulate the operation scheme. The patients in the group did not use the implant guide plate, and the implant was implanted directly by the clinical experience of the operators; the B group used rapid prototyping (RP) to make the digital guide plate and the implantation of the auxiliary implants during the operation. After the operation, two groups of patients were photographed again, and the color cube Tooth Implant software was used to compare the preoperative and postoperative images. The error values of the actual position and the design position of the implants were statistically analyzed with SPSS 18 software. Results: 87 implants were implanted in 20 patients. All the implant bone was good, no loosening fell off, and there was a certain difference between the actual position of the implants and the position of the pre operation simulation in group B without obvious edge bone absorption in group.A. The actual position of the implant is basically the same as the simulated position in the.A group. The measurement error of the shoulder is (2.11 + 0.39) mm (1.35-3.09) mm, the measurement error at the bottom is (2.30 + 0.82) mm (1.55-4.96) mm, the depth measurement error value (0.72 + 0.39) mm (-0.88-1.23) mm, the angle measurement error value is (9.05 + 3.74) degree (2.56-15.98) degree; B group A total of 48 implants were implanted. The measurement error of the shoulder was (1.26 + 0.57) mm (0.17-2.38) mm, the measurement error at the bottom was (1.56 + 0.57) mm (0.31-2.65) mm, the measurement error of the depth was (0.52 + 0.37) mm (-1.03-1.34) mm and the angle measurement error value was (4.87 + 1.55) degree (2.04-7.05) degrees. Statistical analysis showed that two implants were at the shoulder and bottom, There are statistical differences in depth and angle (P0.05). Conclusion: 1. patients with multiple tooth deletion under the guidance of digital guide guidance can make the three-dimensional position of the implant more accurate in the jaw bone, thus obtaining a good repair effect. There is a broad application prospect and good application value.2. due to the dissection of the patients with multiple tooth loss. The construction of digital guide plate and operation process are complicated, and there are some errors in the use of digital guide plate. Therefore, it can not be used arbitrarily or blindly. We should design a certain safety distance before operation to avoid the important anatomical structure of damage.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.6

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