下颌后牙游离缺失伴重度垂直骨量不足的计算机辅助种植修复

发布时间：2018-07-03 03:46

本文选题：计算机辅助设计 + 义齿　；参考：《北京大学学报(医学版)》2014年02期

【摘要】：目的:评价计算机辅助设计制造、牙支持式种植外科手术导板在下颌后牙游离缺失伴垂直骨量不足患者中应用的可行性、精确度及临床效果。方法:选取下颌后牙种植区域垂直骨量小于8 mm的患者3名(2名女性,1名男性),平均年龄45岁(44~46岁),共10个种植位点。术前进行计算机辅助下手术设计,快速成型技术(rapid prototyping,RP)制作手术导板,施行导板引导下种植手术,避开下牙槽神经,术后进行临床评估和影像学评估。结果:3名患者在手术导板引导下共植入10颗种植体,并完成种植体支持固定修复,至最后一次复查,种植修复体临床效果良好,随访期间未观察到下牙槽神经功能障碍症状。术后即刻进行锥形束计算机断层扫描(cone beam computerized tomography,CBCT),确认种植体位置与下牙槽神经之间存在1.5~3.0 mm的安全距离。进一步测量种植体实际植入位置与术前设计之间的偏差,种植体颈部偏移为(0.84±0.30)mm(0.31~1.24 mm),根方偏移为(1.42±0.52)mm(0.52~2.36 mm),角度偏移为7.65°±1.84°(4.43°~9.81°)。结论:对于下颌后牙游离缺失伴重度垂直骨量不足的种植修复疑难病例,计算机辅助、手术导板引导下种植术创伤相对小,缩短了疗程,避免了复杂植骨手术或高风险神经游离术,技术上可行,近期临床效果肯定,但需要严格把握适应征。
[Abstract]:Objective: to evaluate the feasibility, accuracy and clinical effect of computer aided design (CAD) and dental implants in the treatment of free mandibular posterior teeth with vertical bone insufficiency. Methods: three patients (2 females and 1 male) with a vertical bone mass of less than 8 mm in the implant area of the mandibular posterior teeth were selected, with an average age of 45 years (44 ~ 46 years), with 10 implant sites. Preoperative computer-aided surgical design, rapid prototyping RP were used to make the guide plate, guided by the guide plate, to avoid the inferior alveolar nerve, and the clinical and imaging evaluation were performed after the operation. Results 10 implants were implanted under the guidance of the surgical guide plate and 10 implants were implanted under the guidance of the surgical guide plate. Up to the last review, the implant prosthesis had a good clinical effect, and no symptoms of inferior alveolar nerve dysfunction were observed during the follow-up period. Cone-beam computed tomography (cone beam computerized) was performed immediately after operation to confirm the safe distance between the implant position and the inferior alveolar nerve. The deviation between the actual implant position and the preoperative design was further measured. The implant neck deviation was (0.84 卤0.30) mm () 0.31 卤1.24 mm), square deviation (1.42 卤0.52) mm (0.52) mm (0.52 卤2.36 mm),) angle deviation was 7.65 掳卤1.84 掳(4.43 掳卤9.81 掳). Conclusion: for the difficult cases of mandibular posterior tooth free loss and severe vertical bone insufficiency, the trauma of implantation under the guidance of computer aided and guided by surgical guide plate is relatively small, and the course of treatment is shortened. Complicated bone grafting or high risk nerve dissociation were avoided, which was technically feasible, and the clinical effect was positive in the near future, but the adaptation sign should be strictly grasped.
【作者单位】：北京大学口腔医学院·口腔医院口腔种植中心;
【分类号】：R783.6

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