简易牙种植导板的制作及临床应用研究

发布时间：2018-08-18 09:19

【摘要】：目的:基于各种传统种植导板的制作基础上,通过改进设计,研制一种简易牙种植导板,探讨其制作方法及临床应用效果,为临床种植手术提供理论依据和应用指导。方法:1.模型实验研究:利用仿真下颌骨附牙龈软组织种植模型,经翻制得到35、31、42、45、46共5颗牙齿缺失的下颌牙列缺损石膏模型。(1)传统种植导板制作:在下颌牙列缺损石膏模型上按修复原则排牙,翻制含修复体的石膏模型,使用塑料压膜片在真空成型机上压膜。修剪完成导板雏形,将该雏形导板置于模型上就位,在设计好的植入部位使用bredent平行研磨仪钻孔,将金属导向管插入孔内并固定,完成传统种植导板制作。(2)简易牙种植导板的制作:(1)在下颌牙列缺损石膏模型上按修复原则排牙,综合确定合适的植入位置。将硅橡胶重体平铺于下颌缺隙区同时向颊舌侧延伸至粘膜转折处并覆盖邻牙牙冠部,使用bredent平行研磨仪在硅橡胶上沿颊舌向划线,石膏锯沿标记线将硅橡胶同石膏模型一并切开,硅橡胶纵切面绘制辅助线完成骨导图标记模板制作。借助骨导图标记模板,绘制出骨轮廓。在兼顾颌骨解剖条件和上部修复的基础上最终确定植入方向并转移至骨导图标记模板。将含有最终植入方向的骨导图标记模板戴入另一副硬石膏模型,使用bredent平行研磨仪用直径为2mm的钻钻孔,插入定向杆及配套的导向管,使用塑料压膜片在真空成型机上压膜,外形修整,检查其稳定性,最终完成保留牙龈软组织的简易牙种植导板制作(简易导板a)。(2)将仿真下颌骨附牙龈软组织种植模型中牙缺失区局部牙龈软组织去除,并翻制去除牙龈软组织的石膏模型。按制作简易导板a的步骤制作骨导图标记模板并钻孔、压膜,最终完成去除牙龈软组织的简易牙种植导板制作(简易导板b)。(3)模型对比实验:分别利用传统种植导板,简易导板a和简易导板b三种导板,在仿真下颌骨附牙龈软组织种植模型上完成先锋钻导向的备孔,对模拟手术中植入的位置与拟设计植入位置进行比较,研究不同导板引导下植入的准确性。2.临床应用研究:选择牙缺失患者12名,共植入22枚种植体。术前拍摄曲面断层x线片,初步评估种植区颌骨的解剖条件。制作简易导板a,戴入导板,再次拍摄曲面断层x线片或锥体束ct(cbct),观察设计方案的合理性。在导板引导下进行种植手术。术后拍摄曲面断层x线片或锥体束ct,观察和评价导板的临床应用效果。结果:1.传统种植导板引导下,在植入道距牙槽嵴顶4mm处到唇颊侧、舌侧的垂直距离与预先设计位置比较,偏差均数分别为:1.020±0.740mm;0.920±0.692mm,偏差大,差异具有统计学意义(p0.05,n=5)。在植入道距牙槽嵴顶8mm处到唇颊侧、舌侧的垂直距离,种植深度,以及牙槽嵴顶植入点与预先设计位置比较,偏差均数分别为:0.456±0.755mm;-0.698±0.956mm;0.378±0.834mm;0.962±0.242mm,差异无统计学意义(P0.05,n=5)。2.简易导板A引导下,分别在植入道距牙槽嵴顶4mm和8mm处到唇颊侧、舌侧的垂直距离,种植深度,以及牙槽嵴顶植入点与预先设计位置比较,偏差均数分别为:0.070±0.474mm;0.160±0.549mm;0.062±0.642mm;0.066±0.406mm;0.106±0.314mm;0.584±0.204mm,差异均无统计学意义(P0.05,n=5)。3.简易导板B引导下,在植入道距牙槽嵴顶8mm处到唇颊侧、舌侧的垂直距离与预先设计位置比较,偏差均数分别为:0.922±0.690mm,-0.932±0.652mm,偏差大,差异具有统计学意义(P0.05,n=5)。在植入道距牙槽嵴顶4mm处到唇颊侧、舌侧的垂直距离,种植深度,以及牙槽嵴顶植入点与预先设计位置比较,偏差均数分别为:0.712±0.685mm;-0.660±0.745mm;0.106±1.013mm;0.762±0.221mm;差异均无统计学意义(P0.05,n=5)。4.在简易导板A的引导下行种植手术,种植体准确地植入到拟设计位置,植入偏差较小,术中创伤小,符合微创的理念。结论:在种植模型上进行模拟种植比较,保留牙龈软组织的简易牙种植导板比传统种植导板和去除牙龈软组织的简易牙种植导板偏差更小,更精准。能够把术前的设计精确地转移至种植术中,符合临床应用的要求。在保留牙龈软组织的简易牙种植导板引导下完成的种植手术,植入偏差较小,术中创伤小,大大缩短了种植手术的时间,患者满意度高,取得了良好的临床效果。
[Abstract]:AIM: To develop a simple dental implant guide plate based on various traditional implant guides and improve its design, and to explore its fabrication method and clinical application effect, so as to provide theoretical basis and application guidance for clinical implant operation. Methods: 1. Model experiment study: The model of mandibular gingival soft tissue implant was developed by using a simulated mandibular soft tissue implant model. Five mandibular dentition defect plaster models with 35,31,42,45,46 missing teeth were constructed. (1) Traditional implant guides were made by arranging teeth according to the restoration principle on the plaster model of mandibular dentition defect, then the plaster model containing prosthesis was reproduced, and the plastic compression diaphragm was used to press the plaster on the vacuum forming machine. (2) Simple dental implant guide plate was fabricated: (1) Arrange the teeth according to the restoration principle on the plaster model of mandibular dentition defect, and determine the appropriate implant location comprehensively. The maxillary gap extends to the buccal-lingual transition and covers the crown of adjacent teeth. The silicone rubber was cut along the buccal-lingual direction with a plaster saw, and the template was made by drawing the auxiliary line along the longitudinal section of the silicone rubber. The implant direction was determined and transferred to the bone guide marking template on the basis of considering the anatomical conditions of the jaw and the upper restoration. The bone guide marking template containing the final implant direction was put into another anhydrite model. The drill hole with diameter of 2 mm was drilled with the bredent parallel grinder, and the directional rod and the matching guide were inserted. To make a simple dental implant guide plate (simple guide plate a). (2) Removal of the soft tissue in the missing area of the mandible-attached gingival soft tissue implant model, and removing the gingival soft tissue stones. Plaster model. according to the steps of making simple guide plate a, make bone guide marking template and drill holes, press film, and finally complete the simple dental implant guide plate to remove gingival soft tissue (simple guide plate b). (3) model comparison experiment: using traditional implant guide plate, simple guide plate A and simple guide plate b, respectively, in the simulation of mandible attached to gingival soft tissue species Pioneer drill-guided hole preparation was completed on the implant model. The implant position in the simulated operation was compared with the designed implant position to study the accuracy of implant placement under different guide plates. 2. Clinical application study: 12 patients with missing teeth were selected and 22 implants were implanted. Conditions: Make a simple guide plate a, wear a guide plate, take curved section X-ray film or cone bundle CT (cbct) again, and observe the rationality of the design scheme. Implant operation was carried out under the guide plate. The mean deviations were 1.020 (+ 0.740 mm) and 0.920 (+ 0.692 mm) from the apex of alveolar ridge to the lip and buccal side. The differences were statistically significant (p0.05, n = 5). The vertical distance from the apex of alveolar ridge to the lip and buccal side, the depth of implantation, and the implantation point and the pre-implantation of the apex of alveolar ridge were 8 mm from the apex of alveolar ridge to the lip and buccal side. The mean deviations were 0.456 [0.755 mm], - 0.698 [0.956 mm], 0.378 [0.834 mm], and 0.962 [0.242 mm], with no significant difference (P 0.05, n = 5). The mean deviations were 0.070 (+ 0.474 mm), 0.160 (+ 0.549 mm), 0.062 (+ 0.642 mm), 0.066 (+ 0.406 mm), 0.106 (+ 0.314 mm), 0.584 (+ 0.204 mm), respectively. There was no significant difference in the mean deviations between the implant canal and the lip under the guidance of simple guide plate B and the vertical distance from the top of alveolar ridge to the buccal side. The deviations were significant (P 0.05, n = 5). The mean deviations were 0.922 (+ 0.690 mm) and - 0.932 (- 0.652 mm). The deviations were 0.712 (- 0.685 mm), 0.106 (- 0.745 mm), 0.762 (- 1.013 mm) and 0.762 (- 0.762) mm, respectively. No significant difference was found between the two groups (P 0.05, n = 5). 4. Under the guidance of simple guide plate A, implants were accurately implanted into the planned position, with less deviation, less trauma during operation, which accorded with the concept of minimally invasive. The implant guide plate and simple dental implant guide plate for removing gingival soft tissue have smaller deviation and more accurate deviation, which can transfer the preoperative design precisely to the implant operation and meet the requirements of clinical application. The patient's satisfaction was high during the operation and achieved good clinical results.
【学位授予单位】：北华大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.6

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