动态导航技术中植入位点骨质量对种植精度的影响

doi:10.3969/j.issn.1005-4979.2022.03.007

摘要/Abstract

摘要：

目的：探究颌骨骨密度和种植位点骨壁斜坡角度对动态导航技术中种植精度的影响。方法：对2017—2021年通过在上前牙及上颌前磨牙区采用动态导航技术种植的患者进行回顾分析，共纳入42例患者及47颗种植体。测量术区颌骨密度及种植位点骨壁和种植体长轴形成的角度，并计算术前设计和术后种植体位置的偏差。结果：统计结果显示，骨壁斜坡与种植体长轴的交角和种植体轴向的角度偏差具有显著的负相关关系（r=-0.298，P<0.05），种植术区颌骨密度与种植体轴向的角度偏差具有显著的负相关关系（r=-0.289，P<0.05）。种植体颈部骨宽度和种植体精度之间不存在相关关系（P>0.05）。结论：种植体长轴与颌骨骨壁形成的角度越小、种植术区颌骨密度越低，动态导航技术种植精度中的种植体轴向偏差越大。

关键词: 动态导航, 牙种植, 骨密度, 精确度, 误差分析

Abstract:

Objective: To explore the effects of bone density and angle of bone wall of the implant site on the implant accuracy under the dynamic navigation technology. Methods: A retrospective analysis was conducted in patients who underwent implantation with dynamic navigation technology in the upper anterior tooth and premolar regions from 2017 to 2021. A total of 42 patients and 47 implants were included. Measuring the bone density of the implant region and the angle between the bone wall of the implant site and the long axis of the implant, and calculating the deviation of the preoperative design and postoperative implant position. Results: Statistical results showed that there was a significant negative correlation between the slope of the bone wall and the intersection angle of the long axis of the implant and the axial angle deviation of the implant (r=-0.298, P<0.05). There was a significant negative correlation between the regional jaw bone density in the implant region and the axial angle deviation of the implant(r=-0.289, P<0.05). There was no correlation between implant neck bone width and implant accuracy (P>0.05). Conclusion: The results showed that the smaller the angle formed between the long axis of the implant and the mandibular bone wall, and the lower the mandibular bone density in the implant region, the greater axial deviation of the implant accuracy in the dynamic navigation technology.

Key words: dynamic navigation, dental implant, bone density, accuracy, deviation analysis

王磊, 伍颖颖, 满毅. 动态导航技术中植入位点骨质量对种植精度的影响[J]. 《口腔颌面外科杂志》, 2022, 32(3): 174-181.

WANG Lei, WU Yingying, MAN Yi. The effect of bone quality of implant sites on implant accuracy in dynamic navigation technology[J]. 《Journal of Oral and Maxillofacial Surgery》, 2022, 32(3): 174-181.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2022/V32/I3/174

图/表 9

图1 动态导航设备的原理示意图

Figure 1 Schematic diagram of the dynamic navigation device

图2 导航手术术前的准备流程 A. U型管，型号分为A型（矩形，适用于后牙区）、B型（弧形，适用于前牙区）、C13型（适用于右上颌及左下颌牙弓转角区）、C24型（适用于右下颌及左上颌牙弓转角区）；B. 固定装置，分为24M、24L、13M、13L、AUL 5种型号，M为中号，L为大号，24型适用于左上颌及右下颌后牙区，13型适用于左下颌及右上颌后牙区，AUL型适用于上下颌前牙区；C. 使用印模材料固定U型管；D. 佩戴U型管拍CBCT，获取DICOM数据；E. 将DICOM数据导入软件进行设计；F. 连接种植手机和参考板进行标定；G. 连接固定装置与参考板； H. 将固定装置固定在患者牙列；I. 配准；J. 验证。

Figure 2 Preoperative preparation process of navigation surgery

图3 显示器实时导航界面 A. 实时导航CT横截面；B. 实时导航CT矢状面；C. 实时导航CT冠状面；D. CT影像三维重建；E. 钻针尖端位置指示界面；F. 钻针轴向指示界面；G. 钻针深度指示界面。

Figure 3 Real-time navigation interface on the monitor

图4 术后精度验证的测量指标 ①为种植体颈部位置中心点的线性偏差；②为种植体根尖位置的线性偏差；③为种植体轴向的角度偏差；④为术前设计种植体位置；⑤为术后实际植入种植体位置。

Figure 4 Measurements of the postoperative deviation analysis

图5 CBCT测量指标 A. 将CBCT旋转至正矢状面位置，在种植术区测量矩形区域内的平均骨密度；B. 将CBCT旋转至正矢状面位置，在种植体颈部平台处测量骨宽度；C. 测量骨壁和种植体长轴所形成的角度，确定直线L1为种植体长轴，直线L1与骨壁交点为A点，确定直线L2为靠近骨壁斜坡侧的种植体边界延长线，L2与骨壁的交点为B点，连接AB两点形成直线L3，测量直线L1与直线L3之间的交角，记作角α。

Figure 5 CBCT images showing measurement parameters

表1 种植体基本情况

Table 1 Basic information of implants

组别	种植体颗数（%）
种植体长度/mm
10.0	17（36.2）
11.0	3（6.4）
11.5	5（10.7）
12.0	19（40.4）
13.0	1（2.1）
14.0	2（4.2）
种植体直径/mm
3.0	1（2.1）
3.3	31（66.0）
3.4	2（4.2）
3.5	6（12.8）
3.8	2（4.2）
4.1	5（10.7）
种植体系统
Straumann	33（70.2）
Nobel	6（12.8）
Anthogyr	5（10.7）
Astra	1（2.1）
威高	2（4.2）
种植时机
即刻种植	7（14.9）
非即刻种植	40（85.1）

表2 相关分析结果

Table 2 Correlation analysis results

测量指标间相关关系	r值	P值
角度与种植偏差
颈部偏差	0.138	0.356
根尖偏差	0.004	0.979
轴向偏差	-0.298	0.042
密度与种植偏差
颈部偏差	0.064	0.669
根尖偏差	-0.088	0.556
轴向偏差	-0.289	0.049
宽度与种植偏差
颈部偏差	0.014	0.927
根尖偏差	0.152	0.308
轴向偏差	0.169	0.256

图6 角度线性回归散点图

Figure 6 Angle linear regression scatter plot

表3 一元线性回归分析

Table 3 Univariate linear regression analysis

变量	b值	b值标准误	t值	P值	95% CI下限	95% CI上限
骨壁角度	-0.030	0.013	-2.294	0.027	-0.057	-0.004

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