本文選題：計算機輔助設計 + 義齒　； 參考：《北京大學學報(醫(yī)學版)》2014年02期

【摘要】：目的:評價計算機輔助設計制造、牙支持式種植外科手術導板在下頜后牙游離缺失伴垂直骨量不足患者中應用的可行性、精確度及臨床效果。方法:選取下頜后牙種植區(qū)域垂直骨量小于8 mm的患者3名(2名女性,1名男性),平均年齡45歲(44~46歲),共10個種植位點。術前進行計算機輔助下手術設計,快速成型技術(rapid prototyping,RP)制作手術導板,施行導板引導下種植手術,避開下牙槽神經,術后進行臨床評估和影像學評估。結果:3名患者在手術導板引導下共植入10顆種植體,并完成種植體支持固定修復,至最后一次復查,種植修復體臨床效果良好,隨訪期間未觀察到下牙槽神經功能障礙癥狀。術后即刻進行錐形束計算機斷層掃描(cone beam computerized tomography,CBCT),確認種植體位置與下牙槽神經之間存在1.5~3.0 mm的安全距離。進一步測量種植體實際植入位置與術前設計之間的偏差,種植體頸部偏移為(0.84±0.30)mm(0.31~1.24 mm),根方偏移為(1.42±0.52)mm(0.52~2.36 mm),角度偏移為7.65°±1.84°(4.43°~9.81°)。結論:對于下頜后牙游離缺失伴重度垂直骨量不足的種植修復疑難病例,計算機輔助、手術導板引導下種植術創(chuàng)傷相對小,縮短了療程,避免了復雜植骨手術或高風險神經游離術,技術上可行,近期臨床效果肯定,但需要嚴格把握適應征。
[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 鹵0.30) mm () 0.31 鹵1.24 mm), square deviation (1.42 鹵0.52) mm (0.52) mm (0.52 鹵2.36 mm),) angle deviation was 7.65 擄鹵1.84 擄(4.43 擄鹵9.81 擄). 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.
【作者單位】： 北京大學口腔醫(yī)學院·口腔醫(yī)院口腔種植中心;
【分類號】：R783.6

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