【摘要】：目的:基于各種傳統(tǒng)種植導(dǎo)板的制作基礎(chǔ)上,通過(guò)改進(jìn)設(shè)計(jì),研制一種簡(jiǎn)易牙種植導(dǎo)板,探討其制作方法及臨床應(yīng)用效果,為臨床種植手術(shù)提供理論依據(jù)和應(yīng)用指導(dǎo)。方法:1.模型實(shí)驗(yàn)研究:利用仿真下頜骨附牙齦軟組織種植模型,經(jīng)翻制得到35、31、42、45、46共5顆牙齒缺失的下頜牙列缺損石膏模型。(1)傳統(tǒng)種植導(dǎo)板制作:在下頜牙列缺損石膏模型上按修復(fù)原則排牙,翻制含修復(fù)體的石膏模型,使用塑料壓膜片在真空成型機(jī)上壓膜。修剪完成導(dǎo)板雛形,將該雛形導(dǎo)板置于模型上就位,在設(shè)計(jì)好的植入部位使用bredent平行研磨儀鉆孔,將金屬導(dǎo)向管插入孔內(nèi)并固定,完成傳統(tǒng)種植導(dǎo)板制作。(2)簡(jiǎn)易牙種植導(dǎo)板的制作:(1)在下頜牙列缺損石膏模型上按修復(fù)原則排牙,綜合確定合適的植入位置。將硅橡膠重體平鋪于下頜缺隙區(qū)同時(shí)向頰舌側(cè)延伸至粘膜轉(zhuǎn)折處并覆蓋鄰牙牙冠部,使用bredent平行研磨儀在硅橡膠上沿頰舌向劃線,石膏鋸沿標(biāo)記線將硅橡膠同石膏模型一并切開(kāi),硅橡膠縱切面繪制輔助線完成骨導(dǎo)圖標(biāo)記模板制作。借助骨導(dǎo)圖標(biāo)記模板,繪制出骨輪廓。在兼顧頜骨解剖條件和上部修復(fù)的基礎(chǔ)上最終確定植入方向并轉(zhuǎn)移至骨導(dǎo)圖標(biāo)記模板。將含有最終植入方向的骨導(dǎo)圖標(biāo)記模板戴入另一副硬石膏模型,使用bredent平行研磨儀用直徑為2mm的鉆鉆孔,插入定向桿及配套的導(dǎo)向管,使用塑料壓膜片在真空成型機(jī)上壓膜,外形修整,檢查其穩(wěn)定性,最終完成保留牙齦軟組織的簡(jiǎn)易牙種植導(dǎo)板制作(簡(jiǎn)易導(dǎo)板a)。(2)將仿真下頜骨附牙齦軟組織種植模型中牙缺失區(qū)局部牙齦軟組織去除,并翻制去除牙齦軟組織的石膏模型。按制作簡(jiǎn)易導(dǎo)板a的步驟制作骨導(dǎo)圖標(biāo)記模板并鉆孔、壓膜,最終完成去除牙齦軟組織的簡(jiǎn)易牙種植導(dǎo)板制作(簡(jiǎn)易導(dǎo)板b)。(3)模型對(duì)比實(shí)驗(yàn):分別利用傳統(tǒng)種植導(dǎo)板,簡(jiǎn)易導(dǎo)板a和簡(jiǎn)易導(dǎo)板b三種導(dǎo)板,在仿真下頜骨附牙齦軟組織種植模型上完成先鋒鉆導(dǎo)向的備孔,對(duì)模擬手術(shù)中植入的位置與擬設(shè)計(jì)植入位置進(jìn)行比較,研究不同導(dǎo)板引導(dǎo)下植入的準(zhǔn)確性。2.臨床應(yīng)用研究:選擇牙缺失患者12名,共植入22枚種植體。術(shù)前拍攝曲面斷層x線片,初步評(píng)估種植區(qū)頜骨的解剖條件。制作簡(jiǎn)易導(dǎo)板a,戴入導(dǎo)板,再次拍攝曲面斷層x線片或錐體束ct(cbct),觀察設(shè)計(jì)方案的合理性。在導(dǎo)板引導(dǎo)下進(jìn)行種植手術(shù)。術(shù)后拍攝曲面斷層x線片或錐體束ct,觀察和評(píng)價(jià)導(dǎo)板的臨床應(yīng)用效果。結(jié)果:1.傳統(tǒng)種植導(dǎo)板引導(dǎo)下,在植入道距牙槽嵴頂4mm處到唇頰側(cè)、舌側(cè)的垂直距離與預(yù)先設(shè)計(jì)位置比較,偏差均數(shù)分別為:1.020±0.740mm;0.920±0.692mm,偏差大,差異具有統(tǒng)計(jì)學(xué)意義(p0.05,n=5)。在植入道距牙槽嵴頂8mm處到唇頰側(cè)、舌側(cè)的垂直距離,種植深度,以及牙槽嵴頂植入點(diǎn)與預(yù)先設(shè)計(jì)位置比較,偏差均數(shù)分別為:0.456±0.755mm;-0.698±0.956mm;0.378±0.834mm;0.962±0.242mm,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05,n=5)。2.簡(jiǎn)易導(dǎo)板A引導(dǎo)下,分別在植入道距牙槽嵴頂4mm和8mm處到唇頰側(cè)、舌側(cè)的垂直距離,種植深度,以及牙槽嵴頂植入點(diǎn)與預(yù)先設(shè)計(jì)位置比較,偏差均數(shù)分別為:0.070±0.474mm;0.160±0.549mm;0.062±0.642mm;0.066±0.406mm;0.106±0.314mm;0.584±0.204mm,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05,n=5)。3.簡(jiǎn)易導(dǎo)板B引導(dǎo)下,在植入道距牙槽嵴頂8mm處到唇頰側(cè)、舌側(cè)的垂直距離與預(yù)先設(shè)計(jì)位置比較,偏差均數(shù)分別為:0.922±0.690mm,-0.932±0.652mm,偏差大,差異具有統(tǒng)計(jì)學(xué)意義(P0.05,n=5)。在植入道距牙槽嵴頂4mm處到唇頰側(cè)、舌側(cè)的垂直距離,種植深度,以及牙槽嵴頂植入點(diǎn)與預(yù)先設(shè)計(jì)位置比較,偏差均數(shù)分別為:0.712±0.685mm;-0.660±0.745mm;0.106±1.013mm;0.762±0.221mm;差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05,n=5)。4.在簡(jiǎn)易導(dǎo)板A的引導(dǎo)下行種植手術(shù),種植體準(zhǔn)確地植入到擬設(shè)計(jì)位置,植入偏差較小,術(shù)中創(chuàng)傷小,符合微創(chuàng)的理念。結(jié)論:在種植模型上進(jìn)行模擬種植比較,保留牙齦軟組織的簡(jiǎn)易牙種植導(dǎo)板比傳統(tǒng)種植導(dǎo)板和去除牙齦軟組織的簡(jiǎn)易牙種植導(dǎo)板偏差更小,更精準(zhǔn)。能夠把術(shù)前的設(shè)計(jì)精確地轉(zhuǎn)移至種植術(shù)中,符合臨床應(yīng)用的要求。在保留牙齦軟組織的簡(jiǎn)易牙種植導(dǎo)板引導(dǎo)下完成的種植手術(shù),植入偏差較小,術(shù)中創(chuàng)傷小,大大縮短了種植手術(shù)的時(shí)間,患者滿意度高,取得了良好的臨床效果。
[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.
【學(xué)位授予單位】：北華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R783.6

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 董悅斐;;與牙種植失敗率相關(guān)的危險(xiǎn)因素分析[J];口腔頜面外科雜志;2006年01期

2 汪昆,李德華;電視現(xiàn)場(chǎng)直播技術(shù)在牙種植手術(shù)教學(xué)中的實(shí)踐[J];醫(yī)學(xué)教育探索;2005年03期

3 王卓;黃遠(yuǎn)亮;顧力栩;鄭廣超;;牙種植外科導(dǎo)航系統(tǒng)精確度的測(cè)試研究[J];口腔頜面外科雜志;2006年02期

4 孫曉迪;徐欣;;與牙種植失敗相關(guān)的患者行為因素分析[J];中國(guó)口腔種植學(xué)雜志;2010年03期

5 趙士杰,邸萍,邱立新;牙種植外科技術(shù)探討[J];口腔材料器械雜志;1996年01期

6 劉微微;劉秀梅;;牙種植患者的護(hù)理要點(diǎn)[J];解放軍健康;2009年03期

7 戚孟春,由彥玲;羥基磷灰石在牙種植外科植骨中的應(yīng)用[J];醫(yī)學(xué)理論與實(shí)踐;2002年03期

8 任道普;鄭光勇;王廣;;牙種植即刻修復(fù)的臨床應(yīng)用研究[J];中國(guó)口腔種植學(xué)雜志;2006年02期

9 宿玉成;戈怡;耿威;;牙種植的美學(xué)風(fēng)險(xiǎn)因素與對(duì)策[J];中國(guó)實(shí)用口腔科雜志;2009年11期

10 巫家曉;李麗楚;伍曼曼;;腓骨在牙種植應(yīng)用中的解剖學(xué)分析[J];廣西醫(yī)科大學(xué)學(xué)報(bào);2010年01期

相關(guān)會(huì)議論文 前10條

1 柳忠豪;;即刻牙種植64顆臨床體會(huì)[A];第四屆全國(guó)口腔種植學(xué)術(shù)會(huì)議論文集[C];2005年

2 孫燁;曹曉林;阮國(guó)憲;肖亮;;前牙種植即刻修復(fù)技術(shù)的臨床應(yīng)用[A];第四屆全國(guó)口腔種植學(xué)術(shù)會(huì)議論文集[C];2005年

3 姜慧娟;;牙種植患者的健康教育[A];全國(guó)口腔科護(hù)理學(xué)術(shù)交流暨專題講座會(huì)議論文匯編[C];2005年

4 周燕玲;劉福祥;;有限元法在牙種植領(lǐng)域的應(yīng)用及常用有限元分析系統(tǒng)[A];第四屆全國(guó)口腔種植學(xué)術(shù)會(huì)議論文集[C];2005年

5 夏海斌;程祥榮;施斌;;組織旋轉(zhuǎn)瓣用于單個(gè)牙種植Ⅱ期手術(shù)的臨床研究[A];第四屆全國(guó)口腔種植學(xué)術(shù)會(huì)議論文集[C];2005年

6 姜慧娟;李永利;姚莉娟;王琰;;牙種植手術(shù)的感染控制[A];全國(guó)口腔科護(hù)理學(xué)術(shù)交流暨專題講座會(huì)議論文匯編[C];2008年

7 馬泉生;王佩玉;袁錫蘭;秦琥;于殿紳;韓玉玫;劉君;;單牙種植修復(fù)的幾個(gè)問(wèn)題[A];中華口腔醫(yī)學(xué)會(huì)第三次全國(guó)口腔修復(fù)學(xué)術(shù)會(huì)議論文集[C];1997年

8 田莉萍;;牙種植病人的護(hù)理[A];2012年河南省五官科優(yōu)質(zhì)服務(wù)護(hù)理管理與�？谱o(hù)士培養(yǎng)學(xué)術(shù)研討會(huì)論文集[C];2012年

9 劉景躍;孫為偉;韓有亮;;鈦合金前牙種植[A];中華口腔醫(yī)學(xué)會(huì)成立大會(huì)暨第六次全國(guó)口腔醫(yī)學(xué)學(xué)術(shù)會(huì)議論文匯編[C];1996年

10 安鋼;;“牙種植”后的口腔衛(wèi)生措施[A];中華口腔醫(yī)學(xué)會(huì)成立大會(huì)暨第六次全國(guó)口腔醫(yī)學(xué)學(xué)術(shù)會(huì)議論文匯編[C];1996年

相關(guān)碩士學(xué)位論文 前4條

1 向峰;簡(jiǎn)易牙種植導(dǎo)板的制作及臨床應(yīng)用研究[D];北華大學(xué);2017年

2 王慶;牙種植備孔時(shí)先鋒鉆控制的研究[D];復(fù)旦大學(xué);2010年

3 廖文清;基于導(dǎo)板的牙種植手術(shù)中骨骼溫度場(chǎng)的研究[D];浙江工業(yè)大學(xué);2012年

4 解涓;氧化鋯全瓷修復(fù)體在后牙種植區(qū)應(yīng)用的臨床回顧性研究[D];第四軍醫(yī)大學(xué);2014年

，

本文編號(hào)：2189035