Widmann Gerlig, Keiler Martin, Zangerl Antoniette, Stoffner Rudolf, Longato Stefano, Bale Reto, Puelacher Wolfgang
Stereotaxy Intervention Planning, Department for Microinvasive Therapy, Department of Radiology, Innsbruck Medical University, Innsbruck, Austria.
J Oral Maxillofac Surg. 2010 May;68(5):1140-7. doi: 10.1016/j.joms.2009.10.008. Epub 2010 Feb 13.
In computer-assisted implantation surgery, the transfer of prosthodontic-guided planning to the operative site is usually based on a registration template. The precise repositioning of the registration template is crucial for high accuracy and is compromised in edentulous jaws. The purpose was to determine the in vitro registration and targeting accuracy for surgical navigation in the edentulous jaw based on 3 fixed intraoral reference points.
Edentulous maxilla and mandible cadaver specimens were provided with 3 fixed reference-point screws. A resin template with matrices for the fixed reference-point screws was produced and connected to a Vogele-Bale-Hohner registration mouthpiece and external registration frame with a snap-lock system. Surgical implants were planned on computed tomographic data and the corresponding dental stone casts were drilled under guidance of an optical navigation system. For evaluation of the registration accuracy, fiducial registration error was recorded and application accuracy was evaluated by fusion of postsurgical computed tomographic scans of the drilled dental stone casts with the presurgical planning computed tomogram.
In 9 maxillas and 5 mandibles, 14 registrations and 104 stone cast drillings were performed. The mean fiducial registration error was 0.49 +/- 0.14 mm (0.37 to 0.9 mm). The mean total error at the tip of the borehole was 0.88 +/- 0.65 mm (0.0 to 4.24 mm). The mean lateral errors were 0.51 +/- 0.49 mm (0.0 to 2.80 mm) at the base and 0.46 +/- 0.34 mm (0.0 to 1.5 mm) at the tip of the borehole, respectively. The mean angular error was 0.83 +/- 0.60 degrees (0.0 to 2.5 degrees ).
Three fixed intraoral reference points successfully support a registration mouthpiece and provide in vitro registration and targeting accuracy that is comparable to tooth-supported registration templates or bone marker registration.
在计算机辅助种植手术中，将口腔修复引导计划转移至手术部位通常基于一个定位模板。定位模板的精确重新定位对于高精度至关重要，但在无牙颌中会受到影响。本研究旨在基于3个固定的口内参考点确定无牙颌手术导航的体外定位和靶向精度。
为无牙上颌和下颌尸体标本植入3个固定的参考点螺钉。制作一个带有固定参考点螺钉矩阵的树脂模板，并通过卡扣系统将其连接到Vogele-Bale-Hohner定位咬嘴和外部定位框架上。根据计算机断层扫描数据规划手术种植体，并在光学导航系统的引导下对相应的石膏模型进行钻孔。为评估定位精度，记录基准配准误差，并通过将钻孔石膏模型的术后计算机断层扫描与术前规划的计算机断层扫描融合来评估应用精度。
在9例上颌骨和5例下颌骨中进行了14次定位和104次石膏模型钻孔。平均基准配准误差为0.49±0.14 mm（0.37至0.9 mm）。钻孔尖端的平均总误差为0.88±0.65 mm（0.0至4.24 mm）。钻孔底部的平均横向误差为0.51±0.49 mm（0.0至2.80 mm），钻孔尖端的平均横向误差为0.46±0.34 mm（0.0至1.5 mm）。平均角度误差为0.83±0.60度（0.0至2.5度）。
3个固定的口内参考点成功地支撑了一个定位咬嘴，并提供了与牙齿支撑的定位模板或骨标记定位相当的体外定位和靶向精度。
