Hinckfuss Simon, Conrad Heather J, Lin Lianshan, Lunos Scott, Seong Wook-Jin
Department of Diagnostic and Developmental Sciences, University of Minnesota, Minneapolis, MN, USA.
J Oral Implantol. 2012 Aug;38(4):311-23. doi: 10.1563/AAID-JOI-D-10-00046. Epub 2010 Aug 16.
Implant position is a key determinant of esthetic and functional success. Achieving the goal of ideal implant position may be affected by case selection, prosthodontically driven treatment planning, site preparation, surgeon's experience and use of a surgical guide. The combined effect of surgical guide design, surgeon's experience, and size of the edentulous area on the accuracy of implant placement was evaluated in a simulated clinical setting. Twenty-one volunteers were recruited to participate in the study. They were divided evenly into 3 groups (novice, intermediate, and experienced). Each surgeon placed implants in single and double sites using 4 different surgical guide designs (no guide, tube, channel, and guided) and written instructions describing the ideal implant positions. A definitive typodont was constructed that had 3 implants in prosthetically determined ideal positions of single and double sites. The position and angulation of implants placed by the surgeons in the duplicate typodonts was measured using a computerized coordinate measuring machine and compared to the definitive typodont. The mean absolute positional error for all guides was 0.273, 0.340, 0.197 mm in mesial-distal, buccal-lingual, vertical positions, respectively, with an overall range of 0.00 to 1.81 mm. The mean absolute angle error for all guides was 1.61° and 2.39° in the mesial-distal and buccal-lingual angulations, respectively, with an overall range of 0.01° to 9.7°. Surgical guide design had a statistically significant effect on the accuracy of implant placement regardless of the surgeon's experience level. Experienced surgeons had significantly less error in buccal-lingual angulation. The size of the edentulous sites was found to affect both implant angle and position significantly. The magnitude of error in position and angulation caused by surgical guide design, surgeon's experience, and site size reported in this study are possibly not large enough to be clinically significant; however, it is likely that errors would be magnified in clinical practice. Future research is recommended to evaluate the effect of surgical guide design in vivo on implant angulation and position error.
种植体位置是美学和功能成功的关键决定因素。实现理想种植体位置的目标可能会受到病例选择、修复驱动的治疗计划、种植位点预备、外科医生经验以及手术导板使用的影响。在模拟临床环境中评估了手术导板设计、外科医生经验和无牙区大小对种植体植入准确性的综合影响。招募了21名志愿者参与该研究。他们被平均分为3组（新手、中级和经验丰富组）。每位外科医生使用4种不同的手术导板设计（无导板、套管、通道和引导式）以及描述理想种植体位置的书面说明，在单颗和两颗种植位点植入种植体。构建了一个具有在单颗和两颗种植位点的修复确定理想位置的3颗种植体的标准牙模型。使用计算机坐标测量仪测量外科医生在复制牙模型中植入的种植体的位置和角度，并与标准牙模型进行比较。所有导板在近远中、颊舌向、垂直位置的平均绝对位置误差分别为0.273、0.340、0.197mm，总体范围为0.00至1.81mm。所有导板在近远中角度和颊舌向角度的平均绝对角度误差分别为1.61°和2.39°，总体范围为0.01°至9.7°。无论外科医生的经验水平如何，手术导板设计对种植体植入的准确性均有统计学上的显著影响。经验丰富的外科医生在颊舌向角度上的误差明显较小。发现无牙区的大小对种植体角度和位置均有显著影响。本研究中报告的由手术导板设计、外科医生经验和种植位点大小引起的位置和角度误差幅度可能不足以具有临床意义；然而，在临床实践中误差可能会放大。建议未来的研究评估手术导板设计在体内对种植体角度和位置误差的影响。
