Schnitman Paul A, Hayashi Chie, Han Rita K
1 Dental Implants of Boston, Wellesley Hills, Mass.
J Oral Implantol. 2014 Dec;40(6):670-8. doi: 10.1563/aaid-joi-D-14-00231.
Computer-assisted implant planning and subsequent production of a surgical template based on this plan has gained attention because it provides restoratively driven esthetics, patient comfort, satisfaction, and the option of flapless surgery and immediate restoration. However, it adds expense and requires more time. Another significant but not so apparent advantage may be improved survival and success over freehand techniques in types III and IV bone. This retrospective analysis was undertaken to examine that possibility. It reports 1-year outcome for 80 implants in 27 consecutively presenting patients treated over a 7-year period using computer-assisted techniques across all bone qualities in commonly encountered treatment indications in private practice. Implants were placed to support single teeth, small bridges, and complete arch restorations in exposed or immediately restored applications, based on primary stability as determined by insertion torque, resonance frequency analysis, and Periotest. For the 80 implants supporting 35 restorations, the median observation period is 2.66 years; 73 implants supporting prostheses in 22 patients had readable radiographs at 1 year. There was a 1-year overall implant survival and a success rate of 100%. Radiographic analysis demonstrated the change in bone level from the platform at 1-year is less than 2 mm. Intra-operative median measurements of primary stability were insertion torque, 40 Ncm; resonance frequency, 76 ISQ; and Periotest, -3. All intra-operative measurements were consistent for acceptable primary stability regardless of bone density. Restoratively driven diagnosis and precision planning and initial fit were possible with computer-assisted techniques resulting in the achievement of high primary stability, even in areas of less dense bone. The ability to plan implant position, drill sequence, and implant design on the basis of predetermined bone density gives the practitioner enhanced pretreatment information which can lead to improved outcome.
基于计算机辅助的种植体规划以及随后根据该规划制作外科模板已受到关注，因为它能提供修复驱动的美学效果、患者舒适度、满意度，还能选择不翻瓣手术和即刻修复。然而，这会增加费用且需要更多时间。另一个显著但不太明显的优势可能是在Ⅲ型和Ⅳ型骨中，与徒手技术相比，种植体的存留率和成功率更高。进行这项回顾性分析就是为了检验这种可能性。它报告了在7年期间，27例连续就诊患者中使用计算机辅助技术在私人诊所常见治疗适应证的所有骨质量情况下植入的80颗种植体的1年结果。根据植入扭矩、共振频率分析和牙动度测试确定初始稳定性，植入种植体以支持单颗牙齿、小桥体和暴露或即刻修复应用中的全牙弓修复。对于支持35个修复体的80颗种植体，中位观察期为2.66年；22例患者中支持假体的73颗种植体在1年时有可读的X线片。种植体1年的总体存留率和成功率均为100%。X线分析表明，1年时种植体平台处的骨水平变化小于2毫米。术中初始稳定性的中位测量值为：植入扭矩40 Ncm；共振频率76 ISQ；牙动度测试为-3。无论骨密度如何，所有术中测量值对于可接受的初始稳定性都是一致的。借助计算机辅助技术可以进行修复驱动的诊断、精确规划和初始拟合，即使在骨密度较低的区域也能实现较高的初始稳定性。根据预先确定的骨密度来规划种植体位置、钻孔顺序和种植体设计的能力，为从业者提供了更多的术前信息，从而可能改善治疗结果。
