Division of Endodontics & Periodontology, Department of Stomatology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
Division of Dental Implant, Department of Stomatology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; School of Dentistry, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2018 Nov;81(11):970-976. doi: 10.1016/j.jcma.2018.04.004. Epub 2018 Jun 30.
A precise positioning for dental implant placement is important for further prosthesis fabrication and maintenance. Computer-aided surgery has been developed to transfer digitally planned implant positioning to the patient over the past decades. This study aimed to evaluate the accuracy of a computer-aided laboratory-fabricated surgical template. A further objective was to compare the accuracy between in vivo and in vitro groups.
A total of 20 implants were placed in the posterior tooth region through the aid of surgical templates on 17 partially edentulous patients in the in vivo group. The surgical template was fabricated in laboratory after virtual implant planning was completed using computer software. In the in vitro group, the same procedures were performed on the models without placing fixture with the same templates used in surgery. Deviations of the implant access at the implant platform level and apical region, as well as the angle deviations between the virtual planning data and the surgical results, were measured using a follow-up Cone Beam Computerized Tomography (CBCT) investigation, and image fusion with planning data.
The median deviation at platform level, apex and angulation was 0.95 mm (0.3-1.3 mm),1.35 mm (0.1-3.6 mm) and 3.92° (0.44-11.66°) respectively in the in vivo group; and 0.4 mm (0-1.0 mm), 0.65 mm (0.1-1.9 mm), 2.16° (0.17-6.91) respectively in the in vitro group. The in vitro group displayed significantly less deviation (p < 0.05).
The data from this study shows that computer-aided laboratory-fabricated template may be a reliable tool for implant placement. However, the clinical conditions seem to affect the accuracy of the template.
精确的牙种植体定位对于进一步的修复体制作和维护非常重要。在过去的几十年中，计算机辅助手术已经发展起来，以将数字化规划的种植体定位转移到患者身上。本研究旨在评估计算机辅助实验室制造手术模板的准确性。另一个目的是比较体内组和体外组之间的准确性。
在 17 名部分无牙患者的后牙区，通过手术模板辅助共植入 20 颗种植体。在实验室中，使用计算机软件完成虚拟种植体规划后，制作手术模板。在体外组中，使用与手术中相同的模板在模型上进行相同的程序，而不放置固定器。使用后续的锥形束计算机断层扫描（CBCT）检查和与规划数据的图像融合来测量种植体平台水平和根尖区域的植入物通道偏差以及虚拟规划数据与手术结果之间的角度偏差。
体内组平台水平、根尖和角度的中位数偏差分别为 0.95mm（0.3-1.3mm）、1.35mm（0.1-3.6mm）和 3.92°（0.44-11.66°）；体外组分别为 0.4mm（0-1.0mm）、0.65mm（0.1-1.9mm）和 2.16°（0.17-6.91°）。体外组的偏差明显较小（p<0.05）。
本研究数据表明，计算机辅助实验室制造的模板可能是一种可靠的种植体放置工具。然而，临床条件似乎会影响模板的准确性。
