基于磁共振成像的全数字化引导种植手术

Fully Digitally Guided Implant Surgery Based on Magnetic Resonance Imaging.

作者信息

Mercado Felipe, Mukaddam Khaled, Filippi Andreas, Bieri Oliver Paravicini, Lambrecht Thomas J, Kühl Sebastian

出版信息

Int J Oral Maxillofac Implants. 2019 Mar/Apr;34(2):529-534. doi: 10.11607/jomi.7076.

DOI:10.11607/jomi.7076

PMID:30883626

Abstract

PURPOSE

The purpose of this study was to evaluate whether fully digitally guided implant surgery may be performed with sufficient accuracy based on printing virtually designed templates after matching a surface scan with the magnetic resonance imaging (MRI) dataset mimicking edentulous cases based on cadaver maxillae of pigs.

MATERIALS AND METHODS

The palatal mucosa of five young pig cadavers was scanned with an intraoral scanner. High-resolution MRI of the jaws was performed, and the images were exported as DICOM files and uploaded into software for implant planning. Six implant osteotomies were virtually planned in each jaw. The intraoral surface scans were fused with the volumetric MRI data based on the palatal soft tissue, and virtual templates for guided implant surgery were created and exported as STL files. These were printed and the templates were used to perform flapless guided osteotomy, with the templates fitting on the soft tissue of the jaws alone. Cone beam computed tomography (CBCT) of the jaws was performed after osteotomy. These data were fused with the virtually planned osteotomies, and the 3D crestal, apical, and axial deviations between the virtually planned and physically performed osteotomies were determined.

RESULTS

Matching the surface scans with the mucosa was possible in three cases automatically; additional manual corrections were necessary in two cases. Thirty osteotomies were performed by applying the printed mucosa-supported templates. The mean angular deviation between the planned and realized cavities was 3.29 degrees (0.3 to 11.1 degrees; SD = 2.5 degrees), the mean 3D apical deviation was 1.3 mm (0.22 to 3.98 mm; SD = 0.94 mm), and the mean crestal deviation was 1.76 mm (0.39 to 3.79 mm; SD = 0.88 mm).

CONCLUSION

MRI in combination with the presented workflow may be used in edentulous cases for guided implant surgery. Further studies are needed to prove the promising accuracy of this alternative approach in clinical trials.

摘要

目的

本研究的目的是基于猪尸体上颌骨模拟无牙颌病例，将表面扫描与磁共振成像（MRI）数据集匹配后，通过打印虚拟设计的模板，评估是否可以以足够的精度进行完全数字化引导的种植手术。

材料与方法

用口腔内扫描仪对五具幼年猪尸体的腭黏膜进行扫描。对颌骨进行高分辨率MRI检查，并将图像导出为DICOM文件，上传到软件中进行种植体规划。在每个颌骨中虚拟规划六个种植体截骨术。基于腭部软组织将口腔内表面扫描与容积性MRI数据融合，创建引导种植手术的虚拟模板并导出为STL文件。将这些模板打印出来，仅使用模板贴合颌骨软组织进行无瓣引导截骨术。截骨术后对颌骨进行锥形束计算机断层扫描（CBCT）。将这些数据与虚拟规划的截骨术融合，确定虚拟规划和实际进行的截骨术之间的三维嵴顶、根尖和轴向偏差。

结果

三例可自动将表面扫描与黏膜匹配；两例需要额外的手动校正。通过应用打印的黏膜支持模板进行了30次截骨术。计划腔与实际腔之间的平均角度偏差为3.29度（0.3至11.1度；标准差=2.5度），平均三维根尖偏差为1.3毫米（0.22至3.98毫米；标准差=0.94毫米），平均嵴顶偏差为1.76毫米（0.39至3.79毫米；标准差=0.88毫米）。