Department of Prosthodontics, 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, P.R. China.
Department of Implantology, 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, P.R. China.
J Prosthodont. 2019 Jun;28(5):511-518. doi: 10.1111/jopr.13065. Epub 2019 May 8.
This retrospective study investigates the accuracy of freehand implant placement and whether the factors of presence of an adjacent tooth, implant quadrant, number of missing teeth, and location of the implant site influence direction and angulation deviations.
According to specific inclusion and exclusion criteria, a total of 112 implants from 75 partially edentulous patients were recruited for this retrospective study. The implants were inserted using a freehand approach by one experienced clinician (right-handed). The full thickness flap was elevated to expose the alveolar bone in the implant surgery, and the implant crown consisted of an all-ceramic restoration retained by cement. The planned implant position was preoperatively determined using implant planning software. The postoperative implant position was determined by analyzing the alignment after optically scanning the dentition using a specifically designed registration model in Geomagic Studio software. The deviations between the planned and postoperative implant positions were then calculated. The outcomes included direction and angulation deviations between the planned and postoperative implant positions. All data were analyzed by ANOVA, Bonferroni correction, regression analysis, and one-sample t-tests conducted using SPSS.
The 3D deviations between planned and postoperative implant positions were 1.22 ± 0.63 mm at the entrance point, 1.91 ± 1.17 mm at the apical point, and 7.93 ± 5.56° in angulation. The presence of adjacent teeth influenced deviations in the mesiodistal (F = 4.338, p = 0.006) and buccolingual directions (F = 3.017, p = 0.033) at the entrance point and mesiodistal angulation (F = 7.979, p < 0.001). The quadrant influenced deviation in the buccolingual direction at the apical point (F = 6.093, p = 0.001) and buccolingual angulation (F = 6.457, p < 0.001). The number of missing teeth had no effect on deviations of direction and angulation of implants. The location of the implant site affected the deviation in the buccolingual direction at the entrance point (F = 3.096, p = 0.049) and the mesiodistal direction at the apical point (F = 3.724, p = 0.027).
The 3D accuracy of freehand-placed implants could be acceptable in clinical situations. The results showed that the presence of an adjacent tooth and the quadrant and the location of the implant site influenced the direction and angulation deviations of the implant position; however, the factor of number of missing teeth did not.
本回顾性研究旨在探讨徒手种植体植入的准确性，以及邻牙存在、种植体象限、缺牙数量和种植体部位等因素是否会影响方向和角度偏差。
根据特定的纳入和排除标准，共纳入 75 名部分缺牙患者的 112 个种植体进行本回顾性研究。种植体由一位经验丰富的临床医生（右利手）采用徒手方法植入。在种植手术中，全厚瓣被掀起以暴露牙槽骨，种植体冠由通过粘结剂固定的全陶瓷修复体组成。术前使用种植体规划软件确定计划种植体位置。术后种植体位置通过在 Geomagic Studio 软件中使用专门设计的注册模型对光学扫描后的牙列进行分析来确定。然后计算计划种植体位置和术后种植体位置之间的偏差。结果包括计划种植体位置和术后种植体位置之间的方向和角度偏差。所有数据均使用 SPSS 进行 ANOVA、Bonferroni 校正、回归分析和单样本 t 检验进行分析。
计划种植体位置和术后种植体位置之间的 3D 偏差在入口点为 1.22 ± 0.63mm，在根尖点为 1.91 ± 1.17mm，在角度上为 7.93 ± 5.56°。邻牙的存在影响了入口点的近远中（F = 4.338，p = 0.006）和颊舌向（F = 3.017，p = 0.033）以及近远中角度（F = 7.979，p < 0.001）的偏差。象限影响了根尖点的颊舌向（F = 6.093，p = 0.001）和颊舌角度（F = 6.457，p < 0.001）的偏差。缺牙数量对种植体方向和角度的偏差无影响。种植体部位的位置影响了入口点的颊舌向（F = 3.096，p = 0.049）和根尖点的近远中方向（F = 3.724，p = 0.027）的偏差。
在临床情况下，徒手放置种植体的 3D 准确性可以接受。结果表明，邻牙存在、象限以及种植体部位会影响种植体位置的方向和角度偏差，而缺牙数量则不会。
