由数字工作流程引导的即刻全牙弓修复体的图像分析：评估计划与执行之间的差异
Image analysis of immediate full-arch prosthetic rehabilitations guided by a digital workflow: assessment of the discrepancy between planning and execution.
作者信息
Chmielewski Krzysztof, Ryncarz Wojciech, Yüksel Orcan, Goncalves Pedro, Baek Kyung-Won, Cok Susy, Dard Michel
机构信息
SmileClinic Advanced Implant Center - Klinika Stomatologii Estetycznej i Implantologii, ul. Karola Szymanowskiego 2, 80-280, Gdańsk, Poland.
Stomatologia estetyczna implantologia - Klinika Proimplant, ul. Cecylii Śniegockiej 8, 00-430, Warszawa, Poland.
出版信息
Int J Implant Dent. 2019 Jul 15;5(1):26. doi: 10.1186/s40729-019-0179-1.
BACKGROUND
A dentition with adequate function and esthetics is essential for the well-being and quality of life. A full implant-retained fixed prosthetics is an ideal solution for fully edentulous arch, however requires complex planning, surgical, and prosthetic procedure. With the help of digital workflow, it becomes a predictable and fast solution for the dentists and the patients. This retrospective study analyzed the most advanced surgical approach in full-arch rehabilitation with dental implants and immediate loading using digital workflow.
METHODS
Patient records of fully edentulous jaws treated in four clinical centers in Warsaw, Poland, were evaluated. Computer-assisted planning and surgical template fabrication were done using the planning software coDiagnostiX™, based on a pre-op cone beam computed tomography (CBCT) and scanned data of a plaster model. A post-op CBCT was acquired after the placement of four to six implants by the guided system. The influence of different surgical variables on the discrepancy between planning and execution was analyzed, together with the biomechanical indices.
RESULTS
A total of nine patient records were selected of 12 edentulous jaws treated with 62 implants. The overall mean three-dimensional (3D) offset at the implant base was 1.60 mm, at the tip 1.86 mm. The mean angle of deviation was 4.89°, the mean implant stability quotient (ISQ) 70.42, and the insertion torque 35.58 Ncm. The 3D offsets were influenced by the gender of the patient, treated jaw, the diameter, and length of the implant. The angle of deviation was affected only by the treated jaw. Insertion torque was influenced by the treated jaw, the age of the patient, the length of the implant, tooth type, and the side of the jaw.
DISCUSSION
Bone quality of the patient and implant preparation procedure influenced the discrepancy between the planning and the execution of the digitally guided implant placement. Dense bone-mandible, posterior area, young age, and man-and multiple preparations of the implant bed-wider and longer implant-could be suggested as risk factors.
CONCLUSION
Digital workflow successfully enabled the immediate full-arch rehabilitation with a predictable outcome by different surgeons in multiple centers.
背景
具有良好功能和美观的牙列对于身心健康和生活质量至关重要。全牙列种植固定修复体是全口无牙颌的理想解决方案，但需要复杂的规划、手术和修复程序。借助数字化工作流程，它为牙医和患者提供了一种可预测且快速的解决方案。这项回顾性研究分析了使用数字化工作流程进行全牙弓种植修复及即刻负重的最先进手术方法。
方法
对在波兰华沙四个临床中心接受治疗的全口无牙颌患者记录进行评估。基于术前锥形束计算机断层扫描（CBCT）和石膏模型扫描数据，使用coDiagnostiX™规划软件进行计算机辅助规划和手术模板制作。在通过引导系统植入四至六颗种植体后获取术后CBCT。分析了不同手术变量对规划与执行差异的影响以及生物力学指标。
结果
共选取了9例患者记录，涉及12例无牙颌，共植入62颗种植体。种植体基底部的总体平均三维（3D）偏移为1.60毫米，尖端为1.86毫米。平均偏差角度为4.89°，平均种植体稳定性商数（ISQ）为70.42，植入扭矩为35.58牛厘米。3D偏移受患者性别、治疗的颌骨、种植体直径和长度影响。偏差角度仅受治疗的颌骨影响。植入扭矩受治疗的颌骨、患者年龄、种植体长度、牙型和颌骨侧别影响。
讨论
患者的骨质和种植体制备程序影响了数字化引导种植体植入规划与执行之间的差异。致密骨 - 下颌骨、后部区域、年轻患者、男性以及种植床的多次制备 - 更宽更长的种植体 - 可被视为风险因素。
结论
数字化工作流程成功实现了多中心不同外科医生进行的即刻全牙弓修复，结果可预测。
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