Section of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
Department of Oral and Maxillofacial Surgery, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
Clin Oral Implants Res. 2019 Oct;30(10):1005-1015. doi: 10.1111/clr.13514. Epub 2019 Sep 9.
The purpose of this prospective cohort study was to evaluate computer-guided implant surgery with tooth-supported drill guides based on CBCT scans and intraoral scanning.
For partially edentulous patients, a prosthetic and surgical planning was completed in the guided surgery software (coDiagnostiX) and drill guides were 3D-printed accordingly. Three months after implant placement, an intraoral scan of the implant's position was used to evaluate the accuracy of placement using the coDiagnostiX treatment evaluation tool. Deviations were reported in degrees and in distance at implant's entry point and apex. Several risk factors, which might influence the accuracy, were evaluated separately: treated jaw, flap design, prior augmentations, amount of unrestored teeth, crowding, location of implants, cortical interference, and implant's length and diameter.
A total of 66 patients received 145 Straumann tissue level implants that were eligible for accuracy analysis. The mean angular deviation was 2.72° ± 1.42. The mean three-dimensional deviation at the implant's entry point was 0.75 mm ± 0.34. At implant's apex, the mean was 1.06 mm ± 0.44. The amount of unrestored teeth (p = .002 & p = .003), the implant's location (p < .001), the implant's length (p = .004), and cortical interference (p = .033) had a significant influence on the accuracy of placement. Implant survival was 99.3% (n = 1 failed implant) at 12 and 24 months.
Guided surgery with tooth-supported drill guides made in a digital workflow is a feasible treatment option. However, deviations do occur and the implant's length, location, cortical interference and the amount of unrestored teeth have a significant influence on the accuracy.
本前瞻性队列研究旨在评估基于 CBCT 扫描和口内扫描的计算机引导种植手术与牙支持式钻导板的应用。
对于部分缺牙患者，在引导手术软件（coDiagnostiX）中完成修复和手术规划，并相应地 3D 打印钻导板。种植体植入 3 个月后，使用口内扫描获取种植体位置，使用 coDiagnostiX 治疗评估工具评估植入位置的准确性。偏差以角度和种植体入口点和根尖的距离报告。单独评估了可能影响准确性的几个风险因素：治疗颌骨、瓣设计、前期增量、未修复牙齿数量、拥挤程度、种植体位置、皮质干扰、种植体长度和直径。
共有 66 名患者接受了 145 颗 Straumann 组织水平种植体，这些种植体符合准确性分析的条件。平均角度偏差为 2.72°±1.42°。种植体入口点的平均三维偏差为 0.75±0.34mm。在根尖处，平均值为 1.06±0.44mm。未修复牙齿的数量（p=0.002 和 p=0.003）、种植体位置（p<0.001）、种植体长度（p=0.004）和皮质干扰（p=0.033）对放置的准确性有显著影响。12 个月和 24 个月时，种植体的存活率为 99.3%（n=1 个种植体失败）。
基于数字化工作流程的牙支持式钻导板引导手术是一种可行的治疗选择。然而，确实会出现偏差，并且种植体的长度、位置、皮质干扰和未修复牙齿的数量对准确性有显著影响。
