动态计算机辅助种植体植入的准确性评估：一项系统评价和荟萃分析。
Accuracy assessment of dynamic computer-aided implant placement: a systematic review and meta-analysis.
作者信息
Jorba-García Adrià, González-Barnadas Albert, Camps-Font Octavi, Figueiredo Rui, Valmaseda-Castellón Eduard
机构信息
Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
IDIBELL Institute, Barcelona, Spain.
出版信息
Clin Oral Investig. 2021 May;25(5):2479-2494. doi: 10.1007/s00784-021-03833-8. Epub 2021 Feb 26.
OBJECTIVES
To assess the accuracy of dynamic computer-aided implant surgery (dCAIS) systems when used to place dental implants and to compare its accuracy with static computer-aided implant surgery (sCAIS) systems and freehand implant placement.
MATERIALS AND METHODS
An electronic search was made to identify all relevant studies reporting on the accuracy of dCAIS systems for dental implant placement. The following PICO question was developed: "In patients or artificial models, is dental implant placement accuracy higher when dCAIS systems are used in comparison with sCAIS systems or with freehand placement? The main outcome variable was angular deviation between the central axes of the planned and final position of the implant. The data were extracted in descriptive tables, and a meta-analysis of single means was performed in order to estimate the deviations for each variable using a random-effects model.
RESULTS
Out of 904 potential articles, the 24 selected assessed 9 different dynamic navigation systems. The mean angular and entry 3D global deviations for clinical studies were 3.68° (95% CI: 3.61 to 3.74; I = 99.4%) and 1.03 mm (95% CI: 1.01 to 1.04; I = 82.4%), respectively. Lower deviation values were reported in in vitro studies (mean angular deviation of 2.01° (95% CI: 1.95 to 2.07; I = 99.1%) and mean entry 3D global deviation of 0.46 mm (95% CI: 0.44 to 0.48 ; I = 98.5%). No significant differences were found between the different dCAIS systems. These systems were significantly more accurate than sCAIS systems (mean difference (MD): -0.86°; 95% CI: -1.35 to -0.36) and freehand implant placement (MD: -4.33°; 95% CI: -5.40 to -3.25).
CONCLUSION
dCAIS systems allow highly accurate implant placement with a mean angular of less than 4°. However, a 2-mm safety margin should be applied, since deviations of more than 1 mm were observed. dCAIS systems increase the implant placement accuracy when compared with freehand implant placement and also seem to slightly decrease the angular deviation in comparison with sCAIS systems.
CLINICAL RELEVANCE
The use of dCAIS could reduce the rate of complications since it allows a highly accurate implant placement.
目的
评估动态计算机辅助种植手术（dCAIS）系统在植入牙种植体时的准确性，并将其准确性与静态计算机辅助种植手术（sCAIS）系统及徒手种植进行比较。
材料与方法
进行电子检索，以识别所有报告dCAIS系统用于牙种植体植入准确性的相关研究。提出了以下PICO问题：“在患者或人工模型中，与sCAIS系统或徒手种植相比，使用dCAIS系统时牙种植体植入的准确性是否更高？”主要结局变量为种植体计划位置与最终位置中心轴之间的角度偏差。数据提取至描述性表格中，并进行单均值的荟萃分析，以便使用随机效应模型估计每个变量的偏差。
结果
在904篇潜在文章中，所选的24篇评估了9种不同的动态导航系统。临床研究的平均角度偏差和入口处三维整体偏差分别为3.68°（95%CI：3.61至3.74；I² = 99.4%）和1.03 mm（95%CI：1.01至1.04；I² = 82.4%）。体外研究报告的偏差值较低（平均角度偏差为2.01°（95%CI：1.95至2.07；I² = 99.1%），入口处三维整体平均偏差为0.46 mm（95%CI：0.44至0.48；I² = 98.5%）。不同的dCAIS系统之间未发现显著差异。这些系统比sCAIS系统（平均差值（MD）：-0.86°；95%CI：-1.35至-0.36）和徒手种植（MD：-4.33°；95%CI：-5.40至-3.25）明显更准确。
结论
dCAIS系统可实现高度精确的种植体植入，平均角度小于4°。然而，由于观察到偏差超过1 mm，应应用2 mm的安全 margins。与徒手种植相比，dCAIS系统提高了种植体植入的准确性，与sCAIS系统相比，似乎也略微降低了角度偏差。
临床意义
使用dCAIS可以降低并发症发生率，因为它可以实现高度精确的种植体植入。
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