Zhu Ning, Liu Jiayu, Ma Ting, Zhang Yu, Lin Ye
Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China.
Clin Implant Dent Relat Res. 2022 Dec;24(6):809-820. doi: 10.1111/cid.13129. Epub 2022 Sep 6.
To compare the outcome and efficiency of the computer-aided intraoral block bone grafting procedure with those of the conventional technique for the augmentation of horizontal ridge defects.
A total of 28 patients with single missing tooth in esthetic zone with class IV horizontal alveolar bone defect in need of dental implant restoration were recruited. Computer-aided design of the implant restoration and intraoral block bone grafting was performed for all the participants. The patients were randomly and equally divided into guide and control groups. A fully guided bone harvesting, trimming, and grafting surgery was executed in the guide group. The control group patients underwent surgery without any guide. After 6 months, all the patients underwent implant placement. The primary outcomes were the root mean square estimate (RMSE) values between the outer contours of the actual implanted and planned bone block as well as the RMSE values between the inner surface of the implanted bone block and the original bone surface of the recipient site immediately after surgery. The secondary outcomes were the trimming time of bone block and the surgery-associated complications. The postoperative visual analog scale (VAS) of pain, swelling, and mouth opening difficulty was recorded.
All 28 patients underwent intraoral block bone grafting, followed by the placement of implant after 191.8 ± 19.69 days. The RMSE values between the outer contours of the implanted and planned bone blocks were significantly lower in the guide group (0.37 ± 0.16 mm) as compared to those in the control group (0.72 ± 0.29 mm) (p = 0.0007). The RMSE values between the inner contours of the graft block and original bone at the recipient site were lower in the guide group (0.35 ± 0.15 mm) as compared to those in the control group (0.48 ± 0.17 mm) (p = 0.043). The duration of bone block trimming was shorter in the guide group (401.51 ± 97.60 s) as compared to the control group (602.36 ± 160.57 s) (p = 0.0005). In the control group, two patients received secondary bone grafting, one patient experienced bleeding of donor site and temporary hypoesthesia of the lower lip and chin skin, and one patient developed temporary sensitivity of the adjacent tooth.
As compared to the conventional procedure, the fully digital workflow in the present study seemed to be a more accuracy and effective protocol for horizontal ridge augmentation with intraoral block bone.
Chictr.org.cn (ChiCTR2000036390).
比较计算机辅助口腔内块状骨移植术与传统技术在增加水平牙槽嵴缺损方面的效果和效率。
共招募28例美学区单颗牙缺失且伴有IV类水平牙槽骨缺损、需要进行牙种植修复的患者。对所有参与者进行种植修复的计算机辅助设计和口腔内块状骨移植。患者被随机等分为引导组和对照组。引导组实施完全引导下的骨采集、修整和移植手术。对照组患者在无任何引导的情况下进行手术。6个月后，所有患者接受种植体植入。主要结局指标为术后即刻实际植入骨块与计划骨块外轮廓之间的均方根误差（RMSE）值，以及植入骨块内表面与受植区原骨表面之间的RMSE值。次要结局指标为骨块修整时间和手术相关并发症。记录术后疼痛、肿胀和张口困难的视觉模拟量表（VAS）评分。
28例患者均接受了口腔内块状骨移植，术后191.8±19.69天进行种植体植入。引导组植入骨块与计划骨块外轮廓之间的RMSE值（0.37±0.16mm）显著低于对照组（0.72±0.29mm）（p = 0.0007）。引导组移植骨块内轮廓与受植区原骨之间的RMSE值（0.35±0.15mm）低于对照组（0.48±0.17mm）（p = 0.043）。引导组骨块修整时间（401.51±97.60秒）短于对照组（602.36±160.57秒）（p = 0.0005）。对照组有2例患者接受了二次骨移植，1例患者供区出血，下唇及颏部皮肤出现暂时感觉减退，1例患者相邻牙出现暂时敏感。
与传统手术相比，本研究中的全数字化流程在口腔内块状骨水平牙槽嵴增高方面似乎是一种更准确、有效的方案。
中国临床试验注册中心（Chictr.org.cn）（ChiCTR2000036390）
