Department of Oro-Maxillofacial Surgery and Stomatology, Faculty of Dentistry, Semmelweis University.
Doctoral School Of Theoretical And Translational Medicine, Schools of PhD Studies, Semmelweis University.
J Vis Exp. 2022 Sep 13(187). doi: 10.3791/63400.
In modern implantology, the application of surgical navigation systems is becoming increasingly important. In addition to static surgical navigation methods, a guide-independent dynamic navigation implant placement procedure is becoming more widespread. The procedure is based on computer-guided dental implant placement utilizing optical control. This work aims to demonstrate the technical steps of a new dynamic computer-aided implant surgery (DCAIS) system (design, calibration, surgery) and check the accuracy of the results. Based on cone-beam computed tomography (CBCT) scans, the exact positions of implants are determined with dedicated software. The first step of the operation is the calibration of the navigation system, which can be performed in two ways: 1) based on CBCT images taken with a marker or 2) based on CBCT images without markers. Implants are inserted with the aid of real-time navigation according to the preoperative plans. The accuracy of the interventions can be evaluated based on postoperative CBCT images. The preoperative images containing the planned positions of the implants and postoperative CBCT images were compared based on the angulation (degree), platform, and apical deviation (mm) of the implants. To evaluate the data, we calculated the standard deviation (SD), mean, and standard error of the mean (SEM) of deviations within planned and performed implant positions. Differences between the two calibration methods were compared based on this data. Based on the interventions performed so far, the use of DCAIS allows for high-precision implant placement. A calibration system that does not require labeled CBCT recording allows for surgical intervention with similar accuracy as a system that uses labeling. The accuracy of the intervention can be improved by training.
在现代植入物学中，手术导航系统的应用变得越来越重要。除了静态手术导航方法外，一种无引导的动态导航植入物放置程序也越来越普及。该程序基于计算机引导的牙科植入物放置利用光学控制。本工作旨在展示一种新的动态计算机辅助植入手术 (DCAIS) 系统 (设计、校准、手术) 的技术步骤，并检查结果的准确性。基于锥形束计算机断层扫描 (CBCT) 扫描，使用专用软件确定植入物的确切位置。操作的第一步是导航系统的校准，可以通过两种方式进行：1) 基于带有标记的 CBCT 图像，或 2) 基于没有标记的 CBCT 图像。根据术前计划，借助实时导航插入植入物。可以根据术后 CBCT 图像评估干预措施的准确性。基于植入物的角度 (度)、平台和根尖偏差 (mm)，比较包含植入物计划位置的术前图像和术后 CBCT 图像。为了评估数据，我们计算了计划和执行植入物位置的偏差的标准差 (SD)、平均值和平均值的标准误差 (SEM)。基于这些数据比较了两种校准方法之间的差异。基于迄今为止进行的干预，DCAIS 的使用允许高精度的植入物放置。不需要标记 CBCT 记录的校准系统允许具有与使用标记的系统类似精度的手术干预。通过培训可以提高干预的准确性。
