微创导航引导的颧弓 Quad 种植体植入:一项体外对比研究。

Minimally Invasive Navigation-Guided Quad Zygomatic Implant Placement: A Comparative In Vitro Study.

出版信息

Int J Oral Maxillofac Implants. 2023 Mar-Apr;38(2):367-373. doi: 10.11607/jomi.10043.

Abstract

Zygomatic implants (ZIs) have been considered a reliable alternative treatment for patients with maxillary atrophy and/or maxillary defects. The use of a navigation system for assisting ZI placement could be a reliable approach for enhancing accuracy and safety. The purpose of this in vitro study was to evaluate the accuracy of a new dynamic surgical navigation system with its minimally invasive registration guide for quad zygomatic implant placement in comparison with a gold standard navigation approach. A total of 40 zygomatic implants were placed in 10 3D-printed models based on the CBCT scans of edentulous patients. For registration, a surgical registration guide with a quick response plate was used for the test group, and five hemispheric cavities as registered miniscrews in the intraoral area were used for the control group. In each model, a split-mouth approach was employed (two ZIs in bilateral zygomata) to test both systems. After ZI placement, a CBCT scan was performed and merged with pre-interventional planning. The deviations between planned and placed implants were calculated as offset basis, offset apical, and angular deviation and compared between the systems. The offset basis, offset apical, and angular deviation were 1.43 ± 0.55 mm, 1.81 ± 0.68 mm, and 2.32 ± 1.59 degrees in the test group, respectively. For the control group, values of 1.48 ± 0.57 mm, 1.76 ± 0.62 mm, and 2.57 ± 1.51 degrees were measured without significant differences between groups (all < .05). The accuracy of ZI positions (anterior and posterior) were measured without significant differences between groups. Two navigation systems with different registration techniques seem to achieve comparable acceptable accuracy for dynamic navigation of zygomatic implant placement. With the test group system, additional pre-interventional radiologic imaging and invasive fiducial marker insertion could be avoided.

摘要

颧骨种植体(ZIs)已被认为是治疗上颌萎缩和/或上颌缺损患者的可靠替代治疗方法。使用导航系统辅助 ZI 放置可能是提高准确性和安全性的可靠方法。本体外研究的目的是评估一种新的动态手术导航系统及其微创注册导向器在与金标准导航方法相比,用于放置四个颧骨种植体的准确性。总共在 10 个基于无牙患者 CBCT 扫描的 3D 打印模型中放置了 40 个颧骨种植体。对于注册,使用带有快速响应板的手术注册导向器对实验组,使用位于口腔区域的五个半球腔作为注册微型螺钉对对照组。在每个模型中,采用分割口方法(双侧颧骨中的两个 ZIs)来测试两个系统。放置 ZI 后,进行 CBCT 扫描并与术前计划合并。计算计划和放置的种植体之间的偏差作为偏移基础、偏移根尖和角度偏差,并在系统之间进行比较。实验组的偏移基础、偏移根尖和角度偏差分别为 1.43 ± 0.55mm、1.81 ± 0.68mm 和 2.32 ± 1.59°。对于对照组,测量值为 1.48 ± 0.57mm、1.76 ± 0.62mm 和 2.57 ± 1.51°,组间无显著差异(均<0.05)。ZIs 位置(前后)的准确性在组间无显著差异。具有不同注册技术的两种导航系统似乎可以实现可接受的颧骨种植体放置动态导航的可比精度。使用实验组系统,可以避免额外的术前放射成像和侵入性基准标记插入。

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