Quispe-López Norberto, Flores-Fraile Javier, Pardal-Peláez Beatriz, Delgado-Martínez Juan, Montero Javier
Int J Oral Maxillofac Implants. 2023 Jan-Feb;38(1):120-129. doi: 10.11607/jomi.9794.
To examine how the accuracy (linear and angular deviation) of implants placed using computer-guided surgery varies in relation to the type of surgical technique (fully guided, half-guided, vs freehand implant placement), bone density (type D1 to D4 bone), and type of support surface (tooth- vs mucosa-supported). A total of 32 mandible models were produced (16 partially edentulous and 16 edentulous) using acrylic resin, each calibrated to a different bone density (D1 to D4). Four implants planned using Mguide software were placed in each acrylic resin mandible. A total of 128 implants were placed, distributed according to bone density (D1 to D4, n = 32), the degree of intervention in the surgery (fully guided [FG] = 80, half-guided [HG] = 32, and freehand surgery [F] = 16), and the type of support surface (tooth-supported: n = 64 and mucosa-supported: n = 64). To determine the linear, vertical, and angular deviations between the planned three-dimensional position and the actual position of the implants, the linear and angular difference between them was calculated, with the analysis performed through preoperative and postoperative CBCT scans. The effect was analyzed using parametric tests and linear regression models. All parameters of linear and angular discrepancy in the various regions analyzed (neck, body, and apex) were primarily influenced by the technique and, to a lesser extent, by the bone type, although both variables were predictive and highly significant. These discrepancies tend to increase in completely edentulous models. The regression models show that linear deviations increase by between 630.2 μm at neck level in the buccolingual direction and 836.7 μm at apex level in the mesiodistal direction when comparing the FG and HG techniques. This increase is accumulative when comparing the HG and F techniques. Regarding the effect of bone density, the regression models found that linear discrepancies increase by between 132.6 μm in the axial direction and 199.0 μm at the apex of the implant in the buccolingual direction with each reduction in bone density (D1 to D4). According to this in vitro study, the highest implant placement predictability is found among dentate models with high bone density and a fully guided surgical technique.
为研究使用计算机引导手术植入种植体的准确性（线性和角度偏差）如何因手术技术类型（完全引导、半引导与徒手种植体植入）、骨密度（D1至D4型骨）以及支持表面类型（牙支持与黏膜支持）而有所不同。使用丙烯酸树脂制作了总共32个下颌骨模型（16个部分牙列缺失和16个牙列缺失），每个模型校准为不同的骨密度（D1至D4）。在每个丙烯酸树脂下颌骨中植入4颗使用Mguide软件规划的种植体。总共植入了128颗种植体，根据骨密度（D1至D4，n = 32）、手术干预程度（完全引导[FG] = 80、半引导[HG] = 32和徒手手术[F] = 16）以及支持表面类型（牙支持：n = 64和黏膜支持：n = 64）进行分布。为确定种植体计划三维位置与实际位置之间的线性、垂直和角度偏差，计算它们之间的线性和角度差异，并通过术前和术后CBCT扫描进行分析。使用参数检验和线性回归模型分析效果。在所分析的各个区域（颈部、体部和根尖）中，线性和角度差异的所有参数主要受技术影响，在较小程度上受骨类型影响，尽管这两个变量都具有预测性且高度显著。这些差异在完全无牙模型中往往会增加。回归模型表明，比较FG和HG技术时，线性偏差在颈部水平的颊舌向增加630.2μm，在根尖水平的近远中向增加836.7μm。比较HG和F技术时，这种增加是累积的。关于骨密度的影响，回归模型发现，随着骨密度每降低一级（D1至D4），轴向线性差异增加132.6μm，种植体根尖的颊舌向增加199.0μm。根据这项体外研究，在骨密度高且采用完全引导手术技术的有牙模型中，种植体植入的可预测性最高。
