徒手与引导即刻种植精度的比较：一项随机对照试验。
Accuracy of freehand versus guided immediate implant placement: A randomized controlled trial.
机构信息
Santosh University, No.1, Santosh Nagar, Pratap Vihar, Ghaziabad, Uttar Pradesh 201009, India.
Santosh University, No.1, Santosh Nagar, Pratap Vihar, Ghaziabad, Uttar Pradesh 201009, India.
出版信息
J Dent. 2023 Sep;136:104620. doi: 10.1016/j.jdent.2023.104620. Epub 2023 Jul 15.
PURPOSE
This randomized controlled trial (RCT) aimed to compare the accuracy of immediate implant placement with freehand and static guided surgery.
METHODS
An RCT was conducted on 61 subjects who received a total of 80 dental implants. The enrolled patients were randomly allocated to two groups: freehand surgery (control group, n = 40 implants) and static guided surgery with R2Gate® (Megagen, Gyeongbuk, South Korea, test group, n = 40 implants). Crestal and apical deviations in both mesiodistal and buccolingual dimensions, as well as depth and angular deviations, were calculated by comparing the three-dimensional (3D) position of the implant in the planning software with the final implant position, revealed by an intraoral scan of the fixture after placement. The Mann-Whitney test was used for comparative assessment.
RESULTS
In the freehand group (control), crestal deviations of 1.13 ± 0.89 mm and 1.00 ± 0.76 mm were found in the mesiodistal and buccolingual directions, respectively, versus 0.34 ± 0.26 mm (p<0.001) and 0.37 ± 0.24 mm (p = 0.03) in the static guided surgery group (test). Apical deviation was also higher in the freehand group (control) than in the static guided surgery group (test) in the mesiodistal (4.04 ± 1.90 mm vs. 0.97 ± 0.55 mm, p = 0.04) and buccolingual directions (3.46 ± 1.82 mm vs. 0.94 ± 0.67 mm, p = 0.02). Freehand surgery had greater angular deviation (6.09° ± 3.23) compared to guided surgery (0.83° ± 0.53, p = 0.02). However, depth deviation was similar in the freehand surgery group (2.24 ± 1.58 mm) and static guided surgery group (0.66 ± 0.43, p = 0.09).
CONCLUSIONS
Immediate implant placement with static guided surgery demonstrated better accuracy than freehand surgery.
STATEMENT OF CLINICAL RELEVANCE
Guided implant surgery showed fewer deviations compared to freehand surgery in fresh extraction sockets; therefore, the use of static guides should be given preference over the freehand modality.
目的
本随机对照试验（RCT）旨在比较徒手和静态引导手术即刻植入的准确性。
方法
对 61 名接受总共 80 颗牙种植体的患者进行 RCT。入组患者随机分为两组：徒手手术（对照组，n=40 个种植体）和 R2Gate®静态引导手术（韩国庆尚北道 Megagen，试验组，n=40 个种植体）。通过比较种植体在规划软件中的三维（3D）位置与植入后通过口内扫描获得的种植体最终位置，计算在近远中和颊舌向的颊嵴和根尖偏差以及深度和角度偏差。采用 Mann-Whitney 检验进行比较评估。
结果
在徒手组（对照组）中，近远中和颊舌向的颊嵴偏差分别为 1.13±0.89mm 和 1.00±0.76mm，而静态引导手术组（试验组）分别为 0.34±0.26mm（p<0.001）和 0.37±0.24mm（p=0.03）。在近远中和颊舌向，徒手组的根尖偏差也高于静态引导手术组（对照组）（4.04±1.90mm 比 0.97±0.55mm，p=0.04）和 3.46±1.82mm 比 0.94±0.67mm（p=0.02）。与引导手术（6.09°±3.23°）相比，徒手手术的角度偏差更大（0.83°±0.53°，p=0.02）。然而，徒手手术组（2.24±1.58mm）和静态引导手术组（0.66±0.43mm）的深度偏差相似（p=0.09）。
结论
与徒手手术相比，静态引导下即刻植入具有更高的准确性。
临床相关性声明
在新鲜拔牙窝中，与徒手手术相比，引导种植手术的偏差更小；因此，应优先使用静态引导而非徒手方法。
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