Int J Oral Maxillofac Implants. 2024 Jun 21(3):21-46. doi: 10.11607/jomi.10531.
Despite the high clinical accuracy of dynamic navigation, inherent sources of error exist. The purpose of this study was to improve the accuracy of dynamic-navigated surgical procedures in the edentulous maxilla by identifying the optimal configuration of intraoral points that results in the lowest possible registration error for direct clinical implementation.
Six different four-area configurations (left and right sides; n = 12) were tested by three operators against two negative controls (left and right sides) and one positive control (three-area and eight-area configurations, respectively) using a skull model. The two dynamic navigation systems (X-Guide and Navident) and the two registration methods (bone surface tracing and fiducial markers) produced four registration groups: XG tracing, ND tracing, XG fiducial, and ND fiducial. The accuracy of the registration was checked at the frontal process of the zygoma. Intra- and interoperator reliabilities were reported for each registration group. Multiple comparisons were conducted to find the best configuration with the minimum registration error.
Ranking revealed one configuration in the tracing groups (Conf.3) and two configurations in the fiducial groups (Conf.3 and Conf.5) that had the best accuracy. When the inferior surfaces of the zygomatic buttress were excluded, fiducial registration produced better accuracy with both systems (P = .006 and < .0001). However, bilaterally tracing 1-cm areas at these surfaces resulted in similar registration accuracy to placing fiducial markers there (P = .430 and .237). Navident performed generally better (P = .049, .001, and .002), but the values had a wider margin of uncertainty. Changing the distribution of the four tracing areas or fiducial markers had a less pronounced effect with the X-Guide than with the Navident system.
For surgery in the edentulous maxilla, four fiducial markers placed according to Conf.3 or Conf.5 resulted in the lowest registration error. Where implants are being placed bilaterally, an additional two sites may further reduce the error. For bilateral zygomatic implant placement, it is optimal to place two fiducial markers on the inferior surfaces of the maxillary tuberosities, two on their buccal surfaces, and another two on the anterior labial surface of the alveolar bone. Utilizing the inferior zygomatic buttress is recommended over the inferior maxillary tuberosities in other types of maxillary surgeries.
尽管动态导航具有很高的临床准确性，但仍存在固有误差源。本研究旨在通过确定可实现最低注册误差的最佳口内点配置来提高无牙上颌骨中动态导航手术的准确性，以便直接临床应用。
使用颅骨模型，由 3 名操作人员对 6 种不同的 4 区域配置（左侧和右侧；n = 12）进行测试，同时测试了 2 个负对照组（左侧和右侧）和 1 个正对照组（分别为 3 区域和 8 区域配置）。使用了 2 种动态导航系统（X-Guide 和 Navident）和 2 种注册方法（骨表面追踪和基准标记），产生了 4 个注册组：XG 追踪、ND 追踪、XG 基准标记和 ND 基准标记。在颧骨额突处检查注册的准确性。报告了每个注册组的内部和操作人员之间的可靠性。进行了多次比较，以找到具有最小注册误差的最佳配置。
在追踪组中发现了一种配置（Conf.3），在基准标记组中发现了两种配置（Conf.3 和 Conf.5），其准确性最佳。当排除颧骨支柱的下表面时，两种系统的基准标记注册都产生了更好的准确性（P =.006 和 <.0001）。然而，在这些表面双侧追踪 1-cm 区域的效果与放置基准标记相似（P =.430 和.237）。Navident 的表现通常更好（P =.049、<.001 和<.002），但这些值的不确定性范围更大。与 Navident 系统相比，改变 4 个追踪区域或基准标记的分布对 X-Guide 的影响较小。
对于无牙上颌骨手术，根据 Conf.3 或 Conf.5 放置 4 个基准标记可产生最低的注册误差。如果双侧植入物，则另外两个部位可进一步降低误差。对于双侧颧骨植入物放置，在颧上颌结节的下表面放置两个基准标记，在颊侧表面放置两个基准标记，在前唇牙槽骨表面放置另外两个基准标记是最佳的。在其他类型的上颌骨手术中，建议利用颧骨下侧，而不是上颌结节的下侧。
