Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta, 6, 00161, Roma (RM), Italy.
Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta, 6, 00161, Roma (RM), Italy.
J Dent. 2024 Jul;146:105093. doi: 10.1016/j.jdent.2024.105093. Epub 2024 May 22.
The aim of this study was to evaluate the influence of palatal vault morphology and screw length on the accuracy of miniscrew insertion in dynamic computer-assisted surgery (d-CAS).
Twenty-four subjects were allocated into three groups, according to their palatal vault morphology (Group A: medium; Group B: steep/high; Group C: low/flat) and the length of miniscrew used. For each subject, two miniscrews were inserted using a dynamic navigation system. To assess the accuracy of insertion, a postoperative CBCT was performed, and the pre- and post-operative scans were superimposed. Five variables were evaluated: Entry-3D, Entry-2D, Apex-3D, Apex-vertical and angular deviation. Descriptive statistics, Shapiro-wilk, Kruskal-Wallis and Dunn's tests were used for the statistical analysis. The level of significance was P ≤ 0.05.
The mean angular deviation values revealed strong discrepancies amongst the groups (Group A:7.11°±5.70°; Group B:13.30°±7.76°; Group C:4.92°±3.15°) and significant differences were found regarding the Apex-3D (P = 0.036) and angular deviations (P = 0.008). A Dunn's test revealed differences in angular deviation between the medium and high/steep palate group (P = 0.004), and between low/flat and high/steep palate group (P = 0.01) but did not confirm any significant difference in the Apex-3D parameter (Group A-B P = 0.10; Group B-C, P = 0.053; Group A-C, P = 1.00). No significant differences were found regarding the length of the miniscrews.
Palatal vault morphology is a factor that influences the accuracy of miniscrew insertion in d-CAS. In subjects with steep and high palatal vaults, insertion accuracy is lower when considering the angular deviation value. Miniscrew length does not influence accuracy.
Although computer-guided surgery assists the clinician in preventing damage to nearby anatomical structures, individual anatomical variability is a crucial variable. In subjects with a high/steep palate, greater attention should be paid during the planning phase in order to allow for a wide margin from adjacent anatomical structures to achieve better outcomes.
本研究旨在评估腭穹窿形态和螺钉长度对动态计算机辅助手术（d-CAS）中微型螺钉植入准确性的影响。
根据腭穹窿形态（A 组：中；B 组：陡/高；C 组：低/平）和使用的微型螺钉长度，将 24 名受试者分为三组。对于每个受试者，使用动态导航系统植入两颗微型螺钉。为了评估植入的准确性，进行了术后 CBCT 检查，并对术前和术后扫描进行了叠加。评估了五个变量：入口-3D、入口-2D、根尖-3D、根尖-垂直和角度偏差。使用描述性统计、Shapiro-Wilk、Kruskal-Wallis 和 Dunn 检验进行统计学分析。显著性水平为 P≤0.05。
平均角度偏差值显示组间存在明显差异（A 组：7.11°±5.70°；B 组：13.30°±7.76°；C 组：4.92°±3.15°），并且根尖-3D（P=0.036）和角度偏差（P=0.008）存在显著差异。Dunn 检验显示，中高/陡腭组和低/平与高/陡腭组之间的角度偏差存在差异（P=0.004），低/平与高/陡腭组之间的角度偏差也存在差异（P=0.01），但根尖-3D 参数无显著差异（A 组-B 组，P=0.10；B 组-C 组，P=0.053；A 组-C 组，P=1.00）。微型螺钉长度无显著差异。
腭穹窿形态是影响 d-CAS 中微型螺钉植入准确性的因素。在腭穹窿陡峭/高的患者中，考虑角度偏差值时，植入准确性较低。微型螺钉长度不影响准确性。
尽管计算机引导手术有助于临床医生避免损伤邻近解剖结构，但个体解剖结构的变异性是一个关键变量。在高/陡腭患者中，在规划阶段应更加注意，以便为相邻解剖结构留出更大的空间，以获得更好的结果。
