Lara-Muros María, Camps-Font Octavi, Vilarrasa Javi, Vilarrasa Jordi, Mir-Mari Javier, Figueiredo Rui, Valmaseda-Castellón Eduard
Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
Dental and Maxillofacial Pathology and Therapeutics Research Group, IDIBELL Research Institute, Barcelona, Spain.
Clin Oral Investig. 2024 Dec 2;28(12):674. doi: 10.1007/s00784-024-05920-y.
To assess the safety and accuracy of static computer assisted corticotomy surgery (sCACS) in comparison with freehand piezocision.
A randomized in vitro study was conducted. A total of 260 interradicular corticotomies were performed in 20 identical printed models. sCACS was performed in half of the models, while the rest underwent freehand localized decortication. Accuracy was measured in the three spatial axes by overlapping the digital planning with a previous cone-beam computed tomography (CBCT) scan of the patient and a postoperative CBCT of the models. Safety was determined as the number of damaged root surfaces. Descriptive and bivariate analyses were performed.
Freehand corticotomies increased the likelihood of iatrogenic root damage 2.21-fold (95%CI: 1.30 to 3.77; p = 0.004). Both groups showed some degree of deviation compared to digital planning. Nevertheless, the accuracy of sCACS was significantly greater in sagittal (B = -0.21 mm, 95%CI: -0.29 to -0.12; p < 0.001), axial (B = -0.32 mm, 95%CI: -0.48 to -0.18; p < 0.001) and angular deviation (B = -2.02º; 95%CI: -2.37 to -1.66; p < 0.001) compared to freehand surgery, with the exception of depth.
The precision and safety of sCACS are greater than the freehand technique.
Corticotomies are performed in crowded areas where there is usually space limitation. Clinicians should consider the systematic use of surgical guides, since minimal deviations can cause iatrogenic root damage in areas where malocclusions are present.
评估静态计算机辅助皮质切开术（sCACS）与徒手压电切开术相比的安全性和准确性。
进行了一项随机体外研究。在20个相同的打印模型中总共进行了260次根间皮质切开术。一半模型采用sCACS，其余模型进行徒手局部去皮质术。通过将数字规划与患者先前的锥形束计算机断层扫描（CBCT）以及模型的术后CBCT重叠，在三个空间轴上测量准确性。安全性通过受损牙根表面的数量来确定。进行了描述性和双变量分析。
徒手皮质切开术使医源性牙根损伤的可能性增加了2.21倍（95%置信区间：1.30至3.77；p = 0.004）。与数字规划相比，两组均显示出一定程度的偏差。然而，与徒手手术相比，sCACS在矢状面（B = -0.21 mm，95%置信区间：-0.29至-0.12；p < 0.001）、轴向（B = -0.32 mm，95%置信区间：-0.48至-0.18；p < 0.001）和角度偏差（B = -2.02°；置信区间：-2.37至-1.66；p < 0.001）方面的准确性显著更高，深度除外。
sCACS在精度和安全性方面优于徒手技术。
皮质切开术通常在空间有限的拥挤区域进行。临床医生应考虑系统使用手术导板，因为在存在错牙合畸形的区域，微小偏差可能导致医源性牙根损伤。
