中国实用口腔科杂志

中国实用口腔科杂志 ›› 2022, Vol. 15 ›› Issue (5): 558-563.DOI: 10.19538/j.kq.2022.05.009

• 论著 • 上一篇    下一篇

锥形束CT辅助下改良式手术导板用于微创不翻瓣种植6年临床效果研究

郝    平1，张    舒2，王子剑1，陈    锐1，汤雨龙1，闵    英1   

  1. 1. 中国人民解放军北部战区总医院口腔科，辽宁  沈阳  110016；2. 中国人民解放军32683部队，辽宁  沈阳  110095
  • 出版日期:2022-09-30 发布日期:2022-10-14
  • 基金资助:
    辽宁省自然科学基金（20180550635）

  • Online:2022-09-30 Published:2022-10-14

摘要： 目的    评估锥形束CT（cone beam CT，CBCT）辅助下改良式手术导板联合手动牙龈环切刀行后牙区不翻瓣种植手术随访6年的临床应用效果。方法    选择中国人民解放军北部战区总医院口腔科2013年10月至2014年10月期间行上下颌磨牙种植患者35例，术前拍摄CBCT并采用Invivo5软件完成术前设计，在石膏模型上排蜡牙后制作初导板，口内戴入初导板再次拍摄CBCT并微调导环位置，完成改良式手术导板。术中配合使用以球钻为轴的自制手动牙龈环切刀，微创不翻瓣备洞，并植入Straumann软组织水平种植体，术后拍摄CBCT验证种植体位置和方向。平均骨愈合时间为（3.22 ± 0.21）个月，修复完成后定期随访，对种植体行临床和影像学检查。结果    35例患者共植入种植体43颗，全部行种植体上部冠修复，功能使用良好，无种植体脱落，种植体6年累计存留率为100%；平均随访时间为（6.33 ± 0.19）年，失访6例（9颗种植体），失访率为17.1%。根尖片测量边缘骨吸收为（1.21 ± 0.65）mm，种植体累计成功率为94.8%，其中28颗种植体的近远中龈乳头充盈邻间隙高度≥ 1/2，龈缘曲线无明显退缩。结论    利用计算机设计并在改良式手术导板和手动牙龈环切刀的辅助下，能确保种植体植入相对理想的三维位置，微创不翻瓣可对近远中龈乳头起保护作用，从而达到理想的美学修复效果，同时可减少手术创伤和缩短手术时间，远期效果良好。

关键词: 牙种植, 计算机辅助设计, 手术导板, 锥形束CT, 存留率, 成功率

Abstract: Objective    To evaluate the clinical application effects of the cone beam CT（CBCT）-assisted improved surgical guides combined with manual gum ring cutters for flapless implantation of posterior dental area based on a 6-year follow-up. Methods   Thirty-five patients receiving implantation in General Hospital of Northern Theatre Command between 2013 and 2014 were selected. Preoperative design based on CBCT was accomplished on Invivo5. Primary guides were manufactured by arranging wax teeth on a plaster model. CBCT was taken again to slightly adjust the positions of guide rings，and the improved implant surgical guides were made. During operation with the assistance of round burs and customized manual gum ring cutters，flapless implant preparation under guides was finished. Then Straumann soft tissue horizontal implants were placed in. After operation CBCT was taken to validate the position and direction of the implants. The average bone healing time was （3.22 ± 0.21） months. Regular follow-up was conducted after the restoration. The implants were examined both clinically and by imaging. Results    The 35 patients received totally 43 implants，which were all upper crown restorations. The implants functioned well and did not fall off. The 6-year accumulative survival rate of the implants was 100%，and the average follow-up time was （6.33±0.19） years，with a missed rate of 17.1%（9 implants in 6 cases）. The average marginal bone absorption measured by X-ray peripheral films was （1.21 ± 0.65）mm. The accumulative success rate of the implants was 94.8%，and the medial and distal gingival papillary filling adjacent space height was ≥1/2 in 28 implants，and no evident retreat was found on the gingival margin curves. Conclusion    The assistance of computer design，improved surgical guides，and manual gum ring cutters can ensure that the implants are placed at the ideal three-dimensional locations. The micro-invasive flapless method can protect the mesiodistal gingival papillae，thus achieving the ideal aesthetic restoration effect. It also significantly decreases operative trauma and shortens operation time with excellent long-term effects.

Key words: dental implantation, computer-aided design, surgical guide, cone beam CT, CBCT, survival rate, success rate