数字化种植导板手术的精确性：非手术因素分析及对策的专家共识

Accuracy of digital guided implant surgery: expert consensus on nonsurgical factors and their treatments

摘要

计算机辅助静态导板引导种植手术的标准化流程包括术前检查、数据采集、计算机辅助设计、计算机辅助制作以及种植导板引导手术。其间每一环节产生的误差都可能导致误差的叠加效应，从而影响种植体植入的准确性。然而，临床医师往往关注于外科手术中的误差因素，却忽略了术前阶段的不规范操作导致种植手术产生不可逆转的误差。本文结合国内专家的临床实践与国内外研究进展，从种植导板手术术前检查、数据采集、导板设计、导板制作等方面，对种植导板手术的误差来源进行总结，并制定解决误差的策略，形成专家共识。①术前因素考量：术前应该根据患者口腔情况选择合适的种植导板类型，必要时选用固位螺钉辅助支持式导板；② 规范数据采集流程：尽量采用锥形束CT与口外扫描法进行数据采集，建议选择小视野进行CBCT拍摄，同时保持患者头部固定，对于口内带有金属修复体的患者采用配准标记导板，并且合理控制口外扫描的环境温度与光照；③ 优化计算机辅助设计：建议选用手柄引导的种植系统与封闭式金属套筒，并通过标记物重叠的方式进行图像配准，另外，适当地设计固位螺钉、延伸导板的支持结构、增加导板引导段长度都是减少误差的可行方法；④改进计算机辅助制作：根据不同的打印技术设置最佳的打印参数，选择合适的打印后处理与灭菌方法也是至关重要的。

Abstract

The standardized workflow of computer-aided static guided implant surgery includes preoperative examination, data acquisition, guide design, guide fabrication and surgery. Errors may occur at each step, leading to irreversible cumulative effects and thus impacting the accuracy of implant placement. However, clinicians tend to focus on factors causing errors in surgical operations, ignoring the possibility of irreversible errors in nonstandard guided surgery. Based on the clinical practice of domestic experts and research progress at home and abroad, this paper summarizes the sources of errors in guided implant surgery from the perspectives of preoperative inspection, data collection, guide designing and manufacturing and describes strategies to resolve errors so as to gain expert consensus. Consensus recommendation: 1. Preoperative considerations: the appropriate implant guide type should be selected according to the patient's oral condition before surgery, and a retaining screw-assisted support guide should be selected if necessary. 2. Data acquisition should be standardized as much as possible, including beam CT and extraoral scanning. CBCT performed with the patient’s head fixed and with a small field of view is recommended. For patients with metal prostheses inside the mouth, a registration marker guide should be used, and the ambient temperature and light of the external oral scanner should be reasonably controlled. 3. Optimization of computer-aided design: it is recommended to select a handle-guided planting system and a closed metal sleeve and to register images by overlapping markers. Properly designing the retaining screws, extending the support structure of the guide plate and increasing the length of the guide section are methods to feasibly reduce the incidence of surgical errors. 4. Improving computer-aided production: it is also crucial to set the best printing parameters according to different printing technologies and to choose the most appropriate postprocessing procedures.

关键词

数字化种植 / 种植导板手术 / 非手术因素 / 准确性 / 患者因素 / 数据采集 / 导板设计 / 导板制作

Key words

digital implant dentistry / guided implant surgery / non-surgical factors / accuracy / patient factors / data acquisition / guide plate design / guide plate fabrication

Author summay

徐淑兰，主任医师，硕士，Email：[e-mail]，Tel: [phone]，主任医师，博士研究生导师；南方医科大学口腔医院副院长，广东省牙病防治指导中心副主任；中华口腔医学会第六届口腔种植专业委员会副主任委员；广东省医学教育协会副会长；广东省口腔疾病防治专家委员会主任委员；广东省医学教育协会口腔种植学专业委员会主任委员；广东省医师协会口腔医师分会副主任委员；广东省口腔医学会口腔种植专业委员会副主任委员；广东省临床医学学会牙种植学专业委员会副主任委员；广东省医学教育协会医药教师发展专业委员会副主任委员；广东省粤港澳合作促进会医药卫生大健康委员会常务副主任；Clinical Implant Dentistry and Related Research中文版特邀编委；The International Journal of Oral & Maxillofacial Implants中文版编委；《口腔疾病防治》副主编；《中国口腔种植学杂志》副主编，《实用医学杂志》编委。在Materials Today Bio, Journal of Clinical Periodontology，Biomaterials Advances等国内外专业期刊共发表学术论文136篇，其中SCI收录40篇。主持和完成国家级、省部级重点科研项目18项，主要参与国家自然科学基金、国家十一五攻关和省部级基金项目25项，主持教育部教育交流项目1项、广东省教育厅临床教学基地教学改革研究项目1项，主译和参编专著6部。指导硕士、博士研究生和培养进修生80多名。对各种骨增量术、软组织美学处理、前牙种植美学修复、严重萎缩无牙颌的种植修复治疗、即刻种植即刻修复具有丰富的临床经验。