- 期刊
動態導航系統的新應用於上顎大臼齒植牙合併側方開窗法之鼻竇增高術：病例系列報告
A Novel Application of Dynamic Navigation System in Dental Implant with Simultaneous Sinus Lifting by Lateral Window Approach over Molars Area: A Case Series
摘要
上顎後牙缺牙區重建時垂直骨脊高度不足常造成植體置放困難。常用側方開窗法來進行鼻竇增高術在垂直骨高度不足五毫米的案例，而上顎竇周圍複雜的解剖構造時常造成開窗鼻竇增高手術不易執行，如何預先或即時的了解和選取適當的手術部位，是提高此類手術成功率的關鍵。本研究收集三位病人在上顎臼齒區有局部缺牙且骨垂直高度小於五毫米，運用新式的動態電腦輔助導航系統應用於操作側方開窗之鼻竇增高術以及植牙，術中紀錄齒槽骨品質、開窗大小、時間與植牙初級穩定度，術後以錐狀電腦斷層疊合植牙位置做精準度分析與鼻竇增高效果評估。三支植體皆同一位醫師順利完成鼻竇增高術同時植牙且都達到良好的初級穩定度，植牙平均誤差的值（±標準差）在入口（二維）、底部（三維）和底部（垂直）分別是0.56（±0.34）、0.64（±0.05）和0.22（±0.08）毫米，角度為1.67（±0.39）度。術後平均（±標準差）上顎竇骨脊高度增加11.6（±4.0）毫米，平均（±標準差）開窗與翻膜時間為785（±353）秒，大小為41.4（±3.3）毫米平方，術中與術後皆無併發症，傷口恢復良好。動態導航系統輔助植牙可以達到植牙位置的平均誤差小於1毫米，角度偏差小於2度，呈現高度精準性。術中運用導航系統可準確辨識上顎竇隔、動脈和上顎竇底部的位置，使開窗位置更精準的避開解剖限制，以利安全的翻上顎竇膜，範圍也可比傳統開窗縮小一半以上，完成精準、安全且微創的手術。
並列摘要
It is difficult to place implants over limited crestal bone height of maxillary sinus for reconstruction of maxillary posterior edentulous area. In sinus augmentation, if remaining crestal bone height is ≤5 mm, a lateral window approach is recommended. However, maxillary sinus has an anatomical limit that results lateral window sinus lifting more complicated and challenging. How to choose the appropriate surgical site previously or in real-time is the key to improve the surgical outcome. This study included three patients with partial edentulism over maxillary molars area and initial vertical bone height was under 5 mm. Used the novel dynamic navigation to perform implant placement with simultaneous sinus lifting by lateral window approach. Bone quality, time of antrostomy and membrane reflection, area of antrostomy and implant primary stability were measured. Superimposed CBCT for evaluation of accuracy outcomes and sinus lifting. Three implants were placed and good primary stability was achieved. The mean (±SD) implant linear deviations of entry point (2D) was 0.56 (±0.34) mm, apex (3D) was 0.64 (±0.05) mm and apex (vertical) was 0.22 (±0.08) mm. The mean (±SD) implant angular deviations was 1.67 (±0.39) degree. The mean (±SD) bone augmented height was 11.6 (±4.0) mm, time of antrostomy and membrane reflection was 785 (±353) seconds and area of the antrostomy was 41.4 (±3.3) mm2. All surgeries were performed uneventfully by one surgeon (T.-Y. Lin). It was less than 1 mm and 2 degrees of implant linear and angular deviations respectively using the dynamic navigation. The data showed excellent accuracy of implant placement. During surgery, surgeons could use the dynamic navigation to accurately detect the location of sinus septa, arteries and the floor of sinus to make the antrostomy precisely, minimally invasively and reflect the sinus membrane safely. The navigation-assisted surgery was precise, safe and minimally invasive.