3D鑽孔導引軸向參考系統於植牙手術計畫和結果之誤差探討

摘要本論文的研究目的:探討一種新式自製有軸向植牙定位導引手術定位系統的精確度。它是依據電腦斷層的影像資訊，藉由影像導引（Imaging Guide）的技術保留手術導引（Surgical Guide）與電腦導航(Navigation)技術的優點，在植牙手術時可導引鑽孔的軸向與位置並可即時改變或修正手術計畫。研究架構: 收集臨床醫師使用3D診斷模擬軟體(ImplantMax ®)植牙手術計劃與術後 (植體植入後)影像資料兩相疊合進行比較，做為研究素材。紀錄入刀點位置與植體軸向術前規劃與術後的偏差。將案例分類探討。材料與方法︰本文共有5位手術醫生，27位患者，術前與術後皆以牙科電腦斷層(CBCT)拍攝，共計78組植體進行分析。本文將78組植體研究材料分類，針對單顆與局部植牙組、多顆植牙全口重建組，分別探討使用與未使用植牙導引板的差別。結果:單顆與局部植牙，徒手植牙手術對造案例︰位置平均誤差1.0 ±0.7 mm，最大誤差3.4 mm。軸向平均誤差3.5±3.0°，最大誤差11°。導引板植牙案例︰位置平均誤差0.3 ±0.2 mm，最大誤差0.8 mm。軸向平均誤差4.0±3.6°，最大誤差11°。結論:使用新式自製有軸向植體手術定位導引系統，局部植牙的位置誤差為0.3 mm、軸向誤差3.5°。全口重建的位置誤差為0.8 mm、軸向誤差8.2°。據以上分析，本系統的精準度甚佳，是值得推廣的植牙手術的流程，降低手術誤差的手術輔助工具選項。

關鍵字

牙科電腦斷層、影像導引；手術模板；手術定位板；手術導引板； 3D植牙手術計畫

並列摘要

Abstract The aim of this study is to compare the accuracy of a new self-design implant surgical guide system. We use computer image to guide the path of implant placement, it will be more safe and precise. The risks and benefits of the surgical plan can be planned and considered before surgery. Materials and methods: There were 5 dentist and 27 subjects included in this study. Cone Beam Computerized Tomography (CBCT) were taken before and after implant surgery. Total 78 implants were analyzed. All implants were divided into two groups: single or partial implants group, multiple implants for fully edentulous arch. The results were analyzed the different between with or without surgical guide. Results: In the single or partial implants group, without the surgical guide, the difference of implant position before and after surgery was 1.0 ±0.7 mm with maximum 3.4 mm. The difference of implant axis was 3.5±3.0° with maximum11°. With the surgical guide, the difference of implant position before and after surgery was 0.3 ±0.2 mm with maximum 0.8 mm. The difference of implant axis was 4.0±3.6° with maximum 11°. Conclusion: With the surgical guide in the partial implants group, the difference of implant position before and after surgery was 0.3 mm. The difference of implant axis was 3.5°. In the fully edentulous arch, the difference of implant position before and after surgery was 0.8 mm. The difference of implant axis was 8.2°. According to the result , the accuracy of this implant surgical system was good .This is a reliable surgical guide for implant placement.Also it is one of tools options to reduce the surgical error.

並列關鍵字

Imaging Guide ； (CBCT) ； Surgical Stent ； Surgical Template ； Surgical Guide ； 3D Implant Surgical Planning

參考文獻

[27] 賴元隆許博榕羅佐良張夏: “植牙位置導引器於直接植牙手術之研究－座標轉換”，科學與工程技術期刊第八卷第一期，民國一○一年。

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3D鑽孔導引軸向參考系統於植牙手術計畫和結果之誤差探討

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