种植牙手术模板设计的进展

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摘要

背景:三维(3D)打印技术的发展和规划软件的改进提高了牙科种植体定位的准确性和精确度,并为种植手术中的手术模板提供了新的应用。本报告旨在展示局部打印手术模板在各种牙科种植手术和部位开发程序中的应用。方法:九名患者被转诊至美国佐治亚州艾森豪威尔堡研究生牙学院陆军研究生牙学院牙周病学系,使用种植体替换缺失或无望的牙齿。所有手术均通过虚拟方式进行规划,并使用在当地设施内制作的定制手术模板完成。所介绍的病例展示了如何使用手术模板简化各种临床情况下的手术--植入多个相邻的种植体、即刻植入种植体、即刻临时修复、牙缺失和无牙颌患者的上颌窦抬高、在进行种植手术的同时去除滞留的牙根碎片、进行牙槽成形术以增加牙弓间距,以及完全引导下的种植手术。结果:在介绍的种植牙手术中,使用本地制作的手术模板可以将计划的种植体位置转移到患者身上,可靠性很高。在上颌窦提升手术中使用手术模板可确保在适当的位置进行增量,并简化了复杂解剖结构的术中管理。结论:专用手术模板有可能缩短手术时间、限制患者发病率、加强临床医生之间的沟通并简化修复阶段的治疗。新技术的普及使种植外科医生超越了精确植入种植体的时代,进入了以创造性地解决临床问题为特征的时代。
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Advances in Surgical Template Design in Dental Implantology
Background: Expansion of three-dimensional (3D) printing technology and improvements in planning software have led to increased accuracy and precision in dental implant positioning and new applications for surgical templates in implantology. The objective of this report is to demonstrate the application of locally printed surgical templates in various dental implant surgeries and site development procedures. Methods: Nine patients were referred to the Department of Periodontics, Army Postgraduate Dental School, Postgraduate Dental College, Fort Eisenhower, GA, USA, for replacement of missing or hopeless teeth using dental implants. All surgeries were planned virtually and completed using customized surgical templates produced within the local facility. The presented cases demonstrate use of surgical templates to simplify surgery across a wide spectrum of clinical scenarios—placement of multiple adjacent implants, immediate implant placement, immediate provisionalization, sinus elevation in dentate and edentulous patients, removal of a retained root fragment in conjunction with implant surgery, alveoloplasty to increase interarch distance, and fully guided implant surgery. Results: In the presented dental implant surgeries, use of locally produced surgical templates permitted transfer of the planned implant positions to the patients with high reliability. Use of surgical templates in sinus elevation procedures ensured augmentation in the appropriate positions and simplified intraoperative management of complex anatomy. Conclusions: Specialized surgical templates have the potential to reduce the duration of surgery, limit patient morbidity, enhance communication among clinicians, and simplify the restorative phase of therapy. Accessibility to new technology has allowed implant surgeons to move beyond the era of accurate implant placement into a period characterized by creative solutions to clinical problems.
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