利用動態導航系統測量顎側咀嚼黏膜-一種新的非侵入性方法

Abstract

牙周美容手術目前廣泛應用在有美或是功能需求的病人，上顎顎側咀嚼黏膜常為提供軟組織的來源，已經有很多方式被提出來測量顎側咀嚼黏膜厚度，然而這些方式多為侵入性或測量的可重複性不高，本臨床研究希望以非侵入之方式，評估使用動態導航系統下，動態評估顎側咀嚼黏膜厚度相較於標準穿刺探測的精準度，目標期待能提供新的非侵入性手術前診斷評估方式，更精準且穩定即時的確認每位病患顎側軟組織實際厚度。 本研究收案12位牙周健康且需要做上顎植牙也有照過錐狀斷層掃描的病人，每位病人在犬齒到第二大臼齒區域(C、P1、P2、M1、M2)，分別在距離牙齦不同位置(A:4mm、B:8mm、C:12mm)，總共測量15個點，實驗組使用動態導航系統(安適準Navident, ClaroNav, Canada)進行測量，對照組以牙周探針搭配橡皮定位在該點以垂直軟組織穿刺進行量測，之後進行分析導航系統的測量相對於直接以牙周探針測量之精準度。 平均誤差為0.32 ± 0.39 mm，使用動態導航系統測量通常高估真實厚度，在性別、左右側與不同齒位間沒有顯著差異，但誤差在距離牙齦越近越大，在A (0.42 ± 0.34 mm)顯著高於C (0.23 ± 0.44 mm)。 平均顎側咀嚼黏膜厚度為3.47 ± 1.34 mm，在性別與不同齒位間沒有顯著差異，但在左側(3.61 ± 1.42 mm)顯著比右側(3.18 ± 1.12 mm)厚，且厚度隨著距離牙齦越遠顯著越厚(A: 2.46 ± 0.77 mm; B: 3.40 ± 0.92 mm; C: 4.54 ± 1.33 mm)。 動態導航系統是個非侵入性且精準的測量顎側咀嚼黏膜厚度的工具，可以精準且即時的執行測量，讓牙周美容手術提升安全與效率，本研究也是第一個提出此方法來測量軟組織厚度的團隊。

Periodontal plastic surgery is widely used to improve patients' esthetic and functional demands. The palatal masticatory mucosa is the main donor area. Periodontists used many methods to evaluate the thickness of palatal soft tissue. However, the techniques published before were invasive or non-reproducible. Therefore, this study aimed to investigate the accuracy of the novel invasive approach to evaluate the thickness of palatal masticatory mucosa. Twelve periodontally healthy patients with CBCT on the maxilla for implant surgery were recruited in this study. We measured each patient at 15 points of palatal masticatory mucosa from the canine to the second molar area (C, P1, P2, M1, M2) on the right or the left side at 4 (A), 8 (B), and 12(C) mm from the gingival margin. All procedures were done by a dynamic navigation system (test group) and periodontal probe piercing (control group). In addition, we analyzed data to evaluate the accuracy of dynamic navigation in measuring palatal masticatory mucosa thickness. The overall mean measurement difference was 0.32 ± 0.39 mm. The navigation system generally overestimated the thickness of the palatal masticatory mucosa. The mean measurement difference was not statistically significant, according to tooth site, gender, and different sides. However, the mean measurement difference decreased as the distance from the gingival margin. The difference at A (0.42 ± 0.34 mm) was more significant than C (0.23 ± 0.44 mm). The average thickness of the palatal mucosa was 3.47 ± 1.34 mm. The mean thickness of the palatal mucosa did not show a statistically significant difference according to tooth site and gender. However, the mean masticatory mucosa thickness on the left side (3.61 ± 1.42 mm) was more significant than on the right side (3.18 ± 1.12 mm). The thickness increased as the distance from the gingival margin. The mean thickness exhibited a significant difference at A (2.46 ± 0.77 mm), B (3.40 ± 0.92 mm), and C (4.54 ± 1.33 mm). Dynamic navigation is a noninvasive and accurate tool for measuring palatal masticatory mucosal thickness. Obtaining precise thickness in real-time of palatal masticatory mucosa could provide significant benefits, particularly in performing periodontal plastic surgery with improved safety and effectiveness. This is the first study to use dynamic navigation to measure and assess palatal mucosal thickness.