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標題: | 不同保存時間及條件對於植牙手術模板導引精準度之影響 Accuracy of Implant Surgical Stent with Different Storage Durations and Conditions |
作者: | Chia-Chun Chen 陳家駿 |
指導教授: | 林立德 |
關鍵字: | 人工植牙,手術模板,精準度, Implant,surgical stent,accuracy, |
出版年 : | 2010 |
學位: | 碩士 |
摘要: | 緒論: 人工植牙運用於臨床牙科治療已有四十年的歷史,現今對於成功植牙治療的定義,已由過去注重骨整合成功,而進展至要求植體種植於適當的位置。隨著電腦輔助導引系統的成熟發展,目前利用各類電腦導引系統,可以將術前植體規劃位置轉移至實際植體種植位置,減少傷害到重要器官的機率,達成植體及植體補綴物生物力學、美學上的良好結果。 研究動機: 目前的文獻報告皆證實電腦輔助導引系統可以提供臨床所需的導引精準度,在規劃植體與實際植體間,植體距離及角度誤差分別約1 ~ 1.5mm及6 ~ 7°。但醫師在使用特定系統時,最關心的不是誤差平均值,而是該系統可能產生的最大誤差,最大誤差往往是造成植體治療失敗的主因。規劃植體與實際植體間的誤差為植牙治療流程中所有步驟偏差的累積,但現今文獻多為探討整體誤差,針對個別步驟的研究較少,其中探討手術模板保存條件及時間的文獻報告仍相當缺乏。 實驗目的: 本實驗目的在探討不同保存條件和存放時間,對於丙烯酸合成樹脂手術模板導引精準度的影響。 實驗材料與方法:
本實驗備製4個相同的上顎石膏模型,每個模型皆於右上第二小臼齒與第二大臼齒缺牙區埋入兩植體複製體,利用此4個標準模型分別製作4個丙烯酸合成樹脂手術模板(共16個),模板上以植體補綴物暫時性支台代替套筒,並於製作完後依不同相對濕度(70%或100%)保存條件分成兩組(每組8個),每個石膏模型或模板上都有三顆直徑5mm陶瓷圓珠,作為將來誤差計算時空間定位的基準。在每個模板製作完、1天、3天、7天及1個月後5個時間點進行電腦斷層拍攝,全部16個模板共完成80次拍攝,每次拍攝前必須先將人工植體固定於模板上暫時性支台,並配戴至石膏模型相對應位置。之後運用ImplantMax4.0軟體系統進行誤差計算,以每個模板之第一次電腦斷層影像作為控制組,依兩組參考點定位(石膏模型或模板),分別記錄每次影像間植體的距離及角度誤差,最後以ANOVA進行統計分析(P = 0.05)。 實驗結果: 以手術模板參考點定位,在70%相對溼度下,保存1天、3天、7天和1個月後,模板的誤差平均值在植體頸部分別為0.078、0.092、0.082、0.094mm,尖端分別為0.127、0.152、0.137、0.184mm,角度分別為0.87、1.01、0.99、1.07°;在100%相對溼度下,誤差平均值在植體頸部分別為0.085、0.079、0.081、0.097mm,尖端分別為0.126、0.144、0.137、0.180mm,角度分別為0.77、0.91、1.04、0.99°,1個月的保存期間於不同濕度條件下,各類誤差之間皆沒有統計上的差異(P > 0.05)。以石膏模型參考點定位,在70%相對溼度下,保存1天、3天、7天和1個月後,模板的誤差平均值在植體頸部分別為0.073、0.093、0.083、0.108mm,尖端分別為0.138、0.162、0.149、0.184mm,角度分別為0.95、1.01、1.01、1.09°;在100%相對溼度下,誤差平均值在植體頸部分別為0.090、0.091、0.086、0.079mm,尖端分別為0.142、0.169、0.163、0.150mm,角度分別為0.78、0.96、1.06、0.84°,1個月的保存期間於不同濕度條件下,各類誤差之間皆沒有統計上的差異(P > 0.05)。不同參考點定位之間,各類誤差皆沒有統計上的差異(P > 0.05)。 結論: 在本研究的實驗設計下,丙烯酸合成樹脂手術模板於不同濕度條件下,一個月的保存期間內仍能維持穩定的導引精準度。 Objectives: An acrylic implant surgical guide stent may shrink during storage and affect the accuracy of implant surgery. The aim of this study was to investigate the accuracy of surgical stent after different durations in different storage conditions. Material and methods: Two implant replicas were placed at second premolar and second molar positions in four duplicated maxillary stone models with missing right second premolar and molars. Corresponding temporary cylinders were attached to the implant replicas and embedded into an acrylic stent fabricated on the model. Four stents were fabricated on each model and sixteen stents were divided into two storage conditions (70%, 100% humidity). Three ceramic balls were attached to each model and stent as markers for CT image-fusing-analysis. CT-images were taken immediate after stent fabrication and after 4 storage durations (1, 3, 7 days, 1month). The missing right posterior region was removed from the model and two corresponding implants were attached to the stent placed on the model before CT imaging. An image-fusing analyzing technique was used to analyze the changes of implant position and angle relative to the two sets of ceramic markers(model’s and stent’s respectively) after different storage durations. Two-way repeated measures ANOVA was used for statistics analysis. Results: Using the ceramic balls of stents as markers for image-fusing-analysis, the changes of implant position and angle were measured. After storage durations of 1, 3, 7 days, and 1month in 100% humidity, the mean displacement of implant head was 0.085, 0.079, 0.081,and 0.097mm, respectively; the mean displacement of implant apex was 0.126, 0.144, 0.137, and 0.180mm, respectively; the angle deviation was 0.77, 0.91, 1.04, and 0.99 °, respectively. After storage durations of 1, 3, 7 days, and 1month in room humidity, the mean displacement of implant head was 0.078, 0.092, 0.082, and 0.094mm, respectively; the mean displacement of implant apex was 0.127, 0.152,0.137, and 0.184mm, respectively; the angle deviation was 0.87, 1.01, 0.99, and 1.07°, respectively. No statistically significant difference was found after different durations in two storage conditions. Using the ceramic balls of models as markers for image-fusing-analysis, the changes of implant position and angle were measured. After storage durations of 1, 3, 7 days, and 1month in 100% humidity, the mean displacement of implant head was 0.090, 0.091, 0.086,and 0.079mm, respectively; the mean displacement of implant apex was 0.142, 0.169, 0.163, and 0.150mm, respectively; the angle deviation was 0.78, 0.96, 1.06, and 0.84 °, respectively. After storage durations of 1, 3, 7 days, and 1month in room humidity, the mean displacement of implant head was 0.073, 0.093, 0.083, and 0.108mm, respectively; the mean displacement of implant apex was 0.138, 0.162, 0.149, and 0.184mm, respectively; the angle deviation was 0.95, 1.01, 1.01, and 1.09°, respectively. No statistically significant difference was found after different durations in two storage conditions. Neither was between two different sets of ceramic markers attached to models and stents, respectively. Conclusions: The data suggest the accuracy of acrylic surgical stents were maintained within 1 month in 70% and 100% humidity conditions. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/47288 |
全文授權: | 有償授權 |
顯示於系所單位: | 臨床牙醫學研究所 |
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