Clinical Observation Of The Digital Implant Surgical Guide In Oral Cavity Implantation

Objective: Using of own independent development of the digital implant surgical guide applied to oral clinical cases,by comparing the planting plan on software and the completion of clinical planting to see if there were errors,in order to achieve accurate results and verify the accuracy of the digital implant surgical guide for the improvement of the guide and clinical application to provide the basis.Methods: The total was 11 cases.There were 4 cases of males and 7 cases of females.From November 2014 to October 2016,a total of 18 implants were implanted,including 6 missing teeth in upper jaws and 12 missing teeth in lower jaws,all of the objects of study were treated with i-Max? Surgical Kit in Taiwan for designing and outputting the digital implant surgical guide.Step 1.Collect 3D data,from the intraoral3 D CBCT images that patients had taken before the operation,STL scan files of the plaster model,or using plaster model for extraoral CBCT scanning to get the data we need.Step 2.Use software and navigation machine to produce treatment plans and the digital implant surgical guide.Step 3.Take advantage of the digital implant surgical guide to guide implant surgery.Step 4.After the operation,the patients will take intraoral 3D CBCT images,and then use software to compared to the planting plan and the completion of clinical planting to see if there were errors,in order to achieve accurate results.More specifically,Before the operation,the patients had taken intraoral 3D CBCT images and got their DICOM output files.Their upper and lower intraoral dies with the capture of occlusal relationship were sent to the design center of digital Implant surgical guide for post-production after removing their gypsum molds.For the patients with partial missing teeth,we used three-dimensional locator to fix on plaster models for extraoral CBCT scanning.For the patients who were completely edentulous,we fixed three-dimensional locator on the base of the edentulous area for CBCT scanning,and then imported parameters into the software of digital Implant surgical guide.The software automatically combined the original files and the files containing three-dimensional locator.Basically,we first verified in order to decide whether to carry out the next step or re-photograph.We also import plaster models into software according to the articulate information in the missing teeth area,and imitated the first implant plan.Based on the plan,we discussed with dentists to the difficulty of surgery and methods.According to the patients' budget and expectations,we decided how many teeth would be planted and what methods of the denture production after implantation.To match up with dentists' diagnoses,physically we measured the width of the mandible,the distance between the lower jaw and lower bone alveolar,the shape of alveolar bone in the implant area,and the distance between the maxillary sinus.We also measured whether jaw bone was homogeneous,whether there was space in jaw bone,and whether bone formation and bone mass were enough.We also checked the position and occlusion of dentures to make sure whether dentures interfere with the axial and distance of the adjacent teeth,and so on.Finally,all the data to determine the specifications of the implant,the direction of placement,angle,depth,determine the way to determine the operation and repair,and digital planting guide plate production.Under the guidance of the guide to complete the implant surgery,and then shot CBCT,measuring and comparing the implant implantation of the actual location and design position between the errors.Results: After using digital Implant surgical guide,all of the 11 cases,with 18 implants,had showed differences with the original angle and direction we planned.The difference was within the allowable range.The Maximum error of the position of knife point was 1.6mm.The average error was less than 0.7mm.The maximum error of implant's axial direction was 17.1 degree.The average error was less than 4.5degree.For the accuracy of clinical implantation,the operation time was shortened;thesurgical trauma was reduced,so that the unnecessary results of complications of implant repair were reduced.Conclusion: After comprehensive evaluation,the clinical reports showed that no matter the pre-simulation planning or the two-way communication of the medical treatment,we could get the indispensable and big information as planning treatment projects.Furthermore,surgical guidance of dental implants could be implemented.As the post-mortem examination,the expected planning could also be achieved.We could get the realm of seeing the anatomical structure,accurate measuring the surgical information,and doing the implant surgery.