| Objective: To develop a simple implant surgical guide and explore its fabrication method and clinical application effect based on the fabrication of various traditional implant guides by improving their design,and to provide theoretical basis and application guidance for implant surgery.Method:1.Model experimental study: The mandibular dentition defect plaster model with 35,31,42,45 and 46 teeth were obtained by simulated mandibular gingival soft tissue implantation model.(1)Fabrication of traditional implant guide:Arrangementing tooth in the mandibular dentition defect plaster model according to the principle of repair row of teeth,to get the plaster model of restoration,the use of plastic plywood in the vacuum forming machine on the film.Pruning to complete the guide prototype,the prototype guide placed in place on the model,in the design of the implant site using bredent parallel grinding machine drilling,the metal guide tube into the hole and fixed,complete the traditional planting guide production.(2)Fabrication of simple implant surgical guide:(1)Arrangementing tooth in the mandibular dentition defect plaster model according to the principle of repair row of teeth,determine the appropriate implant location.The silicone rubber body was laid in themandibular gap area and extended to the mucosal transition and covering the adjacent tooth crown.The bredent parallel grinding machine was crossed along the buccolingual on the silicone rubber,and the gypsum saw along the marking line Silicone rubber with plaster model cut together,silicone rubber longitudinal section drawing auxiliary line to complete the bone guide mark template production.Draw the bone outline with the help of bone guide mark template.The implantation direction was determined by taking into account both the anatomical conditions of the jaw and the need for repair,and transferred to the bone guide marker template.Insert the bone guide mark template with the final implantation direction into another secondary anhydrite model.Use a bredent parallel grinding machine with a drill hole of 2mm in diameter,insert the guide bar and the guide tube,pressed film on Vacuum molding machine,shape dressing,check its stability,the final production to complete the simple implant surgical guide of retaining the soft tissue of the gingival(simple guide A).(2)The localized gingival soft tissue in the tooth loss area of simulated mandibular gingival soft tissue implantation model was removed and the plaster model of removing soft tissue of the gingiva was obtained.According to the steps of making the simple guide A,the bone guide mark template is prepared and drilled and pressed,and simple implant surgical guide of removing the soft tissue of the gingival is finished(simple guide B).(3)model comparison experiment: the use oftraditional implant guide,simple guide A and simple guide B three guides in the simulated mandibular gingival soft tissue implantation model to complete the Pioneer drilling guide hole,the simulated operation of the implanted position and the proposed implant location,to compare the accuracy of the implantation under different guides.2.Clinical application study:12 patients with missing teeth were selected and a total of 22 implants were implanted.Preoperative orthopantomography(OPG)were taken to evaluate the anatomical conditions of the jaws in the planting area.Making a simple guide A,wearing a guide,once again shooting OPG or CBCT,observe the rationality of the design.Under the guidance of the guide to carry out implant surgery.Shooting OPG or CBCT after operation,observation and evaluation the clinical application effect of the guide.Result:1.With the help of the traditional implant guide,the deviation mean of the vertical distance of labiobuccal and lingual sides of the alveolar crest at 4mm compared with the pre designed position was 1.020±0.740mm;0.920±0.692 mm,the difference was statistically significant(P<0.05,n=5).The deviation mean of the vertical distance of labiobuccal and lingual sides of the alveolar crest at 8mm,planting depth and the alveolar crest implantation point compared with the pre designed position was0.456±0.755mm;-0.698±0.956mm;0.378±0.834mm;0.962±0.242 mm,the difference was not statistically significant(P>0.05,n=5).2.With the help of the simple guide A,the deviation mean of the vertical distance of labiobuccal and lingual sides of the alveolar crest at4 mm and 8mm,planting depth and the alveolar crest implantation point compared with the pre designed position was 0.070±0.474mm;0.160±0.549mm;0.062±0.642 mm;0.066±0.406mm;0.106±0.314mm;0.584±0.204 mm,the difference was not statistically significant(P>0.05,n=5).3.With the help of the simple guide B,the deviation mean of the vertical distance of labiobuccal and lingual sides of the alveolar crest at8 mm compared with the pre designed position was 0.922±0.690mm;-0.932±0.652 mm,the difference was statistically significant(P<0.05,n=5).The deviation mean of the vertical distance of labiobuccal and lingual sides of the alveolar crest at 4mm,planting depth and the alveolar crest implantation point with the pre designed position was0.712±0.685mm;-0.660±0.745mm;0.106±1.013mm;0.762±0.221 mm,the difference was not statistically significant(P>0.05,n=5).4.Under the guidance of the simple guide A,the implant is precisely implanted into the intended location,with implant bias is small,less trauma and minimally invasive.Conclusion: Comparison of planting in the experimental model,the simple implant surgical guide of retaining the soft tissue of the gingival was less deviation and more accurate than the traditional implant guideand simple implant surgical guide of removing the soft tissue of the gingival.The design of the preoperative was accurately transferred,clinical application requirements.In the simple implant surgical guide of retaining the soft tissue of the gingival to complete the implant surgery,implant bias is small,intraoperative trauma is small,greatly shorten the time of implant surgery,patient satisfaction is high and achieved good clinical results. |
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