Publication: Bilgisayar destekli cerrahi rehberler ile hazırlanan implant yuvalarındaki sapmaların in vivo incelenmesi
Abstract
1.ÖZET Bilgisayar destekli yöntemler içeren bu klinik çalışmada tam dişsiz çenelerde, konvansiyonal bilgisayarlı tomografiler (BT) ve dental volumetrik tomografilerden (DVT) elde edilen veriler ışığında bir bilgisayar mPlant Planner Ver.15, Materialise Dental, Leuven, Belçika) yardımıyla üç boyutlu dijital implantlar (sanal implant) kullanılarak planlamalar yapıldı. Planlanan implantlar için cerrahi rehberler (SurgiGuide SLA, Materialise Dental, Leuven, Belçika) üretilerek in vivo ortamda implant yuvaları hazırlandı. Tam dişsiz çenelerden operasyonlardan üç ay sonra alınan ikinci tomografiler ile ilk tomografiler bilgisayar programında çakıştırılarak sistemin doğruluğu hesaplandı. Bu klinik çalışmada, 5 erkek 5 kadın olmak üzere tam çene dişsizliğe sahip toplam 10 hastaya yer verildi. 10 hastaya ait 12 adet tam dişsiz çenede uygulanan kemik içi dental implant (Biohorizons Implant System, Inc, Birmingham, AL, A.B.D.) sayısı toplam 83 adettir. Sanal olarak yapılan planlamanın operasyon sahasına transferi sırasındaki doğruluğa etkisi olduğu düşünülen farklı çenelerde uygulama, farklı tomografi çekim teknikleri, kemik yoğunluğu farklılıkları, implant boyutları ve mukoza kalınlığı gibi faktörler incelendi. Ayrıca; hastanın ağrı hissi seviyesi ölçümleri ve ameliyat konforu değerlendirmeleri görsel analog skala (VAS) yöntemine göre toplandı ve değerlendirildi. Verilerin değerlendirilmesinde tanımlayıcı istatistiksel metotların (ortalama, standart sapma) yanı sıra ikili grupların karşılaştırmasında Tukey’s analizi, ANOVA testleri ve Kruskal-Wallis analizi kullanıldı. Sonuçlar p<0,05 anlamlılık düzeyinde değerlendirildi. Buna göre; implant yuvalarındaki sapma değerleri; koronalde 1.14 ± 0.66 mm, apikalde, 1.31 ± 0.90 mm, vertikalde 1.07 ± 0.78 mm olarak bulunurken, açısal sapma değeri 5.31 ± 3.49° olarak ölçüldü. Hastaların marjinal kemik seviyelerindeki değişimler, keratinize dişeti değişimleri, ağrı ölçümleri, plak-gingival-kanama indeksleri gibi klinik değerlendirmeler takip edildi. mplant, cerrahi rehberler, bilgisayar destekli implant 2.
IN VIVO STUDY OF EVALUATION OF IMPLANT DEVIATION USING COMPUTER AIDED MUCOSA SUPPORTED SURGICAL GUIDE The aim of this study is to determine the accuracy of computer guided implant surgery in vivo. For this purpose, 10 patients with edentulous jaws which had adequate bone volume and bone height were involved in this study. Implants were placed at every edentulous jaws using a surgical guide (SimPlant, SurgiGuide SLA, Materialise Dental, Leuven, Belgium). After the initial volumetric tomographies were taken in order to examine bone quality and quantity of patients, the virtual implant placement was planned through the software (SimPlant Planner Ver.15, Materialise Dental, Leuven, Belgium). The mucosa-supported surgical guides were fabricated with reference to virtual implant placement. To determine the deviation between virtual and actual implant placement, two tomographic datas were superposed by the software and deviations were calculated in three dimensions. In this study; 83 implants (Biohorizons Implant System, Inc, Birmingham, AL, USA) were placed at a sum of 12 edentoluos jaws. The results of deviations are 1.14 ± 0.66 mm at coronal, 1.31 ± 0.90 mm at apical, 1.07 ± 0.78 mm at vertical and 5.31 ± 3.49° at angular. The factors –the type of jaws, the techniques of tomography, the size of implants, the bone quality and the thickness of mucosa- effecting the deviatons were examined. In this study; marginal bone loss, the changes of keratinized gingiva, gingival index, bleeding index, and plaque index were evaluted. The results of the marginal bone loss is recorded 0.40 ± 0.36 mm at third month and 0.63 ± 0.52 mm at sixth month. The level of pain, the comfort of operation ant operation times is also evaluted by the method of visual analogue scale (VAS). All datas were analysed statistically used ANOVA tests, Tukey’s analysis and Kruskal-Wallis analysis by SPSS (Version 15.0, SPSS Inc., Chicago,Illinois, USA) (p<0,05). Key words: implant, surgical guides, accuracy, computer aided implant
IN VIVO STUDY OF EVALUATION OF IMPLANT DEVIATION USING COMPUTER AIDED MUCOSA SUPPORTED SURGICAL GUIDE The aim of this study is to determine the accuracy of computer guided implant surgery in vivo. For this purpose, 10 patients with edentulous jaws which had adequate bone volume and bone height were involved in this study. Implants were placed at every edentulous jaws using a surgical guide (SimPlant, SurgiGuide SLA, Materialise Dental, Leuven, Belgium). After the initial volumetric tomographies were taken in order to examine bone quality and quantity of patients, the virtual implant placement was planned through the software (SimPlant Planner Ver.15, Materialise Dental, Leuven, Belgium). The mucosa-supported surgical guides were fabricated with reference to virtual implant placement. To determine the deviation between virtual and actual implant placement, two tomographic datas were superposed by the software and deviations were calculated in three dimensions. In this study; 83 implants (Biohorizons Implant System, Inc, Birmingham, AL, USA) were placed at a sum of 12 edentoluos jaws. The results of deviations are 1.14 ± 0.66 mm at coronal, 1.31 ± 0.90 mm at apical, 1.07 ± 0.78 mm at vertical and 5.31 ± 3.49° at angular. The factors –the type of jaws, the techniques of tomography, the size of implants, the bone quality and the thickness of mucosa- effecting the deviatons were examined. In this study; marginal bone loss, the changes of keratinized gingiva, gingival index, bleeding index, and plaque index were evaluted. The results of the marginal bone loss is recorded 0.40 ± 0.36 mm at third month and 0.63 ± 0.52 mm at sixth month. The level of pain, the comfort of operation ant operation times is also evaluted by the method of visual analogue scale (VAS). All datas were analysed statistically used ANOVA tests, Tukey’s analysis and Kruskal-Wallis analysis by SPSS (Version 15.0, SPSS Inc., Chicago,Illinois, USA) (p<0,05). Key words: implant, surgical guides, accuracy, computer aided implant