华西口腔医学杂志 ›› 2023, Vol. 41 ›› Issue (2): 134-139.doi: 10.7518/hxkq.2023.2022386

• 临床决策 • 上一篇    下一篇

种植术区开口度新分类引导的种植引导方式临床决策

于海洋(), 吴嘉诚, 胡楠   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院修复科,成都 610041
  • 收稿日期:2022-09-28 修回日期:2022-11-21 出版日期:2023-04-01 发布日期:2023-04-14
  • 通讯作者: 于海洋 E-mail:yhyang6812@scu.edu.cn
  • 作者简介:于海洋,博士研究生导师,二级教授,一级临床专家。擅长显微美学修复、数字种植修复等。现任中华口腔医学会修复专业委员会主任委员,口腔修复国家临床重点专科负责人,四川大学口腔医学技术专业负责人,修复Ⅱ科主任。国际牙医师学院院士,教育部新世纪优秀人才;宝钢优秀教师;四川省有突出贡献的专家、四川省“天府万人计划”天府名师、健康四川——大美医者;《华西口腔医学杂志》、Bone Research副主编。主笔国家及行业标准8项;研究成果获教育部自然科学一等奖,教学成果获国家教学成果二等奖等。主编规划教材《口腔固定修复学》《口腔医学美学》以及专著《数字引导式显微修复学》《引导式精准植入术》《口腔微距摄影速成》等29部。提出口腔TRS数论、美学修复形—色—心三要素四维辩证论,发明了“牙体预备精准定深技术”“TRS空间测量分析设计及转移技术”“定深孔显微牙体预备术”“实测引导种植术”“E-clasp”以及“TRS可测量种植导板”“备牙定深导板”“分区粘接导板”“注射树脂导板”等多项临床技术方案;研发的多项软件及医疗器械产品已经成功转化临床。E-mail:
  • 基金资助:
    四川省科技厅基金项目(2020YFS0040)

Clinical decision making of implant guidance methods guided by new classification of surgical area mouth ope-ning

Yu Haiyang(), Wu Jiacheng, Hu Nan.   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Prosthodontics,West China Hospital of Stomatology,Sichuan University,Chengdu 610041,China
  • Received:2022-09-28 Revised:2022-11-21 Online:2023-04-01 Published:2023-04-14
  • Contact: Yu Haiyang E-mail:yhyang6812@scu.edu.cn
  • Supported by:
    Fund Project of Sichuan Science and Technology Department(2020YFS0040);Correspondence: Yu Haiyang, E-mail: yhyang6812@scu.edu.cn

摘要:

判断患者是否可以进行种植治疗或选择具体的种植引导方案时,不少医生忽视或者仅采用目测粗略估计患者的开口度,常导致在术中才发现开口度不足而无法完成植入或者角度受限勉强植入产生偏斜等不正确种植位点,进而诱发相关并发症。出现这类问题的主要原因还是术者缺乏对口内术区整体环境几何条件的准确分析与把控,术中出现了手术器械三维空间位阻而产生的。以往的开口度定义是患者大张口时上下中切牙切缘之间的距离,而种植位点可以在任一缺牙牙位,当位于后牙区时其开口度的具体测量方案不能简单等同于以往在前牙区的测量方法,而如何快速便捷地测量获得任一术区开口度的数值,并据此判断能否植入以及是否满足选定引导方式的开口度需求,就是本文讨论的重点。为了避免术区出现空间位阻影响种植治疗,本文介绍了种植术区开口度的新概念、新分类及相应的准确测量方案,并根据实测值建立了以开口度数值为引导的种植治疗引导方案决策树,为种植治疗术前设计提供了一种数量关系决策依据。

关键词: 种植术区开口度, 三维空间位阻, 正确位点, 引导, 临床决策, 分类

Abstract:

When selecting implant guidance methods or judging whether the patient can be implanted, many doctors ignore or only use visual inspection to estimate a patient’s mouth opening. This phenomenon often leads to failure to complete the implantation due to insufficient mouth opening or the deflection of the implant due to limited angle, resulting in the high incidence of corresponding complications. The main reason is that doctors lack accurate analysis and control of the overall geometric conditions of the intraoral surgical area, and three-dimensional position blocking of surgical instruments occurs during the operation. In the past, mouth opening was defined as the distance between the incisor edges of the upper and lower central incisors when the patient opens his mouth widely, and the implant area could be in any missing tooth position. When it is in the posterior tooth area, the specific measurement scheme of the mouth opening could not be simply equivalent to the previous measurement method in the anterior tooth area. However, how to measure quickly and conveniently the mouth opening of any surgical area to determine whether it could be implanted and meet the needs of the selected guidance method remains unclear. This paper introduces new concepts, establishes new classification and corresponding accurate measurement scheme of implant area, and establishes a decision tree of implant methods guided by the actually measured value. Results provide a quantitative basis for rational formulation and implementation of implant treatment.

Key words: surgical area mouth opening, three-dimensional position blocking, correct planting site, guide, clinical decision making, classification

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