计算机辅助技术在纤维桩拆除中的应用

doi:10.7518/gjkq.2022104

摘要/Abstract

摘要：

随着“引导式牙髓治疗”在牙体牙髓领域的应用研究逐渐开展，动态导航系统和数字化导板技术也被应用于纤维桩拆除的临床操作中。相较于现有的纤维桩拆除系统，计算机辅助拆除具有准确、高效、微创等特点。本文通过介绍各种纤维桩拆除方式的临床应用和优缺点，分析计算机辅助技术在临床纤维桩拆除中的准确度及误差因素，以此作一综述，为医师的临床操作提供相关参考依据。

关键词: 数字化导板, 动态导航系统, 纤维桩拆除, 准确度, 误差分析

Abstract:

With the gradual development of “Guided endodontics” in the field of endodontics, dynamic navigation system and digital surgical guide have also been applied to remove the fiber post in clinical. Compared with the current fiber post removal systems, the computer-aided removal methods are accurate, efficient, and minimally invasive. This article reviews the clinical application, advantages and disadvantages of various fiber post removal methods, analyzes the accuracy and error factors of computer-aided technology in fiber post removal, and provides reference for the operations to clinicians.

Key words: digital surgical guide, dynamic navigation system, fiber post removal, accuracy, error analysis

中图分类号:

R 783.4

蔡娉娉,卓盈颖,林捷,郑志强. 计算机辅助技术在纤维桩拆除中的应用[J]. 国际口腔医学杂志, 2022, 49(6): 731-736.

Cai Pingping,Zhuo Yingying,Lin Jie,Zheng Zhi-qiang.. Application of computer-aided technology in fiber post removal[J]. Int J Stomatol, 2022, 49(6): 731-736.

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参考文献 38

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方式			优点	缺点
传统方式	机械钻头	拆除套装	1）相较于超声波和钻头，拆除速度快；2）拆除后没有改变牙体抗断裂性	1）相较于超声波和钻头，拆除后根管壁上剩余材料量多；2）根管壁上微裂纹产生；3）仅适用于特定的桩系统
		钻头	1) 相较于拆除套装，拆除后根管壁上剩余材料量少；2）拆除后对根尖微裂缝的形成和扩散没有影响	1）去除牙体组织多，侧向穿孔发生率高；2）相较于拆除套装，拆除时间长；3）拆除时间和有效性受操作员经验的显著影响
	超声波		相较于拆除套装，拆除后根管壁上剩余材料量少	1）相较于拆除套装，去除牙体组织多；拆除时间长；2）拆除时间和有效性受操作员经验的显着影响；3）相较于未被移除或者拆除套装，拆除后牙体断裂阻力值显著降低
计算机辅助技术	导板		1）高精度，将钻头精确地保持在桩的轴线上；2）拆除速度快；3) 微创，去除牙体组织少；4) 降低技术敏感性，无需学习周期	1）数据采集、设计制作及应用中的任何误差都会影响准确性；2）咬合空间有限的区域难以应用；3）冲洗困难、无法顺利排出碎屑；4）缺乏3D 实时可视化，不允许术中改变钻头轨迹
	导航		1）相较于传统方式，高精度、偏差小；拆除速度快；微创、去除牙体组织少；2）相较于导板，咬合空间有限的区域可以使用；3D实时可视化，允许术中改变钻头轨迹；易于冲洗，降低过热风险	1）数据采集、设备应用中的任何误差都会影响准确性；2）手术区同颌对侧无牙或重度松动者难以应用；3）成本高、附件笨重和设置繁琐；4）需要学习周期，操作成功取决于操作者的熟练程度

方式	误差类型
方式	数据误差	技术误差	人为误差
数字化导板技术	1）CBCT数据的采集	1）不同导板设计软件	1）患者的开口度
	2）口内数字化印模过程	2）3D打印设备和打印材料	2）操作者的视野受阻
		3）导板的就位情况
动态导航技术	1）CBCT数据的采集	1）不同动态导航系统软件	1）患者的配合程度
	2）口内数字化印模过程	2）跟踪定位系统	2）操作者的熟练程度
		3）配准方式及配准过程

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