摘要
目的研究在体外牙颌模型上具有不同经验的操作者行计算机辅助显微根尖手术的准确性和操作时间。方法本研究共纳入6对上下颌牙颌模型,将其固定于仿真人头颅模型上模拟临床操作,每个模型上下颌各10个牙位,共120颗牙,由2位具有不同经验的操作者(新手和经验者)分别在自由手与导航技术[包括动态导航技术(dynamic navigation,DN)和静态导板技术(static navigation,SN)](每位操作者每种技术各20颗牙)下完成显微根尖手术中骨开窗与根尖切除操作,记录操作时间。术前拍摄牙颌模型锥形束CT,模拟手术路径规划;术后拍摄锥形束CT,在导航精度分析软件中比较模拟与实际手术的路径在测量起点、终点和角度的偏差。结果对于起点偏差,新手与经验者间仅在自由手组中[分别为(1.44±0.49)、(1.02±0.58)mm]差异有统计学意义(q=4.67,P=0.020)。新手和经验者在终点和角度偏差上差异均无统计学意义(P>0.05)。新手组内,DN和SN亚组的起点偏差[(0.76±0.32)和(0.66±0.20)mm]均显著低于自由手亚组(q=7.58,P<0.001;q=8.66,P<0.001),两亚组的角度偏差(5.0°±3.5°、3.9°±2.1°)也均显著低于自由手亚组(10.9°±6.1°)(q=7.38,P<0.001;q=8.70,P<0.001)。经验者组中,DN、SN亚组仅在角度偏差(3.6°±1.9°、3.2°±1.7°)上与自由手亚组(8.2°±3.9°)相比差异均有统计学意义(q=5.74,P=0.001;q=6.29,P<0.001)。对于手术时间,使用DN和SN后,新手[DN和SN亚组分别为(4.80±2.15)、(1.09±0.48)min](q=14.60,P<0.001;q=20.10,P<0.001)和经验者[DN和SN亚组分别为(3.40±1.96)、(1.02±0.34)min](q=5.86,P<0.001;q=9.37,P<0.001)手术时间均显著短于使用自由手[新手和经验者组分别为(14.72±6.00)、(7.39±3.33)min]。对于不同牙位,新手和经验者使用自由手在前牙的操作时间均显著性少于后牙(q=8.14,P<0.001;q=5.20,P=0.007),而使用DN和SN时前后牙的操作时间差异均无统计学意义(P>0.05)。不同操作者、使用不同技术对前后牙操作的准确性差异均无统计学意义(P>0.05)。结论计算机辅助显微根尖手术有助于提高临床医师特别是新手操作的准确性,缩短操作时间。
Objective To assess and compare the accuracies and operating time of endodontic microsurgery performed by operators with different levels of experience in endodontics using computer-guided techniques including dynamic and static navigations in a surgical simulation model.Methods Six pairs of three dimensional(3D)-printed models of upper and lower jaws were set up on dental manikins.A total of 120 teeth(10 teeth each jaw)were included in the models.Microsurgeries of osteotomy and root-resection were performed on the models by two operators with different experience,namely novices and experts,under of free hand(FH)(n=20),dynamic navigation(DN)(n=20),and static navigation(SN)(n=20)conditions,respectively.The duration of each operation was recorded.Cone-beam CT was taken for 3D-printed models before and after the operation.The path of preoperative surgery planning was simulated.The linear deviations at the entry and the end point and the angular deviation of the access path between the simulated and the actual operation were compared by the software.Results Significant difference of the entry deviation was observed between the novices and the experts in the FH group[(1.44±0.49)and(1.02±0.58)mm](q=4.67,P=0.020).There were no significant differences between the novices and the experts in the end point and angular deviations(P>0.05).For the novices,the entry deviations in both DN and SN groups[(0.76±0.32)and(0.66±0.20)mm]were significantly lower than those in FH group(q=7.58,P<0.001;q=8.66,P<0.001).The angular deviations in the abovementioned two groups(5.0°±3.5°,3.9°±2.1°)were significantly lower than that in FH group(10.9°±6.1°)(q=7.38,P<0.001;q=8.70,P<0.001).For the experts,significant differences were found only in the angular deviations among DN,SN and FH groups(3.6°±1.9°,3.2°±1.7°and 8.2°±3.9°)(q=5.74,P=0.001;q=6.29,P<0.001).The operation durations were significantly shortened for both the novices[(4.80±2.15),(1.09±0.48)min](q=14.60,P<0.001;q=20.10,P<0.001)and the experts[(3.40±1.96),(1.02±0.34)min](q=5.86,P<0.001;q=9.37,P<0.001)by using DN and SN techniques.Regarding the differences between tooth types,in FH group,the operating time on the anterior teeth was significantly shorter than that on the posterior teeth(q=8.14,P<0.001;q=5.20,P=0.007),while in DN and SN groups,there were no significant differences in the operating time between two tooth types(P>0.05).No significant differences were discovered in the accuracies on the anterior and posterior teeth among three techniques or between two kinds of operators(P>0.05).Conclusions Dynamic and static navigation techniques could assist the clinicians,especially the novices,to improve the accuracies and shorten the operating time of osteotomy and root resection microsurgeries.
作者
陈晨
王富市
张睿
边专
孟柳燕
Chen Chen;Wang Fushi;Zhang Rui;Bian Zhuan;Meng Liuyan(The State Key Laboratory Breeding Base of Basic Science of Stomatology&Key Laboratory of Oral Biomedicine Ministry of Education,School of Stomatology,Wuhan University,Wuhan 430079,China)
出处
《中华口腔医学杂志》
CAS
CSCD
北大核心
2022年第1期44-51,共8页
Chinese Journal of Stomatology
基金
国家自然科学基金(81870761,82071107)。
