动态导航引导下上颌部倾斜种植的临床效果评价

doi:10.19438/j.cjoms.2025.06.010

摘要/Abstract

摘要： 目的：分析动态导航引导下在上颌部进行倾斜种植的精准度和临床效果。方法：选取南京医科大学附属江宁医院2023年2月—2024年6月就诊的伴有上颌后牙区骨量不足的上颌牙列缺失或后牙缺失患者28例,在动态导航引导下进行倾斜种植和轴向种植。对比分析倾斜种植体和轴向种植体的术前设计位置和术后实际位置的偏离情况和种植失败率,观察术中、术后并发症情况和功能恢复情况。结果：共植入种植体97颗,其中倾斜种植体42颗,轴向种植体55颗。精准度测量显示,倾斜种植体和轴向种植体颈部偏差分别为（1.03±0.39）和（1.12±0.25）mm,尖部偏差分别为（1.21±0.23）和（1.29±0.32）mm,深度偏差分别为（0.63±0.20）和（0.54±0.34）mm,角度偏差分别为2.46°±0.68°和2.22°±0.57°。两组种植体的种植精准度各项指标均无显著差异（P>0.05）。术中未出现上颌窦损伤等并发症。1颗倾斜种植体和1颗轴向种植体在修复前脱落失败,种植失败率分别为2.38% 和1.82%,差异无统计学意义（P=0.885）。随访3~12个月,种植体和修复体稳定性良好,咀嚼功能恢复良好,无上颌窦炎发生。结论：动态导航引导下在上颌后牙区进行倾斜种植精准度高、安全性好、创伤小、治疗周期短,是上颌后牙区牙槽骨萎缩的有效治疗方法：。

关键词: 牙种植, 倾斜种植, 上颌骨萎缩, 动态导航, 精准度

Abstract: PURPOSE: To evaluate the accuracy and clinical outcomes of dynamic navigation for the placement of intentionally tilted implants in the posterior maxilla. METHODS: Twenty-eight patients with maxillary edentulism or continuous multiple posterior maxillary tooth loss who were treated in Affiliated Jiangning Hospital of Nanjing Medical University from February 2023 to June 2024 were selected. All patients were treated with axial and tilted implants under dynamic navigation guidance. Implant three-dimensional deviation was calculated after surgery, and survival rate of axial and tilted implants was compared. Follow up visits were performed every 3 months after rehabilitation with definitive prosthesis, and any complication was noted and the stability of the implants and prosthesis as well as proper occlusion were checked. RESULTS: A total of 97 implants were implanted, including 42 tilted implants and 55 axial implants. The accuracy measurement showed that the neck deviations of the inclined implant and the axial implant were (1.03±0.39) and (1.12±0.25) mm, respectively, the tip deviations were (1.21±0.23) and (1.29±0.32) mm, respectively, and the depth deviations were (0.63±0.20) and (0.54±0.34) mm, respectively, the angular deviations were 2.46°±0.68° and 2.22°±0.57°, respectively. There was no significant difference in the various indicators of implant accuracy between the two groups(P>0.05). No complications such as maxillary sinus injury occurred during operation. One tilted implant and one axial implant failed to fall off before restoration. The implant failure rates were 2.38% and 1.82%, respectively, and the difference was not significant(P=0.885). The patients were followed up for 3 to 12 months. The stability of the implants and restorations was good, the masticatory function recovered well, and no maxillary sinusitis occurred. CONCLUSIONS: Tilted implantation in the maxillary posterior region under the guidance of dynamic navigation has the advantages of high accuracy, good safety, minimal trauma and short treatment cycle. It is an effective method for the treatment of alveolar bone atrophy in the maxillary posterior region.

Key words: Dental implants, Tilted implants, Maxillary atrophy, Dynamic navigation, Accuracy

中图分类号:

R783

郑悦, 张森林. 动态导航引导下上颌部倾斜种植的临床效果评价[J]. 中国口腔颌面外科杂志, 2025, 23(6): 600-607.

Zheng Yue, Zhang Senlin. Clinical investigation on tilted implant placement in the maxilla using dynamic navigation[J]. China J Oral Maxillofac Surg, 2025, 23(6): 600-607.

参考文献

[1] Annibali S, Cristalli MP, Dell’Aquila D, et al. Short dental implants: a systematic review[J]. J Dent Res, 2012, 91(1): 25-32.
[2] 陈浚, 徐光宙. 上颌窦底提升技术的研究现状[J]. 中国口腔颌面外科杂志, 2023, 21(3): 291-300.
Chen J, Xu GZ.Current status of maxillary sinus floor augmentation technology[J]. China Journal of Oral and Maxillofacial Surgery, 2023, 21(3): 291-300.
[3] Angelis N, De Benedicenti S, Zekiy A, et al.Current trends in bone augmentation techniques and dental implantology: an editorial overview[J]. J Clin Med, 2022, 11(15): 4348-4354.
[4] Menini M, Signori A, Tealdo T, et al.Tilted implants in the immediate loading rehabilitation of the maxilla: a systematic review[J]. J Dent Res, 2012, 91(9): 821-827.
[5] 范震, 刘月, 王佐林. 牙列缺失倾斜种植设计[J]. 华西口腔医学杂志, 2021, 39(4): 377-385.
Fan Z, Liu Y, Wang ZL.Tilted implantation technique for edentulous patients[J]. West China Journal of Stomatology, 2021, 39(4): 377-385.
[6] Dryer RR, Conrad HJ.Displacement of a dental implant into the pterygoid fossa: a clinical report[J]. J Prosthodont, 2019, 28(9): 1044-1046.
[7] Krekmanov L, Kahn M, Rangert B, et al.Tilting of posterior mandibular and maxillary implants for improved prosthesis support[J]. Int J Oral Maxillofac Implants, 2000, 15(3): 405-414.
[8] Chan MH, Nudell YA.All-on-4 concept update[J]. Dent Clin North Am, 2021, 65(1): 211-227.
[9] Agliardi EL, Pozzi A, Stappert CF, et al.Immediate fixed rehabilitation of the edentulous maxilla: a prospective clinical and radiological study after 3 years of loading[J]. Clin Implant Dent Relat Res, 2014, 16(2): 292-302.
[10] Agliardi EA, Romeo D, Wenger A, et al.Immediate rehabilitation of the posterior maxilla with extensive sinus pneumatization with one axial and one trans-sinus tilted implant: a 3-year clinical report and a classification[J]. J Prosthet Dent, 2015, 113(1): 163-168.
[11] Aalam AA, Krivitsky-Aalam A, Zelig D, et al.Trans-sinus dental implants, for immediate placement when insufficient alveolar height is present: an alternative to zygomatic implants-surgical case series[J]. Ann Med Surg (Lond), 2023, 85(1): 51-56.
[12] Grandi T, Faustini F, Casotto F, et al.Immediate fixed rehabilitation of severe maxillary atrophies using trans-sinus tilted implants with or without sinus bone grafting: one-year results from a randomised controlled trial[J]. Int J Oral Implantol(Berl), 2019, 12(2): 141-152.
[13] Maló P, Nobre Md, Lopes A.Immediate load of “all-on-4” maxillary prostheses using trans-sinus tilted implants without sinus bone grafting: a retrospective study reporting the 3-year outcome[J]. Eur J Oral Implant, 2013, 6(3): 273-283.
[14] Zaninovich M.Immediate rehabilitation of the severely atrophic maxilla using trans-sinus nasal protocol and extended length subcrestal angulated (ELSA) implants. case series with one-year follow up[J]. J Oral Implantol, 2022, 48(2): 117-124.
[15] Agliardi EL, Francetti L, Romeo D, et al.Immediate rehabilitation of the edentulous maxilla: preliminary results of a single-cohort prospective study[J]. Int J Oral Maxillofac Implants, 2009, 24(5): 887-895.
[16] Araujo RZ, Santiago Júnior JF, Cardoso CL, et al.Clinical outcomes of pterygoid implants: systematic review and meta-analysis[J]. J Craniomaxillofac Surg, 2019, 47(4): 651-660.
[17] Balaji VR, Lambodharan R, Manikandan D, et al.Pterygoid implant for atrophic posterior maxilla[J]. J Pharm Bioallied Sci, 2017, 9(Suppl 1): S261-S263.
[18] Ren J, Shu L.Pterygoid implant-based “VIV” design for rehabilitation of extreme maxillary atrophy[J]. J Craniofac Surg, 2022, 33(7): 2195-2198.
[19] Lim TJ, Csillag A, Irinakis T, et al.Intentional angulation of an implant to avoid a pneumatized maxillary sinus: a case report[J]. J Can Dent Assoc, 2004, 70(3): 164-168.
[20] Guo H, Jiang X, Di P, et al.A novel method to achieve preferable bone-to-implant contact area of zygomatic implants in rehabilitation of severely atrophied maxilla[J]. Int J Oral Maxillofac Implants, 2023, 38(1): 111-119.
[21] Molinero-Mourelle P, Baca-Gonzalez L, Gao B, et al.Surgical complications in zygomatic implants: a systematic review[J]. Med Oral Patol Oral Cir Bucal, 2016, 21(6): e751-e757.
[22] 张卉卉, 黄志, 杨小东, 等. 定制基台用于上颌后牙区倾斜种植体修复的临床研究[J]. 中国口腔种植学杂志, 2013, 18(1): 18-21.
Zhang HH, Huang Z, Yang XD, et al.Clinical studies of using custo-made abutments on tilted implants in the posterior region of maxilla[J]. Chinese Journal of Oral Implantology, 2013, 18(1): 18-21.
[23] Aydemir CA, Arisan V.Accuracy of dental implant placement via dynamic navigation or the freehand method: a split-mouth randomized controlled clinical trial[J]. Clin Oral Impl Res, 2020, 31(3): 255-263.
[24] Deng H, Geng N, Yang S, et al.Clinical study of dynamic navigation-assisted immediate implant placement in posterior maxillary alveolar bone defects[J]. BMC Oral Health, 2025, 25(1): 617-625.
[25] Block MS, Emery RW, Cullum DR, et al.Implant placement is more accurate using dynamic navigation[J]. J Oral Maxillofac Surg, 2017, 75(7):1377-1386.