구강회복응용과학지 (Journal of Dental Rehabilitation and Applied Science)

  • 제28권4호
  • /
  • Pages.423-439
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  • 2012
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  • 2384-4353(pISSN)
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  • 2384-4272(eISSN)
대한턱관절교합학회 (Korean Academy of Stomatognathic Function and Occlusion)
권호 표지

상악 완전 무치악 환자의 CAD/CAM 을 이용한 임플란트 식립(NobelGuide$^{TM}$) 및 즉시하중 후 고정성 보철수복 증례

Implant Supported Fixed Restoration for Maxillary Edentulism using CAD/CAM Guided Implant Surgery (NobelGuide$^{TM}$) and Immediate Loading

  • 허윤혁 (분당서울대학교병원 치과 보철과) ;
  • 이양진 (분당서울대학교병원 치과 보철과) ;
  • 김대곤 (강릉원주대학교 치과대학 보철학교실 및 구강과학연구소) ;
  • 조리라 (강릉원주대학교 치과대학 보철학교실 및 구강과학연구소) ;
  • 박찬진 (강릉원주대학교 치과대학 보철학교실 및 구강과학연구소)
  • Huh, Yoon-Hyuk (Department of Prosthodontics, Section of dentistry, Seoul National University Bundang Hospital) ;
  • Yi, Yang-Jin (Department of Prosthodontics, Section of dentistry, Seoul National University Bundang Hospital) ;
  • Kim, Dae-Gon (Department of Prosthodontics and Research Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University) ;
  • Cho, Lee-Ra (Department of Prosthodontics and Research Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University) ;
  • Park, Chan-Jin (Department of Prosthodontics and Research Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University)
  • 투고 : 2012.09.03
  • 심사 : 2012.12.25
  • 발행 : 2012.12.30
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초록

NobelGuide$^{TM}$ 임플란트 시스템은 골량과 골질을 수술 전에 판단하여 점막을 젖히지 않고 미리 계획된 스텐트와 보철물을 이용하여 즉시하중을 부여하는 CAD/CAM 기반의 임플란트 보철 치료방법이다. 환자의 불편감을 최소화하여 미리 예측 가능한 위치에 임플란트를 식립함으로써 술 후 합병증 및 보철과정을 간소화 할 수 있는 장점이 있다. 본 증례의 환자는 56세 남성으로 상,하악 부분 무치악 상태였으며, 상악전치부 보철물 탈락과 하악 전치가 흔들린다는 주소로 내원하였다. 이에 상악 잔존치 모두와 하악 4전치 발거 및 치주치료를 실시한 뒤 임시 의치를 6개월간 사용하여 발치와 치유 및 의치 적응여부를 평가하였다. 골량은 충분하다고 판단되었고 환자의 협조도와 경제적인 여건, 전신건강 등 여러 사항이 양호하여 CAD/CAM 기반의 수술템플렛을 이용한 무판막 수술을 통해, 미리 제작된 임시 고정성 보철물로 즉시하중을 부여하는 상악 NobelGuide$^{TM}$ 임플란트 시스템을 계획하였다. 사용중인 임시의치를 이용하여 제작한 방사선 스텐트로 CT를 촬영하고, computer based planning (Procera$^{(R)}$ software)을 통해 3차원적인 골형상과 각 부위별 단면상을 참고하여 상악에 8개의 임플란트 식립체를 생역학적 관점 및 골조건을 고려하여 분산 배치하였다. 미리 제작된 임시 고정성 보철물을 임플란트 수술 후 즉시 장착 및 하중을 부여하여 기능하도록 하였으며 6개월 후 골유착 정도를 평가한 뒤 금속구조물을 이용한 최종 보철물을 제작하였다. 하악의 경우 전치부 도재전장주조금속관과 우측 구치부 임플란트 보철물 제작을 통해 상, 하악 치료를 마무리하였다.

This case report described a technique utilizing a computer-aided design (CAD)/computer-aided machining (CAM) - guided surgical implant placement and prefabricated temporary fixed prosthesis for an immediately loaded restoration. The advantages of CAD/CAM guided implant procedures are flapless, minimally invasive surgery and shorter surgery time. With this technique, less postoperative morbidity and delivery of prosthesis for immediate function would be possible. A patient with an edentulous maxilla received 8 implants in maxilla using CAD/CAM surgical templates. Prefabricated provisional maxillary implant supported fixed prosthesis were connected immediately after implant installation. Provisional prosthesis was evaluated for aesthetics, function during 6 months. Definitive implant supported fixed porcelain fused metal bridges were fabricated.

키워드

참고문헌

  1. Adell R, Lekholm U, Rockler B, Branemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981; 10: 387-416.
  2. Park H, Hwang J. Implant overdenture & fixed complete prosthesis. . Well Pub. Co. Seoul
  3. Sadowsky SJ. The implant-supported prosthesis for the edentulous arch: design considerations. J Prosthet Dent 1997; 78: 28-33.
  4. Tee-Khin N, Cheng AC, Lee H, Wee AG, Leong EW. The management of a completely edentulous patient using simultaneous maxillary and mandibular CAD/CAM-guided immediately loaded definitive implant-supported prostheses: a clinical report. J Prosthet Dent 2008; 99: 416-420.
  5. Fuster-Torres MA, Albalat-Estela S, Alcaniz-Raya M, Penarrocha-Diago M. CAD / CAM dental systems in implant dentistry: update. Med Oral Patol Oral Cir Bucal 2009; 14: E141-145.
  6. Strub JR, Rekow ED, Witkowski S. Computer-aided design and fabrication of dental restorations: current systems and future possibilities. J Am Dent Assoc 2006; 137: 1289-1296.
  7. Verstreken K, Van Cleynenbreugel J, Marchal G, Naert I, Suetens P, van Steenberghe D. Computer-assisted planning of oral implant surgery: a three-dimensional approach. Int J Oral Maxillofac Implants 1996; 11: 806-810.
  8. Szmukler-Moncler S, Piattelli A, Favero GA, Dubruille JH. Considerations preliminary to the application of early and immediate loading protocols in dental implantology. Clin Oral Implants Res 2000; 11: 12-25.
  9. Gapski R, Wang HL, Mascarenhas P, Lang NP. Critical review of immediate implant loading. Clin Oral Implants Res 2003; 14: 515-527.
  10. Ostman PO. Immediate/early loading of dental implants. Clinical documentation and presentation of a treatment concept. Periodontol 2000 2008; 47: 90-112.
  11. Degidi M, Piattelli A, Felice P, Carinci F. Immediate functional loading of edentulous maxilla: a 5-year retrospective study of 388 titanium implants. J Periodontol 2005; 76: 1016-1024.
  12. Horiuchi K, Uchida H, Yamamoto K, Sugimura M. Immediate loading of Branemark system implants following placement in edentulous patients: a clinical report. Int J Oral Maxillofac Implants 2000; 15: 824-830.
  13. Bergkvist G, Sahlholm S, Karlsson U, Nilner K, Lindh C. Immediately loaded implants supporting fixed prostheses in the edentulous maxilla: a preliminary clinical and radiologic report. Int J Oral Maxillofac Implants 2005; 20: 399-405.
  14. Aalam AA, Nowzari H, Krivitsky A. Functional restoration of implants on the day of surgical placement in the fully edentulous mandible: a case series. Clin Implant Dent Relat Res 2005; 7: 10-16.
  15. Wolfinger GJ, Balshi TJ, Rangert B. Immediate functional loading of Branemark system implants in edentulous mandibles: clinical report of the results of developmental and simplified protocols. Int J Oral Maxillofac Implants 2003; 18: 250-257.
  16. Ioannidou E, Doufexi A. Does loading time affect implant survival? A meta-analysis of 1,266 implants. J Periodontol 2005; 76: 1252-1258.
  17. Balshi SF, Wolfinger GJ, Balshi TJ. Surgical planning and prosthesis construction using computed tomography, CAD/CAM technology, and the Internet for immediate loading of dental implants. J Esthet Restor Dent 2006; 18: 312-323; discussion 324-315.
  18. Kupeyan HK, Shaffner M, Armstrong J. Definitive CAD/CAM-guided prosthesis for immediate loading of bone-grafted maxilla: a case report. Clin Implant Dent Relat Res 2006; 8: 161-167.
  19. van Steenberghe D, Glauser R, Blomback U, Andersson M, Schutyser F, Pettersson A, Wendelhag I. A computed tomographic scan-derived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae: a prospective multicenter study. Clin Implant Dent Relat Res 2005; 7 Suppl 1: S111-120.
  20. Marchack CB. An immediately loaded CAD/CAMguided definitive prosthesis: a clinical report. J Prosthet Dent 2005; 93: 8-12.
  21. Van Assche N, van Steenberghe D, Guerrero ME, Hirsch E, Schutyser F, Quirynen M, Jacobs R. Accuracy of implant placement based on pre-surgical planning of three-dimensional cone-beam images: a pilot study. J Clin Periodontol 2007; 34: 816-821.
  22. Yong LT, Moy PK. Complications of computer-aideddesign/ computer-aided-machining-guided (Nobel- Guide) surgical implant placement: an evaluation of early clinical results. Clin Implant Dent Relat Res 2008; 10: 123-127.
  23. Eggers G, Patellis E, Muhling J. Accuracy of template-based dental implant placement. Int J Oral Maxillofac Implants 2009; 24: 447-454.
  24. Valente F, Schiroli G, Sbrenna A. Accuracy of computer-aided oral implant surgery: a clinical and radiographic study. Int J Oral Maxillofac Implants 2009; 24: 234-242.
  25. Dreiseidler T, Neugebauer J, Ritter L, Lingohr T, Rothamel D, Mischkowski RA, Zoller JE. Accuracy of a newly developed integrated system for dental implant planning. Clin Oral Implants Res 2009; 20: 1191-1199.
  26. Eggers G, Senoo H, Kane G, Muhling J. The accuracy of image guided surgery based on cone beam computer tomography image data. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: e41-48.