The Journal of Korean Academy of Prosthodontics (대한치과보철학회지)

The Korean Academy of Prosthodonitics (대한치과보철학회)
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Accuracy assessment of implant placement using a stereolithographic surgical guide made with digital scan

디지털 스캔을 이용하여 제작된 임플란트 수술가이드의 정확도

  • Jeong, Seung-Mi (Department of Prosthodontics, Wonju College of Medicine, Yonsei University) ;
  • Fang, Jeong-Whan (Department of Prosthodontics, Wonju College of Medicine, Yonsei University) ;
  • Hwang, Chan-Hyeon (Department of Prosthodontics, Wonju College of Medicine, Yonsei University) ;
  • Kang, Se-Ha (Department of Prosthodontics, Wonju College of Medicine, Yonsei University) ;
  • Choi, Byung-Ho (Department of Oral and Maxillofacial Surgery, Wonju College of Medicine, Yonsei University) ;
  • Fang, Yiqin (Department of Oral and Maxillofacial Surgery, Wonju College of Medicine, Yonsei University) ;
  • Jeon, Hyongtae (Dio research institute) ;
  • An, Sunghun (Dio research institute)
  • 정승미 (연세대학교 원주의대 치과보철과) ;
  • 방정환 (연세대학교 원주의대 치과보철과) ;
  • 황찬현 (연세대학교 원주의대 치과보철과) ;
  • 강세하 (연세대학교 원주의대 치과보철과) ;
  • 최병호 (연세대학교 원주의대 구강악안면외과) ;
  • 방일흠 (연세대학교 원주의대 구강악안면외과) ;
  • 전형태 (부산 디오임플란트연구소) ;
  • 안성훈 (부산 디오임플란트연구소)
  • Received : 2015.01.13
  • Accepted : 2015.03.02
  • Published : 2015.04.30
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Abstract

Purpose: The objective of this study was to evaluate the accuracy of a stereolithographic surgical guide that was made with information from intraoral digital impressions and cone beam CT (CBCT). Materials and methods: Six sets of resin maxilla and mandible models with missing teeth were used in this study. Intraoral digital impressions were made. The virtual models provided by these intraoral digital impressions and by the CBCT scan images of the resin models were used to create a surgical guide. Implant surgery was performed on the resin models using the surgical guide. After implant placement, the models were subjected to another CBCT scan to compare the planned and actual implant positions. Deviations in position, depth and axis between the planned and actual positions were measured for each implant. Results: The mean deviation of the insertion point and angulation were 0.28 mm and $0.26^{\circ}$, apex point were 0.11 mm and 0.14 mm respectively. The implants were situated at a mean of 0.44 mm coronal to the planned vertical position. Conclusion: This study demonstrates that stereolithographic surgical guides created without the use of impressions and stone models show promising accuracy in implant placement.

목적: 인상재와 석고모형을 사용하지 않고 디지털 영상 만을 사용하여 제작된 수술가이드를 이용한 치과 임플란트 수술의 정확도를 평가하고자 하였다. 재료 및 방법: 상하악 부분 무치악 모델 6개 세트를 본 연구에 사용하였다. 모델을 환자 구강구조로 간주하고 부분 무치악 모델을 Trios 구강스캐너로 디지털 인상을 채득하였다. 수술가이드의 정확도 평가를 위해 제작된 Reference plate를 모델의 교합면에 고정한 상태로 CBCT를 촬영하였다. CBCT에서 얻은 영상과 디지털 인상에서 얻은 영상을 정합하고 정합한 영상에서 임플란트 식립위치를 진단하고 수술가이드를 디자인하였다. 제작된 수술가이드를 이용하여 부분 무치악 모델에서 임플란트를 식립하였다. 시술 후, 시술 전과 동일한 방법으로 CBCT를 촬영하여 시술 전 컴퓨터 소프트웨어에서 측정한 수치와 시술 후 CBCT촬영하여 소프트웨어상에서 측정한 시술 후 수치 사이 차이점을 비교하였다. 결과: 평균거리오차가 임플란트 상단 X축에서 0.27 mm, Y축에서 0.29 mm 였으며, 임플란트 하단(Apex)부위에서는 X축에서 0.11 mm, Y축에서 0.14 mm 평균각도오차가 X축에서 $0.26^{\circ}$, Y축에서 $0.26^{\circ}$ 였다. 평균수직오차는 +0.44 mm로 시술 전 계획한 높이보다 평균 0.44 mm 더 위로 임플란트가 식립되었다. 결론: 본 연구의 결과는 인상재와 석고모형을 사용하지 않고 디지털 영상 만을 사용하여 제작된 수술가이드를 사용하여 임플란트를 시술할 경우 계획한 임플란트 식립 위치와 방향으로 높은 정확도를 가지고 임플란트를 식립할 수 있음을 보여 주었다.

Keywords

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