摘要
目的：利用锥形束计算机断层扫描（CBCT）评估模板引导颧种植体植入的三维精度，并量化计划位置与实际位置之间的线性、角度和方向偏差。
方法：本回顾性病例系列纳入14例使用静态骨支持立体光固化手术导板进行21颗颧种植体修复的患者。通过基于体素的配准，将术前虚拟计划（.stl文件）与术后CBCT扫描进行比较。分析计划（P1, P2）和实际（P3, P4）种植体颈部和根尖的位置，计算垂直偏移（v3, v4）和水平偏移（h3, h4）、角度偏差（θ），以及描述偏差传播的差异参数（Δv = v4-v3, Δh = h4-h3）。采用基于矢量的几何模型分别量化沿种植体轨迹的轴向和径向偏差。采用非参数检验（Wilcoxon符号秩检验，p < 0.05）。
结果：中位偏差如下：v3 = +0.12 mm，h3 = 1.18 mm，v4 = -0.05 mm，h4 = 1.98 mm，θ = 1.05°。偏移变化显示Δv = -0.35 mm，Δh = +0.81 mm。根尖处的水平偏差显著大于颈部（p = 0.0002），而两个种植体层面的垂直偏差差异显著（p = 0.0057）。大多数种植体（约71%）呈现Q4模式（-Δv, +Δh），表明轴向插入深度减少伴随沿种植体轴线的侧向位移增加。总体而言，偏差保持在2 mm和2°以下，证实了由修复驱动的颧种植体植入具有临床可接受的精度。
结论：静态模板引导的颧种植体手术实现了高空间精度，角度和线性偏差有限。基于矢量的分析显示主要存在Q4偏差模式，其特征为轻度侧向放大伴随轴向插入深度减少。尽管变异度高于常规种植位点，但结果支持基于静态CBCT的引导在颧种植体修复中的临床可靠性。
原文摘要
PURPOSE: To evaluate the three-dimensional accuracy of template-guided zygomatic implant placement using cone-beam computed tomography (CBCT) and to characterize linear, angular, and directional discrepancies between planned and actual implant positions.
METHODS: This retrospective case series included 14 patients rehabilitated with 21 zygomatic implants using static, bone-supported, stereolithographic surgical guides. Preoperative virtual plans (.stl files) were compared with postoperative CBCT scans through voxel-based registration. The positions of planned (P1, P2) and actual (P3, P4) implant necks and apices were analyzed to compute vertical (v3,v4) and horizontal (h3, h4) offsets, angular deviation (θ), and differential parameters describing deviation propagation (Δv = v4-v3, Δh = h4-h3). A vector-based geometric model was used to separately quantify axial and radial deviations along the implant trajectory. Nonparametric tests were performed (Wilcoxon signed-rank, p < 0.05).
RESULTS: Median deviations were as follows: v3 = + 0.12 mm, h3 = 1.18 mm, v4 = - 0.05 mm, h4 = 1.98 mm, and θ = 1.05°. The change in offsets revealed Δv = - 0.35 mm and Δh = + 0.81 mm. Horizontal deviations were significantly greater at the apex than at the neck (p = 0.0002), whereas vertical deviations differed significantly between the two implant levels (p = 0.0057). Most implants (≈ 71%) showed a Q4 pattern (-Δv, +Δh), indicating reduced axial insertion depth associated with increased lateral displacement along the implant axis. Overall, deviations remained below 2 mm and 2°, confirming clinically acceptable precision for prosthetically driven zygomatic implant placement.
CONCLUSION: Static template-guided zygomatic implant surgery achieved high spatial accuracy with limited angular and linear deviations. The vector-based analysis demonstrated a predominant Q4 deviation pattern characterized by mild lateral amplification associated with reduced axial insertion depth. Despite higher variability than conventional implant sites, the results support the clinical reliability of static CBCT-based guidance for zygomatic implant rehabilitation.
出处
Oral and maxillofacial surgery 2026;30(1). DOI: 10.1007/s10006-026-01598-6.
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