动态导航辅助环钻取骨的准确性

doi:10.19723/j.issn.1671-167X.2026.02.022

摘要/Abstract

摘要：

目的: 评估在颏部和外斜线区域使用动态导航辅助环钻法取骨的准确性。方法: 设计并使用3D打印技术以聚醚酮酮(polyetheretherketone, PEKK)材料制作10个标准下颌骨模型以模拟天然下颌骨的力学性能。实验前拍摄模型的锥形束CT(cone beam CT，CBCT)，参数设定为管电压70 kV、管电流70 mA、体积像素250 μm。将数据导入动态导航软件(迪凯尔公司，中国)，并在颏部(距前牙≥15 mm)和外斜线区域(距磨牙≥6 mm)各2个常规手术位点设计具有相同深度(6 mm)和直径(8 mm)的圆柱形预备道。使用20 mm和50 mm长度的球钻完成导航系统标定后，在动态导航辅助下于每个位点使用8 mm外径的环钻完成共计40个位点的预备道制备。拍摄术后模型的CBCT，利用Mimics 20.0软件(Materialise公司，比利时)将实际预备道拟合成标准圆柱体，并基于金属配准标记将实际预备道与设计预备道叠加，测量进入中心点偏差、结束中心点偏差、深度偏差及中心轴角度偏差，比较不同供区的准确性差异。结果: 动态导航辅助环钻取骨的进入及结束中心点误差分别为(1.91±0.69) mm和(1.54±0.66) mm，深度误差为(－0.83±0.77) mm，中心轴角度差为3.02°±0.38°，其中在颏部和外斜线的进入中心点误差分别为(1.32±0.36) mm和(2.50±0.35) mm(P＜0.01)，结束中心点误差分别为(1.06±0.31) mm和(2.02±0.56) mm(P＜0.01)，深度误差分别为(－0.30±0.52) mm和(－1.38±0.57) mm(P＜0.01)，中心轴角度差分别为3.03°±0.38°和3.00°±0.39°(P=0.80)。结论: 在本研究的局限性范围内，动态导航辅助环钻取骨有着良好的准确性表现，其中颏部取骨准确性优于外斜线区域，这可能与两个区域的骨表面形态及手术操作等因素的差异有关；本研究结果为动态导航辅助环钻法取骨技术的临床应用提供了参考数据，但仍需要后续临床研究进一步验证其准确性。

关键词: 牙种植, 外科导航系统, 骨移植

Abstract:

Objective: To evaluate the positional accuracy of dynamic navigation-assisted trephine bone harvesting in the symphysis and external oblique ridge. Methods: Ten standardized mandibular models were 3D-printed using polyetheretherketone (PEEK), mimicking natural mandibular mechanical properties. Pre-operative cone beam CT (CBCT) scans (70 kV, 70 mA, 0.25 mm×0.25 mm ×0.25 mm voxel) were acquired, and data were imported into dynamic navigation software (Dcarer, China). Two donor sites were designed in both the symphysis (≥15 mm from anterior teeth) and external oblique ridge (≥6 mm from molars), with 8 mm-diameter, 6 mm-deep cylindrical osteotomy tracts planned for each site.After calibrating the navigation system with 20 mm and 50 mm spherical burs, an 8 mm outer-diameter trephine prepared 40 tracts under real-time guidance. Post-operative CBCT scans were taken, and Mimics 20.0 software fitted actual tracts to standard cylinders. Superimposing actual and designed tracts via metal registration markers, we measured coronal/apical center point deviation, depth deviation, and axis angle deviation in order to compare site-specific accuracy. Results: Deviations of the dynamic navigation-assisted trephine method for bone harvesting was (1.91±0.69) mm at the coronal center point, (1.54±0.66) mm at the apical center point, (－0.83±0.77) mm at the depth of the apical center point and 3.02°±0.38° at the axis angle. The four deviations in symphysis and external oblique ridge were (1.32±0.36) mm and (2.50±0.35) mm at the coronal center point (P < 0.01), (1.06± 0.31) mm and (2.02±0.56) mm at the apical center point (P < 0.01), (－0.30±0.52) mm and (－1.38±0.57) mm at the depth of apical center point (P < 0.01), 3.03°± 0.38° and 3.00°± 0.39° at axis angle (P=0.80). Conclusion: Within the limitations of this study, dynamic navigation-assisted trephine harvesting shows good accuracy. The symphysis exhibits higher accuracy than the external oblique ridge, possibly due to surface morphology and operability differences. These findings support its clinical potential, but future clinical studies are needed to validate results.

Key words: Dental implant, Surgical navigation systems, Bone transplantation

中图分类号:

R783

刘嘉昱, 祝宁, 张育祯, 高贤明, 张宇. 动态导航辅助环钻取骨的准确性[J]. 北京大学学报（医学版）, 2026, 58(2): 365-371.

Jiayu LIU, Ning ZHU, Yuchen CHANG, Xianming GAO, Yu ZHANG. Accuracy of dynamic navigation-assisted trephine method for bone harvesting[J]. Journal of Peking University (Health Sciences), 2026, 58(2): 365-371.

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Deviations	n	${\bar x}$±s	Minimum	Maximum
Coronal center point/mm	40	1.91±0.69	0.64	3.12
Apical center point/mm	40	1.54±0.66	0.41	2.94
Depth of apical center point/mm	40	－0.84±0.77	－2.22	0.63
Axis angle/(°)	40	3.02±0.38	2.11	3.72

Deviations	Donor sites	n	${\bar x}$±s	Minimum	Maximum	t	P
Coronal center point/mm	Symphysis	20	1.32±0.36	0.64	1.98	－10.42	＜0.01
Coronal center point/mm	External oblique line	20	2.50±0.35	1.98	3.12	－10.42	＜0.01
Apical center point/mm	Symphysis	20	1.06±0.31	0.41	1.57	－6.70	＜0.01
Apical center point/mm	External oblique line	20	2.02±0.56	0.86	2.94	－6.70	＜0.01
Depth of apical center point/mm	Symphysis	20	－0.30±0.52	-1.13	0.63	4.81	＜0.01
Depth of apical center point/mm	External oblique line	20	－1.38±0.57	-2.22	-0.55	4.81	＜0.01
Axis angle/(°)	Symphysis	20	3.03±0.38	2.43	3.72	0.26	0.80
Axis angle/(°)	External oblique line	20	3.00±0.39	2.11	3.56	0.26	0.80

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