제작방법에 따른 임플란트 수술 가이드의 정확성비교 : stereolithography와 positioning device로 제작한 수술 가이드

권창렬,최병호,정승미,주상돈 대한치과보철학회 2012 대한치과보철학회지 Vol.50 No.4

연구 목적: 최근 정확하면서도 외상이 적은 임플란트 식립을 위해 임플란트 수술용 가이드가 많이 쓰이고 있다. 그 중 대표적인 방식이 stereolithography 방식과 positioning device로 제작한 방식이다. 본 연구는 이 두 가지 방식의 정확성을 비교하기 위하여 4 가지 형태의 치아상실 모델에서 실험 후 정확성에 관하여 분석하였다. 연구 재료 및 방법: 4가지 형태 치아 결손 모델 각각에 대하여 stereolithography 방법과 positioning device를 이용한 방법으로 수술 가이드를 제작하였다. 제작된 수술 가이드를 제작에 사용되었던 치아모델에 장착하여 수술 가이드의 내면과 모델의 치아표면 사이 공간크기를 측정하여 가이드의 적합도를 평가하였다. 또한 이 수술 가이드를 이용하여 총 40개 모델에서 임플란트 시술을 진행하고, 시술 후 모델을 다시cone-beam computed tomography촬영 하여 수술 전후 영상을 중첩시켜 계획 상의 임플란트와 실제 시술한 임플란트의 위치를 비교하였다. 통계학적인 검증을 위하여 PASW Statistics 18.0을 이용하여서 Mann-Whitney U 검정을 사용하였다. 결과: 수술 가이드 내면과 모델 사이 공간크기가 stereolithography는1.4 ± 0.3 mm이고, positioning device는 0.4 ± 0.3 mm로 통계학적으로 유의한 차이를 보였다(P<.05). Stereolithography는 오차가 근원심 측에서 3.9 ± 1.6, 협설 측에서 2.7 ± 1.5, 깊이에서 1.9 ± 0.9 mm였다. 반면 positioning device는 오차가 근원심 측에서 0.7 ± 0.3였고, 협설측에서 0.3 ± 0.2, 깊이에서 0.4 ± 0.2 mm였다. 두 수술 가이드 제작방법은 모든 방향에서의 오차에서 통계학적으로 유의한 차이를 보였다(P<.05). 결론: 본 연구의 결과는 stereolithography 방법보다 positioning device를 이용하여 수술 가이드를 제작할 때 C.T.와 임플란트 치료 계획 프로그램을 이용하여 미리 계획한 임플란트 식립 위치와 방향으로 더 정확하게 식립 할 수 있음을 보여 주었다. Purpose: Recently implant surgical guides were used for accurate and atraumatic operation. In this study, the accuracy of two different types of surgical guides, positioning device fabricated and stereolithography fabricated surgical guides, were evaluated in four different types of tooth loss models. Materials and methods: Surgical guides were fabricated with stereolithography and positioning device respectively. Implants were placed on 40 models using the two different types of surgical guides. The fitness of the surgical guides was evaluated by measuring the gap between the surgical guide and the model. The accuracy of surgical guide was evaluated on a pre- and post-surgical CT image fusion. Results: The gap between the surgical guide and the model was 1.4 ± 0.3 mm and 0.4 ± 0.3 mm for the stereolithography and positioning device surgical guide, respectively. The stereolithography showed mesiodistal angular deviation of 3.9 ± 1.6, buccolingual angular deviation of 2.7 ± 1.5and vertical deviation of 1.9 ± 0.9 mm, whereas the positioning device showed mesiodistal angular deviation of 0.7 ± 0.3, buccolingual angular deviation of 0.3 ± 0.2and vertical deviation of 0.4 ± 0.2 mm. The differences were statistically significant between the two groups (P<.05). Conclusion: The laboratory fabricated surgical guides using a positioning device allow implant placement more accurately than the stereolithography surgical guides in dental clinic.

Reliability of a chairside CAD-CAM surgical guide for dental implant surgery on the anterior maxilla: An in vitro study

Phyo Ei Ei Htay,이성복,이석원,이유진,Kyung Lhi Kang,Sung Ok Hong 대한치과보철학회 2023 The Journal of Advanced Prosthodontics Vol.15 No.5

PURPOSE. This study evaluated the reliability of the chair-side CAD-CAM surgical guide (CSG) in the anterior maxilla by comparing its accuracy with the laboratory 3D-printed surgical guide (3DSG) and manual surgical guide (MSG) concerning different levels of dentists' surgical experience. MATERIALS AND METHODS. Ten surgical guides of each type (MSG, 3DSG, and CSG) were fabricated on a control study model with missing right and left central incisors. Sixty implants were placed in 30 study models by two dentists (one inexperienced and one experienced) using three different types of surgical guides. Horizontal deviations at shoulder and at apex, vertical, and angular deviations were measured after superimposing the planned and placed implant positions in the software. Kruskal-Wallis and Mann-Whitney U tests were used to compare the accuracy of three types of surgical guides in each dentist group and the accuracy of each surgical guide between two dentists (α = .05). RESULTS. There were no significant differences in any deviations between CSG and 3DSG, apart from angular deviation, for both dentists’ groups. Moreover, both CSG and 3DSG showed no significant differences in accuracy between the two dentists (P > .05). In contrast, MSG demonstrated significant differences from CSG and 3DSG and a significant difference in accuracy between the two dentists (P < .05). CONCLUSION. CSG provides superior accuracy to MSG in implant placement in the maxillary anterior region and is comparable to 3DSG at different levels of surgical experience, while offering the benefits of shorter manufacturing time and reduced patient visits.

Clinical Precautions for Implant Placement using Computer-guided Implant Surgical Guide: A Systematic Review

배재휘,이수영 대한구강악안면임플란트학회 2021 대한구강악안면임프란트학회지 Vol.25 No.4

Purpose: The purpose of this study was to review the literature related to implant deviations that may occur when using a computer-guided implant surgical guide and to consider clinical precautions to reduce these deviations when placing implants using a computer-guided implant surgical guide. Materials and Methods: Articles published between 2010 and 2020 were searched in PubMed according to custom criteria. The selected articles were classified according to the cause of the deviation, and the degree of the deviation was analyzed. Results: Twelve articles were included based on the selection criteria. During implant surgery using a computer-guided implant surgical guide, various implant deviations were observed depending on the implant location, sleeve, drill, implant system, residual teeth, and 3D printer type. Conclusion: Deviations in implant placement can occur even when computer-guided implant surgical guide are used. It is necessary to recognize the possibility of implant deviations occurring according to various clinical situations and attempt to reduce these deviations.

Wire-guided Localization Biopsy to Determine Surgical Margin Status in Patients with Non-palpable Suspicious Breast Lesions

Dogan, Lutfi,Gulcelik, M. Ali,Yuksel, Murat,Uyar, Osman,Reis, Erhan Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.10

Purpose: Guide-wire localization (GWL) has been a standard technique for many years. Excision of nonpalpable malignant breast lesions with clear surgical margins reduces the risk of undergoing re-excision. The objective of the present study was to evaluate the efficacy of GWL biopsy for assessing surgical margins. Methods: This retrospective study concerned 53 patients who underwent GWL biopsy for non-palpable breast lesions and breast carcinoma diagnosed by histological examination. Age of the patients, tumour size, radiographic findings, breast density specifications, specimen volumes, menopausal status and family history of the patients and surgical margin status were recorded. Results: Median age was 53.3 years, median tumour size was 1.5 cm and median specimen volume was $71.5cm^3$. In fifteen patients (28%) DCIS and in 38 patients (72%) invasive ductal carcinoma was diagnosed. There was positive surgical margins in twenty eight (52.8%) patients. The median distance to the nearest surgical margin was 7.2 mm in clear surgical margins. Younger age and denser breast specifications were found as statistically significant factors for surgical margin status. Median age of the patients who had positive margins was 49.4 years where it was 56.9 years in the patients with negative margins (p=0.04). 79% of the patients with positive margins had type 3-4 pattern breast density according to BIRADS classification as compared to 48% in the patients who had negative margins (p=0.03). Some 38 patients who had positive or close surgical margins received re-excision (72%). Conclusion: Positive margin rates may be higher because of inherent biological differences and diffuse growth patterns in younger patients. There are also technical difficulties that are relevant to denser fibroglandular tissue in placing hooked wire. High re-excision rates must be taken into consideration while performing GWL biopsy in non-palpable breast lesions.

임플란트 수술용 가이드를 이용하여 임플란트를 식립한 환자의 만족도

이재라 한국치위생과학회 2022 대한치위생과학회지 Vol.5 No.2

Background: This study was aimed at improving the satisfaction of patients with implants placed using an implant surgical guide by analyzing patient satisfaction with the implant procedure carried out using the guide . Methods: We extracted convenient samples from patients with implants who had visited dental hospitals and clinics in Mokpo from March 2 to June 30, 2022. We used 228 copies of the self-report survey for analyses. Results: All items of implant satisfaction were positively correlated with the use of an implant surgical guide. Conclusions:The results of this study showed that implant satisfaction can be increased with the use of implant surgical guides.

네비게이션 수술용 가이드를 이용한 치조정 접근식 상악동 거상술 : 증례보고

나지연(Jiyeon Na),조란영(Ranyeong Cho),장원석(Won-Seok Jang),조승원(Seoung-Won Cho),이상민(Sangmin Yi),온성운(Sung-Woon On),양병은(Byoung-Eun Yang),변수환(Soo-Hwan Byun) 대한치과의사협회 2021 대한치과의사협회지 Vol.59 No.10

Objective : The purpose of this study is to introduce a novel method for safe and precise crestal approach technique for sinus augmentation and implant placement using digital technology. The study further aims to verify effectiveness of the technique in implant placement and sinus augmentation. Materials and Methods : 5 patients who needed crestal approach sinus augmentation for implant placement were collected. There were more than 4mm residual bone in those patients. Intraoral image taking and CBCT taking were performed for digital planning. Digital planning was conducted for crestal approach sinus augmentation and implant placement. 2 navigation surgical guides (crestal/implant) were fabricated for each patient. Results : 10 implants were placed in the patients without specific problems by using crestal approach surgical guide and implant surgical guide. Conclusion : Crestal approach for maxillary sinus augmentation by using navigation surgical guide would be a reliable treatment option for successful implant placement in insufficient residual bone height of maxilla.

A Method for Fluoroscopy Based Navigation System to Assist Needle Insertion Concerning Reduced Radiation Exposure for Endoscopic Disc Surgery

Jinkon Park,Hyon Min Yoon,Siyeop Yoon,Malinda Vania,Deukhee Lee 제어로봇시스템학회 2015 제어로봇시스템학회 국제학술대회 논문집 Vol.2015 No.10

Endoscopic disc surgery requires a process of inserting a guide-needle to the target lumbar disc. And the insertion path is manually planned by drawing lines on the patient’s skin while monitoring the fluoroscopic view of the lumbar. Such operative procedure inevitably exposes both surgeon and patient to the fluoroscopic radiation emitted from c-arm for a long time. To reduce the radiation exposure time, this study proposes a computer assisted operative planning method implemented by using computer vision and computer graphics theory. This method calculates the 3-dimensional path line of guide-needle from multiple triangular planes. Triangular planes can be obtained by analyzing 2-dimensional images of patient’s disc in 3 different angles from rotationally movable c-arm. Additionally, a method of guiding robot’s control based on the 3-dimensional needle path was developed by implementing the Hand-eye (end-effector and camera) calibration. Hand-eye calibration method calculates the geometric transformation matrix between the c-arm coordinate system and base of guidance robot coordinate system. The proposed system was then tested for its accuracy.

Genioplasty using a simple CAD/CAM (computer-aided design and computer-aided manufacturing) surgical guide

Lim, Se-Ho,Kim, Moon-Key,Kang, Sang-Hoon Korean Association of Maxillofacial Plastic and Re 2015 Maxillofacial Plastic Reconstructive Surgery Vol.37 No.-

Background: The present study introduces the design and fabrication of a simple surgical guide with which to perform genioplasty. Methods: A three-dimensional reconstruction of the patient's cranio-maxilla region was built, with a dentofacial skeletal model, then derived from CT DICOM data. A surgical simulation was performed on the maxilla and mandible, using three-dimensional cephalometry. We then simulated a full genioplasty, in silico, using the three-dimensional (3D) model of the mandible, according to the final surgical treatment plan. The simulation allowed us to design a surgical guide for genioplasty, which was then computer-rendered and 3D-printed. The manufactured surgical device was ultimately used in an actual genioplasty to guide the osteotomy and to move the cut bone segment to the intended location. Results: We successfully performed the osteotomy, as planned during a genioplasty, using the computer-aided design and computer-aided manufacturing (CAD/CAM) surgical guide that we initially designed and tested using simulated surgery. Conclusions: The surgical guide that we developed proved to be a simple and practical tool with which to assist the surgeon in accurately cutting and removing bone segments, during a genioplasty surgery, as preoperatively planned during 3D surgical simulations.

Investigating the accuracy of mandibulectomy and reconstructive surgery using 3D customized implants and surgical guides in a rabbit model

Min Keun Kim,Min Ji Ham,Won Rae Kim,Hyung Giun Kim,Kwang Jun Kwon,Seong Gon Kim,Young Wook Park 대한악안면성형재건외과학회 2023 Maxillofacial Plastic Reconstructive Surgery Vol.45 No.-

Background This study aimed to analyze the accuracy of the output of three-dimensional (3D) customized surgical guides and titanium implants in a rabbit model, and of mandibulectomy, reconstructive surgery, and surgical outcome; additionally, the correlation between surgical accuracy and surgical outcomes, including the differences in surgical outcome according to surgical accuracy, was analyzed. Results The output of implants was accurately implemented within the error range (− 0.03–0.03 mm), and the surgical accuracy varied depending on the measured area (range − 0.4–1.1 mm). Regarding surgical outcomes, angle between the mandibular lower borders showed the most sensitive results and distance between the lingual cusps of the first molars represented the most accurate outcomes. A significant correlation was noted between surgical accuracy in the anteroposterior length of the upper borders pre- and postoperatively and the angle between the mandibular lower borders (regression coefficient = 0.491, p = 0.028). In the group wherein surgery was performed more accurately, the angle between the mandibular lower borders was reproduced more accurately (p = 0.021). A selective laser melting machine accurately printed the implants as designed. Considering the positive correlation among surgical accuracy in the mandibular upper borders, angle between the mandibular lower borders, and more accurately reproduced angle between the mandibular lower borders, the angle between the mandibular lower borders is considered a good indicator for evaluating the outcomes of reconstructive surgery. Conclusion To reduce errors in surgical outcomes, it is necessary to devise a positioner for the surgical guide and design a 3D surgical guide to constantly maintain the direction of bone resection. A fixed area considering the concept of three-point fixation should be selected for stable positioning of the implant; in some cases, bilateral cortical bone fixation should be considered. The angle between the mandibular lower borders is a sensitive indicator for evaluating the outcomes of reconstructive surgery.

라인 레이저를 이용한 수술기기 삽입 유도 시스템의 제어 방법

박철우(Chul-Woo Park),박일형(Il-Hyung Park),정상현(Sanghyun Joung) 한국정보기술학회 2018 한국정보기술학회논문지 Vol.16 No.5

In orthopedic surgery, the medical staff determines the insertion position and direction of the surgical instrument, depending on the 2D fluoroscopic images taken with the C-arm and the clinical experience. Such a surgical technique is not only difficult to accurately treat, but also causes medical staff to experience radiation exposure problems. In this paper, we propose a system and a control method to indicate insertion position and direction of surgical instruments by attaching two line laser projection devices to C-arm head. In the proposed system, if the insertion position and direction of the surgical instrument are specified, two line lasers are projected on the lesion to guide the insertion position and direction of the surgical instrument. The medical staff can insert the surgical instrument such as the fixing screw in the position and direction guided by the line laser, so that it can be treated more quickly and accurately than the existing surgical method. The surgical instrument insertion guiding system proposed in this paper can reduce the radiation dose of the medical staff and reduce the operation time, which can contribute to the recovery of the patient.