种植术前设计

STRAUMANN术前设计种植事业部周杨STRAUMANNPatientsexpectationSTRAUMANN术前设计原则ITIConsensusConference98•患者评估•向患者解释种植的优点与风险•患者的期望值•全身、口腔和社会史•临床系统检查•口腔系统检查•综合考虑上述因素•评估受植区情况STRAUMANNITIConsensusConference98•局部因素•粘膜疾病口干症•夜磨牙•系统传染病•植牙区骨质风险因素STRAUMANNITIConsensusConference98•局部因素(相对禁忌症)•植牙区骨量不足•未治愈的牙周病•植牙区有残根•植牙区局部感染风险因素STRAUMANNITIConsensusConference98•绝对禁忌症•被辐照过后的骨要有恢复期•服用抗骨质疏松药物（氢化可的松）•严重的糖尿病出血性疾病，或抗凝血治疗•严重吸烟风险因素STRAUMANNITIConsensusConference98•高风险因素•严重的全身性的疾病(类风湿病,成骨不全，软骨病等)•由于感染HIV导致的免疫力低下•滥用药物(酒精或药物)•心理障碍，精神疾病风险因素STRAUMANNF.Higginbottom,USASTRAUMANNF.Higginbottom,USASTRAUMANNF.Higginbottom,USASTRAUMANN植入方向不平行F.Higginbottom,USASTRAUMANN错误的植入位置F.Higginbottom,USASTRAUMANN不用种植系统F.Higginbottom,USASTRAUMANN种植团队技工患者外科医生牙周医生修复医生Team助手STRAUMANN诊断辅助工具诊断蜡型X-ray外科导板•植牙位置•骨的高度•骨的宽度•植入轴向CBCTSTRAUMANN确定种植体位置STRAUMANNUBrägger,Switzerland确定种植体长度STRAUMANNUBrägger,Switzerland确定种植体长度STRAUMANNUBrägger,Switzerland确定种植体长度STRAUMANNUBrägger,Switzerland确定种植体长度STRAUMANN5.0mmX片子中骨的高度(14mm)片子中钢珠的直径(6mm)(X-ray)Ø5.0mm14mmØ6.0mm11.6mm≈STRAUMANNOralImplantologyThiemeVerlag1994BH11.6mmSBXr5.0mm计算可用的骨量:剩余骨量=11.6mm安全距离=1-2mm11.6–2=10mmSTRAUMANN锥形束CTSTRAUMANN判断牙槽骨颊舌向厚度1mm确定种植体直径STRAUMANN≤5.3mm≥5.3mm≥5.3mmGBRSP,NN,3.3mmS,3.3mm≥6.8mm≥6.8mmS,4.8mmS,4.8mm≥6.1mmS,4.1mm确定种植体直径STRAUMANN5,5mm确定种植体肩台直径STRAUMANNG.Salvi,SwitzerlandSTRAUMANN6,8mm确定种植体肩台直径STRAUMANNG.Salvi,Switzerland确定种植体肩台直径STRAUMANN8.5mm确定种植体肩台直径STRAUMANNG.Salvi,Switzerland确定种植体肩台直径STRAUMANNG.Salvi,Switzerland种植距离:天然牙与种植体1.5mm种植体与种植体3mmSTRAUMANNG.Salvi,SwitzerlandSTRAUMANN间距尺WN6.5mmNN3.5mmRN4.8mmRN4.8mmSTRAUMANN间距尺用法STRAUMANN间距尺用法STRAUMANNStraumann®T形测量尺3,0mm4,0mm5,0mm9,0mm7,0mm5,0mm33,0mm6,0mm7,0mmSTRAUMANN3,0mm4,0mm5,0mm9,0mm7,0mm5,0mm33,0mm6,0mm7,0mmStraumann®T形测量尺STRAUMANN3,0mm4,0mm5,0mm9,0mm7,0mm5,0mm33,0mm6,0mm7,0mmStraumann®T形测量尺STRAUMANN导板•自制导板•专业导板STRAUMANN自制导板STRAUMANNSTRAUMANNSTRAUMANN数字化种植步骤1.取模/CT扫描2.诊断分析（是否需导板）3.三维重建（CT及模型双扫描数据）4.软件模拟种植5.导板制作6.引导外科专业导板SimplantSTRAUMANNDABCBoneLoss(mm)LateralA(n=36)B(n=36)Mean1.341.40SD(+)0.360.60BoneLoss(mm)CrestalDC3mm(n=25)1.043mm(n=11)0.45TarnowD.P.,ChoS.C.,WallaceS.S.STRAUMANN3mm3mmTarnowD.P.,ChoS.C.,WallaceS.S.STRAUMANND.Buser,SwitzerlandSTRAUMANNBoneLevelBoneLevelCriticalDimension:H5mmContactPointContactPointTarnowetal.:JPeriodontal63:995,1992HHHSTRAUMANN5mmBonetoContactPoint=98%CompletePapillaeTarnowetal.:JPeriodontal63:995,1992STRAUMANN6mmBonetoContactPoint=56%CompletePapillaeTarnowetal.:JPeriodontal63:995,1992STRAUMANN7mmBonetoContactPoint=27%CompletePapillaeTarnowetal.:JPeriodontal63:995,1992STRAUMANNRestorativecorrectiveoptionsTarnowetal.:JPeriodontal63:995,1992STRAUMANN