제작방법에 따른 임플란트 수술 가이드의 정확성비교: stereolithography와 positioning device로 제작한 수술 가이드
Evaluation of the accuracy of two different surgical guides in dental implantology: stereolithography fabricated vs. positioning device fabricated surgical guides
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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.
Abstract
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.
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