무치악 환자에서 CAD/CAM을 이용한 임플란트 식립(NobelGuide^(TM)) 및 즉시하중 증례
Restoration of an Edentulous Patient with CAD/CAM Guided Implant Surgery (NobelGuide^(TM)) and Immediate Loading: Case Report
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임플란트 시술에서 CAD/CAM을 포함한 컴퓨터 기술의 발달은 단순히 임플란트를 보다 정확하고, 예측 가능하게 식립하는 것뿐 아니라, 무피판(flapless) 수술과 즉시하중을 가능하게 하였다. 그러므로 술후 출혈과 불편감의 감소 및 시술시간과 치유기간을 단축시키는 장점이 있으며, 시술 후 즉시 보철물을 장착해 줌으로써 환자의 구강기능을 단기간에 회복시키고 경조직과 연조직의 형태를 보존하여 최종보철 시 유리한 환경을 만들어 줄 수 있게 되었다. 본 증례는 상․하악 무치악 상태로 내원한 40세 남성 환자로 하악 총의치의 불안정성 및 불편감 등을 호소하였으며, 하악에 임플란트 지지 고정성 보철물을 통한 수복을 원하였다. 충분한 골량, 환자의 참여도, 경제적인 여건, 전신적인 건강 등을 고려하여 하악에는 CAD/CAM 기반의 수술용 스텐트를 이용한 수술 및 미리 제작된 고정성 임시보철물을 이용하여 즉시하중을 부여하는 NobelGuide 보철을 계획하였으며, 상악에는 총의치를 계획하였다. 환자의 안모를 평가하여 임시의치를 제작하였으며, 복제한 임시의치를 바탕으로 스텐트를 제작하고, 컴퓨터단층촬영을 시행하였다. 3차원으로 변환된 영상을 기반으로 하악에 7개의 고정체를 생역학적 조건과 치조골의 상태에 맞게 분산 배치하였다. 제작된 수술용 스텐트에 맞게 주모형을 제작하고, 임시고정성 보철물을 제작하여 장착함으로써 즉시하중을 부여하였다. 식립 3개월 후 골유착 정도를 평가하고 최종보철물을 제작하였다. 추후 발생할 수 있는 상악 골흡수를 방지하기 위해 주기적인 내원 및 검사를 통해 성공적인 치료가 될 수 있도록 노력하였다.
Abstract
With the use of computed tomography (CT), computer-aided design/ computer-assisted machining (CAD/CAM) technology and internet, the implant dentistry has been evolved. The surgical templates made by CAD/CAM technology and precise installation of implants, permit restorations to be inserted immediately after implants have been placed. The advantages of CAD/CAM guided implant procedures are flapless, minimally invasive surgery and shorter surgery time. With this technique, less postoperative morbidity and delivery of prosthesis for immediate function would be possible. A patient with an edentulous maxilla and mandible received 7 implants in mandible using CAD/CAM surgical templates. Prefabricated provisional fixed prostheses were connected immediately after implant installation. Provisional prostheses were evaluated for aesthetics and function during 6 months. Definitive prostheses were fabricated. At 6 months recall appointment, patient’s occlusion was slightly changed. To prevent additional adverse effect, regular check-up and occlusal adjustment would be needed.
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