基于力传感实时检测系统的正畸微植体植入导航及其引导的植入安全稳定性

Microimplant, implanted in the jaws as an anchorage and assists the treatment of many difficult cases, has been increasingly used nowadays. However,root damage and low stability of microimplant caused by implantation deviation, which make the patients discomfort and impede treatment, have been noticed. To solve this problem, markers were used to direct the implantation, while they can not provide adequate guide in 3 dimensional(3D) implantation regions. A surgical template based on the 3D CBCT images and CAD-CAM technique, has been fabricated in our previous research. Implantation has been proved more accurate with this guide. But high radiation dose, additional cost, and system errors of this guide, have been noticed. Another system independent of CT images, should be developed. The microimplant may touch different tissues, such as cortical bone, cancellous bone, periodontal ligament, root of the tooth, and pulp cavity, in different implantation way. The implantation resistance force and insertion torque may be varied accordingly, due to different modulus of elasticity and hardness of the tissues. The varied force signal may direct the implantation. Measurement near the bit and weak signal detection techniques developed in engineering field make it possible to detect the varied forces and torque during implantation. By dynamic three dimensional finite element analysis and force sensing detection method, the stress and torque of implantation driver tip during implantation process will be detected, and characteristic signals will be found to guide the implantation. The implantation safety and stability guided by the template, real time sensor signal system, and by freehand will be analyzed in beagle dogs.

正畸微植体是植入颌骨内为矫治力提供支抗的装置，能辅助疑难病例的矫治，目前临床需求越来越大。但是，微植体植入位置偏差造成的牙根损伤、稳定性不足的现象较常见。以往研究主要是应用标志物进行植入定位，不能充分引导微植体植入到三维的牙槽间隔区。前期利用自行研制的基于CBCT三维图像的CAD-CAM微植体植入导板引导植入，取得了较好效果。但是有X线辐射等系列问题。由于植入中可能接触到的组织结构的弹性模量和硬度有差异，微植体植入不同路径下受到的组织阻力可能不同，检测到变化的力信号从而对植入路径进行及时调整将为安全植入提供新方法。近钻头测量及微信号检测技术的发展为检测这种力信号提供了可能。本研究拟应用动态三维有限元分析法及电测法研究改锥头在微植体植入过程的受力及力矩，并提取不同植入路径下的特征信号以指导植入。分别在导板及实时力信号检测两种导航引导及徒手在比格犬颌骨上植入微植体，探讨植入安全稳定性。

微种植体支抗目前广泛应用在正畸错颌畸形的矫正中。但是，在微种植体植入中牙根损伤等安全问题、以及种植体与牙根接触而引起的种植体稳定性不足等问题，困扰着正畸医生。本研究目的是为了开发能够增加微种植体植入的准确性的方法和装置系统。在前期研究的基础上，本研究完善了基于三维图像的植CAD-CAM导板引导的种植体植入系统，同时基于力触觉实时引导的理念，研发了力传感微植体植入实时检测装置系统，在离体骨上进行多路径植入以发现不同路径植入下植入装置不同受力信号的特征曲线，发现了4种特征曲线可用于指导植入，并对实时检测装置系统的灵敏性、特异性进行检测，显示装置有较高灵敏性特异性。在CAD-CAM导板引导，力传感微植体植入实时检测装置引导下植入正畸微植体，显示植入安全性，稳定性均有提高。