这项研究的目的是介绍一个完整的3D工作流程,用于在癌症手术中进行上颌骨切除术后立即进行植入物保留假体康复。工作流程包括肿瘤切除的3D虚拟手术计划,颧骨植入物放置,以及用于植入物保留的假体闭塞器,以适应计划的结果情况,以便立即加载。
在这项研究中,上颌骨的3D虚拟手术计划和切除,然后引导放置10个颧骨植入物,使用自定义切割和钻孔/放置指南,在5个新鲜冷冻的人类尸体上进行。放置了术前数字设计和打印的闭孔假体,并将其连接到the骨植入物。通过合并术前和术后CT扫描数据集,使用3D偏差分析获得植入物定位的准确性。
术前设计和制造的闭孔假体与每次手术的植入位置精确匹配。可以放置并固定所有五个闭塞器以立即装载。尸体上的平均假体点偏差为1.03±0.85mm;平均入口点偏差为1.20±0.62mm;3D角度偏差为2.97±1.44°。
可以进行3D计划并准确执行消融手术,颧骨植入物的放置,并立即放置具有3D虚拟手术计划的植入物保留的闭孔假体。下一步是在计划进行上颌骨切除术的患者中应用手术室的工作流程。
The aim of this study was to introduce a complete 3D workflow for immediate implant retained prosthetic rehabilitation following maxillectomy in cancer surgery. The workflow consists of a 3D virtual surgical planning for tumor resection, zygomatic implant placement, and for an implant-retained prosthetic-obturator to fit the planned outcome situation for immediate loading.
In this study, 3D virtual surgical planning and resection of the maxilla, followed by guided placement of 10 zygomatic implants, using custom cutting and drill/placement-guides, was performed on 5 fresh frozen human cadavers. A preoperatively digitally designed and printed obturator prosthesis was placed and connected to the zygomatic implants. The accuracy of the implant positioning was obtained using 3D deviation analysis by merging the pre- and post-operative CT scan datasets.
The preoperatively designed and manufactured obturator prostheses matched accurately the per-operative implant positions. All five obturators could be placed and fixated for immediate loading. The mean prosthetic point deviation on the cadavers was 1.03 ± 0.85 mm; the mean entry point deviation was 1.20 ± 0.62 mm; and the 3D angle deviation was 2.97 ± 1.44°.
It is possible to 3D plan and accurately execute the ablative surgery, placement of zygomatic implants, and immediate placement of an implant-retained obturator prosthesis with 3D virtual surgical planning.The next step is to apply the workflow in the operating room in patients planned for maxillectomy.