背景:这项研究提出了一种使用动态导航技术传递骨内麻醉的新颖方法。与传统徒手注射骨内麻醉相比,该研究旨在评估其安全性和三维(3D)准确性。
方法:六套相同的3D打印手术颌骨模型(TrueJaw;DELendo,圣巴巴拉,CA)包括模拟牙槽和牙齿解剖结构,并具有54个神经根部位。注射部位根据神经根间距的范围均匀分布(即,1.5-2.5mm,2.5-3.5mm,和3.5-4.5毫米)。经董事会认证的牙髓学家使用徒手技术和导航动态导航系统(ClaroNav,多伦多,安大略省,加拿大)具有X-Tip系统(DentsplySirona,约克,PA).使用Fisher精确检验比较两组之间与神经根间距相关的根穿孔率。二维(2D)和3D水平,垂直,使用叠加的锥形束计算机断层扫描对计划的和动态导航的导向套筒之间的角度差异进行了数字测量。使用方差模型的分析来确定齿间距离是否与来自动态导航系统的准确度度量相关联。显著性水平设定为0.05。
结果:徒手组的根部穿孔率明显高于动态导航组(22%vs0%,P<0.05)。对于动态导航,2D进入偏差为0.71mm(95%置信区间[CI],0.56-0.87)。平均2D水平偏差为0.96mm(95%CI,0.79-1.14),平均2D垂直偏差为0.70mm(95%CI,0.55-0.84)。尖端处的3D偏差平均为1.23mm(95%CI,1.05-1.42)。总体3D角度偏差平均为1.36°(95%CI,1.15-1.56)。神经根间距与任何2D或3D差异没有显着相关。
结论:成功且准确的动态导航骨内输送钻孔发生在100%的注射部位,而与神经根间距无关。与徒手骨内钻孔相比,防止近邻牙齿的根部受伤要安全得多。
BACKGROUND: This study presents a novel method to deliver intraosseous anesthesia using dynamic navigation technology. The study aimed to evaluate its safety and 3-dimensional (3D) accuracy in comparison to traditional freehand injection of intraosseous anesthesia.
METHODS: Six identical sets of 3D-printed surgical jaw models (TrueJaw; DELendo, Santa Barbara, CA) comprising simulated alveolar and dental anatomy with 54 interradicular sites were used in this study. The injection sites were equally distributed based on the range of the inter-radicular distance (ie, 1.5-2.5 mm, 2.5-3.5 mm, and 3.5-4.5 mm). A board-certified endodontist randomly completed intraosseous drilling at inter-radicular sites of varying distance using freehand technique and the Navident dynamic navigation system (ClaroNav, Toronto, Ontario, Canada) with the X-Tip system (Dentsply Sirona, York, PA). The rate of root perforation associated with inter-radicular distance was compared between the 2 groups using the Fisher exact test. Two-dimensional (2D) and 3D horizontal, vertical, and angulation discrepancies between the planned and dynamically navigated guide sleeves were digitally measured using superimposed cone-beam computed tomographic scans. Analysis of variance models were used to determine if the interdental distance was associated with the accuracy measures from the dynamic navigation system. The significance level was set at 0.05.
RESULTS: The rate of root perforation was significantly higher for the freehand group than the dynamic navigation (22% vs 0%, P < .05). For dynamic navigation, the 2D entry deviation was 0.71 mm (95% confidence interval [CI], 0.56-0.87). The mean 2D horizontal deviation was 0.96 mm (95% CI, 0.79-1.14), and the mean 2D vertical deviation was 0.70 mm (95% CI, 0.55-0.84). The 3D deviation at the tip was on an average 1.23 mm (95% CI, 1.05-1.42). The overall 3D angular deviation was on average 1.36° (95% CI, 1.15-1.56). The inter-radicular distance was not significantly associated with any 2D or 3D discrepancies.
CONCLUSIONS: Successful and accurate drilling of dynamically navigated intraosseous delivery occurred in 100% of injection sites irrespective of the inter-radicular distance. It was significantly safer in comparison to freehand intraosseous drilling to prevent injury of the roots of the adjacent teeth in close proximity.