Name: real-time dynamic navigation system for the precise quad-zygomatic implant placement in a patient with a severely atrophic maxilla
Uploaded: 2021-10-18T13:00:00
Description: Watch this Scientific Journal Video about Real-Time Dynamic Navigation System for the Precise Quad-Zygomatic Implant Placement in a Patient with a Severely Atrophic Maxilla at JoVE.com

笔者感谢范胜驰博士提供的宝贵导航技术支持。本病例报告由国家科技部重点项目（2017YFB1302904）、上海市自然科学基金（No. 21ZR1437700）、上海交通大学临床研究计划（SHDC2020CR3049B）和上海交通大学工学与医学联合项目（YG2021QN72）资助。

所有临床方案均由上海交通大学医学院附属第九人民医院医学伦理审查委员会批准（SH9H-2020-T29-3）。
1. 患者选择
<ol><li>患者纳入标准如下（表1）。<ol><li>确保患者呈现完全无牙颌或部分无牙颌，牙齿很少松动（图 1A-G）。</li>
		<li>确保患者上颌骨严重萎缩，骨体积不足，无法在前上颌骨和/或后上颌骨进行常规种植...

<ol>
	<li>Francischone, C. L., Vasconcelos, L. W., Filho, H. N., Francischone, C. E., Sartori, I. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chapter+15.+The+zygoma+fixture.">Chapter 15. The zygoma fixture.</a> The osseointegration book. From calvarium to calcaneus. , 317-320 (2005).</li><li>Weischer, T., Schettler, D., Mohr, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Titanium+implants+in+the+zygoma+as+retaining+elements+after+hemimaxillectomy.">Titanium implants in the zygoma as retaining elements after hemimaxillectomy.</a> The International Journal of Oral &amp; Maxillofacial Implants. 12 (2), 211-214 (1997).</li><li>Jensen, O. T., Brownd, C., Blacker, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nasofacial+prostheses+supported+by+osseointegrated+implants.">Nasofacial prostheses supported by osseointegrated implants.</a> The International Journal of Oral &amp; Maxillofacial Implants. 7 (2), 203-211 (1992).</li><li>Duarte, L. R., Filho, H. N., Francischone, C. E., Peredo, L. G., Branemark, P. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+establishment+of+a+protocol+for+the+total+rehabilitation+of+atrophic+maxillae+employing+four+zygomatic+fixtures+in+an+immediate+loading+system--a+30-month+clinical+and+radiographic+follow-up.">The establishment of a protocol for the total rehabilitation of atrophic maxillae employing four zygomatic fixtures in an immediate loading system--a 30-month clinical and radiographic follow-up.</a> Clinical Implant Dentistry and Related Research. 9 (4), 186-196 (2007).</li><li>Hung, K. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+of+a+real-time+surgical+navigation+system+for+the+placement+of+quad+zygomatic+implants+in+the+severe+atrophic+maxilla:+A+pilot+clinical+study.">Accuracy of a real-time surgical navigation system for the placement of quad zygomatic implants in the severe atrophic maxilla: A pilot clinical study.</a> Clinical Implant Dentistry and Related Research. 19 (3), 458-465 (2017).</li><li>Wu, Y., Wang, F., Huang, W., Fan, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-time+navigation+in+zygomatic+implant+placement:+Workflow.">Real-time navigation in zygomatic implant placement: Workflow.</a> Oral and Maxillofacial Surgery Clinics of North America. 31 (3), 357-367 (2019).</li><li>Wang, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+four+zygomatic+implant-supported+prostheses+for+the+rehabilitation+of+the+atrophic+maxilla:+a+systematic+review.">Reliability of four zygomatic implant-supported prostheses for the rehabilitation of the atrophic maxilla: a systematic review.</a> The International Journal of Oral &amp; Maxillofacial Implants. 30 (2), 293-298 (2015).</li><li>Xiaojun, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+integrated+surgical+planning+and+virtual+training+system.">An integrated surgical planning and virtual training system.</a> IEEE 2010 International Conference on Audio, Language and Image Processing (ICALIP). , 1257-1261 (2010).</li><li>Fan, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+the+configurations+of+fiducial+markers+on+accuracy+of+surgical+navigation+in+zygomatic+implant+placement:+An+in+vitro+study.">The effect of the configurations of fiducial markers on accuracy of surgical navigation in zygomatic implant placement: An in vitro study.</a> The International Journal of Oral &amp; Maxillofacial Implants. 34 (1), 85-90 (2019).</li><li>Xiaojun, C., Ming, Y., Yanping, L., Yiqun, W., Chengtao, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Image+guided+oral+implantology+and+its+application+in+the+placement+of+zygoma+implants.">Image guided oral implantology and its application in the placement of zygoma implants.</a> Computer Methods and Programs in Biomedicine. 93 (2), 162-173 (2009).</li><li>Cawood, J. I., Howell, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+classification+of+the+edentulous+jaws.">A classification of the edentulous jaws.</a> The International Journal of Oral &amp; Maxillofacial Surgery. 17 (4), 232-236 (1988).</li><li>Davo, R., Pons, O., Rojas, J., Carpio, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immediate+function+of+four+zygomatic+implants:+a+1-year+report+of+a+prospective+study.">Immediate function of four zygomatic implants: a 1-year report of a prospective study.</a> European Journal of Oral Implantology. 3 (4), 323-334 (2010).</li><li>Jensen, O. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complete+arch+site+classification+for+all-on-4+immediate+function.">Complete arch site classification for all-on-4 immediate function.</a> The Journal of Prosthetic Dentistry. 112 (4), 741-751 (2014).</li><li>Triplett, R. G., Schow, S. R., Laskin, D. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oral+and+maxillofacial+surgery+advances+in+implant+dentistry.">Oral and maxillofacial surgery advances in implant dentistry.</a> The International Journal of Oral &amp; Maxillofacial Implants. 15 (1), 47-55 (2000).</li><li>Aparicio, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+proposed+classification+for+zygomatic+implant+patient+based+on+the+zygoma+anatomy+guided+approach+(ZAGA):+a+cross-sectional+survey.">A proposed classification for zygomatic implant patient based on the zygoma anatomy guided approach (ZAGA): a cross-sectional survey.</a> European Journal of Oral Implantology. 4 (3), 269-275 (2011).</li><li>Hung, K. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measurement+of+the+zygomatic+region+for+the+optimal+placement+of+quad+zygomatic+implants.">Measurement of the zygomatic region for the optimal placement of quad zygomatic implants.</a> Clinical Implant Dentistry and Related Research. 19 (5), 841-848 (2017).</li><li>Kahnberg, K. E., Nystrom, E., Bartholdsson, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combined+use+of+bone+grafts+and+Br+fixtures+in+the+treatment+of+severely+resorbed+maxillae.">Combined use of bone grafts and Br fixtures in the treatment of severely resorbed maxillae.</a> The International Journal of Oral &amp; Maxillofacial Implants. 4 (4), 297-304 (1989).</li><li>Nystrom, E., Kahnberg, K. E., Gunne, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bone+grafts+and+Br+implants+in+the+treatment+of+the+severely+resorbed+maxilla:+A+2-year+longitudinal+study.">Bone grafts and Br implants in the treatment of the severely resorbed maxilla: A 2-year longitudinal study.</a> The International Journal of Oral &amp; Maxillofacial Implants. 8 (1), 45-53 (1993).</li><li>Jensen, S. S., Terheyden, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bone+augmentation+procedures+in+localized+defects+in+the+alveolar+ridge:+Clinical+results+with+different+bone+grafts+and+bone-substitute+materials.">Bone augmentation procedures in localized defects in the alveolar ridge: Clinical results with different bone grafts and bone-substitute materials.</a> The International Journal of Oral &amp; Maxillofacial Implants. 24, 218-236 (2009).</li><li>Bedrossian, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rehabilitation+of+the+edentulous+maxilla+with+the+zygoma+concept:+A+7-year+prospective+study.">Rehabilitation of the edentulous maxilla with the zygoma concept: A 7-year prospective study.</a> The International Journal of Oral &amp; Maxillofacial Implants. 25 (6), 1213-1221 (2010).</li><li>Dhamankar, D., Gupta, A. R., Mahadevan, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immediate+implant+loading:+A+case+report.">Immediate implant loading: A case report.</a> Journal of Indian Prosthodontic Society. 10 (1), 64-66 (2010).</li><li>Aparicio, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Zygomatic+implants:+indications,+techniques+and+outcomes,+and+the+zygomatic+success+code.">Zygomatic implants: indications, techniques and outcomes, and the zygomatic success code.</a> Periodontol 2000. 66 (1), 41-58 (2014).</li><li>Chrcanovic, B. R., Abreu, M. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Survival+and+complications+of+zygomatic+implants:+A+systematic+review.">Survival and complications of zygomatic implants: A systematic review.</a> Journal of Oral and Maxillofacial Surgery. 17 (2), 81-93 (2013).</li><li>Br&#229;nemark, P. I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Zygoma+fixture+in+the+management+of+advanced+atrophy+of+the+maxilla:+Technique+and+long-term+results.">Zygoma fixture in the management of advanced atrophy of the maxilla: Technique and long-term results.</a> Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. 38 (2), 70-85 (2004).</li><li>Balshi, T. J., Wolfinger, G. J., Petropoulos, V. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quadruple+zygomatic+implant+support+for+retreatment+of+resorbed+iliac+crest+bone+graft+transplant.">Quadruple zygomatic implant support for retreatment of resorbed iliac crest bone graft transplant.</a> Implant Dentistry. 12 (1), 47-53 (2003).</li><li>Chrcanovic, B. R., Oliveira, D. R., Cust&#243;dio, A. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+evaluation+of+computed+tomography-derived+stereolithographic+surgical+guides+in+zygomatic+implant+placement+in+human+cadavers.">Accuracy evaluation of computed tomography-derived stereolithographic surgical guides in zygomatic implant placement in human cadavers.</a> The Journal of Oral Implantology. 36 (5), 345-355 (2010).</li><li>Gellrich, N. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Computer-assisted+secondary+reconstruction+of+unilateral+posttraumatic+orbital+deformity.">Computer-assisted secondary reconstruction of unilateral posttraumatic orbital deformity.</a> Plast and Reconstructive Surgery. 110 (6), 1417-1429 (2002).</li><li>Watzinger, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Placement+of+endosteal+implants+in+the+zygoma+after+maxillectomy:+A+Cadaver+study+using+surgical+navigation.">Placement of endosteal implants in the zygoma after maxillectomy: A Cadaver study using surgical navigation.</a> Plast and Reconstructive Surgery. 107 (3), 659-667 (2001).</li><li>Wagner, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Computer-aided+placement+of+endosseous+oral+implants+in+patients+after+ablative+tumour+surgery:+Assessment+of+accuracy.">Computer-aided placement of endosseous oral implants in patients after ablative tumour surgery: Assessment of accuracy.</a> Clinical Oral Implants Research. 14 (3), 340-348 (2003).</li><li>Casap, N., Wexler, A., Tarazi, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Application+of+a+surgical+navigation+system+for+implant+surgery+in+a+deficient+alveolar+ridge+postexcision+of+an+odontogenic+myxoma.">Application of a surgical navigation system for implant surgery in a deficient alveolar ridge postexcision of an odontogenic myxoma.</a> The Journal of Oral &amp; Maxillofacial Surgery. 63 (7), 982-988 (2005).</li><li>Pellegrino, G., Tarsitano, A., Basile, F., Pizzigallo, A., Marchetti, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Computer-aided+rehabilitation+of+maxillary+oncological+defects+using+zygomatic+implants:+A+defect-based+classification.">Computer-aided rehabilitation of maxillary oncological defects using zygomatic implants: A defect-based classification.</a> The Journal of Oral &amp; Maxillofacial Surgery. 73 (12), 1-11 (2015).</li><li>Fan, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+the+configurations+of+fiducial+markers+on+accuracy+of+surgical+navigation+in+zygomatic+implant+placement:+An+in+vitro+study.">The effect of the configurations of fiducial markers on accuracy of surgical navigation in zygomatic implant placement: An in vitro study.</a> The International Journal of Oral &amp; Maxillofacial Implants. 34 (1), 85-90 (2019).</li><li>D'Haese, J., Van De Velde, T., Elaut, L., De Bruyn, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+prospective+study+on+the+accuracy+of+mucosally+supported+stereolithographic+surgical+guides+in+fully+edentulous+maxillae.">A prospective study on the accuracy of mucosally supported stereolithographic surgical guides in fully edentulous maxillae.</a> Clinical Implant Dentistry and Related Research. 14 (2), 293-303 (2012).</li><li>St&#252;binger, S., Buitrago-Tellez, C., Cantelmi, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deviations+between+placed+and+planned+implant+positions:+an+accuracy+pilot+study+of+skeletally+supported+stereolithographic+surgical+templates.">Deviations between placed and planned implant positions: an accuracy pilot study of skeletally supported stereolithographic surgical templates.</a> Clinical Implant Dentistry and Related Research. 16 (4), 540-551 (2014).</li></ol>

使用移植物对萎缩性上颌骨进行重建是困难的，因为它需要良好的手术技术，覆盖移植物上的高质量软组织，大量的患者合作以及有利于顶端修复的患者17，18。在上颌萎缩患者中放置用于重建的牙科植入物是一项重大的临床挑战。面部骨吸收的模式与年龄有关，在无牙颌上颌中尤其明显，在使用完全可拆卸假体的患者中尤其明显19...

在 1990 年代，Branemark 引入了一种替代骨移植技术，即颧骨植入物 （ZI），也称为颧骨固定装置1。它最初用于治疗创伤受害者和上颌骨结构有缺陷的肿瘤切除患者。上颌骨切除术后，许多患者仅在颧骨体或颧骨的额叶延伸处保留锚定1，2，3。
最近，ZI技术已广泛用于上颌骨严重再吸收的无牙颌和齿状患者。ZI植入物的主要适应症是萎缩性上颌骨。对于具有丰富临床经验的外科医生来说，在即时负荷系统（固定修复学）中使用四个ZI是实用的，并且它似乎是骨移植技术的绝佳替代方法2，4。然而，徒手或使用手术模板进行指导放置 ZI 时存在风险。风险包括肺泡内放置不准确、眶腔或颞下窝穿透以及颧突内放置不当5.多个ZI的放置使这种手术有风险且难以进行。因此，提高ZI放置的精度对其临床使用和安全性至关重要。
实时手术导航系统提供了一种不同的方法。它通过分析术前和术中计算机断层扫描图像提供实时和完全可视化的轨迹。借助实时导航系统，通过复杂的手术和治疗提高了精度和安全性5，6。使用实时手术导航系统开发了一种实用、可行且可重复的方案，以精确地将 ZI 放置在严重萎缩的上颌骨5，7，8，9，10 中。通过该方案，我们已经治疗了数百名患者，临床结果令人满意5，6，7，8，9，10。在这里，我们提供了有关治疗程序的详细信息的协议。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Bistoury scalpel</td>
			<td>Hufriedy Group</td>
			<td>10-130-05</td>
			<td></td>
		</tr>
		<tr>
			<td>Branemark system zygoma TiUnite RP 35mm</td>
			<td>Nobel Biocare AB</td>
			<td>34724</td>
			<td>TiUnite implant with overlength to place from the maxilla to the zygoma</td>
		</tr>
		<tr>
			<td>Branemark system zygoma TiUnite RP 40mm</td>
			<td>Nobel Biocare AB</td>
			<td>34735</td>
			<td>TiUnite implant with overlength to place from the maxilla to the zygoma</td>
		</tr>
		<tr>
			<td>Branemark system zygoma TiUnite RP 42.5mm</td>
			<td>Nobel Biocare AB</td>
			<td>34736</td>
			<td>TiUnite implant with overlength to place from the maxilla to the zygoma</td>
		</tr>
		<tr>
			<td>Branemark system zygoma TiUnite RP 45mm</td>
			<td>Nobel Biocare AB</td>
			<td>34737</td>
			<td>TiUnite implant with overlength to place from the maxilla to the zygoma</td>
		</tr>
		<tr>
			<td>Branemark system zygoma TiUnite RP 47.5mm</td>
			<td>Nobel Biocare AB</td>
			<td>34738</td>
			<td>TiUnite implant with overlength to place from the maxilla to the zygoma</td>
		</tr>
		<tr>
			<td>Branemark system zygoma TiUnite RP 50mm</td>
			<td>Nobel Biocare AB</td>
			<td>34739</td>
			<td>TiUnite implant with overlength to place from the maxilla to the zygoma</td>
		</tr>
		<tr>
			<td>Branemark system zygoma TiUnite RP 52.5mm</td>
			<td>Nobel Biocare AB</td>
			<td>34740</td>
			<td>TiUnite implant with overlength to place from the maxilla to the zygoma</td>
		</tr>
		<tr>
			<td>CBCT</td>
			<td>Planmeca Oy,Helsinki, Finland</td>
			<td>Pro Max 3D Max</td>
			<td></td>
		</tr>
		<tr>
			<td>connection to handpiece</td>
			<td>Nobel Biocare AB</td>
			<td>29081</td>
			<td>the accessories to connect the intrument</td>
		</tr>
		<tr>
			<td>Drill guard</td>
			<td>Nobel Biocare AB</td>
			<td>29162</td>
			<td>the accessories to protect the lips and soft tissue during the surgery</td>
		</tr>
		<tr>
			<td>Drill guard short</td>
			<td>Nobel Biocare AB</td>
			<td>29162</td>
			<td>the accessories to protect the lips and soft tissue during the surgery</td>
		</tr>
		<tr>
			<td>Handpiece zygoma 20:1</td>
			<td>Nobel Biocare AB</td>
			<td>32615</td>
			<td>the basic instrument for implant drill</td>
		</tr>
		<tr>
			<td>Instrument adapter array size L</td>
			<td>BRAINLAB AG</td>
			<td>41801</td>
			<td></td>
		</tr>
		<tr>
			<td>Instrument adapter array size M</td>
			<td>BRAINLAB AG</td>
			<td>41798</td>
			<td></td>
		</tr>
		<tr>
			<td>Instrument calibration matrix</td>
			<td>BRAINLAB AG</td>
			<td>41874</td>
			<td>a special tool for drill to calibration</td>
		</tr>
		<tr>
			<td>I-plan automatic image fusion software STL data import/export for I-plan VectorVision2&#174;, (I-plan CMF software)</td>
			<td>BRAINLAB AG</td>
			<td>inapplicability</td>
			<td>the software for navigation surgery planning</td>
		</tr>
		<tr>
			<td>Multi-unit abutment 3mm</td>
			<td>Nobel Biocare AB</td>
			<td>32330</td>
			<td>the connection accessory between the implant and the titanium base</td>
		</tr>
		<tr>
			<td>Multi-unit abutment 5mm</td>
			<td>Nobel Biocare AB</td>
			<td>32331</td>
			<td>the connection accessory between the implant and the titanium base</td>
		</tr>
		<tr>
			<td>Periosteal elevator</td>
			<td>Hufriedy Group</td>
			<td>PPR3/9A</td>
			<td>the instrument for open flap surgery</td>
		</tr>
		<tr>
			<td>Pilot drill</td>
			<td>Nobel Biocare AB</td>
			<td>32630</td>
			<td>the drill for the surgery</td>
		</tr>
		<tr>
			<td>Pilot drill short</td>
			<td>Nobel Biocare AB</td>
			<td>32632</td>
			<td>the drill for the surgery measuring the depth of the implant holes</td>
		</tr>
		<tr>
			<td>Pointer with blunt tip for cranial/ENT</td>
			<td>BRAINLAB AG</td>
			<td>53106</td>
			<td></td>
		</tr>
		<tr>
			<td>Reference headband star</td>
			<td>BRAINLAB AG</td>
			<td>41877</td>
			<td></td>
		</tr>
		<tr>
			<td>Round bur</td>
			<td>Nobel Biocare AB</td>
			<td>DIA 578-0</td>
			<td>the drill for the surgery</td>
		</tr>
		<tr>
			<td>Screwdriver manual</td>
			<td>Nobel Biocare AB</td>
			<td>29149</td>
			<td></td>
		</tr>
		<tr>
			<td>Skull reference array</td>
			<td>BRAINLAB AG</td>
			<td>52122</td>
			<td>a special made metal reference for navigation camera to receive the signal</td>
		</tr>
		<tr>
			<td>Skull reference base</td>
			<td>BRAINLAB AG</td>
			<td>52129</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture vicryl 4-0</td>
			<td>Johnson &#38;Johnson, Ethicon</td>
			<td>VCP310H</td>
			<td></td>
		</tr>
		<tr>
			<td>Temporary copping multi-unit titanium (with prosthetic screw)</td>
			<td>Nobel Biocare AB</td>
			<td>29046</td>
			<td>the temporary titanium base to fix the teeth</td>
		</tr>
		<tr>
			<td>Titanium mini-screw</td>
			<td>CIBEI</td>
			<td>MB105-2.0*9</td>
			<td>the mini-screw for navigation registration</td>
		</tr>
		<tr>
			<td>Twist drill</td>
			<td>Nobel Biocare AB</td>
			<td>32628</td>
			<td>the drill for the surgery</td>
		</tr>
		<tr>
			<td>Twist drill short</td>
			<td>Nobel Biocare AB</td>
			<td>32629</td>
			<td>the drill for the surgery</td>
		</tr>
		<tr>
			<td>Zygoma depth indicator angled</td>
			<td>Nobel Biocare AB</td>
			<td>29162</td>
			<td></td>
		</tr>
		<tr>
			<td>Zygoma depth indicator straight</td>
			<td>Nobel Biocare AB</td>
			<td>29162</td>
			<td>the measurement scale for</td>
		</tr>
		<tr>
			<td>Zygoma handle</td>
			<td>Nobel Biocare AB</td>
			<td>29162</td>
			<td>the instrument for zygomatic implant placement</td>
		</tr>
	</tbody>
</table>

real-time dynamic navigation system for the precise quad-zygomatic implant placement in a patient with a severely atrophic maxilla

颧骨植入物（ZIs）是解决严重萎缩性无牙颌和上颌骨缺陷病例的理想方法，因为它们取代了广泛的骨增量并缩短了治疗周期。然而，放置ZI存在相关风险，例如穿透眶腔或颞下窝。此外，多个ZI的放置使这种手术有风险并且更难以执行。潜在的术中并发症非常危险，并可能导致无法弥补的损失。在这里，我们描述了一种实用，可行且可重复的实时手术导航系统方案，用于将四颧植入物精确放置在残余骨患者的严重萎缩上颌骨中，不符合常规植入物的要求。根据该协议，我们部门已有数百名患者接受了 ZI。临床结局令人满意，术中和术后并发症较低，输注设计图像和术后三维图像所指示的准确性较高。在整个手术过程中应使用此方法，以确保ZI放置安全。

入组患者是一名60岁的女性，没有任何系统性疾病（图1A-D，F）。CBCT扫描后，上颌前部的牙槽嵴小于2.9 mm，而上颌后区的残余骨高度小于2.4 mm（图1E，G和表1）。颧骨的宽度和厚度分别约为22.4-23.6毫米和6.1-8.0毫米（图2，表3）。根据颧骨解剖引导方法，前ZI的入口位于?...

Watch this Scientific Journal Video about Real-Time Dynamic Navigation System for the Precise Quad-Zygomatic Implant Placement in a Patient with a Severely Atrophic Maxilla at JoVE.com

Real-Time Dynamic Navigation System for the Precise Quad-Zygomatic Implant Placement in a Patient with a Severely Atrophic Maxilla

在这里，我们提出了一种协议，使用实时动态导航系统在严重萎缩性上颌骨患者中实现精确的四颧植入物放置。

实时动态导航系统，用于在严重萎缩性上颌骨患者中精确放置四颧植入物

Zygomatic implants (ZIs) are an ideal way to address cases of a severely atrophic edentulous maxilla and maxilla defects because they replace extensive ...

使用实时导航手术，我们可以快速、准确、安全地治疗需要立即植入物负荷的严重萎缩性上颌骨患者。该技术的一个主要优点是它提高了这种颧骨植入物放置的精度，这对于其临床使用和安全性至关重要。该技术可以治疗由于外胚层发育不良、肿瘤或严重牙周炎引起的严重萎缩性上颌骨患者。麻醉患者仰卧躺在手术台上，用 1.5 x 6 毫米的单个自攻钛螺钉将颅骨参考基部牢固地固定在颅骨上。将参考阵列固定在底座上，并用三个标记的反射球组装。将导航系统摄像头放在一点钟位置，以监控头骨参考。对于注册，使用带有定制反射球的定位探头专门针对个体患者设置导航系统，以逐个接触迷你螺钉的外表面。然后在导航屏幕上显示可用的矢状冠状轴向和 3D 重建图像。为了在手术中使用之前标准化钻孔，请使用带有不同直径孔的校准块。钻头应由外科医生直接连接到块的底部，然后助手需要将接口调整到校准模块中。该过程完成后，设备将发出声音。使用手术导航确定切口的范围后，抬起全层皮瓣，以便有足够的视野来暴露计划的植入部位。骨膜抬高的范围应包括牙槽嵴、上颌骨侧壁和颧骨下缘。在导航探头的帮助下，找到入口点并使用颧骨手机固定入口点。然后用探针找到颧骨的入口，并使用颧骨手机准备颧骨的入口点。接下来，执行钻孔程序，确保它按计划遵循从入口到出口点的轨迹。首先使用2.9毫米钻头准备从入口点到颧骨入口的路径，该入口点使用导航探头定位。先准备内侧的，然后准备远端的。要加宽植入床，请使用手机并将路径从颧骨入口延伸到设计在颧骨表面的终点。要求助手将手放在侧眶壁的表面上，以确保其安全。接下来，用直径为3.5毫米的扩展钻头扩大轨迹。使用测量条和导航探头检查轨迹的方向和位置。使用测量工具确定植入物的长度。如果深度不符合计划长度的要求，请将其准备到设定的深度。接下来，使用特定的手动工具植入颧骨植入物，然后使用导航探头验证正确定位。在植入物上放置多单元基台和愈合帽后，用聚丙烯4-0缝合线缝合切口。对于图像整合，获取术后CBCT扫描图像和全景X线片，以评估术后72小时内的颧骨植入物位置。将术后数据导出到计划软件，叠加术后CBCT和术前手术计划的图像。比较入口点、终点和角度偏差的位置。手术后，使用导航系统，患者在三天内接受了临时修复，解决了美学和发音问题。术后CBCT扫描和图像整合显示起始和终端位置误差以及角度偏差。请用探头检查位置，以确保钻孔正确。我们还可以使用我们特殊的手动工具来测量从起点到目标点的距离。该协议鼓励研究人员进一步探索该领域。越来越多的研究团队正试图为上颌面部和种植牙手术开发新的导航系统，以提高准确性和效率，并缩短学习曲线。

Research

JoVE Journal

Medicine

Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures

遥控磁导航导管定位准确，实时和心脏电生理消融程序

New remote navigation systems have been developed to improve current limitations of conventional manually guided catheter ablation in complex cardiac ...

科研

医学

Intraoperative Detection of Subtle Endometriosis: A Novel Paradigm for Detection and Treatment of Pelvic Pain Associated with the Loss of Peritoneal Integrity

术中的微妙的子宫内膜异位症的检测：A新型范式为相关联的与的的腹膜的完整性之亏损盆腔疼痛的的的的检测和治疗的

Endometriosis is a  common disease affecting 40 to 70% of reproductive-aged women with chronic  pelvic pain (CPP) and/or infertility. The purpose of this ...

Development of an Audio-based Virtual Gaming Environment to Assist with Navigation Skills in the Blind

基于音频的虚拟游戏环境的发展，以帮助盲人的导航技巧

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio ...

Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic ...

Evaluation of Lung Metastasis in Mouse Mammary Tumor Models by Quantitative Real-time PCR

评价肺转移的小鼠乳腺肿瘤模型定量实时荧光定量PCR

Metastatic disease is the spread of malignant tumor cells from the primary cancer site to a distant organ and is the primary cause of cancer associated ...

Quantitative [18F]-Naf-PET-MRI Analysis for the Evaluation of Dynamic Bone Turnover in a Patient with Facetogenic Low Back Pain

Quantitative [18F]-Naf-PET-MRI Analysis for the Evaluation of Dynamic Bone Turnover in a Patient with Facetogenic Low Back Pain

定量 =18F_-Naf-PET-MRI 分析,用于评估面部腰痛患者的动态骨质周转率

Imaging techniques that reflect dynamic bone turnover may aid in characterizing a wide range of bone pathologies. Bone is a dynamic tissue undergoing ...

Evaluation of Capnography Sampling Line Compatibility and Accuracy when Used with a Portable Capnography Monitor

与便携式刻度学监视器一起使用时，评估卡光采样线兼容性和准确性

Capnography is commonly used to monitor patient&#8217;s ventilatory status. While sidestream capnography has been shown to provide a reliable assessment ...

Real-Time Assessment of Spinal Cord Microperfusion in a Porcine Model of Ischemia/Reperfusion

猪缺血/再灌注模型中脊髓微灌注的实时评估

Spinal cord injury is a devastating complication of aortic repair. Despite developments for the prevention and treatment of spinal cord injury, its ...

Dynamic Navigation for Dental Implant Placement

种植牙的动态导航

In modern implantology, the application of surgical navigation systems is becoming increasingly important. In addition to static surgical navigation ...

Dynamic Navigation in Endodontics: Guided Access Cavity Preparation by Means of a Miniaturized Navigation System

In the case of teeth with pulp canal calcification (PCC) and apical pathology or pulpitis, root canal treatment can be very challenging. PCC are common ...