Implant scanbody와 Encoded healing abutment를 이용한 스캔 데이터의 정확성 비교

Abstract

임플란트 보철물의 정확성은 환자의 치료 예후에 큰 영향을 미치는데, 이를 위해서는 정확한 인상 채득이 필수적이다. 최근 들어 임플란트 인상 채득과정에서, 환자가 겪는 불편은 최소화하면서도 정확도는 높일 수 있는 다양한 디지털 방법들이 도입되고 있다. 본 연구는 기존의 임플란트 디지털 인상 채득에 사용되던 scanbody와 새롭게 소개된 encoded healing abutment의 정확성을 비교하고자 한다. 상악 덴티폼(Model 400, Hanil Dental, Gyeonggi-do, Korea)을 복제하여 석고 모형을 제작한 뒤, 우측 제2소구치(#15), 제2대구치(#17), 좌측 중절치(#21) 부위를 삭제하여 scanbody를 꽂아 고정시켰다. 모델 스캐너(Medit identica hybrid, Medit corp, Seoul, Korea)로 스캔을 시행한 뒤, exocad로 디자인하여 #15, #17, #21 부위에 임플란트 아날로그(SGISLA500, Neobiotech, Seoul, Korea)가 식립된 최종 실험 모형을 3D프린터(ZENITH L, Dentis, Daegu, Korea)로 제작하였다. 임플란트 모형 #15i, #17i, #21i 부위에 scanbody를 체결한 뒤 모델 스캐너로 스캔하였고, exocad를 이용해 abutment hex부분을 생성한 뒤, 기준 데이터로 사용하였다. 실험군은 두 그룹으로 나누어 첫번째 그룹(Group 1)은 scanbody (IS D5, Neobiotech, Seoul, Korea)를 연결하고, 두번째 그룹(Group 2)은 encoded healing abutment (IS 4004S, Neobiotech, Seoul, Korea)를 연결한 뒤, 1명의 숙련된 실험자가 20번씩 스캔을 시행하여 abutment hex를 생성하였다. 중첩프로그램인 Geomagic® Control X (3D systems, Rock Hill, South Carolina, USA)로 모델 스캐너의 데이터를 가져와 #17i #15i, #21i의 좌표를 구하여 기준값으로 정하였다. 실험군 데이터 또한 같은 방법으로 좌표값을 구하였고, 모델 스캐너의 기준값과 비교하여 group 1과 group 2의 좌표 간의 거리를 산출하였다. 통계분석은 R Project 3.6.2 (R Foundation, 1020 Vienna, Austria) 소프트웨어를 이용하였으며, 이원분산분석과 독립표본 t-검정을 이용하여 실험군간의 정확성을 비교하였다. (p<0.05) 연구 결과 실험군간 정확도의 차이는 있지만 구강 내 위치에 따른 정확도 차이는 없었다. 구강 내 위치 변수를 제외하고 실험군간의 차이를 비교한 결과 scanbody가 encoded healing abutment보다 기준값에 가깝게 나타났다. ;The accuracy of implant prosthesis has a great effect on the patient's treatment prognosis, which requires accurate impression acquisition. Digital impression acquisition was introduced for accurate impression acquisition of implant prosthesis. This study aims to compare the accuracy of scan images using encoded healing abutment with the scanbody used to acquire existing implant digital impressions. After replicating the maxillary dentiform (Model 400, Hanil Dental, Gyeonggi-do, Korea) with PVS (CharmFlex Ultra Light, Heavy, Dentkist inc, Gyeonggi-do, Korea), a stone model was poured. After removing #15, #17, and #21 teeth from the model, the scanbody was fixed with wax. After scanning the model with model scanner (Medit identica hybrid, MEDIT corp, Seoul, Korea), the final experimental model with implant analog (SGISLA500, Neobiotech, Seoul, Korea) on #15, #17, and #21 was made with exocad and 3D printer (ZENITH L, DENTIS, Daegu, Korea). After scanbody was connected to on the model on #15i, #17i, and #21i, it was scanned with the model scanner and created the element hex using exocad. This data was saved as STL file and used as reference data. After signing group 1 to scanbody (IS D5, Neobiotech, Seoul, Korea) and group 2 to encoded healing abutment (IS 4004S, Neobiotech, Seoul, Korea) respectively, 20 scans per each group were performed by 1 expert, and abutment hex was created in the same way. The reference data was imported into the Geomagic® Control X (3D systems, Rock Hill, South Carolina, USA) to set the coordinates in the center of #17i hex, and then the coordinates of #15i and #21i were obtained. The previously generated data was set as a reference value, and the data of the experimental group was also performed in the same way. Based on the reference coordinate values, the distance between the coordinates of group 1 and group 2 was calculated and statistically analyzed using the R Project 3.6.2 software (R Foundation, 1020 Vienna, Austria). Two-way analysis of variance was performed to compare the difference in average distance from the reference value using the position of the experimental group and the oral cavity as a factor. Later, the distance differences between the two groups were compared using the independent sample t-test, which was based solely on the experimental group (p<0.05). Studies have shown that there were no significant differences in distance depending on the location. The data values of group 1 appeared closer to the reference coordinate values than group 2. Inferring the reason, it can be considered as one factor that the scanbody has a longer and clearer shape than the encoded healing abutment. In addition, it can be expected that in the case of an encoded healing abutment made of metal, the scan recognition rate may be lower than that of a scanbody which was made of PEEK. In conclusion, it can be said that the scanbody is more accurate than the encoded healing abutment.