ỨNG DỤNG HỆ THỐNG HƯỚNG DẪN ĐỘNG TRONG TRƯỜNG HỢP CẤY GHÉP IMPLANT PHỨC TẠP: BÁO CÁO CA BỆNH

Abstract

Dental implant therapy has been proven to be an effective approach for restoring missing teeth, in which precise implant placement is critical to long-term success. Accordingly, navigation systems have been implemented to enhance accuracy and minimize complications. This report presents a clinical case of severe maxillary bone resorption in the posterior region, characterized by a large maxillary sinus, residual bone height of less than 2 mm, and poor bone quality (classified as D4 according to Misch). Furthermore, based on the classification proposed by Sun et al. (2023) for pterygoid implants, this case was categorized as type D, in which the whole implant body is completely contained within the maxillary sinus cavity. Therefore, the patient was indicated for treatment using a trans-sinus pterygoid implant placement assisted by a dynamic navigation system. Postoperatively, the patient exhibited improved masticatory and phonetic function, with no biological or mechanical complications observed. The deviations at the two pterygoid implant sites were 1.74 mm (neck), 2.83 mm (apex), and 4.48° (angle) at R17, and 1.41 mm (neck), 2.40 mm (apex), and 2.88° (angle) at R27. For the three anterior implant sites, the deviations were 1.42 mm (neck), 1.97 mm (apex), and 3.18° (angle) at R14; 1.11 mm (neck), 1.50 mm (apex), and 3.99° (angle) at R21; and 1.03 mm (neck), 2.36 mm (apex), and 4.36° (angle) at R24. Radiographic examination at the 2-year follow-up showed stable implants with successful osseointegration. These findings provide additional evidence supporting the feasibility and effectiveness of navigation systems in complex anatomical situations.