経験豊富な術者と未熟な術者が行う歯根端切除術における静的ナビゲーションと動的ナビゲーションの比較。in vitro研究

Comparison of static and dynamic navigation in root-end resection performed by experienced and inexperienced operators: An in vitro study.

抄録

はじめに:

本研究は、根端切除術におけるスタティックナビゲーション（SN）、ダイナミックナビゲーションシステム（DNS）、フリーハンドテクニック（FH）の効果を比較し、術者の経験値による効果の違いを検討することを目的とした。

INTRODUCTION: This study aimed to compare the effects of the static navigation (SN), a dynamic navigation system (DNS) and freehand technique (FH) in root-end resection and the differences between these effects according to the level of experience of the operator.

研究方法:

Mimicsソフトウェアで再建した上顎模型を3Dプリントし、実験手技（FH/SN/DNS）および術者（経験者/未経験者）に応じて分けた。SNは3-matic Medicalソフトウェアで設計しプリント、DNSはDCARERソフトウェアで外科的アプローチ計画を立て、実施した。切除の精度、効率、安全性が評価された。

METHODOLOGY: The maxillary models reconstructed with the Mimics software were 3D printed and divided according to the experimental techniques (FH/SN/DNS) and operators (experienced/inexperienced). SN was designed using 3-matic Medical software and printed, and a surgical approach plan for DNS was established and performed using DCARER software. The accuracy, efficiency and safety of resection were assayed.

結果:

根端切除の長さ、角度、体積、深さの偏差は、FH群に比べSN群、DNS群で有意に小さかった。SNは両手術者の効率を有意に向上させたが，DNSは経験の浅い術者の効率を向上させただけであった．SN群とDNS群の間には，手術に要する時間以外の差は認められなかった．手術中の誤操作はSN群、DNS群ともに発生しなかった。FH法では、未熟練者による誤操作の発生件数が他の群より有意に多かった。また，術式と術者の経験値との交互作用は認められなかった．

RESULTS: The length, angle, volume and depth deviations of root-end resection were significantly lower in the SN and DNS group compared with the FH group. SN significantly improved the efficiency of both operators, whereas DNS only improved the efficiency of the inexperienced. No difference between the SN and DNS group was found, except for the time required for the surgery. No mishaps occurred during surgery in the SN or DNS group. The number of mishaps with the FH technique when employed by the inexperienced operator was significantly higher than that registered for the rest of the groups. No interaction effect between technique and operator experience level was detected.

結論:

操作者の経験に関係なく，SN と DNS は根端切除術の精度と安全性を向上させることができた．SNは両手術者のチェアサイドでの作業効率を有意に向上させたが，DNSは経験の浅い術者により有用であった．

CONCLUSIONS: Regardless of operator experience, both SN and DNS could improve the accuracy and safety of root-end resection. SN significantly improved chair-side efficiency of both operators, whereas DNS was more helpful for the inexperienced.