下颌第一磨牙区种植三维定位的修复导向标准化训练与量化评价OA
Prosthetically driven standardized training and quantitative assessment of three-dimensional implant positioning in the mandibular first molar region
目的:构建并评价面向全科规培医生的下颌第一磨牙缺失区种植三维定位标准化教学路径与质量评价体系,验证其对植入质量与错误谱的影响.方法:采用单组前后对照研究.连续纳入无种植经验全科规培医生,在标准化模型下完成 T0 基线与 T1 结业考核;完成两次考核且数据完整者纳入分析(n=32).实施"定点-定深-定轴-复核-纠错"标准化训练.评价包括近远中偏差(mesiodistal,MD)、颊舌向偏差(buccolingual,BL)、深度偏差(verti-cal depth,Z)及轴向角度偏差、合格/不合格与 I～IV 错误分型;合格阈值为|MD|≤1 mm、|BL|≤1 mm、|Z|≤2 mm(模拟教学阶段的容错及格线)、角度≤5°.采用配对检验与 McNemar 检验;一致性以 ICC 与线性加权 Kappa 评价.结果:T1 合格率较 T0 显著提高(62.5%vs 15.6%,P<0.001;绝对提升 46.9%).MD、BL、Z 及轴向角度偏差均显著下降(P<0.01).错误谱由 III/IV 类为主转向以 I/II 类为主(III 类错误由 50.0%降至 6.3%,IV 类错误由 18.8%降至0).ICC 范围 0.743～0.973,线性加权 Kappa=0.913.结论:该标准化教学路径与配套评价体系可显著提升全科规培医生在下颌第一磨牙缺失区的三维定位能力并改善错误谱,且评价具有良好可重复性,可用于后牙区种植模拟教学的质量控制与持续改进.
Objective:To develop and evaluate a standardized,prosthetically driven training pathway and a quantita-tive assessment system for three-dimensional(3D)implant positioning at a mandibular first molar edentulous site among gen-eral practice residents,and to examine its effects on placement quality and the distribution of positioning errors.Methods:This single-group pre-post study consecutively enrolled implant-inexperienced general practice residents.Participants comple-ted a baseline(T0)and a post-training(T1)assessment on a standardized mandibular first molar edentulous model;those with complete paired assessments and 3D measurement data were included in the analysis(n=32).The intervention followed a standardized workflow comprising"positioning-depth/axis control-intraoperative verification-correction".Outcomes included continuous deviation metrics(mesiodistal[MD],buccolingual[BL],vertical depth[Z],and axial angular deviation),a binary pass/fail outcome,and an I～IV error classification.Passing required meeting all thresholds:|MD|≤1 mm,|BL|≤1 mm,|Z|≤2 mm,and angular deviation≤5°.Paired tests and the McNemar test were used for pre-post comparisons.Reliability was evaluated using intraclass correlation coefficients(ICC)for continuous measures and linearly weighted Kappa for error classification.Results:The pass rate increased significantly from T0 to T1(15.6%vs 62.5%,P<0.001),with an absolute improvement of 46.9%.MD,BL,Z,and axial angular deviations all decreased significantly at T1(P<0.01).The error profile shifted from predominantly severe type III/IV errors to mainly correctable type I/II deviations(type III:50.0%→6.3%;type IV:18.8%→0%).ICCs ranged from 0.743 to 0.973,and the linearly weighted kappa for classification was 0.913.Conclusion:The proposed standardized training pathway and assessment system significantly improved residents'3D implant positioning performance at a mandibular first molar edentulous site and favorably shifted the error profile,with good measurement reproduc-ibility.This framework may support quality assurance and continuous improvement in posterior implant simulation training.
冯楠;许庭翔;刘琪;高原;彭琳
口腔疾病防治全国重点实验室,国家口腔疾病临床医学研究中心,四川大学华西口腔医院口腔种植科 四川 成都 610041口腔疾病防治全国重点实验室,国家口腔疾病临床医学研究中心,四川大学华西口腔医院口腔种植科 四川 成都 610041口腔疾病防治全国重点实验室,国家口腔疾病临床医学研究中心,四川大学华西口腔医院牙体牙髓病科 四川 成都 610041口腔疾病防治全国重点实验室,国家口腔疾病临床医学研究中心,四川大学华西口腔医院牙体牙髓病科 四川 成都 610041口腔疾病防治全国重点实验室,国家口腔疾病临床医学研究中心,四川大学华西口腔医院口腔种植科 四川 成都 610041
医药卫生
口腔种植教学全科规培医生三维定位标准化教学路径错误分型质量控制
Dental implant educationGeneral practice residencyThree-dimensional positioningStandardized training pathwayError classificationQuality assurance
《临床口腔医学杂志》 2026 (7)
413-418,6
国家自然科学基金面上项目(82571065)
评论