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Li P, Guan J, Chen J, Xu S, Li A, Yang S. Trephination-based autonomous robotic surgery for dental implant placement: A proof of concept. J Dent 2024; 148:105090. [PMID: 38777103 DOI: 10.1016/j.jdent.2024.105090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/17/2024] [Accepted: 05/18/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES To present a novel drilling protocol of trephine osteotomy technique for autologous bone grafting with simultaneous implant placement using an autonomous robotic system. METHODS The novel protocol consists of 1) preoperative procedures: marker fabrication and fixation, data acquisition, and preoperative planning; 2) intraoperative procedures: registration and calibration, and osteotomy and implant placement performed by an autonomous dental implant robot; 3) postoperative procedures: CBCT acquisition and accuracy assessment. RESULT The protocol was an effective method for implant osteotomy, with no reported intraoperative complications. The implant surgery was successfully completed, and autogenous bone was obtained. Meanwhile, the accuracy of implant placement was clinically acceptable, with minor deviations. CONCLUSIONS Trephination-based robotic surgery can be successfully implemented in implant osteotomy, which might replace freehand implant surgery and conventional drilling protocol. However, further clinical studies are necessary. CLINICAL SIGNIFICANCE The main finding of this case is a potential alternative for preserving autogenous bone during implant surgery.
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Affiliation(s)
- Ping Li
- Department of Prosthodontics, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Medical University, Guangzhou 510180, China; Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Guangzhou 510180, China; Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510280, PR China
| | - Jiajia Guan
- Department of Prosthodontics, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Medical University, Guangzhou 510180, China; Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Guangzhou 510180, China
| | - Jiahao Chen
- Department of Stomatology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, PR China
| | - Shulan Xu
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510280, PR China
| | - An Li
- Department of Periodontology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510280, PR China.
| | - Shuo Yang
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510280, PR China.
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2
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Shi Y, Wang J, Ma C, Shen J, Dong X, Lin D. A systematic review of the accuracy of digital surgical guides for dental implantation. Int J Implant Dent 2023; 9:38. [PMID: 37875645 PMCID: PMC10597938 DOI: 10.1186/s40729-023-00507-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023] Open
Abstract
PURPOSE This review aimed to reveal the influence of implant guides on surgical accuracy with regard to supporting types, manufacturing methods and design (including fixation screws and sleeves). METHODS A literature search related to accuracy of surgical guides for dental implantation was performed in Web of Science and PubMed. Studies with in vivo or in vitro deviation data published in recent 5 years (2018-2022) were included and assessed by Newcastle-Ottawa Scale with regard to risk of bias and reliability degree of clinical studies. Accuracy-related deviation data were summarized as forest plots and normal distributions. RESULTS Forty-one articles were included with high degree of credibility. Data showed that implant surgery accuracy can be achieved with mean distance deviation < 2 mm (most < 1 mm) and angular deviation < 8° (most < 5°). CONCLUSIONS Bilateral tooth-supported guides exhibited highest in vitro accuracy and similar in vivo accuracy to unilateral tooth-supported guides; mucosa-supported guides exhibit lowest in vivo accuracy, while its in vitro data showed low credibility due to mechanical complexity of living mucosa tissue. Milling exhibited higher in vivo accuracy of guides than 3d-printing, though further data support was needed. Design of fixation screws and sleeves of implant guides affected the surgical accuracy and might remain a research focus in near future. However, lack of universal evaluation standards for implantation accuracy remained a major problem in this field. The influence of implant guides on surgical accuracy revealed in this review might shed light on future development of dental implantology.
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Affiliation(s)
- Yiting Shi
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, People's Republic of China
| | - JunKai Wang
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, People's Republic of China
| | - Chao Ma
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, People's Republic of China
| | - Jiayi Shen
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, People's Republic of China
| | - Xian Dong
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, People's Republic of China.
| | - Dan Lin
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, People's Republic of China.
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Adams CR, Ammoun R, Deeb GR, Bencharit S. Influence of Metal Guide Sleeves on the Accuracy and Precision of Dental Implant Placement Using Guided Implant Surgery: An In Vitro Study. J Prosthodont 2023; 32:62-70. [PMID: 35257456 PMCID: PMC10078659 DOI: 10.1111/jopr.13503] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/02/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Metal sleeves are commonly used in implant guides for guided surgery. Cost and sleeve specification limit the applications. This in vitro study examined the differences in the implant position deviations produced by a digitally designed surgical guide with no metal sleeve in comparison to a conventional one with a metal sleeve. MATERIALS AND METHODS The experiment was conducted in two steps for each step: n = 20 casts total, 10 casts each group; Step 1 to examine one guide from each group with ten implant placements in a dental cast, and Step 2 to examine one guide to one cast. Implant placement was performed using a guided surgical protocol. Postoperative cone-beam computed tomography images were made and were superimposed onto the treatment-planning images. The implant horizontal and angulation deviations from the planned position were measured and analyzed using t-test and F-test (p = 0.05). RESULTS For Step 1 and 2, respectively, implant deviations for the surgical guide with sleeve were -0.3 ±0.17 mm and 0.15 ±0.23 mm mesially, 0.60 ±1.69 mm, and -1.50 ±0.99 mm buccolingual at the apex, 0.20 ±0.47 mm and -0.60 ±0.27 mm buccolingual at the cervical, and 2.73° ±4.80° and -1.49° ±2.91° in the buccolingual angulation. For Step 1 and 2, respectively, the implant deviations for the surgical guide without sleeve were -0.17 ±0.14 mm and -0.06 ±0.07 mm mesially, 0.35 ±1.04 mm and -1.619 ±1.03 mm buccolingual at the apex, 0.10 ±0.27 mm and -0.62 ±0.27 mm buccolingual at the cervical, and 1.73° ±3.66° and -1.64° ±2.26° in the buccolingual angulation. No statistically significant differences were found in any group except for mesial deviation of the Step 2 group (F-test, p < 0.001). CONCLUSIONS A digitally designed surgical guide with no metal sleeve demonstrates similar accuracy but higher precision compared to a surgical guide with a metal sleeve. Metal sleeves may not be required for guided surgery.
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Affiliation(s)
- Coleman R Adams
- Department of Oral & Craniofacial Molecular Biology and Philips Institute for Oral Health Research, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - Rami Ammoun
- Department of Prosthodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - George R Deeb
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - Sompop Bencharit
- Department of Oral & Craniofacial Molecular Biology and Philips Institute for Oral Health Research, School of Dentistry, Virginia Commonwealth University, Richmond, VA.,Department of Oral & Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, VA.,Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, VA
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Evaluation of Implant Stability and Trephination Depth for Implant Removal-An In Vitro Study. MATERIALS 2022; 15:ma15124200. [PMID: 35744258 PMCID: PMC9227053 DOI: 10.3390/ma15124200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/25/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
Malpositioned and broken implants are usually fully osseointegrated; hence, their removal, especially from the lower arch, can be very challenging. Implant removal techniques include reverse torque and trephination. Trephination is an invasive technique that can jeopardize vital structures, cause mandibular fatigue fractures, or lead to osteomyelitis. In this study, we aimed to assess the relationship between trephination depth and implant stability by recording implant stability quotient (ISQ) readings at varying trephination depths in vitro. Materials and methods: Forty-eight implants were inserted into dense synthetic polyurethane foam blocks as artificial bone. Primary implant stability was measured with a Penguin resonance frequency analysis (RFA) device. Implants of two designs with a diameter of 3.75 mm and a length of 13 or 8 mm were inserted. Twenty-four internal hexagon (IH) (Seven®) and twenty-four conical connection (CC) implants (C1®; MIS® Implants, Ltd., Misgav, Israel) were used. The primary implant stability was measured with the RFA device. Trephination was performed, and implant stability was recorded at depths of 0, 3, and 6 mm for the 8 mm implants and 0, 3, 6, 8, 10, and 11.5 mm for the 13 mm implants. Results: Linear regression revealed a significant relation between the trephination depth and the ISQ (F (1, 213) = 1113.192, p < 0.001, adjusted r2 = 0.839). The trephination depth significantly predicted the ISQ (β = −5.337, p < 0.001), and the ISQ decreased by −5.33 as the trephination depth increased by 1 mm. Conclusion: Implant stability reduction as measured using an RFA device during trephination may be a valuable guide to achieving safe reverse torque for implant removal. Further studies are needed to evaluate these data in clinical settings.
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Ku JK, Lee J, Lee HJ, Yun PY, Kim YK. Accuracy of dental implant placement with computer-guided surgery: a retrospective cohort study. BMC Oral Health 2022; 22:8. [PMID: 35034613 PMCID: PMC8762866 DOI: 10.1186/s12903-022-02046-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study was to assess the accuracy of virtual planning of computer-guided surgery based on the actual outcomes of clinical dental implant placement. Methods
This retrospective study enrolled patients among whom implant treatment was planned using computer-guided surgery with cone beam computed tomography (CBCT). The patients who received implant according to the guide with the flapless and flapped approach were classified as group 1 and 2, respectively, and the others who could not be placed according to the guide were allocated to the drop-out group. The accuracy of implant placement was evaluated with the superimposition of CBCT. Results We analyzed differences in the deviated distance of the entrance point and deviated angulation of the insertion of implant fixtures. With regard to the surgical approach, group 2 exhibited greater accuracy compared to group 1 in deviation distance (2.22 ± 0.88 and 3.18 ± 0.89 mm, respectively, P < 0.001) and angulation (4.27 ± 2.30 and 6.82 ± 2.71°, respectively, P = 0.001). The limitations of guided surgery were discussed while considering the findings from the drop-out group. Conclusions Computer-guided surgery demonstrates greater accuracy in implant placement with the flapless approach. Further research should be conducted to enhance the availability of guides for cases with unfavorable residual bone conditions.
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Affiliation(s)
- Jeong-Kui Ku
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, 211, Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Junggon Lee
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Korea
| | - Hyo-Jung Lee
- Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Korea
| | - Pil-Young Yun
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Korea
| | - Young-Kyun Kim
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Korea. .,Department of Dentistry and Dental Research Institute, School of Dentistry, Seoul National University, 101, Daehak-ro Jongno-gu, Seoul, 03080, Korea.
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Deeb JG, Frantar A, Deeb GR, Carrico CK, Rener-Sitar K. In Vitro Comparison of Time and Accuracy of Implant Placement Using Trephine and Conventional Drilling Techniques Under Dynamic Navigation. J ORAL IMPLANTOL 2021; 47:199-204. [PMID: 32780820 DOI: 10.1563/aaid-joi-d-19-00125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this randomized in vitro study was to compare the time and accuracy of implant-site preparation and implant placement using a trephine drill versus a conventional drilling technique under dynamic navigation. In total, 42 implants were placed in simulation jaw models with the 2 drilling techniques by 2 operators who had previous experience with dynamic navigation. The timing of each implant placement was recorded, and horizontal, vertical, and angulation discrepancies between the planned and placed implants were compared. There was no significant difference in time or accuracy between the trephine and conventional drilling techniques. Implant-site preparation with a single trephine drill using dynamic navigation was as accurate under in vitro experimental conditions as a conventional drilling sequence.
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Affiliation(s)
- Janina Golob Deeb
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, Va
| | - Anja Frantar
- Department of Prosthodontics, Medical Faculty, Division of Dental Medicine, University of Ljubljana, Ljubljana, Slovenia, EU
| | - George R Deeb
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, Va
| | - Caroline K Carrico
- Department of Dental Public Health and Policy, Virginia Commonwealth University, Richmond, Va
| | - Ksenija Rener-Sitar
- Department of Prosthodontics, Medical Faculty, Division of Dental Medicine, University of Ljubljana, Ljubljana, Slovenia, EU.,University Medical Centre of Ljubljana, University Dental Clinics, Department of Prosthodontics, Ljubljana, Slovenia, EU
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Ammoun R, Dalal N, Abdulmajeed AA, Deeb GR, Bencharit S. Effects of two Postprocessing Methods onto Surface Dimension of in-Office Fabricated Stereolithographic Implant Surgical Guides. J Prosthodont 2020; 30:71-75. [PMID: 32686246 DOI: 10.1111/jopr.13227] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the effects of two postprocessing methods in terms of the overall, intaglio, and cameo surface dimensions of in-office stereolithographic fabricated implant surgical guides. MATERIALS AND METHODS Twenty identical implant surgical guides were fabricated using a stereolithographic printer. Ten guides were postprocessed using an automated method. The other ten guides were postprocessed using a series of hand washing in combination with ultrasonics. Each guide was then scanned using cone-beam computed tomography to produce a set of digital imaging and communications in medicine (DICOM) files which were converted into standard tessellation language (STL) files. The STL file was then superimposed onto the original STL design file using the best fit alignment. The average positive and negative surface discrepancy differences in terms of means and variances were analyzed using t-test (α = 0.05). RESULTS For the alternative group, the average positive and negative overall, intaglio, and cameo surface discrepancies were 77.38 ± 10.68 µm and -67.74 ± 6.55 µm; 78.83 ± 8.65 µm and -68.16 ± 5.26 µm; and 70.5 ± 8.48 µm -64.84 ± 5.55 µm, respectively. For the automated group, the average positive and negative overall, intaglio, and cameo surface discrepancies were 51.88 ± 4.38 µm and -170.7 ± 11.49 µm; 64.3 ± 4.44 µm and -89.45 ± 6.25 µm; and 83.59 ± 4.81 µm and -144.26 ± 13.19 µm, respectively. There was a statistical difference between the means of the two methods for the overall, intaglio, and cameo positive and negative discrepancies (p < 0.001). CONCLUSIONS For a single implant tooth-supported implant guide, using hand washing with ultrasonics appeared to be consistently better than the automated method. The manual method presented with more positive discrepancies, while the automated method presented with more negative discrepancies.
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Affiliation(s)
- Rami Ammoun
- Department of Prosthodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - Nishchal Dalal
- Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - Aous A Abdulmajeed
- Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - George R Deeb
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - Sompop Bencharit
- Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, VA.,Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, VA
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Talmazov G, Bencharit S, Waldrop TC, Ammoun R. Accuracy of Implant Placement Position Using Nondental Open-Source Software: An In Vitro Study. J Prosthodont 2020; 29:604-610. [PMID: 32495453 DOI: 10.1111/jopr.13208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/29/2020] [Accepted: 05/31/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To evaluate the accuracy of implant placement position using two different dental implant planning software. MATERIALS AND METHODS A set of Digital Imaging and Communications in Medicine (DICOM) files from a cone beam computed tomography of a patient missing maxillary right first premolar was used. Implant planning was done using two open-source programs: A nondental 3D Slicer/Blender (3DSB) software and a commercial dental implant treatment planning program: Blue Sky Plan 4 (BSP4). An intraoral scan of the same patient was used to create a standard tessellation language (STL) file of the maxillary arch and later printed into 20 identical casts. Ten surgical guides were printed for each group as well. A dental implant (3.8 mm × 12 mm, Biohorizons) was placed into each cast using fully guided surgical protocol. The horizontal displacements at the implant cervical platform and at the implant apex as well as the angulation displacements were measured using digital scanning of the implant scan bodies and were analyzed using a 3D compare software. Statistical analyses were conducted (⍺ = 0.05) using t-test and F-test to examine differences in trueness and precision, respectively. RESULTS The average horizontal deviations for the platform and the apex, respectively, were 0.33 ± 0.12 mm and 0.76 ± 0.30 mm for 3DSB and 0.44 ± 0.21 mm and 0.98 ± 0.48 mm for BSP4. The average angulation deviations for 3DSB and BSB4 were 2.34 ± 0.93° and 3.07 ± 1.57°, respectively. There were no statistical differences in the means (t-test) of the platform, apex, and angulation deviations (p = 0.16, p = 0.19, and p = 0.18, respectively). There were statistical differences in the variances (F test) of the platform (p = 0.043) and angulation (p = 0.049) deviations but not the apex (p = 0.059) deviations. CONCLUSIONS The combination of nondental open-source software, 3D Slicer/Blender can be used to plan implant guided surgery with an accuracy similar to commercial dental software with slightly higher precision. Open-source nondental software can be considered as an alternative in dental implant treatment planning and guided surgery.
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Affiliation(s)
- Georgi Talmazov
- Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - Sompop Bencharit
- Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, VA.,Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, VA.,Department of Oral & Maxillofacial Surgery, School of Dentistry Commonwealth University, Richmond, VA
| | | | - Rami Ammoun
- Department of Prosthodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA
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Dalal N, Ammoun R, Abdulmajeed AA, Deeb GR, Bencharit S. Intaglio Surface Dimension and Guide Tube Deviations of Implant Surgical Guides Influenced by Printing Layer Thickness and Angulation Setting. J Prosthodont 2020; 29:161-165. [PMID: 31886914 DOI: 10.1111/jopr.13138] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To measure overall intaglio dimensional and tube deviations of implant guides printed at 50 and 100 µm layer thickness at 0°, 45°, and 90° angulation using a stereolithographic (SLA) printer. MATERIALS AND METHODS A surgical implant guide design from a subject missing a maxillary right central incisor, used as the original standard tessellation language (STL) were stereolithographically fabricated at each thickness and angulation, 50 and 100 µm layer thickness at 0°, 45°, and 90° angulation (n = 10 each group). The guide was then scanned using cone beam computed tomography. The digital imaging and communications in medicine (DICOM) scanned files were then converted to an STL format. The overall dimensional deviations of the intaglio surface and the positioning of the implant guide tube were then superimposed onto the original designed STL file using best-fitting alignment. A t-test and an F-test as well as ANOVA followed by a post hoc t-test were used to determine statistical significant differences (α = 0.05) for the intaglio surface and guide tube deviation, respectively. RESULTS The overall intaglio surface discrepancies (µm) printed at 0°, 45°, and 90° were 55.07 ± 1.36, 52.39 ± 2.09, and 61.02 ± 15.96 for 50 µm layer; and 98.38 ± 10.55, 84.47 ± 10.61, and 90.26 ± 5 for 100 µm layer with statistically significant differences for both t-test and F-test, p < 0.001. The maximal guide tube linear deviations (µm) printed at 0°, 45°, and 90° were 10.78 ± 3.84, 8.16 ± 3.68, and 12.57 ± 5.39 for 50 µm layer (ANOVA, p = 0.096); and 10.95 ± 5.23, 16.79 ± 4.97, and 22.63 ± 2.81 for 100 µm layer (ANOVA, p < 0.001). The maximal guide tube angular deviations (°) printed at 0°, 45°, and 90° were 1.29 ± 0.30, 0.64 ± 0.13, and 0.56 ± 0.21 for 50 µm layer (ANOVA, p < 0.001); and 1.57 ± 0.29, 0.86 ± 0.14, and 1.02 ± 0.31 for 100 µm layer (ANOVA, p = 0.034). There was a statistical difference in the deviations between 50 and 100 µm layer printing in all printed angulations except at 0° (t-test, p = 0.05, p = 0.03, and p = 0.001 for 0°, 45°, and 90°) and linear deviations (t-test, p < 0.001, p = 0.009, and p = 0.001 for 0°, 45°, and 90°). CONCLUSION Printing at 50 µm layer reduces dimensional intaglio deviations in general and reduces tube angular deviations with different angulations of printing. However, the deviations were only ∼60 to 100 µm for the intaglio dimension deviations; and ∼0.04 to 0.26 mm and ∼0.25° to ∼2° for tube deviations.
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Affiliation(s)
- Nishchal Dalal
- School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - Rami Ammoun
- Department of Prosthodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - Aous A Abdulmajeed
- Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - George R Deeb
- Department of Oral and Maxillofacial Surgery Virginia Commonwealth University, Richmond, VA
| | - Sompop Bencharit
- Department of General Practice and Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, VA.,Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, VA
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10
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Yeung M, Abdulmajeed A, Carrico CK, Deeb GR, Bencharit S. Accuracy and precision of 3D-printed implant surgical guides with different implant systems: An in vitro study. J Prosthet Dent 2019; 123:821-828. [PMID: 31653399 DOI: 10.1016/j.prosdent.2019.05.027] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 04/23/2019] [Accepted: 05/21/2019] [Indexed: 11/15/2022]
Abstract
STATEMENT OF PROBLEM Implant guided surgery systems promise implant placement accuracy and precision beyond straightforward nonguided surgery. Recently introduced in-office stereolithography systems allow clinicians to produce implant surgical guides themselves. However, different implant designs and osteotomy preparation protocols may produce accuracy and precision differences among the different implant systems. PURPOSE The purpose of this in vitro study was to measure the accuracy and precision of 3 implant systems, Tapered Internal implant system (BioHorizons) (BH), NobelReplace Conical (Nobel Biocare) (NB), and Tapered Screw-Vent (Zimmer Biomet) (ZB) when in-office fabricated surgical guides were used. MATERIAL AND METHODS A cone beam computed tomography (CBCT) data set of an unidentified patient missing a maxillary right central incisor and intraoral scans of the same patient were used as a model. A software program (3Shape Implant Studio) was used to plan the implant treatment with the 3 implant systems. Three implant surgical guides were fabricated by using a 3D printer (Form 2), and 30 casts were printed. A total of 10 implants for each system were placed in the dental casts by using the manufacturer's recommended guided surgery protocols. After implant placement, postoperative CBCT images were made. The CBCT cast and implant images were superimposed onto the treatment-planning image. The implant positions, mesiodistal, labiopalatal, and vertical, as well as implant angulations were measured in the labiolingual and mesiodistal planes. The displacements from the planning in each dimension were recorded. ANOVA with the Tukey adjusted post hoc pairwise comparisons were used to examine the accuracy and precision of the 3 implant systems (α=.05). RESULTS The overall implant displacements were -0.02 ±0.13 mm mesially (M), 0.07 ±0.14 mm distally (D), 0.43 ±0.57 mm labially (L), and 1.26 ±0.80 mm palatally (P); 1.20 ±3.01 mm vertically in the mesiodistal dimension (VMD); 0.69 ±2.03 mm vertically in the labiopalatal dimension (VLP); 1.69 ±1.02 degrees in mesiodistal angulation (AMD); and 1.56 ±0.92 degrees in labiopalatal angulation (ALP). Statistically significant differences (ANOVA) were found in M (P=.026), P (P=.001), VMD (P=.009), AMD (P=.001), and ALP (P=.001). ZB showed the most displacements in the M and vertical dimensions and the least displacements in the P angulation (P<.05), suggesting statistically significant differences among the M, VMD, VLP, AMD, and ALP. NB had the most M variation. ZB had the least P deviation. NB had the fewest vertical dimension variations but the most angulation variations. CONCLUSIONS Dimensional and angulation displacements of guided implant systems by in-office 3D-printed fabrication were within clinically acceptable limits: <0.1 mm in M-D, 0.5 to 1 mm in L-P, and 1 to 2 degrees in angulation. However, the vertical displacement can be as much as 2 to 3 mm. Different implant guided surgery systems have strengths and weaknesses as revealed in the dimensional and angulation implant displacements.
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Affiliation(s)
- Matthew Yeung
- Former doctoral student, Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, Va
| | - Aous Abdulmajeed
- Assistant Professor and Director of Biomaterials, Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, Va
| | - Caroline K Carrico
- Assistant Professor, Department of Oral Health Promotion and Community Outreach, School of Dentistry, Virginia Commonwealth University, Richmond, Va; Assistant Professor, Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, Va
| | - George R Deeb
- Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, Va
| | - Sompop Bencharit
- Associate Professor and Director of Digital Dentistry Technologies, Department of General Practice and Department of Oral & Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, Va; Associate Professor, Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Va.
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