Computer-aided planning and surgical guiding system fabrication in premolar autotransplantation: a 12-month follow up

Effect of 3D printed replicas on the duration of third molar autotransplantation surgery: A controlled clinical trial

BACKGROUND/AIM

This study aimed to develop a protocol that combines cone-beam computed tomography (CBCT), software, and 3D printing to design 3D replicas for tooth autotransplantation. The goal was to evaluate the impact of this approach on the extraoral time of the donor teeth and the total surgical time, thereby enhancing surgical efficiency and outcomes.

MATERIALS AND METHODS

A non-randomized trial (protocol 10.1186/ISRCTN13563091) was conducted at Riga Stradins University, enrolling 46 patients (13-22 years old) who required molar extraction and possessed a non-erupted third molar. The patients were sequentially assigned to a 3D replica group (24 patients) or a control group (22 patients). The primary outcome measured was the extra-alveolar time of the donor tooth, and the secondary outcome was the total duration of surgery. Both were assessed using a sample size capable of detecting a 10-min difference. A generalized linear model adjusted for various factors was used to test for significant time differences (p < .05) between the groups.

RESULTS

Forty-six patients were included in this analysis. The effect of using 3D replicas was not statistically significant and was associated with a decrease in the extraoral time of the donor tooth in seconds (β = -9.35, 95% CI [-40.86, 22.16]). For the total surgical time in minutes, the use of 3D replicas had a statistically significant impact, reducing the operation duration in minutes (β = -13.42, 95% CI [-24.50, -2.34]). No early complications were observed in either group, with all teeth present at 3-4 weeks post-surgery.

CONCLUSIONS

The integration of 3D printing technology can enhance the efficiency of autotransplantation surgeries, primarily by reducing surgical time.

Use of 3D printing models for donor tooth extraction in autotransplantation cases

OBJECTIVE

To clarify whether the 3D printing model has auxiliary functions in toto extraction of donor tooth in autotransplantation cases.

METHODS

Two hundred and sixty patients who would have operation of ATT were divided into two groups. In group 1, determination of the tooth extraction in toto was predicted only according to the clinical and imaging examination. In group 2, the prediction was performed according to the clinical and imaging examination as well as the 3D model of donor tooth pre-extraction. A prespctive clinical study was designed on intra-group comparison between the predicted and actual donor teeth situation when extraction in cases of ATT. The consistent rate for the predicted results and the actual results were compared with the two groups.

RESULTS

A remarkable difference was observed between the predicted results and the actual results of tooth positions and root numbers in group without model (p < 0,05). The consistency rate of the model group (94.62%) was significantly higher than that of non 3D model group (86.15%) (p = 0.034).

CONCLUSION

The 3D printing model for the donor tooth is helpful for dentists to predict the accuracy of toto extraction of donor teeth in autotransplantation cases.

An evaluation of 1654 premolars transplanted in the posterior region-A retrospective analysis of survival, success and complications

AIM

The aim of this retrospective analysis was to evaluate the survival, success and possible complications of transplanted premolars in the posterior region subdivided by developmental stage and patient age.

MATERIALS AND METHODS

This study included patients who underwent tooth transplantation between April 2004 and December 2021. A total of 1654 premolars were transplanted into 1243 patients. Tooth mobility, oral hygiene and periodontal parameters were clinically evaluated. Intraoral radiographs were used to evaluate pulpal and periodontal healing, and root formation. The cumulative survival rate was calculated using the Kaplan-Meier method.

RESULTS

Data were subdivided into three groups based on the stage of root development and patient age. The mean age at surgery was 14.5 years. The main indication for transplantation was agenesis, followed by trauma and other indications, such as impacted or malformed teeth. A total of 11 premolars were lost during the study period. The overall survival and success rates in the immature premolar group after an observation period of 10 years were 99.7% and 99.4%, respectively. High survival and success rates (95.7% and 95.5%, respectively) were also observed when fully developed premolars were transplanted into the posterior region of adolescents. In adults, the success rate after 10-year follow-up is 83.3%.

CONCLUSIONS

Transplantation of premolars with developing and fully developed roots is a predictable treatment modality.

Role of 3D Printing in Post-op Rehabilitation of Palatal Bone Loss by Mucormycosis: A Survey

BACKGROUND

Three dimensions (3D) modeling, printing, and manufacturing can help in personalized and customized surgical reconstruction of complex defects in the craniofacial region with precision by manipulating tissues based on the preoperative assessment, planning the shape of metal and alloplastic materials, and reduction in the total cost and time of the surgery.

AIM

The present survey study aimed to assess the approach of treating surgeons towards the role of 3D printing in post-op rehabilitation of palatal bone loss by mucormycosis.

METHODS

One thousand eyes nose and throat (ENT) and maxillofacial surgeons were given a pre-formed structured survey questionnaire to be filled by subjects themselves for their view on the role of 3D printing for rehabilitation and reconstruction of palatal bone loss due to mucormycosis.

RESULTS

Efficacy of 3D printing to print the pneumatic sinus design and palatal contour helping to design accurate support with a lightweight prosthesis, 67.2% (n=672) subjects whereas, exact duplication of the excised tissue, 85.4% (n=854) subjects, to detect and duplicate undercuts, 58.4% (n=584) subjects, 3D printing can be helpful as the proper extension of impression 73.2% (n=732) subjects responded positively. For reconstruction of a lost palate by prosthesis 91.2% (n=912) of study participants, in making obturators using Titanium framework and Polyetheretherketone (PEEK) was given a positive response by 82.2% (n=822) subjects, to fabricate prosthesis obturator required in palatal perforation in case of mucormycosis was given a positive response by 88.1% (n=881) subjects, the role of 3D printing to overlay zygomatic implant prosthesis was responded positively by 68.9% (n=689) study subjects.

CONCLUSION

The present survey study concludes that 3D printing is a reliable and accurate method for palatal reconstruction following bone destruction by mucormycosis as reported by the majority of ENT and maxillofacial surgeons.

Three-Dimensional (3D) Stereolithographic Tooth Replicas Accuracy Evaluation: In Vitro Pilot Study for Dental Auto-Transplant Surgical Procedures

After immediate tooth extraction or after alveolar socket healing, tooth transplants are increasingly used for functional restoration of edentulous maxillary areas. Recent studies have shown the periodontal ligament (PDL) viability and the tooth housing time in the adapted neo-alveolus as key factors for transplantation success. During surgical time, 3D stereolithographic replicas are used for fitting test procedures. In this paper, the accuracy of 3D dental replicas, compared with the corresponding natural teeth, is assessed in surgical transplantation. Lamb skulls were selected and submitted to Cone Beam Computer Tomography (CBCT). Scanning information, converted into Standard Digital Imaging and Communications in Medicine (DICOM) and Standard Triangulation Language (STL), was sent to the Volux X-ray Centre for 3D replica printing. After the tooth extractions, all lambs’ incisors were measured with a digital caliber and compared with the 3D replicas. Volume and dimensional error values were evaluated. All replicas showed macroscopically smaller volume (45.54%). Root replicas showed higher variations compared with the crown areas, with several unreplicated apical root areas. The cement–enamel junction tooth area was replicated quite faithfully, and the base area relative error showed 9.8% mean value. Even further studies with a larger number of replicas are needed. Data obtained confirmed high volumes of macroscopic discrepancies with several unreproduced apical root sites. The achieved accuracy (90.2%) confirmed that the 3D replicas cannot be used to reduce the surgical time during transplantation predictable procedures.

Dental 3D-Printing: Transferring Art from the Laboratories to the Clinics

The rise of three-dimensional (3D) printing technology has changed the face of dentistry over the past decade. 3D printing is a versatile technique that allows the fabrication of fully automated, tailor-made treatment plans, thereby delivering personalized dental devices and aids to the patients. It is highly efficient, reproducible, and provides fast and accurate results in an affordable manner. With persistent efforts among dentists for refining their practice, dental clinics are now acclimatizing from conventional treatment methods to a fully digital workflow to treat their patients. Apart from its clinical success, 3D printing techniques are now employed in developing haptic simulators, precise models for dental education, including patient awareness. In this narrative review, we discuss the evolution and current trends in 3D printing applications among various areas of dentistry. We aim to focus on the process of the digital workflow used in the clinical diagnosis of different dental conditions and how they are transferred from laboratories to clinics. A brief outlook on the most recent manufacturing methods of 3D printed objects and their current and future implications are also discussed.

The use of 3D additive manufacturing technology in autogenous dental transplantation

Background

In medicine and dentistry, 3D technology allows the virtual planning and printing of surgical replicas of anatomical structures that can facilitate certain transplant procedures. In dentistry, 3D technology is useful in autogenous tooth transplantation.

Case presentation

We present a clinical case of an ectopic mandibular second premolar, describing the preoperative planning with dental replicas and the autotransplantation surgery. 3D prints of the surgical replica of the tooth to be transplanted was made using an Objet30 Prime® Printer, PolyJet. Clinical controls performed at 3, 6 and 12 months indicated the satisfactory evolution of the transplanted tooth.

Conclusion

3D additive manufacturing technology allows the preparation of a new recipient socket with the aid of a surgical replica of the tooth to be transplanted, thus minimizing handling and extraoral time.

Autotransplantation of third molars with completely formed roots to replace compromised molars with the computer-aided rapid prototyping

OBJECTIVE

To describe a method to fabricate donor tooth replica to assist surgeons in preparation of recipient socket during tooth autotransplantation.

MATERIALS AND METHODS

A total of 28 compromised molars in 27 patients were transplanted with third molars using computer-aided rapid prototyping (CARP) technique. Surgery time and extra-alveolar time were documented. Postoperatively, the distance between cervix of transplanted tooth and the alveolar wall was measured. The degree of postoperative pain experienced was assessed with visual analog scale at day 1, 3, and 7.

RESULTS

From 28 clinical cases, the average extra-alveolar time and surgery time were 2.5 minutes (±1.3) and 44 minutes (±6.8), respectively. Postoperatively, the average distance between cervix of transplanted tooth and the alveolar wall was 0.87 mm (±0.15) at the mesial-cervix, 0.95 mm (±0.17) at the distal-cervix, 0.88 mm (±0.18) at the buccal-cervix, and 0.95 mm (±0.13) at the lingual-cervix. The value of visual analog scale score significantly decreased from day 1 to day 3.

CONCLUSIONS

CARP is a reliable technique for fabrication of tooth like surgical replicas in conventional autotransplantation.

CLINICAL SIGNIFICANCE

CARP technique minimized extra-oral time, reduced iatrogenic damage, and consequently increased the survival rate of tooth autotransplantation.

Computer-aided autotransplantation of teeth with 3D printed surgical guides and arch bar: a preliminary experience

Background/Aim

Autotransplantation of teeth is a method to restore the missing teeth and computer-aided techniques have been applied in this field. The aim of this study was to describe a novel approach for computer-aided autotransplantation of teeth and to preliminarily assess its feasibility, accuracy, and stability.

Methods

Eight wisdom teeth with complete root formation of eight adult patients were autotransplanted. Individual replicas of donor teeth with local splints, surgical templates, and arch bars were virtually designed and fabricated using three-dimensional printing, these were then applied in the autotransplantation surgeries. Clinical and radiological outcomes were observed, the extra-alveolar time, success rate, and 1-year survival rate were analyzed, and accuracy and stability of this approach were evaluated.

Results

The extra-alveolar time of donor teeth were less than 3 min. The average follow-up duration was 2.00 ± 1.06 years. All autotransplanted teeth showed normal masticatory function. Ankylosis was found in one patient, and the overall success rate was 87.5%, whereas the 1-year survival rate was 100%. Linear differences between the designed and the immediate autotransplanted positions at crowns and apexes of the donor teeth were 1.43 ± 0.57 and 1.77 ± 0.67 mm, respectively. Linear differences between immediate and the stable positions at crowns and apexes of the donor teeth were 0.66 ± 0.36 and 0.67 ± 0.48 mm, respectively.

Conclusion

The present study illustrated the feasibility, clinical satisfied accuracy, and stability of a novel approach for computer-aided autotransplantation of teeth. This new approach facilitated the surgical procedure and might be a viable and predictable method for autotransplantation of teeth.