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Hüfner M, David S, Brunello G, Kerberger R, Rauch N, Busch CV, Drescher D, Bourauel C, Becker K. Autoclaving-induced dimensional changes of three-dimensional printed surgical guides: An in vitro study. Clin Oral Implants Res 2024; 35:821-829. [PMID: 37565539 DOI: 10.1111/clr.14158] [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: 04/25/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES Surgical guides are frequently used for dental implant placement. The aim of this study was to evaluate the impact of the 3D printing process itself and subsequent steam autoclaving on the dimensional stability of five different resin/printer combinations (RPCs). MATERIALS AND METHODS Fifty identical surgical guides (10 per group) were produced consisting of five RPCs. Half of the guides (5 per group) were steam autoclaved with cycle 1 (121°C, 1 bar, 20.5 min) and the other half with cycle 2 (134°C, 2 bar, 5.5 min). All guides were scanned with a structured-light (SL) 3D scanner before (T0) and after (T1) autoclaving. Linear measurements along the x-, y-, and z-axes were performed at landmarks on the original STL file and on SL scans at T0 and T1, respectively. Wilcoxon signed-rank test, Kruskal-Wallis test, and linear mixed-effects models were performed, depending on the analysis. RESULTS Three-dimensional printing was associated with significant dimensional alterations for all RPCs. Steam autoclaving using cycle 1 was associated with significant shrinkage in x- (1 RPC), y- (2 RPCs), and z-direction (2 RPCs), while cycle 2 was also associated with shrinkage in x- (2 RPCs), y- (1 RPC), and z-direction (1 RPC). One resin did not present any dimensional changes independently of the cycle. CONCLUSIONS The majority of the guides presented minor but significant shrinkage due to 3D printing itself and both steam autoclaving cycles, the extent varied between different RPCs. Whether these changes compromise implant placement accuracy remains to be investigated.
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Affiliation(s)
- Mira Hüfner
- Department of Orthodontics, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Samuel David
- Department of Orthodontics, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Giulia Brunello
- Department of Oral Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Robert Kerberger
- Department of Orthodontics, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Nicole Rauch
- Department of Oral Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Caroline Viola Busch
- Department of Oral Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Dieter Drescher
- Department of Orthodontics, University Hospital of Düsseldorf, Düsseldorf, Germany
| | | | - Kathrin Becker
- Department of Orthodontics, University Hospital of Düsseldorf, Düsseldorf, Germany
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Ben-Izhack G, Lugassy D, Rosner O, Nissan J, Rachmiel S, Khoury Y, Shely A. Post sterilization of intraoral scan body and the effect it has on the axes and distances between three adjacent implants: in-vitro study. BMC Oral Health 2024; 24:870. [PMID: 39090634 PMCID: PMC11295592 DOI: 10.1186/s12903-024-04664-1] [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: 02/14/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The purpose of this pilot in-vitro study was to assess the effect of sterilization on the intra-implant axis, inter-implant axis, intra-implant distance and inter-implant distance of three implants in a straight line by using laboratory scanner (LBS) versus intra-oral scanner (IOS) with intra-oral scan bodies (ISB). METHODS A printed 3D model with three internal hex analogs in the positions 15#,16#,17# was used. Zirkonzhan (ZZ) intra-oral scan body (ISB), two-piece titanium was used. The ZZ ISBs were scanned by 7 Series dental wings (LBS) and 30 times by Primescan (IOS) pre sterilization and 30 times post sterilization. For each scan (pre and post) stereolithography (STL) file was created and a comparison between all the scans pre sterilization and post sterilization were superimposed on the laboratory scan by using a 3D analyzing software. A Kolmogorov-Smirnov test performed followed by Wilcoxon Signed Ranks tests. (p < 0.05) Results: Post sterilization of the ZZ ISB, the mean errors were significantly increased for the inter-implant distances (p < 0.0005), intra-implant distances 1,2,3 (p < 0.0005), intra-implant axis 1,3 (p < 0.0005) and inter-implant axes 13,23 (p < 0.05). In contrast, the mean errors for intra-implant axis 2 (p < 0.0005) and inter-implant axis 12 (p < 0.0005) were significantly reduced. CONCLUSIONS ZZ ISB showed changes in all four parameters after sterilization. The middle ISB had the largest changes in mean error regarding all four parameters. Sterilization process may affect the three-dimensional (3D) structure of the ZZ ISB after three cycles. There is a lack in the literature in this field and there is a need for further studies to explore the effect of sterilization (multiple cycles) on different ISBs and for creating an approved guidelines regarding the amount of sterilization for each ISB in the industry.
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Affiliation(s)
- Gil Ben-Izhack
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, 6997801, Israel.
| | - Diva Lugassy
- Department of Orthodontics, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Ofir Rosner
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Joseph Nissan
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Shir Rachmiel
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Yara Khoury
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Asaf Shely
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, 6997801, Israel
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El-Mahallawy Y, Dessoky NY, Abdelrahman HH, Al-Mahalawy H. Evaluation of the resection plane three-dimensional positional accuracy using a resection guide directional guidance slot; a randomized clinical trial. BMC Oral Health 2024; 24:736. [PMID: 38926728 PMCID: PMC11210047 DOI: 10.1186/s12903-024-04476-3] [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: 03/09/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
AIM The study was performed to compare the mandibular resection guide with a directional guidance slot with the conventional guide regarding three-dimensional positional accuracy. MATERIALS AND METHODS Twenty-six patients with lateral segmental mandibular defects were selected, and randomly allocated into two groups. All defects were managed with preoperative virtual surgical planning. Resection in the test group was conducted using a resection guide with a directional guidance slot, while a conventional resection guide design was utilized in the control group. The linear and angular deviation of the osteotomy planes was analyzed for both groups, along with the accuracy of the insertion of the reconstruction bone block in the resected defect. Data were documented, absolute deviation was calculated, statistical analysis was performed and significance was set at the 5% level. RESULTS The cases conducted with a directional guidance templet reported a statistically significant difference when compared to the conventional edge-cutting guide regarding the linear and angular spatial osteotomy plane position (P < 0.001). The defect span analysis reported excellent levels of agreement in both groups (ICC = 1.00, ICC = 0.995), however, the difference between the groups was statistically significant (P < 0.001). CONCLUSION The study demonstrated the enhanced positional accuracy of the resection plane and reconstruction block placement when a directional slot is incorporated in the computer-generated resection guide.
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Affiliation(s)
- Yehia El-Mahallawy
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Noha Y Dessoky
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Hams H Abdelrahman
- Dental Public Health and Pediatric Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Haytham Al-Mahalawy
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Fayoum University, Fayoum, Egypt
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Kang S, Zhao C, Fan Y. Puncture and Drainage Surgery for Intracerebral Hemorrhage Guided by 3D Printing Puncture Guide Plate. J Craniofac Surg 2024; 35:1264-1267. [PMID: 38363294 DOI: 10.1097/scs.0000000000010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVES Accurate puncture is the key to ensure the effect of puncture and drainage surgery for intracerebral hemorrhage. It usually uses CT to guide the drainage tube to reach the center of the hematoma cavity, which has the problems of inaccurate positioning using 2D images and high requirements for surgeon's experience in brain anatomy and imaging diagnosis. The aim of this study was to use a 3D printing puncture guide plate to guide the puncture and drainage surgery for intracerebral hemorrhage. METHODS The CT images were imported into 3D Slicer software to reconstruct 3D models of the head skin and intracerebral hematoma. The target was set in the center of the hematoma and the puncture path from the target to the entry point was designed, the 3D model of puncture guide plate was constructed and saved as stereolithography format file, which was imported into 3D printer to print. During surgery, the drainage tube was placed in the center of the hematoma guided by the 3D printing puncture guide plate, and the blood clot was extracted by the suction syringe. RESULTS Eight patients with hypertensive intracerebral hemorrhage were treated with puncture and drainage surgery guided by 3D printing puncture guide plate. The average operation time of the 8 surgeries was 17.63 minutes. The drainage tubes were all precisely placed in the center of the hematoma, and the blood clots were all successfully extracted. The positioning errors of the 8 drainage tubes were between 1.76 mm and 2.68 mm, and the mean value was 2.10±0.32 mm. The hematoma clearance rate of the 8 patients was between 74.18% and 96.73%, and the mean value was 85.14±6.71%. CONCLUSIONS The puncture and drainage surgery for intracerebral hemorrhage guided by 3D printing puncture guide plate helps to quickly and effortlessly localize intracerebral hematoma and achieves satisfactory hematoma clearance rate.
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Affiliation(s)
- Shengyu Kang
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Chengle Zhao
- Department of Neurosurgery, Zhenping People's Hospital, Nanyang, China
| | - Yifeng Fan
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, Zhejiang, China
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Goetze E, Zeller AN, Pabst A. Approaching 3D printing in oral and maxillofacial surgery - suggestions for structured clinical standards. Oral Maxillofac Surg 2024; 28:795-802. [PMID: 38214873 DOI: 10.1007/s10006-024-01208-3] [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: 12/28/2022] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
PURPOSE With respect to the European Union 2017 amendment of the Medical Device Regulations (MDR), this overview article presents recommendations concerning medical 3D printing in oral and maxillofacial surgery (OMFS). METHODS The MDR were screened for applicability of the rules to medical in-house 3D printing. Applicable regulations were summarized and compared to the status of medical use of 3D printing in OMFS in Germany. Recommendations were made for MDR concerning medical 3D printing. RESULTS In-house printed models, surgical guides, and implants fall under the category of Class I-III, depending on their invasive and active properties. In-house medical 3D printing for custom-made medical devices is possible under certain prerogatives: (1) the product is not being used in another facility, (2) appropriate quality systems are applied, (3) the reason for omitting commercial products is documented, (4) information about its use is supplied to the responsible authority, (5) there is a publicly accessible declaration of origin, identification, and conformity to the MDR, (6) there are records of manufacturing site, process and performance data, (7) all products are produced according to the requirements proclaimed before, and (8) there is an evaluation of clinical use and correction of possible issues. CONCLUSION Several aspects must be addressed for in house medical 3D printing, according to the MDR. Devising MDR related to medical 3D printing is a growing challenge. The implementation of recommendations in OMFS could help practitioners to overcome the challenges and become aware of the in-house production and application of 3D printed devices.
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Affiliation(s)
- Elisabeth Goetze
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland
| | - Alexander-N Zeller
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Andreas Pabst
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstr. 170, 56072, Koblenz, Germany.
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Li R, Zhu J, Wang S, Li X, Li S. Effects of sterilization and disinfection methods on digitally designed surgical implant guide accuracy: An in vitro study. Clin Implant Dent Relat Res 2024. [PMID: 38808751 DOI: 10.1111/cid.13350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/10/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Surgical guides are commonly used to assist with dental implant placement. This study investigated the effects of five sterilization and disinfection methods on the accuracy of implant guides. METHODS Thirty surgical guides (five in each group) were designed and printed (with digital light processing technology) using different sterilization or disinfection methods categorized into six groups: hydrogen peroxide sterilization (group one); glutaraldehyde sterilization (group two); autoclaving (group three); plasma sterilization (group four); iodophor disinfection (group five); and blank group (group six). Verification was determined using three methods: distance and angle between the cross-shaped marks, deformation after superimposing the guides, and displacement and axial changes in the virtual implant. RESULTS After disinfection and sterilization, the guides in the autoclaving and iodophor groups showed a more pronounced color change and the guide in the autoclaving group had visible cracks. More significant changes were observed in the H2O2, glutaraldehyde, autoclaving, and iodophor groups regarding deformation after superimposing the guides and the distance and angle between the cross-shaped marks. The average labial deformation values (mm) of the first through fifth groups of guides were 0.283, 0.172, 0.289, 0.153, and 0.188, respectively. All groups were statistically different from the blank group for displacement and axial changes of the virtual implant (p < 0.05). CONCLUSION The sizes of almost all surgical guides changed after sterilization and disinfection treatments, with between-group differences. Plasma sterilization was more suitable for surgical guide sterilization because of the smaller deformations after treatment.
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Affiliation(s)
- Ruikun Li
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jie Zhu
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Shuo Wang
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xueyuan Li
- Department of Ophthalmology, the General Hospital of Western Theater Command, Chengdu, China
| | - Songhang Li
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Labakoum B, Farhan A, Taleb LB, Mouhsen A, Lyazidi A. Effects of autoclaving and disinfection on 3D surgical guides using LCD technology for dental implant. 3D Print Med 2024; 10:14. [PMID: 38656429 PMCID: PMC11040828 DOI: 10.1186/s41205-024-00214-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Surgical guides can improve the precision of implant placement and minimize procedural errors and their related complications. This study aims to determine how different disinfection and sterilization methods affect the size changes of drill guide templates and the mechanical properties of 3D-printed surgical guides made with LCD technology. METHODS We produced a total of 100 samples. Forty surgical guides were fabricated to assess the implant drill guides' surface and geometric properties. We subjected sixty samples to mechanical tests to analyze their tensile, flexural, and compressive properties. We classified the samples into four groups based on each analytical method: GC, which served as the control group; GA, which underwent autoclave sterilization at 121 °C (+ 1 bar, 20 min); GB, which underwent autoclave sterilization at 134 °C (+ 2 bar, 10 min); and GL, which underwent disinfection with 70% isopropyl alcohol for 20 min. RESULT The results show that sterilization at 121 °C and 134 °C affects the mechanical and geometric characteristics of the surgical guides, while disinfection with 70% isopropyl alcohol gives better results. CONCLUSION Our study of 3D-printed surgical guides using LCD technology found that sterilization at high temperatures affects the guides' mechanical and geometric properties. Instead, disinfection with 70% isopropyl alcohol is recommended.
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Affiliation(s)
- Badreddine Labakoum
- Radiation-Matter & Instrumentation Laboratory (RMI), Faculty of Science and Technology, University Hassan 1st, Settat, Morocco.
- Health Sciences and Techniques Laboratory, Higher Institute of Health Sciences (ISSS), University Hassan 1st, Settat, Morocco.
| | - Amr Farhan
- Radiation-Matter & Instrumentation Laboratory (RMI), Faculty of Science and Technology, University Hassan 1st, Settat, Morocco
- Health Sciences and Techniques Laboratory, Higher Institute of Health Sciences (ISSS), University Hassan 1st, Settat, Morocco
| | - Lhoucine Ben Taleb
- Radiation-Matter & Instrumentation Laboratory (RMI), Faculty of Science and Technology, University Hassan 1st, Settat, Morocco
| | - Azeddine Mouhsen
- Radiation-Matter & Instrumentation Laboratory (RMI), Faculty of Science and Technology, University Hassan 1st, Settat, Morocco
| | - Aissam Lyazidi
- Radiation-Matter & Instrumentation Laboratory (RMI), Faculty of Science and Technology, University Hassan 1st, Settat, Morocco.
- Health Sciences and Techniques Laboratory, Higher Institute of Health Sciences (ISSS), University Hassan 1st, Settat, Morocco.
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Schafer S, Swain T, Parra M, Slavin BV, Mirsky NA, Nayak VV, Witek L, Coelho PG. Nonthermal Atmospheric Pressure Plasma Treatment of Endosteal Implants for Osseointegration and Antimicrobial Efficacy: A Comprehensive Review. Bioengineering (Basel) 2024; 11:320. [PMID: 38671741 PMCID: PMC11048570 DOI: 10.3390/bioengineering11040320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
The energy state of endosteal implants is dependent on the material, manufacturing technique, cleaning procedure, sterilization method, and surgical manipulation. An implant surface carrying a positive charge renders hydrophilic properties, thereby facilitating the absorption of vital plasma proteins crucial for osteogenic interactions. Techniques to control the surface charge involve processes like oxidation, chemical and topographical adjustments as well as the application of nonthermal plasma (NTP) treatment. NTP at atmospheric pressure and at room temperature can induce chemical and/or physical reactions that enhance wettability through surface energy changes. NTP has thus been used to modify the oxide layer of endosteal implants that interface with adjacent tissue cells and proteins. Results have indicated that if applied prior to implantation, NTP strengthens the interaction with surrounding hard tissue structures during the critical phases of early healing, thereby promoting rapid bone formation. Also, during this time period, NTP has been found to result in enhanced biomechanical fixation. As such, the application of NTP may serve as a practical and reliable method to improve healing outcomes. This review aims to provide an in-depth exploration of the parameters to be considered in the application of NTP on endosteal implants. In addition, the short- and long-term effects of NTP on osseointegration are addressed, as well as recent advances in the utilization of NTP in the treatment of periodontal disease.
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Affiliation(s)
- Sogand Schafer
- Division of Plastic, Reconstructive and Oral Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Tina Swain
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Marcelo Parra
- Center of Excellence in Morphological and Surgical Studies (CEMyQ), Faculty of Medicine, Universidad de la Frontera, Temuco 4811230, Chile
- Department of Comprehensive Adult Dentistry, Faculty of Dentistry, Universidad de la Frontera, Temuco 4811230, Chile
| | - Blaire V. Slavin
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | | | - Vasudev Vivekanand Nayak
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Lukasz Witek
- Biomaterials Division, New York University Dentistry, New York, NY 10010, USA
- Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY 11201, USA
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Paulo G. Coelho
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- DeWitt Daughtry Family Department of Surgery, Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Eveland R, Antloga K, Meyer A, Tuscano L. Low temperature vaporized hydrogen peroxide sterilization of 3D printed devices. 3D Print Med 2024; 10:6. [PMID: 38416324 PMCID: PMC10900786 DOI: 10.1186/s41205-024-00206-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Low temperature vaporized hydrogen peroxide sterilization (VH2O2) is used in hospitals today to sterilize reusable medical devices. VH2O2 sterilized 3D printed materials were evaluated for sterilization, biocompatibility and material compatibility. MATERIALS & METHODS Test articles were printed at Formlabs with BioMed Clear™ and BioMed Amber™, and at Stratasys with MED610™, MED615™ and MED620™. Sterilization, biocompatibility and material compatibility studies with 3D printed materials were conducted after VH2O2 sterilization in V-PRO™ Sterilizers. The overkill method was used to evaluate sterilization in a ½ cycle. Biocompatibility testing evaluated the processed materials as limited contact (< 24-hours) surface or externally communicating devices. Material compatibility after VH2O2 sterilization (material strength and dimensionality) was evaluated via ASTM methods and dimensional analysis. RESULTS 3D printed devices, within a specific design window, were sterile after VH2O2 ½ cycles. After multiple cycle exposure, the materials were not cytotoxic, not sensitizing, not an irritant, not a systemic toxin, not pyrogenic and were hemo-compatible. Material compatibility via ASTM testing and dimensionality evaluations did not indicate any significant changes to the 3D printed materials after VH2O2 sterilization. CONCLUSION Low temperature vaporized hydrogen peroxide sterilization is demonstrated as a suitable method to sterilize 3D printed devices. The results are a subset of the data used in a regulatory submission with the US FDA to support claims for sterilization of 3D printed devices with specified materials, printers, and device design 1.
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Affiliation(s)
| | | | - Ashley Meyer
- STERIS, 5960 Heisley Road, Mentor, OH, 44060, USA
| | - Lori Tuscano
- STERIS, 5960 Heisley Road, Mentor, OH, 44060, USA
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Zeller AN, Goetze E, Thiem DGE, Bartella AK, Seifert L, Beiglboeck FM, Kröplin J, Hoffmann J, Pabst A. A survey regarding the organizational aspects and quality systems of in-house 3D printing in oral and maxillofacial surgery in Germany. Oral Maxillofac Surg 2023; 27:661-673. [PMID: 35989406 DOI: 10.1007/s10006-022-01109-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/02/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE The aim of the study was to get a cross-sectional overview of the current status of specific organizational procedures, quality control systems, and standard operating procedures for the use of three-dimensional (3D) printing to assist in-house workflow using additive manufacturing in oral and maxillofacial surgery (OMFS) in Germany. METHODS An online questionnaire including dynamic components containing 16-29 questions regarding specific organizational aspects, process workflows, quality controls, documentation, and the respective backgrounds in 3D printing was sent to OMF surgeons in university and non-university hospitals as well as private practices with and without inpatient treatment facilities. Participants were recruited from a former study population regarding 3D printing; all participants owned a 3D printer and were registered with the German Association of Oral and Maxillofacial Surgery. RESULTS Sixty-seven participants answered the questionnaires. Of those, 20 participants ran a 3D printer in-unit. Quality assurance measures were performed by 13 participants and underlying processes by 8 participants, respectively. Standard operating procedures regarding computer-aided design and manufacturing, post-processing, use, or storage of printed goods were non-existent in most printing units. Data segmentation as well as computer-aided design and manufacturing were conducted by a medical doctor in most cases (n = 19, n = 18, n = 8, respectively). Most participants (n = 8) stated that "medical device regulations did not have any influence yet, but an adaptation of the processes is planned for the future." CONCLUSION The findings demonstrated significant differences in 3D printing management in OMFS, especially concerning process workflows, quality control, and documentation. Considering the ever-increasing regulations for medical devices, there might be a necessity for standardized 3D printing recommendations and regulations in OMFS.
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Affiliation(s)
- Alexander-N Zeller
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Elisabeth Goetze
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstr. 11, 91054, Erlangen, Germany
| | - Daniel G E Thiem
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Alexander K Bartella
- Department of Oral and Maxillofacial Surgery, University Hospital Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Lukas Seifert
- Department of Oral, Cranio Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60528, Frankfurt am Main, Germany
| | - Fabian M Beiglboeck
- Department of Oral and Maxillofacial Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Munster, Germany
- MAM Research Group, Department of Biomedical Engineering, University of Basel, Gewerbestr. 16, 4123, Allschwil, Switzerland
| | - Juliane Kröplin
- Department of Oral and Maxillofacial Surgery, Helios Hospital Schwerin, Wismarsche Str. 393-397, 19049, Schwerin, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Andreas Pabst
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstr. 170, 56072, Koblenz, Germany.
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Marturello DM, Déjardin LM. Post-sterilization Dimensional Accuracy of Methacrylate Monomer Biocompatible Three-Dimensionally Printed Mock Surgical Guides. Vet Comp Orthop Traumatol 2023; 36:279-286. [PMID: 37327880 DOI: 10.1055/s-0043-1768991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the post-sterilization dimensional accuracy of a standardized drilling guide, three-dimensionally printed using biocompatible methacrylate monomers. STUDY DESIGN A mock surgical guide was designed and printed in five resins (n = 5/material) using a commercially available desktop stereolithography printer. Pre- and post-sterilization dimensions were measured for each sterilization method (steam, ethylene oxide, hydrogen peroxide gas), then statistically compared; p-value less than or equal 0.05 was considered significant. RESULTS While all resins produced highly accurate replicas of the designed guide, the amber and black resins were unaffected by any sterilization method (p ≥ 0.9). For other materials, ethylene oxide produced the largest dimensional changes. However, mean post-sterilization dimensional changes for all materials and sterilization methods remained less than or equal to 0.05mm CONCLUSION: This study demonstrated that post-sterilization dimensional change of evaluated biomaterials was minimal, and less than previously reported. Additionally, amber and black resins may be preferred to reduce post-sterilization dimensional change, as they were unaffected by any sterilization method. Given the results of this study, surgeons should feel confident using the Form 3B printer to create patient surgical guides. Furthermore, bioresins may provide safer alternatives for patients compared with other three-dimensional printed materials.
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Affiliation(s)
- Danielle M Marturello
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, United States
| | - Loïc M Déjardin
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, United States
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Schneider KH, Oberoi G, Unger E, Janjic K, Rohringer S, Heber S, Agis H, Schedle A, Kiss H, Podesser BK, Windhager R, Toegel S, Moscato F. Medical 3D printing with polyjet technology: effect of material type and printing orientation on printability, surface structure and cytotoxicity. 3D Print Med 2023; 9:27. [PMID: 37768399 PMCID: PMC10540425 DOI: 10.1186/s41205-023-00190-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Due to its high printing resolution and ability to print multiple materials simultaneously, inkjet technology has found wide application in medicine. However, the biological safety of 3D-printed objects is not always guaranteed due to residues of uncured resins or support materials and must therefore be verified. The aim of this study was to evaluate the quality of standard assessment methods for determining the quality and properties of polyjet-printed scaffolds in terms of their dimensional accuracy, surface topography, and cytotoxic potential.Standardized 3D-printed samples were produced in two printing orientations (horizontal or vertical). Printing accuracy and surface roughness was assessed by size measurements, VR-5200 3D optical profilometer dimensional analysis, and scanning electron microscopy. Cytotoxicity tests were performed with a representative cell line (L929) in a comparative laboratory study. Individual experiments were performed with primary cells from clinically relevant tissues and with a Toxdent cytotoxicity assay.Dimensional measurements of printed discs indicated high print accuracy and reproducibility. Print accuracy was highest when specimens were printed in horizontal direction. In all cytotoxicity tests, the estimated mean cell viability was well above 70% (p < 0.0001) regardless of material and printing direction, confirming the low cytotoxicity of the final 3D-printed objects.
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Affiliation(s)
- Karl H Schneider
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Gunpreet Oberoi
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Austrian Center for Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria
| | - Ewald Unger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Klara Janjic
- University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Sabrina Rohringer
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Stefan Heber
- Institute of Physiology, Center for Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstraße 17, 1090, Vienna, Austria
| | - Hermann Agis
- University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Andreas Schedle
- University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bruno K Podesser
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Karl Chiari Lab for Orthopaedic Biology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Toegel
- Department of Orthopedics and Trauma Surgery, Karl Chiari Lab for Orthopaedic Biology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria.
| | - Francesco Moscato
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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13
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Yazigi C, Chaar MS, Busch R, Kern M. The Effect of Sterilization on the Accuracy and Fit of 3D-Printed Surgical Guides. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5305. [PMID: 37570008 PMCID: PMC10419648 DOI: 10.3390/ma16155305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
This study was conducted to evaluate the accuracy of 3D-printed surgical guides before and after sterilization in a steam sterilizer. A test-model incorporating three implant replicas was customized. A total of forty guides were printed from five printable resins. A group made from a self-curing composite served as control group. The guides were checked for fit. Vertical discrepancies between the model and guides were measured at standardized points at a load of 500 g (P1). The guides were connected to implant replicas and scanned, and their angles were digitally measured. The specimens were sterilized in a steam sterilizer at 121 °C for 20 min at 2 bar pressure. Vertical discrepancies (P2) and angulations were remeasured. Additionally, the specimens were repositioned with an increased load, and measurements were repeated (P3). All specimens were repositionable after sterilization. The smallest variation in discrepancy at a 500 g load was 428 µm, whereas the greatest was 1487 µm. Under an increased force, the smallest change was 94 µm, while the greatest was 260 µm. The level of significance α = 0.05 (95% confidence interval) was set for all tests. The variation in the measured angles was not statistically significant (Kruskal-Wallis's test, p > 0.05). The accuracy was affected by the material and sterilization, but it was clinically acceptable when an increased load was applied during repositioning.
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Affiliation(s)
- Christine Yazigi
- Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, 24105 Kiel, Germany; (M.S.C.); (R.B.); (M.K.)
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14
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Khalil RT, Alshimy A, Elsherbini E, Abd-Ellah ME. Disinfection of 3D-printed surgical guides using virgin coconut oil (in vitro study). BMC Oral Health 2023; 23:379. [PMID: 37301954 PMCID: PMC10257485 DOI: 10.1186/s12903-023-03092-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND/OBJECTIVE Disinfection of a 3D-printed surgical guide is of utmost importance as it comes into contact with hard and soft tissue during implant placement so it poses a potential risk of pathogenic transmission. Methods used for disinfection in the surgical field should be reliable, practical, and safe for the instruments and the patients. The objectives of this study were to compare the antimicrobial potential of 100% Virgin Coconut Oil, 2% Glutaraldehyde, and 70% Ethyl Alcohol used to decontaminate 3D-printed surgical guides. MATERIALS AND METHODS Thirty identical surgical guides were printed and cut into two halves (N = 60). Both halves were then contaminated with a defined amount of human saliva samples (2 ml). The first half (n = 30) was sub-grouped into three study groups which were immersed in one of the three disinfectants for 20 min as follows; group VCO was immersed in 100% Virgin Coconut Oil, group GA was immersed in 2% Glutaraldehyde, and group EA was immersed in 70% Ethyl Alcohol. The second half (n* = 30) was sub-grouped into three control groups which were immersed in sterile distilled water as follows group VCO*, group GA*, and group EA*. The microbial count was expressed as colony-forming units per plate and the comparison of the antimicrobial potential of the three tested disinfectants between the three study and three control groups was done using the One-Way ANOVA test. RESULTS The culture results of three study groups revealed no bacterial growth with the highest % of reduction in the mean microbial count of the oral microorganisms (about100%) and an uncountable bacterial growth was shown between the three control groups (more than 100 CFU/plate) representing the baseline of the oral microorganisms. Therefore; statistically significant differences were found between the three control and three study groups (P < .001). CONCLUSION The antimicrobial potential of Virgin Coconut Oil was comparable and equivalent to Glutaraldehyde and Ethyl Alcohol with a significant inhibitory action against oral pathogens.
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Affiliation(s)
- Rania T Khalil
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Ahmed Alshimy
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Eglal Elsherbini
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mervat E Abd-Ellah
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Valls-Esteve A, Lustig-Gainza P, Adell-Gomez N, Tejo-Otero A, Englí-Rueda M, Julian-Alvarez E, Navarro-Sureda O, Fenollosa-Artés F, Rubio-Palau J, Krauel L, Munuera J. A state-of-the-art guide about the effects of sterilization processes on 3D-printed materials for surgical planning and medical applications: A comparative study. Int J Bioprint 2023; 9:756. [PMID: 37555083 PMCID: PMC10406103 DOI: 10.18063/ijb.756] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/01/2023] [Indexed: 08/10/2023] Open
Abstract
Surgeons use different medical devices in the surgery, such as patient-specific anatomical models, cutting and positioning guides, or implants. These devices must be sterilized before being used in the operation room. There are many sterilization processes available, with autoclave, hydrogen peroxide, and ethylene oxide being the most common in hospital settings. Each method has both advantages and disadvantages in terms of mechanics, chemical interaction, and post-treatment accuracy. The aim of the present study is to evaluate the dimensional and mechanical effect of the most commonly used sterilization techniques available in clinical settings, i.e., Autoclave 121, Autoclave 134, and hydrogen peroxide (HPO), on 11 of the most used 3D-printed materials fabricated using additive manufacturing technologies. The results showed that the temperature (depending on the sterilization method) and the exposure time to that temperature influence not only the mechanical behavior but also the original dimensioning planned on the 3D model. Therefore, HPO is a better overall option for most of the materials evaluated. Finally, based on the results of the study, a recommendation guide on sterilization methods per material, technology, and clinical application is presented.
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Affiliation(s)
- Arnau Valls-Esteve
- Innovation Department, Hospital Sant Joan de Déu,
Esplugues de Llobregat, Spain
- Medicina i Recerca Translacional, Facultat de Medicina i
Ciències de la Salut, Universitat de Barcelona, Spain
- 3D for Health Unit (3D4H), Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
| | | | - Nuria Adell-Gomez
- Innovation Department, Hospital Sant Joan de Déu,
Esplugues de Llobregat, Spain
- 3D for Health Unit (3D4H), Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
| | - Aitor Tejo-Otero
- Centre CIM, Universitat Politècnica de Catalunya
(CIM UPC), Barcelona, Spain
| | - Marti Englí-Rueda
- Innovation Department, Hospital Sant Joan de Déu,
Esplugues de Llobregat, Spain
- 3D for Health Unit (3D4H), Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
| | | | - Osmeli Navarro-Sureda
- Sterilization Department, Hospital Sant Joan de Déu,
Universitat de Barcelona, Spain
| | - Felip Fenollosa-Artés
- Centre CIM, Universitat Politècnica de Catalunya
(CIM UPC), Barcelona, Spain
- Department of Mechanical Engineering, School of Engineering
of Barcelona (ETSEIB), Universitat Politècnica de Catalunya, Barcelona,
Spain
| | - Josep Rubio-Palau
- Medicina i Recerca Translacional, Facultat de Medicina i
Ciències de la Salut, Universitat de Barcelona, Spain
- 3D for Health Unit (3D4H), Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
- Department of Pediatric Surgery, Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
- Maxillofacial Unit, Department of Pediatric Surgery,
Hospital Sant Joan de Déu, Universitat de Barcelona, Spain
| | - Lucas Krauel
- Medicina i Recerca Translacional, Facultat de Medicina i
Ciències de la Salut, Universitat de Barcelona, Spain
- 3D for Health Unit (3D4H), Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
- Department of Pediatric Surgery, Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
| | - Josep Munuera
- Medicina i Recerca Translacional, Facultat de Medicina i
Ciències de la Salut, Universitat de Barcelona, Spain
- 3D for Health Unit (3D4H), Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
- Department of Diagnostic Imaging, Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
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16
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Sharma N, Zubizarreta-Oteiza J, Tourbier C, Thieringer FM. Can Steam Sterilization Affect the Accuracy of Point-of-Care 3D Printed Polyetheretherketone (PEEK) Customized Cranial Implants? An Investigative Analysis. J Clin Med 2023; 12:jcm12072495. [PMID: 37048579 PMCID: PMC10094830 DOI: 10.3390/jcm12072495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Polyetheretherketone (PEEK) has become the biomaterial of choice for repairing craniofacial defects over time. Prospects for the point-of-care (POC) fabrication of PEEK customized implants have surfaced thanks to the developments in three-dimensional (3D) printing systems. Consequently, it has become essential to investigate the characteristics of these in-house fabricated implants so that they meet the necessary standards and eventually provide the intended clinical benefits. This study aimed to investigate the effects of the steam sterilization method on the dimensional accuracy of POC 3D-printed PEEK customized cranial implants. The objective was to assess the influence of standard sterilization procedures on material extrusion-based 3D-printed PEEK customized implants with non-destructive material testing. Fifteen PEEK customized cranial implants were fabricated using an in-house material extrusion-based 3D printer. After fabrication, the cranial implants were digitalized with a professional-grade optical scanner before and after sterilization. The dimensional changes for the 3D-printed PEEK cranial implants were analyzed using medically certified 3D image-based engineering software. The material extrusion 3D-printed PEEK customized cranial implants displayed no statistically significant dimensional difference with steam sterilization (p > 0.05). Evaluation of the cranial implants’ accuracy revealed that the dimensions were within the clinically acceptable accuracy level with deviations under 1.00 mm. Steam sterilization does not significantly alter the dimensional accuracy of the in-house 3D-printed PEEK customized cranial implants.
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Affiliation(s)
- Neha Sharma
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167C, 4123 Allschwil, Switzerland
- Correspondence:
| | - Jokin Zubizarreta-Oteiza
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167C, 4123 Allschwil, Switzerland
| | - Céline Tourbier
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167C, 4123 Allschwil, Switzerland
| | - Florian M. Thieringer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167C, 4123 Allschwil, Switzerland
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Nam NE, Hwangbo NK, Jin G, Shim JS, Kim JE. Effects of heat-treatment methods on cytocompatibility and mechanical properties of dental products 3D-printed using photopolymerized resin. J Prosthodont Res 2023; 67:121-131. [PMID: 35570000 DOI: 10.2186/jpr.jpr_d_21_00345] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose of this study was to test heat-treatment methods for improving the cytocompatibility of dental 3D printable photopolymer resins. METHODS Nextdent C&B resin and a digital light processing 3D printer were used to print all specimens, which were divided into seven groups as follows: 1-month storage at controlled room temperature, 20 to 25 °C (RT), 24-hour storage at RT, 24-hour storage in RT water, 1-min immersion in 80 °C water, 1-min immersion in 100 °C water, 5-min immersion in 100 °C water, and autoclaving. Cell viability tests, cytotoxicity tests, and confocal laser scanning microscopy were performed to analyze the cytocompatibility of the 3D-printed resin. Fourier-transform infrared spectroscopy was performed after heat-treatment to determine the degree of conversion (DC). RESULTS Immersing printed resin samples in 100 °C water for 1 or 5 min after the curing process was an effective method for increasing cytocompatibility by inducing the preleaching of toxic substances such as unpolymerized monomers, photoinitiators, and additives. Moreover, the DC can be increased by additional polymerization without affecting the mechanical properties of the material. CONCLUSIONS Immersing the printed photosensitive dental resins in 100 °C water for 5 min is a suitable method for increasing cytocompatibility and the DC.
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Affiliation(s)
- Na-Eun Nam
- BK21 FOUR Project, Department of Prosthodontics, Yonsei University College of Dentistry, Korea
| | - Na-Kyung Hwangbo
- Department of Orofacial Pain and Oral Medicine, Yonsei University College of Dentistry, Korea
| | - Gan Jin
- Department of Prosthodontics, College of Dentistry, Yonsei University, Korea
| | - June-Sung Shim
- Department of Prosthodontics, College of Dentistry, Yonsei University, Korea
| | - Jong-Eun Kim
- Department of Prosthodontics, College of Dentistry, Yonsei University, Korea
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18
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Khalil RT, Alshimy A, Elsherbini E, Abd-ELLAH ME. The microbiological effect of virgin coconut oil on the morphological and volumetric dimensional changes of 3D printed surgical guides (in vitro study). BMC Oral Health 2022; 22:636. [PMID: 36564796 PMCID: PMC9786529 DOI: 10.1186/s12903-022-02671-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/OBJECTIVES Disinfection of surgical guides is mandatory for intraoperative use. Virgin Coconut Oil may be a potent alternative disinfectant; however, its effect has not been fully discussed in dentistry. The objectives of this study were to compare the morphological and the volumetric dimensional changes of 3D printed surgical guides after immersion in three disinfectants: 100%Virgin Coconut Oil, 2% Glutaraldehyde, and 70% Ethyl Alcohol and to assess the antimicrobial effectiveness of the tested disinfectants. MATERIALS AND METHODS A surgical guide was designed using open platform software to print thirty guides and then cut them into two halves (N = 60). Pre-disinfection scans of the first half of the three study groups (n = 30) were performed using Cone-beam Computed Tomography, then immersed for 20 min in three disinfectants as follows: group VCO was immersed in 100% Virgin Coconut Oil, group GA was immersed in 2% Glutaraldehyde, and group EA was immersed in 70% Ethyl Alcohol. Post-disinfection scans of the first half of the three study groups (n = 30) were performed and then compared morphologically and volumetrically using an analyzing software program The second half of the three control groups (n* = 30) were soaked for 20 min in sterile distilled water as follows: group VCO*, group GA*, and group EA* for the assessment of the antimicrobial effectiveness of the three tested disinfectants. RESULTS At the morphological assessment of the dimensional changes, group VCO were the most accurate with the lowest mean deviation value of 0.12 ± 0.02 mm and root mean square value of 0.12 mm, group GA and group EA were less accurate with mean deviation value of = 0.22 ± 0.05 mm and = 0.19 ± 0.03 mm and root mean square value of 0.22 and 0.20 respectively (p < 0.001). At the volumetric assessment, group VCO showed lower volumetric changes with a mean deviation value of 0.17 ± 0.10 mm, root mean square value of 0.19 mm, than group GA with mean deviation value of 0.23 ± 0.10 mm, root mean square value of 0.25 mm and group EA with mean deviation value of 0.27 ± 0.11 mm, root mean square value of 0.29 mm, however, no statistically significant differences were found between the three study groups (p = 0.10). The antimicrobial effectiveness of the three tested disinfectants showed a hundred percent (100%) reduction in the total microbial count in the first half of the three study groups treated with the three disinfectants revealing no bacterial growth, however, statistically significant differences were found between the second half of the three control and the first half of the three study groups. (p < 0.001). CONCLUSIONS Virgin Coconut Oil showed higher morphological dimensional accuracy of the tested surgical guides than Glutaraldehyde and Ethyl Alcohol without causing any volumetric dimensional changes in the 3D printed surgical guides after disinfection for 20 min and the antimicrobial effectiveness was the same between the three tested disinfectants without showing any microbial growth.
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Affiliation(s)
- Rania T. Khalil
- grid.7155.60000 0001 2260 6941Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Ahmed Alshimy
- grid.7155.60000 0001 2260 6941Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Eglal Elsherbini
- grid.7155.60000 0001 2260 6941Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mervat E. Abd-ELLAH
- grid.7155.60000 0001 2260 6941Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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19
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Matheus DMD, Gomes EA, Barcellos DC, Rosetti EP, Margonar R. Linear dimensional accuracy of stereolithographic surgical guide after chemistry and physics sterilization. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:510-513. [PMID: 34844017 DOI: 10.1016/j.jormas.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the dimensional stability of prototyped surgical guides after autoclave and 2% glutaraldehyde sterilization processes. MATERIAL AND METHODS Twenty prototyped surgical guides were prepared and submitted to two sterilization processes (n = 10): Physics - sterilization by autoclave (saturated water vapor under pressure, temperature of 126 to 130 °C, pressure of 1,7 at 1.9 kgf/cm2, 16 min); Chemistry - sterilization by 2% glutaraldehyde for 10 h. Six pre-established points were measured in the prototyped surgical guides, before and after sterilization, using a digital caliper rule. The comparisons were made using orthogonal contrasts using the linear model of mixed effects (random and fixed). RESULTS there are no significant differences between autoclave and glutaraldehyde 2% (p>0.05) there are significant differences after autoclave sterilization (p<0.05) and there are not significant differences after 2% glutaraldehyde sterilization (p>0.05). CONCLUSION autoclave promoted dimensional alteration of the prototyped surgical guides, and the chemical sterilization by glutaraldehyde 2% did not cause dimensional alteration of the prototype surgical guides, being a favorable choice for sterilization. CLINICAL SIGNIFICANCE the sterilization of surgical guides can be performed through the chemical process with 2% glutaraldehyde without changing the linear precision of the prototype surgical guides.
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Affiliation(s)
- Diego Moraes De Matheus
- Private Practitioner, DDS, MS. University Centre of Araraquara, UNIARA, Araraquara, SP, Brazil
| | - Erica Alves Gomes
- DDS, MS, PhD, Doctor Assistant Professor, School of Dentistry, University of Ribeirão Preto, UNAERP, Ribeirão Preto, SP, Brazil
| | - Daphne Camara Barcellos
- DDS, MS, PhD, Adjunct Professor, Department of Prosthodontics, Federal University of Espírito Santo, Vitória, ES, Brazil.
| | - Elizabeth Pimentel Rosetti
- DDS, MS, PhD, Adjunct Professor, Department of Prosthodontics, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Rogério Margonar
- DDS, MS, PhD, Doctor Assistant Professor, School of Dentistry, University of Ribeirão Preto, UNAERP, Ribeirão Preto, SP, Brazil
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20
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Impact of Steam Autoclaving on the Mechanical Properties of 3D-Printed Resins Used for Insertion Guides in Orthodontics and Implant Dentistry. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12126195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Guided implant placement has been shown to be more accurate than free-handed insertion. Still, implant position deviations occur and could possibly pose risks. Thus, there is a quest to identify factors that might impair the accuracy of implantation protocols using templates. This study aimed to investigate the influence of autoclaving cycles (cycle 1: 121 °C, 1 bar, 20.5 min; cycle 2: 134 °C, 2 bar, 5.5 min) on the Vickers hardness and flexural modulus of five different materials used for 3D-printed insertion guides. The specimens were subjected to Vickers hardness tests, showing significant changes in the Vickers hardness for two and three materials out of five for cycle 1 and 2, respectively. The results of the three-point bending tests (n = 15 specimens per material) showed decreasing flexural moduli after autoclaving. However, changes were significant only for one material, which presented a significant decrease in the flexural modulus after cycle 2. No significant changes were detected after cycle 1. In conclusion, our findings show that autoclaving can alter the mechanical properties of the templates to some extent, especially with cycle 2. Whether these modifications are associated with dimensional changes of the templates and reduced accuracy of the implantation protocols remains to be investigated.
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Pop SI, Dudescu M, Mihali SG, Păcurar M, Bratu DC. Effects of Disinfection and Steam Sterilization on the Mechanical Properties of 3D SLA- and DLP-Printed Surgical Guides for Orthodontic Implant Placement. Polymers (Basel) 2022; 14:polym14102107. [PMID: 35631989 PMCID: PMC9144921 DOI: 10.3390/polym14102107] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 02/01/2023] Open
Abstract
Three-dimensional printed surgical guides increase the precision of orthodontic mini-implant placement. The purpose of this research was to investigate the effects of disinfection and of two types of autoclave sterilization on the mechanical properties of 3D printed surgical guides obtained via the SLA (stereolithography) and DLP (digital light processing) printing methods. A total of 96 standard specimens (48 SLA and 48 DLP) were printed to analyze the tensile and flexural properties of the materials. A total of 80 surgical guide (40 SLA and 40 DLP) specimens from each printing method were classified into four groups: CG (control group); G1, disinfected with 4% Gigasept (Gigasept Instru AF; Schülke & Mayer Gmbh, Norderstedt, Germany); G2, autoclave-sterilized (121 °C); and G3, autoclave-sterilized (134 °C). Significant differences in the maximum compressive load were determined between the groups comprising the DLP-(p < 0.001) and the SLA- (p < 0.001) printed surgical guides. Groups G2 (p = 0.001) and G3 (p = 0.029) showed significant parameter modifications compared with the CG. Disinfection with 4% Gigasept (Gigasept Instru AF; Schülke & Mayer Gmbh, Norderstedt, Germany) is suitable both for SLA- and DLP-printed surgical guides. Heat sterilization at both 121 °C and 134 °C modified the mechanical properties of the surgical guides.
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Affiliation(s)
- Silvia Izabella Pop
- Orthodontic Department, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gh. Marinescu Str., 540139 Târgu Mureș, Romania; (S.I.P.); (M.P.)
| | - Mircea Dudescu
- Department of Mechanical Engineering, Technical University of Cluj-Napoca, 28 Memorandumului Street, 400114 Cluj-Napoca, Romania
- Correspondence: (M.D.); (S.G.M.)
| | - Sorin Gheorghe Mihali
- Department of Prosthodontics, Faculty of Dentistry, “Vasile Goldis” Western University of Arad, 94 Revolutiei Blvd, 310025 Arad, Romania
- Correspondence: (M.D.); (S.G.M.)
| | - Mariana Păcurar
- Orthodontic Department, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gh. Marinescu Str., 540139 Târgu Mureș, Romania; (S.I.P.); (M.P.)
| | - Dana Cristina Bratu
- Department of Orthodontics and Dento-Facial Orthopedics, Orthodontic Research Center, Faculty of Dental Medicine, Victor Babeș University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timișoara, Romania;
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22
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Elliott T, Hamilton A, Griseto N, Gallucci GO. Additively Manufactured Surgical Implant Guides: A Review. J Prosthodont 2022; 31:38-46. [PMID: 35313020 DOI: 10.1111/jopr.13476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2021] [Indexed: 01/21/2023] Open
Abstract
Static computer assisted implant surgery (s-CAIS) is an integral part of the digital workflow in implant dentistry and provides the link between the virtual planning environment and surgical field. The accuracy of s-CAIS is influenced by many cumulative factors including the fit of the template which is related to the manufacturing process. This critical review provides an overview of the current research on additively manufactured surgical implant guides.
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Affiliation(s)
- Tom Elliott
- Division of Oral Restorative and Rehabilitative Sciences, University of Western Australia, Perth, Western Australia
| | - Adam Hamilton
- Division of Oral Restorative and Rehabilitative Sciences, University of Western Australia, Perth, Western Australia.,Division of Regenerative and Implant Sciences, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA
| | - Neil Griseto
- Division of Regenerative and Implant Sciences, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA
| | - German O Gallucci
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA
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Dautzenberg P, Volk HA, Huels N, Cieciora L, Dohmen K, Lüpke M, Seifert H, Harms O. The effect of steam sterilization on different 3D printable materials for surgical use in veterinary medicine. BMC Vet Res 2021; 17:389. [PMID: 34949184 PMCID: PMC8697434 DOI: 10.1186/s12917-021-03065-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background Different 3D-printed materials polyactic acid (PLA), polyamide (PA), polycarbonates (PC), acrylonitrile butadiene styrene (ABS) and GreenTEC Pro®I have been considered for surgical templates, but there is a sparity of data about how these materials are affected by steam sterilization. The aim of the current study was to test if and how these materials change morphologically when high temperature, pressure and humidity are applied during the steam sterilization process. The overall aim is to create patient-specific sawing templates for performing corrective osteotomies. After the designing process, test-specimens with five different materials: PLA, PC, ABS, PA and GreenTEC Pro® were 3D-printed in two filling grades (30 and 100%). The FDM method was used for printing. After 3D-printing, the test-specimens were steam sterilized with a standard program lasting 20 min, at a temperature of 121 °C and a pressure of 2–3 bar. In order to measure the deviation of the printed model, we measured the individual test-specimens before and after steam sterilization using a sliding gauge. Results PC, PA and ABS showed great morphological deviations from the template after 3D-printing and steam sterilization (> 1%) respectively. ABS proved unsuitable for steam sterilization. PLA and GreenTEC Pro® demonstrated fewer morphological deviations both before and after sterilization. Therefore, we decided to perform a second test just with PLA and Green-TEC Pro® to find out which material has the highest stability and is probably able to be used for clinical application. The smallest deviations were found with the GreenTEC Pro® solid body. After autoclaving, the specimens showed a deviation from the planned body and remained below the 1% limit. Conclusion Steam sterilization causes morphological deviations in 3D printed objects. GreenTEC Pro® seems to be a suitable material for clinical use, not only for intraoperative use, but also for precise modeling. Microbiological examination, as well as biomechanical tests, should be performed to further assess whether intraoperative use is possible. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-021-03065-8.
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Affiliation(s)
- Philipp Dautzenberg
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.
| | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - Nikolaus Huels
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - Lena Cieciora
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - Katharina Dohmen
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - Matthias Lüpke
- Department of General Radiology and Medical Physics, University of Veterinary Medicine Hanover, Bischofsholer Damm 15, 30173, Hannover, Germany
| | - Herman Seifert
- Department of General Radiology and Medical Physics, University of Veterinary Medicine Hanover, Bischofsholer Damm 15, 30173, Hannover, Germany
| | - Oliver Harms
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
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Popescu D, Baciu F, Amza CG, Cotrut CM, Marinescu R. The Effect of Disinfectants Absorption and Medical Decontamination on the Mechanical Performance of 3D-Printed ABS Parts. Polymers (Basel) 2021; 13:4249. [PMID: 34883752 PMCID: PMC8659898 DOI: 10.3390/polym13234249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/23/2021] [Accepted: 12/02/2021] [Indexed: 12/13/2022] Open
Abstract
Producing parts by 3D printing based on the material extrusion process determines the formation of air gaps within layers even at full infill density, while external pores can appear between adjacent layers making prints permeable. For the 3D-printed medical devices, this open porosity leads to the infiltration of disinfectant solutions and body fluids, which might pose safety issues. In this context, this research purpose is threefold. It investigates which 3D printing parameter settings are able to block or reduce permeation, and it experimentally analyzes if the disinfectants and the medical decontamination procedure degrade the mechanical properties of 3D-printed parts. Then, it studies acetone surface treatment as a solution to avoid disinfectants infiltration. The absorption tests results indicate the necessity of applying post-processing operations for the reusable 3D-printed medical devices as no manufacturing settings can ensure enough protection against fluid intake. However, some parameter settings were proven to enhance the sealing, in this sense the layer thickness being the most important factor. The experimental outcomes also show a decrease in the mechanical performance of 3D-printed ABS (acrylonitrile butadiene styrene) instruments treated by acetone cold vapors and then medical decontaminated (disinfected, cleaned, and sterilized by hydrogen peroxide gas plasma sterilization) in comparison to the control prints. These results should be acknowledged when designing and 3D printing medical instruments.
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Affiliation(s)
- Diana Popescu
- Faculty of Industrial Engineering and Robotics, University Politehnica of Bucharest, 060042 Bucharest, Romania; (D.P.); (C.G.A.)
| | - Florin Baciu
- Faculty of Industrial Engineering and Robotics, University Politehnica of Bucharest, 060042 Bucharest, Romania; (D.P.); (C.G.A.)
| | - Catalin Gheorghe Amza
- Faculty of Industrial Engineering and Robotics, University Politehnica of Bucharest, 060042 Bucharest, Romania; (D.P.); (C.G.A.)
| | - Cosmin Mihai Cotrut
- Faculty of Materials Science and Engineering, University Politehnica of Bucharest, 060042 Bucharest, Romania;
| | - Rodica Marinescu
- Department of Orthopedics, University of Medicine and Pharmacology Carol Davila, 020021 Bucharest, Romania;
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Rouzé l'Alzit F, Cade R, Naveau A, Babilotte J, Meglioli M, Catros S. Accuracy of commercial 3D printers for the fabrication of surgical guides in dental implantology. J Dent 2021; 117:103909. [PMID: 34852291 DOI: 10.1016/j.jdent.2021.103909] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/20/2021] [Accepted: 11/25/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To evaluate the accuracy of two different surgical guides (small extent = single implant and large extent = full arch) fabricated by five additive manufacturing technologies (SLA=Stereolithography, DLP= Digital Light Processing, FDM=Fused Deposition Modeling, SLS=Selective Laser Sintering, Inkjet). METHODS Overall, 72 guides (6 per type) were obtained with the different machines (SLA=Form2; DLP=Rapid Shape D40 and Cara Print 4.0; FDM=Raise 3D Pro2; SLS=Prodways P1000; Polyjet®=Stratasys J750). The guides were surface-scanned with an optical dental scanner, and the resulting files were compared with the initial design files using a surface matching software. Root Mean Square (RMS) and standard deviation were calculated, representing respectively trueness and precision. Kruskall-Wallis non-parametric test was used to compare trueness and precision between small-extent and large-extent guides and 3D printer by pairs. The threshold for significance was α=0.05, except for the comparison of printers by pairs where a Bonferroni-corrected level of 0.0033 was used. RESULTS Significant differences were observed for trueness and precision between small-extent and large-extent guides, regardless the printer except for DLP (trueness and precision) and SLS (precision). SLA, DLP and Polyjet® technologies showed similar results in terms of trueness and precision for both small-extend and large-extend guides (P>0.05). CONCLUSIONS The size affected the accuracy of CAD-CAM surgical guides. The different additive manufacturing technologies had a limited impact on the accuracy. CLINICAL SIGNIFICANCE This study is of clinical interest as it shows that the 3D printing technology (SLA/DLP) has a limited impact on 3D printed surgical guides accuracy. However, the size of the guide can have a significant impact, as small-extent guides were more accurate than large-extent guides.
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Affiliation(s)
- Francois Rouzé l'Alzit
- Institute of Condensed Matter Chemistry of Bordeaux, CNRS UMR5026, University of Bordeaux, Bordeaux, France; Department of prosthodontic dentistry, CHU Bordeaux, Bordeaux, France.
| | | | - Adrien Naveau
- Department of prosthodontic dentistry, CHU Bordeaux, Bordeaux, France; Tissue Bioengineering, INSERM U1026, University of Bordeaux, Bordeaux, France
| | - Joanna Babilotte
- Tissue Bioengineering, INSERM U1026, University of Bordeaux, Bordeaux, France
| | - Matteo Meglioli
- Center of Dental Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sylvain Catros
- Tissue Bioengineering, INSERM U1026, University of Bordeaux, Bordeaux, France; Department of Oral Surgery, CHU Bordeaux, Bordeaux, France
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Accuracy of static fully guided implant placement in the posterior area of partially edentulous jaws: a cohort prospective study. Clin Oral Investig 2021; 26:2783-2791. [PMID: 34782925 DOI: 10.1007/s00784-021-04254-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE A cohort prospective study was conducted to assess the three-dimensional positioning accuracy of the implant between pre-surgical and the final implant position using a static fully guided approach in the posterior area of the jaws. MATERIALS AND METHODS A total of 60 implants (30 patients) were digitally analyzed after superimposing the Digital Imaging and Communications in Medicine (DICOM) files obtained from the Cone Beam Computed Tomography (CBCT) pre- and post-implant placement. The software calculations included deviations at the implant shoulder and at the implant apex, global deviation (3D offset), and angle deviation. Statistical analysis was performed with α = 0.05. RESULTS Considering the total number of implants, mesiodistal, buccolingual, and apicocoronal mean deviations at the shoulder and implant apex were equal or below 0.21 ± 0.69 mm, and only the buccolingual mean deviation at the apex reached up to 0.67 ± 1.06 mm. The mesiodistal and apicocoronal deviations were not statistically significant at both the shoulder and apex levels of the implant. The mean total angular deviation was 5.62° ± 4.09. The main limitation of this surgical approach was the requirement for a wide mouth opening. CONCLUSIONS Static fully guided surgery for dental implant placement exhibits minimum deviations respect to presurgical planning. The main limitation in the posterior areas is the requirement for a wide mouth opening. CLINICAL RELEVANCE Even with minimum deviations clinically acceptable, precautions and safety margins must be respected when using static full-guided surgery to place dental implants.
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27
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Ivone R, Yang Y, Shen J. Recent Advances in 3D Printing for Parenteral Applications. AAPS J 2021; 23:87. [PMID: 34145513 PMCID: PMC8212901 DOI: 10.1208/s12248-021-00610-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/17/2021] [Indexed: 12/25/2022] Open
Abstract
3D printing has emerged as an advanced manufacturing technology in the field of pharmaceutical sciences. Despite much focus on enteral applications, there has been a lack of research focused on potential benefits of 3D printing for parenteral applications such as wound dressings, biomedical devices, and regenerative medicines. 3D printing technologies, including fused deposition modeling, vat polymerization, and powder bed printing, allow for rapid prototyping of personalized medications, capable of producing dosage forms with flexible dimensions based on patient anatomy as well as dosage form properties such as porosity. Considerations such as printing properties and material selection play a key role in determining overall printability of the constructs. These parameters also impact drug release kinetics, and mechanical properties of final printed constructs, which play a role in modulating immune response upon insertion in the body. Despite challenges in sterilization of printed constructs, additional post-printing processing procedures, and lack of regulatory guidance, 3D printing will continue to evolve to meet the needs of developing effective, personalized medicines for parenteral applications.
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Affiliation(s)
- Ryan Ivone
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, 7 Greenhouse Road, Kingston, Rhode Island, 02881, USA
| | - Yan Yang
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China.
| | - Jie Shen
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, 7 Greenhouse Road, Kingston, Rhode Island, 02881, USA.
- Department of Chemical Engineering, University of Rhode Island, 7 Greenhouse Road, Kingston, Rhode Island, 02881, USA.
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28
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Ferràs-Tarragó J, Sabalza-Baztán O, Sahuquillo-Arce JM, Angulo-Sánchez MÁ, De-La-Calva Ceinos C, Amaya-Valero JV, Baixauli-García F. Autoclave sterilization of an in-house 3D-printed polylactic acid piece: biological safety and heat-induced deformation. Eur J Trauma Emerg Surg 2021; 48:3901-3910. [PMID: 33959787 DOI: 10.1007/s00068-021-01672-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/12/2021] [Indexed: 12/17/2022]
Abstract
AIMS Fused filament fabrication 3D printing with polylactic acid filaments is the most widely used method to generate biomodels at hospitals throughout the world. The main limitation of this manufacturing system is related to the biomodels' temperature sensitivity, which all but prevents them to be sterilized using conventional methods. The purpose of this study is to define an autoclave temperature-resistant FFF-PLA 3D printing protocol to print 3D fractures biomodels during preoperative planning. METHODS AND RESULTS Six different printing protocols were established, each with a different infill percentage. Ten distal radius biomodels were printed with each protocol and each biomodel was subject to 3D scanning. The biomodels were subsequently autoclave-sterilized at 134 °C and subjected to a new scanning process, which was followed by a calculation of changes in area, volume and deformity using the Hausdorff-Besicovitch method. Finally, 192 polylactic acid models were produced using the printing protocol offering the greatest resistance and were contaminated with 31 common nosocomial pathogens to evaluate the effectiveness of sterilizing the model printed using the said protocol. Sterilization resulted in a mean deformation of the biomodel of 0.14 mm, a maximum deformity of 0.75 mm, and a 1% area and a 3.6% volume reduction. Sterilization of the pieces printed using the analyzed protocol was 100% effective. CONCLUSIONS The analyzed 3D printing protocol may be applied with any FFF-PLA 3D printer, it is safe and does not significantly alter the morphology of biomodels. These results indicate that 3D printing is associated with significant advantages for health centers as it increases their autonomy, allowing them to easily produce 3D biomodels that can be used for the treatment of fractures.
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Affiliation(s)
- Joan Ferràs-Tarragó
- Orthopaedic Surgery and Traumatology, Hospital La Fe, Av Fernando Abril Martorell 106, Valencia, Spain.
| | | | | | | | | | - Jose Vicente Amaya-Valero
- Orthopaedic Surgery and Traumatology, Hospital La Fe, Av Fernando Abril Martorell 106, Valencia, Spain
| | - Francisco Baixauli-García
- Orthopaedic Surgery and Traumatology, Hospital La Fe, Av Fernando Abril Martorell 106, Valencia, Spain
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29
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Ferràs-Tarragó J, Sabalza-Baztán O, Sahuquillo-Arce JM, Angulo-Sánchez MÁ, Amaya-Valero J, De-La-Calva Ceinos C, Baixauli-García F. Security of 3D-printed polylactide acid piece sterilization in the operating room: a sterility test. Eur J Trauma Emerg Surg 2021; 48:3895-3900. [PMID: 33452547 DOI: 10.1007/s00068-020-01564-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/19/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION 3D-printing technology has become very popular the last 10 years, and their advantages have been widely proved. However, its safety in the operating room after sterilization has not been evaluated. Thus, the use of 3D printing is still questioned. The aim of this work is to evaluate the security of polylactic acid (PLA) to print surgical models after its sterilization. MATERIALS AND METHODS One hundred and eighty-six PLA plates and 6 negative controls without microorganisms were seeded. After 10 days of culture, the PLA plates were randomized into three groups: A, B, and C. Group A underwent a sterilization process using an autoclave program at 134 °C. Group B was seeded in different culture media and group C was used to make crystal violet stains on the biofilms formed on the PLA. Mechanical properties of PLA after autoclave sterilization including, the breaking load, deformation and breaking load per surface were calculated. RESULTS Hundred percent of the group B showed monomicrobial growth. Stains performed on group C PLA showed biofilms in all PLA pieces. After sterilization, no pathogen growth was observed in group A during the culture observation period showing 100% sterilization effectiveness. A filling percentage of 5% obtained a breaking load of 6.36 MPa, and its elastic limit occurred after an elongation of 167.4%. A 10% infill was mechanically safe. CONCLUSIONS Autoclave sterilization of PLA-printed pieces is safe for the patient and mechanically strong for the surgeon. This is the first 3D-printing protocol described and evaluated to implement 3D-printing technology safely in the operating room. SIGNIFICANCE AND IMPACT OF STUDY This is the first 3D-printing protocol described to print and sterilize 3D biomodels using an autoclave showing its biological safety and its mechanical resistance.
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Affiliation(s)
- Joan Ferràs-Tarragó
- Orthopaedic Surgery and Traumatology. Hospital La Fe, Av Fernando Abril Martorell 106, Valencia, Spain.
| | | | | | | | - Jose Amaya-Valero
- Orthopaedic Surgery and Traumatology. Hospital La Fe, Av Fernando Abril Martorell 106, Valencia, Spain
| | | | - Francisco Baixauli-García
- Orthopaedic Surgery and Traumatology. Hospital La Fe, Av Fernando Abril Martorell 106, Valencia, Spain
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Tian Y, Chen C, Xu X, Wang J, Hou X, Li K, Lu X, Shi H, Lee ES, Jiang HB. A Review of 3D Printing in Dentistry: Technologies, Affecting Factors, and Applications. SCANNING 2021; 2021:9950131. [PMID: 34367410 PMCID: PMC8313360 DOI: 10.1155/2021/9950131] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/20/2021] [Accepted: 06/24/2021] [Indexed: 05/14/2023]
Abstract
Three-dimensional (3D) printing technologies are advanced manufacturing technologies based on computer-aided design digital models to create personalized 3D objects automatically. They have been widely used in the industry, design, engineering, and manufacturing fields for nearly 30 years. Three-dimensional printing has many advantages in process engineering, with applications in dentistry ranging from the field of prosthodontics, oral and maxillofacial surgery, and oral implantology to orthodontics, endodontics, and periodontology. This review provides a practical and scientific overview of 3D printing technologies. First, it introduces current 3D printing technologies, including powder bed fusion, photopolymerization molding, and fused deposition modeling. Additionally, it introduces various factors affecting 3D printing metrics, such as mechanical properties and accuracy. The final section presents a summary of the clinical applications of 3D printing in dentistry, including manufacturing working models and main applications in the fields of prosthodontics, oral and maxillofacial surgery, and oral implantology. The 3D printing technologies have the advantages of high material utilization and the ability to manufacture a single complex geometry; nevertheless, they have the disadvantages of high cost and time-consuming postprocessing. The development of new materials and technologies will be the future trend of 3D printing in dentistry, and there is no denying that 3D printing will have a bright future.
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Affiliation(s)
- Yueyi Tian
- The Conversationalist Club, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - ChunXu Chen
- The Conversationalist Club, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Xiaotong Xu
- The Conversationalist Club, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Jiayin Wang
- The Conversationalist Club, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Xingyu Hou
- The Conversationalist Club, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Kelun Li
- The Conversationalist Club, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Xinyue Lu
- The Conversationalist Club, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - HaoYu Shi
- The Conversationalist Club, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Eui-Seok Lee
- Department of Oral and Maxillofacial Surgery, Graduate School of Clinical Dentistry, Korea University, Seoul 08308, Republic of Korea
| | - Heng Bo Jiang
- The Conversationalist Club, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
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31
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Zhang PC, Ahmed Y, Hussein IM, Afenu E, Feasson M, Daud A. Optimization of community-led 3D printing for the production of protective face shields. 3D Print Med 2020; 6:35. [PMID: 33230665 PMCID: PMC7682762 DOI: 10.1186/s41205-020-00089-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023] Open
Abstract
Background As the healthcare system faced an acute shortage of personal protective equipment (PPE) during the COVID-19 pandemic, the use of 3D printing technologies became an innovative method of increasing production capacity to meet this acute need. Due to the emergence of a large number of 3D printed face shield designs and community-led PPE printing initiatives, this case study examines the methods and design best optimized for community printers who may not have the resources or experience to conduct such a thorough analysis. Case presentation We present the optimization of the production of 3D printed face shields by community 3D printers, as part of an initiative aimed at producing PPE for healthcare workers. The face shield frames were manufactured using the 3DVerkstan design and were coupled with an acetate sheet to assemble a complete face shield. Rigorous quality assurance and decontamination protocols ensured community-printed PPE was satisfactory for healthcare use. Conclusion Additive manufacturing is a promising method of producing adequate face shields for frontline health workers because of its versatility and quick up-start time. The optimization of stacking and sanitization protocols allowed 3D printing to feasibly supplement formal public health responses in the face of a global pandemic.
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Affiliation(s)
- Peter Chengming Zhang
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Rotman School of Management, University of Toronto, Toronto, Ontario, Canada
| | - Yousuf Ahmed
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isra M Hussein
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Edem Afenu
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Manon Feasson
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anser Daud
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Ashurko I, Vlasova I, Yaremchuk P, Bystrova O. Autotransplantation of teeth as an alternative to dental implantation. BMJ Case Rep 2020; 13:13/6/e234889. [PMID: 32532914 DOI: 10.1136/bcr-2020-234889] [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] [Indexed: 11/04/2022] Open
Abstract
Autotransplantation of teeth is a considerable option for tooth replacement in adults who are to undergo orthodontic treatment. Being compared with dental implantation, this procedure is more preferable as a grafted tooth functions as a normal one. In this case report, we describe successful autotransplantation of the third molar with complete root formation. To provide better adaptation of the donor tooth, we used its preoperatively printed replica. The donor tooth was immediately placed to the recipient site and splinted for 28 days. Endodontic treatment was initiated 2 weeks after transplantation. Clinical and radiographic findings at 6 and 12 months of follow-up are compared with the results described in the literature.
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Affiliation(s)
- Igor Ashurko
- Surgery Dentistry, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Iuliia Vlasova
- Surgery Dentistry, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Polina Yaremchuk
- Surgery Dentistry, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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Sharma N, Cao S, Msallem B, Kunz C, Brantner P, Honigmann P, Thieringer FM. Effects of Steam Sterilization on 3D Printed Biocompatible Resin Materials for Surgical Guides-An Accuracy Assessment Study. J Clin Med 2020; 9:jcm9051506. [PMID: 32429549 PMCID: PMC7291001 DOI: 10.3390/jcm9051506] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 12/13/2022] Open
Abstract
Computer-assisted surgery with three-dimensional (3D) printed surgical guides provides more accurate results than free-hand surgery. Steam sterilization could be one of the factors that affect the dimensions of surgical guide resin materials, leading to inaccuracies during surgeries. The purpose of this study was to evaluate the effects of steam sterilization on the dimensional accuracy of indication-specific hollow cube test bodies, manufactured in-house using Class IIa biocompatible resin materials (proprietary and third-party). To evaluate the pre- and post-sterilization dimensional accuracy, root mean square (RMS) values were calculated. The results indicate that, in all the groups, steam sterilization resulted in an overall linear expansion of the photopolymeric resin material, with an increase in outer dimensions and a decrease in inner dimensions. The effects on the dimensional accuracy of test bodies were not statistically significant in all the groups, except PolyJet Glossy (p > 0.05). The overall pre- and post-sterilization RMS values were below 100 and 200 µm, respectively. The highest accuracies were seen in proprietary resin materials, i.e., PolyJet Glossy and SLA-LT, in pre- and post-sterilization measurements, respectively. The dimensional accuracy of third-party resin materials, i.e., SLA-Luxa and SLA-NextDent, were within a comparable range as proprietary materials and can serve as an economical alternative.
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Affiliation(s)
- Neha Sharma
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; (N.S.); (S.C.); (B.M.); (C.K.)
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 16, 4123 Allschwil, Switzerland; (P.B.); (P.H.)
| | - Shuaishuai Cao
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; (N.S.); (S.C.); (B.M.); (C.K.)
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 16, 4123 Allschwil, Switzerland; (P.B.); (P.H.)
| | - Bilal Msallem
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; (N.S.); (S.C.); (B.M.); (C.K.)
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 16, 4123 Allschwil, Switzerland; (P.B.); (P.H.)
| | - Christoph Kunz
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; (N.S.); (S.C.); (B.M.); (C.K.)
| | - Philipp Brantner
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 16, 4123 Allschwil, Switzerland; (P.B.); (P.H.)
- Radiology Department, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Philipp Honigmann
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 16, 4123 Allschwil, Switzerland; (P.B.); (P.H.)
- Hand Surgery, Cantonal Hospital Basel-land, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Florian M. Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; (N.S.); (S.C.); (B.M.); (C.K.)
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 16, 4123 Allschwil, Switzerland; (P.B.); (P.H.)
- Correspondence:
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