1
|
Wu Q, Lou Y, Sun J, Xie C, Wu J, Yu H. Accuracy of the novel digital non-cross-arch surgical guides with integration of tooth undercut retention and screw-bone support for implant placement in mandibular free-end. BMC Oral Health 2024; 24:550. [PMID: 38734597 PMCID: PMC11088151 DOI: 10.1186/s12903-024-04329-z] [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: 01/29/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Large cross-arch free-end surgical guides can obscure the visual field, compromising surgical accuracy due to insufficient stability at the free-end. This in vitro study aims to evaluate the accuracy of novel digital non-cross-arch surgical guides designed for implant placement at the mandibular free-end, incorporating tooth undercut retention and screw-bone support. MATERIALS AND METHODS A mandibular dental model lacking left molars was utilized to fabricate unilateral (cross-arch) tooth-supported surgical guides (GT I, n = 20). Subsequently, two additional types of surgical guides were fabricated: GT II (covering two teeth, n = 20) and GT III (covering three teeth, n = 20). These novel surgical guides were designed to utilize the undercut of the supporting teeth for retention and enhance stability with screw-bone support at the guide's free-end. Furthermore, 60 identical guiding blocks were assembled on the three types of surgical guides to facilitate the implants' insertion. On a phantom head, 120 implant replicas were placed at the Federal Dentaire Internationale (FDI) teeth positions #36 and #37 on the dental model, employing a combination of surgical guides and guiding blocks. To assess accuracy, planned and placed implant positions were compared using intraoral optical scanning. Discrepancies in angulation and linear deviations, including the coronal/apical 3D deviations, lateral deviation as well as depth deviation, were measured. Statistical analysis was performed using two-way ANOVA and Bonferroni test (α = 0.05). RESULTS GT I exhibited significantly largest discrepancies, including angular and linear deviations at the crest and apex at every implant site. Especially in depth, at implant site #36, the mean deviation value of GT I (0.27 ± 0.13 mm) was twice as large as GT III (0.13 ± 0.07 mm), and almost twice as large as GT II (0.14 ± 0.08 mm). However, at implant site #37, this deviation increased to almost a five-fold relationship between GT I (0.63 ± 0.12 mm) and II (0.14 ± 0.09 mm), as well as between GT I and III (0.13 ± 0.09 mm). No significant discrepancies existed between the novel surgical guides at either implant site #36 or #37. CONCLUSION This study provides a practical protocol for enhancing accuracy of implant placement and reducing the size of free-end surgical guides used at mandibular molar sites.
Collapse
Affiliation(s)
- Qin Wu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Department of Prosthodontics II, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road, 3rd Section, Chengdu, Sichuan, 610041, China
| | - Yuxin Lou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Department of Dental Technology, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road, 3rd Section, Chengdu, Sichuan, 610041, China
| | - Jikui Sun
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Department of Prosthodontics II, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road, 3rd Section, Chengdu, Sichuan, 610041, China
| | - Chenyang Xie
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Department of Dental Technology, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road, 3rd Section, Chengdu, Sichuan, 610041, China
| | - Jiacheng Wu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Department of Dental Technology, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road, 3rd Section, Chengdu, Sichuan, 610041, China
| | - Haiyang Yu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Department of Prosthodontics II, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road, 3rd Section, Chengdu, Sichuan, 610041, China.
| |
Collapse
|
2
|
Lan D, Luo Y, Qu Y, Man Y. The three-dimensional stability and accuracy of 3D printing surgical templates: An In Vitro study. J Dent 2024; 144:104936. [PMID: 38492806 DOI: 10.1016/j.jdent.2024.104936] [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: 08/15/2023] [Revised: 02/23/2024] [Accepted: 03/10/2024] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVE To evaluate the three-dimensional (3D) stability and accuracy of additively manufactured surgical templates fabricated using two different 3D printers and materials. MATERIALS AND METHODS Forty surgical templates were designed and printed using two different 3D printers: the resin group (n = 20) used a digital light processing (DLP) 3D printer with photopolymer resin, and the metal group (n = 20) employed a selective laser melting (SLM) 3D printer with titanium alloy. All surgical templates were scanned immediately after production and re-digitalized after one month of storage. Similarly, the implant simulations were performed twice. Three-dimensional congruency between the original design and the manufactured surgical templates was quantified using the root mean square (RMS), and the definitive and planned implant positions were determined and compared. RESULTS At the postproduction stage, the metal templates exhibited higher accuracy than the resin templates (p < 0.001), and these differences persisted after one month of storage (p < 0.001). The resin templates demonstrated a significant decrease in three-dimensional stability after one month of storage (p < 0.001), whereas the metal templates were not affected (p > 0.05). No significant differences in implant accuracy were found between the two groups. However, the resin templates showed a significant increase in apical and angular deviations after one month of storage (p < 0.001), whereas the metal templates were not affected (p > 0.05). CONCLUSION Printed metal templates showed higher fabrication accuracy than printed resin templates. The three-dimensional stability and implant accuracy of printed metal templates remained unaffected by one month of storage. CLINICAL SIGNIFICANCE With superior three-dimensional stability and acceptable implant accuracy, printed metal templates can be considered a viable alternative technique for guided surgery.
Collapse
Affiliation(s)
- Dongping Lan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yilin Luo
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yili Qu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yi Man
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| |
Collapse
|
3
|
Khaohoen A, Powcharoen W, Sornsuwan T, Chaijareenont P, Rungsiyakull C, Rungsiyakull P. Accuracy of implant placement with computer-aided static, dynamic, and robot-assisted surgery: a systematic review and meta-analysis of clinical trials. BMC Oral Health 2024; 24:359. [PMID: 38509530 PMCID: PMC10956322 DOI: 10.1186/s12903-024-04033-y] [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: 10/09/2023] [Accepted: 02/14/2024] [Indexed: 03/22/2024] Open
Abstract
This systematic review explores the accuracy of computerized guided implant placement including computer-aided static, dynamic, and robot-assisted surgery. An electronic search up to February 28, 2023, was conducted using the PubMed, Embase, and Scopus databases using the search terms "surgery", "computer-assisted", "dynamic computer-assisted", "robotic surgical procedures", and "dental implants". The outcome variables were discrepancies including the implant's 3D-coronal, -apical and -angular deviations. Articles were selectively retrieved according to the inclusion and exclusion criteria, and the data were quantitatively meta-analysed to verify the study outcomes. Sixty-seven articles were finally identified and included for analysis. The accuracy comparison revealed an overall mean deviation at the entry point of 1.11 mm (95% CI: 1.02-1.19), and 1.40 mm (95% CI: 1.31-1.49) at the apex, and the angulation was 3.51˚ (95% CI: 3.27-3.75). Amongst computerized guided implant placements, the robotic system tended to show the lowest deviation (0.81 mm in coronal deviation, 0.77 mm in apical deviation, and 1.71˚ in angular deviation). No significant differences were found between the arch type and flap operation in cases of dynamic navigation. The fully-guided protocol demonstrated a significantly higher level of accuracy compared to the pilot-guided protocol, but did not show any significant difference when compared to the partially guided protocol. The use of computerized technology clinically affirms that operators can accurately place implants in three directions. Several studies agree that a fully guided protocol is the gold standard in clinical practice.
Collapse
Affiliation(s)
- Angkoon Khaohoen
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Warit Powcharoen
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Tanapon Sornsuwan
- Department of Restorative Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok, 65000, Thailand
| | - Pisaisit Chaijareenont
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chaiy Rungsiyakull
- Department of Mechanical Engineering, Faculty of Engineering, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Pimduen Rungsiyakull
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai, 50200, Thailand.
| |
Collapse
|
4
|
de Almeida JC, Soares MQS, Mamani MP, Franco A, Junqueira JLC. Influence of surgeon experience on implant placement in guided surgeries: A systematic review and meta-analysis of randomized clinical trials. J Prosthet Dent 2024:S0022-3913(24)00004-0. [PMID: 38336565 DOI: 10.1016/j.prosdent.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 02/12/2024]
Abstract
STATEMENT OF PROBLEM Guided surgical techniques in implant dentistry use virtual planning to accurately position implants. Understanding the effect of a surgeon's experience on guided surgery is essential to ensure successful outcomes. PURPOSE The purpose of this systematic review and meta-analysis of randomized clinical trials was to evaluate the influence of a surgeon's experience on the accuracy of implant positioning in guided surgery for completely or partially edentulous patients. MATERIAL AND METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, searches were conducted in the PubMed, Scopus, Web of Science, EMBASE, Cochrane Library, SciELO, and nonpeer-reviewed literature databases. Studies that met the population, intervention, control, and outcome (PICO) strategy were included: a completely or partially edentulous maxilla or mandible, guided surgery performed by experienced and inexperienced surgeons, and assessing implant positioning accuracy. A random-effects meta-analysis with a 95% confidence interval was conducted using Stata 15.1. The risk of bias was assessed with the Cochrane risk-of-bias tool for randomized trials (RoB2), and evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022302288). RESULTS Three articles from 2017 to 2020 encompassing 43 participants (22 men and 21 women) with a mean age of 61.2 years and a total of 150 implants were included. No significant difference was found between experienced and inexperienced surgeons in terms of angular, cervical, or apical deviations of the implants (95% confidence interval, P<.05). The difference between surgeons regarding positioning accuracy was less than 0.01 degrees for angular deviation, 0.35 mm for apical deviation, and 0.16 mm for cervical deviation. Low heterogeneity was observed for angular deviations (Q P=.021, I2=34%, and t2<.001) and cervical deviations (Q P=.18, I2=45%, and t2=.064). High heterogeneity was observed for apical deviations (Q P<.001, I2=87% and t2=.522). The overall bias risk was moderate, with the evidence certainty ranging from low to moderate. CONCLUSIONS In guided surgery, the surgeon's experience did not significantly impact the occurrence of deviations in implant positioning.
Collapse
Affiliation(s)
| | | | | | - Ademir Franco
- Professor, Forensic Odontology Division, São Leopoldo Mandic Research Institute (SLM), Campinas, Brazil
| | | |
Collapse
|
5
|
Song YW, Yoo SH, Jung UW. Effects of a modified surgical protocol on the positional accuracy of dental implants placed using fully guided implant surgery in the partially edentulous posterior ridge with distal extension: a dentiform model study. J Adv Prosthodont 2024; 16:1-11. [PMID: 38455680 PMCID: PMC10917626 DOI: 10.4047/jap.2024.16.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE The present experiment aimed to evaluate the placement accuracy of fully guided implant surgery using a mucosa-supported surgical guide when the protocol of osteotomy and installation was modified (MP) compared to when the protocol was sequentially and conventionally carried out (CP). MATERIALS AND METHODS For 24 mandibular dentiform models, 12 dentists (6 experts and 6 beginners) performed fully guided implant placements two times at the right first and second molar sites using a mucosa-supported surgical guide, once by the CP (CP group) and at the other time by the MP (MP group). The presurgical and postsurgical stereolithographic images were superimposed, and the deviations between the virtually planned and actually placed implant positions and the procedure time were compared statistically (P < .05). RESULTS The accuracies were similar in the CP and MP groups. In the CP group, the mean platform and apex deviations at the second molar site for the beginners were +0.75 mm and +1.14 mm, respectively, which were significantly larger than those for the experts (P < .05). In the MP group, only the mean vertical deviation at the second molar site for the beginners (+0.53 mm) was significantly larger than that for the experts (P < .05). The procedure time was significantly longer for the MP group (+94.0 sec) than for the CP group (P < .05). CONCLUSION In fully guided implant surgery using a mucosa-supported guide, the MP may improve the placement accuracy when compared to the CP, especially at sites farther from the most-posterior natural tooth.
Collapse
Affiliation(s)
- Young Woo Song
- Department of Periodontology, Dental Hospital, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Seung Ha Yoo
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
| |
Collapse
|
6
|
Wagendorf O, Nahles S, Vach K, Kernen F, Zachow S, Heiland M, Flügge T. The impact of teeth and dental restorations on gray value distribution in cone-beam computer tomography: a pilot study. Int J Implant Dent 2023; 9:27. [PMID: 37676412 PMCID: PMC10484826 DOI: 10.1186/s40729-023-00493-z] [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: 03/08/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
PURPOSE To investigate the influence of teeth and dental restorations on the facial skeleton's gray value distributions in cone-beam computed tomography (CBCT). METHODS Gray value selection for the upper and lower jaw segmentation was performed in 40 patients. In total, CBCT data of 20 maxillae and 20 mandibles, ten partial edentulous and ten fully edentulous in each jaw, respectively, were evaluated using two different gray value selection procedures: manual lower threshold selection and automated lower threshold selection. Two sample t tests, linear regression models, linear mixed models, and Pearson's correlation coefficients were computed to evaluate the influence of teeth, dental restorations, and threshold selection procedures on gray value distributions. RESULTS Manual threshold selection resulted in significantly different gray values in the fully and partially edentulous mandible. (p = 0.015, difference 123). In automated threshold selection, only tendencies to different gray values in fully edentulous compared to partially edentulous jaws were observed (difference: 58-75). Significantly different gray values were evaluated for threshold selection approaches, independent of the dental situation of the analyzed jaw. No significant correlation between the number of teeth and gray values was assessed, but a trend towards higher gray values in patients with more teeth was noted. CONCLUSIONS Standard gray values derived from CT imaging do not apply for threshold-based bone segmentation in CBCT. Teeth influence gray values and segmentation results. Inaccurate bone segmentation may result in ill-fitting surgical guides produced on CBCT data and misinterpreting bone density, which is crucial for selecting surgical protocols. Created with BioRender.com.
Collapse
Affiliation(s)
- Oliver Wagendorf
- Department of Oral and Maxillofacial Surgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Susanne Nahles
- Department of Oral and Maxillofacial Surgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Kirstin Vach
- Faculty of Medicine and Medical Center, Institute of Medical Biometry and Statistics, University of Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg im Breisgau, Germany
| | - Florian Kernen
- Department of Oral and Maxillofacial Surgery and Translational Implantology, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg im Breisgau, Germany
| | - Stefan Zachow
- Department of Oral and Maxillofacial Surgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
- Zuse Institute Berlin (ZIB), Takustraße 7, 14195, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tabea Flügge
- Department of Oral and Maxillofacial Surgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| |
Collapse
|
7
|
Mangano FG, Admakin O, Lerner H, Mangano C. Artificial Intelligence and Augmented Reality for Guided Implant Surgery Planning: a Proof of Concept. J Dent 2023; 133:104485. [PMID: 36965859 DOI: 10.1016/j.jdent.2023.104485] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 03/27/2023] Open
Abstract
PURPOSE To present a novel protocol for authentic three-dimensional (3D) planning of dental implants, using artificial intelligence (AI) and augmented reality (AR). METHODS The novel protocol consists of (1) 3D data acquisition, with an intraoral scanner (IOS) and cone-beam computed tomography (CBCT); (2) application of AI for CBCT segmentation to obtain standard tessellation language (STL) models and automatic alignment with IOS models; (3) loading of selected STL models within the AR system and surgical planning with holograms; (4) surgical guide design with open-source computer-assisted-design (CAD) software; and (5) surgery on the patient. RESULTS This novel protocol is effective and time-efficient when used for planning simple cases of static guided implant surgery in the partially edentulous patient. The clinician can plan the implants in an authentic 3D environment, without using any radiological guided surgery software. The precision of implant placement looks clinically acceptable, with minor deviations. CONCLUSIONS AI and AR technologies can be successfully used for planning guided implant surgery for authentic 3D planning that may replace conventional guided surgery software. However, further clinical studies are needed to validate this protocol. STATEMENT OF CLINICAL RELEVANCE The combined use of AI and AR may change the perspectives of modern guided implant surgery for authentic 3D planning that may replace conventional guided surgery software.
Collapse
Affiliation(s)
- Francesco Guido Mangano
- Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russian Federation; Honorary Professor in Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, China.
| | - Oleg Admakin
- Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russian Federation.
| | - Henriette Lerner
- Academic Teaching and Research Institution of Johann Wolfgang Goethe University, Frankfurt, Germany.
| | | |
Collapse
|
8
|
Retentive design of a small surgical guide for implant surgery: An in-vitro study. J Dent 2023; 128:104384. [PMID: 36470471 DOI: 10.1016/j.jdent.2022.104384] [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: 03/21/2022] [Revised: 10/17/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Instability of the surgical guide is an overlooked factor that can result in a difference between the planned and the actual positions of an implant. Our aim was to compare the stability of the retentive surgical guide (RSG) with a conventional surgical guide (CSG) in an in-vitro experiment. METHODS A platform to evaluate the stability of the surgical guide was designed using 3D-modelling software (Meshmixer 3.5, Autodesk). Imaging data from 15 patients with a single missing tooth were used to plan the virtual implant. Two surgical guides were designed (Blue Sky Plan 4.8, Blue Sky Bio) and 3D printed (Form2, Dental SG resin, Formlabs) for each case: the CSG with the default, predetermined software settings, and the RSG, designed on a dental model with a 0.1-mm undercut and altered production parameters (reduced guide-to-teeth offset of 0.07 mm, reduced guide thickness of 2.3 mm and a retentive clasp in a marginal area). The dental models were reproducibly secured on the testing platform using a digital force gauge, and the surgical guides were positioned. An increasing force of 0.1 N, 1 N, 2.5 N, and 5 N was sequentially applied from the buccal and the oral directions to the surgical guide via a drill handle. For each force, either the magnitude of the guide's displacement was captured with an intra-oral scanner (CEREC Omnicam AC, Dentsply Sirona; software version: SW 4.5.2) or the dislodgement of the guide was recorded. Scans were imported for analysis (GOM Inspect 2018, GOM GmbH), and library files of the surgical guides and implants were superimposed as a joined complex. The deviation of the implant's position was calculated from the displacement of the guide's position RESULTS: Three-way repeated measures using ANOVA revealed a more significant guide displacement and virtually projected implant deviation in the CSG group than the RSG group and with increasing force in all the deviation parameters. Both groups showed greater resistance to the displacement with the force applied from the oral direction than the buccal direction. The application of the force in the buccal direction resulted in guide dislodgements of 13% and 0% for the CSG and RSG, respectively. In the oral direction, the dislodgement rates were 33% and 7% for the CSG and RSG, respectively. CONCLUSIONS Within the limitations of this study, the retentive design increased the stability of the surgical guide and, consequently, the accuracy of the virtually projected implants in comparison to the conventional surgical guide designed using the default settings. Clinical trials are needed to confirm its advantages in clinical use. CLINICAL SIGNIFICANCE With a simple modification to the design, the surgical guide retention provided greater stability, with smaller deviations under loading; this resulted in improved implant precision parameters without requiring additional materials or software. Further studies are needed to assess the clinical feasibility of this surgical guide with improved retention and function.
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Wang ZY, Chao JR, Zheng JW, You M, Liu Y, Shen JF. The influence of crown coverage on the accuracy of static guided implant surgery in partially edentulous models: An in vitro study. J Dent 2021; 115:103882. [PMID: 34742831 DOI: 10.1016/j.jdent.2021.103882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To evaluate the influence of crown coverage of surgical guides on the accuracy of static computer-assisted implant surgeries (sCAISs) in different partially edentulous situations. METHODS Acrylic models with five types of partially edentulous situations were fabricated in this study. In coDiagnostiX software (Dental Wings, Montreal, Canada), surgical templates were designed and fabricated with reduced crown coverage (RCC), standard crown coverage (SCC) and extended crown coverage (ECC). Then, fully guided implant placement into the acrylic models was performed by dental surgeons with more than 10 years of experience. In total, 120 models and 120 guides were manufactured, and 168 bone-level Straumann replica implants (4.1 × 10 mm, Institut Straumann AG, Basel, Switzerland) were inserted. Postoperative implant positions were scanned (Trios 3, 3 shape, Copenhagen, Denmark) and compared with the preplanned virtual positions via coDiagnostiX (Dental Wings, Montreal, Canada). The angular, coronal and apical deviations were measured and analyzed to evaluate the accuracy of implant insertion. Statistical analysis was performed using one-way ANOVA and Tukey's test. RESULTS For single tooth missing situations, the RCC group was similar to the SCC group and ECC group in anterior sites. In premolar or molar sites, the SCC and ECC groups had no statistically significant difference (p > .05), while the RCC group had more coronal and apical deviation (p < .05). For multiple teeth missing situations, there was no difference among the RCC, SCC and ECC groups (p > .05). No difference was found among the five edentulous situations with different CCs (p > .05). CONCLUSION The CC of templates can significantly affect the accuracy of guided surgeries when implants are inserted in a single gap at posterior sites. Templates with CC extended to the undercut line may be an optimal choice for static guided surgeries. CLINICAL SIGNIFICANCE The accuracy of static guided implant surgery can be influenced by the CC of templates, and proper CC with the guide covering extending to the undercut line may contribute to improved accuracy. CC should be taken into consideration when designing surgical templates.
Collapse
Affiliation(s)
- Zhen-Yu Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, Sichuan Province, China; West China School of Stomatology, Sichuan University, Chengdu, Sichuan Province, China
| | - Jia-Rui Chao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, Sichuan Province, China; West China School of Stomatology, Sichuan University, Chengdu, Sichuan Province, China
| | - Jia-Wen Zheng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, Sichuan Province, China; West China School of Stomatology, Sichuan University, Chengdu, Sichuan Province, China
| | - Meng You
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, Sichuan Province, China; West China School of Stomatology, Sichuan University, Chengdu, Sichuan Province, China; Department of Radiology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan Province, China
| | - Yang Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, Sichuan Province, China; West China School of Stomatology, Sichuan University, Chengdu, Sichuan Province, China; The Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan Province, China
| | - Jie-Fei Shen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, Sichuan Province, China; West China School of Stomatology, Sichuan University, Chengdu, Sichuan Province, China; Department of Prosthodontics II, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan Province, China.
| |
Collapse
|