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Xu Z, Zhou L, Han B, Wu S, Xiao Y, Zhang S, Chen J, Guo J, Wu D. Accuracy of dental implant placement using different dynamic navigation and robotic systems: an in vitro study. NPJ Digit Med 2024; 7:182. [PMID: 38971937 PMCID: PMC11227595 DOI: 10.1038/s41746-024-01178-6] [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: 12/11/2023] [Accepted: 06/26/2024] [Indexed: 07/08/2024] Open
Abstract
Computer-aided implant surgery has undergone continuous development in recent years. In this study, active and passive systems of dynamic navigation were divided into active dynamic navigation system group and passive dynamic navigation system group (ADG and PDG), respectively. Active, passive and semi-active implant robots were divided into active robot group, passive robot group and semi-active robot group (ARG, PRG and SRG), respectively. Each group placed two implants (FDI tooth positions 31 and 36) in a model 12 times. The accuracy of 216 implants in 108 models were analysed. The coronal deviations of ADG, PDG, ARG, PRG and SRG were 0.85 ± 0.17 mm, 1.05 ± 0.42 mm, 0.29 ± 0.15 mm, 0.40 ± 0.16 mm and 0.33 ± 0.14 mm, respectively. The apical deviations of the five groups were 1.11 ± 0.23 mm, 1.07 ± 0.38 mm, 0.29 ± 0.15 mm, 0.50 ± 0.19 mm and 0.36 ± 0.16 mm, respectively. The axial deviations of the five groups were 1.78 ± 0.73°, 1.99 ± 1.20°, 0.61 ± 0.25°, 1.04 ± 0.37° and 0.42 ± 0.18°, respectively. The coronal, apical and axial deviations of ADG were higher than those of ARG, PRG and SRG (all P < 0.001). Similarly, the coronal, apical and axial deviations of PDG were higher than those of ARG, PRG, and SRG (all P < 0.001). Dynamic and robotic computer-aided implant surgery may show good implant accuracy in vitro. However, the accuracy and stability of implant robots are higher than those of dynamic navigation systems.
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Affiliation(s)
- Zonghe Xu
- Fujian Provincial Engineering Research Center of Oral Biomaterial, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | - Lin Zhou
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | - Bin Han
- Fujian Provincial Engineering Research Center of Oral Biomaterial, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | | | - Yanjun Xiao
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | - Sihui Zhang
- Fujian Provincial Engineering Research Center of Oral Biomaterial, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | - Jiang Chen
- Fujian Provincial Engineering Research Center of Oral Biomaterial, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | - Jianbin Guo
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China.
| | - Dong Wu
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China.
- Research Center of Dental and Craniofacial Implants, Fujian Medical University, Fuzhou, 350001, China.
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Liu Q, Liu Y, Chen D, Wu X, Huang R, Liu R, Chen Z, Chen Z. Placement accuracy and primary stability of implants in the esthetic zone using dynamic and static computer-assisted navigation: A retrospective case-control study. J Prosthet Dent 2024; 131:427-435. [PMID: 36473750 DOI: 10.1016/j.prosdent.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
STATEMENT OF PROBLEM Both the placement accuracy and primary stability of implants are important to implant therapy in the esthetic zone. The effect of dynamic and static computer-assisted navigation on the primary stability of implants in the esthetic zone remains uncertain. PURPOSE The purpose of this case-control study was to investigate the effect of dynamic and static computer-assisted navigation on the placement accuracy and primary stability of implants in the esthetic zone. MATERIAL AND METHODS Partially edentulous participants who received at least 1 implant in the anterior maxilla using either fully guided static or dynamic computer-assisted implant surgery (s-CAIS, d-CAIS) from January 2020 to February 2022 were screened. Participant demographic information, timing of implant placement, primary stability represented by the insertion torque value (ITV) in Ncm, and implant survival were collected from the treatment record. Bone quality at the implant sites was determined according to the Lekholm and Zarb classification. The accuracy of implant placement represented by the linear (platform: Dpl, mm; apex: Dap, mm) and angular deviations (axis: Dan, degree) between the planned and placed implants was evaluated based on the preoperative surgical plan and postoperative cone beam computed tomography (CBCT) data. A statistical analysis of the data was completed by using the chi-squared, Fisher exact, Student t, and Mann-Whitney U tests (α=.05). RESULTS A total of 32 study participants (38 implants) were included. The groups of s-CAIS (16 participants, 18 implants) and d-CAIS (16 participants, 20 implants) were statistically comparable in sex (P=.072), age (P=.548), bone quality (P=.671), and timing of implant placement (P=.719). All implants survived during an average follow-up period of 13 months. The d-CAIS group showed close linear deviations (Dpl 1.07 ±0.57 mm, Dap 1.26 ±0.53 mm) but lower angular deviation (Dan 2.14 ±1.20 degrees) and primary stability (ITV 25.25 ±7.52 Ncm) than the s-CAIS group (Dpl 0.92 ±0.46 mm, Dap 1.31 ±0.43 mm, Dan 3.31 ±1.61 degrees, ITV 30.56 ±11.23 Ncm, PDpl=.613, PDap=.743, PDan=.016, PITV=.028). CONCLUSIONS Comparable linear positioning accuracy and higher angular deviation were found for implants placed in the esthetic zone by using s-CAIS than when using d-CAIS. Higher primary stability of implants may be achieved by using s-CAIS, as s-CAIS seemed to have higher osteotomy accuracy than d-CAIS.
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Affiliation(s)
- Quan Liu
- Research Assistant, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Yuanxiang Liu
- Research Assistant, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Danying Chen
- Research Assistant, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Xiayi Wu
- Research Assistant, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Ruoxuan Huang
- Graduate student, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Runheng Liu
- Research Assistant, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Zetao Chen
- Professor, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Zhuofan Chen
- Professor, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China.
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Knipper A, Kuhn K, Luthardt RG, Schnutenhaus S. Accuracy of Dental Implant Placement with Dynamic Navigation-Investigation of the Influence of Two Different Optical Reference Systems: A Randomized Clinical Trial. Bioengineering (Basel) 2024; 11:155. [PMID: 38391641 PMCID: PMC10886004 DOI: 10.3390/bioengineering11020155] [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: 12/30/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
This randomized prospective clinical study aims to analyze the differences between the computer-assisted planned implant position and the clinically realized implant position using dynamic navigation. In the randomized prospective clinical study, 30 patients were recruited, of whom 27 could receive an implant (BLT, Straumann Institut AG, Basel, Switzerland) using a dynamic computer-assisted approach. Patients with at least six teeth in their jaws to be implanted were included in the study. Digital planning was performed using cone beam tomography imaging, and the visualization of the actual situation was carried out using an intraoral scan. Two different workflows with differently prepared reference markers were performed with 15 patients per group. The actual clinically achieved implant position was recorded with scan bodies fixed to the implants and an intraoral scan. The deviations between the planned and realized implant positions were recorded using evaluation software. The clinical examinations revealed no significant differences between procedures A and B in the mesiodistal, buccolingual and apicocoronal directions. For the mean angular deviation, group B showed a significantly more accurate value of 2.7° (95% CI 1.6-3.9°) than group A, with a value of 6.3° (95% CI 4.0-8.7°). The mean 3D deviation at the implant shoulder was 2.35 mm for workflow A (95% CI 1.92-2.78 mm) and 1.62 mm for workflow B (95% CI 1.2-2.05 mm). Workflow B also showed significantly higher accuracy in this respect. Similar values were determined at the implant apex. The clinical examination shows that sufficiently accurate implant placement is possible with the dynamic navigation system used here. The use of different workflows sometimes resulted in significantly different accuracy results. The data of the present study are comparable with the published findings of other static and dynamic navigation procedures.
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Affiliation(s)
- Anne Knipper
- Center for Dentistry, Dr. Schnutenhaus Community Health Center (CHC) GmbH, Breiter Wasmen 10, 78247 Hilzingen, Germany
| | - Katharina Kuhn
- Department for Dentistry, Clinic for Prosthodontics, Ulm University, Albert-Einstein-Allee 11, 89081 Ulm, Germany
| | - Ralph G Luthardt
- Department for Dentistry, Clinic for Prosthodontics, Ulm University, Albert-Einstein-Allee 11, 89081 Ulm, Germany
| | - Sigmar Schnutenhaus
- Center for Dentistry, Dr. Schnutenhaus Community Health Center (CHC) GmbH, Breiter Wasmen 10, 78247 Hilzingen, Germany
- Department for Dentistry, Clinic for Prosthodontics, Ulm University, Albert-Einstein-Allee 11, 89081 Ulm, Germany
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Rutkunas V, Gendviliene I, Auskalnis L, Mangano F, Zlatev S, Ivanova V, Mijiritsky E, Borusevicius R. Influence of Kennedy class and number of implants on the accuracy of dynamic implant navigation: An in vitro study using an X-ray free evaluation methodology. J Dent 2023; 139:104679. [PMID: 37683800 DOI: 10.1016/j.jdent.2023.104679] [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: 09/15/2022] [Revised: 05/21/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES The aim of this in vitro study was to evaluate the accuracy of fully guided dynamic implant navigation surgery in Kennedy I, II, and III class dental arch defects with two different implant designs, using an X-ray free evaluation method. METHODS Polyurethane resin maxillary models simulated posterior edentulous defects. Four cone beam computed tomography (CBCT) scans and four intraoral (IOS) scans were obtained for each model and a digital wax-up with the correct implant positions was made. The accuracy of implant positions was evaluated using an IOS-based X-ray-free method (3Shape). Four deviation characteristics were evaluated: insertion point, depth deviation, horizontal and angle deviation. RESULTS The insertion point deviation measures ranged from 0.19 mm to 1.71 mm. Depth (s) and (u) deviations ranged from -1.47 mm to 0.74 mm and from 0.02 mm to 1.47 mm, respectively. Horizontal deviation ranged from 0.09 mm to 1.37 mm. CONCLUSIONS There is a tendency of a decreasing insertion point deviation for an increasing number and distribution area of the teeth (increasing Kennedy class number). Kennedy class II and distal implant position had the most influence for the higher deviations. CLINICAL SIGNIFICANCE Dynamic implant guidance provides accurate spacing, angulation, depth and position of the implants. It is important to understand how the number of missing teeth and implant design could influence the accuracy of dynamic implant navigation. Thus, it is important to evaluate factors influencing the accuracy of dynamic systems by using a X-ray-free post-operative method and to overcome the limitations of providing multiple CBCT scans.
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Affiliation(s)
- Vygandas Rutkunas
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius 03101, Lithuania
| | - Ieva Gendviliene
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius 03101, Lithuania
| | - Liudas Auskalnis
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius 03101, Lithuania
| | - Francesco Mangano
- Honorary Professor in Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Stefan Zlatev
- CAD/CAM Center of Dental Medicine at the Research Institute, Medical University-Plovdiv, Plovdiv 4000, Bulgaria
| | - Vasilena Ivanova
- Oral Surgery Department, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv 4000, Bulgaria
| | - Eitan Mijiritsky
- Head and Neck Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Department of Otolaryngology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 699350, Israel
| | - Rokas Borusevicius
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius 03101, Lithuania.
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Senthil S, R V, C BNK, Mahendra J, N A. Current opinion on guided implant surgery. Bioinformation 2023; 19:786-789. [PMID: 37885775 PMCID: PMC10598351 DOI: 10.6026/97320630019786] [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: 06/01/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 10/28/2023] Open
Abstract
Implant dentistry has been evolving with various new technologies, materials and techniques of placement. Conventionally, determination of implant position, size and placement depend on pre-surgical diagnostic imaging, which is limited to two-dimensional radiographs and on the guiding acrylic stent which will be usually prepared over the duplicated casts. Guided implant surgery using cone beam computed tomography, virtual treatment planning software and stereolithographic surgical templates has undoubtedly been a major step toward achieving optimal 3-D implant positioning with respect to both anatomical and prosthetic parameters. This article discusses about the indications, advantages and the concept of guided implant surgery in the successful outcome of the implant placement.
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Affiliation(s)
- Surthi Senthil
- Department of Periodontology, Meenakshi Ammal Dental College and Hospital, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai - 600095, Tamil Nadu
| | - Vijayalakshmi R
- Department of Periodontology, Meenakshi Ammal Dental College and Hospital, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai - 600095, Tamil Nadu
| | - Burnice Nalina Kumari C
- Department of Periodontology, Meenakshi Ammal Dental College and Hospital, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai - 600095, Tamil Nadu
| | - Jaideep Mahendra
- Department of Periodontology, Meenakshi Ammal Dental College and Hospital, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai - 600095, Tamil Nadu
| | - Ambalavanan N
- Department of Periodontology, Meenakshi Ammal Dental College and Hospital, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai - 600095, Tamil Nadu
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Todaro C, Cerri M, Rodriguez Y Baena R, Lupi SM. Full-Arch Guided Restoration and Bone Regeneration: A Complete Digital Workflow Case Report. Healthcare (Basel) 2023; 11:healthcare11091301. [PMID: 37174843 PMCID: PMC10177883 DOI: 10.3390/healthcare11091301] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE complex rehabilitations present multiple difficulties, regarding both the planification of the surgery and the design of the prothesis. A digital approach can support the workflow, as well as the degree of intraoperative precision, and improve the long-term prognosis. METHODS A surgical guide was designed for implant placement. An extensive regeneration of the upper jaw was performed with contextual implant insertion, and a delayed load rehabilitation was chosen. After four months, a second surgery and a simultaneous soft tissue augmentation was performed, and a 3D-printed temporary restoration was placed. After another two months, new dental and facial scans, smile design, and facial bite registrations were obtained. Upper and lower dentures were built using an exclusively digital workflow. Both metal substructures were passivated and cemented in one session; in the following appointment, the aesthetic and occlusal checks were carried out. During the third visit, both prostheses were delivered. RESULTS Careful case planning and the surgical guide made it possible to achieve primary stability and acceptable emergence profiles in an extremely reabsorbed upper jaw. Leukocyte-Platelet Rich Fibrin (L-PRF) made the extensive bone regeneration more approachable and lowered the post-operative pain and swelling, while speeding up the soft tissue healing process. During the re-entry surgery, the volumes of soft tissues were increased to improve aesthetics, and the amount of keratinized gingiva around the six implants was also increased. Smile design and facial scans have provided the means to create acceptable aesthetics and function in a few sessions with minimal patient discomfort. CONCLUSIONS Computer-assisted implantology is a safe and precise method of performing dental implant surgery. Preliminary studies have a high degree of accuracy, but further studies are needed to arrive at a fully digital clinical protocol at all stages.
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Affiliation(s)
- Claudia Todaro
- School of Dentistry, Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | | | - Ruggero Rodriguez Y Baena
- School of Dentistry, Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Saturnino Marco Lupi
- School of Dentistry, Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Computer-Guided Osteotomy with Simultaneous Implant Placement and Immediately Loaded Full-Arch Fixed Restoration: A Case Report. PROSTHESIS 2023. [DOI: 10.3390/prosthesis5010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Aim: This case report aims to illustrate a clinical protocol that allows for the rehabilitation of patients requiring extensive osteotomy, simultaneous implant placement, and full-arch, screwed-in prosthetics in one session. This protocol allows for the improvement of the aesthetics and functionality of the fixed implant-supported prosthesis through the preoperative planning of all surgical procedures, including osteotomy, and of the prosthesis through the application of 3D-printing technology for the creation of surgical templates and prostheses. Methods: This case report concerns a 72-year-old patient, ASA1, who, following diagnosis, the establishment of a treatment plan, and the provision of informed consent, opted for an immediate, full-arch rehabilitation of the lower arch. The digital planning stage started with the correct positioning of the fixtures. The proper bone levels were found and used to guide the creation of the provisional screwed-in prothesis. Two templates with the same supports (landmarks/pins) were then 3D-printed: a positioning template, including a slit to assist the surgeon during the osteotomy, and a surgery template to assist the surgeon during the implants’ positioning. A screwed-in prosthesis encased in resin C&B MFH (NEXTDENT®, Soesterberg, The Netherlands) was delivered. Minimal occlusal adjustments were performed. Results: In a single clinical session, through careful planning and the pre-operative 3D printing of a prosthesis, a temporary implant-supported prosthetic rehabilitation was possible in a case that required an extended osteotomy. Clinically, the correspondence between the virtual design phase and the final realization was consistent. At a functional level, the provisional prosthesis required minimal occlusal adjustments and the DVO values obtained in the immediate post-operative period were found to be comparable to those of the virtual design. By planning the final position of the bone and the implants in advance, it was possible to deliver a full-arch prothesis with proper implant emergence, occlusal vertical dimensions, and occlusal relationship. Conclusion: This fully digital protocol allows the clinician to preview and plan the osteotomy and implant surgery as well as the delivery of the temporary, immediately loaded, complete, fixed prosthesis in patients who are candidates for post-extraction surgery with the need for severe osteotomy.
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Rezaie F, Farshbaf M, Dahri M, Masjedi M, Maleki R, Amini F, Wirth J, Moharamzadeh K, Weber FE, Tayebi L. 3D Printing of Dental Prostheses: Current and Emerging Applications. JOURNAL OF COMPOSITES SCIENCE 2023; 7:80. [PMID: 38645939 PMCID: PMC11031267 DOI: 10.3390/jcs7020080] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Revolutionary fabrication technologies such as three-dimensional (3D) printing to develop dental structures are expected to replace traditional methods due to their ability to establish constructs with the required mechanical properties and detailed structures. Three-dimensional printing, as an additive manufacturing approach, has the potential to rapidly fabricate complex dental prostheses by employing a bottom-up strategy in a layer-by-layer fashion. This new technology allows dentists to extend their degree of freedom in selecting, creating, and performing the required treatments. Three-dimensional printing has been narrowly employed in the fabrication of various kinds of prostheses and implants. There is still an on-demand production procedure that offers a reasonable method with superior efficiency to engineer multifaceted dental constructs. This review article aims to cover the most recent applications of 3D printing techniques in the manufacturing of dental prosthetics. More specifically, after describing various 3D printing techniques and their advantages/disadvantages, the applications of 3D printing in dental prostheses are elaborated in various examples in the literature. Different 3D printing techniques have the capability to use different materials, including thermoplastic polymers, ceramics, and metals with distinctive suitability for dental applications, which are discussed in this article. The relevant limitations and challenges that currently limit the efficacy of 3D printing in this field are also reviewed. This review article has employed five major scientific databases, including Google Scholar, PubMed, ScienceDirect, Web of Science, and Scopus, with appropriate keywords to find the most relevant literature in the subject of dental prostheses 3D printing.
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Affiliation(s)
- Fereshte Rezaie
- Department of Endodontic, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz P.O. Box 5163639888, Iran
| | - Masoud Farshbaf
- Department of Medical Nanotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz P.O. Box 5163639888, Iran
| | - Mohammad Dahri
- Research Center for Pharmaceutical Nanotechnology, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz P.O. Box 5163639888, Iran
| | - Moein Masjedi
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz P.O. Box 6468571468, Iran
| | - Reza Maleki
- Department of Chemical Technologies, Iranian Research Organization for Science and Technology (IROST), Tehran P.O. Box 33535111, Iran
| | - Fatemeh Amini
- School of Dentistry, Shahed University of Medical Sciences, Tehran P.O. Box 5163639888, Iran
| | - Jonathan Wirth
- School of Dentistry, Marquette University, Milwaukee, WI 53233, USA
| | - Keyvan Moharamzadeh
- Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai P.O. Box 505055, United Arab Emirates
| | - Franz E. Weber
- Center for Dental Medicine/Cranio-Maxillofacial and Oral Surgery, Oral Biotechnology and Bioengineering, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Lobat Tayebi
- School of Dentistry, Marquette University, Milwaukee, WI 53233, USA
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Wang XY, Liu L, Guan MS, Liu Q, Zhao T, Li HB. The accuracy and learning curves of active and passive dynamic navigation-guided dental implant surgery: An in vitro study. J Dent 2022; 124:104240. [PMID: 35872224 DOI: 10.1016/j.jdent.2022.104240] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Infrared dynamic navigation principles can be categorized into active and passive navigation systems based on whether the surgical instruments can emit or only reflect light, respectively. This in vitro study aimed to compare the accuracy of implant placement and the learning curves of both active and passive dynamic navigation systems using different registration methods. METHODS Implants (n=704) were placed in 64 sets of models and divided into active (Yizhime, DCARER, Suzhou, China) and passive (Iris-Clinic, EPED, Kaohsiung, China) dynamic navigation groups. Both marker point-based registration (M-PBR) and feature point-based registration (F-PBR) were employed by two groups mentioned above. Based on preoperative and postoperative cone-beam computed tomography imaging, the coronal, midpoint, apical, and angular deviations were analyzed from 2D and 3D views. The operation time was recorded for each group. RESULTS The active dynamic navigation group exhibited significantly greater accuracy than the passive dynamic navigation group for outcome variables (angular deviation, 4.13 ± 2.39° and 4.62 ± 3.32°; coronal global deviation, 1.48 ± 0.60 and 1.86 ± 1.12 mm; apical global deviation, 1.75 ± 0.81 and 2.20 ± 1.68 mm, respectively). Significant interaction effects were observed for both registration methods and four quadrants with different dynamic navigation systems. Learning curves for the two dynamic navigation groups approached each other after 12 procedures, and finally converged after 27 procedures. CONCLUSIONS The accuracy of active dynamic navigation system was superior to that of passive dynamic navigation system. Different combinations of dynamic navigation systems, registration methods, and implanted quadrants displayed various interactions. CLINICAL SIGNIFICANCE Our findings could provide guidance for surgeons in choosing an appropriate navigation system use in various implant surgeries. Furthermore, the time required by surgeons to master the technique was calculated for reference. Nevertheless, there are certain limitations to this in vitro study, and therefore further research is required.
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Affiliation(s)
- Xiao-Yu Wang
- Department of Stomatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Stomatology, The Strategic Support Force Medical Center, PLA, Beijing, China
| | - Lin Liu
- Department of Stomatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Miao-Sheng Guan
- Department of Stomatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Research, PLA Rocket Force Characteristic Medical Center, PLA, Beijing, China
| | - Qian Liu
- Department of Stomatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Tong Zhao
- School of Mathematical Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Hong-Bo Li
- Department of Stomatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
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Ochandiano S, García-Mato D, Gonzalez-Alvarez A, Moreta-Martinez R, Tousidonis M, Navarro-Cuellar C, Navarro-Cuellar I, Salmerón JI, Pascau J. Computer-Assisted Dental Implant Placement Following Free Flap Reconstruction: Virtual Planning, CAD/CAM Templates, Dynamic Navigation and Augmented Reality. Front Oncol 2022; 11:754943. [PMID: 35155183 PMCID: PMC8833256 DOI: 10.3389/fonc.2021.754943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/24/2021] [Indexed: 12/16/2022] Open
Abstract
Image-guided surgery, prosthetic-based virtual planning, 3D printing, and CAD/CAM technology are changing head and neck ablative and reconstructive surgical oncology. Due to quality-of-life improvement, dental implant rehabilitation could be considered in every patient treated with curative intent. Accurate implant placement is mandatory for prosthesis long-term stability and success in oncologic patients. We present a prospective study, with a novel workflow, comprising 11 patients reconstructed with free flaps and 56 osseointegrated implants placed in bone flaps or remnant jaws (iliac crest, fibula, radial forearm, anterolateral thigh). Starting from CT data and jaw plaster model scanning, virtual dental prosthesis was designed. Then prosthetically driven dental implacement was also virtually planned and transferred to the patient by means of intraoperative infrared optical navigation (first four patients), and a combination of conventional static teeth supported 3D-printed acrylic guide stent, intraoperative dynamic navigation, and augmented reality for final intraoperative verification (last 7 patients). Coronal, apical, and angular deviation between virtual surgical planning and final guided intraoperative position was measured on each implant. There is a clear learning curve for surgeons when applying guided methods. Initial only-navigated cases achieved low accuracy but were comparable to non-guided freehand positioning due to jig registration instability. Subsequent dynamic navigation cases combining highly stable acrylic static guides as reference and registration markers result in the highest accuracy with a 1–1.5-mm deviation at the insertion point. Smartphone-based augmented reality visualization is a valuable tool for intraoperative visualization and final verification, although it is still a difficult technique for guiding surgery. A fixed screw-retained ideal dental prosthesis was achieved in every case as virtually planned. Implant placement, the final step in free flap oncological reconstruction, could be accurately planned and placed with image-guided surgery, 3D printing, and CAD/CAM technology. The learning curve could be overcome with preclinical laboratory training, but virtually designed and 3D-printed tracer registration stability is crucial for accurate and predictable results. Applying these concepts to our difficult oncologic patient subgroup with deep anatomic alterations ended in comparable results as those reported in non-oncologic patients.
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Affiliation(s)
- Santiago Ochandiano
- Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- *Correspondence: Santiago Ochandiano,
| | - David García-Mato
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
| | - Alba Gonzalez-Alvarez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
| | - Rafael Moreta-Martinez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
| | - Manuel Tousidonis
- Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Carlos Navarro-Cuellar
- Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ignacio Navarro-Cuellar
- Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - José Ignacio Salmerón
- Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Javier Pascau
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
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