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Burkhardt F, Handermann L, Rothlauf S, Gintaute A, Vach K, Spies BC, Lüchtenborg J. Accuracy of additively manufactured and steam sterilized surgical guides by means of continuous liquid interface production, stereolithography, digital light processing, and fused filament fabrication. J Mech Behav Biomed Mater 2024; 152:106418. [PMID: 38295512 DOI: 10.1016/j.jmbbm.2024.106418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/02/2024]
Abstract
Different printing technologies can be used for prosthetically oriented implant placement, however the influence of different printing orientations and steam sterilization remains unclear. In particular, no data is available for the novel technology Continuous Liquid Interface Production. The objective was to evaluate the dimensional accuracy of surgical guides manufactured with different printing techniques in vertical and horizontal printing orientation before and after steam sterilization. A total of 80 surgical guides were manufactured by means of continuous liquid interface production (CLIP; material: Keyguide, Keyprint), digital light processing (DLP; material: Luxaprint Ortho, DMG), stereolithography (SLA; Surgical guide, Formlabs), and fused filament fabrication (FFF; material: Clear Base Support, Arfona) in vertical and horizontal printing orientation (n = 10 per subgroup). Spheres were included in the design to determine the coordinates of 17 reference points. Each specimen was digitized with a laboratory scanner after additive manufacturing (AM) and after steam sterilization (134 °C). To determine the accuracy, root mean square values (RMS) were calculated and coordinates of the reference points were recorded. Based on the measured coordinates, deviations of the reference points and relevant distances were calculated. Paired t-tests and one-way ANOVA were applied for statistical analysis (significance p < 0.05). After AM, all printing technologies showed comparable high accuracy, with an increased deviation in z-axis when printed horizontally. After sterilization, FFF printed surgical guides showed distinct warpage. The other subgroups showed no significant differences regarding the RMS of the corpus after steam sterilization (p > 0.05). Regarding reference points and distances, CLIP showed larger deviations compared to SLA in both printing orientations after steam sterilization, while DLP manufactured guides were the most dimensionally stable. In conclusion, the different printing technologies and orientations had little effect on the manufacturing accuracy of the surgical guides before sterilization. However, after sterilization, FFF surgical guides exhibited significant deformation making their clinical use impossible. CLIP showed larger deformations due to steam sterilization than the other photopolymerizing techniques, however, discrepancies may be considered within the range of clinical acceptance. The influence on the implant position remains to be evaluated.
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Affiliation(s)
- Felix Burkhardt
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Leon Handermann
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Severin Rothlauf
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Aiste Gintaute
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Kirstin Vach
- Medical Center - University of Freiburg, Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Benedikt C Spies
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Jörg Lüchtenborg
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
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Rothlauf S, Pieralli S, Wesemann C, Burkhardt F, Vach K, Kernen F, Spies BC. Influence of planning software and surgical template design on the accuracy of static computer assisted implant surgery performed using surgical guides fabricated with material extrusion technology: An in vitro study. J Dent 2023; 132:104482. [PMID: 36931618 DOI: 10.1016/j.jdent.2023.104482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 03/05/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES This in vitro study aimed to assess the influence of the planning software and design of the surgical template on both trueness and precision of static computer assisted implant surgery (sCAIS) performed using surgical guides fabricated using material extrusion (ME). METHODS Three-dimensional radiographic and surface scans of a typodont were aligned using two planning software (coDiagnostiX, CDX; ImplantStudio, IST) to virtually position the two adjacent oral implants. Thereafter, surgical guides were created with either an original (O) or modified (M) design with reduced occlusal support and were steam sterilized. Forty surgical guides were used to instal 80 implants equally distributed among four groups: CDX-O, CDX-M, IST-O, and IST-M. Thereafter, the scan bodies were adapted to the implants and digitised. Finally, inspection software was used to assess discrepancies between the planned and final positions at the implant shoulder and main axis level. Multilevel mixed-effects generalised linear models were used for statistical analyses (p = 0.05). RESULTS In terms of trueness, the largest average vertical deviations (0.29 ± 0.07 mm) could be assessed for CDX-M. Overall, vertical errors were significantly dependent on the design (O < M; p ≤ 0.001). Furthermore, in horizontal direction, the largest mean discrepancy was 0.32 ± 0.09 mm (IST-O) and 0.31 ± 0.13 mm (CDX-M). CDX-O was superior compared to IST-O (p = 0.003) regarding horizontal trueness. The average deviations regarding the main implant axis ranged between 1.36 ± 0.41 ° (CDX-O) and 2.63 ± 0.87 ° (CDX-M). In terms of precision, mean standard deviation intervals of ≤ 0.12 mm (IST-O and -M) and ≤ 1.09 ° (CDX-M) were calculated. CONCLUSIONS Implant installation with clinically acceptable deviations is possible with ME surgical guides. Both evaluated variables affected trueness and precision with negligible differences. CLINICAL SIGNIFICANCE The planning system and design influenced the accuracy of implant installation using ME-based surgical guides. Nevertheless, discrepancies were ≤ 0.32 mm and ≤ 2.63 °, which may be considered within the range of clinical acceptance. ME should be further investigated as an alternative to the more expensive and time-consuming 3D printing technologies.
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Affiliation(s)
- Severin Rothlauf
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Stefano Pieralli
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Christian Wesemann
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Felix Burkhardt
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Kirstin Vach
- Medical Center - University of Freiburg, Institute for Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Zinkmattenstr. 6A, 79108, Freiburg, Germany.
| | - Florian Kernen
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Benedikt Christopher Spies
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
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