Keys to achieving successful restoratively-driven implant placement with CAD/CAM surgical guide: A technical note

Abstract Background: Technological advancements in dentistry in the past decade have led to many innovations and improvements. These advances have led to faster procedures that are more comfortable for the patient and dental surgeon compared to standard methodologies, such as conventional impressions and implant placement surgeries performed without surgical guides or with conventional handmade guides, which generate less predictable results. Use of CAD/CAM technology, both in manufacturing prostheses and in surgical planning, has led to optimization of the procedures and reductions of patient morbidity. Techniques have been developed for the preparation of surgical guides with the goal of optimizing the surgical procedure. Therefore, the aim of the study was to evaluate the reproducibility and precision of two types of surgical guides, obtained by using prototyping and milling methods.Methods: A virtual model was developed, which allowed the virtual design of surgical guide projections that were milled (n = 10) or prototyped (n = 10). Surgical guides were digitally oriented and overlapped on the virtual model that had generated them. In this way, mismatches from the master model were determined. Coefficients of variation, root mean square deviations, and mismatches during an overlap were evaluated. Results: The evaluations showed that the prototyped surgical guides had a higher coefficient of variation than the milled guides.Conclusions: Milling of the guides resulted in smaller misalignments from the master model.

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Computer-Guided Bone Biopsy: A Technical Note with the Description of a Clinical Case

Bioengineering ◽

10.3390/bioengineering8120214 ◽

2021 ◽

Vol 8 (12) ◽

pp. 214

Author(s):

Federica Altieri ◽

Giovanna Iezzi ◽

Valeria Luzzi ◽

Gianni Di Giorgio ◽

Antonella Polimeni ◽

...

Keyword(s):

Minimally Invasive ◽

Computer Aided Design ◽

Bone Biopsy ◽

Three Dimensional ◽

Technical Note ◽

Invasive Approach ◽

Surgical Guide ◽

Stl File ◽

Computer Aided ◽

Cad Cam

Aim: The aim of this technical note is to present a computer-aided design–computer-aided manufacturing (CAD–CAM) surgical guide to perform a computer-guided bone biopsy. Traditionally, to diagnose abnormal conditions affecting jawbone, a bone biopsy is performed with the use of a trephine bur. The positioning of the bur, during the biopsy, is based on the skill of the surgeon; therefore, an inaccurate placement of a trephine bur may occur. The use of a guide, however, can minimize this risk and achieve a better result. Materials and Methods: To determine the site and the extension of bone sampling, the stereolithography file (STL) file of cone–beam computed tomography (CBCT) images is acquired using a specific planning software and superimposed with the STL file of a dental cast; a virtual surgical guide is designed, using the same software that allows a 3D (three-dimensional) view of the guide from different perspectives and planes. The number and site of guide tubes are determined on the basis of the width and the extension of the sampling; thanks to a 3D printer, the surgical guide is manufactured. Results: The use of a customized surgical guide realized with CAD–CAM technology allows a precise and minimally invasive approach, with an accurate three-dimensional localization of the biopsy site. Conclusions: The high precision, great predictability, time-effectiveness and versatility of the present guide should encourage the clinician to use this minimally invasive surgical approach, but controlled clinical trials should be conducted to evaluate the advantages as well as any possible complications.

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Bone Reduction to Facilitate Immediate Implant Placement and Loading Using CAD/CAM Surgical Guides for Patients With Terminal Dentition

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-16-00016 ◽

2016 ◽

Vol 42 (5) ◽

pp. 406-410

Author(s):

Fawaz Alzoubi ◽

Nima Massoomi ◽

Anders Nattestad

Keyword(s):

Computer Aided Design ◽

Immediate Loading ◽

Computer Aided Manufacturing ◽

Surgical Guide ◽

Implant Placement ◽

Surgical Guides ◽

Computer Aided ◽

Cad Cam ◽

Immediate Implant ◽

Aided Design

The aim of this study is to present a method, using 3 computer-aided design/computer-aided manufacturing (CAD/CAM) surgical guides, to accurately obtain the desired bone reduction followed by immediate implant placements and loading for patients diagnosed with terminal dentition. Patients who had bone reduction, implants placed, and immediate loading using Anatomage Invivo 5 CAD/CAM surgical guides between the period 2013 and 2015 were evaluated retrospectively. Patients diagnosed with terminal dentition and treated using the “3-guide technique” were identified. Pre- and postsurgical images were superimposed to evaluate deviations of the bone reduction and deviations at the crest, apex, and angle of implants placed. Twenty-six implants placed in 5 patients were included in this study. The overall deviation means measured for bone reduction was 1.98 mm. The overall deviation means measured for implant placement at the crest, apex, and angle were 1.43 mm, 1.90 mm, and 4.14°, respectively. The CAD/CAM surgical guide fabrication is an emerging tool that may facilitate the surgical process and aid in safe and predictable execution of bone reduction and immediate implant placement. Using 3 CAD/CAM surgical guides, a method is presented to obtain the desired bone reduction followed by immediate implant placement and loading for patients diagnosed with terminal dentition. This method may improve guide stability for patients with terminal dentition undergoing complete implant-supported treatment by taking advantage of the teeth to be extracted.

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Knowledge and awareness of cad cam surgical guide in digitalization of implants among dental practitioners.

International Journal of Pharmaceutical Research ◽

10.31838/ijpr/2020.12.04.301 ◽

2020 ◽

Vol 12 (04) ◽

Keyword(s):

Surgical Guide ◽

Dental Practitioners ◽

Cad Cam

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Managing the Edentulous Mandible using Recent Technological Developments: A Case Study

Primary Dental Journal ◽

10.1308/205016813806144254 ◽

2013 ◽

Vol 2 (2) ◽

pp. 50-54

Author(s):

Ashok Sethi ◽

Thomas Kaus ◽

Naresh Sharma ◽

Peter Sochor

Keyword(s):

Computed Tomography ◽

Spatial Information ◽

Imaging Techniques ◽

Accurate Information ◽

Imaging Data ◽

Surgical Guide ◽

Prosthetic Reconstruction ◽

Anterior Teeth ◽

Edentulous Mandible ◽

Cad Cam

Safe clinical practice in implant dentistry requires an accurate investigation of the availability of bone for implant placement and the avoidance of critical anatomical structures. Modern imaging techniques using computed tomography (CT) and cone beam computed tomography (CBCT) provide the clinician with the required information. The imaging thus obtained provides accurate representation of the height, width and length of the available bone.1 In addition, whenever adequate radiation dose is used, accurate information about the bone density in Hounsfield units can be obtained. Important spatial information regarding the orientation of the ridges and the relationship to the proposed prosthetic reconstruction can be obtained with the aid of radiopaque templates during the acquisition of CT scan data. Modern software also provides the facility to decide interactively upon the positioning of the implants and is able to relate this to a stereolithographic model constructed from the imaging data. A surgical guide for the accurate positioning of the implants can be constructed. The construction of screw retained prostheses is fraught with difficulties regarding the accuracy of the construction. Accurate fit of the prosthesis is difficult to obtain due to the inherent errors in impression taking, component discrepancies, investing and casting inaccuracies.2,3 CAD/CAM technology eliminates the inaccuracies involved with the investing and casting of superstructures. Clinical Case This case describes the management of an 84 year old female patient, who had recently lost her remaining mandibular anterior teeth. This resulted in the patient's inability to wear conventional dentures in the mandible.

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Effects of Groove Sealing of the Posterior Occlusal Surface and Offset of the Internal Surface on the Internal Fit and Accuracy of Implant Placements Using 3D-Printed Surgical Guides: An In Vitro Study

Polymers ◽

10.3390/polym13081236 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1236

Author(s):

Jung-Hwa Lim ◽

Enkhjargal Bayarsaikhan ◽

Seung-Ho Shin ◽

Na-Eun Nam ◽

June-Sung Shim ◽

...

Keyword(s):

In Vitro Study ◽

Internal Surface ◽

Three Dimensions ◽

Surface Shape ◽

Digital Data ◽

Surgical Guide ◽

Implant Placement ◽

Surgical Guides ◽

Internal Fit

This study evaluated the internal fit and the accuracy of the implant placement position in order to determine how the surface shape of the tooth and the offset influence the accuracy of the surgical guide. The acquired digital data were analyzed in three dimensions using 3D inspection software. The obtained results confirmed that the internal fit was better in the groove sealing (GS) group (164.45 ± 28.34 μm) than the original shape (OS) group (204.07 ± 44.60 μm) (p < 0.001), and for an offset of 100 μm (157.50 ± 17.26 μm) than for offsets of 30 μm (206.48 ± 39.12 μm) and 60 μm (188.82 ± 48.77 μm) (p < 0.001). The accuracy of implant placement was better in the GS than OS group in terms of the entry (OS, 0.229 ± 0.092 mm; GS, 0.169 ± 0.061 mm; p < 0.001), apex (OS, 0.324 ± 0.149 mm; GS, 0.230 ± 0.124 mm; p < 0.001), and depth (OS, 0.041 ± 0.027 mm; GS, 0.025 ± 0.022 mm; p < 0.001). In addition, the entries (30 μm, 0.215 ± 0.044 mm; 60 μm, 0.172 ± 0.049 mm; 100 μm, 0.119 ± 0.050 mm; p < 0.001) were only affected by the amount of offset. These findings indicate that the accuracy of a surgical guide can be improved by directly sealing the groove of the tooth before manufacturing the surgical guide or setting the offset during the design process.

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Evaluation of the accuracy of a novel surgical guide for flapless dental implant placement for immediate loading in edentulous jaws

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-20-00071 ◽

2021 ◽

Author(s):

Giovanni de Almeida Prado Di Giacomo ◽

Patrícia Cury ◽

Airton Moreira da Silva ◽

Jorge Vicente Lopes da Silva ◽

Carlos Eduardo Pompeo Souto ◽

...

Keyword(s):

Dental Implants ◽

Dental Implant ◽

Selective Laser Sintering ◽

Apical Region ◽

Virtual Planning ◽

Surgical Guide ◽

Implant Placement ◽

Surgical Guides ◽

Edentulous Jaws ◽

Edentulous Jaw

This study was designed to evaluate the accuracy of a novel computer-designed and selectively laser sintered surgical guide for flapless dental implant placement in the edentulous jaw. Fifty dental implants were placed in 11 patients with at least one totally edentulous jaw. Initially, cone-beam computed tomography (CBCT) was performed in each patient to define the virtual position of the dental implants based on the assessment of bone availability and the proposed dental prosthesis. After virtual planning, 3D surgical guides were printed using selective laser sintering. CBCT was repeated after the surgery, and the pre-and postoperative images were overlapped in the CAD software to compare the planned and actual positions of the dental implants using a one-sample t-test. The mean ± angular standard deviation between the long axes of the planned and final dental implant positions was 4.58 ±2.85 degrees; The linear deviation in the coronal position was 0.87 ± 0.49 mm and in the apical region of the dental implants was 1.37 ± 0.69 mm. These differences were statistically significant (p <0.001). The proposed modifications reduced the deviations, resulting in an improvement in the technique. We were able to place implants and temporary prostheses using the present protocol, taking into account the differences between the planned and final positions of the dental implants.

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Digital planning and guided surgery in oral rehabilitation

Clinical and Laboratorial Research in Dentistry ◽

10.11606/issn.2357-8041.clrd.2020.172078 ◽

2020 ◽

Author(s):

Larissa Braga dos Santos ◽

Adriano Relvas Barreira de Oliveira ◽

Mauro Lefrançois ◽

Marcos Venício Azevedo ◽

Pablo Sotelo ◽

...

Keyword(s):

Surgical Planning ◽

Three Dimensional ◽

Oral Rehabilitation ◽

Digital Workflow ◽

Surgical Guide ◽

Surgical Guides ◽

Digital Planning ◽

Cad Cam ◽

Correct Understanding ◽

Plaster Model

Digital planning of the prosthesis associated with surgical planning increased predictability, since surgical guides indicate the best place for implant installation, thus reducing the number of complications, and the CAD/CAM system provides predictability in the preparation of final restorations, according to the procedure previously planned. Our study reported a digital workflow used for the guided installation of two dental implants in regions 14 and 16, extraction of tooth 15 and installation of a fixed prothesis over implants. After anamnesis and clinical evaluation, intra- and extra-oral photographs of the patient were performed, molding the upper arch with polyvinylsiloxane (2-step putty/light-body technique) and requesting computed tomography. The plaster model obtained was sent to the laboratory and scanned. The generated file (STL) was used to create a diagnostic wax-up that was aligned to the tomography (in DICOM format), enabling the three-dimensional planning of the implants, which generated a partial printed surgical guide after approval of the dentist. After six months, the patient received the provisional fixed prosthesis printed in PMMA (polymethylmethacrylate) on an intermediate in PEEK (polyetheretherketone) aiming to condition an emergency profile to receive a definitive prosthesis two months later, with zirconia-milled infrastructure on a ti-base. The correct understanding of the operator about the steps of the digital workflow (diagnosis, prosthetic planning, surgical planning, guide preparation, temporary and final restorations) gives the operator improved predictability at the time of surgery as well as satisfactory aesthetic and functional result of definitive restorations.

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