How Accurate Is Oral Implant Installation Using Surgical Guides Printed from a Degradable and Steam-Sterilized Biopolymer?

3D printed surgical guides are used for prosthetically-driven oral implant placement. When manufacturing these guides, information regarding suitable printing techniques and materials as well as the necessity for additional, non-printed stock parts such as metal sleeves is scarce. The aim of the investigation was to determine the accuracy of a surgical workflow for oral implant placement using guides manufactured by means of fused deposition modeling (FDM) from a biodegradable and sterilizable biopolymer filament. Furthermore, the potential benefit of metal sleeve inserts should be assessed. A surgical guide was designed for the installation of two implants in the region of the second premolar (SP) and second molar (SM) in a mandibular typodont model. For two additive manufacturing techniques (stereolithography [SLA]: reference group, FDM: observational group) n = 10 surgical guides, with (S) and without (NS) metal sleeves, were used. This resulted in 4 groups of 10 samples each (SLA-S/NS, FDM-S/NS). Target and real implant positions were superimposed and compared using a dedicated software. Sagittal, transversal, and vertical discrepancies at the level of the implant shoulder, apex and regarding the main axis were determined. MANOVA with posthoc Tukey tests were performed for statistical analyses. Placed implants showed sagittal and transversal discrepancies of <1 mm, vertical discrepancies of <0.6 mm, and axial deviations of ≤3°. In the vertical dimension, no differences between the four groups were measured (p ≤ 0.054). In the sagittal dimension, SLA groups showed decreased deviations in the implant shoulder region compared to FDM (p ≤ 0.033), whereas no differences in the transversal dimension between the groups were measured (p ≤ 0.054). The use of metal sleeves did not affect axial, vertical, and sagittal accuracy, but resulted in increased transversal deviations (p = 0.001). Regarding accuracy, biopolymer-based surgical guides manufactured by means of FDM present similar accuracy than SLA. Cytotoxicity tests are necessary to confirm their biocompatibility in the oral environment.

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Computer-Guided Inferior Alveolar Nerve Lateralization With Simultaneous Implant Placement: A Preliminary Report

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-17-00141 ◽

2018 ◽

Vol 44 (3) ◽

pp. 192-197

Author(s):

Mohamed Atef ◽

Mohamed Mounir

Keyword(s):

Dental Implants ◽

Fused Deposition Modeling ◽

Inferior Alveolar Nerve ◽

Case Series ◽

Rectangular Window ◽

Fused Deposition ◽

Implant Placement ◽

Surgical Guides ◽

Case Series Study ◽

Bone Height

Placement of dental implants in the posterior mandibular alveolar ridges may become a challenging procedure because of limited bone height between the crest of the ridge and the inferior alveolar canal. The aim of this study was to introduce an innovative, less invasive, highly accurate, and easy surgical technique of inferior alveolar nerve lateralization in the posterior deficient mandible using a special customized 3-dimensional–printed surgical guide to enhance the bone height for implant placement. This case series study included 7 patients with unilateral edentulous mandibular alveolar ridges. Customized surgical guides were manufactured using fused deposition modeling technology to accurately place a rectangular window to uncover the canal and also for immediate placement of dental implants in all cases. The results of this limited study provided information on an innovative technique that decreased intraoperative time and demonstrated decreased risks for (1) inferior alveolar nerve injury and (2) postoperative nerve dysfunction.

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Implementation of Fused Filament Fabrication in Dentistry

Applied Sciences ◽

10.3390/app11146444 ◽

2021 ◽

Vol 11 (14) ◽

pp. 6444

Author(s):

Jörg Lüchtenborg ◽

Felix Burkhardt ◽

Julian Nold ◽

Severin Rothlauf ◽

Christian Wesemann ◽

...

Keyword(s):

Fused Deposition Modeling ◽

Present Report ◽

Cost Effective ◽

Great Promise ◽

Temperature Sensitive ◽

Fused Filament Fabrication ◽

Digital Light Processing ◽

Fused Deposition ◽

Surgical Guides ◽

Novel Approach

Additive manufacturing is becoming an increasingly important technique for the production of dental restorations and assistive devices. The most commonly used systems are based on vat polymerization, e.g., stereolithography (SLA) and digital light processing (DLP). In contrast, fused filament fabrication (FFF), also known under the brand name fused deposition modeling (FDM), is rarely applied in the dental field. This might be due to the reduced accuracy and resolution of FFF compared to vat polymerization. However, the use of FFF in the dental sector seems very promising for in-house production since it presents a cost-effective and straight forward method. The manufacturing of nearly ready-to-use parts with only minimal post-processing can be considered highly advantageous. Therefore, the objective was to implement FFF in a digital dental workflow. The present report demonstrates the production of surgical guides for implant insertion by FFF. Furthermore, a novel approach using a temperature-sensitive filament for bite registration plates holds great promise for a simplified workflow. In combination with a medical-grade filament, a multi-material impression tray was printed for optimized impression taking of edentulous patients. Compared to the conventional way, the printed thermoplastic material is pleasant to model and can allow clean and fast work on the patient.

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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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Variety of Surgical Guides and Protocols for Bone Reduction Prior to Implant Placement: A Narrative Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052341 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2341

Author(s):

Eitan Mijiritsky ◽

Hadar Ben Zaken ◽

Maayan Shacham ◽

Ihsan Caglar Cinar ◽

Cem Tore ◽

...

Keyword(s):

Surgical Procedure ◽

Material Selection ◽

Bone Architecture ◽

Surgical Guide ◽

Framework Design ◽

Implant Placement ◽

Surgical Guides ◽

Bone Width ◽

Reduction Methods ◽

Bone Level

Edentulism and terminal dentition are still considered significant problems in the dental field, posing a great challenge for surgical and restorative solutions especially with immediate loading protocols. When the implant placement is planned immediately after extraction with irregular bone topography or there is an un-leveled alveolar ridge topography for any other reason, bone reduction may be required to level the alveolar crest in order to create the desired bone architecture allowing for sufficient bone width for implant placement and to insure adequate inter-arch restorative space. Bone reduction protocols exist in analog and digitally planned methodologies, with or without surgical guides to achieve the desired bone level based upon the desired position of the implants with regard to the restorative outcome. The objective of this paper was to scrutinize the literature regarding the practice of bone reduction in conjunction with implant placement, and to review different types of bone reduction surgical guides. Results: The literature reveals different protocols that provide for bone reduction with a variety of bone reduction methods. The digitally-planned surgical guide based on Cone-Beam computerized tomography (CBCT) scan reconstructed data can improve accuracy, reduce surgical time, and deliver the desired bone level for the implant placement with fewer surgical and restorative complications. The clinician’s choice is based on personal experience, training, and comfort with a specific guide type. Conclusions: Bone reduction, when required, is an indispensable step in the surgical procedure to attain suitable width of bone in anticipation of implant placement ideally determined by the desired tooth position and required restorative space based on material selection for the chosen framework design, i.e., hybrid, monolithic zirconia. Additionally, bone reduction and implant placement can be accomplished in the same surgical procedure, minimizing trauma and the need for two separate interventions.

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Assessment of The Reproducibility And Precision For Milling And Prototyped Surgical Guides

10.21203/rs.2.14840/v1 ◽

2019 ◽

Author(s):

Sueli Mukai ◽

Eduardo Mukai ◽

Jamil Awad Shibli DDS ◽

GABRIELA GIRO

Keyword(s):

Surgical Planning ◽

Virtual Model ◽

Virtual Design ◽

Surgical Guide ◽

Implant Placement ◽

Surgical Guides ◽

Patient Morbidity ◽

Coefficients Of Variation ◽

Cad Cam ◽

Master Model

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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A Novel Guided Zygomatic and Pterygoid Implant Surgery System: A Human Cadaver Study on Accuracy

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18116142 ◽

2021 ◽

Vol 18 (11) ◽

pp. 6142

Author(s):

Francesco Grecchi ◽

Luigi V. Stefanelli ◽

Fabrizio Grivetto ◽

Emma Grecchi ◽

Rami Siev ◽

...

Keyword(s):

Computed Tomography ◽

Cadaver Study ◽

Angular Deviation ◽

Human Cadaver ◽

Surgical Guide ◽

Implant Placement ◽

Surgical Guides ◽

Custom Made ◽

Guide System ◽

Human Cadaver Study

The aim of this human cadaver study was to assess the accuracy of zygomatic/pterygoid implant placement using custom-made bone-supported laser sintered titanium templates. For this purpose, pre-surgical planning was done on computed tomography scans of each cadaver. Surgical guides were printed using direct metal laser sintering technology. Four zygomatic and two pterygoid implants were inserted in each case using the guided protocol and related tools. Post-operative computed tomography (CT) scans were obtained to evaluate deviations between the planned and inserted implants. Accuracy was measured by overlaying the real position in the post-operative CT on the virtual presurgical placement of the implant in a CT image. Descriptive and bivariate analyses of the data were performed. As a result, a total of 40 zygomatic and 20 pterygoid implants were inserted in 10 cadavers. The mean deviations between the planned and the placed zygomatic and pterygoid implants were respectively (mean ± SD): 1.69° ± 1.12° and 4.15° ± 3.53° for angular deviation. Linear distance deviations: 0.93 mm ± 1.23 mm and 1.35 mm ± 1.45 mm at platform depth, 1.35 mm ± 0.78 mm and 1.81 mm ± 1.47 mm at apical plane, 1.07 mm ± 1.47 mm and 1.22 mm ± 1.44 mm for apical depth. In conclusion, the surgical guide system showed accuracy for all the variables studied and allowed acceptable and accurate implant placement regardless of the case complexity.

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Accuracy of Different Surgical Guide Designs for Static Computer-Assisted Implant Surgery: An in vitro Study

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-21-00055 ◽

2021 ◽

Author(s):

Yu Tsung Wu ◽

Panos Papaspyridakos ◽

Kiho Kang ◽

Matthew Finkelman ◽

Yukio Kudara ◽

...

Keyword(s):

In Vitro Study ◽

Vitro Study ◽

Computer Assisted ◽

Surgical Guide ◽

Implant Placement ◽

Surgical Guides ◽

Significant Difference ◽

Group 3 ◽

Group 2

The aims of this study were to evaluate the effect of (i) the different surgical guide designs and (ii) implant placement location on the accuracy of fully guided implant placement in single edentulous sites using an in vitro study model. Forty-five partially edentulous models were scanned and divided into three groups: group 1, tooth-supported full-arch surgical guide; group 2, three different tooth-supported shortened surgical guides (SSGs); and group 3, tooth-supported full-arch surgical guide with a crossbar. All surgical guides were printed and used for fully guided implant placement. A total of 180 implants (60 per group) were placed, and scanbodies were positioned on all models, and postoperative surface scan files (STL) files were obtained. Superimposition of preoperative and postoperative STL files was performed, and the accuracy of implant position was evaluated. The interaction between group and implant location was statistically significant for angle, 3D offset at the base, and at the tip (p<0.001). The post-hoc tests showed a statistically significantly higher deviation for group 2 compared to group 3 for all outcomes for implants #4 (p<0.05) and #7 (p<0.05). There was also a statistically significant difference in all outcomes between groups 1 and 3 for implant #7 (p<0.05). All surgical guide designs presented satisfactory performance with clinically acceptable levels of deviation. However, SSGs presented higher accuracy for guided implant placement in a single-edentulous site, whereas a full-arch surgical guide with a crossbar presented superior outcomes when two or more guided implants were placed simultaneously.

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Open Surgical Guides – A Novel Concept in Computer Guided Implantology

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl4.4079 ◽

2020 ◽

Vol 11 (SPL4) ◽

pp. 817-822

Author(s):

Anil Kumar CH ◽

Ramana Kumar K.V. ◽

Paul T Joyes ◽

Padmanabhan P

Keyword(s):

Positive Impact ◽

The United States ◽

Drilling Depth ◽

Surgical Guide ◽

Point Of Entry ◽

Implant Placement ◽

Surgical Guides ◽

Immediate Implant ◽

Novel Concept ◽

Implant Treatment

Dental implants have become so popular that more than 5 million implants are placed each year by dentists in the United States alone. However, it is generally observed that a majority of implants are placed in a less-than-ideal manner. Computer-guided surgeries are proven to have a positive impact on implant placement as well as implant treatment planning. But, despite the indisputable compensations, only a partial number of clinicians regularly practice directed transplant surgery nowadays. This article aims to examine the challenges in guided implant surgery and how a novel concept of the open guide is trying to solve these issues. The latter was used during a CT scan and was eventually converted into an actual surgical guide. However, using conventional guides is not a guarantee for proper implant placement. The reason for that was inherent in their design. Conventional guides take marvelous leeway in the drilling trajectory and no drilling depth control. Using them relies on several variables that may not be trustworthy, such as hand stability, patient immobility, and another person’s feedback on the drilling angle. Bone quality can also affect the osteotomy in situations of immediate implant placement, as the drills commonly bounce off dense bone affecting the angulation and point of entry. From a safety perspective, conventional guides do not consider the patient’s relevant anatomy.

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