Accuracy evaluation of a universal dental implant guide for simulating implantation in posterior area on dental molds.

OBJECTIVES: This study aims to compare the accuracy of self-developed universal implant guide (SDG), 3D printed digital guide (DG), and free hand (FH) simulated implantation in the posterior tooth area of dental models. METHODS: Ten junior dentists were selected to place three implants in the 35, 37, and 46 tooth sites of the mandibular models (35, 36, 37, and 46 missing teeth) by using SDG, DG, and FH, and the process was repeated again to take the average value. Cone beam computed tomography (CBCT) was used to evaluate the global coronal deviation, global apical deviation, depth deviation, and angular deviation between the actual position and preoperative planned position. RESULTS: The coronal deviation and apical deviation of the three implant sites in the SDG group were not significantly different from those in the two other groups (P>0.05). The depth deviation and angular deviation in the SDG group were smaller than those in the DG group (P<0.05) and FH group (P<0.05), respectively. All deviations at site 37 in the SDG group were not different from those at site 35 (P>0.05), while the depth and angular deviation at site 37 in the DG group were higher than those at site 35 (P<0.05). CONCLUSIONS: The precision of the self-developed universal dental implant guide can meet the requirements of clinical posterior implantation.

Virtual Implant Planning and Surgical Guide for Single Implant Placement Fabricated from a Digital Diagnostic Cast, 2-dimensional Radiographic Imaging, and an Open-source Program: A Dental Technique.

A technique for virtually planning single implant by combining an intraoral digital scan, an opensource computer-aided design software program, bone sounding, and 2-dimensional radiographic imaging is described. The surgical implant guide is fabricated by using additive manufacturing technologies. Furthermore, the surgical implant guide positioned in the patient's mouth is used to radiographically verify the estimated mesio-distal implant angulation before proceeding with the surgical intervention and modified, if necessary. When a cone bean computed tomography scan is not available, this technique eases implant planning procedures and minimize possible surgical complications.

Effects of autoclaving and disinfection on 3D surgical guides using LCD technology for dental implant.

BACKGROUND: Surgical guides can improve the precision of implant placement and minimize procedural errors and their related complications. This study aims to determine how different disinfection and sterilization methods affect the size changes of drill guide templates and the mechanical properties of 3D-printed surgical guides made with LCD technology. METHODS: We produced a total of 100 samples. Forty surgical guides were fabricated to assess the implant drill guides' surface and geometric properties. We subjected sixty samples to mechanical tests to analyze their tensile, flexural, and compressive properties. We classified the samples into four groups based on each analytical method: GC, which served as the control group; GA, which underwent autoclave sterilization at 121 °C (+ 1 bar, 20 min); GB, which underwent autoclave sterilization at 134 °C (+ 2 bar, 10 min); and GL, which underwent disinfection with 70% isopropyl alcohol for 20 min. RESULT: The results show that sterilization at 121 °C and 134 °C affects the mechanical and geometric characteristics of the surgical guides, while disinfection with 70% isopropyl alcohol gives better results. CONCLUSION: Our study of 3D-printed surgical guides using LCD technology found that sterilization at high temperatures affects the guides' mechanical and geometric properties. Instead, disinfection with 70% isopropyl alcohol is recommended.

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.

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.

Accuracy of static digital surgical guides for dental implants based on the guide system: A systematic review.

In the present study, we tried to review the current literature, focusing on the effect of different guide systems on the accuracy of the digital surgical guides. A search in PubMed's database, without any date restriction, was performed using keywords based on the PICO question. 54 of the 2378 articles' were chosen for full-text assessment. Articles were screened using predetermined inclusion and exclusion criteria. 21 articles were included in the qualitative assessment. Descriptive analysis was performed for numeric parameters using mean ± standard deviation. Six types of guide systems were used in the included articles. The commonest guide system was SimPlant (45.64%) followed by NobleGuide (23.00%). The pooled mean angle deviation, global coronal deviation, and global apical deviation were 3.43 mm (95% CI = 2.96, 3.90), 1.16 mm (95% CI = 0.98, 1.24) and 1.35 mm (95% CI = 1.11, 1.59), respectively. The maximum mean(SD) of angle deviation, global coronal deviation, and global apical deviation happened in Stent Cad 4.1(1.86) degrees, NobleGuide 1.86(0.56) mm, and OnDemend3d 1.56(1.48) mm, respectively. Although a final statement could not be made on which system is better, it is certain that the software affects the deviation and could be as important as the implant itself. CLINICAL SIGNIFICANCE: The choice of guide systems used for the production of static guide systems which was studied in this article could affect the accuracy of the implant placement procedure.

Accuracy of Implant Placement Position Using Nondental Open-Source Software: An In Vitro Study.

PURPOSE: To evaluate the accuracy of implant placement position using two different dental implant planning software. MATERIALS AND METHODS: A set of Digital Imaging and Communications in Medicine (DICOM) files from a cone beam computed tomography of a patient missing maxillary right first premolar was used. Implant planning was done using two open-source programs: A nondental 3D Slicer/Blender (3DSB) software and a commercial dental implant treatment planning program: Blue Sky Plan 4 (BSP4). An intraoral scan of the same patient was used to create a standard tessellation language (STL) file of the maxillary arch and later printed into 20 identical casts. Ten surgical guides were printed for each group as well. A dental implant (3.8 mm × 12 mm, Biohorizons) was placed into each cast using fully guided surgical protocol. The horizontal displacements at the implant cervical platform and at the implant apex as well as the angulation displacements were measured using digital scanning of the implant scan bodies and were analyzed using a 3D compare software. Statistical analyses were conducted (⍺ = 0.05) using t-test and F-test to examine differences in trueness and precision, respectively. RESULTS: The average horizontal deviations for the platform and the apex, respectively, were 0.33 ± 0.12 mm and 0.76 ± 0.30 mm for 3DSB and 0.44 ± 0.21 mm and 0.98 ± 0.48 mm for BSP4. The average angulation deviations for 3DSB and BSB4 were 2.34 ± 0.93° and 3.07 ± 1.57°, respectively. There were no statistical differences in the means (t-test) of the platform, apex, and angulation deviations (p = 0.16, p = 0.19, and p = 0.18, respectively). There were statistical differences in the variances (F test) of the platform (p = 0.043) and angulation (p = 0.049) deviations but not the apex (p = 0.059) deviations. CONCLUSIONS: The combination of nondental open-source software, 3D Slicer/Blender can be used to plan implant guided surgery with an accuracy similar to commercial dental software with slightly higher precision. Open-source nondental software can be considered as an alternative in dental implant treatment planning and guided surgery.

[Comparative study of 3D printing implant guide in different implant surgeries in anterior tooth defect area].

OBJECTIVE: To study the accuracy of 3D printing implant-guided anterior tooth implantation under flap or flapless surgery. METHODS: Twenty-one cases (32 teeth) with missing teeth were divided into two groups: tooth implantation on the maxillary models under flap surgery (FP group) and tooth implantation on the maxillary models under flapless surgery (FPS group). A dental implant guide was designed and used in the two groups. The actual position of the dental implants in the two groups was compared with the preplanned deviation values of implant top, bottom, vertical distance, and angle deviation. SPSS 19.0 software was used for statistical analysis. RESULTS: The deviation values of implant top, bottom, vertical distance, and angle were significantly lower in the FP group than in the FPS group (P<0.05). CONCLUSIONS: High accuracy of tooth implantation can be realized by using the 3D printing implant guide. The different surgical methods influence the precision of tooth implantation. Clinicians can choose the surgery reasonably depending on the actual situation.

Comparative study of 3D printing implant guide in different implant surgeries in anterior tooth defect area / 华西口腔医学杂志

OBJECTIVE@#To study the accuracy of 3D printing implant-guided anterior tooth implantation under flap or flapless surgery.@*METHODS@#Twenty-one cases (32 teeth) with missing teeth were divided into two groups: tooth implantation on the maxillary models under flap surgery (FP group) and tooth implantation on the maxillary models under flapless surgery (FPS group). A dental implant guide was designed and used in the two groups. The actual position of the dental implants in the two groups was compared with the preplanned deviation values of implant top, bottom, vertical distance, and angle deviation. SPSS 19.0 software was used for statistical analysis.@*RESULTS@#The deviation values of implant top, bottom, vertical distance, and angle were significantly lower in the FP group than in the FPS group (P<0.05).@*CONCLUSIONS@#High accuracy of tooth implantation can be realized by using the 3D printing implant guide. The different surgical methods influence the precision of tooth implantation. Clinicians can choose the surgery reasonably depending on the actual situation.

CAD/CAM implant surgical guides: maximum errors in implant positioning attributable to the properties of the metal sleeve/osteotomy drill combination.

BACKGROUND: The purpose of this study is to provide the relevant equations and the reference tables needed for calculating the maximum errors in implant positioning attributed to the properties of the mechanical parts of any CAD/CAM implant surgical guide, especially the in-office manufactured ones. METHODS: An algorithm was developed and implemented in C programming language in order to accurately calculate the maximum error at the apex, error at the neck, vertical error at the apex and deviation of implant axis, between the planned and the actual implant position. The calculations were based on the parameters of total length (= implant length + offset), offset (distance from neck of implant to the lip of the metal sleeve), clearance (space between the bur and the sleeve), sleeve length. The variability of the parameters was constrained: (1) implant length, 8-18 mm; (2) sleeve length, 4-7 mm; (3) clearance, 50-410 µm; and (4) offset values, 6-17 mm. Multiple regression analysis was conducted to quantify the relationship between the error at the apex and the error at the neck and various predictors. RESULTS: The equations used for the bespoke estimation of the errors in implant positioning along with three reference tables of the various errors tabulated are presented. The maximum error at the apex of the implant was computed 2.8 mm, the maximum deviation of the implant axis 5.9° and the maximum error at the neck (entrance) of the implant was estimated 1.5 mm. The vertical error between the planned and actual implant position can be considered negligible (< 0.1 mm). CONCLUSIONS: The results of this study compute part of the expected differences in final clinical implant position when any CAD/CAM surgical guide is used. Given that the implantologist, with the capability of an in-office digital designed and 3d printed surgical guide, can readily decide upon the dimensions of the metal sleeve, the clearance between the osteotomy bur and the sleeve, and the design of the guide in relation to the distance of the lip of the sleeve to the implant neck (offset), in order to minimise the inevitable errors.

An analysis on satisfaction level of clinicians on implant surgical guidance system based on computed tomography

PURPOSE: The purpose of this study was to conduct a comparative assessment on the satisfaction level for the two interfaces of surgical guide system (SimPlant and R2GATE), the design and convenience of manufactured surgical guides and the importance of using the surgical guides thereof by means of survey. MATERIALS AND METHODS: Hereupon, they simulated the implant surgical process by mounting the two manufactured systems of surgical guide on a dental mold, respectively. The study subjects were instructed to complete the questionnaire as to the satisfaction level upon completion of the simulated surgery. This study summarized the data of each question after collecting the completed questionnaires. Then, this study analyzed the summarized data by utilizing statistical program SPSS 20.0 (IBM). RESULTS: R2GATE had a higher value of the satisfaction level on the design and convenience of manufactures surgical guides. R2GATE group (7.33 +/- 1.26) was found to have a higher value in terms of the overall satisfaction level compared to SimPlant group (6.67 +/- 1.26) (alpha = 0.05). CONCLUSION: The user satisfaction level on the surgical guide manufactured for R2GATE system was to such an extent as it can be widely used in clinical environment. Moreover, the surgical guide manufactured as R2GATE system can guide both the length and direction of a drill simultaneously. As a result, it is highly recommended for those beginners who do not have a lot of experience in implant placement.