Abstract
BackgroundTo evaluate the accuracy of a computer numerical control (CNC) milled surgical guide for implant placement in edentulous jaws.MethodsEdentulous patients seeking implants treatment were recruited in this prospective cohort study. Radiographic guides with diagnostic templates were fabricated from wax-up dentures. Patients took cone-beam computed tomography (CBCT) wearing the radiopaque radiographic guides. Implant positions were virtually designed in the planning software based on the CBCT data, and the radiographic templates were converted into surgical guides using CNC milling technique. Forty-four implants were placed into 12 edentulous jaws following guided implant surgery protocol. Post-surgery CBCT scans were made for each jaw, and the deviations between the planned and actual implant positions were measured. Deviation of implant position was compared between maxilla and mandible, and between cases with and without anchor pins using independent t-test.ResultsNine patients (3 males and 6 females) with 12 edentulous jaws were recruited. The mean age of patients was 59.2 ± 13.9 years old. All 44 implants was placed without complication and survived, the mean three dimensional linear deviation of implant position between virtual planning and actual placement was 1.53 ± 0.48 mm at the implant neck and 1.58 ± 0.49 mm at the apex. The angular deviation was 3.96 ± 3.05 degrees. No significant difference was found in the deviation of implant position between maxilla and mandible (P = 0.28 at neck, 0.08 at apex), nor between cases with and without anchor pins (P = 0.87 at neck, 0.06 at apex).ConclusionsThe guides fabricated using the CNC milling technique provided comparable accuracy as those fabricated by Stereolithography. The displacement of the guides on edentulous arch might be the main contributing factor of deviation.Trial registration: Chinese Clinical Trial Registry, ChiCTR-ONC-17014159 (July 26, 2017).
Highlights
To evaluate the accuracy of a computer numerical control (CNC) milled surgical guide for implant placement in edentulous jaws
The fabrication of implant surgical guides usually follows a digital workflow [3]: cone-beam computed tomography (CBCT)/multidetector computed tomography (MDCT) data are converted into a virtual, three-dimensional (3D)
Stumpel reported that the mean difference between the SLA duplicate denture printed from Digital Imaging and Communications in Medicine (DICOM) data and the original diagnostic prosthesis ranges from 0.56 to 2.17 mm [6]
Summary
To evaluate the accuracy of a computer numerical control (CNC) milled surgical guide for implant placement in edentulous jaws. The fabrication of implant surgical guides usually follows a digital workflow [3]: cone-beam computed tomography (CBCT)/multidetector computed tomography (MDCT) data are converted into a virtual, three-dimensional (3D). Chai et al BMC Oral Health (2020) 20:288 digital model using planning software, and this allows virtual implants to be placed in an ideal, prosthetically driven manner. There are two ways to fabricate surgical templates, namely, rapid prototyping (RP) and milling. Rapid prototyping or stereolithography (SLA) is the most widely used technique to fabricate surgical guides. Data fusion to fabricate a surgical guide is even more challenging due to the lack of rigid support. Stumpel reported that the mean difference between the SLA duplicate denture printed from Digital Imaging and Communications in Medicine (DICOM) data and the original diagnostic prosthesis ranges from 0.56 to 2.17 mm [6]
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