Abstract

This study integrates cone-beam computed tomography (CBCT)/laser scan image superposition, computer-aided design (CAD) and rapid prototyping (RP) technologies to develop a simplified and accurate technique for producing customized orthodontic mini-screw surgical templates. Maxillary bone solid models with the bone and teeth reconstructed using CBCT images and teeth and mucosa outer profile acquired using laser scanning were superimposed to allow mini-screw visual insertion planning and permit surgical template fabrication. The customized surgical template CAD model was fabricated offset based on the teeth/mucosa/bracket contour profiles in the superimposition model and exported to duplicate the plastic template using the rapid prototyping technique. An anterior retraction and intrusion clinical test for the maxillary canines/incisors showed that two mini-screws were placed safely and did not produce inflammation or other discomfort symptoms one week after surgery. The fitness between the mucosa and template indicated that the average gap sizes were found smaller than 0.5mm and confirmed that the surgical template presented good holding power and well-fitting adaption. This study addressed integrating CBCT and laser scan image superposition, CAD and RP techniques can be applied to fabricate an accurate customized surgical template for orthodontic mini-screws.

Highlights

  • The orthodontic mini-screw provides skeletal anchorage with the advantages of relatively inexpensive, implemented and predictable enough to be used routinely in medical practice [1]

  • The mini-screw placement poses a challenge to the orthodontist because of the limited space available for miniscrew placement and the potential risk for root damage, puncture to the maxillary sinus and neurovascular damage during mini-screw placement procedures [3]

  • Custom-made surgical guides and templates have recently been proposed for transferring computed tomography (CT) images to the surgical site and outlining the ideal mini-screw axis, to promote safe miniscrew placement into the dentoalveolar bone [7,8]

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Summary

Introduction

The orthodontic mini-screw provides skeletal anchorage with the advantages of relatively inexpensive, implemented and predictable enough to be used routinely in medical practice [1]. The mini-screw placement poses a challenge to the orthodontist because of the limited space available for miniscrew placement and the potential risk for root damage, puncture to the maxillary sinus and neurovascular damage during mini-screw placement procedures [3]. Custom-made surgical guides and templates have recently been proposed for transferring computed tomography (CT) images to the surgical site and outlining the ideal mini-screw axis, to promote safe miniscrew placement into the dentoalveolar bone [7,8]. Fabricating the accuracy and fit of individualized surgical guides is time-consuming and requires extensive advance preparation because CT images only isolate the hard tissue positions (jawbone or teeth). Complex double CT scan, landmark definition and image processing procedures are needed to identify the accurate position and thickness of the soft tissue (mucosa) that comes in direct contact with the surgical templates [1, 4]

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