Implant Surgical Guides Research Articles

Technique Tips: Vacuum-formed Implant Surgical Guides

Technique Tips: Vacuum-formed Implant Surgical Guides

The Effect of Distribution of Teeth Support on the Accuracy of Implant Surgical Guide In Distal Extension Cases (In-vitro study)

The Effect of Distribution of Teeth Support on the Accuracy of Implant Surgical Guide In Distal Extension Cases (In-vitro study)

C.E. Credit. Effect of Steam Sterilization on Accuracy of 3D Printed Implant Surgical Guides: A Pilot Study

C.E. Credit. Effect of Steam Sterilization on Accuracy of 3D Printed Implant Surgical Guides: A Pilot Study

Assessing the Impact of Resin Type, Post-Processing Technique, and Arch Location on the Trueness and Precision of 3D-Printed Full-Arch Implant Surgical Guides

Objective: The purpose of this study was to assess the impact of photopolymer resin type, arch location, and post-processing techniques on the trueness and precision of three-dimensionally printed (3DP) full-arch surgical implant guides. Methods: Stereolithography reference images of an upper and lower surgical guide with six drill holes from a full-mouth rehabilitation clinical case were used. The files were imported into the Asiga MAX UV slicing software (Asiga Composer) where build orientation, print resolution, and support structures were added. A digital light processing 3D printer (MAX UV, Asiga Max) was used for printing the samples. The samples assessed were printed using two different, manufacturer-validated resins, DentaGuide (n = 35) and DentaClear (n = 20). The samples were subdivided and measured based on the post-processing technique used: handwashing (n = 20), sonication (n = 25), a mix of handwashing and sonication (n = 10), and post-curing using 385 nm UVA light with nitrogen (n = 50) or without nitrogen (n = 5). The diameter of each drill hole per guide was measured using a coordinate measuring machine (Absolute Arm 7-Axis, Hexagon) and compared with the reference STL to calculate each sample’s trueness (median error) and precision (interquartile range). The Mann–Whitney and Kruskal–Wallis tests were used for statistical analyses. Results: All samples demonstrated a dimensional error of <70 µm. No significant differences (p > 0.05) were observed between upper and lower arches and between post-processing techniques using nitrogen, irrespective of the use of hand- or ultrasonic washing. In contrast, DentaClear resin was significantly (p < 0.001) more accurate with a trueness of 26 µm and precision of 12 to 34 µm versus the DentaGuide at −31 µm and −54 to −17 µm, respectively. The samples post-cured without nitrogen were significantly (p < 0.05) the least accurate of all surgical guides, with a trueness of −42 µm and precision of −68 to −39 µm. Conclusion: The resin type and nitrogen post-processing are parameters that can significantly impact the accuracy of surgical guides. The tolerance of 3DP surgical guides needs to account for the dimensional changes occurring during the manufacturing process to minimise implant positioning errors.

Fixation Pins Increase the Accuracy of Implant Surgery in Free-End Models: An In Vitro Study

Implant surgical guides, in combination with implant planning software, have been designed for accurate surgery, especially in partial edentulism. The purpose of this study was to examine the effect of fixation pins of surgical guides on the accuracy of static computer-assisted implant surgeries in a maxillary free-end situation. This invitro study was conducted to compare surgical guides using various fixation pin protocols in implant surgery. A patient dental model with missing teeth from maxillary right first premolar to third molar was used as the study model… Implant placement was planned at maxillary right first premolar, right first molar, and right second molar; Straumann full guide templates were designed and fabricated using the coDiagnostiX software. The experiment involved surgical guides with no fixation pins (NF), buccal unilateral fixation pin (BF), palatal unilateral fixation pin (PF), and bilateral fixation pins on the buccal and palatal sides (BPF), based on the position and number of fixation pins. The deviation between the actual and planned positions was used to evaluate implant accuracy. The fixation pin protocols were the primary predictive variables. Angular, 3D platform, and 3D apex deviations were the primary outcome variables. Statistical analysis was performed using the one-way analysis of variance and Tukey's test (α=0.05). NF generated the maximum angular deviation (3.65±1.39°), 3D platform deviation (1.58±0.55mm), and 3D apex deviation (2.18±0.79mm), whereas BPF produced the minimum angular deviation (1.88±0.86°), 3D platform deviation (1.09±0.51mm), and 3D apex deviation (1.53±0.45mm). A statistically significant difference between NF and BPF in the angular deviation, 3D platform, and apex deviation (P<.0001, P=.009, and P=.002, respectively) was identified. The unilateral fixation pin exerted a significant effect only on the angular accuracy (BF, P=.0018; PF, P=.0001). In a maxillary free-end situation, templates with a fixation pin generate better implant accuracy than those without it. A bilateral fixation pin protocol may produce less deviation than those without fixation pins. The implant accuracy does not appear to be affected by the position of the unilateral fixation pin.

A Survey of Surgeons' Satisfactory Level on Using Zero-Setup Implant Surgical Guide System

Purpose: This study aimed to evaluate the user experience regarding template fabrication and dental implant surgery of a model-free, zero-setup static computer-guided surgery (CGS) system.Materials and Methods: A survey consisting of 15 questions regarding the accuracy and convenience of the implant planning software was conducted from June 2020 to January 2021 at Dankook University Dental Hospital on six surgeons who had experience with the CGS system.Results: Regarding the question about the convenience of registering cone-beam computed tomography (CBCT) data and surgical template in the planning software, 54.5% of surgeons answered “slightly convenient”. The responses to the question about the accuracy of the process of matching the CT data and the surgical template were “very accurate” and “slightly accurate” at 45.5%, respectively. As part of the surgical procedure, when questioned about the level of fitness after the template was installed, 72.7% answered that the movement was “adequate”. The answer that the amount of coolant through the irrigation hole was “slightly insufficient” during implant placement, accounted for 45.5% of the response. Regarding the subjective feeling about the accuracy of the implant after surgery, approximately 91.9% answered that it was “very accurate”.Conclusion: The satisfaction level regarding the ease of planning and implant surgery and that with post-implantation accuracy was high.

Accuracy Assessment of Static Computer-aided Implant Surgical Guide

&lt;p&gt;As the progress of science and technology and its application in medical treatment, the static computer-aided surgical guide for implant surgery is commonly used nowadays. For achieving a more accurate implant position, factors affecting the accuracy of the computer- aided surgical guide are generally concerned. The aim of this article was to perform a comprehensive overview of literatures and assessment of patient-related, guide stent-related and surgery-related factors affecting the accuracy of the static computer-aided implant surgical guide. It could be concluded that the position of guide, types of tissue support, fixation of guide, types of guided surgery (totally or partially guided), the sleeve length, the key height, and the distance between the sleeve and the implant platform might influence the accuracy of static computer-aided implant surgery. Knowledge of factors related to the accuracy of the surgical guide can aid the clinician to place implants precisely and safety, prevent complications and achieve predictable outcomes.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Evaluation of the Accuracy of a New Geometric Approach to Implant Guidance

Implant surgical guides are often fabricated using CBCT technology. In this study, an alternative technique is proposed. The aim of this in vitro study was to compare the accuracy of the guide sleeve corrections of a geometric approach to guided surgery to the accuracy of in vitro studies of stereolithographic guides. Four arch forms were milled from acrylic blocks each with 12 root form sites. Root form inserts were made. Holes were milled in the inserts at arbitrary angles. Guide posts were placed in these sites. Guide sleeves were placed on the posts and connected with light-cured resin to form verification jigs. The goal was to correct the angles of the guide sleeves to a vertical position 90 degrees from the base of the arch forms. The initial angles from the vertical and horizontal positions of the center of each guide sleeve were determined radiographically and geometrically. Horizontal and angle corrections were made using two-piece guide posts. Guide sleeves placed over the corrected guide posts were connected with light-cured resin, forming new verification jigs. The accuracy of the angle correction and the coronal horizontal and apical horizontal deviations of the 3-mm guide sleeves were determined. The experimental sites were divided into two groups to determine if the size of the initial angles of the guide sleeves had any effect on the accuracy of the corrections. The initial angles of the guide sleeves before corrections revealed the mean difference between the two methods of measurements in groups 1 and 2 as 0.36 degrees (P = .14) and 0.69 degrees (P = .07), respectively. A comparison of the angle error measurements from 90 degrees after corrections between the two groups in the mesiodistal and buccolingual planes was not significant. The coronal and apical horizontal deviations after corrections revealed a significant difference between the two groups at the coronal level (P = .005) but not at the apical level (P = .14). In comparison of the methods of the two measurements of the angle error from vertical after corrections, the mean difference was 1.23 degrees (P = .01) and 0.69 degrees (P = .02). The in vitro accuracy of the guide sleeve corrections made with the geometric approach for implant guidance was compared to the results of the meta-analyses of in vitro studies of implant placement with stereolithographic guides. The mean errors were smaller and within the recommendations of the EAO Consensus Conference of 2012.

In Vitro Comparison between Metal Sleeve-Free and Metal Sleeve-Incorporated 3D-Printed Computer-Assisted Implant Surgical Guides.

The present study aims to compare the accuracy of metal sleeve-free 3D-printed computer-assisted implant surgical guides (MSF group) (n = 10) with metal sleeve-incorporated 3D-printed computer-assisted implant surgical guides (MSI group) (n = 10). Implants of diameter 4.0 mm and 5.0 mm were placed in the left second premolars and bilateral first molars, respectively, using a fully guided system. Closed-form sleeves were used in teeth on the left and open-form sleeves on the right. The weight differences of the surgical guides before and after implant placement, and angular deviations before and after implant placement were measured. Weight differences were compared with Student’s t-tests and angular deviations with Mann–Whitney tests. Cross-sectional views of the insert parts were observed with a scanning electron microscope. Preoperative and postoperative weight differences between the two groups were not statistically significant (p = 0.821). In terms of angular deviations, those along the mesiodistal direction for the left second premolars were significantly lower in the MSF group (p = 0.006). However, those along the mesiodistal direction for the bilateral molars and those along the buccolingual direction for all teeth were not significantly different (p > 0.05). 3D-printed implant surgical guides without metal sleeve inserts enable accurate implant placement without exhausting the guide holes, rendering them feasible for fully guided implant placement.

A Novel Method for Precise Guided Hole Fabrication of Dental Implant Surgical Guide Fabricated with 3D Printing Technology

A dental implant surgical guide fabricated by 3-dimensional (3D) printing technology is widely used in clinical practice due to its convenience and fast fabrication. However, the 3D printing technology produces an incorrect guide hole due to the shrinkage of the resin materials, and in order to solve this, the guide hole is adjusted using a trimmer or a metal sleeve is attached to the guide hole. These methods can lead to another inaccuracy. The present method reports a technique to compensate for a decreased guide hole caused by shrinkage that can occur when a computer-guided implant surgical guide is fabricated with a 3D printer. The present report describes a technique to adjust the size of the guide hole using a free software program to identify the optimized guide hole size that is fabricated with the 3D printer.

Implant Surgical Guide Accuracy: CBCT cast scan

Implant Surgical Guide Accuracy: CBCT cast scan

Effects of two Postprocessing Methods onto Surface Dimension of in‐Office Fabricated Stereolithographic Implant Surgical Guides

To evaluate the effects of two postprocessing methods in terms of the overall, intaglio, and cameo surface dimensions of in-office stereolithographic fabricated implant surgical guides. Twenty identical implant surgical guides were fabricated using a stereolithographic printer. Ten guides were postprocessed using an automated method. The other ten guides were postprocessed using a series of hand washing in combination with ultrasonics. Each guide was then scanned using cone-beam computed tomography to produce a set of digital imaging and communications in medicine (DICOM) files which were converted into standard tessellation language (STL) files. The STL file was then superimposed onto the original STL design file using the best fit alignment. The average positive and negative surface discrepancy differences in terms of means and variances were analyzed using t-test (α = 0.05). For the alternative group, the average positive and negative overall, intaglio, and cameo surface discrepancies were 77.38 ± 10.68 µm and -67.74 ± 6.55 µm; 78.83 ± 8.65 µm and -68.16 ± 5.26 µm; and 70.5 ± 8.48 µm -64.84 ± 5.55 µm, respectively. For the automated group, the average positive and negative overall, intaglio, and cameo surface discrepancies were 51.88 ± 4.38 µm and -170.7 ± 11.49 µm; 64.3 ± 4.44 µm and -89.45 ± 6.25 µm; and 83.59 ± 4.81 µm and -144.26 ± 13.19 µm, respectively. There was a statistical difference between the means of the two methods for the overall, intaglio, and cameo positive and negative discrepancies (p < 0.001). For a single implant tooth-supported implant guide, using hand washing with ultrasonics appeared to be consistently better than the automated method. The manual method presented with more positive discrepancies, while the automated method presented with more negative discrepancies.

Intaglio Surface Dimension and Guide Tube Deviations of Implant Surgical Guides Influenced by Printing Layer Thickness and Angulation Setting.

To measure overall intaglio dimensional and tube deviations of implant guides printed at 50 and 100 µm layer thickness at 0°, 45°, and 90° angulation using a stereolithographic (SLA) printer. A surgical implant guide design from a subject missing a maxillary right central incisor, used as the original standard tessellation language (STL) were stereolithographically fabricated at each thickness and angulation, 50 and 100 µm layer thickness at 0°, 45°, and 90° angulation (n = 10 each group). The guide was then scanned using cone beam computed tomography. The digital imaging and communications in medicine (DICOM) scanned files were then converted to an STL format. The overall dimensional deviations of the intaglio surface and the positioning of the implant guide tube were then superimposed onto the original designed STL file using best-fitting alignment. A t-test and an F-test as well as ANOVA followed by a post hoc t-test were used to determine statistical significant differences (α = 0.05) for the intaglio surface and guide tube deviation, respectively. The overall intaglio surface discrepancies (µm) printed at 0°, 45°, and 90° were 55.07 ± 1.36, 52.39 ± 2.09, and 61.02 ± 15.96 for 50 µm layer; and 98.38 ± 10.55, 84.47 ± 10.61, and 90.26 ± 5 for 100 µm layer with statistically significant differences for both t-test and F-test, p < 0.001. The maximal guide tube linear deviations (µm) printed at 0°, 45°, and 90° were 10.78 ± 3.84, 8.16 ± 3.68, and 12.57 ± 5.39 for 50 µm layer (ANOVA, p = 0.096); and 10.95 ± 5.23, 16.79 ± 4.97, and 22.63 ± 2.81 for 100 µm layer (ANOVA, p < 0.001). The maximal guide tube angular deviations (°) printed at 0°, 45°, and 90° were 1.29 ± 0.30, 0.64 ± 0.13, and 0.56 ± 0.21 for 50 µm layer (ANOVA, p < 0.001); and 1.57 ± 0.29, 0.86 ± 0.14, and 1.02 ± 0.31 for 100 µm layer (ANOVA, p = 0.034). There was a statistical difference in the deviations between 50 and 100 µm layer printing in all printed angulations except at 0° (t-test, p = 0.05, p = 0.03, and p = 0.001 for 0°, 45°, and 90°) and linear deviations (t-test, p < 0.001, p = 0.009, and p = 0.001 for 0°, 45°, and 90°). Printing at 50 µm layer reduces dimensional intaglio deviations in general and reduces tube angular deviations with different angulations of printing. However, the deviations were only ∼60 to 100 µm for the intaglio dimension deviations; and ∼0.04 to 0.26 mm and ∼0.25° to ∼2° for tube deviations.

Do Implant Surgical Guides Allow an Adequate Zone of Keratinized Tissue for Flapless Surgery?

A major advantage of guided implant surgery using 3-dimensionally printed guides is the ability to perform accurate flapless surgery.A drawback of a flapless technique is the inability to manipulate soft tissue to ensure sufficient gingiva around the implant. The purpose of this study was to determine how often flapless surgery using surgical guides results in less than 2mm of keratinized tissue surrounding the implant. This retrospective analysis included 27 maxillary and 27 mandibular implant sites that underwent treatment planning for implant-guided surgery using 3Shape Implant Studio (3Shape, Copenhagen, Denmark).Intraoral scan images were used to measure the width of the keratinized tissue on the buccal aspect of each implant site in both arches and the lingual aspect in the mandibular arch. Three examiners measured the amount of buccal and lingual keratinized tissue in millimeters at each implant site. Analysis of variance (P<.05) and correlation coefficients were used to determine statistically significant differences in keratinized tissue among sites. No statistically significant difference was found either between the widths of buccal keratinized tissue in the maxillary anterior (4.06±1.42mm) and posterior (4.93±2.54mm) areas (P=.293) or between the amounts of buccal and lingual keratinized tissue in the mandible (P=.995). The keratinized tissue width in the maxillary buccal area was significantly different (4.48±2.04mm) from that in the mandibular posterior buccal (1.98±1.41mm) and lingual (1.98±1.23mm) areas (P<.001). Over 77% of maxillary implant sites had greater than 3mm of gingiva, and just over 20% had sufficient gingiva in the mandible. Adequate keratinized tissue was found in most of the planned maxillary implant sites, whereas most of the mandibular posterior implant sites had inadequate keratinized tissue. Therefore, elevation of a flap to preserve and reposition existing keratinized tissue around implants should be considered when planning to use tooth-borne surgical guides in the posterior mandible.

In Vivo Tooth-Supported Implant Surgical Guides Fabricated With Desktop Stereolithographic Printers: Fully Guided Surgery Is More Accurate Than Partially Guided Surgery

Desktop stereolithographic printers combined with intraoral scanning and implant planning software promise precise and cost-effective guided implant surgery. The purpose of the present study was to determine the overall range of accuracy of tooth-supported guided implant surgery using desktop printed stereolithographic guides. A cross-sectional study comparing fully and partially guided implant surgery was conducted. Preoperative cone beam computed tomography (CBCT) and intraoral scans were used to plan the implant sites. Surgical guides were then fabricated using a desktop stereolithographic 3-dimensional printer. Postoperative CBCT was used to evaluate the accuracy of placement. Deviations from the planned positions were used as the primary outcome variables. The planning software used, implant systems, and anterior/posterior positions were the secondary outcome variables. The differences between the planned and actual implant positions in the mesial, distal, buccal, and lingual dimensions and buccolingual angulations were determined, and the accuracy was compared statistically using the 1-tail F-test (P=.01), box plots, and 95% confidence intervals for the mean. Sixteen partially edentulous patients requiring placement of 31 implants were included in the present study. The implant deviations from the planned positions for mesial, distal, buccal, and lingual dimensions and buccolingual angulations with the fully guided protocol (n=20) were 0.17±0.78mm, 0.44±0.78mm, 0.23±1.08mm, -0.22±1.44mm, and -0.32°±2.36°, respectively. The corresponding implant deviations for the partially guided protocol (n=11) were 0.33±1.38mm, -0.03±1.59mm, 0.62±1.15mm, -0.27±1.61mm, and 0.59°±6.83°. The difference between the variances for fully and partially guided surgery for the distal and angulation dimensions was statistically significant (P=.006 and P<.001, respectively). No statistically significant difference was found between the software programs. Anterior implants had less variation in deviation than posterior implants. Fully guided implant surgery is more accurate than partially guided implant surgery. Implant positional deviation is influenced by implant location but not implant systems or software. If possible, clinicians should use guided surgery protocols that allow placement of implants through a surgical guide.

Development and Assessment of a 3D-Printed Scaffold with rhBMP-2 for an Implant Surgical Guide Stent and Bone Graft Material: A Pilot Animal Study.

In this study, a new concept of a 3D-printed scaffold was introduced for the accurate placement of an implant and the application of a recombinant human bone morphogenetic protein-2 (rhBMP-2)-loaded bone graft. This preliminary study was conducted using two adult beagles to evaluate the 3D-printed polycaprolactone (PCL)/β-tricalcium phosphate (β-TCP)/bone decellularized extracellular matrix (bdECM) scaffold conjugated with rhBMP-2 for the simultaneous use as an implant surgical guide stent and bone graft material that promotes new bone growth. Teeth were extracted from the mandible of the beagle model and scanned by computed tomography (CT) to fabricate a customized scaffold that would fit the bone defect. After positioning the implant guide scaffold, the implant was placed and rhBMP-2 was injected into the scaffold of the experimental group. The two beagles were sacrificed after three months. The specimen block was obtained and scanned by micro-CT. Histological analysis showed that the control and experimental groups had similar new bone volume (NBV, %) but the experimental group with BMP exhibited a significantly higher bone-to-implant contact ratio (BIC, %). Within the limitations of this preliminary study, a 3D-printed scaffold conjugated with rhBMP-2 can be used simultaneously as an implant surgical guide and a bone graft in a large bone defect site. Further large-scale studies will be needed to confirm these results.

How Accurate Are Implant Surgical Guides Produced With Desktop Stereolithographic 3-Dimentional Printers?

The use of tooth-supported static stereolithographic guides has greatly improved the ability to ideally place implants. This study was designed to determine the accuracy of in office-printed implant surgical guides. Using 3shape Implant Studio, a treatment plan for implant placement for tooth 8 was developed using a digital intraoral scan from a Trios scanner and cone-beam computed tomography. Ten stereolithographic guides were printed using a Form2 3-dimensional printer. Pre- and post-implant insertion digital scans were used to determine distance and angulation differences in the mesiodistal and faciolingual positions of the implants compared with the planned position. The mean difference in mesiodistal direction at the alveolar crest between planned implants and placed implants was 0.28mm (range, 0.05 to 0.62mm) and the difference in the faciolingual direction was 0.49mm (range, 0.08 to 0.72mm). The mean mesiodistal angulation deviation was 0.84° (range, 0.08° to 4.48°) and the mean faciolingual angulation deviation was 3.37° (range, 1.12° to 6.43°). In-office fabricated stereolithographic implant surgical guides show similar accuracy to laboratory- or manufacturer-prepared guides. This technique provides a convenient and cost-effective means of assuring proper implant placement.

Simultaneous Virtual Planning Implant Surgical Guides and Immediate Laboratory-Fabricated Provisionals: An Impressionless Technique.

Abstract Since the emergence of dental implants as treatment modality, there has been a constant evolution to improve the accuracy, efficiency and long term success even in the most complicated cases. In this day and age, patient's expectations are higher than ever to achieve their desired treatment in a prompt and convenient manner. To meet these expectations implant therapy has grown to be highly sophisticated. For the past decade, computed tomography (CT) scans have been utilized to improve the treatment planning process. Further more they have been used to fabricate surgical guides, making implant placement not only more accurate but also safer. On the other hand, advancements in the implant prosthetics now have made immediate restorations more feasible. This article reviews two cases, where dental implants are based through a CT fabricated surgical guide, and immediately restored with a lab fabricated screw retained bridge. This novel technique utilizes intraoral digital scanner instead of the conventional alginate impression and combines the electronic data with the CT images to fabricate both the surgical guide and the immediate provisional restoration.

Implant surgical guides: From the past to the present

Advent of osseointegration has rapidly led to use of dental implants over recent years. Implant complications are often inadvertent sequelae of improper diagnosis, treatment planning, surgical method, and placement. This can be overcome by using surgical guides for implant positioning. Although conventionally made surgical guide are used, the clinical outcome is often unpredictable, and even if the implants are well placed, the location and deviation of the implants may not meet the optimal prosthodontic requirements. High accuracy in planning and execution of surgical procedures is important in securing a high success rate without causing iatrogenic damage. This can be achieved by computed tomography, 3D implant planning software, image-guided template production techniques, and computer-aided surgery. This article evaluates about the various systems of conventionally made surgical guide using radiograph and also the newer computer generated surgical guide in detail.

Reliability of Implant Surgical Guides Based on Soft-Tissue Models

The purpose of this study was to determine the accuracy of implant surgical guides fabricated on diagnostic casts. Guides were fabricated with radiopaque rods representing implant positions. Cone beam computerized tomograms were taken with guides in place. Accuracy was evaluated using software to simulate implant placement. Twenty-two sites (47%) were considered accurate (13 of 24 maxillary and 9 of 23 mandibular sites). Soft-tissue models do not always provide sufficient accuracy for fabricating implant surgical guides.