Stereolithographic Surgical Guides Research Articles

An evaluation of the sources and extent of error in the position of implants placed using 3D-printed stereolithographic surgical guides.

Introduction/Background. Errors can be introduced in implant placement when using stereolithographically manufactured fully limiting surgical guides due to various factors, such as discrepancies in designing and manufacturing of surgical guides (intrinsic error), built-in variations in design of mechanical components of guide systems and implant dimensions (inherent error) or due to placement error by the operator (operator error). Aim. The aim of this study was to evaluate influence of various factors on implant position when using these guides. Materials and Methods. Prosthetically-driven implant positions were planned with pre-operative cone beam computed tomography (CBCT) data and digital scans using a computer aided designing (CAD) software. Static guided implant surgery was performed under local anaesthesia using fully limiting mucosa-supported surgical guide. Pre-operative and post-operative CBCTs were superimposed using surgical sleeve as a reference to evaluate the placement error by operator (N=12). To evaluate intrinsic error, standard tessellation language (STL) files of the virtual design of the surgical guides and the STL file obtained after scanning the 3D printed stereolithographic surgical guides were superimposed. Inherent error was calculated using a geometric model. Results. Intrinsic error was observed to be a major contributing factor in angular deviation of implant, linear deviation observed at implant shoulder as well as at implant apex. Operator error was observed to be a major contributing factor for mean vertical deviation observed at apex of implant. Conclusion. This study showed that accuracy of implant placement was largely influenced by discrepancies introduced during designing and manufacturing of stereolithographic surgical guides as compared to other sources.

An evaluation of the sources and extent of error in the position of implants placed using 3D-printed stereolithographic surgical guides.

Introduction/Background. Errors can be introduced in implant placement when using stereolithographically manufactured fully limiting surgical guides due to various factors, such as discrepancies in designing and manufacturing of surgical guides (intrinsic error), built-in variations in design of mechanical components of guide systems and implant dimensions (inherent error) or due to placement error by the operator (operator error). Aim. The aim of this study was to evaluate influence of various factors on implant position when using these guides. Materials and Methods. Prosthetically-driven implant positions were planned with pre-operative cone beam computed tomography (CBCT) data and digital scans using a computer aided designing (CAD) software. Static guided implant surgery was performed under local anaesthesia using fully limiting mucosa-supported surgical guide. Pre-operative and post-operative CBCTs were superimposed using surgical sleeve as a reference to evaluate the placement error by operator (N=12). To evaluate intrinsic error, standard tessellation language (STL) files of the virtual design of the surgical guides and the STL file obtained after scanning the 3D printed stereolithographic surgical guides were superimposed. Inherent error was calculated using a geometric model. Results. Intrinsic error was observed to be a major contributing factor in angular deviation of implant, linear deviation observed at implant shoulder as well as at implant apex. Operator error was observed to be a major contributing factor for mean vertical deviation observed at apex of implant. Conclusion. This study showed that accuracy of implant placement was largely influenced by discrepancies introduced during designing and manufacturing of stereolithographic surgical guides as compared to other sources.

Impact of 3D imaging techniques and virtual patients on the accuracy of planning and surgical placement of dental implants: A systematic review.

The integration of advanced technologies, including three-dimensional (3D) imaging modalities and virtual simulations, has significantly influenced contemporary approaches to preoperative planning in implant dentistry. Through a meticulous analysis of relevant studies, this review synthesizes findings related to accuracy outcomes in implant placement facilitated by 3D imaging in virtual patients. A comprehensive literature search was conducted across relevant databases to identify relevant studies published to date. The inclusion criteria were studies utilizing 3D imaging techniques, virtual patients, and those focusing on the accuracy of dental implant planning and surgical placement. The selected studies were critically appraised for their methodological quality. After a rigorous analysis, 21 relevant articles were included out of 3021 articles. This study demonstrates the versatility and applicability of these technologies in both in vitro and in vivo settings. Integrating Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM), cone bean computed tomography (CBCT), and advanced 3D reconstruction methodologies showcases a trend toward enhanced precision in implant planning and placement. Notably, the evaluation parameters varied, encompassing distances, discrepancies, and deviations in the implant placement. The ongoing integration of systems such as dynamic navigation systems, augmented reality, and sophisticated software platforms shows a promising trajectory for the continued refinement of virtual reality applications in dental implantology, providing valuable insights for future research and clinical implementation. Moreover, using stereolithographic surgical guides, virtual planning with CBCT data, and 3D-printed templates consistently demonstrates enhanced precision in dental implant placement compared to traditional methods. The synthesis of the available evidence underscores the substantial positive impact of 3D imaging techniques and virtual patients on dental implant planning and surgical placement accuracy. Utilizing these technologies contributes to a more personalized and precise approach that enhances overall treatment outcomes. Future research directions and potential refinements to the application of these technologies in clinical practice should be discussed.

Comparison of Dental Surface Image Registration and Fiducial Marker Registration: An In Vivo Accuracy Study of Static Computer-Assisted Implant Surgery.

This study compared the accuracy of static computer-assisted implant surgery (sCAIS) planned through dental surface image registration and fiducial marker registration. Stone models of 30 patients were converted into digital dental casts by using a desktop scanner. Cone-beam computed tomography (CBCT) was performed and superimposed to the digital dental casts with two methods: matching the dental surface images or matching the fiducial markers on a stereolithographic radiographic template. Following the implant planning, stereolithographic surgical guides were fabricated, and 56 fully guided implants were inserted by the same doctor. Deviations between planned and inserted implants were measured and compared using postoperative CBCT images. After adjustment for other potential influencing factors, compared with the fiducial marker registration group, significantly larger mean lateral deviations were noted in the dental surface registration group at both the implant platform and apex (p = 0.0188 and 0.0371, respectively). However, the mean lateral deviations for the dental surface registration (0.83 ± 0.51 mm at implant platform and 1.24 ± 0.68 mm at implant apex) were comparable to the literature. In conclusion, our findings indicate that although sCAIS planned using dental surface image registration was not statistically as accurate as that using fiducial marker registration, its accuracy was satisfactory for clinical use.

An evaluation of virtually planned and 3D-printed stereolithographic surgical guides from CBCT and digital scans: An in vitro study

Statement of problemThe process of manufacturing stereolithographic surgical guides for static computer-guided implant placement involves a series of steps. Errors can be incorporated in various forms and at various stages of manufacturing these guides. Errors introduced during this process have not been fully investigated. PurposeThe purpose of this in vitro study was to assess the errors introduced during the manufacture of stereolithographic surgical guides generated from cone beam computed tomography (CBCT) and digital scans by using a virtual implant planning software. Material and methodsTen stereolithographic surgical guides with the associated standard tessellation language (STL) files of their virtual design were used in this study. The STL files of the virtual design and the scans of the stereolithographic surgical guides were superimposed. Linear deviation at the center of the sleeve top and sleeve base and the angular deviation at the center of the sleeve were measured. ResultsThe minimum and maximum linear deviation at the center of the sleeve top and the sleeve base was found to be 0 and 40 μm, with less linear deviation observed at the center of the sleeve top (mean ±standard deviation 18 ±7 μm) than at the center of the sleeve base (20 ±7 μm). The minimum and maximum angular deviation at the center of the sleeve was found to be 0 degrees and 5.9 degrees respectively, with a mean ± standard deviation of 1.36 ±0.74 degrees. ConclusionsErrors were found in the sleeve position between the virtual design and the stereolithographically manufactured surgical guide. This error may introduce errors in the final implant position.

Accuracy and Deviation Analysis of Static and Robotic Guided Implant Surgery: A Case Study.

Guided dental implant surgery can optimize implant placement positioning, increase predictability, and decrease surgical invasiveness through flapless techniques. Static surgical guides have been used to accomplish this task, though limitations of patient opening and lack of coolant contact with the surgical site have been clinically significant weaknesses. Technologic advances have allowed robotically guided implant placement using haptic guidance. The absence of a static stereolithographic guide over the surgical area allows for optimal access and adequate cooling during osteotomies. The aim of this case series was to present the workflows of both static and robotic guidance in the same patient and measure deviations from the presurgical planning software to determine the practicability and accuracy of robotic guidance. Based on this case series, it can be concluded that using robotically assisted implant surgery can yield deviation results that are comparable to static CAD/CAM stereolithographic surgical guides. Robotic surgery can be performed predictably with minimal deviation in both simple and complex clinical situations. Further testing and analysis are needed to confirm this case study's results in a larger cohort of patients.

Fully Digital Workflow for Planning Static Guided Implant Surgery: A Prospective Accuracy Study.

The accuracy of static guided implant surgery (sGIS) using conventional planning workflow has been extensively examined; however, more information is required to justify the application of fully digital planning protocol. The purpose of this study was to investigate the clinical accuracy of sGIS with a fully digital planning workflow. Twenty-one partially edentulous patients were enrolled in this prospective study. Cone-beam computed tomography (CBCT) and intraoral scans were taken and superimposed by matching the dental surface images directly (surface registration protocol) or by matching fiducial markers on a stereolithographic (SLA) radiographic template fabricated from the digital data of the intraoral scan (fiducial marker registration protocol). Virtual implant treatment plans were then determined, and tooth-supported SLA surgical guides were fabricated according to the plans. Twenty-six implant surgeries were performed via the surgical guide by one surgeon. Pre- and post-operative CBCT images were superimposed, and the positional and angular deviations between placed and planned implants were measured with metrology software. A total of 43 fully guided implants were placed, in which 25 implants were planned with the surface registration protocol. Implants planned based on the surface registration protocol had a larger mean angular deviation than the fiducial marker registration protocol. No significant differences were found for any deviations of the examined variables. Within the limits of this study, we concluded that the clinical accuracy of the sGIS planned with a fully digital workflow was consistent with the conventional workflow for partially edentulous patients.

Stereolithographic Surgical Guide with a Combination of Tooth and Bone Support: Accuracy of Guided Implant Surgery in Distal Extension Situation.

A distal free-end situation could result in insufficient stability of the surgical guide, and could reduce accuracy of the static guided implant surgery (sGIS). The purpose of this study was to investigate the accuracy of sGIS using a combination tooth-and-bone supported stereolithographic (SLA) surgical guide in distal extension situation. Thirty dentists, each placed three implants at the Federal Dentaire Internationale (FDI) teeth positions #46, #47 (a distal extension situation), and #36 (a single tooth gap) via the surgical guide on a model fixed to a manikin. Pre- and post-operative computed tomography (CT) images of the models were superimposed, and the positional and angular deviations of the implants were measured with metrology software. An analysis of variance (ANOVA) test was performed to evaluate the intergroup differences. No significant differences were found for all the positional and angular deviations among the three implant sites, except the bucco-lingual deviation at the implant platform in the #47 position (0.43 ± 0.19 mm) that was significantly larger than the #46 (0.21 ± 0.14 mm) and #36 (0.24 ± 0.25 mm) positions (p < 0.0001). Within the limits of this study, we conclude that, in distal extension situation of missing mandibular molars, adding a bone-supported strut in the distal part of the surgical guide can be beneficial to the accuracy of the sGIS.

Accuracy of implant position when placed using static computer-assisted implant surgical guides manufactured with two different optical scanning techniques: a randomized clinical trial

Data from cone beam computed tomography (CBCT) and optical scans (intraoral or model scanner) are required for computer-assisted implant surgery (CAIS). This study compared the accuracy of implant position when placed with CAIS guides produced by intraoral and extraoral (model) scanning. Forty-seven patients received 60 single implants by means of CAIS. Each implant was randomly assigned to either the intraoral group (n=30) (Trios Scanner, 3Shape) or extraoral group (n=30), in which stereolithographic surgical guides were manufactured after conventional impression and extraoral scanning of the stone model (D900L Lab Scanner, 3Shape). CBCT and surface scan data were imported into coDiagnostiX software for virtual implant position planning and surgical guide design. Postoperative CBCT scans were obtained. Software was used to compare the deviation between the planned and final positions. Average deviation for the intraoral vs. model scan groups was 2.42°±1.47° vs. 3.23°±2.09° for implant angle, 0.87±0.49mm vs. 1.01±0.56mm for implant platform, and 1.10±0.53mm vs. 1.38±0.68mm for implant apex; there was no statistically significant difference between the groups (P>0.05). CAIS conducted with stereolithographic guides manufactured by means of intraoral or extraoral scans appears to result in equal accuracy of implant positioning.

Potential Deviation Factors Affecting Stereolithographic Surgical Guides: A Systematic Review.

The aim of this study was to review potential deviation factors in stereolithographic surgical guides for dental implantology, warnings, and limitations of the system. An electronic search in databases EMBASE, the Cochrane Library, and PubMed were conducted by 3 researchers to collect information on the accuracy of static computer-guided implant placement to summarize and analyze the overall accuracy. The latter included a search for correlations between factors such as support (teeth/mucosa/bone), number of templates, use of fixation pins, jaw, template production, guiding system, and guided implant placement in articles related to guided surgery with stereolithographic static systems. Studies published between 2012 and 2017 were reviewed. From 761 identified articles, a total of 24 articles were reviewed, which included 2767 dental implants. Data from studies analysis had shown a mean deviation of 3.08 degrees in angular position, 1.14 at the entry point, and 1.46 at apex position. Involved deviation factors were related to planning, laboratory, and surgical phases. Guided surgery may have a limited precision as technique, which surgeons need to be aware in the planning process. This review suggests some security measures in guided surgery process.

The Evaluation of the Accuracy of a Completely Limiting Tooth Supported Stereolithographic Surgical Guide in Dental Implant Placement Using Superim position Protocol of Pre-Operative and Post-Operative CBCT Data: A Clinical Study

The aim of this study was to evaluate the accuracy of a completely limiting tooth supported stereolithographic surgical guide, with sleeve structure incorporated into the design, for computer-guided dental implant placement in partially edentulous patients using the superimposition protocol using preoperative and postoperative CBCT data.

EVALUATION OF PIEZOTOMED ALVEOLAR RIDGE SPLITTING WITH STEREOLITHOGRAPHIC SURGICAL GUIDE FOR IMPLANT PLACEMENT

INTRODUCTION: Narrow dentoalveolar ridges remain a serious challenge for the successful placement of endosseous implants. Several techniques for this procedure may be considered, such as guided bone regeneration, bone block grafting, and ridge splitting for bone expansion. The ridge split procedure provides a quicker and a more reliable method. Advances in technology, Stereolithography allow fabrication of surgical guide from 3D generated models for precise implant placement. OBJECTIVES: Evaluation of minimally invasive ridge splitting procedure aided with surgical guide. MATERIALS AND METHODS: A clinical study was performed on a total of 7 patients with mandibular free end saddle. The sample was selected conveniently to fulfill a list of inclusion and exclusion criteria. Then the selected participants performed ridge splitting with the aid of surgical guide. After ridge splitting, all patients had simultaneous implant placement followed by clinical and radiographical evaluation over a period of 6 months. RESULTS: Merging the preoperative, immediate and 6 months postoperative CBCT images showed statistically significant values of accuracy and increase in bone width. CONCLUSIONS: Alveoalar ridge splitting with the aid of stereolithographic surgical stent is a well acceptable technique for implant placement.

In-office fabrication of dental implant surgical guides using desktop stereolithographic printing and implant treatment planning software: A clinical report

Guided surgery is accepted as the most accurate way to place an implant and predictably relate the implant to its definitive prosthesis, although few clinicians use it. However, recent developments in high-quality desktop 3-dimensional stereolithographic printers have led to the in-office fabrication of stereolithographic surgical guides at reduced cost. This clinical report demonstrates a protocol for using a cost-effective, in-office rapid prototyping technique to fabricate a surgical guide for dental implant placement.

Accuracy of computer-guided implant placement and influencing factors

Digital technology is a new trend in implant dentistry and oral medical technology. Stereolithographic surgical guides, which are computer-guided implant placement, have been introduced gradually to the market. Surgeons are attracted to this approach because of it features visualized preoperative planning, simple surgical procedure, flapless implant, and immediate restoration. However, surgeons are concerned about the accuracy and complications of this approach. This review aims to introduce the classification of computer-guided implant placement. The advantages, disadvantages, and accuracy of this approach are also analyzed. Moreover, factors that may affect the outcomes of computer-guided implant placement are determined. Results will provide a reference to surgeons regarding the clinical application of this approach.

Mandibular reconstruction through CAD/CAM, virtual surgery and stereolithographic surgical guides for skeletal defects after oncological resections

Mandibular reconstruction through CAD/CAM, virtual surgery and stereolithographic surgical guides for skeletal defects after oncological resections

Flexible thermoplastic resin to add retention to tooth-supported stereolithographic surgical guides

Surgical guides produced by stereolithography use hard resin. The hard resin prevents seating beyond the height of contour, hence these guides are not intrinsically retentive. By covering the guide with a flexible thermoplastic material that extends into the undercuts, the resulting guide now has a retentive feature. This allows it to maintain its position during surgery yet it can easily be removed and repositioned.

Bone and Skin-Supported Stereolithographic Surgical Guides for Cranio-Facial Implant Placement.

Osseointegrated skin-penetrating implants enhance the retention and stability of the craniofacial prostheses and provide the long-term comfort. However, to determine the implant locations is a great challenge facing the surgeon. Implants may either be located in conventional manner or by STL generated surgical guides. Present study reports the CT based 3D virtual modeling, preoperative virtual planning and the implant placement by using a STL surgical guide, in an anotia case. Employed materials and the methods facilitated the implant surgery while improving the operational security. CT based 3D virtual modeling of the surgical site, determining the implant locations virtually and the STL guided placement of the craniofacial implants, were found useful applications in order to facilitating the surgical intervention and providing prevention from complications.

Validation of Mandibular Genioplasty Using a Stereolithographic Surgical Guide: In Vitro Comparison With a Manual Measurement Method Based on Preoperative Surgical Simulation

Stereolithographic guidance, increasingly used in orthognathic surgery, has not been completely verified for genioplasty. This study compared the accuracy of manual measurement with that of a stereolithographic guide invitro. Thirty rapid prototype (RP) mandibular models (15 pairs) were included in the experimental (stereolithographic) and control (manual) groups (15 each). Surgical simulation was performed in the 2 groups by advancing the chin 5 mm and then vertically reducing the chin 5 mm using Mimics software. In the stereolithographic group, genioplasty was performed on mandibular RP models using a 3-dimensionally printed surgical guide based on surgical simulation results. In the control group, it was performed using an osteotomy line drawn according to simulation measurements. For the 2 groups, anterior horizontal transverse error and anterior and posterior vertical errors were compared, as were data from the osteotomized chin segment and the preoperative surgical simulation. Positional difference error was calculated and the differences were evaluated with t tests. For advancement genioplasty, the absolute anterior transverse error value was 0.47 ± 0.35 (mean ± standard deviation) with the stereolithographic guide, less than with the manual method (0.77 ± 0.45; P= .001). For reduction genioplasty, the absolute anterior vertical error value was 0.27 ± 0.23 mm with the stereolithographic guide versus 0.58 ± 0.49 mm with the manual method (P < .001). Use of a stereolithographic surgical guide increased accuracy, but the difference in mean error values between methods was only approximately 0.3 mm. The superior accuracy may not be compelling in favor of stereolithographic surgical guides.

Factors affecting accuracy of implant placement with mucosa-supported stereolithographic surgical guides in edentulous mandibles

This study aimed to evaluate the accuracy of implant placement with mucosa-supported surgical guides in edentulous mandibles and to determine the factors affecting accuracy. Implant placement was simulated on the preoperative CT image and mucosa-supported surgical guides were fabricated for six edentulous mandible models and 15 patients with edentulous mandibles, using CAD/CAM technology. Deviations of the actual implant position from the planned position were calculated by comparing the planned image and the postoperative image. Based on the results, it was concluded that mucosa-supported surgical guides have high accuracy and that bone density and mucosal thickness could affect accuracy.

The Influence of the Tolerance between Mechanical Components on the Accuracy of Implants Inserted with a Stereolithographic Surgical Guide: A Retrospective Clinical Study

The stereolithographic-guided surgery system involves a sequence of diagnostic and therapeutic events, and errors can arise at different stages. In these systems, one of the potentially clinically relevant errors may be the mechanical errors caused by the bur-guide gap due to the presence of a rotational allowance of the drills in the tubes. The purpose of this retrospective clinical study is to determine if it is possible to reduce the total error by limiting the tolerance among the mechanical components and to evaluate its clinical incidence. Sixty-six implants were inserted using the External Hex Safe® (Materialise Dental, Leuven, Belgium) system (Group A), and 71 implants were inserted using the same system with mechanical components modified to minimize the tolerance (Group B). Regarding only the angular deviation values, the t-test was used to determine the influence of reduced tolerance among the mechanical components on the accuracy values. t-Test showed that there is a statistically significant better accuracy with the modified system (Group B). Limiting the error that originates from mechanical components, total error could be statistically significantly reduced. Mechanical error is one of the most important source of error using External Hex Safe stereolithographic surgical guide.