Fabrication Of Surgical Template Research Articles

Merging Mandibular Virtual Data Sets in Partially Edentulous Patients with a High-level of Scattering on Cone-beam CT Scans: A Technical Report.

Digital implant planning, utilizing the convergence of digital surface scanners, cone beam computer tomography (CBCT) scans, and advanced planning software, has transformed dental implantology. The merging of these data sets through triangulation of landmarks provides a detailed digital model of the jaws, facilitating precise implant positioning in edentulous areas. A critical step in this digital workflow is the accurate merging of DICOM files with STL/PLY/OBJ files, which underpins the design and fabrication of surgical templates for accurate implant placement. Errors in this phase can lead to implant mispositioning or damage to adjacent structures. Particularly in partial edentulism, the merging is based on the occlusal topography of the remaining teeth but scattering in the CBCT data-caused by interactions of radiation with radiodense materials-can complicate this process or even render it impossible. The manuscript presents a technique utilizing radiopaque markers to overcome scattering effects, ensuring accurate dataset superimposition in the mandible.

The Accuracy of Guided Implant Surgery With Different Fields of View of Cone-Beam Computerized Tomography.

Although a smaller size field of view (FOV) of cone-beam computerized tomography (CBCT) reduces radiation exposure, its effect on the accuracy of static computer-aided implant surgery (s-CAIS) remains unknown. This study aimed to evaluate the impact of the size of FOV on the accuracy of s-CAIS and to investigate if the arch affects this effect. A total of 32 implant sites on 8 identical scannable models (maxillae and mandibles) were randomly allocated to 2 FOV sizes: test (5 × 5 cm) and control (10 × 10 cm). All models were scanned with an intraoral scanner (IOS). With the registration of the surface scan and CBCT image, a prosthetic-driven implant position was planned. Following the fabrication of surgical templates, a single-blinded surgeon placed all implants with the fully guided s-CAIS protocol. IOS captured the implant positions with the scan body attached. Implant-planning software measured the angular deviation, 3-dimensional (3D) deviation at the crest, and 3D deviation at the apex between preplanned and actual implant positions. Two-way analysis of variance was used to analyze the effect of FOV and arch on the deviations. The size of FOV did not show a significant effect (P > .198) on angular deviation, 3D deviation at the crest, or 3D deviation at the apex. No significant difference was found when comparing the effect of the size of FOV between the maxillary and mandibular implants. In conclusion, the use of small FOV CBCT demonstrated comparable accuracy of s-CAIS to the use of medium FOV CBCT.

Evaluation of the accuracy of fully guided implant placement by undergraduate students and postgraduate dentists: a comparative prospective clinical study

PurposeThis study aimed to assess the accuracy of implant placement through three-dimensional planning and fully guided insertion, comparing outcomes between undergraduate and postgraduate surgeons.MethodsThirty-eight patients requiring 42 implants in posterior single-tooth gaps were enrolled from the University Clinic for Prosthodontics at the Martin Luther University Halle Wittenberg and the Department of Prosthodontics, Geriatric Dentistry, and Craniomandibular Disorders of Charité University Medicine, Berlin. Twenty-two implants were placed by undergraduate students (n = 18), while 20 implants were placed by trainee postgraduate dentists (n = 5). Pre-operative intraoral scans and cone beam computed tomography images were performed for implant planning and surgical template fabrication. Postoperative intraoral scans were superimposed onto the original scans to analyze implant accuracy in terms of apical, coronal, and angular deviations, as well as vertical discrepancies.ResultsIn the student group, two implant insertions were performed by the assistant dentist because of intraoperative complications and, thus, were excluded from further analysis. For the remaining implants, no statistically significant differences were observed between the dentist and student groups in terms of apical (p = 0.245), coronal (p = 0.745), or angular (p = 0.185) implant deviations, as well as vertical discrepancies (p = 0.433).ConclusionsThis study confirms the viability of fully guided implant placement by undergraduate students, with comparable accuracy to postgraduate dentists. Integration into dental education can prepare students for implant procedures, expanding access and potentially reducing costs in clinical practice. Collaboration is essential for safe implementation, and future research should explore long-term outcomes and patient perspectives, contributing to the advancement of dental education and practice.Trial registration: DRKS, DRKS00023024, Registered 8 September 2020—Retrospectively registered, https://drks.de/search/de/trial/DRKS00023024.

Introduction of temporomandibular joint and skull base combined reconstruction by autogenous bone graft.

This study introduces the application of autogenous bone graft for the reconstruction of temporomandibular joint (TMJ) and skull base combined defects. Patients treated with autogenous bone grafts for reconstruction of the TMJ and skull base were reviewed. All patients underwent virtual surgical design to confirm the osteotomies of the combined lesion and the selections of autogenous bone graft, fabrication of surgical templates to transfer the plan to actual operation, and reconstruction of autogenous bone graft for the TMJ and/or skull base. Surgical outcomes were assessed by clinical examinations and radiological data. Twenty-two patients were involved in this study. Ten patients underwent reconstruction of the skull base by a free iliac or temporal bone graft and preservation of the TMJ. Twelve patients underwent skull base reconstruction by the same methods and total reconstruction of the TMJ by half sternoclavicular joint flap or costochondral bone graft. No severe complications occurred after surgery. The occlusion relationship was stable and similar to that of the preoperative state. The pain and maximal interincisal opening were significantly improved by the 101.2-month follow-up. Autogenous bone graft is a good alternative for repairing the TMJ and the skull base structure and function. The study introduced the application of autogenous bone graft for the reconstruction of temporomandibular joint and skull base combined defect, which is a good way to repair the defect and restore the function.

Reducing the manual length setting error of a passive Gough-Stewart platform for surgical template fabrication using a digital measurement system

Abstract As recently demonstrated, a passive Gough-Stewart platform (a.k.a. hexapod) can be used to create a personalized surgical template to achieve minimally invasive access to the cochlea. The legs of the hexapod are manually adjusted to the desired length, which must be read off an analog scale. Previous experiments have shown that manual length setting of the hexapod’s legs is error-prone because of the imprecise readability of the analog scale. The objective of this study is to determine if integration of a linear encoder and digitally displaying the measured length help reduce the length setting error. Two experiments were conducted where users set the leg length manually. In both experiments, the users were asked to set the leg length to 20 nominal values using the whole setting range from 0 mm to 10 mm. In the first experiment, users had to rely only on the analog scale; in the second experiment, the electronic display additionally showed the user the actual leg length. Results show that the mean length setting error without using the digital display and only relying on the analog scale was (0.036 ± 0.020) mm (max: 0.107 mm) in contrast to (0.001 ± 0.000) mm (max: 0.002 mm) for the experiment with the integrated digital measurement system. The results support integration of digital length measurement systems as a promising tool to increase the accuracy of surgical template fabrication and thereby patients’ safety. Future studies must be conducted to evaluate if integration of a linear encoder in each of the six legs is feasible.

Guided surgery in dental implantology

Dental implant surgery requires precise planning due to various anatomic limitations and restorative goals. The greatest challenges in the surgical and the prosthetic stages of dental implant surgery are due to diagnostic failure and poor case planning. With the advent of new technology surgical guides and templates can be fabricated which has made it possible to achieve more reliable agreement between the planned and final position of dental implants. These templates fabricated by sophisticated data acquisition methods and virtual planning software, seat directly on bone. They are preprogrammed with the individual depth and angulation during 3D computer simulation. It has improved preoperative planning reducing the surgical morbidity. This article reviews the concept of virtual planning and procedure of stereolithography for fabrication of surgical templates during implant planning and placement. Keywords: Dental implant, Guided implant surgery, Surgical guide, Rapid prototyping technology, Stereolithographic template, Radiographic template.

An Easy Approach for the Fabrication of Surgical Template for Placement of Mini-implant

The success of dental implant depends on meticulous treatment planning. Restorative problems are often common with improper placement of implants, especially where the alveolar bone quantity is compromised. The accuracy needed in placement of the mini-implant is even more. Hence, the use of a surgical guide becomes essential. Various authors have suggested techniques for the fabrication of surgical and radiographic stents. These techniques make use of different materials in fabrication of stent. This article presents a simple technique for the fabrication of a surgical guide for the placement of mini-implants using simple readily available materials. The technique can be modified to be used for regular diameter implants.

Image analysis of immediate full-arch prosthetic rehabilitations guided by a digital workflow: assessment of the discrepancy between planning and execution

BackgroundA dentition with adequate function and esthetics is essential for the well-being and quality of life. A full implant-retained fixed prosthetics is an ideal solution for fully edentulous arch, however requires complex planning, surgical, and prosthetic procedure. With the help of digital workflow, it becomes a predictable and fast solution for the dentists and the patients. This retrospective study analyzed the most advanced surgical approach in full-arch rehabilitation with dental implants and immediate loading using digital workflow.MethodsPatient records of fully edentulous jaws treated in four clinical centers in Warsaw, Poland, were evaluated. Computer-assisted planning and surgical template fabrication were done using the planning software coDiagnostiX™, based on a pre-op cone beam computed tomography (CBCT) and scanned data of a plaster model. A post-op CBCT was acquired after the placement of four to six implants by the guided system. The influence of different surgical variables on the discrepancy between planning and execution was analyzed, together with the biomechanical indices.ResultsA total of nine patient records were selected of 12 edentulous jaws treated with 62 implants. The overall mean three-dimensional (3D) offset at the implant base was 1.60 mm, at the tip 1.86 mm. The mean angle of deviation was 4.89°, the mean implant stability quotient (ISQ) 70.42, and the insertion torque 35.58 Ncm. The 3D offsets were influenced by the gender of the patient, treated jaw, the diameter, and length of the implant. The angle of deviation was affected only by the treated jaw. Insertion torque was influenced by the treated jaw, the age of the patient, the length of the implant, tooth type, and the side of the jaw.DiscussionBone quality of the patient and implant preparation procedure influenced the discrepancy between the planning and the execution of the digitally guided implant placement. Dense bone—mandible, posterior area, young age, and man—and multiple preparations of the implant bed—wider and longer implant—could be suggested as risk factors.ConclusionDigital workflow successfully enabled the immediate full-arch rehabilitation with a predictable outcome by different surgeons in multiple centers.

Surgical Template Fabrication Using Cost-Effective 3D Printers.

This in vitro study aimed to evaluate the accuracy of surgical templates fabricated using three different 3D printing technologies. Ten identical surgical templates were printed using four 3D printers (two of an identical make and model). Each of the surgical templates was scanned by a reference scanner and then imported into the inspection software. Inspection software utilized a best-fit alignment to automatically calculate the 3D variation at all points. Statistically significant differences were found among the three groups (χ2[2] = 12.880, P = .0016). Mean 3D deviation was also significantly different between the two printers of an identical make and model (χ2[1] = 8.251, P = .0041). All of the tested printers had a high level of accuracy in the fabrication of surgical templates, which would justify the trial of cost-effective printers for clinical fabrication of surgical implant templates.

Developing Customized Dental Miniscrew Surgical Template from Thermoplastic Polymer Material Using Image Superimposition, CAD System, and 3D Printing.

This study integrates cone-beam computed tomography (CBCT)/laser scan image superposition, computer-aided design (CAD), and 3D printing (3DP) to develop a technology for producing customized dental (orthodontic) miniscrew surgical templates using polymer material. 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 miniscrew 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 3DP technique and polymer material. An anterior retraction and intrusion clinical test for the maxillary canines/incisors showed that two miniscrews 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 0.5 mm 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 3DP techniques can be applied to fabricate an accurate customized surgical template for dental orthodontic miniscrews.

CAD/CAM fabrication and clinical application of surgical template and bone model in oral implant surgery

A novel implant surgery support system with computer simulation for implant insertion and fabrication of a surgical template that helps in drilling bone was developed. A virtual reality haptic device that gives the sense of touch was used for simulation and a surgical template was fabricated by CAD/CAM method. Surgical guides were applied for two clinical cases. Three-dimensional (3D) jaw bone images transferred from DICOM data filmed by CT scanner were fed to the software and manipulated using the haptic device. The site for implant insertion was determined after evaluating the quality of bone and position of the mandibular canal. The surgical template was designed with ease using the free design CAD function of haptic device. The surgical template and bone model were fabricated by a fused deposit modeling machine. Two clinical cases were applied using the present system. Simulation to determine the site of implant insertion and fabrication of the surgical bone templates were successfully done in two clinical cases, one for three implant insertion in lower right jaw and the other is for seven implant insertion in lower edentulous jaw, respectively. During surgery, the templates could be firmly adapted on the bone and drilling was successfully performed in both cases. The present simulation and drilling support using the surgical template may help to perform safe and accurate implant surgery.

Simplified Fabrication of Surgical Template for Orthodontic‐Implant Treatment

This article proposes a simple method to fabricate an implant surgical template that provides good visual access, operator flexibility, and template stability for use in multidisciplinary cases involving orthodontic devices.

Fabrication of a stable surgical template using staged tooth extraction for immediate implant placement

When a patient with a nonrestorable dentition desires an immediate restoration, fabrication and use of a stable surgical template can be challenging. Conventionally made surgical templates may lack stability and may, therefore, be less predictable. This article describes the fabrication of a surgical template that permitted the use of staged tooth extraction to facilitate predictable immediate implant placement in a patient with a nonrestorable dentition.

Surgical templates for prosthetically guided implant placement

The article describes a prosthetically guided method for the fabrication of surgical templates for partially edentulous patients. A number of stainless steel components are used to capture the optimal prosthetic position for the placement of the implant determined from a diagnostic arrangement. A radiopaque stainless steel guide sleeve is used to guide the drill in preparation of the osteotomy after radiographs are made to verify the position and proposed trajectory of the guide sleeve.

Computer-Guided Surgery Utilizing a Computer-Milled Surgical Template

Computer-Guided Surgery Utilizing a Computer-Milled Surgical Template

Surgical template fabrication for immediate dentures.

T he use of a clear surgical template’ for immediate complete or temporary removable partial denture construction is of considerable benefit, especially if the alveolar contour is to be altered significantly. Proper contour of a master cast to anticipated bone loss; reduction of bony prominences, tori, or tuberosities; or reattachment of the mucogingival junction at a desired depth may be necessary in immediate denture construction.*xl A surgical template is desirable when these procedures are to be accomplished. The following modification of a technique previously described for construction of custom trays has an application for construction of surgical templates.’ It provides an accurate reproduction of the tissue surface of an immediate complete or temporary removable partial denture.