In-office fabrication of surgical guides using DLP 3D printing and planning software – A clinical report

Background

In order to provide a successful long-term outcome, a proper positioning of implants is essential. Ideally, implants should be placed in native bone with at least of 1.5 mm on both buccal and lingual aspects, also in a prosthetically driven position. Various techniques have been developed to predictably improve the practitioner's ability to place implants accurately [1,2]. Contemporary planning software allows to plan the desired implant placement and to fabricate a low cost in-office surgical.

Aim/Hypothesis

To aim of this study was to evaluate the feasibility and accuracy of in-office surgical guides produced using Implant Studio 2018 software (3 Shape Dental Systems, Copenhagen, Denmark) and desktop 3D printer (Moonray, S100).

Material and Methods

A 55-year-old female patient presented to our clinic, with the chief concern being replacement of the missing lateral upper and lower teeth. Using Trios 3 scanner, dental arches were scanned and later superimposed onto the CBCT-scan using a three-point registration method. In 3Shape Implant Studio 2018, virtual wax-up of missing teeth was performed, implants were placed in a prosthetically driven position. Surgical guides were designed and exported into RayWare software and subsequently 3D printed using MoonRay S100. A total number of 14 Dentium implants were inserted using a flapless approach in the upper jaw (7 implants) and with a minimally invasive flap elevation in the lower jaw (7 implants). At 6 months, a CBCT-scan was performed to evaluate osseointegration of dental implants. Post- implant insertion STL model was generated in 3D Slicer and then was superimposed with pre- surgical plan to evaluate distance and angulation differences. During follow-up period no implant were lost.

Results

In the case reported, detailed measurements and analysis of each implant revealed that the mesiodistal and bucco-lingual deviations ranged from 0.15–0.97 mm and 0.42–1.04 mm, respectively. Angular difference between the planned and placed implant positions ranged from 0.37 to 5.64 degrees mesiodistally and 1.44–7.23 degrees bucco-lingually. Similar results were previously shown by Edelman et al., these deviations are acceptable and can be well tolerated when compared to a free-hand implant placement method. There will always be minor differences between actual and planned implant position which may be the result of inaccuracies of CBCT-scans, various anatomical structures, bone density, precision in guide fitting, surgeon's skills, etc. The main advantage of in-office guided surgery is the possibility to predictably obtain and reproduce surgical guides with high accuracy at a low cost. The planning software enables to create a consistent workflow for every implant procedure.

Conclusion and Clinical Implications

In-office fabricated surgical guides using contemporary implant software and desktop 3D printers show similar accuracy to laboratory manufactured guides. The main benefit of in-office guided surgery is mainly to reduce the time and costs for a surgical guide fabrication. Although this workflow can provide an accurate outcome, clinicians should get adequate training in order to become familiar with implant planning software and the fabrication of 3D printed surgical guides.