Accuracy of a chairside fused deposition modeling 3D-printed single-tooth surgical template for implant placement: An in vitro comparison with a light cured template
Introduction
Correct implant position is critical to the esthetics and function of restorations. A ‘prosthetically driven’ implant treatment concept was proposed in 1995 (Garber and Belser, 1995), which required clinicians to consider the esthetics and function of the final restoration during implant surgery. Thus, a well-established preoperative design and an accurate transfer to surgery are needed.
With the advent of computer-aided design/computer-aided manufacture (CAD/CAM) technology, and cone beam computed tomography (CBCT), many types of software have been developed that can assist the clinician in the preoperative design (Jemt and Stenport, 2011, Van Assche et al., 2012, Vercruyssen et al., 2014). Mainly two types of technique are used to transfer the planned implant position information to the clinical situation: ‘static guidance’, which applies surgical templates; and ‘dynamic guidance’, which uses visual imaging tools on a monitor to achieve intraoperative real-time guidance (Jung et al., 2009, Jayaratne et al., 2010, Block et al., 2017). Surgical templates are more widely used, due to their low cost and high predictability (Hultin et al., 2012, D'Haese et al., 2017).
To date, numerous studies have focused on the accuracy of template-guided surgery, which refers to the deviation between the planned and final implant position (D'Haese et al., 2012). Implant placement using a surgical template can significantly improve accuracy, as compared with freehand placement, both in vitro (Vermeulen, 2017, Tan et al., 2018) and in vivo (Nickenig et al., 2010, Arisan et al., 2013). Compared with the conventional thermo-formed surgical guide, a digitalized surgical template can achieve even higher accuracy (Matta et al., 2017).
At present, digitalized surgical templates are mainly manufactured using additive manufacturing technology, with stereolithographic 3D printing technology — a type of light-curing 3D printing technology — being used most commonly (D'Haese et al., 2017). However, stereolithographic surgical templates mostly require the use of specific equipment in a dental laboratory, as well as a complex procedure (Hu et al., 2012, Kattadiyil et al., 2014). They require a long production time and are not suited to chairside application. On the other hand, fused deposition modeling (FDM) technology is based on a relatively simple principle, has lower costs and higher printing efficiency, and can be used for printing oral medical products with appropriate precision (Chen et al., 2016, Calcagnile et al., 2018). Current 3D-printing accuracy, which is the deviation between the printed object and standard triangulation language (STL) file dimensions, is less than 1 mm in general, and typically less than 0.5 mm (George et al., 2017). Some studies of FDM printing technology have demonstrated accuracy of around 0.1–0.5 mm (El-Katatny et al., 2010, George et al., 2017), and even 0.013 mm (Deng et al., 2017). Nevertheless, no research on, or application of, FDM technology for printing surgical guides has been reported to date.
The aim of this study was to evaluate the accuracy of implant placement with a new type of surgical template fabricated using FDM technology, in comparison with a frequently used, light-cured template, in an in vitro environment. Development of both templates was based on the same 3D planning. The null hypothesis was that there would be no significant difference between these two types of surgical template in terms of transfer accuracy.
Section snippets
Selected models and data sets
Twenty standard mandibular resin models, produced using the same matrix, with missing teeth 36 and 46 were chosen to represent a typical clinical situation in this in vitro study (Fig. 1). Bone analog was placed under the surface of the edentulous area, to simulate class Ⅱ bone quality. Surface data for the standard mandibular resin model were obtained using a 3D optical model scanner (Activity 880, Smart Optics, Bochum, Germany), and were saved as an STL file. In addition, a CBCT scan of the
Results
A total of 40 implants were inserted into 20 models. All deviation values were used as absolute values; thus, the distance from the position of the placed implants to their planned position was measured, without consideration of direction. These details can be found in Table 1.
No statistically significant difference in accuracy was found between the test group and the control group for any of the parameters.
Discussion
FDM technology was used to fabricate surgical templates, and the accuracy of these templates for implant placement was compared with that using a light-cured 3D-printed surgical template. The results showed that the two template types had similar accuracy.
To our knowledge, no previous report has described using FDM 3D-printed templates to assist implant bed preparation, or compared this with light-cured 3D-printed templates. FDM is an efficient 3D-printing technology (Chen et al., 2016,
Conclusion
In this in vitro study, implant placement using an FDM chair-side 3D-printed surgical template yielded a similarly high accuracy as obtained with a light curing 3D-printed template for indication single tooth gap, but with improved efficiency. Although this model study cannot fully simulate a clinical situation, it demonstrated the feasibility and reliability of using an FDM guide plate in clinical applications to some extent. Future research is needed to verify whether the technique is
Funding
This study was supported by the Beijing Municipal Science and Technology Commission Research Fund (Z161100000116092) and National Natural Science Foundation of China (81671026, 51475004).
Conflicts of interest
The authors report no conflicts of interest related to this study.
Acknowledgments
The authors would like to express their sincere gratitude to: Associate Professor Lin Zeng from Peking University Third Hospital for statistical analysis; Associate Professor Yijiao Zhao, engineer Xinyue Zhang, and students Kehui Deng, Rong Li, and Hefei Bai at the National Engineering Laboratory for Digital and Material Technology of Stomatology; and Straumann AG for supporting this study.
References (39)
- et al.
The intrinsic error of a stereolithographic surgical template in implant guided surgery
Int J Oral Maxillofac Surg
(2013) - et al.
Impact of operator experience on the accuracy of implant placement with stereolithographic surgical templates: an in vitro study
J Prosthet Dent
(2013) - et al.
Geometric accuracy of digital volume tomography and conventional computed tomography
Br J Oral Maxillofac Surg
(2008) - et al.
The impact of the fabrication method on the three-dimensional accuracy of an implant surgery template
J Craniomaxillofac Surg
(2017) - et al.
Evaluation of the difference in accuracy between implant placement by virtual planning data and surgical guide templates versus the conventional free-hand method — a combined in vivo–in vitro technique using cone-beam CT (Part II)
J Craniomaxillofac Surg
(2010) - et al.
Accuracy of three different types of stereolithographic surgical guide in implant placement: an in vitro study
J Prosthet Dent
(2012) - et al.
Implant positioning errors in freehand and computer-aided placement methods: a single-blind clinical comparative study
Int J Oral Maxillofac Implants
(2013) - et al.
Implant placement accuracy using dynamic navigation
Int J Oral Maxillofac Implants
(2017) - et al.
A feasibility study of processing polydimethylsiloxane(-)sodium carboxymethylcellulose composites by a low-cost fused deposition modeling 3D-printer
Materials (Basel)
(2018) - et al.
The influence of the tolerance between mechanical components on the accuracy of implants inserted with a stereolithographic surgical guide: a retrospective clinical study
Clin Implant Dent Relat Res
(2015)
Application of FDM three-dimensional printing technology in the digital manufacture of custom edentulous mandible trays
Sci Rep
Quantitative evaluation of printing accuracy and tissue surface adaptation of mandibular complete denture polylactic acid pattern fabricated by fused deposition modeling technology
Zhonghua Kou Qiang Yi Xue Za Zhi
Current state of the art of computer-guided implant surgery
Periodontol 2000
Accuracy and complications using computer-designed stereolithographic surgical guides for oral rehabilitation by means of dental implants: a review of the literature
Clin Implant Dent Relat Res
Accuracy of a newly developed open-source system for dental implant planning
Int J Oral Maxillofac Implants
Error analysis of FDM fabricated medical replicas
Rapid Prototyp J
An in vitro model to evaluate the accuracy of guided implant placement based on the surgeon's experience
Int J Oral Maxillofac Implants
Restoration-driven implant placement with restoration-generated site development
Compend Contin Educ Dent
Measuring and establishing the accuracy and reproducibility of 3D printed medical models
Radiographics
Cited by (22)
Comparison of the accuracy of implants placed with CAD-CAM surgical templates manufactured with various 3D printers: An in vitro study
2021, Journal of Prosthetic DentistryCitation Excerpt :Although Sun et al reported no statistically significant difference in accuracy between the 2 groups, the deviations reported are higher than those of the present study. Sun et al13 used a drilling protocol to create an osteotomy on a bone model, where the density of the bone could have influenced the path in which the bed was prepared. In addition, the implant placement was conducted without template guidance.
Dimensional accuracy of extrusion- and photopolymerization-based 3D printers: In vitro study comparing printed casts
2021, Journal of Prosthetic DentistryCitation Excerpt :Therefore, they should not be used to produce applications that are to remain in the patient’s mouth for an extended period. However, they are suitable for producing surgical templates.32 The selection of the AM system is user specific: In addition to the acquisition costs and printing accuracy, factors such as the intended application, maintenance costs, and planned production output (build volume and AM speed) should be considered.19
Research progress in application of fused deposition modeling technology in stomatology
2023, Journal of Jilin University Medicine Edition