| BackgroundSince the 1960s, Swedish scientists Branemark Present the theory of osseointegration,the oral implantology have developing rapidly. After nearly fifty years research and clinical practice by scholars in many countries. implant had an important role in dental restoration. In present, it had become one of the preferred method of dental prosthesis.In order to arrive the good effect of prosthesis, Mainly depended on preoperative check the height, width, bone density and anatomical structures of alveolar ridge, then making the correct diagnosis and treatment plan, transferred the preoperative design to surgery. Although experienced doctor can accurately grasp the implant position, direction and depth during surgery according to the X-ray images, but the individual differences of oral maxillofacial anatomy, limitation of radiation condition and the field of vision, plus the field of vision making actual planting location and the prediction planting position prone to error. This situation was easy to cause the bone of implantation perforate and damage alveolar neural tube, maxillary sinus, cutting teeth adjacent. Improper implant position also affected he prosthesis of the upper structure,thus affect the functionality and aesthetics of restoration.With the development of the planting technology, the concept of restoration guided implant was put forwarded. Asked the doctor to implant to meet the needs of the postoperative prosthetic, then the accuracy of implantation becomes the important role to implant.Edge use implant surgical guide applied to implantation at first time in 1987,changed the situation clinical doctor just according their experience and limit radiation condition complete the implant surgery. With the development of science and technology,3D imaging techniques, computer aided design and computer aided manufacture using in stomatology, a digital implant surgical guide also arisedat the historic moment. Such as computer aided design and computer aided manufacture (CAD/CAM) of implant surgical guide. Due to the popularity of 3 D printing,3D printing plant surgical guide as a kind of computer aided design and computer aided manufacture implant surgical guide has pay a great attention.Currently, there are many research about implant surgical guide,mainly focuses on the accuracy of implant surgical guide, but lack of the research about the design and manufacture of implant surgical guide,specially the design and manufacture of 3D printing implant surgical guide. Therefore, in this experiment, we will design and manufacture the conventional surgical guide and 3 D implant surgical guide and analyze its accuracy.Conventional implant surgical guide was more used in clinical application, It was easy to manufacture and cost a little, but it was considering the effect after the implant prosthesis and anatomic structure of jaw bone partially. For multiple missing teeth and jaw bone mass insufficient also has certain limitation. With the development of digital medical and a lot of advantages of 3Dprinting technology and its widely used..According to the patients CT data, we could use the computer aided design and manufactured with 3D printing technology for implant surgical guide. Efficient and accurate was the main advantages of 3D printing implant surgical guide, but its cost is expensive.Objectivehis experiment design and manufacture the 3D printing implant surgical guide and conventional implant guide by using 3D printing technology and vacuum hot pressing membrane technology respectively, evaluation the accuracy of 3D implant surgical guide and conventional implant guide.MaterialsThis experiment’s subjects was planting model of missing teeth offered by dentium company, Selected 14 implants made in korea Dentium company its Dentium SuperLine series FX4010SW. The used equipment were Dentium planter, plant box, Cone Beam Computed Tomography of planmeca,3D printer. The software using in this research were Mimics10.0(Materialise, Belgium), Geomagical Studio2012 (Magical, America), NX6.0 (Siemens a g, Germany)Methods1. The design and manufacture of 3D printing surgical guide and conventional surgical guide1.1 Grouping and the manufacture of models7 pair of missing teeth planting model can be divided into two groups, including four deputy for traditional plant guide,3 pair for 3 d printing plant guide. The implant place for traditional planting guide and 3 D printing implant guide are 14.Using anhydrite turned over planting model of missing teeth, trimming model, ready for use.1.2The design and manufacture of conventional surgical guideArranged artificial teeth on the plaster model, recover the denture to integrity and then turn over 2 pair of model with anhydrite, put the model with filling concave on the Vacuum machine, manufacture 2 pair of surgical guide with transparent resin membrane of 1.5mm width. Putting one pate on the viewer together with the model, determining the best position and direction of the plant, ensure parallel between the implant.Fixed slow turbine on the viewer. Drilling hole of 6.1mm diameter on the occlusal to accommodate the guide tube of 6mm outside diameter. Another pate drilling hole of 4mm diameter on the occlusal as above pate and filling gutta-percha into the drilling hole on buccal as the radiation guide.Using UX6.0 software design tubes of 2.4/2.8/3.6/4.0mm inside diameter,5mm outside diameter,6mm length, then import to 3D printer with STL format to manufacture tubes with different inside diameter. As mentioned above, design and manufacture cathetes of 5.1mm inside diameter,6mm outside diameter,5.5mm length. Inserted and fixed the cathetes into conventional surgical guide with resin flow. Using Cone Beam Computed Tomography scanning model with radiation plate and the single radiation plate respectively. Calculated 3D image according different threshold value in Mimics 10.0 software then Combined with occlusal recordes recorded by radiation pate and the anatomy construction of model to simulation implants place, this place will be the postoperative evaluation of accuracy.1.3The design and manufacture of 3D printing surgical guideAs conventional surgical guide to make radiation plate, Using Cone Beam Computed Tomography scanning model with radiation plate and the single radiation plate respectively. Calculated 3D image according different threshold value in Mimics 10.0 software then combined with occlusal recordes recorded by radiation pate and the anatomy construction of model to simulation implants place, this place will be the postoperative evaluation of accuracy.Output the implants data with IGES format to UX6.0 software, then design tubes of 5.1mm inside diameter according to the implant axial.output the tubes date to Gemagic Studio software with STL format and design the retention structure stretch to 2mm thick pate. Finally, using Boolean operation connected the tubes and pate to surgical final guide, then output the surgical guide to 3D printer transform to supporting file and print out the surgical guide.2 The accuracy evaluation of 3D printing surgical guide and conventional surgical guide2.1ImplantationPut the different surgical guide on the models respectively, Determine the guides insertion were ready, then began to implant. Replace the inner diameter of 2.4 mm/2.8 mm/3.6 mm/4.0 mm tubes in turn to ensure that the accurate use of pioneer drill and forming drill with diameter of 2.2 mm/2.6 mm/3.4 mm/3.8 mm in the operation process, to determine whether the depth achieve the implant required based on drilling scale. After the completion of the drilling, implanted implant 4.0mm diameter 10mm length with the help of surgical guide.2.2 Registration and evaluation of accuracyUsing Cone Beam Computed Tomography scan models after implantation, Calculated 3D image in Mimics 10.0 software, separate implants and model according to difference threshold value. Registration the preoperative model and postoperative model, then the actual implant and simulated implant were registration. Redefine the coordinates, redefine the axis of the virtual implants for z axis, mesisal to distal of the alveolar ridge for x axis, buccal to lingual of alveolar ridge for y axis, the center of the virtual implants in the head for origin. Record the actual implant and virtual implant 3 d coordinate of center of the neck and apex,use the coordinates margin between actual implant and the virtual implants to indicate the deviation about actual implant on three dimension. Using Geomagic Studio software matching the axis of actual implant and virtual implant respectively,export the axis with IGES format and input it into UX6.0 software analysis the angle between the actual and virtual implant.2.3 Statistical analysisTo evaluate the reliability of the measurement, measurement again 7 days after first measurement,the before and after measurement were analyzed with paired-t tests. when P>0.05,no significant difference was considered, then get twice the average of the measured value as the final measured values. Using SPSS13.0 statistical software for analysis the deviation of apex, neck and angle of actual implant with the help of 3D printing surgical guide or conventional surgical guide. Analysis the three dimension of apex and neck of actual implant. Analysis the deviation of disto-mesial, bucco-palatal,vertical direction of implant using two-way ANOVA. P< 0.05 were statistically significant.Result1.obtain high quality scan images according Cone Beam Computed Tomography scan, create accurate three-dimensional models image through Mimics 10.0 software.2.Using vacuum machine manufacture the conventional surgical guide successfully, the conventional surgical guides were suitable for models, It were not only no gap between pate and alveolar ridge,the rest of the tooth,but also no swinging and no tilting when put on the model. It also has good light penetration and have good hardness.3.Design the digital surgical implant guide through Mimics10.0,Geomagical Studio2012,UX6.0 software successfully.4.Put the digital surgical implant guide data into 3D printer and printing the implant surgical guide successfully. The surface of the pate were smooth and continuous. It were so hard that not easy to deformation. The surgical guides were suitable for models,It were not only no gap between pate and alveolar ridge the rest of the tooth,but also no swinging and no tilting when put on the model.5.With the help of 3D printing and conventional implant surgical guide, the implant input into the mandible model successfully.6.Using Cone Beam Computed Tomography scan models after implantation, Calculated 3D image in Mimics10.0 software, then registration the preoperative model and postoperative model, evaluation the accuracy. With the aid of 3D-printing surgical guide, the deviations of the position at the apex of the implant, at the neck of the implant and the projected deviation of angle were 0.60±0.21mm,0.42±0.10mm and 1.84±0.61°. respectively; the deviations of the position at the apex of the implant were 0.27±0.11mm、0.20±0.07mm、0.46±0.25mm at three dimension; the deviations of the position at the neck of the implant were0.19±0.11mm、0.13±0.04mm、 0.33±0.10mm at three dimension. With the aid of conventional surgical guide, the deviations of the position at the apex of the implant, at the neck of the implant and the projected deviation of angle were 161±0.13mm、1.37±0.20mm and 2.89±0.72° respectively; the deviations of the position at the apex of the implant were0.86±0.16、 0.83±0.20mm、0.67±0.17mm at three dimension; the deviations of the position at the neck of the implant were 1.03±0.13mm、1.00±015mm、0.76±0.19mm at three dimension.Conclusion1. The traditional guide takes certain extent account the restoration after implantation which were fabricated on plaster models and basically ensures the final restoration effect. Because of the advantage of easy fabricate and low cost, it had been Widely used in clinical. But this approach was made on the diagnosis model, only had the information surface the model, lacking inside information of bone so it can’t provide the most reliable information which has some limitations for multiple missing teeth and insufficiency of bone mass.2.3 D printing implant surgical guide was finished with the image data and digital processing. Product rapidly and high accuracy were it advantage. it could be designed according corresponding software by self and following send to fabricated in order to save time and cost, avoid the communication barriers between doctors and technicians.The accuracy at disto-mesial, bucco-palatal of 3D -printing surgical guide were better than the accuracy of vietical. |
PDF Full Text Request