Clinical Application Of 3D Printing Surgical Guide In Dental Implant

Objective: To evaluate intraoperative and postoperative clinical effects of implantation when applying 3D-printing surgical guide manufactured on the basis of clinical CBCT data,computer aided design/computer aided manufacturing(CAD/C AM)technology and 3D printing technology in patients with dentition defect or edentulous patients,and analyze its accuracy.Methods: Jawbone of 12 patients with maxillary or mandibular dentition defeat were scanned by CBCT with high resolution.Then 12 kinds of 3D-printing surgical guide were designed and made,and with the help of the guide plate,23 implants were implanted in the anterior region/posterior region.After the implantation,C BCT scanning was conducted and its data could reconstruct 3D jawbone with Mimics software,as well as implants at the same time.Then point-to-point registration technique(N-point registration)was employed to achieve preoperative and postoperative CBCT 3D reconstruction model registration,and finally the deviation of neck,apex and depth of actual and virtual implants,angle deviation between the center axis of actual and virtual implants in the buccolingual and mesio-distally direction were measured and recorded,and the deviation between the preoperative virtual implant site and the postoperative site of the actual implantation was compared.Patients were followed up with clinical examination after 2 weeks to observe the condition of the surrounding mucosa of the implant,with or without swelling and pus,as well as oral health status;3 to 6 months later,C BCT examination was conducted to observe the implant bone combination,whether the implant loose and fall off,whether the denture repair conditions were meet;6 months and 12 months later the clinical examination or telephone follow-up was made to observe repair effect of implant denture and satisfaction of patients.Results: The 23 implants which were implanted under the support of the 3D printing surgical guide in the 12 patients all had good location,and when compared with original design,the average deviation of the neck,apex,depth and axial angle in 3D direction were(1.10 ± 0.63)mm,(1.35 ± 0.64)mm,(0.76 ± 0.68)mm,and the average angle deviation in mesio-distally direction was(3.41 ± 2.73)°,4.39 ± 2.70 ° in the buccolingual direction.The average cost per surgical guide was 1583.33 yuan,and the average time of each implant operation was 21.39 min.In order to evaluate the reliability of the measurement,the experimental data were tested twice,and their P> 0.05,the difference was not statistically significant.After 2 weeks of implantation,the clinical examination was performed on these 12 patients.The mucosal around the implant was ruddy,and no inflammation was found.The implant had no percussion pain and no loosening.Patients kept good oral hygiene.3 months later,8 patients had CBCT examination,and the results showed good combination of implant bone and no low density around the implant,without percussion pain,loosing and inflammation around,so denture repair could be carried.The other 4 cases did not reach the observation time,no need for shooting observation;6 months later the 8 patients were followed by telephone,and they did not respond to have discomfort,occlusal contact of implant denture was good,also with no implant loosing off.Recently the patient was satisfied with the effect.The other 4 cases did not reach the observation time so there was no follow-up observation;12 months later one patient was followed up by telephone,and the patient did not respond to have discomfort,occlusal contact of implant denture was good,also with no implant loosing off,and the patient was satisfactory with the effect.The other 11 cases did not reach the observation time so there was no follow-up observation.Conclusion:(1)Application of 3D printing surgical guide in dental implant can enhance the accuracy of implantation,shorten operation time and guarantee its safety.(2)3D printing surgical guide also has deviation;its accuracy in mesio-distally direction is superior to that in buccolingual direction.