Comparative Study Of 3D Printed Implant Guide In Different Implant Surgery In Anterior Tooth Defect Area

Purpose Cone beam CT(CBCT)is widely used in stomotology,greatly improved the accuracy of diagnosis of oral diseases.The emergence of 3D printed implant guides based on CBCT data has significantly improved the scientificity and precision in dental implant,especially in anterior tooth defect area with complex anatomical structure.3D printed implant guides effectively reduce the implant complications.The implant surgery type is mainly divided into flap surgery type and flapless surgery type,and each type has its own advantages.In this study,CBCT data of patients were used to make flap and flapless surgery models and 3D printed implant guides.After implant surgery,evaluate the accuracy of dental implants and discuss the effects of different surgical procedures on 3D printed implant guides accuracy,in order to provide guidance for clinicians.Methods21 patients with anterior teeth missing from the department of implantology,stomatology center,Anhui Provincial Hospital from January 1,2017 to October 1,2017,a total of 32 missing teeth,and preoperative preparation of patients with plaster model,CBCT scans the patient's jaw.After the CBCT data and the plaster model scan data are superimposed,the CBCT data was imported into Mimics 19.0 software,and after 3D reconstruction,it was stored as an STL format file,and it contains hard tissue information such as the patient's jaw bone,dentition,and incisor tube,similar to the clinical "flap" effect,recorded as STL 1.The laser scanner scanned the patient's plaster model and stored it as an STL file,and it contains complete intraoral information such as the patient's gums,mucous membranes,and dentition,and is recorded as STL 2.(1)Flap-type model making: STL 1 is imported into a 3D printer to print a model,which is divided into a flap-type surgery group(Flap-type surgery group,FP).(2)Flapless-type model making: On the Geomagic Studio software platform,STL 1and STL 2 are registered and superimposed and stored as STL files containing the complete information overlay image,denoted as STL 3.On the Mimics 19.0 software platform,after importing STL 3 and performing Boolean operations,the STL file containing the files of complete soft and hard tissue information such as gingival mucosa,incisor tube,dentition,etc.,is recorded as STL 4,and imported into 3D printer.Divided into a flapless surgery group(flapless surgery group,FPS group)Using the Simplant Pro 17.01 software,the dental implant guides were designed separately in the two groups.Compare the actual position of the dental implants with the preoperative planning of the top,bottom,vertical distance deviation and angular deviation.Statistical analysis was performed using SPSS 19.0,and P < 0.05 was considered to be statistically significant.Results1.Based on the patient's CBCT data and plaster model data,a high-precision simulated jaw model was successfully produced.Using the dental implant planning software and3 D printer,we can designed and printed personalized dental implant guides successfully.2.The deviations of the implant top in FP group and FPS group were(0.94±0.13)mm,(2.72±0.09)mm,and the deviations of the implant bottom were(1.45±0.16)mm,(3.04±0.12)mm,and the deviations of the implant vertical were(1.08±0.12)mm,(2.72±0.12)mm,and the overall distance deviation of the implants were(1.16±0.14)mm,(2.83±0.14)mm,and the implant angle deviation was(3.33±0.50)°.(4.88±0.24)°,respectively.Compared with the FPS group,the FP group had smaller deviation and higher precision,and the deviation values of implant top,bottom,vertical distance and angular were statistically different(p<0.05).Conclusion1.Based on the patient's CBCT data and plaster model data,a high-precision simulated jaw model was successfully produced by 3D printing.2.The anterior region has a complex anatomical structure,and 3D printed implant guides can achieve the accuracy and scientificity of dental implants.3.Different surgical procedures of flapping and flapless have an influence on the accuracy of dental implanting,The better accuracy of tooth implantation can be realized under flap surgical procedures.Clinician needs to select the surgical procedure according to the actual clinical situation.