Accuracy assessment of implant placement using a stereolithographic surgical guide made with digital scan

Seung-Mi Jeong; Jeong-Whan Fang; Chan-Hyeon Hwang; Se-Ha Kang; Byung-Ho Choi; Yiqin Fang; Hyongtae Jeon; Sunghun An

doi:10.4047/jkap.2015.53.2.111

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Jeong, Fang, Hwang, Kang, Choi, Fang, Jeon, and An: Accuracy assessment of implant placement using a stereolithographic surgical guide made with digital scan

Original Article

J Korean Acad Prosthodont 2015;53(2):111-119.

Published online: 9 February 2015

DOI: https://doi.org/10.4047/jkap.2015.53.2.111

Accuracy assessment of implant placement using a stereolithographic surgical guide made with digital scan

Seung-Mi Jeong^1,^∗, Jeong-Whan Fang¹, Chan-Hyeon Hwang¹, Se-Ha Kang¹, Byung-Ho Choi², Yiqin Fang², Hyongtae Jeon³, Sunghun An³

¹Department of Prosthodontics, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea

²Department of Oral and Maxillofacial Surgery, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea

³Dio research institute, Pusan, Republic of Korea

^∗Corresponding Author: Seung-Mi Jeong Department of Prosthodontics, Wonju College of Medicine, Yonsei University, 20 Iisan-ro, Wonju 220-701, Republic of Korea +82 33 741 2114 : e-mail, smj3@yonsei.ac.kr

^※ This work was supported by a research grant from Yonsei University Wonju College of medicine (YUWCM-2008-25).

Received 13 January 201516 February 2015 Accepted 2 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The objective of this study was to evaluate the accuracy of a stereolithographic surgical guide that was made with information from intraoral digital impressions and cone beam CT (CBCT).

Materials and methods

Six sets of resin maxilla and mandible models with missing teeth were used in this study. Intraoral digital impressions were made. The virtual models provided by these intraoral digital impressions and by the CBCT scan images of the resin models were used to create a surgical guide. Implant surgery was performed on the resin models using the surgical guide. After implant placement, the models were subjected to another CBCT scan to compare the planned and actual implant positions. Deviations in position, depth and axis between the planned and actual positions were measured for each implant.

Results

The mean deviation of the insertion point and angulation were 0.28 mm and 0.26®, apex point were 0.11 mm and 0.14 mm respectively. The implants were situated at a mean of 0.44 mm coronal to the planned vertical position.

Conclusion

This study demonstrates that stereolithographic surgical guides created without the use of impressions and stone models show promising accuracy in implant placement.

Keywords: CAD/CAM, Digital data, Digital impression, Digital implant, Guided surgery

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Fig. 1.

Resin maxilla and mandible model with artificial silicone gums.

Fig. 2.

Intraoral scanning of the resin model.

Fig. 3.

Scanned model.

Fig. 4.

Plastic plate for determination of a reference plane.

Fig. 5.

Plastic plate attached to the resin model.

Fig. 6.

The merged image of the CBCT scan and the intraoral scan.

Fig. 7.

Virtual surgical guides for the maxilla (A) and mandible (B).

Fig. 8.

Surgical guides for the maxilla (A) and mandible (B).

Fig. 9.

Guide tube of 9 mm in length.

Fig. 10.

Drilling through the guide tube with a 2 mm drill.

Fig. 11.

Surgical guides: Implant placement using the guide (A) and impant connector position at buccal view (B).

Fig. 12.

The X- and Y-axis on the CBCT image.

Fig. 13.

These illustrations show the procedure used to determine the position and angle of the virtual implant. The insertion point P (X, Y) and apex point P' (X', Y') is determined by the crossing point between the axis of the virtual implant and the XOY-plane. ∠X (Xθ) and ∠Y (Yθ) are defined as the angles from the X- and Y-axes, respectively.

Fig. 14.

Position and angulation of the implant on the CBCT image.

Fig. 15.

Position and angulation of the implant on the Simplant software.

Fig. 16.

Surgical guides on the resin maxilla (A) and mandible models (B).

Table 1.

Determine the position and angle of the virtual implant at X, Y, Z-axes. The insertion point P (X, Y) and apex point P' (X', Y') are determined by the crossing point between the axis of the virtual implant and the XOY-plane. ∠X (Xθ) and ∠Y (Yθ) are defined as the angles from the X- and Y-axes, X (Xθ) and ∠Y (Yθ) are defined as the angles from the X- and Y-axes. △Z is defined as vertical discrepancy

Discrepancy	△ X (mm)	△ X' (mm)	△ Y (mm)	△ Y' (mm)	∠ Xθ(®)	∠ Yθ(®)	△ Z (mm)
Mean	0.27	0.11	0.29	0.14	0.26	0.26	0.44
SD	0.11	0.10	0.13	0.08	0.10	0.11	0.17

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