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Abstract
With the recent progress of digital technology, the computer guided surgery utilizing a guide template in the placement of implant has been actively performed, and the method employing the intraoral scanner at the implant prosthesis introduced. Fabrication method of the guide template can be largely classified into design-related rapid prototyping (RP) system and vector milling system, and each of the method has its own weakness in the clinical application despite of excellent accuracy. Thus, in this case study, a working model was fabricated by the wax RP technology using images acquired by CBCT and an intraoral scanner, and the metal bushing was picked up with orthodontic resin cast upon the wax model. Using this method, a surgical guide template was fabricated and used in surgery. From this, we could obtain a satisfactory outcome clinically in the implant placement and the fabrication of the final prostheses and thus report this case herein.
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Fig. 1.
Surgical template fabrication and implant placement. (A) Initial panoramic X-ray. (B) Analysis by CBCT. (C) CBCT image (DCM format) and intraoral scan data (STL format) were superimposed by a best fit algorithm. (C) Planned implant location information and normal anatomic structure were printed into wax model by rapid prototyping machine. (D) Fabricated wax-based RP model. (E) Guide bushings were placed onto the planned position. (F) Block out was made before the application of framework material. (G) Resin pouring. (H) Completed surgical template. (I) Template was tried in the patient's mouth. Drilling and implant placement was performed through the metal bushings.
Fig. 2.
Superstructure fabrication and delivery. (A) Scan bodies were connected and digital intraoral scanning was performed. (B) Customized abutment and working model for final restoration were designed with CAD software. (C) Master model made of polyurethane resin. (D) Customized abutments were tried in the patient' s mouth. (E) Intraoral photos after superstructure delivery. (F) Final panoramic X-ray.
Fig. 3.
Analysis of errors between vectors of objects.4 (A) Method. (Left) Horizontal error (horizontal distance of the positions of bushings from those planned before surgery, average of h1 and h2); (Center) Vertical error (vertical distance of the positions of bushings from those planned before surgery, v); (Right) Angular error (an angle between a bushing and a stopping, a). (B) Accuracy analysis was done by reverse engineering software.
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