Pieralli Stefano, Spies Benedikt Christopher, Hromadnik Valentin, Nicic Robert, Beuer Florian, Wesemann Christian
Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center-University of Freiburg, Faculty of Medicine-University of Freiburg, 79106 Freiburg, Germany.
Department of Prosthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Geriatric Dentistry and Craniomandibular Disorders, 14197 Berlin, Germany.
J Clin Med. 2020 Jul 22;9(8):2322. doi: 10.3390/jcm9082322.
3D printed surgical guides are used for prosthetically-driven oral implant placement. When manufacturing these guides, information regarding suitable printing techniques and materials as well as the necessity for additional, non-printed stock parts such as metal sleeves is scarce. The aim of the investigation was to determine the accuracy of a surgical workflow for oral implant placement using guides manufactured by means of fused deposition modeling (FDM) from a biodegradable and sterilizable biopolymer filament. Furthermore, the potential benefit of metal sleeve inserts should be assessed. A surgical guide was designed for the installation of two implants in the region of the second premolar (SP) and second molar (SM) in a mandibular typodont model. For two additive manufacturing techniques (stereolithography [SLA]: reference group, FDM: observational group) n = 10 surgical guides, with (S) and without (NS) metal sleeves, were used. This resulted in 4 groups of 10 samples each (SLA-S/NS, FDM-S/NS). Target and real implant positions were superimposed and compared using a dedicated software. Sagittal, transversal, and vertical discrepancies at the level of the implant shoulder, apex and regarding the main axis were determined. MANOVA with posthoc Tukey tests were performed for statistical analyses. Placed implants showed sagittal and transversal discrepancies of <1 mm, vertical discrepancies of <0.6 mm, and axial deviations of ≤3°. In the vertical dimension, no differences between the four groups were measured ( ≤ 0.054). In the sagittal dimension, SLA groups showed decreased deviations in the implant shoulder region compared to FDM ( ≤ 0.033), whereas no differences in the transversal dimension between the groups were measured ( ≤ 0.054). The use of metal sleeves did not affect axial, vertical, and sagittal accuracy, but resulted in increased transversal deviations ( = 0.001). Regarding accuracy, biopolymer-based surgical guides manufactured by means of FDM present similar accuracy than SLA. Cytotoxicity tests are necessary to confirm their biocompatibility in the oral environment.
3D打印手术导板用于以修复为导向的口腔种植体植入。在制造这些导板时，关于合适的打印技术和材料以及诸如金属套筒等额外的非打印库存部件的必要性的信息很少。本研究的目的是确定使用由可生物降解和可消毒的生物聚合物细丝通过熔融沉积建模（FDM）制造的导板进行口腔种植体植入手术流程的准确性。此外，应评估金属套筒插入物的潜在益处。设计了一种手术导板，用于在下颌牙模型的第二前磨牙（SP）和第二磨牙（SM）区域植入两颗种植体。对于两种增材制造技术（立体光刻[SLA]：对照组，FDM：观察组），使用了n = 10个带（S）和不带（NS）金属套筒的手术导板。这产生了4组，每组10个样本（SLA - S/NS，FDM - S/NS）。使用专用软件将目标种植体位置和实际种植体位置进行叠加并比较。确定了种植体肩部、根尖水平以及关于主轴的矢状、横向和垂直差异。进行多变量方差分析及事后Tukey检验以进行统计分析。植入的种植体显示矢状和横向差异<1毫米，垂直差异<0.6毫米，轴向偏差≤3°。在垂直维度上，四组之间未测量到差异（≤0.054）。在矢状维度上，与FDM相比，SLA组在种植体肩部区域的偏差减小（≤0.033），而在横向维度上各组之间未测量到差异（≤0.054）。使用金属套筒不影响轴向、垂直和矢状准确性，但导致横向偏差增加（= 0.001）。关于准确性，通过FDM制造的基于生物聚合物的手术导板与SLA具有相似的准确性。需要进行细胞毒性测试以确认它们在口腔环境中的生物相容性。
