Department of Prosthodontics, University of São Paulo School of Dentistry, São Paulo, Brazil.
Private Practice, Bahia, Brazil.
J Esthet Restor Dent. 2024 Dec;36(12):1604-1613. doi: 10.1111/jerd.13265. Epub 2024 Jun 12.
The aim of this report is to present the complete workflow of 3D virtual patient for planning and performing implant surgery with magnetically retained 3D-printed stackable guides.
A 3D-printed stackable system was proposed based on bone, dental, and facial references. Initially, a 66-year-old male patient was digitalized through photographs, cone beam computed tomography, and intraoral scans (Virtuo Vivo, Straumann). All files were merged to create a 3D virtual patient in the planning software (coDiagnostiX, Straumann). Sequential stackable guides were designed, printed, and cured. Magnets were inserted into connectors, and the interim protheses received color characterization. Four mounted guides were produced for the specific purposes of pin fixation, bone reduction, implant placement, and immediate provisionalization. After surgery and healing period, patient digital data were updated. Final implant positions were compared to planned values and inconsistencies were clinically acceptable. The mean angular deviation was 5.4° (3.2-7.3) and mean 3D discrepancies were of 0.90 mm (0.46-1.12) at the entry point and 1.68 mm (1.00-2.20) at implant apex. Case follow-up revealed stability, patient's comfort, and no intercurrences.
Magnetically retained stackable guides provide treatment accuracy and reduce surgical and prosthetic complications. The projected virtual patient enhances decision-making and communication between the multidisciplinary team and the patient, while decreases time and costs.
Bidimensional diagnosis and freehand implant placement have limitations and outcomes often rely on professionals' expertise. Performing facially driven virtual planning improves treatment predictability. This approach promotes function, esthetic harmony, and patient satisfaction. Implant guided surgery and 3D printed prostheses constitute a reproducible digital workflow that can be implemented into clinical practice to optimize dental care.
本报告旨在介绍使用磁性固位 3D 打印可堆叠导板规划和执行种植手术的 3D 虚拟患者的完整工作流程。
基于骨、牙和面部参考，提出了一种 3D 打印可堆叠系统。最初，对一名 66 岁男性患者进行了数字化处理，使用了照片、锥形束计算机断层扫描和口腔内扫描（Virtuo Vivo、Straumann）。将所有文件合并到规划软件（coDiagnostiX、Straumann）中，以创建 3D 虚拟患者。设计、打印和固化了可连续堆叠的导板。将磁铁插入连接件中，并对临时修复体进行颜色特征化处理。制作了四个安装导板，用于特定目的，如固定销钉、骨减少、植入物放置和即刻临时修复。手术后和愈合期后，更新了患者的数字数据。比较了最终植入物位置与计划值，差异在临床可接受范围内。平均角度偏差为 5.4°（3.2-7.3），入口处平均三维差异为 0.90mm（0.46-1.12），植入物根尖处为 1.68mm（1.00-2.20）。病例随访显示稳定、患者舒适度和无并发症。
磁性固位可堆叠导板可提供治疗准确性并减少手术和修复并发症。虚拟患者可增强多学科团队和患者之间的决策和沟通，同时减少时间和成本。
二维诊断和徒手植入物放置有局限性，结果往往依赖于专业人员的专业知识。进行面驱动的虚拟规划可提高治疗的可预测性。这种方法可促进功能、美观和谐和患者满意度。植入物引导手术和 3D 打印修复体构成了可重复的数字工作流程，可将其应用于临床实践，以优化牙科护理。
