Wu Jiacheng, Shui Yusen, Xie Chenyang, Wu Qin, Yu Meiqi, Luo Tian, Zhao Yuwei, Yu Haiyang
Graduate student, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Dental Technology, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China.
Graduate student, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China.
J Prosthet Dent. 2025 Feb;133(2):530.e1-530.e9. doi: 10.1016/j.prosdent.2024.10.031. Epub 2024 Nov 16.
Implant surgical guides manufactured using different fabrication methods have been commonly used for computer-guided implant placement. However, how fabrication methods and the number of supporting teeth influence accuracy and stability remains uncertain.
The purpose of this in vitro study was to evaluate the influence of fabrication methods and number of supporting teeth on the surface accuracy and dimensional stability of implant surgical guides with 3 different 3-dimensional (3D) printers and 1 computer numeric controlled (CNC) milling machine.
Two tooth-supported maxillary implant surgical guides with different number of supporting teeth (S: short span with 4 supporting teeth, L: long span with complete arch supporting) were used to fabricate the specimens. Eighty surgical guides were fabricated from 3 different 3D printers and 1 milling machine as follows: group SLA-S (n=10) and SLA-L (n=10) were fabricated with a desktop stereolithography (SLA) 3D printer and photopolymerizing resin; group PolyJet-S (n=10) and PolyJet-L (n=10) were fabricated with a PolyJet 3D printer and photopolymerizing resins; group DLP-S (n=10) and DLP-L (n=10) were fabricated with a desktop digital light processing (DLP) 3D printer and photopolymerizing resin; and group MILL-S (n=10) and group MILL-L (n=10) were fabricated with a 5-axis milling machine and polymethyl methacrylate (PMMA) blanks. All surgical guides were digitized immediately after postprocessing and after 1, 2, and 3 months using a desktop scanner. The congruency between design files and digitized files was quantified with the root mean square (RMS) error with a metrology program (Geomagic Control X). Two-way ANOVA was used to analyze trueness, and the Levene test was used to assess precision (α=.05).
The fabrication methods and number of supporting teeth significantly affected the surface trueness of the guide (P<.001). Milled guides had the lowest mean RMS value for surface trueness, 45 µm for guides with 4 supporting teeth and 59 µm for guides with complete arch supporting. Regarding precision, the Levene test revealed significant difference among fabrication methods (P<.05), while no significant difference was found in the same fabrication method group (P>.05). After 3 months of storage, RMS values increased significantly in the complete arch supporting group comparison of SLA, PolyJet, and DLP (P<.001, P<.001, and P=.015, respectively). RMS values remained similar in other groups.
The trueness and dimensional stability of the surface of the implant surgical guides were affected by fabrication methods and the number of supporting teeth. However, the precision was only affected by fabrication methods. Milled surgical guides showed higher accuracy and better dimensional stability after storage than those produced with 3D printers. Among the groups of 3D printing, guides with 4 supporting teeth showed higher trueness and a lower degree of deformation after storage.
使用不同制造方法制造的种植手术导板已普遍用于计算机引导的种植体植入。然而，制造方法和支持牙数量如何影响准确性和稳定性仍不确定。
本体外研究的目的是评估制造方法和支持牙数量对使用3种不同的三维（3D）打印机和1台计算机数控（CNC）铣床制造的种植手术导板的表面精度和尺寸稳定性的影响。
使用两个具有不同支持牙数量的牙支持上颌种植手术导板（S：短跨度，有4个支持牙；L：长跨度，有全牙弓支持）来制作标本。如下从3种不同的3D打印机和1台铣床制造了80个手术导板：SLA-S组（n = 10）和SLA-L组（n = 10）使用桌面立体光刻（SLA）3D打印机和光聚合树脂制造；PolyJet-S组（n = 10）和PolyJet-L组（n = 10）使用PolyJet 3D打印机和光聚合树脂制造；DLP-S组（n = 10）和DLP-L组（n = 10）使用桌面数字光处理（DLP）3D打印机和光聚合树脂制造；MILL-S组（n = 10）和MILL-L组（n = 10）使用5轴铣床和聚甲基丙烯酸甲酯（PMMA）坯料制造。所有手术导板在进行后处理后以及在1、2和3个月后使用桌面扫描仪进行数字化处理。使用计量程序（Geomagic Control X）通过均方根（RMS）误差对设计文件和数字化文件之间的一致性进行量化。使用双向方差分析来分析准确性，使用Levene检验来评估精度（α = 0.05）。
制造方法和支持牙数量显著影响导板的表面准确性（P < 0.001）。铣削导板的表面准确性平均RMS值最低，有4个支持牙的导板为45μm，有全牙弓支持的导板为59μm。关于精度，Levene检验显示制造方法之间存在显著差异（P < 0.05），而在相同制造方法组中未发现显著差异（P > 0.05）。在储存3个月后，SLA、PolyJet和DLP的全牙弓支持组的RMS值显著增加（分别为P < 0.001、P < 0.001和P = 0.015）。其他组的RMS值保持相似。
种植手术导板表面的准确性和尺寸稳定性受制造方法和支持牙数量的影响。然而，精度仅受制造方法的影响。铣削手术导板在储存后显示出比3D打印机制造的导板更高的准确性和更好的尺寸稳定性。在3D打印组中，有4个支持牙的导板在储存后显示出更高的准确性和更低的变形程度。
