Accuracy of Implants Placed with Surgical Guides: Thermoplastic Versus 3D Printed
Accuracy of Implants Placed with Surgical Guides: Thermoplastic Versus 3D Printed
复制标题
DOI：
10.11607/prd.3254
复制
发表时间：
2018-01-01
影响因子：
1.6
通讯作者：
Rice, Dwight D.
中科院分区：
文献类型：
--
作者：
Bell, Caitlyn K.;Sahl, Erik F.;Rice, Dwight D.
本研究旨在评价使用两种不同的引导植入手术材料（热塑性塑料与三维（3D）打印材料）放置植入物的准确性。将之前获得并选择用于单牙种植体置换的锥形束计算机断层扫描（CBCT）扫描转换为医学数字成像和通信（DICOM）文件。使用BlueSkyBio Plan软件和DICOM文件计划并导出所有模型以进行打印。通过Right Choice Milling打印了总共20个复制CBCT的3D打印下颌象限颌骨，作为接受对照种植体的对照模型。此前，10个热塑性塑料和10个3D打印手术导向器由Right Choice Milling的同一实验室技术人员制造。每个导向器和复制钳口模型对放置一个带有三叶连接的Nobel Biocare种植体。按照Nobel Biocare引导手术方案，使用热塑性塑料和3D打印手术导向器（代表两个试验组）放置植入物。然后共进行21次CBCT扫描，对照植入物和每个试验植入物各一次。将CBCT容积转换为DICOM文件并传输至Invivo 5软件版本5.4（Anatomage）。将每个试验植入物的DICOM文件叠加在对照的DICOM文件上。根据对照和试验植入物叠加的测量结果，评价植入物头部的偏差、植入物顶点的偏差和偏差角度。使用Mann-Whitney U检验在α = 0.05和95%置信区间下检验零假设。平均值+/-标准差采用描述性统计量。使用热塑性手术导向器放置的植入物显示出平均3.40度的角度偏差，而使用3D打印手术导向器放置的植入物显示出2.36度的角度偏差（P = .143）。使用热塑性手术导板放置的植入物在植入物头部显示出平均1.33 mm的偏差，而使用3D打印手术导板放置的植入物为0.51 mm（P < 0.001）。使用热塑性手术导板放置的植入物在植入物顶点处显示出平均1.6 mm的偏差，而使用3D打印手术导板放置的植入物为0.76 mm（P < .001）。与使用3D打印手术导向器放置的植入物相比，使用热塑性手术导向器放置的植入物的角度偏差没有显著差异。然而，与使用热塑性手术导向器放置的植入物相比，使用3D打印手术导向器放置的植入物的植入物头和植入物顶点的位置明显更准确。
This study was conducted to evaluate the accuracy of implants placed using two different guided implant surgery materials: thermoplastic versus three-dimensionally (3D) printed. A cone beam computed tomography (CBCT) scan previously obtained and selected for single-tooth implant replacement was converted into a Digital Imaging and Communications in Medicine (DICOM) file. All models were planned and exported for printing using BlueSkyBio Plan Software with the DICOM files. A total of 20 3D-printed mandibular quadrant jaws replicating the CBCT were printed by Right Choice Milling, as was the control model to accept the control implant. Previously, 10 thermoplastic and 10 3D-printed surgical guides had been made by the same lab technician at Right Choice Milling. One Nobel Biocare implant with a trilobe connection was placed per guide and replica jaw model pair. Implants were placed using the thermoplastic and 3D-printed surgical guides, representing the two test groups, following the Nobel Biocare guided surgical protocol. A total of 21 CBCT scans were then taken, one for the control implant and one for each test implant. The CBCT volume was converted to a DICOM file and transferred to Invivo5 software version 5.4 (Anatomage). The DICOM file of each test implant was superimposed over the DICOM file of the control. The deviation of the head of the implant, the deviation of the apex of the implant, and the angle of deviation were evaluated from measurements on the superimposition of the control and test implants. Mann-Whitney U test was used to test the null hypotheses at alpha = .05 and a confidence interval of 95%. Descriptive statistics were used for the average +/- standard deviation. The implants placed with the thermoplastic surgical guides showed an average of 3.40 degrees of angular deviation compared to 2.36 degrees for implants placed with the 3D-printed surgical guides (P = .143). The implants placed with the thermoplastic surgical guides showed an average of 1.33 mm of deviation at the head of the implant compared to 0.51 mm for implants placed with the 3D-printed surgical guides (P < 0.001). The implants placed with the thermoplastic surgical guides showed an average of 1.6 mm of deviation at the apex of the implant compared to 0.76 mm for implants placed with the 3D-printed surgical guides (P < .001). There was no significant difference in the angular deviations of implants placed with thermoplastic surgical guides compared to those placed with the 3D-printed surgical guide. However, the locations of the implant head and implant apex were significantly more accurate for the implants placed with the 3D-printed surgical guides compared to those placed with the thermoplastic surgical guides.