Accuracy Evaluation of a Stereolithographic Surgical Template for Dental Implant Insertion Using 3D Superimposition Protocol

Corina Marilena Cristache, Silviu Gurbanescu, Corina Marilena Cristache, Silviu Gurbanescu

Abstract

The aim: of this study was to evaluate the accuracy of a stereolithographic template, with sleeve structure incorporated into the design, for computer-guided dental implant insertion in partially edentulous patients.

Materials and methods: Sixty-five implants were placed in twenty-five consecutive patients with a stereolithographic surgical template. After surgery, digital impression was taken and 3D inaccuracy of implants position at entry point, apex, and angle deviation was measured using an inspection tool software. Mann-Whitney U test was used to compare accuracy between maxillary and mandibular surgical guides. A p value < .05 was considered significant.

Results: Mean (and standard deviation) of 3D error at the entry point was 0.798 mm (±0.52), at the implant apex it was 1.17 mm (±0.63), and mean angular deviation was 2.34 (±0.85). A statistically significant reduced 3D error was observed at entry point p = .037, at implant apex p = .008, and also in angular deviation p = .030 in mandible when comparing to maxilla.

Conclusions: The surgical template used has proved high accuracy for implant insertion. Within the limitations of the present study, the protocol for comparing a digital file (treatment plan) with postinsertion digital impression may be considered a useful procedure for assessing surgical template accuracy, avoiding radiation exposure, during postoperative CBCT scanning.

Figures

Figure 1
Figure 1
Planned implant insertion in R2GATE® software.
Figure 2
Figure 2
The stereolithographic surgical guide utilized in all cases had the guide sleeve incorporated in the design, eliminating the need for additional insertion of metal guide sleeves. All surgical drills used had 3 parts: the stopper part, the guide part, and the drilling part [19]. Stopper and guide parts are identical for all drills and especially designed for R2Gate® surgical template. Drilling part varies in length and diameter according to the drilling protocol.
Figure 3
Figure 3
(a) Surgical template applied over the edentulous area and adjacent teeth. (b) Second drill used for flapless implant site preparation.
Figure 4
Figure 4
Implant insertion with hand ratchet. The ratchet connector has six green vertical landmarks (corresponding to implant hex) and a horizontal reference line. In order to reproduce the planned implant position, the horizontal reference line should match with the upper border and the green vertical landmark with the window of the surgical template.
Figure 5
Figure 5
Digital impression of the implants after screwing the scan abutment.
Figure 6
Figure 6
Study workflow.
Figure 7
Figure 7
Measurement of 3D accuracy of the planned (reference) and effective implant insertion (test), ∗ represents degree symbol (°) as it measures an angle.
Figure 8
Figure 8
Qualitative color-codded graphical analysis of implants planned (reference) and placed (test) in Geomagic Qualify® software.
Figure 9
Figure 9
Mean 3D error at entry point, measured at the center of the implant in mandible and maxilla.
Figure 10
Figure 10
Mean 3D error at the apex measured at the center of the implant in mandible and maxilla.
Figure 11
Figure 11
Mean angular deviation for implants inserted in mandible and maxilla.

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