In-office fabrication of surgical guides using DLP 3D printing and planning software: A clinical

report.
Background (500 characters max.)
In order to provide a successful long-term outcome, a proper positioning of implants is essential.
Ideally, implants should be placed in native bone with at least of 1.5 mm on both buccal and
lingual aspects, also in a prosthetically driven position. Various techniques have been developed
to predictably improve the practitioner’s ability to place implants accurately [1,2]. Contemporary
planning software allows to plan the desired implant placement and to fabricate a low cost in-
office surgical.
Aim/Hypothesis (300 characters max.)
To aim of this study was to evaluate the feasibility and accuracy of in-office surgical guides
produced using Implant Studio 2018 software (3Shape Dental Systems, Copenhagen, Denmark)
and desktop 3D printer (Moonray, S100).
Materials and Methods (1000 characters max.)
A 55-year-old female patient presented to our clinic, with the chief concern being replacement
of the missing lateral upper and lower teeth. Using Trios 3 scanner, dental arches were scanned
and later superimposed onto the CBCT-scan using a three-point registration method. In 3Shape
Implant Studio 2018, virtual wax-up of missing teeth was performed, implants were placed in a
prosthetically driven position. Surgical guides were designed and exported into RayWare
software and subsequently 3D printed using MoonRay S100. A total number of 14 Dentium
implants were inserted using a flapless approach in the upper jaw (7 implants) and with a
minimally invasive flap elevation in the lower jaw (7 implants). At 6 months, a CBCT-scan was
performed to evaluate osseointegration of dental implants. Post- implant insertion STL model
was generated in 3D Slicer and then was superimposed with pre- surgical plan to evaluate
distance and angulation differences. During follow-up period no implant were lost.
Results (1000 characters max.)
In the case reported, detailed measurements and analysis of each implant revealed that the
mesiodistal and bucco-lingual deviations ranged from 0.15-0.97 mm and 0.42-1.04 mm,
respectively. Angular difference between the planned and placed implant positions ranged from
0.37-5.64 degrees mesiodistally and 1.44-7.23 degrees bucco-lingually. Similar results were
previously shown by Edelman et al, these deviations are acceptable and can be well tolerated
when compared to a free-hand implant placement method. There will always be minor
differences between actual and planned implant position which may be the result of inaccuracies
of CBCT-scans, various anatomical structures, bone density, precision in guide fitting, surgeon’s
skills, etc. The main advantage of in-office guided surgery is the possibility to predictably obtain
and reproduce surgical guides with high accuracy at a low cost. The planning software enables
to create a consistent workflow for every implant procedure.
Conclusions and Clinical implications (500 characters max.)
In-office fabricated surgical guides using contemporary implant software and desktop 3D printers
show similar accuracy to laboratory manufactured guides. The main benefit of in-office guided
surgery is mainly to reduce the time and costs for a surgical guide fabrication. Although this
workflow can provide an accurate outcome, clinicians should get adequate training in order to
become familiar with implant planning software and the fabrication of 3D printed surgical guides.