Abstract
Statement of problem
Digital light processing (DLP), continuous liquid interface printing (CLIP), and stereolithography
(SLA) technologies enable 3-dimensional (3D) printing of surgical guides. However,
how their accuracy compares and how accuracy may affect subsequent steps in guided
surgery is unclear.
Purpose
The purpose of this in vitro study was to investigate the fabrication and seating
accuracy of surgical guides printed by using DLP, SLA, and CLIP technologies and evaluate
the positional deviation of the osteotomy site and placed implant compared with the
digital implant plan.
Material and methods
Twenty-one polyurethane models were divided into 3 groups and used to plan implants
and design surgical guides. The guides were fabricated by using DLP, SLA, or CLIP
3D printers (n=7) and scanned, and the scan file was compared with the digital design
file to analyze the fabrication accuracy at the intaglio and overall external surfaces
using root mean square (RMS) values. The triple scan protocol was used to evaluate
the seating accuracy of the guides on their respective models. Osteotomies were prepared
on models by using the guides followed by a microcomputed tomography image of each
osteotomy. The implants were placed through the guides, the scan bodies were tightened
to implants, and the models were scanned to obtain the images of placed implant position.
Osteotomy and placed implant images were used to calculate the entry point, apex,
and long axis deviations from the planned implant position with a software program.
A 2-way repeated-measures ANOVA of the RMS data was used to analyze printing and seating
trueness, and homogeneity of variance analyses were used at each surface for precision.
A 3-way repeated-measures ANOVA was used to analyze distance deviations over the stages
(osteotomy and final implant) and locations studied, and a 2-way repeated-measures
ANOVA was used for angular deviations. Homogeneity of variance analyses were performed
for precision (α=.05).
Results
The 3D printer type significantly affected the trueness of the guide at the intaglio
surface (P<.001). SLA guides had the lowest mean RMS (59.04 μm) for intaglio surface, while
CLIP had the highest mean RMS (117.14 μm). Guides from all 3D printers had low variability
among measured deviations and therefore were similarly precise. The seating accuracy
of SLA and DLP guides was not significantly different, but both had lower mean RMS
values than CLIP (P=.003 for SLA, P=.014 for DLP). There were no significant interactions between the stage of surgery,
the printer type, or the location of implant deviation (P=.734). Only the location of deviation (cervical versus apical) had a significant
effect on distance deviations (P<.001). The printer type, stage of surgery, and their interaction did not significantly
affect angular deviations (P=.41).
Conclusions
The 3D printing technology affected printing trueness. The intaglio surface trueness
was higher with SLA and overall trueness was higher with the CLIP printer. The precision
of all guides was similarly high. Guides from SLA and DLP printers had more accurate
seating than those from CLIP. Higher deviations were observed at the apex; however,
osteotomy and final implant position did not significantly differ from the digitally
planned position.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Prosthetic DentistryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Precision and trueness of dental models manufactured with different 3-dimensional printing techniques.Am J Orthod Dentofac Orthop. 2018; 153: 144-153
- Digital workflows in the management of the esthetically discriminating patient.Dent Clin North Am. 2019; 63: 331-334
- Predictability of reformatted computed tomography for pre-operative planning of endosseous implants.Dentomaxillofac Radiol. 1999; 28: 37-41
- Three-dimensional comparative study on the accuracy and reproducibility of dental casts fabricated by 3D printers.J Prosthet Dent. 2018; 119: 861.e1-861.e7
- Integrating a full digital workflow to achieve optimal surgical and restorative outcomes in implant dentistry.Compend Contin Educ Dent. 2019; 40: 414-422
- A computed tomographic scan–derived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae: a prospective multicenter study.Clin Implant Dent Relat Res. 2005; 7: 111-120
- Is digital guided implant surgery accurate and reliable?.Dent Clin North Am. 2019; 63: 381-397
- Reliability of implant placement with stereolithographic surgical guides generated from computed tomography: clinical data from 94 implants.J Periodontol. 2008; 79: 1339-1345
- An update on applications of 3D printing technologies used for processing polymers used in implant dentistry.Odontology. 2020; 108: 331-338
- Comparison of different types of 3D printing technologies.Int J Sci Res Publ. 2018; 8: 1-9
- Methods and apparatus for production of three-dimensional objects by stereolthography.1991
- Method and apparatus for production of high resolution three-dimensional objects by stereolithography.1993
- United States Patent, Arcadia1984: 16
- Continuous liquid interface production of 3D objects.Science. 2015; 347: 1349-1352
- A benchmark study on rapid prototyping processes and machines: quantitative comparisons of mechanical properties, accuracy, roughness, speed, and material cost.Proc Inst Mech Eng. 2008; 222: 201-215
- Slicing procedures in layered manufacturing: a review.Rapid Prototyp J. 2003; 9: 274-288
- Accuracy of computer-guided surgery: a comparison of operator experience.J Prosthet Dent. 2015; 114: 407-413
- In Vivo tooth-supported implant surgical guides fabricated with desktop stereolithographic printers: fully guided surgery is more accurate than partially guided surgery.J Oral Maxillofac Surg. 2018; 76: 1431-1439
- Layerless fabrication with continuous liquid interface production.Proc Natl Acad Sci USA. 2016; 113: 11703-11708
- A new Steiner patch based file format for additive manufacturing processes.CAD Comput Aided Des. 2015; 63: 86-100
- A computing method for accurate slice contours based on an STL model.Virtual Phys Prototyp. 2009; 4: 29-37
- Formlabs [Internet]. SLA vs. DLP: compare Resin 3D Printers. c2020.(Available from:)https://formlabs.com/blog/resin-3d-printer-comparison-sla-vs-dlp/Date accessed: May 10, 2022
- Accuracy of surgical guides from 2 different desktop 3D printers for computed tomography-guided surgery.J Prosthet Dent. 2019; 121: 498-503
- Continuous liquid interface production of alginate/polyacrylamide hydrogels with supramolecular shape memory properties.Carbohydr Polym. 2020; 231: 1-8
- Investigations on the accuracy of 3D-printed drill guides for dental implantology.Int J Comput Dent. 2017; 20: 35-51
- A randomized controlled clinical trial comparing guided with nonguided implant placement: a 3-year follow-up of implant-centered outcomes.J Prosthet Dent. 2019; 121: 904-910
- Accuracy of implants placed with surgical guides: thermoplastic versus 3D printed.Int J Periodontics Restorative Dent. 2018; 38: 113-119
- Computer technology applications in surgical implant dentistry: a systematic review.Int J Oral Maxillofac Implants. 2009; 24: 92-109
- Accuracy of three different types of stereolithographic surgical guide in implant placement: an in vitro study.J Prosthet Dent. 2012; 108: 181-188
- Clinical accuracy of 3 different types of computed tomography-derived stereolithographic surgical guides in implant placement.J Oral Maxillofac Surg. 2009; 67: 394-401
- Accuracy of implant placement with computer-guided surgery: a systematic review and meta-analysis comparing cadaver, clinical, and in vitro studies.Int J Oral Maxillofac Implants. 2018; 33: 101-115
- The accuracy of computer-guided implant surgery with tooth-supported, digitally designed drill guides based on CBCT and intraoral scanning. A prospective cohort study.Clin Oral Implants Res. 2019; 30: 1005-1015
- A new triple-scan protocol for 3D fit assessment of dental restorations.Quintessence Int. 2011; 42: 651-657
- Congruence between the meshes of a combied healing abutment-scan body system acquired with four different scanners and the corresponding library file: an in vitro analysis.J Dent. 2022; 118: 1-7
- Accuracy of 3D printed models created by two technologies of printers with different designs of model base.J Prosthodont. 2020; 29: 124-128
- Congruence between Meshes and Library Files of Implant Scanbodies: an In Vitro Study Comparing Five Intraoral Scanners.J Clin Med. 2020; 9: 1-18
- Accuracy of static digital surgical guides for dental implants based on the guide system: a systematic review.J Stomatol Oral Maxillofac Surg. 2021; 122: 600-607
- Computer-guided implant therapy and soft- and hard-tissue aspects. The Third EAO Consensus Conference.Clin Oral Implant Res. 2012; 23: 157-161
- Safety Zone to Mandibular canal for posterior mandible implant surgeries.J Dent & Oral Disord. 2016; 2: 1-5
- Accuracy of complete- and partial-arch impressions of actual intraoral scanning systems in vitro.Int J Comput Dent. 2019; 22: 11-19
- 3Shape [Internet]. c2022. TRIOS 4.(Available from:)https://www.3shape.com/en/scanners/trios-4Date accessed: July 20, 2022
Article info
Publication history
Published online: January 21, 2023
Publication stage
In Press Corrected ProofFootnotes
Funding: Supported in part by a Stanley D. Tylman Research Grant from the American Academy of Fixed Prosthodontics and Department of Restorative and Prosthetic Dentistry, The Ohio State University.
Identification
Copyright
© 2022 by the Editorial Council for the Journal of Prosthetic Dentistry.
