A Comparative Study on the Accuracy of Implant Placement Using 3D-Printed and Milled Guides Without Metal Sleeves

IF 3.7 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Clinical Implant Dentistry and Related Research Pub Date : 2025-06-27 DOI:10.1111/cid.70072

Juan Ballesteros, Solange Vásquez, Marta Revilla-León, Miguel Gómez-Polo

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Abstract

Purpose

The present study aims to evaluate whether differences in accuracy of the implant positions exist for static computer-aided implant placement based on the manufacturing process of surgical guides and the inclusion or not of metal sleeves.

Methods

Seventy-two implants (6 per model) were placed in 12 models simulating a partially edentulous maxilla using 12 dentally supported surgical guides anchored with 2 anchor pins. The surgical guides were divided into three groups: additive manufactured with a metal sleeve (Group PS), additive manufactured without a metal sleeve (Group PNS), and subtractive manufactured without a metal sleeve (Group MNS). The internal drilling diameter was standardized for all groups (4.85 mm). Deviations between the planned virtual implant positions and the scanned postoperative models were assessed in three parameters: 3D deviations at the crest, 3D deviations at the apex, and angular deviations in the implant insertion axis. The Shapiro–Wilk test was applied to analyze the normality of the sample distribution. Kruskal–Wallis and Mann–Whitney tests were used to analyze the deviations among the groups (α = 0.05).

Results

Statistical differences were reported among the groups in the parameters: 3D deviations at the crest, 3D deviations at the apex, and angular deviations in the implant insertion axis (p < 0.05). At the crest, the smallest 3D deviation was recorded in the MNS group (0.498 ± 0.337 mm) followed by the PNS group (0.660 ± 0.572 mm) and the PS group (1.028 ± 0.424 mm) (p < 0.05). At the apex, as well, the lowest deviation was observed in the MNS group (0.810 ± 0.544 mm) followed by the PNS group (0.840 ± 0.620) and the PS group (1.360 ± 0.990 mm) (p < 0.05). Regarding angular deviations, the best results were obtained by the PNS group (1.44° ± 1.57°) with statistically significant differences with both the MNS group (2.90° ± 2.35°) and the PS group (3.88° ± 2.85°) (p < 0.05).

Conclusions

The accuracy of the implant position was affected by the inclusion or absence of metal sleeves and the manufacturing method. Overall, non-sleeved guides deliver better accuracy by reducing crestal and apical deviations, as well as angular errors. Differences between the groups without metal sleeves, 3D printed and milled, were found in the implant angulation, where the 3D printed group obtained more accurate results.

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3d打印与无金属套管铣削导轨种植体植入精度的比较研究

目的本研究旨在评估在静态计算机辅助种植体植入中，是否存在基于手术导尿管制造工艺和是否包含金属套管的种植体位置准确性差异。方法采用12根牙支撑导板，2根锚钉固定，将72颗种植体（每个模型6颗）植入12个模拟部分无牙颌模型中。手术指南分为三组：带金属套管的增材制造组（PS组）、不带金属套管的增材制造组（PNS组）和不带金属套管的减法制造组（MNS组）。各组内钻孔直径均标准化（4.85 mm）。通过三个参数评估计划的虚拟种植体位置与扫描的术后模型之间的偏差：嵴的3D偏差，顶点的3D偏差和种植体插入轴的角度偏差。采用Shapiro-Wilk检验分析样本分布的正态性。采用Kruskal-Wallis检验和Mann-Whitney检验分析组间差异（α = 0.05）。结果两组间牙冠三维偏差、牙尖三维偏差、种植体插入轴角度偏差均有统计学差异（p < 0.05）。在峰值处，MNS组三维偏移最小（0.498±0.337 mm），其次是PNS组（0.660±0.572 mm）和PS组（1.028±0.424 mm）（p < 0.05）。在尖部，MNS组的偏差最小（0.810±0.544 mm），其次是PNS组（0.840±0.620）和PS组（1.360±0.990 mm）（p < 0.05）。角度偏差方面，PNS组效果最佳（1.44°±1.57°），与MNS组（2.90°±2.35°）、PS组（3.88°±2.85°）差异有统计学意义（p < 0.05）。结论金属套的植入与否及制作方法影响种植体定位的准确性。总的来说，无套导轨通过减少顶点和顶点偏差以及角度误差来提供更好的精度。无金属套管组、3D打印组和铣削组在种植体角度上存在差异，其中3D打印组获得的结果更准确。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Implant Dentistry and Related Research 医学-牙科与口腔外科

CiteScore

6.00

自引率

13.90%

发文量

103

审稿时长

4-8 weeks

期刊介绍： The goal of Clinical Implant Dentistry and Related Research is to advance the scientific and technical aspects relating to dental implants and related scientific subjects. Dissemination of new and evolving information related to dental implants and the related science is the primary goal of our journal. The range of topics covered by the journals will include but be not limited to: New scientific developments relating to bone Implant surfaces and their relationship to the surrounding tissues Computer aided implant designs Computer aided prosthetic designs Immediate implant loading Immediate implant placement Materials relating to bone induction and conduction New surgical methods relating to implant placement New materials and methods relating to implant restorations Methods for determining implant stability A primary focus of the journal is publication of evidenced based articles evaluating to new dental implants, techniques and multicenter studies evaluating these treatments. In addition basic science research relating to wound healing and osseointegration will be an important focus for the journal.