J Korean Assoc Oral Maxillofac Surg.  2010 Oct;36(5):402-407.

Implant surgery based on computer simulation surgical stent and the assessment with the image fusion technique

• Lee JH
• Kim SM
• Paeng JY
• Kim MJ

Abstract

INTRODUCTION
The planning of implant surgery is an important factor for the implant prosthesis. Stereolithographic (SLA) surgical stents based on a computer simulation are quite helpful for clinicians to perform the surgery as planned. Although many clinical and technical trials have been performed for computed tomography (CT)-guided implant stents to improve the surgical procedures and prosthetic treatment, there are still many problems to solve. We developed a system of a surgical guide based on 3 dimensional (3D) CT for implant therapy and achieved satisfactory results in the terms of planning and operation.
MATERIALS AND METHODS
Fifteen patients were selected and 30 implant fixtures were installed. The preoperative CT data for surgical planning were prepared after obtaining informed consent. Surgical planning was performed using the simulation program, Ondemend3D In2Guide. The stents were fabricated based on the simulation data containing information of the residual bone, the location of the nerve, and the expected design of the prostheses. After surgery with these customized stents, the accuracy and reproducibility of implant surgery were evaluated based on the computer simulation. The data of postoperative CT were used to confirm this system using the image fusion technique and compare the implant fixtures between the planned and implanted.
RESULTS
The mean error was 1.18 (+/-0.73) mm at the occlusal center, 1.23 (+/-0.67) mm at the apical center, and the axis error between the two fixtures was 3.25degrees (+/-3.00). These stents showed superior accuracy in maxilla cases. The lateral side error at the apical center was significantly different from the error at the occlusal center but there were no significant differences between the premolars, 1st molars and 2nd molars.
CONCLUSION
SLA surgical stents based on a computer simulation have the satisfactory accuracy and are expected to be useful for accurate planning and surgery if some errors can be improved.

Keyword

Stereolithographic (SLA) surgical stents; Computer simulation; Image fusion

MeSH Terms

Axis, Cervical Vertebra
Bicuspid
Computer Simulation
Humans
Informed Consent
Maxilla
Molar
Prostheses and Implants
Stents

Figure

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  Fig. 1. The implant surgery simulation on the computer software.

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  Fig. 2. Fabrication of the stereolithographic (SLA) surgical guide based on the computer simulation. A. Virtual SLA surgical stent on the computer program. B. Real SLA surgical stent made by rapid prototyping technique with metal sleeve for drill guide and implant fixture.

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  Fig. 3. Quick Guide system – surgical kit for the sequential drilling.

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  Fig. 4. Implant site preparation by the guidance of stereolithographic (SLA) surgical stent. A. Sequential drilling through the metal sleeve. B. Guiding of metal sleeve for the fixture insertion.

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  Fig. 5. Image fusion processing for the comparison of implant positions between the planned and the placed.

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  Fig. 6. The result of image fusion of two implants. A. Occlusal difference of fixture center (mm). B. Apical difference of fixture center (mm). C. Axis difference of implant fixtures (�).

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  Fig. 7. The disassembling of errors into the two directions between two implant fixtures. A(A´). Lateral error of the occlusal (apical) center. B(B´). Vertical error of the occlusal (apical) center.

Reference

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