Is there any change in accuracy of dental implant position during guided surgery with 3D Printed and Milled surgical stent while placing the dental implant
Satish narula@
How you will assess the three dimensional accuracy of stent while in mouth during surgery , which one is superior
the key consideration is accuracy of the stent. It is dependent form the scanning, to the software and to the CBCT and finally the 3D printing thickness and also teh milling accuracy . USually milling provides a more accurate outcome if all conditions are kept the same. however, milling is more costly compared to 3D printing and less portable. Nevertheless, if you have a good scanner, good software and a good printer, then a printed stent would suffice, and in turn keeping cost low.
From an accuracy standpoint there should not be much difference between the two. Of course there are technical factors that need to be considered with each approach and in the hands of some people one approach may be vastly superior to the other while another clinician might find just the opposite to be true.
If you are talking about the use of a surgical guide that you are going to convert to a full arch fixed provisional prosthesis then there is much more to talk about than accuracy, putting the implant predictably in the spot that you intended to place it, or precision, repeatedly being able to place something in the same position.
As soon as you start talking about the guide as a foundation for a conversion prosthesis then you start to consider factors of how securely a denture tooth is connected to the denture base and how strong the denture base itself will be.
Considering the conversion prosthesis, the milling approach will rarely be done whereby a receptacle is created for a prefabricated denture tooth and then chemically/mechanically connecting that denture tooth to the base. Milling Creates a solid structure with more material and, hence, more strength.
The downside to this is that you don't end up with a denture tooth which is probably more cosmetic but the upside to this is that you end up with a solid structure that has more bulk to it than if the denture tooth were to be added on as a secondary procedure and this bulk leads to much greater strength of the prosthesis and should result in a much lower breakage rate. Once again this is all predicated on the thought that you are converting the prosthesis on the day of tooth extraction and implant placement.
Risking making a generalization, if everything else is equal and we are just using the surgical guide to guide implant placement there really shouldn't be much difference between the two and it comes down to personal preference. You should be able to print something that is quite intricate and potentially might be slightly more accurate but this all depends upon the size and quality of the instrumentation he would use Regardless of which process you use.
I am using CBCT and Scanner from Sirona for planning. For 3D printing of Stent i use foam lab printer and for milling i am using milling machine from Sirona. But in most of the condition i find difficulty with milled stent compared with the printed one. I could not find the cause for this.
You mean, in your experience printed one are better and more predictable than milled ones?
Dear Shyam Kaji Maharjan,
The accuracy of the resulting implant determines the preferences most often. So I would focus my attention on making the print. Nowadays, using an oral scanner is an advantage and a relief for the dentist. The resulting 3D scanned model can be processed by adding the missing teeth to the cavity model. It can then be switched to fabrication using an additional technology - 3D printing of a metal or ceramic 3D prototype. Another classic approach by taking away - machining a metal or ceramic workpiece - could be accepted. Naturally, the durability of the implant received depends on the method of use and the method of production.
This is, of course, still being explored by researchers to this day.
Dear Amit Agrawal , in my experience Printing is better than Milling
In my experience the printed one is more easer in fabrication and don’t waste a lot of materials but in accuracy there is no difference between two types
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