Accuracy and surgical feasibility of a CBCT‐based stereolithographic surgical guide aiding autotransplantation of teeth: in vitro validation

Abstract

The aims of this study were to determine the accuracy of a 3D computer model and stereolithographic (STL) replica when compared to the real tooth and to develop a cone beam computed tomography (CBCT)-based planning technique including surgical guide fabrication. A STL surgical guide and a tooth replica were fabricated using SimPlant Pro 12.1. To validate this process, tooth segmentation and replica design were prepared for comparison to an optical scan of the corresponding tooth. For surgical intervention, a dry dentate mandible was scanned using a Scanora CBCT and the donor tooth was segmented. The donor tooth was repositioned, and two guides were designed. These tooth replica and guides were used in socket preparation of the dry mandible. The 3D computer model of the segmented teeth and related STL models showed satisfactory results with an acceptable accuracy. The surfaces were within 0·25mm distance, but in some areas up to 2·5mm deviation were seen. The results showed that 79% of the points was between 0·25 and -0·25mm, 3% was overestimated (>0·25mm) and 18% was underestimated (<-0·25mm). The computer-based repositioning of the donor tooth and construction of tooth replica and guide allowed socket preparation before donor tooth extraction and optimization of the STL procedure for in vivo planning of CBCT-based autotransplantation.

Endodontic applications of 3D printing

“…In two early prospective studies at the Yonsei University College of Dentistry (Seoul, Korea), computer aided rapid prototyping (CARP) was used to print replicas of teeth such that manipulation of the recipient bone sites could be completed prior to extraction of the transplanted teeth without PDL damage from repeated insertion and removal (Lee et al 2001, Lee & Kim 2012. Numerous additional case reports, clinical studies and in vitro models provide evidence that preoperative CARP of transplant teeth decreases extra-oral time and improves outcomes (Honda et al 2010, Keightley et al 2010, Shahbazian et al 2010, 2012, Pang et al 2011, Park et al 2012, 2014, Cross et al 2013, Jang et al 2013, Lee et al Strbac et al (2016) described the autotransplantation of immature premolars in a maxillary incisor avulsion scenario using a completely digital workflow. The authors used CAD to select the appropriate donor teeth based on dimensions and stage of root development.…”

3-dimensional Analysis of Regenerative Endodontic Treatment Outcome

“…Moreover, volumetric measurements from CBCT data have been reported and validated in several studies in vitro and in vivo (13)(14)(15)(17)(18)(19)(20). The overall aim of this study was to develop a standardized quantitative method for the evaluation and analysis of the outcome of RET based on CBCT volumetric measurements.…”

Dental cone beam ct and its justified use in oral health care

“…Yet in complex maxillofacial and head trauma, the suspected presence of pre-surgical planning with transfer by stereolithographic surgical guidance. The final outcome of the autotransplantation may benefit from a significantly reduced extra-oral time, a more accurate recipient site preparation, and a better position of the donor tooth (35).…”

“…Finally, sometimes it is impossible to wait till adult age for replacing the particular tooth (eg esthetic demand in absence of upper lateral incisor), in that case a protocol for stereolithographic based tooth autotransplantation may be considered a valuable treatment option. Although the use and benefit of rapid prototyping models has already been documented (35), it is often claimed that a major drawback -especially in children -is the radiation burden. Yet when using a lowdose CBCT, with an exposure equivalent to 2 panoramic radiographs, approximating 1 day of background radiation, this drawback could be easily justified.…”