Stereolithographic Surgical Templates for Placement of Dental Implants in Maxilla

Objective: Recently, novel CAD/CAM techniques of stereolithographic rapid prototyping have been developed to build surgical guides in an attempt to improve precision of implant placement. The purpose of this study was to compare the accuracy of a bone-borne stereolithographic surgical guide to that of a tooth-bone-borne surgical guide. Materials and Methods: CT scanning of partial edentulous maxilla were performed for 4 patients using a CT scanner with high isotropic spatial resolution (Philip Brilliance 64). The planning for 4 implants on lateral distal extension edentulous areas in 4 patients was performed using a new developed interactive software system. One surgeon performed osteotomies on the maxilla of all patients; bone-borne surgical templates were used for two of the patients, and tooth-bone-borne surgical guides were used for remaining two patients. Each maxilla was then CT scanned, and a registration method was applied to match it to the initial planning. Measurements included distance between planned implants and actual osteotmies. Results: The results indicated a nearly perfect match and stable between the tooth-bone-born templates and receptor sites. The average distances between planned implants and the actual osteotomy was 0.8mm at the entrance and 1.1mm at the apex when the bone-borne guide was used. The same measurements were reduced to 0.6mm and 0.9mm when the tooth-bone-borne guide was used. Conclusions: This novel approach may be advantageous once available in dental offices. Based on the presurgical planning transferred to the surgical reality with tooth-bone-borne stereolithographic template, the cases can then be completed with complete confidence. Resulting clinical benefits over only bone-borne surgical templates are discussed.