Objective: The purpose of this study was to evaluate the accuracy of surgical guides for dental implant placement fabricated by additive and subtractive techniques.
Methods: A standardized mandible model (BoneModels, Castellón, Spain) was duplicated and the proposed implant position was performed from a diagnostic wax-up. An implant was placed in the printed model as a reference. Cone beam computed tomography (CBCT) was made with the radiographic surgical guide to design a surgical guide on BlueSky Plan 4 software. The .stl file of the surgical guide was exported and fabricated by two different techniques: additive (3D printing) and subtractive (milling). Fifteen surgical guides per group were used to place implants in the printed models. The angular deviations, differences in depth, coronal and apical deviations were measured using GeoMagic Control X software. Results were analyzed by Wilcoxon-Mann-Whitney (Wilcoxon Rank Sum) test and PERMANOVA (Permutational Multivariate Analysis of Variance). Intraclass correlation was used to analyze the reproducibility. A 0.05 level of significance was used, with Bonferroni multiple adjustment as needed.
Results: There were no significant differences in accuracy of implant placement using additive technique vs subtractive techniques. The mean angular deviations between planned and actual position of implant in mesio-distal cross-section were 0.780±0.803 degrees for printed group and 0.772±0.724 degrees for the milled group. The analogous results in bucco-lingual cross-section were 1.601±1.223 degrees in in printed group and 1.767±0.762 degrees in the milled group. The differences in depth (mm) were measured in four aspects including mesial, distal, buccal and lingual. The mean differences in depth in the group that using printed surgical guides were 0.373±0.285 mm, 0.325±0.230 mm, 0.240±0.228 mm, and 0.247±0.168 mm in those 4 aspects, respectively. The mean differences in depth in the group that using milled surgical guides were 0.511±0.326 mm, 0.396±0.316 mm, 0.215±0.230 mm, and 0.230±0.122 mm in those four aspects, respectively. The mean coronal deviation showed 0.32 mm in the printed group and 0.27 mm in the milled group. For the apical deviation, the results of this study showed mean apical deviation 0.84 mm in the printed group and 0.80 mm in the milled group.
Conclusions: No statistically significant difference was identified between the position of implant placed using surgical guide fabricated by the additive technique (3D printing) vs surgical guides fabricated by subtractive technique (milling). The 3D-printed surgical guide could be an alternative for guided-implant surgery with the benefits of high accuracy, ease of fabrication and reduction of laboratory time and materials, thereby increasing cost-effectiveness.