[EO-27] Radiopaque marker impression and 3D Boolean operations for implant planning data alignment in the presence of computerized tomography artifacts: a digital workflow and accuracy evaluation
[Abstract]
[Objective]
This study aimed to introduce a new computer-assisted implant surgery (CAIS) technique for CBCT artifact cases, which could eliminate the production of radiographic templates, reduce patient visits and increase accuracy. The implant placement accuracy was compared among dynamic navigation (DN), double-scan method (DS), and this new technique radiopaque marker (RM).
[Method]
Digital workflow (Figure 1):
Step 1: Take an impression by the 3D-printed tray.
Step 2: Scan a CBCT for the patient with the impression.
Step 3: Scan another CBCT for the impression individually.
Step 4: Align 2 CBCT through radiopaque markers.
Step 5: 3D reconstructs for impression CBCT and inverse the virtual impression by 3D Boolean.
Step 6: Virtually remove the undercut, and finish implant planning.
Accuracy comparison (Figure 2):
Thirty 3D-printed models with an edentulous area of the left central incisor were randomly allocated to three CAIS techniques. After implant planning, 30 implants Active (Nobel Biocare, Sweden) were placed for DS and RM by surgical guides, and for DN by dynamic navigated X-Guide (Nobel Biocare, Sweden). The implant position was acquired by implant scan bodies and the desktop scanner. The deviations including implant apex, neck, depth, angulation, and 3D global deviation were measured and analyzed by One-way ANOVA and multiple comparisons with a significant level of 0.05.
[Result and Discussion]
DN had lower 3D global deviations than DS (p = 0.022), and lower angular deviations than DS (p = 0.003) and RM (p = 0.002). RM exhibited lower depth deviations than DS (p = 0.001) and DN (p = 0.027), and lower neck deviations than DN (p = 0.005). Studies showed artifacts can reduce the accuracy of CAIS1. In this research, standard-shaped markers can reduce CAIS deviations at neck and depth, and dynamic navigation can control implant angulation better which shows the potential of zygomatic implantation in artifact cases.
[References]
1) Biun J, Dudhia R, Arora H. The influence of metal artifact reduction on the trueness of registration of a cone-beam computed tomography scan with an intraoral scan in the presence of severe restoration artifact. Journal of Prosthodontics, 2023.
[Objective]
This study aimed to introduce a new computer-assisted implant surgery (CAIS) technique for CBCT artifact cases, which could eliminate the production of radiographic templates, reduce patient visits and increase accuracy. The implant placement accuracy was compared among dynamic navigation (DN), double-scan method (DS), and this new technique radiopaque marker (RM).
[Method]
Digital workflow (Figure 1):
Step 1: Take an impression by the 3D-printed tray.
Step 2: Scan a CBCT for the patient with the impression.
Step 3: Scan another CBCT for the impression individually.
Step 4: Align 2 CBCT through radiopaque markers.
Step 5: 3D reconstructs for impression CBCT and inverse the virtual impression by 3D Boolean.
Step 6: Virtually remove the undercut, and finish implant planning.
Accuracy comparison (Figure 2):
Thirty 3D-printed models with an edentulous area of the left central incisor were randomly allocated to three CAIS techniques. After implant planning, 30 implants Active (Nobel Biocare, Sweden) were placed for DS and RM by surgical guides, and for DN by dynamic navigated X-Guide (Nobel Biocare, Sweden). The implant position was acquired by implant scan bodies and the desktop scanner. The deviations including implant apex, neck, depth, angulation, and 3D global deviation were measured and analyzed by One-way ANOVA and multiple comparisons with a significant level of 0.05.
[Result and Discussion]
DN had lower 3D global deviations than DS (p = 0.022), and lower angular deviations than DS (p = 0.003) and RM (p = 0.002). RM exhibited lower depth deviations than DS (p = 0.001) and DN (p = 0.027), and lower neck deviations than DN (p = 0.005). Studies showed artifacts can reduce the accuracy of CAIS1. In this research, standard-shaped markers can reduce CAIS deviations at neck and depth, and dynamic navigation can control implant angulation better which shows the potential of zygomatic implantation in artifact cases.
[References]
1) Biun J, Dudhia R, Arora H. The influence of metal artifact reduction on the trueness of registration of a cone-beam computed tomography scan with an intraoral scan in the presence of severe restoration artifact. Journal of Prosthodontics, 2023.