Steam-sterilized and degradable fused filament fabrication-printed polylactide/ polyhydroxyalkanoate surgical guides for dental implants: Are they accurate enough for static navigation?
Three-dimensional (3D) printing is a rapidly evolving field and has gained increasing importance in the medical sector. However, the increasing usage of printing materials is accompanied by more wastages. With a rising awareness of the environmental impact of the medical sector, the development of highly accurate and biodegradable materials is of great interest. This study aims to compare the accuracy of polylactide/polyhydroxyalkanoate (PLA/PHA) surgical guides printed by fused filament fabrication and material jetted guides of MED610 in fully guided dental implant placement before and after steam sterilization. Five guides were tested in this study and each was either printed with PLA/PHA or MED610 and either steam-sterilized or not. After implant insertion in a 3D-printed upper jaw model, the divergence between planned and achieved implant position was calculated by digital superimposition. Angular deviation and 3D deviation at the base and the apex were determined. Non-sterilized PLA/PHA guides showed an angle deviation of 0.38 ± 0.53° compared to 2.88 ± 0.75° in sterile guides (P > 0.001), an offset of 0.49 ± 0.21 mm and 0.94 ± 0.23 mm (P < 0.05), and an offset at the apex of 0.50 ± 0.23 mm before and 1.04 ± 0.19 mm after steam sterilization (P < 0.025). No statistically significant difference could be shown for angle deviation or 3D offset at both locations for guides printed with MED610. PLA/PHA printing material showed significant deviations in angle and 3D accuracy after sterilization. However, the reached accuracy level is comparable to levels reached with materials already used in clinical routine and therefore, PLA/PHA surgical guide is a convenient and green alternative.
1. Gibson I, David R, Stucker B, 2015, Additive Manufacturing Technologies: 3D Printing, Rapid Prototyping, and Direct Digital Manufacturing. Berlin: Springer. https://doi.org/10.1007/978-1-4939-2113-3
2. Goetze E, Gielisch M, Moergel M, et al., 2017, Accelerated workflow for primary jaw reconstruction with microvascular fibula graft. 3D Print Med, 3: 3. https://doi.org/10.1186/s41205-017-0010-7
3. Goetze E, Kämmerer PW, Al-Nawas B, et al., 2020, Integration of perforator vessels in CAD/CAM free fibula graft planning: A clinical feasibility study. J Maxillofac Oral Surg, 19: 61–66. https://doi.org/10.1007/s12663-019-01215-y
4. Goetze E, Thiem DG, Gielisch M, et al., 2020, Digitalization and use of artificial intelligence in microvascular reconstructive facial surgery. Chirurg, 91: 216–221. https://doi.org/10.1007/s00104-019-01103-8
5. Hatz CR, Msallem B, Aghlmandi S, et al., 2020, Can an entry-level 3D printer create high-quality anatomical models? Accuracy assessment of mandibular models printed by a desktop 3D printer and a professional device. Int J Oral Maxillofac Surg, 49: 143–148. https://doi.org/10.1016/j.ijom.2019.03.962
6. Hanisch M, Kroeger E, Dekiff M, et al., 2020, 3D-printed surgical training model based on real patient situations for dental education. Int J Environ Res Public Health, 17: 2901. https://doi.org/10.3390/ijerph17082901
7. Dimitroulis G, Austin S, Sin Lee PV, et al., 2018, A new three-dimensional, print-on-demand temporomandibular prosthetic total joint replacement system: Preliminary outcomes. J Craniomaxillofac Surg, 46: 1192–1198. https://doi.org/10.1016/j.jcms.2018.05.028
8. Kammerer PW, Muller D, Linz F, et al., 2021, Patient-specific 3D-printed cutting guides for high oblique sagittal osteotomy-an innovative surgical technique for nerve preservation in orthognathic surgery. J Surg Case Rep, 2021: rjab345. https://doi.org/10.1093/jscr/rjab345
9. Pietzka S, Mascha F, Winter K, et al., 2020, Clinical accuracy of 3D-planned maxillary positioning using CAD/ CAM-generated splints in combination with temporary mandibular fixation in bimaxillary orthognathic surgery. Craniomaxillofac Trauma Reconstr, 13: 290–299. https://doi.org/10.1177/1943387520949348
10. Thiem DG, Al-Nawas B, Kammerer PW, 2020, Ankylosis of the temporomandibular joint-impression free CAD/CAM based joint replacement using patient-specific implants. J Surg Case Rep, 2020: rjaa416. https://doi.org/10.1093/jscr/rjaa416
11. Kunrath MF, 2020, Customized dental implants: Manufacturing processes, topography, osseointegration and future perspectives of 3D fabricated implants. Bioprinting, 20: e00107. https://doi.org/10.1016/j.bprint.2020.e00107
12. Azlin MN, Ilyas RA, Zuhri MY, et al., 2022, 3D Printing and shaping polymers, composites, and nanocomposites: A review. Polymers (Basel), 14: 180. https://doi.org/10.3390/polym14010180
13. Naser AZ, Deiab I, Defersha F, et al., 2021, Expanding poly(lactic acid) (PLA) and polyhydroxyalkanoates (PHAs) applications: A review on modifications and effects. Polymers (Basel), 13: 4271. https://doi.org/10.3390/polym13234271
14. Sathya AB, Sivasubramanian V, Santhiagu A, et al., 2018, Production of polyhydroxyalkanoates from renewable sources using bacteria. J Polym Environ, 26: 3995–4012. https://doi.org/10.1007/s10924-018-1259-7
15. Patti A, Acierno D, 2022, Towards the sustainability of the plastic industry through biopolymers: Properties and potential applications to the textiles World. Polymers (Basel), 14: 692. https://doi.org/10.3390/polym14040692
16. Voet VS, Guit J, Loos K, 2021, Sustainable photopolymers in 3D printing: A review on biobased, biodegradable, and recyclable alternatives. Macromol Rapid Commun, 42: 2000475. https://doi.org/0.1002/marc.202000475
17. Ng WL, Lee JM, Zhou M, et al., 2020, Vat polymerization-based bioprinting-process, materials, applications and regulatory challenges. Biofabrication, 12: 022001. https://doi.org/10.1088/1758-5090/ab6034
18. Moreno E, González FR, Arrieta M, et al., 2020, Technical evaluation of mechanical recycling of PLA 3D Printing Wastes. Proceedings, 69: 19. https://doi.org/10.3390/CGPM2020-07187
19. Anderson I, 2017, Mechanical properties of specimens 3D printed with virgin and recycled polylactic acid. 3D Print Addit Manuf, 4: 110–115. https://doi.org/10.1089/3dp.2016.0054
20. Pieralli S, Spies BC, Hromadnik V, et al., 2020, How accurate is oral implant installation using surgical guides printed from a degradable and steam-sterilized biopolymer? J Clin Med, 9: 2322. https://doi.org/10.3390/jcm9082322
21. Elliott T, Hamilton A, Griseto N, et al., 2022, Additively manufactured surgical implant guides: A review. J Prosthodont, 31: 38–46. https://doi.org/10.1111/jopr.13476
22. Chen L, Lin WS, Polido WD, et al., 2019, Accuracy, reproducibility, and dimensional stability of additively manufactured surgical templates. J Prosthet Dent, 122: 309–314.
https://doi.org/10.1016/j.prosdent.2019.02.007
23. Marei HF, Alshaia A, Alarifi S, et al., 2019, Effect of steam heat sterilization on the accuracy of 3D printed surgical guides. Implant Dent, 28: 372–377. https://doi.org/10.1097/ID.0000000000000908
24. Török G, Gombocz P, Bognár E, et al., 2020, Effects of disinfection and sterilization on the dimensional changes and mechanical properties of 3D printed surgical guides for implant therapy- pilot study. BMC Oral Health, 20: 19.https://doi.org/10.1186/s12903-020-1005-0
25. Matheus DM, Gomes EA, Barcellos DC, et al., 2021, Linear dimensional accuracy of stereolithographic surgical guide after chemistry and physics sterilization. J Stomatol Oral Maxillofac Surg, 123: 510–513. https://doi.org/10.1016/j.jormas.2021.11.006
26. Herschdorfer L, Negreiros WM, Gallucci GO, et al., 2021, Comparison of the accuracy of implants placed with CAD-CAM surgical templates manufactured with various 3D printers: An in vitro study. J Prosthet Dent, 125: 905–910. https://doi.org/10.1016/j.prosdent.2020.03.017
27. Sun Y, Ding Q, Tang L, et al., 2019, Accuracy of a chairside fused deposition modeling 3D-printed single-tooth surgical template for implant placement: An in vitro comparison with a light cured template. J Craniomaxillofac Surg, 47: 1216–1221. https://doi.org/10.1016/j.jcms.2019.03.019
28. Skjerven H, Riis UH, Herlofsson BB, et al., 2019, In vivo accuracy of implant placement using a full digital planning modality and stereolithographic guides. Int J Oral Maxillofac Implants, 34: 124–132. https://doi.org/10.11607/jomi.6939
29. Derksen W, Wismeijer D, Flügge T, et al., 2019, The accuracy of computer-guided implant surgery with tooth-supported, digitally designed drill guides based on CBCT and intraoral scanning. A prospective cohort study. Clin Oral Implants Res, 30: 1005–1015. https://doi.org/10.1111/clr.13514
30. Gjelvold B, Mahmood DJ, Wennerberg A, 2019, Accuracy of surgical guides from 2 different desktop 3D printers for computed tomography-guided surgery. J Prosthet Dent, 121: 498–503. https://doi.org/10.1016/j.prosdent.2018.08.009
31. Turbush SK, Turkyilmaz I, 2012, Accuracy of three different types of stereolithographic surgical guide in implant placement: An in vitro study. J Prosthet Dent, 108: 181–188. https://doi.org/10.1016/S0022-3913(12)60145-0
32. Widmann G, Berggren JP, Fischer B, et al., 2015, Accuracy of image-fusion stereolithographic guides: Mapping CT data with three-dimensional optical surface scanning. Clin Implant Dent Relat Res, 17 Suppl 2: e736–e744. https://doi.org/10.1111/cid.12313
33. Sommacal B, Savic M, Filippi A, et al., 2018, Evaluation of two 3D printers for guided implant surgery. Int J Oral Maxillofac Implants, 33: 743–746. https://doi.org/10.11607/jomi.6074
34. Tallarico M, Lumbau AI, Park CJ, et al., 2021, In vitro evaluation of bioburden, three-dimensional stability, and accuracy of surgical templates without metallic sleeves after routinely infection control activities. Clin Implant Dent Relat Res, 23(3): 380–387. https://doi.org/10.1111/cid.12986
35. Bover-Ramos F, Viña-Almunia J, Cervera-Ballester J, et al., 2018, Accuracy of implant placement with computer-guided surgery: A systematic review and meta-analysis comparing cadaver, clinical, and in vitro studies. Int J Oral Maxillofac Implants, 33: 101–115. https://doi.org/10.11607/jomi.5556
36. El Kholy K, Janner SM, Schimmel M, et al., 2019, The influence of guided sleeve height, drilling distance, and drilling key length on the accuracy of static Computer-assisted implant surgery. Clin Implant Dent Relat Res, 21(1): 101–107. https://doi.org/10.1111/cid.12705