Influence of planning software and template design on the accuracy of static computer assisted implant surgery performed using guides fabricated with material extrusion technology: An in vitro study

Computer-aided design (CAD) softwares allow implant planning based on prospective reconstruction. This approach, known as "backward planning", is essential for implant-supported rehabilitations to achieve successful esthetics and function and to avoid complications [1].

For virtual planning, three-dimensional (3D) radiographic images in digital imaging and communications in medicine (DICOM) format are merged with intraoral surface data, usually used as open-format standard tessellation language (STL) files [2]. Implant planning software is used to align the DICOM and STL files in a procedure called registration [3,4]. Furthermore, discrepancies between the final and planned implant positions are derived from an accumulation of errors during the entire digital workflow [5,6], including data acquisition and management [7,8] and registration [4].

After virtual positioning of the implant, the surgical guide is designed and exported for computer-aided manufacturing (CAM). The most adapted additive manufacturing (AM) technique is Vat-polymerisation [9]. However, extensive post-processing procedures, including alcohol washes, air drying, and light curing, are required [10,11]. A simplified and more economical 3D printing technology is Material Extrusion (ME), also known as Fused Filament Fabrication (FFF) or Fused Deposition Modelling (FDM) [12,13]. The advantages of ME include the possibility of using different materials and requirement of minimal postprocessing steps [14].

ME-based surgical guides are being increasingly investigated in terms of reproducibility [15] and accuracy of implant installation in vitro [16,17] and clinically [18]. However, data from studies directly comparing workflows with multiple planning systems or alternative surgical guide designs in terms of the accuracy of implant installation are scarce.

The design of the surgical guides, which is determined by the planning software, is not uniform and is largely determined by the workflow. Previous studies have shown that the number of teeth used for placement has a significant impact on the accuracy of static computer assisted implant surgery (sCAIS) [19]. The type and size of the support could also influence the accuracy of the sCAIS, especially when considering new manufacturing techniques such as ME.

This study aimed to assess whether two variables, implant planning software and surgical guide design, can affect the accuracy, intended as trueness and precision, of implant installation using ME-based surgical guides. The null hypothesis assumes no significant influence of either of the evaluated variables.

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