Customized surgical template fabrication under biomechanical consideration by integrating CBCT image, CAD system and finite element analysis

Abstract

This study developed a customized surgical template under mechanical consideration for molar intrusion. Two finite element (FE) models were analyzed for the primary stability under 100 gf traction forces with one mini-screw inserted at the buccal side in horizontal and another in palatal side with two optional positions at 60° (P60) or 15° (P15) angles with inclination toward the molar occlusal surface. The surgical template was generated using rapid prototyping (RP) printing for the clinical application based on improved primarily stability model. The surrounding bone strains for models P15 and P60 were far lower than the bone remodeling critical value. Model P60 presented much lower micro-motion in the screw/bone interface and the screw head displacement than those values in model P15. Using FE analysis for biomechanical evaluation and combining with CT image, image superimposed method and CAD technique can fabricate accuracy/security customized surgical template for mini-screws with better primary stability.

Multifunctional Templates for Minimized Osteotomy, Implantation, and Palatal Distraction with a Mini-Screw-Assisted Expander in Schizodontism and Maxillary Deficit

“…Even after transverse expansion with a conventional removable expansion plate and pulling of the attached upper first incisors against it, the plate would not have provided support due to the beginning of tooth change in the second mixed dentition. Mini-screw-assisted palatal expanders are supported with titanium [ 13 ], stainless steel [ 14 ], or orthodontic miniscrews, like the used bone-borne apparatus (IGPD). In addition, anchoring by implants offers the advantage that neither the setting of the incisors nor the palatal expansion is dependent on the compliance of the young patient.…”

Clinical effectiveness of orthodontic miniscrew implantation guided by a novel cone beam CT image-based computer aided design and computer aided manufacturing (CAD-CAM) template

“…Using 3D CT images combined with rapid prototyping and computer aided design and computer aided manufacturing (CAD-CAM) technology, another surgical guide has been applied in clinical practice for prosthetic implants in recent years. Some research also showed surgical guides for miniscrew implantation in orthodontic treatment could be made with the same method or process, and the implantation accuracy was increased (16)(17)(18)(19)(20). However, in the former research (16), the author found the design and production system to be mostly suitable for prosthetic implants, which were placed in the edentulous area, while orthodontic miniscrews are commonly placed in the buccal or palatal alveolar septum.…”

“…In addition, miniscrews are smaller and have a different shape to prosthetic implants, and the template of prosthetic implants has a larger volume and is more expensive. In some studies, spin-off slots on the insertion holes and guided cylinders were designed to remove surgical templates from patients (19,20), and while this solved the problem of removing the template after implantation, it could result in inadequate guidance during implantation. In our study, we improved the surgical template design and production system to make the computer design process simpler, and to make the guide more accurate and suitable for orthodontic miniscrew use.…”

Accuracy of Mini-Implant Placement Using a Computer-Aided Designed Surgical Guide, with Information of Intraoral Scan and the Use of a Cone-Beam CT

“…In order to combine information about the condition of the soft and hard tissue, others have used CBCT in addition to intraoral scans and scans of dental casts. Surgical guides have been designed on digital models created by merging Digital Imaging and Communications in Medicine (DICOM) and .stl files [ 24 , 25 , 26 , 27 ].…”