Accuracy of 3-dimensional computer-aided manufactured single-tooth implant definitive casts

The integration of the digital workflow into routine prosthodontic practice for single-tooth implant surgery and fixed prosthesis fabrication has occurred at a remarkable pace in the last 5 years. With the greater demands of esthetics and precision, the definitive implant analog cast must ensure accurate implant positioning as well as an accurate relationship to adjacent teeth.

The purpose of this in vitro study was to evaluate the accuracy of the 3-dimensional (3D) implant position of definitive casts produced by 3D printing and analog technology.

A master patient model was created from a dentate typodont. The maxillary left central incisor was removed, and a Straumann RC implant was positioned for a screw-retained prosthesis. A laboratory scanner with an accuracy of 5 μm was used for all scanning. A scanbody was connected to the master model implant and scanned to create a master patient file, which served as the control master patient for all comparisons. The two 3D printing systems used for this study were the Statasys Objet500 (group OBJ), an industrial Polyjet production system, and the Formlabs Formlab 2 (group FORM), a budget SLA Vat system. In addition, a conventional gypsum cast (group GYP) with an implant analog was made with elastomeric impression material. With a sample size of 10 per group, each gypsum cast and 2 printed group casts were scanned with the D2000 laboratory scanner 5 times per cast. Convince software (3Shape) was used for 3D analysis to calculate accuracy. The following variables were measured: implant analog vertical displacement, horizontal displacement of implant platform and apex, degree of tilting in the vertical axis, and rotational position change around the vertical axis. Means and standard deviations were calculated for trueness. One-way ANOVA and the post hoc t test with Bonferroni correction were used to investigate any significant differences among the experimental groups (α=.05).

For vertical displacement of the implant body, group OBJ had the lowest value of -30 ±24 μm. The values obtained for OBJ and FORM were significantly different from that obtained for GYP (P<.05). For horizontal displacement of the implant shoulder, Group OBJ had the lowest value, 85 ±12 μm, and the difference among these groups was significantly different (P<.05). The value for horizontal displacement of the implant apex was 123 ±25 μm for group OBJ and not significantly different from that obtained for group GYP (136 ±40 μm) but significantly different from that obtained for group FORM (326 ±54 µm). Also, the analysis of implant body tilting in the vertical axis showed significant differences between the values obtained for groups GYP and OBJ and between the values obtained for groups OBJ and FORM. With regard to implant rotational position change around the vertical axis, the values obtained for the gypsum cast and group FORM were not statistically different from those obtained for the master patient control model (P>.05). However, the implant orientation of group OBJ was significantly different from the orientation of groups GYP and FORM (P<.05). The actual clinical relevance of these printing system discrepancies is yet to be determined because the level of clinical acceptable discrepancy in the x, y, and z vectors is still undefined.

This study showed statistically significant differences in accuracy among the implant analog cast fabrication systems; however; the level of clinical acceptable discrepancy is still undefined. Although further research is needed, this study supports the conclusion that the Polyjet industrial printing system was more accurate than the conventional implant analog gypsum cast.