In recent years, the field of oral and maxillofacial surgery has witnessed a remarkable transformation resulting from advances in additive manufacturing. Better known as “3 dimensional (3D) printing,” this technology offers unprecedented precision and customization in implant treatment procedures. This technology has allowed providers to efficiently fabricate highly accurate dental models, surgical guides, and prosthetic components. The 3D printing in dental surgery has paved the way for more personalized and efficient full-arch implant treatment. Moreover, the ability to iterate designs quickly allows for rapid prototyping and adjustments based on patient-specific anatomic variations and preferences.
Key points
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This article explains the fundamentals of 3 dimensional (3D) printing in context of implant dentistry.
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This article tracks the evolution of 3D printing within the dental field and identifies its applications within full-arch implant surgery and immediate loading.
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This article discusses the accuracy and precision of 3D printing applications.
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This article with review associated challenges and future directions of 3D printing for full-arch dental rehabilitation.
Introduction
In recent years, the field of oral and maxillofacial surgery has witnessed a remarkable transformation resulting from advances in additive manufacturing. Better known as “3 dimensional (3D) printing,” this technology offers unprecedented precision and customization in implant treatment procedures. This technology has allowed providers to efficiently fabricate highly accurate dental models, surgical guides, and prosthetic components. 3D printing in dental surgery has paved the way for more personalized and efficient full-arch implant treatment. Moreover, the ability to iterate designs quickly allows for rapid prototyping and adjustments based on patient-specific anatomic variations and preferences. This not only improves treatment outcomes but also reduces surgical time and enhances patient comfort during procedures.
3D printing in full-arch implant dentistry has proven to be a pivotal advancement in fully digital treatment workflows by decreasing the amount of time from data acquisition to delivery of the immediate-load prosthesis. Currently, there are very few clinical trials and no long-term clinical studies involving 3D-printed products in clinical dentistry. However, there are many applications for 3D printing that are Food and Drug Administration (FDA) approved and abide by ISO standards, including dental casts, surgical guides, and provisional restorations. These applications are not to be discounted, as they are highly accurate, precise, cost-effective, and efficient from a planning and execution standpoint.
This study aims to explain the fundamentals of 3D printing, its evolution, and applications in full-arch implant surgery and immediate loading. It explores the various applications of 3D printing in preoperative planning, surgical interventions, and the integration of digital technologies. Included within are case studies illustrating its applications in surgical interventions, demonstrating how it improves outcomes with superior precision and accuracy. Challenges and future directions in 3D printing will also be identified throughout this text.
Fundamentals of 3 dimensional printing in oral maxillofacial surgery and full-arch implant dentistry
Innovations with additive manufacturing (3D printing) have revolutionized the way surgeons can plan and execute complex procedures, particularly in the realm of full-arch implant dentistry. 3D printing involves the creation of 3D objects by layering materials based on digital designs. This technology has opened new possibilities for patient-specific treatments, enhanced precision, and improved surgical outcomes.
The most common forms of 3D printing in dental clinics and dental laboratories are stereolithography (SLA) and digital light processing (DLP). Both technologies utilize photopolymerization to create 3D objects, but they differ in the light source and curing processes involved. Both printing methods also require post-processing steps after printing, including a solvent rinse to remove any uncured resin and a post-print cure under ultraviolet light to achieve optimal mechanical properties.
In SLA 3D printing, a laser beam is used to trace the cross-section of the object on the surface of the photopolymer resin. The laser selectively hardens the resin in the desired pattern, creating a solid layer ( Fig. 1 ). The build platform then lowers by a small increment, typically around 25 to 100 microns. The process then repeats, with the laser tracing the next cross-section on top of the previous layer. This layer-by-layer approach continues until the entire object is built. SLA is known for its high accuracy, smooth surface finish, and ability to produce intricate details.
DLP 3D printing uses a digital projector screen to flash a single image of each layer across the entire surface of the photopolymer resin. A projector screen displays the cross-section of the object, and the exposed resin hardens in a single layer (see Fig. 1 ). The build platform then moves upward, and the process repeats for the next layer. DLP printing is generally faster than SLA because it cures an entire layer at once rather than tracing it with a laser. It also offers good resolution and can handle larger build volumes compared to SLA. DLP can also achieve high precision, making it suitable for dental models and restorations. Both SLA and DLP are used in dentistry depending on the specific requirements of the application, such as the level of detail, speed, and material properties.
The application of 3D printing in oral surgery and full-arch implant dentistry has gained significant traction due to its ability to address challenges faced by surgeons, restorative dentists, and patients. By leveraging the power of digital imaging, computer-aided design (CAD), and 3D printing, providers can now create highly accurate anatomic models, surgical guides, and customized restorative designs tailored to each patient’s specific needs. This level of personalization not only enhances the predictability and success of surgical interventions but also improves patient satisfaction and quality of life.
One of the greatest benefits of implementing 3D printing in full-arch implant dentistry is the ability to streamline diagnostics, planning, and manufacturing by minimizing inaccuracies intrinsic to conventional approaches. Currently, most 3D printers have highly precise projector resolutions allowing them to produce layer thicknesses that provide repeatable, sufficiently accurate outcomes in a clinical setting. It is worth noting that other components associated with printers and their associated parts can have an effect on the accuracy of the final object, but these will not be discussed in detail at this time.
The 3D printing process, itself, can be time-consuming, particularly for complex or large-scale objects. Although DLP is generally faster than SLA, both technologies require careful preparation, printing, and post-processing steps. The time required for printing and post-processing can vary depending on the size and complexity of the object, ranging from several minutes to hours. The choice of software, hardware, and resins used can also have an effect on the processing time. These factors can impact the overall efficiency and turnaround time for surgical planning and treatment; however, these shortcomings are mitigated with ongoing technological improvements.
The larger the object, the more material is required to be cured layer by layer, which inherently extends the print time. For example, printing a 3 unit bridge should take only 10 to 20 minutes; whereas printing a full arch or a surgical model could take 60 to 100 minutes. More complex designs with intricate details, undercuts, or internal structures require finer resolution and more precise printing, all of which increase the time. Complex designs such as large models will also require more layers of deposited resin that also slows down the process. There are some current techniques to decrease printing time for highly detailed appliances. A common example is the incorporation of support beams placed prior to printing. The function of these supports is 2 fold; they prevent object deformation if the angle of an overhang is greater than 45° from vertical and reduces both printing and post-processing times.
High-resolution printers are more suitable for FP1-FP3 cases as they produce finer details, which allows for improved esthetics at the cost of longer printing times. Printers with lower resolution are faster and well suited for applications requiring less precision like surgical models, nightguards, and surgical guides. Several manufactures provide larger build plates, which efficiently allow for printing multiple objects simultaneously, but it might also mean a longer total print time if multiple objects are printed at once.
Applications of 3 dimensional printing in preoperative planning
The ability to efficiently print accurate replicas of 3D imaged data has provided multiple benefits in the full-arch implant surgery and restoration workflow, patient communication being paramount. 3D printing can also create tangible communication tools for the surgical team, fostering better understanding and collaboration. It is also used to educate and inform patients about their condition and the proposed treatment plan, enhancing patient engagement and informed consent ( Fig. 2 ).
Prosthetically Driven Full-Arch Implant Planning
In full-arch implant dentistry, establishing the correct vertical dimension and tooth positioning relative to the jaw is crucial for achieving optimal functional and esthetic outcomes. Conventional methods, such as wax rims and diagnostic setups, can be time-consuming and may not provide a precise representation of the final prosthetic outcome. 3D printing streamlines processes involved in determining functional jaw relationships and esthetics by enabling faster turnaround times and reducing the number of patient visits.
By integrating CAD, clinicians can create accurate and customized diagnostic designs and products, such as interim complete dentures or teeth-try-ins, that simulate the desired vertical dimension and tooth positioning. The process begins with capturing digital impressions of the patient’s existing dentition, jaw relationship, and surrounding soft tissues using intraoral scanners. Combined with extraoral photography and/or facial scanning, these digital setups provide a comprehensive 3D representation of the patient’s initial presentation. This design process also allows adjustments to the vertical dimension, considering factors such as the patient’s facial proportions, phonetics, and esthetic preferences.
Once the desired vertical dimension is established, the clinician can digitally position the prosthetic teeth in relation to the jaw and implant positions. This virtual setup enables the clinician to assess functional and esthetic aspects of the proposed restoration, including occlusal relationships, arch form, and tooth alignment. The digital design can be refined through printed try-ins and subsequent recollection of intraoral and extraoral data allowing the creation of multiple iterations until the optimal configuration is achieved. The finalized digital design is then saved for use in surgical treatment planning and the immediate-load prosthesis. This approach improves the accuracy, efficiency, and predictability of the treatment process, ultimately leading to better patient care and outcomes ( Fig. 3 ).
Anatomic Modeling and Surgical Simulations
The process of creating patient-specific anatomic models begins with the acquisition of high-resolution medical imaging data, such as computed tomography or cone-beam computed tomographic scans. Imaging data are then processed using specialized software that segments and isolates the relevant anatomic structures into DICOM or STL format files. These files are then modified in printer-specific software that utilizes algorithms and artificial intelligence to produce a printable 3D product. The resultant printed model provides a tactile and visual representation of the patient’s unique anatomy, enabling surgeons to better comprehend spatial relationships, anomalies, or pathologies that may not be easily appreciated on 2 dimensional imaging or in software-based visualization alone.
Once the digital model is created, it can be further manipulated, and custom adjustments can be made based on the specific needs related to the surgical case. This may involve virtual planning, where the surgeon can practice implant positioning or osseous reductions. This allows the identification of osseous landmarks and anticipation of potential challenges before the actual surgery ( Figs. 4 and 5 ).
Three dimensional printing in surgical interventions
An accurate guide should have intimate contact with the dental arch, with no gaps or rocking while allowing clear visualization. The fit of a 3D-printed surgical guide is influenced by factors such as the accuracy of the digital impression, the design of the guide, and the post-processing procedures. The guide should allow for verification of bone leveling, multiunit abutment positioning during surgery leading to precise implant placement, improved surgical efficiency, and a predictable outcome.
The accuracy of 3D-printed surgical guides is influenced by several factors, including the resolution of the 3D printer, the quality of the digital design (SLA offers higher quality surface finish), and the properties of the resin used as well as appropriate post-processing steps taken.
Integration of 3 dimensional printing with digital technologies in full-arch implant dentistry
The All-on-X treatment concept has revolutionized the rehabilitation of edentulous patients by providing a fixed, full-arch prosthesis supported by 4 or more strategically placed implants. In the past, the All-on-X workflow involved a combination of digital and conventional techniques. However, with advancements in digital dentistry and 3D printing technologies, a fully digital All-on-X workflow has emerged, offering numerous benefits for both patients and dental professionals by increasing clinical efficiency, and diminishing the magnitude and quantity of errors associated with treatment planning and prosthetic design ( Figs. 6 and 7 ).
