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Application of CAD/CAM and 3D Printing Technologies in Dentistry

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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Materials Science and Engineering".

Deadline for manuscript submissions: closed (31 July 2020) | Viewed by 58406

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Prof. Dr. Yong-Deok Kim

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Guest Editor

1. Dental Research Institute, Pusan National University Dental Hospital, Yangsan 50612, Republic of Korea
2. School of Dentistry, Pusan National University, Busan 46241, Republic of Korea
Interests: orthognathics; implantology; cleft lip and palate; reconstruction of head and neck
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Special Issue Information

Dear Colleagues,

CAD/CAM and 3D printing technologies are not a new concept in the dentistry field but have allowed for the introduction of methods which previously would not have been reliable and attractive because of numerous limitations. This technology has changed the global development of dental cone beam CT, 3D printing technology, and CAD/CAM in dentistry, and the multiple applications resulting from the ideas have been reintroduced by several technicians and doctors, especially regarding the placement of implants, design and manufacturing of prostheses, planning of orthodontics, diagnosis before orthognathics, and even in the reconstruction of the head and neck region. After a lot of trial and error, we have now been introduced to digitally guided implant installation, facial/teeth scanning, zirconia crowns using CAD/CAM, staged orthodontic treatments using virtual planning, virtual surgery for orthognathics, and reconstruction of the head and neck with 3D printing.

To allow for further development of new applications based on these techniques, we need to consolidate knowledge—not only regarding laboratory-based findings, but clinical evidence of success is also important.

This Special Issue of the journal Applied Sciences “Application of CAD/CAM and 3D Printing Technologies in Dentistry” aims to cover recent advances in the development and application of technologies of any type that have demonstrated success through their routine application in clinics.

Prof. Yong-Deok Kim
Guest Editor

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Keywords

CAD/CAM
3D printing
dental implants
orthognathics
orthodontics
prosthodontics
oral and maxillofacial surgery
periodontics
reconstruction
head and neck

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Published Papers (12 papers)

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11 pages, 8997 KiB

Open AccessArticle

Integrating CAD and 3D-Printing Techniques to Construct an In Vitro Laser Standard Treatment Platform for Evaluating the Effectiveness of Sterilization by Er:YAG Laser in Peri-Implant Intra-Bony Defects

by Shih-Hao Chang, Hsiang-I Mei and Chun-Li Lin

Appl. Sci. 2020, 10(10), 3431; https://doi.org/10.3390/app10103431 - 15 May 2020

Cited by 1 | Viewed by 2003

Abstract

This study established an in vitro model mimicking clinical peri-implant intra-bony defects. We investigated the effect of access limitation and the bactericidal effectiveness of erbium-doped yttrium, aluminum and garnet (Er:YAG) laser irradiation in shallow and deep peri-implant defects at different tooth positions. Reverse engineering, computer-aided design (CAD), and 3D-printing techniques were integrated to establish physical peri-implant intra-bony defect models at mandibular central incisor, first premolar, and first molar positions with shallow (2 mm depth) or deep (6 mm depth) defects and with 1.5 mm and 1.8 mm widths at the bottom and crestal portions of the alveolar process, respectively. Three-dimensional printed suites at the corresponding implant sites replaced experimental implant specimens for the investigation of bacterial adhesion in individuals. Dental implants with diameters of 3, 4 and 5 mm were utilized at the mandibular incisor, premolar, and molar positions, respectively. Bacterial adhesion of Gram (–) Escherichia coli on the exposed implant surfaces prior to sterilization was assessed. Sterilization with shallow and deep intra-bony defects was investigated by measuring the reduction of residual viable bacteria on implants after 60 s of irradiation with an Er:YAG laser. The adhesion rate of Gram (–) Escherichia coli on the investigated implant surfaces ranged from 1% to 3% (1.76

\pm

1.25%, 2.19

\pm

0.75% and 2.66

\pm

1.26% for 3, 4, and 5 mm implants, respectively). With shallow peri-implant bony defects, the Er:YAG laser sterilization rates were 99.6 ± 0.5%, 99.3

\pm

0.41% and 93.8 ± 7.65% at mandibular incisor, premolar, and molar positions, respectively. Similarly, sterilization rates in deep peri-implant defects were 99 ± 1.35%, 99.1 ± 0.98% and 97.14 ± 2.57%, respectively. A 3D-printed model with replaceable implant specimens mimicking human peri-implant intra-bony defects was established and tested in vitro. This investigation demonstrated effective sterilization using Er:YAG laser irradiation in both shallow and deep peri-implant intra-bony defects at different positions and diameters of dental implants. Full article

(This article belongs to the Special Issue Application of CAD/CAM and 3D Printing Technologies in Dentistry)

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14 pages, 9595 KiB

Open AccessArticle

A Prospective Study on Accuracy of Computer-Based Fully Guided Versus Pilot-Guided Implant Surgery

by Hyo Joon Kim, Hee Jin Kim and Seong Yong Moon

Appl. Sci. 2020, 10(6), 1975; https://doi.org/10.3390/app10061975 - 13 Mar 2020

Cited by 2 | Viewed by 3228

Abstract

The aim of this study is to compare the implant placement deviations and evaluate the 1-year post-implant placement bone loss of pilot and fully guided implant placement protocols. In the first method, the pilot drill is used for guide surgery, and the following procedure is a method for performing implant surgery in a non-guided protocol. The second method is to perform fully guided surgery. A total of 74 implants in 20 patients were included. Postoperative CT scans were used to compare the implant placement deviations with the preoperative plan. In addition, bone loss was compared one year after surgery. In shoulder area, the implant deviations from the planned positions for dx(mesio-distal), dy(bucco-lingual), dz(vertical) dimensions, mean deviations with pilot-guided protocol (n = 31) were 0.50 ± 0.42 mm, 0.61 ± 0.55 mm, 0.87 ± 0.71 mm, and 1.33 ± 0.75 mm, respectively. The corresponding deviations for fully guided protocol (n = 41) were 0.50 ± 0.52 mm, 0.29 ± 0.27 mm, 0.56 ± 0.51 mm, and 0.96 ± 0.57 mm. In apical area, the corresponding deviations for pilot-guided protocol were 0.75 ± 0.72 mm, 0.61 ± 0.46 mm, 0.98 ± 0.76 mm, and 1.54 ± 0.87 mm. Deviations for fully guided protocol were 0.91 ± 0.90 mm, 0.44 ± 0.39 mm, 0.54 ± 0.51 mm, and 1.38 ± 0.76 mm, respectively. Angular deviations were 3.33 ± 3.23° with pilot-guided protocol and 3.90 ± 1.85° with fully guided protocol. The average bone loss after 1 year was 0.50 + 0.29 mm and 0.50 ± 0.24 mm, respectively. In the shoulder area, dy(bucco-lingual) of horizontal deviations, vertical deviations, and mean value of the deviations showed a statistically significant difference between fully guided and pilot-guided (p = 0.005, p = 0.033, and p = 0.023, respectively). In the apical area, vertical deviations showed a statistically significant difference. However, the mean value of the deviations did not show a statistically significant difference (p = 0.347). There was no statistically significant difference in angular deviations (p = 0.59). Full article

(This article belongs to the Special Issue Application of CAD/CAM and 3D Printing Technologies in Dentistry)

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15 pages, 7392 KiB

Open AccessArticle

Three-Dimensional Printed Silicone Bite Blocks for Radiotherapy of Head and Neck Cancer—A Preliminary Study

by Yu-Ming Huang, Jehn-Chuan Lee, Chien-Ming Chu, Hung-Chi Tai, Tien-Chi Hou, Fred Yi-Shueh Chen, Chih-Wen Chi and Yu-Jen Chen

Appl. Sci. 2020, 10(5), 1688; https://doi.org/10.3390/app10051688 - 2 Mar 2020

Cited by 8 | Viewed by 10153

Abstract

Conventional methods that have been developed to immobilize the mouth and tongue for radiotherapy (RT) in head and neck cancer (HNC) treatment have been unsatisfactory. We, therefore, developed three-dimensional (3D), customizable, silicone bite blocks and examined their clinical feasibility. For HNC patients, before RT, the 3D printed bite blocks were fabricated based on primary computed tomography (CT) simulation images. The placement of the 3D bite blocks was followed by a secondary CT simulation before RT planning was finalized. Dosimetric parameters and positioning verification achieved with the propose bite blocks were compared with conventional universal oral corks. The 3D printed bite blocks were conformal to the occlusal surface, ensuring immobilization of the tongue without eliciting a gag reflex, and an elastic and firm texture that supports opening of the mouth, with a smooth surface with tolerable intraoral tactility. The dosimetry of patients using the proposed bite blocks showed better coverage of the planning target volume and surface of a tumour bed along with reduction in normal tissue doses. Good concordance of positioning by 3D printed bite blocks during the RT course was verified. The 3D printed bite blocks with silicone might be a customizable, safe, and practical advanced technology in RT for HNC. Full article

(This article belongs to the Special Issue Application of CAD/CAM and 3D Printing Technologies in Dentistry)

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11 pages, 1365 KiB

Open AccessArticle

Soft Tissue Evaluation of an Immediate Esthetic Zone Single Implant with a Stereolithographic Guide Using 3D Reconstruction and a CAD/CAM Customized Titanium Anatomic Abutment

by Tae-Heung Kim, You-Kyoung Oh, Chang-Mo Jeong, Edward Chengchuan Ko, George K. Sándor and Yong-Deok Kim

Appl. Sci. 2020, 10(5), 1678; https://doi.org/10.3390/app10051678 - 2 Mar 2020

Cited by 2 | Viewed by 4070

Abstract

The replacement of an unrestorable tooth with a single implant-supported prosthesis is a treatment with predictable and successful outcomes. The anterior maxilla region is a complicated site for such treatment, due to its esthetic, functional, and physiological sensitivity. The purpose of this study was to evaluate the changes in the soft tissue following an immediate implant procedure using guided surgery in combination with a computer-aided design and computer-aided manufacturing (CAD/CAM) customized titanium anatomic abutment in the esthetic zone. A total of 13 patients who had been treated with an immediate post-extraction implant placement and an immediate provisional restoration were included in the study. The changes in the soft tissue dimension, interdental papilla, and esthetic score were evaluated with a follow-up of at least one year. There was no significant change in the midfacial mucosal status when compared to the pre-treatment situation. The recession of the mesial papillary height was 0.32 mm and the distal papillary height was 0.10 mm. The mean horizontal change in the labial mucosa was 0.32 ± 0.83 mm. There was no significant difference between the mesial papilla index and the distal papilla index. The pink esthetic score value prior to treatment was 11.16, and at one-year follow-up, 10.25. Within the limitations of this study, the immediate post-extraction implant placement procedure with a stereolithographic guide and a provisionalization with a CAD/CAM customized titanium anatomic abutment may be a treatment option with predictable outcomes for the replacement of teeth in the esthetic zone. Full article

(This article belongs to the Special Issue Application of CAD/CAM and 3D Printing Technologies in Dentistry)

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10 pages, 2768 KiB

Open AccessFeature PaperArticle

Application of Computational Fluid Dynamics Analysis after Bimaxillary Orthognathic Surgery

by Jae Min Song, Heerim Seo, Na-Rae Choi, Eunseop Yeom and Yong-Deok Kim

Appl. Sci. 2020, 10(5), 1676; https://doi.org/10.3390/app10051676 - 2 Mar 2020

Cited by 2 | Viewed by 2751

Abstract

Bimaxillary orthognathic surgery is widely used to treat skeletal class III malocclusion. Changes in jaw position affect the shape of surrounding soft tissues. We used computational fluid dynamics (CFD) simulation to observe changes in airways observed in a patient who underwent bimaxillary orthognathic surgery. For CFD simulation, we performed cone beam computed tomography (CBCT) preoperatively (T0), 3 days postoperatively (T1), and 7 months postoperatively (T2). The values of velocity, pressure drop (ΔP), and wall shear stress all increased 7 months after surgery (V_max 7.038 m/s to 12.054 m/s, ΔP −7.723 Pa to −53.739 Pa, WSS_max 4.214 Pa to 14.323 Pa). Locations where the velocity and pressure gradients are large included the velopharynx, oropharynx, and epiglottis, with narrow cross-sectional areas. Wall shear stress was also observed at these locations. The velopharynx, oropharynx, and epiglottis are structures most vulnerable to morphological changes, that is, they can easily become obstructed. Full article

(This article belongs to the Special Issue Application of CAD/CAM and 3D Printing Technologies in Dentistry)

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10 pages, 21661 KiB

Open AccessArticle

Computer-Assisted Preoperative Simulations and 3D Printed Surgical Guides Enable Safe and Less-Invasive Mandibular Segmental Resection: Tailor-Made Mandibular Resection

by Bo-Yeon Hwang, Jae-Yeol Lee, Junho Jung, Joo-Young Ohe, Young-Gyu Eun, YoungChan Lee and Jung-Woo Lee

Appl. Sci. 2020, 10(4), 1325; https://doi.org/10.3390/app10041325 - 15 Feb 2020

Cited by 3 | Viewed by 6229

Abstract

This study aimed to present and evaluate alternative lesion-specific mandibulectomy methods for preserving the mandibular anatomical structures as compared with the conventional virtual surgical plan. Fifteen patients who received segmental mandibulectomy were included in this study, and the following parameters were evaluated: (1) the disease-free bone margin, (2) the volume and surface between the tailor-made resection simulation and conventional resection simulation, and (3) the preserved mandibular anatomical structures. In all 15 patients, disease-free bone margins were confirmed by histopathology. Volumes of conventional resection simulation and tail-made resection simulation were 49,468.66 ± 14,007.96 mm³ and 52,610.01 ± 13,755.33 mm³ and the surfaces were 20,927.38 ± 4471.70 mm² and 22,356.49 ± 4185.73 mm², respectively; these were statistically significant (both, p < 0.001). Mandibular dentition was partially preserved in six patients. Twelve of the 15 patients had changes in defect classification with preservation of the mandibular inferior border. In conclusion, alternative lesion-specific mandibulectomy was a less invasive method for effectively removing mandibular lesions while preserving the important anatomical structures of the mandible. Full article

(This article belongs to the Special Issue Application of CAD/CAM and 3D Printing Technologies in Dentistry)

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8 pages, 2542 KiB

Open AccessArticle

Feasibility of a 3D Surgical Guide Technique for Impacted Supernumerary Tooth Extraction: A Pilot Study with 3D Printed Simulation Models

by Hyeonjong Lee, Yong Kwon Chae, Seulki Choi, Myeong Kwan Jih, Jung-Woo Lee, Sung Chul Choi and Ok Hyung Nam

Appl. Sci. 2019, 9(18), 3905; https://doi.org/10.3390/app9183905 - 18 Sep 2019

Cited by 7 | Viewed by 4227

Abstract

This study aimed to evaluate the feasibility of a 3-dimensional (3D) planned surgical guide technique designed for impacted supernumerary teeth (STs) extraction using 3D printed simulation models. In total, 17 participants from two university hospitals were recruited. Each participant performed surgery with both the conventional and surgical guide techniques. The following parameters were evaluated: (1) The time required for ST extraction, (2) the area of the window opening, and (3) the volume of the material removed. Time required for ST extraction was 213.65 ± 167.45 sec and 114.76 ± 42.87 sec in the conventional and surgical guide techniques, respectively, with significant differences (p = 0.028). The required area of the window opening was 48.10 ± 9.44 mm² and 45.90 ± 8.17 mm², respectively, in the conventional and surgical guide techniques, with no significant differences (p > 0.05). The required volume of the material removed was 121.65 ± 43.69 mm³ and 99.12 ± 17.88 mm³ in the conventional and surgical guide techniques, respectively, with significant differences (p = 0.031). The 3D planned surgical guide technique was effective for impacted ST extraction. Within the limits of this study, the surgical guide technique allows us to accomplish minimally invasive surgery within a shorter duration. Full article

(This article belongs to the Special Issue Application of CAD/CAM and 3D Printing Technologies in Dentistry)

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8 pages, 3495 KiB

Open AccessArticle

Digital Evaluation of the Accuracy of Computer-Guided Dental Implant Placement: An In Vitro Study

by Seong-Min Kim, Keunbada Son, Duk-Yeon Kim and Kyu-Bok Lee

Appl. Sci. 2019, 9(16), 3373; https://doi.org/10.3390/app9163373 - 16 Aug 2019

Cited by 8 | Viewed by 4319

Abstract

Compared to traditional implant surgical guides, computer-assisted implant surgical guides can be considered for positioning implants in the final prosthesis. These computer-assisted implant surgical guides can be easily fabricated with personal 3D printers after being designed with implant planning CAD software. Although the accuracy of computer-assisted implant surgical guides fabricated using personal 3D printers is an important factor in their clinical use, there is still a lack of research examining their accuracy. Therefore, this study evaluated the accuracy of computer-assisted implant surgical guides, which were designed using two implant planning CAD software programs (Deltanine and R2gate software) and fabricated with personal 3D printers using a non-radiographic method. Amongst the patients who visited Kyungpook National University Dental Hospital, one patient scheduled to undergo surgery of the left mandibular second premolar was randomly selected. Twenty partially edentulous resin study models were produced using a 3D printer. Using the Deltanine and R2gate implant planning CAD software, 10 implant surgical guides per software were designed and produced using a personal 3D printer. The implants (SIII SA (Ø 4.0, L = 10 mm), Osstem, Busan, Korea) were placed by one skilled investigator using the computer-assisted implant surgical guides. To confirm the position of the actual implant fixture, the study models with the implant fixtures were scanned with a connected scan body to extract the STL files, and then overlapped with the scanned file by connecting the scan body-implant fixture complex. As a result, the mean apical deviation of the Deltanine and R2gate software was 0.603 ± 0.19 mm and 0.609 ± 0.18 mm, while the mean angular deviation was 1.97 ± 0.84° and 1.92 ± 0.52°, respectively. There was no significant difference between the two software programs (p > 0.05). Thus, the accuracy of the personal 3D printing implant surgical guides is in the average range allowed by the dental clinician. Full article

(This article belongs to the Special Issue Application of CAD/CAM and 3D Printing Technologies in Dentistry)

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6 pages, 2099 KiB

Open AccessTechnical Note

Easy, Fast, and Accurate Method of 3-Dimensional Mirror Plane Creation for Actual Clinical Users

by Min-Soo Kwon, Hyunwoo Lee, Bo-Yeon Hwang and Jung-Woo Lee

Appl. Sci. 2020, 10(17), 6141; https://doi.org/10.3390/app10176141 - 3 Sep 2020

Viewed by 2182

Abstract

The first thing to do before planning the surgical treatment of unilateral defects or the asymmetry of the facial area is probably establishing adequate mid-plane for comparison and analysis of the normal and affected side. In such cases, a mirror image can be useful to obtain customized and optimized mid-plane for specific individuals considering the degree of the defect and asymmetry. With the concept of the iterative closest point (ICP) algorithm, the surface-based registration of the initial structure and mirrored structure allow us to generate a mirror plane that bisects the mid planes of each structure. This mirror plane would improve the quality of pre-operative evaluation and provide an appropriate start point for the treatment plan with as few errors as possible. Hence, the aim of this article is to introduce a method to create a mirror plane that can be assisting in increasing the accuracy of evaluation and analysis so a precise treatment plan would follow consequently. Full article

(This article belongs to the Special Issue Application of CAD/CAM and 3D Printing Technologies in Dentistry)

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8 pages, 6731 KiB

Open AccessCase Report

3D-Printed Surgical Guide for Crown Lengthening Based on Cone Beam Computed Tomography Measurements: A Clinical Report with 6 Months Follow Up

by Abdulkareem Alhumaidan, Ayed Alqahtani and Faisal al-Qarni

Appl. Sci. 2020, 10(16), 5697; https://doi.org/10.3390/app10165697 - 17 Aug 2020

Cited by 10 | Viewed by 11060

Abstract

Excessive gingival display is a common clinical presentation that often requires surgical intervention. This report is for a patient for whom esthetic crown lengthening is indicated due to altered passive eruption. Cone beam computed tomography (CBCT) scan and an intraoral scan were used to design and print a single surgical guide which provided a reference for both gingivectomy and osteoectomy. A satisfactory outcome was obtained 6 months after surgery. The present technique provided a simplified method of generating a surgical guide with predictable results by relying on the existing tooth anatomy rather than diagnostic waxing. This technique is particularly useful when crowns or veneers are not indicated. Full article

(This article belongs to the Special Issue Application of CAD/CAM and 3D Printing Technologies in Dentistry)

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9 pages, 5388 KiB

Open AccessCase Report

A Novel Approach Using Customized Miniplates as Skeletal Anchorage Devices in Growing Class III Patients: A Case Report

by Ji-In Ryu, Seoung-Won Cho, So-Hee Oh, In-Young Park, Ju-Won Kim, Soo-Hwan Byun and Byoung-Eun Yang

Appl. Sci. 2020, 10(12), 4067; https://doi.org/10.3390/app10124067 - 12 Jun 2020

Cited by 3 | Viewed by 3543

Abstract

Facemasks using tooth-borne anchorages have been used primarily for the treatment of Class III malocclusion with maxillary undergrowth. However, when using a tooth as an anchorage, if the stability of the tooth used as an anchor is weak, the anchoring function may fail as the tooth tilts. Meanwhile, the use of skeletal anchorages such as implants, mini-implants, and mini-plates has been claimed to minimize the side effects of using dental anchorage. This case report describes the treatment of a six-year-old male patient with Class III malocclusion, presenting maxillary undergrowth and mandibular prognathism. Due to the mobility of the anchoring primary teeth, a device using dental anchorage was replaced with that using customized skeletal anchorage for the treatment. Customized guides and miniplates for the surgery were fabricated in advance through a computer-assisted system, in order to avoid possible damage to the adjacent tooth buds. The customized plates were accurately and passively placed on the intended part, showing the desired outcome. Full article

(This article belongs to the Special Issue Application of CAD/CAM and 3D Printing Technologies in Dentistry)

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7 pages, 2217 KiB

Open AccessCase Report

The Deep Circumflex Iliac Artery Flap for Mandibular Reconstruction and Donor Site Reconstruction with a Patient-Specific Implant: A Case Report

by Hyo Joon Kim and Seong Yong Moon

Appl. Sci. 2020, 10(5), 1587; https://doi.org/10.3390/app10051587 - 27 Feb 2020

Cited by 8 | Viewed by 3382

Abstract

Jaw defects may occur due to various causes such as tumors, trauma, and diseases caused by infection such as osteomyelitis. Reconstruction of jaw defects has been improved by the free flaps and refined microvascular techniques. The deep circumflex iliac artery (DCIA) flap offers a large amount of bone for complex reconstructions of the mandible. However, several complications and adverse effects can occur, such as abnormal hip contour, hernia, severe bleeding tendency, gait disturbance, and hypoesthesia. To reduce these complications, the monocortical DCIA flap can be used, or iliac crest bone defects can be restored with titanium mesh. However, these methods have limitations when used to reduce hip contour reproduction and gait disturbance. In this study, we report a case of iliac bone reconstruction using a 3D-printed patient-specific implant to reduce donor site morbidity in the reconstruction of the DCIA flap in a patient with oral squamous carcinoma. Full article

(This article belongs to the Special Issue Application of CAD/CAM and 3D Printing Technologies in Dentistry)

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