Interactive design of dental implant placements through CAD-CAM technologies: from 3D imaging to additive manufacturing

In the field of oral rehabilitation, the combined use of 3D imaging technologies and computer-guided approaches allows the development of reliable tools to be used in preoperative assessment of implant placement. In particular, the accurate transfer of the virtual planning into the operative field through surgical guides represents the main challenge of modern dental implantology. Guided implant positioning allows surgical and prosthetic approaches with minimal trauma by reducing treatment time and decreasing patient’s discomfort. This paper aims at defining a CAD/CAM framework for the accurate planning of flapless dental implant surgery. The system embraces three major applications: (1) freeform modelling, including 3D tissue reconstruction and 2D/3D anatomy visualization, (2) computer-aided surgical planning and customised template modelling, (3) additive manufacturing of guided surgery template. The tissue modelling approach is based on the integration of two maxillofacial imaging techniques: tomographic scanning and surface optical scanning. A 3D virtual maxillofacial model is created by matching radiographic data, captured by a CBCT scanner, and surface anatomical data, acquired by a structured light scanner. The pre-surgical planning process is carried out and controlled within the CAD application by referring to the integrated anatomical model. A surgical guide is then created by solid modelling and manufactured by additive techniques. Two different clinical cases have been approached by inserting 11 different implants. CAD-based planned fixture placements have been transferred into the clinical field by customised surgical guides, made of a biocompatible resin and equipped with drilling sleeves.