Accuracy of Implant Placement Utilizing Stereolithographic Guides Printed with and without Cross-arch Stabilization Struts

Objectives: The purpose of this study was to assess the accuracy of implant placement using stereolithographic guides printed with and without stabilization struts by comparing the post-operative position to the planned implant position.Methods: A pre-operative cone-beam computed tomography (CBCT) of a drillable maxillary model was obtained and data was uploaded into coDiagnostiX for preoperative planning. The implant position was planned in an edentulous space of #5 using a 3.3x10mm Bone Level Tapered (BLT) implant (Straumann). Ten surgical guides were designed utilizing a stabilization strut (Group A), while ten guides were designed without the stabilization strut (Group B). Twenty guides total, ten in each group, were 3-D printed and 5 mm sleeves were inserted to allow full preparation of the osteotomy. The osteotomy sites were prepared following Straumann guided surgery protocols, apart from utilizing irrigation. Twenty 3.3x10mm BLT implants were placed partially guided in the maxillary models. The implants were placed free-handed until full depth was achieved. Post-operative CBCT scans of each sample were obtained, uploaded into coDiagnostiX, and merged with the planned implant position. The treatment evaluation tool was used to compare the post-operative implant positions to the planned position. As the guides were printed in two separate batches, both of which containing equal numbers of Group A and Group B templates, the same evaluation tool was used to determine if there was any batch-to-batch 3-D print variability.Results: No significant differences were found between the planned and post-operative implant position of implants placed using Group A guides and implants placed using Group B guides. There was a statistically significant difference found between the prints in Batch 1 and Batch 2, although it is important to note that the differences would not be clinically significant. The angle measurement is significantly greater in Print Batch 1 (P = .0115). The Vestibular (Base) measurement is significantly greater in Print Batch 1 (P = .0076), as is the 3D Offset (Apex) measurement (P = .0155). The Distal (Apex) measurement is weakly significantly (90% confidence level) greater in Print Batch 1 (P = .0684), while the Vestibular (Apex) measurement is significantly greater in Print Batch 1 (P = .0061).Conclusions: No significant differences were found in post-operative implant position of implants placed utilizing surgical guides with a stabilization strut (Group A) vs the guides without the stabilization strut (Group B). Further studies using larger samples sizes are indicated in order to validate if significant differences can be expected between guides printed and processed in difference batches.