Int J Stomatol ›› 2022, Vol. 49 ›› Issue (3): 296-304.doi: 10.7518/gjkq.2022061

• Original Articles • Previous Articles     Next Articles

Effect of 3D printing orthognathic surgical splints with different dental model offsets on occlusal precision

Ma Jianbin(),Xue Chaoran,Wang Peiqi,Li Bin,Bai Ding.()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2021-11-16 Revised:2022-03-05 Online:2022-05-01 Published:2022-05-09
  • Contact: Ding. Bai E-mail:Jianbin_Ma@outlook.com;baiding@scu.edu.cn
  • Supported by:
    Miaozi Project in Science and Technology Innovation Program of Sichuan Province(20-YCG045)

Abstract: Objective

This study aimed to assess the precision of 3D-printed orthognathic surgical splints (OSS) with different dental model offsets and explore the optimal offsets of OSS.

Methods

Ten resin models that met the standard of normal occlusion were selected, and the digital models were obtained by using an optical scanner. The research models were made by using a 3D photosensitive resin printer, and then the original digital models were obtained. Digital OSS with different offsets (0.00, 0.05, 0.10, 0.15, 0.20, and 0.25 mm groups) was designed for each model, and physical OSS was fabricated by 3D printing. The upper and lower dentition of each resin model was reoccluded in OSS with different offsets, and the deviation of the actual occlusion from the original occlusion in six dimensions of horizontal, sagittal, vertical, pitch, roll, and yaw was evaluated.

Results

1) The actual occlusion obtained by OSS without offsets (0.00 mm group) had deviation in six dimensions, and the deviation in vertical (1.044±0.181 mm) and pitch (1.738°±0.772°) dimensions was the largest. 2) In sagittal, vertical, pitch, and roll dimensions, the mean value of actual occlusal deviation gradually decreases with the increase of offsets. In the vertical and pitch dimensions, the actual occlusal deviation of the 0.15 mm group was significantly less than that of the 0.00, 0.05, and 0.10 mm groups (P<0.01), but no significant difference was found between the 0.20 mm and 0.25 mm groups (P>0.05). In addition, no significant difference in sagittal and roll dimensions was found among the groups (P>0.05). 3) In the horizontal and yaw dimensions, within the range of 0.00-0.20 mm, the mean value of actual occlusal deviation gradually decreased with the increase of offsets (P>0.05). However, the actual occlusal deviation of the 0.25 mm group was larger than that of the 0.20 mm group (P>0.05).

Conclusion

3D printed OSS with offsets can reduce the deviation of the actual occlusion. Among the parameters, 0.15 mm is the suitable option for generating OSS.

Key words: computer-aided technology, 3D printing, orthognathic surgical splints, offsets

CLC Number: 

  • R 783

TrendMD: 

Fig 1

Research models with different offsets"

Fig 2

Fabrication of OSS with offsets"

Fig 3

Physical OSS and occlusal model"

Fig 4

Global coordinate system of reference model"

Tab 1

Definition of measurement dimension"

维度正向负向
X配准模型相对于参考模型位于坐标原点右侧配准模型相对于参考模型位于坐标原点左侧
Y配准模型相对于参考模型位于坐标原点前方配准模型相对于参考模型位于坐标原点后方
Z配准模型相对于参考模型位于坐标原点上方配准模型相对于参考模型位于坐标原点下方
P配准模型相对于参考模型位于坐标原点前上或后下配准模型相对于参考模型位于坐标原点前下或后上
Q配准模型相对于参考模型位于坐标原点左上或右下配准模型相对于参考模型位于坐标原点左下或右上
R配准模型相对于参考模型位于坐标原点左后或右前配准模型相对于参考模型位于坐标原点左前或右后

Tab 2

Repeatability results of measurement and opera-tion by the same researcher"

ICC水平向(X矢状向(Y垂直向(Z俯仰(P滚转(Q偏航(R
测量方法0.9840.9970.9990.9980.9850.994
试验操作0.9670.9350.9680.9650.9320.920

Tab 3

The overall view of translation deviation of OSS with different offsets in X, Y, Z three-dimensional direction mm,n=10"

补偿间隙最大值最小值均值标准差P
XYZXYZXYZXYZXYZ
0.000.1740.1861.4210.0210.0110.8130.0750.1211.0440.0510.0500.1810.1060.8270.542
0.050.1980.1721.0950.0120.0630.4130.0720.1090.7430.0540.0410.2170.1250.2960.576
0.100.0860.2200.7120.0010.0110.1230.0350.1040.3880.0330.0710.2180.0500.7130.272
0.150.1150.2180.5440.0110.0120.0030.0300.0770.1760.0410.0630.1750.0690.0560.124
0.200.0560.2480.2660.0020.0010.0120.0280.0740.1130.0170.0750.1010.5910.1030.056
0.250.1640.2210.1550.0060.0010.0050.0580.0720.0660.0470.0760.0490.1940.0630.437

Tab 4

The overall view of rotation deviation of OSS with different offsets in P, Q, R three-dimensional direction °,n=10"

补偿间隙/mm最大值最小值均值标准差P
PQRPQRPQRPQRPQR
0.002.9380.6460.1180.6500.0170.0161.7380.2840.1570.7720.1890.0340.3960.0770.297
0.052.7320.8470.3870.0180.0510.0121.6690.2440.1320.7810.2370.1150.4940.0530.106
0.101.6291.2330.5090.0280.0080.0010.8340.2210.0940.6210.4090.1590.1590.0630.052
0.151.4600.6590.2140.0780.0090.0190.6240.1760.0870.5240.2110.0640.0880.1390.279
0.200.9520.7090.1060.1100.0120.0030.5670.1310.0470.3310.2140.0360.1860.0720.407
0.250.8690.6270.9100.0440.0030.0420.2870.0960.2020.2960.1880.2630.0680.1210.685

Tab 5

Deviation values of OSS with different offsets in each dimension"

维度补偿间隙/mm
0.000.050.100.150.200.25
X/mm0.071±0.0510.072±0.0540.035±0.0330.056±0.0410.028±0.0170.058±0.047
Y/mm0.083±0.0500.109±0.0410.104±0.0710.077±0.0630.077±0.0750.072±0.076
Z/mm1.044±0.181☆◇△○0.743±0.217☆◇△○0.388±0.218*#◇△○0.176±0.175*#☆0.113±0.100*#☆0.066±0.048*#☆
P/°1.738±0.772☆◇△○1.669±0.781☆◇△○0.834±0.621*#0.624±0.524*#☆0.567±0.331*#☆0.287±0.296*#☆
Q/°0.204±0.1890.189±0.2370.281±0.4090.209±0.2110.151±0.2140.096±0.188
R/°0.057±0.0340.132±0.1150.094±0.1590.087±0.0640.047±0.0360.202±0.263

Fig 5

Taking the original occlusion as a reference, the influence of occlusion deviation caused by OSS on the position of the mandibular in vertical dimension"

Fig 6

Taking the original occlusion as a reference, the influence of occlusion deviation caused by OSS on the position of the mandibular in pitch dimension"

1 Lin HH, Lonic D, Lo LJ. 3D printing in orthognathic surgery-a literature review[J]. J Formos Med Assoc, 2018, 117(7): 547-558.
2 Sun Y, Luebbers HT, Agbaje JO, et al. Accuracy of upper jaw positioning with intermediate splint fabrication after virtual planning in bimaxillary orthognathic surgery[J]. J Craniofacial Surg, 2013, 24(6): 1871-1876.
3 李运峰, 祝颂松. 数字化技术在牙颌面畸形诊疗中的应用[J]. 口腔疾病防治, 2019, 27(2): 74-82.
Li YF, Zhu SS. Application of digital technology in diagnosis and treatment of dentofacial deformities[J]. J Prev Treat Stomatol Dis, 2019, 27(2): 74-82.
4 Chen X, Xu L, Wang W, et al. Computer-aided design and manufacturing of surgical templates and their clinical applications: a review[J]. Expert Rev Med Devices, 2016, 13(9): 853-864.
5 Lin YP, Zhang SL, Chen XJ, et al. A novel method in the design and fabrication of dental splints based on 3D simulation and rapid prototyping technology[J]. Int J Adv Manuf Technol, 2006, 28(9/10): 919-922.
6 Metzger MC, Hohlweg-Majert B, Schwarz U, et al. Manufacturing splints for orthognathic surgery using a three-dimensional printer[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2008, 105(2): e1-e7.
7 Shaheen E, Sun Y, Jacobs R, et al. Three-dimensio-nal printed final occlusal splint for orthognathic surgery: design and validation[J]. Int J Oral Maxillofac Surg, 2017, 46(1): 67-71.
8 Kim BC, Lee CE, Park W, et al. Clinical experien-ces of digital model surgery and the rapid-prototyped wafer for maxillary orthognathic surgery[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2011, 111(3): 278-285.e1.
9 Olszewski R, Reychler H. Les limites de la chirurgie des modèles en chirurgie orthognathique: implications théoriques et pratiques[J]. Revue De Stomatol et De Chir Maxillo Faciale, 2004, 105(3): 165-169.
10 Choi JY, Song KG, Baek SH. Virtual model surgery and wafer fabrication for orthognathic surgery[J]. Int J Oral Maxillofac Surg, 2009, 38(12): 1306-1310.
11 Cousley RR, Turner MJ. Digital model planning and computerized fabrication of orthognathic surgery wafers[J]. J Orthod, 2014, 41(1): 38-45.
12 Ghai S, Sharma Y, Jain N, et al. Use of 3-D printing technologies in craniomaxillofacial surgery: a review[J]. Oral Maxillofac Surg, 2018, 22(3): 249-259.
13 Jacobs CA, Lin AY. A new classification of three-dimensional printing technologies: systematic review of three-dimensional printing for patient-specific craniomaxillofacial surgery[J]. Plast Reconstr Surg, 2017, 139(5): 1211-1220.
14 Shehab MF, Barakat AA, AbdElghany K, et al. A novel design of a computer-generated splint for vertical repositioning of the maxilla after Le Fort Ⅰ osteotomy[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2013, 115(2): e16-e25.
15 Kim SY, Shin YS, Jung HD, et al. Precision and trueness of dental models manufactured with diffe-rent 3-dimensional printing techniques[J]. Am J Orthod Dentofac Orthop, 2018, 153(1): 144-153.
16 Lauren M, McIntyre F. A new computer-assisted method for design and fabrication of occlusal splints[J]. Am J Orthod Dentofac Orthop, 2008, 133(4): S130-S135.
17 Song KG, Baek SH. Comparison of the accuracy of the three-dimensional virtual method and the conventional manual method for model surgery and intermediate wafer fabrication[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 107(1): 13-21.
18 Shqaidef A, Ayoub AF, Khambay BS. How accurate are rapid prototyped (RP) final orthognathic surgical wafers? A pilot study[J]. Br J Oral Maxillofac Surg, 2014, 52(7): 609-614.
19 Ye NS, Wu TT, Dong T, et al. Precision of 3D-prin-ted splints with different dental model offsets[J]. Am J Orthod Dentofac Orthop, 2019, 155(5): 733-738.
20 Kim SJ, Lee KJ, Yu HS, et al. Three-dimensional effect of pitch, roll, and yaw rotations on maxillomandibular complex movement[J]. J Craniomaxillofac Surg, 2015, 43(2): 264-273.
21 Xue C, Xu H, Tian Y, et al. Precise control of maxillary multidirectional movement in Le Fort Ⅰ osteo-tomy using a surgical guiding device[J]. Br J Oral Maxillofac Surg, 2018, 56(9): 797-804.
22 Hazeveld A, Huddleston Slater JJ, Ren Y. Accuracy and reproducibility of dental replica models reconstructed by different rapid prototyping techniques[J]. Am J Orthod Dentofac Orthop, 2014, 145(1): 108-115.
23 Sherman SL, Kadioglu O, Currier GF, et al. Accuracy of digital light processing printing of 3-dimensional dental models[J]. Am J Orthod Dentofac Orthop, 2020, 157(3): 422-428.
24 Gateno J, Xia J, Teichgraeber JF, et al. The precision of computer-generated surgical splints[J]. J Oral Maxillofac Surg, 2003, 61(7): 814-817.
25 Adolphs N, Liu WC, Keeve E, et al. RapidSplint: virtual splint generation for orthognathic surgery- results of a pilot series[J]. Comput Aided Surg, 2014, 19(1/2/3): 20-28.
26 Elbokle N, Sultan O. The precision of 3D printed CAD/CAM occlusal splints in orthognathic surgery[J]. Egypt Dent J, 2018, 64(3): 2073-2079.
27 Choi JY, Choi JH, Kim NK, et al. Analysis of errors in medical rapid prototyping models[J]. Int J Oral Maxillofac Surg, 2002, 31(1): 23-32.
28 Winder J, Bibb R. Medical rapid prototyping technologies: state of the art and current limitations for application in oral and maxillofacial surgery[J]. J Oral Maxillofac Surg, 2005, 63(7): 1006-1015.
29 Dietrich CA, Ender A, Baumgartner S, et al. A validation study of reconstructed rapid prototyping mo-dels produced by two technologies[J]. Angle Orthod, 2017, 87(5): 782-787.
30 Vasques MT, Laganá DC. Accuracy and internal fit of 3D printed occlusal splint, according to the prin-ting position[J]. Clin Lab Res Dent, 2018. doi:10.11606/issn.2357-8041.clrd.2018.148012.
31 Marcel R, Reinhard H, Andreas K. Accuracy of CAD/CAM-fabricated bite splints: milling vs 3D printing[J]. Clin Oral Investig, 2020, 24(12): 4607-4615.
32 Unkovskiy A, Bui PHB, Schille C, et al. Objects build orientation, positioning, and curing influence dimensional accuracy and flexural properties of ste-reolithographically printed resin[J]. Dent Mater, 2018, 34(12): e324-e333.
33 Favero CS, English JD, Cozad BE, et al. Effect of print layer height and printer type on the accuracy of 3-dimensional printed orthodontic models[J]. Am J Orthod Dentofac Orthop, 2017, 152(4): 557-565.
34 Zhang ZC, Li PL, Chu FT, et al. Influence of the three-dimensional printing technique and printing layer thickness on model accuracy[J]. J Orofac Orthop, 2019, 80(4): 194-204.
[1] Zhang Xinchi,Wu Wei. Research progress on 3D printing technology and biomaterials for bone reconstruction in maxillofacial regions [J]. Int J Stomatol, 2020, 47(6): 677-685.
[2] Liu Chunxu,Lu Yuqing,Jia Luming,Dong Bo,Zhang Qianqian,Yu Haiyang. Comparative study of the retention force of titanium-alloy clasps fabricated through selective laser melting and casting [J]. Int J Stomatol, 2020, 47(2): 152-158.
[3] Wang Ke, Xiang Tao, Tang Yaling, Liang Xinhua. Application of 3D printing in oral and maxillofacial surgery education [J]. Inter J Stomatol, 2018, 45(1): 119-124.
[4] Wang Jing, Yuan Rongtao, Dong Qian.. Application of computer aided surgery system and 3D printing technology in the reconstruction of the defects in oral and maxillofacial region [J]. Inter J Stomatol, 2016, 43(6): 725-728.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[2] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[3] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[4] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[5] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[6] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[7] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[8] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[9] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[10] . [J]. Inter J Stomatol, 2008, 35(S1): .