title: Accuracy of orthodontic miniscrew implantation guided by stereolithographic surgical stent based on cone-beam CT-derived 3D images.
abstract: OBJECTIVE
  To develop surgical stents for cone-beam computed tomography (CBCT) 3-dimensional (3D) image-based stent-guided orthodontic miniscrew implantation and to evaluate its accuracy.
  
  
  METHODS
  Ten surgical stents were fabricated with stereolithographic appliances (SLAs) according to 3D CBCT image-based virtual implantation plans. Thirty self-drilling miniscrews were implanted at two to three positions on each side of the maxillary or mandibular posterior arches in three phantoms: 20 guided by 10 surgical stents in two phantoms (stent group) and 10 guided freehand in one phantom (freehand group). Six parameters (mesiodistal and vertical deviations at the corona and apex and mesiodistal and vertical angular deviations) were measured to compare variations between the groups.
  
  
  RESULTS
  No root damage was found in the stent group, whereas four of 10 miniscrews contacted with roots in the freehand group. In the stent group, deviations in the mesiodistal and vertical directions were 0.15 ± 0.09 and 0.19 ± 0.19 mm at the corona, respectively, and 0.28 ± 0.23 and 0.33 ± 0.25 mm at the apex, respectively; angular deviations in the mesiodistal and vertical directions were 1.47° ± 0.92° and 2.13° ± 1.48°, respectively. In the freehand group, the corresponding results were 0.48 ± 0.46 mm and 0.94 ± 0.87 mm (corona), 0.81 ± 0.61 mm and 0.78 ± 0.49 mm (apex), and 7.49° ± 6.09° and 6.31° ± 3.82°. Significant differences were found in all six parameters between the two groups (Student's t-test, P < .05).
  
  
  CONCLUSIONS
  3D CBCT image-based SLA-fabricated surgical stents can provide a safe and accurate method for miniscrew implantation.
authors.affiliation: Section of Maxillofacial Orthognathics, Department of Maxillofacial/Neck Reconstruction, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Lingling
authors.initials: L
authors.lastname: Qiu
authors.forename: Naoto
authors.initials: N
authors.lastname: Haruyama
authors.forename: Shoichi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yamada
authors.forename: Naoto
authors.initials: N
authors.lastname: Obayashi
authors.forename: Toru
authors.initials: T
authors.lastname: Kurabayashi
authors.forename: Keiji
authors.initials: K
authors.lastname: Moriyama
mesh_terms: D001863:Bone Screws; D017076:Computer-Aided Design; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003724:Dental Arch / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008334:Mandible / Q000601:surgery; D008437:Maxilla / Q000601:surgery; D052280:Orthodontic Anchorage Procedures / Q000295:instrumentation* / Q000592:standards; D010347:Patient Care Planning; D019047:Phantoms, Imaging; D015203:Reproducibility of Results; D015607:Stents / Q000592:standards*; D025321:Surgery, Computer-Assisted; D014092:Tooth Root / Q000033:anatomy & histology; D014584:User-Computer Interface