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A Step-by-Step Guide to Creating Surgical Guides with CBCT, IO Scanner, and 3D Printing.

The world of dentistry has experienced a significant transformation in recent years, thanks to the adoption of cutting-edge digital technology. With tools such as Cone Beam Computed Tomography (CBCT), intraoral scanners, and 3D printers, dental professionals can now streamline their workflows, improve patient outcomes, and provide a higher standard of care. In this blog, we'll explore the digital workflow in dentistry, specifically focusing on the creation of surgical guides using CBCT, intraoral scanner technology, and 3D printers. We'll also discuss the various file types generated by each technology and walk you through the step-by-step process of creating a surgical guide.

CBCT Scans and DICOM Files (.DCM)

Cone Beam Computed Tomography (CBCT) is a diagnostic imaging tool that generates detailed, three-dimensional images of the patient's teeth, bone structure, and soft tissues. CBCT scans are stored in a digital format known as Digital Imaging and Communications in Medicine (DICOM) files. These files provide valuable insights to dental professionals, allowing them to make more accurate diagnoses and plan treatments with greater precision.

Intraoral Scanners and STL Files (.STL)

Intraoral scanners have replaced traditional dental impressions with digital scans that capture accurate, three-dimensional models of a patient's teeth and surrounding tissues. These digital models are saved as Standard Tessellation Language (STL) files. STL files are widely used in the dental industry for designing and fabricating dental restorations, orthodontic appliances, and other prosthetic devices.

3D Printing and STL Files

3D printing, also known as additive manufacturing, is a process that creates physical objects by building them layer by layer using a variety of materials, such as resins or plastics. In the context of dentistry, 3D printers use STL files to create highly accurate dental models, restorations, and surgical guides. The STL file format is essential because it provides the necessary data for the 3D printer to understand the object's geometry and reproduce it accurately.

Creating a Surgical Guide: A Step-by-Step Process

Step 1: Acquire CBCT and Intraoral Scans The process of creating a surgical guide starts with obtaining a CBCT scan (DICOM file) and an intraoral scan (STL file) of the patient's dentition.

Step 2: Import DICOM and STL Files into Planning Software Next, import the DICOM and STL files into specialized dental planning software, such as BlueSky Plan, which allows dental professionals to merge the data from both files to create a comprehensive 3D model of the patient's oral structures.

Step 3: Align and Merge the Files Align the STL file with the DICOM data to ensure the digital model of the teeth and soft tissues is correctly positioned within the 3D representation of the patient's jaw.

Step 4: Mark Anatomical Landmarks and Plan Implant Placement Identify and mark critical anatomical landmarks, such as nerves and sinus cavities, to ensure safe implant placement. Plan the implant position, considering factors like bone density, available bone volume, and the ideal angulation for the implant.

Step 5: Design the Surgical Guide Using the planning software, design the surgical guide to fit securely on the patient's teeth or soft tissues. Ensure that the implant sleeves align with the planned implant positions. The following is a video showing the process in Blue Sky Plan.

Step 6: Export the Surgical Guide Design Once the surgical guide design is finalized, export it as an STL file to be used by a 3D printer or milling machine for fabrication.

Step 7: Fabricate the Surgical Guide with a 3D Printer or Milling Station Use a 3D printer or milling station to create the physical surgical guide from the exported STL file. Choose a biocompatible material suitable for intraoral use and sterilize the surgical guide according to the manufacturer's instructions.

Step 8: Perform the Surgery With the surgical guide in place, perform the dental implant surgery or other procedures as planned. The guide will help ensure accurate implant placement and optimal results for the patient.

Avoid these three mistakes in the process to ensure a good clinical result.

Inaccurate digital impressions and CBCT data: Poor-quality digital impressions or misaligned CT/CBCT data can lead to incorrect planning and an ill-fitting surgical guide. To avoid this, ensure that your intraoral scanner is well-calibrated and the recommended scan pattern is followed. It also helps to dry the teeth prior and during scanning. When taking CBCT scans ensure that the patient is properly positioned and stabilized. Movement in a CBCT scan can result in fuzzy edges which makes it more difficult to align the CBCT with the I/O scan.

Poor design of the surgical guide: A poorly designed surgical guide can result in improper implant placement and angle, causing complications. The planning software allows for verification of alignment between the DICOM file from the CBCT and the STL file from the I/O scanner. Ensure that there is accurate alignment or the guide may not fit and the implant will likely not be placed as planned. Also verify that the correct size drill guides are chosen for the surgical guide so implant angle and depth are accurate.

Inadequate thickness or rigidity of the guide: A thin or flexible surgical guide may not provide adequate support during drilling, leading to inaccuracies in implant placement. Ensure that the surgical guide material is of appropriate thickness and rigidity by using materials like high-quality resins, polycarbonate, or acrylics recommended for dental surgical guides. Also, Use fixation methods such as bone or tooth-supported guides, or use fixation screws to secure the guide in place during surgery.

The digital workflow in dentistry, including CBCT, intraoral scanners, and 3D printers, has revolutionized the way dental professionals diagnose, plan, and execute treatments. By leveraging the power of DICOM and STL files in creating surgical guides, dentists can ensure greater accuracy, efficiency, and improved patient outcomes. However, proper digital creation and fabrication is necessary to avoid an inaccurate implant placement. As technology continues to advance, dental professionals can look forward to even more innovative solutions that will further enhance the quality of care they provide. Embracing these advancements is essential for staying at the forefront of the dental industry and offering patients the best possible treatment experience.

Dental TI is dedicated to assisting dentists in tackling the obstacles they encounter while navigating the "digital jungle." If you're considering investing in digital imaging technologies to elevate your practice, we're here to help. Click below to embark on your journey or progress further with Dental TI as your trusted digital partner.


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