Dental Asia July/August 2022

BEHIND THE SCENES
of bone exposed during CBCT
radiation to perform an accurate and
minimally invasive osteotomy (Fig. 1).
Plan and design with Geomagic
Freeform
Next, Iraimudi virtually planned and
designed customised subperiosteal
implants for every step of the
procedure using Oqton’s Geomagic
Freeform software and a Touch haptic
device.
Fig. 2 Fig. 3
He imported the converted STL file
into Geomagic Freeform as an exact
virtual replica of the patient’s jaw.
He then used Geomagic Freeform
and a Touch haptic device to design
the implant framework for location,
length, depth, and angle using the
interocclusal distance to position the
abutment length and angulation for
the prosthetic replacement
(Fig. 2).
By superimposing the pre-operative
impression over the mandibular
STL file in Geomagic Freeform, he
designed a custom implant and saved
time by assessing the procedure
50–60% faster, avoiding clinical
obstacles, and eliminating multiple
post-operative impressions and
patient appointments.
3D printing anatomical models and
implants with plastic and metal AM
Next, Iraimudi used the mandibular
STL file to 3D print an anatomical
model of the patient’s jaw and
customised implants for the surgical
procedure with a combination
of plastic and metal additive
manufacturing (AM) technologies
(Fig. 3).
He had the anatomical model of the
patient’s jaw 3D printed on a plastic
3D printer with fused deposition
modelling (FDM) technology using
PLA. He had the customised implants
3D printed on a metal 3D printer
using medical-grade titanium
Fig. 4 Fig. 5
Fig. 2: Customised implants and anatomical model designed in Geomagic Freeform
Fig. 3: 3D-printed plastic anatomical model of patient’s jaw with customised metal implants
Fig. 4: Modified Ginwalla incision and elevated buccal flap
Fig. 5: Post-operative orthopantomogram
Ti6Al4V (Ti-64), which is compatible
with human anatomy.
SURGICAL PROCEDURE
The prosthetic replacement operation
was comprised of three steps that took
place over one week. The surgeon
informed the patient of each step
before surgery.
Dr Karthick diagnosed the patient
with a posterior edentulous mandible
and administered local anaesthesia
(inferior alveolar nerve block) to each
side of the mandible. Then, an alveolar
incision was performed in the middle
third of the premolar region (modified
Ginwalla incision) and the buccal flap
was elevated, relieving the underlying
periosteum (Fig. 4).
A customised subperiosteal implant
was placed on the edentulous ridge, on
each side of the mandible. Dr Karthick
also placed the screws and adjusted
the implants accordingly with minimal
bone scraping and closed the buccal
flap with simple suturing. Finally, a
post-operative radiograph was taken
(Fig. 5).
OUTCOME
Periodontal disease is the main cause
of edentulous conditions. Bone loss
occurs in infectious conditions, which
can lead to standard dental implant
failure. Clinicians can avoid such
outcomes by customising minimallyinvasive,
patient-specific subperiosteal
implants through surgical planning.
Using Oqton’s D2P and Geomagic
Freeform software, clinicians can work
interactively with patient-specific
virtual models to simulate surgical
procedures and improve the planning
process. 3D-printed patient-specific
implants are the bridge between a
virtual platform and reality. DA
DENTAL ASIA JULY / AUGUST 2022 53