Cureus · 2025
Clinical and Radiographic Assessment of Milled Versus 3D-Printed Patient-Specific Subperiosteal Implants for Atrophic Mandibular Ridges: A Randomized Clinical Trial.
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Darwish Saad A, El-Mohandes Wael A, Abd Rabbo Bahaa El-Din
Аннотация
OBJECTIVE: This study evaluated the clinical and radiographic outcomes of patient-specific subperiosteal implants fabricated via milling or 3D printing for mandibular rehabilitation in patients with severely atrophic mandibles.
METHODOLOGY: Twenty patients with severely atrophic edentulous mandibular ridges were randomly assigned to receive subperiosteal implants manufactured by Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) milling or 3D printing. Preoperative cone beam computed tomography scans and digital planning generated customized stereolithography (STL) files that guided the fabrication of implants from titanium grade 4 using either subtractive (milling) or additive (3D printing) techniques. After creating a full-thickness mucoperiosteal flap, the custom-made implants were seated and secured with mini-screws, and patients received written postoperative care instructions and medications. Primary outcomes included implant survival, bone resorption, and placement accuracy assessed by measuring mesiodistal and buccolingual angular deviations. Secondary outcomes comprised the duration of the intervention and soft tissue dehiscence evaluated at multiple postoperative intervals up to 12 months. Data were analyzed using the chi-square test for categorical data and the t-test for continuous data.
RESULTS: There were no statistically significant differences between the two groups regarding implant survival, with one implant failing in the milling group (P = 0.869). Changes in bone resorption between the baseline and after 12 months showed no statistically significant results between the two groups (P = 0.1396). The angular deviation between the planned abutments and the postoperative scans showed no statistically significant results between the two groups regarding the mesiodistal and bucco-lingual deviations (P > 0.05). The two groups showed similar results in soft tissue dehiscence and duration of the treatment, with no significant differences between them (P > 0.05).
CONCLUSIONS: Both milling and 3D printing techniques offer effective and comparable solutions for fabricating patient-specific subperiosteal implants to rehabilitate atrophic mandibles. Available resources and clinician expertise should inform the choice between these methods.
METHODOLOGY: Twenty patients with severely atrophic edentulous mandibular ridges were randomly assigned to receive subperiosteal implants manufactured by Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) milling or 3D printing. Preoperative cone beam computed tomography scans and digital planning generated customized stereolithography (STL) files that guided the fabrication of implants from titanium grade 4 using either subtractive (milling) or additive (3D printing) techniques. After creating a full-thickness mucoperiosteal flap, the custom-made implants were seated and secured with mini-screws, and patients received written postoperative care instructions and medications. Primary outcomes included implant survival, bone resorption, and placement accuracy assessed by measuring mesiodistal and buccolingual angular deviations. Secondary outcomes comprised the duration of the intervention and soft tissue dehiscence evaluated at multiple postoperative intervals up to 12 months. Data were analyzed using the chi-square test for categorical data and the t-test for continuous data.
RESULTS: There were no statistically significant differences between the two groups regarding implant survival, with one implant failing in the milling group (P = 0.869). Changes in bone resorption between the baseline and after 12 months showed no statistically significant results between the two groups (P = 0.1396). The angular deviation between the planned abutments and the postoperative scans showed no statistically significant results between the two groups regarding the mesiodistal and bucco-lingual deviations (P > 0.05). The two groups showed similar results in soft tissue dehiscence and duration of the treatment, with no significant differences between them (P > 0.05).
CONCLUSIONS: Both milling and 3D printing techniques offer effective and comparable solutions for fabricating patient-specific subperiosteal implants to rehabilitate atrophic mandibles. Available resources and clinician expertise should inform the choice between these methods.