Comparison of the CBCT, CT, 3D printing, and CAD-CAM Milling options for the most accurate root form duplication required for the root analogue implant (RAI) protocol

Abstract

Background: A computerized tomography (CT) scan or a cone beam computerized tomography (CBCT) imaging techniques can be used for tooth segmentation and acquisition of a three-dimensional (3D) reconstruction using CADCAM milling and 3D printing methods. Aim: This experimental study was done to assess the accuracy of CBCT, CT, CAD-CAM milling, and 3D printing for acquiring the most accurate duplication for root analog implant (RAI). Materials and Methods: The study was an ex-vivo feasibility study comparing CBCT, CT, CAD-CAM milling, and 3D printing methods for acquiring the most accurate duplication for root analog implant (RAI). Informed consent was obtained from patients for the study purpose for recording CT and CBCT scans and to utilize the extracted teeth for research purpose. The teeth were segmented from the DICOM files of CBCT and CT scans of the patients and Standard Tessellation Language files (STL) were obtained for individual teeth. The STL files of the individual teeth obtained were printed and milled in polymethylmethacrylate material (PMMA). The study thus consisted of 5 groups-Natural teeth as control, CBCT milled group, CT milled group, CBCT printed group and CT printed group of 16 samples each. Morphological differences in the three dimensions namely apico-coronal, bucco-lingual, and mesio-distal between the natural tooth and the 3D replicas were assessed using the one-way ANOVA test using the statistical software. Results: There was no statistically significant difference among the dimensions between the CBCT, CT, CAD-CAM milling, and 3D printing groups with respect to the most accurate duplication for root analog implant (p > 0.05). Conclusion: Within the limitations of this study, the CBCT segmentation and the Milling technique produce the least distortion for fabricating the root analog implant.