Objectives: Here we present a new digital implant planning protocol using 3-D printing, cone beam CT (CBCT), scanners and computer-assisted design software. Biomodels and surgical guides are manufactured with 3-D printers and digital planningis used to allow implant placement based on the concept of prosthetically driven implantology. Methods: The digital implant planning protocol with 3-D printers is based on the premise that digital files obtained from CBCTs and scanners can be imported to computer-assisted design (CAD) software and all phases of the treatment can be performed virtually, before implant surgery. First, CBCTs from the areas of interest are obtained. A set of frontal photographs are taken and the teeth are scanned with intra-oral scanners (impressions can be taken and scanned if an intra-oral scanner is not available). The digital CBCT files are converted from DICOM (digital imaging and communications in medicine) to stereolithography (STL) files using open-access software and imported to CAD software. Images are edited using the principles of digital smile design, and a digital wax-up is produced. Digital planning allows all the images to be overlaid (CBCT; scanned teeth plus gingiva; digital wax-up; photos) so that implant positions can be planned with all the references needed with respect to prosthetically driven implantology. When digital planning is finished, polylactic acid biomodels can be printed by 3-D printers, reproducing the area to be operated. Biomodels are particularly useful in cases where large bone defects will be grafted, because the surgeon can plan the bone reconstruction procedure and adapt bone blocks and titanium meshes more easily. Surgical guides are also printed and used to drive the burs during surgery. Three cases are described. Results: The first case was a young patient who had suffered a car accident and lost the upper incisors. Orthodontic treatment was used to obtain an ideal mesiodistal space for implant placement and a fixed bridge supported by two implants. After orthodontics, CBCT showed that bone reconstruction was needed and autologous bone grafts were planned. A biomodel was printed by 3-D printer and used to help adapt the block before elevating the flap in the area receiving the graft. After 4 months, another CBCT was obtained and the implant position was digitally planned based on the virtual wax-up. Implants were successfully placed and a fixed bridge with ceramic gingiva was built. The second case was an elderly patient who needed implant surgery for placement of two implants to support a fixed bridge. The patient already had implants on the posterior mandible and on the right central incisor. After digital wax-up and CBCT evaluation, two implants were placed and the bridge was successfully built. The third case was another young patient who needed orthodontics before surgery for single implant placement. Every step of the planning protocol was followed and the implant was placed in the predetermined position. All cases healed uneventfully and were followed up for two years or more. Conclusion: The digital implant planning protocol appears to be a feasible and affordable treatment for oral rehabilitation. It allows surgeons and restorative dentists to preview the desired results and study cases in a very detailed manner, by overlaying different images providing precise information about the relation between the teeth, gums, bone and face. The software is open-source and the 3-D printers are low-cost and use affordable polymer feedstock, so this protocol is a useful tool with an excellent cost–benefit ratio. To the best of our knowledge, we are the first to use low-cost domestic 3-D printers to manufacture biomodels and surgical guides. Case–control multicentre studies will be useful for validating the protocol and comparing the accuracy of less expensive polymer-based 3-D printers with larger, expensive industrial printers.

The Osteology Foundation’s motto is „Linking Science with Practice in Regeneration“. The foundation was established in 2003 and its core activities include funding of research projects and organisation of national and international symposia throughout the world. In recent years, the Foundation has expanded its focus. Today, it also offers courses and textbooks specifically for researchers, as well as the online platform THE BOX, which connects practitioners and scientists in the field of oral tissue regeneration worldwide, and provides tools and information. www.osteology.org

Materialliste: Parodontometer, Griff 6 (Hu-Friedy); Universal-Sonde, Griff 6 (Hu-Friedy); Spiegelgriff Nr. 6 (Hu-Friedy); Skalpellgriff rund; Raspatorium Hirschfeld; Chirurgische Kürette Prichard; Univ.-Kürette Younger-Good, Griff 6; Univ.-Kürette Ind. University, Griff 6; Univ.-Kürette Langer After-Five, Griff 6; Pinzette Gerald; Feine Pinzette; Feiner Spatel; Gewebeschere Super-Cut; Fadenschere Godman-Fox; Nadelhalter Lichtenberg; Nadelhalter Castroviejo; Arterienklemme; Skalpellklingen; Tunnelierinstrumente; Gingivektomiemesser Orban, Griff 6; Klingenhalter Universal 360°; Nahtmaterial Polypropylene C6; Nahtmaterial Polypropylene C17.