A digital workflow for modeling of custom dental implants

Modern dental treatment with standard screw-type implants leave some cases unaddressed in patients with extreme jaw bone resorption. Custom-made subperiosteal dental implant could be an alternative treatment modality to sinus lift, nerve lateralization or zygomatic implant techniques. Subperiosteal dental implants were utilized for many years to treat such patients. A combination of traditional subperiosteal implant designs with current advancements in 3D imaging, design and printing allow to reduces treatment time and provides abutments for prostheses in cases where other techniques do not provide satisfactory results. The data manipulation and design software are important aspects in the manufacturing of custom implants. Programs that are specialized for industrial or medical design typically cost tens of thousands of US dollars. In this work I establish and test steps for design and production of a custom medical device (subperiosteal implant) from patient computed tomography (CT) data. Work stages to be defined are: selection of necessary software, CT data processing, 3D virtual model creation, modeling technique for custom implant and data file preparation for printing. Patient CT data was successfully converted into a watertight STL (Standard Tessellation Language) model of the maxilla. Error corrections and design were completed using freely available programs from Autodesk Inc.. The implant was produced in Ti64 (a type 5 titanium alloy) using three-dimensional (3D) printing DMLS (direct metal laser sintering) process. The avoidance of high cost software makes this treatment modality more accessible to smaller clinics or mid-size production facilities and subsequently more available to patients.