ONLINE ONLY

Accuracy of surgical positioning of orthodontic

miniscrews with a computer-aided design and
manufacturing template
Hong Liu,a Dong-xu Liu,b Guangchun Wang,c Chun-ling Wang,d and Zhen Zhaoa
Jinan, China

Introduction: Our objective was to enable accurate miniscrew placement after preoperative simulation. We
developed a new template for miniscrew placement and evaluated its accuracy. Methods: Eleven patients
who had bimaxillary protrusion were scanned with computed tomography. The 3-dimensional computed to-
mography data were used to produce, with stereolithography apparatus, a template for accurate miniscrew
placement. The interradicular space available for miniscrew placement was calculated in the 3-dimensional
images. Postoperative computed tomography images were matched with preoperative images to calculate
the deviations between the planned and actual placements. Results: The distance for placement of a mini-
screw between 2 roots was 4.12 mm (SD, 0.25 mm; range, 3.7-4.5 mm). The placed miniscrews showed an
average angular deviation of 1.2 (SD, 0.43 ; range, 0.6 -2.41 ) compared with the plan, whereas the mean
linear distomesial deviation was 0.42 mm (SD, 0.13 mm; range, 0.15-0.6 mm) at the tip. Conclusions: The pro-
posed template has high accuracy and will be especially useful for patients who require precise miniscrew
placement. (Am J Orthod Dentofacial Orthop 2010;137:728.e1-728.e10)

damage or suboptimal biomechanical stabilization.5-7

M
iniscrews have been used for absolute an-
chorage in orthodontics for a long time.1,2
Miniscrews are always placed in alveolar
bone between the first molar and the second premolar,
and the placement angle is always 30 (the long axis
of the miniscrew and the tooth axis) in the maxilla
and 20 in the mandible.3 However, the high failure
rates of miniscrews troubles orthodontists. According
to previous articles, the rates of failure are about 11%
to 30.4%.1,2,4 Placing a miniscrew in the limited space
between the roots of the second premolar and the first
molar causes some risk of injury to important
anatomic structures.4 Safe and optimal miniscrew stabi-
lization requires ideal placement point and trajectory.
Improper screw placement can lead to neurovascular
From Shandong University, Jinan, China.
a
Postgraduate student, Department of Orthodontics, School of Dentistry,
Shandong Provincial Key Laboratory of Oral Biomedicine.
b
Professor, Department of Orthodontics, School of Dentistry, Shandong
Provincial Key Laboratory of Oral Biomedicine.
c
Professor, Research Center of Mould.
d
Professor and chairman, Department of Orthodontics, School of Dentistry.
The authors report no commercial, proprietary, or financial interest in the
products or companies described in this article.
Supported by grants from Shandong Science and Technology Planning Project
Contract Research (2008GG30002019 and 2008GG30001001) of China.
Reprint requests to: Dong-xu Liu, Department of Orthodontics, School of
Dentistry, Shandong University, Jinan, 250012, China; e-mail, liudongxu@sdu.
edu.cn.
Submitted, October 2009; revised and accepted, December 2009.
0889-5406/$36.00
Copyright Ó 2010 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2009.12.025
To achieve precise and safe placement of miniscrews
in interradicular sites, several methods have been
developed, but they cannot guarantee precise
placement.8-14 A controllable method for miniscrew
placement and direction is important for orthodontists.
Computed tomography (CT), 3-dimensional (3D)
software, and stereolithography apparatus (SLA)
(Xi’an Jiaotong University, Xi’an, China) have been
widely used in oral medicine.9,15-23 CT has been used
for measurement of interradicular space for
miniscrews and assessment of their position. The 3D
software helps to render objects from the CT images
for diagnosis and treatment planning. Computer-aided
design and computer-aided manufacturing (CAD/
CAM) technology has been used in dental restorations
and implantology.24-26,33 The CAD/CAM template for
implants has been accepted and used widely, and
gives us another method to aid in achieving
controllable miniscrew placement. In this article, the
CAD/CAM template for orthodontic miniscrews is
introduced, and its accuracy is assessed.
MATERIAL AND METHODS
Materialise’s interactive medical image control sys-
tem (MIMICS) and Magics (both, Materialise, Leuven,
Belgium) are both widely used medical software pro-
grams. The miniscrew template described in this article
was designed with these tools.
728.e1
728.e2 Liu et al American Journal of Orthodontics and Dentofacial Orthopedics
June 2010

Fig 1. A, Miniscrew (diameter, 1.6 mm; length, 11 mm; pitch, 0.2 mm); B, self-drilling driver.

Fig 2. A, Template with buccal and lingual vestibular border extensions was fabricated on the stone
cast with the vacuum-formed technique; B, radiopaque markers were placed on the template; C and
D, template was adjusted in the mouth to ensure proper seating.

MIMICS is an interactive tool for the visualization
and segmentation of CT and magnetic resonance images
and the 3D rendering of objects. Therefore, in medicine,
MIMICS can be used for diagnosis, operation planning,
and rehearsal purposes. A flexible interface to rapid pro-
totyping systems is included for building distinctive
segmentation objects. Magics is companion software
to MIMICS; the user can further process the 3D model
(stereolithography [STL] file) that is created in
MIMICS.
Stereolithography apparatus (SLA) is the process of
using photosensitive resins cured by a laser that traces
the parts across sectional geometry layer by layer.
SLA produces accurate models with various materials.
We used a resin (SOMOS 11120 photosensitive resin,
DSM, Elgin, IL).
Eleven patients with bimaxillary protrusion agreed
to have their 4 first premolars extracted; 34 miniscrews
(Beici Medical Company, Ningbo, China; Fig 1) were
planned to provide absolute anchorage. The miniscrews
were placed in the interradicular area between the sec-
ond premolar and the first molar. Six patients received
4 miniscrews, and 5 patients had miniscrews placed in
the maxilla only.
The CAD/CAM template for the miniscrews in this
study was designed based on the CT data and fabricated
by the SLA. After preparing mounted diagnostic casts
with fully extended vestibular borders of the jaws, the
radiographic templates were fabricated with the
vacuum-formed technique (Fig 2), and the patients
and the radiographic template were scanned before the
procedure with the double-scan technique17 (the first
scan is of the patient with the radiographic template in
place, and the second scan is of the radiographic tem-
plate only). The 3D virtual models of the teeth and the
2 jaws were reconstructed based on the CT data in the
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 137, Number 6
Fig 3. A-C, 3D models of bone, teeth, and template were reconstructed; D, with references of the
radiographic markers (arrows in A and B), the 3D models were matched to each other.
MIMICS software (Fig 3, A-C) by superimposing the 2
sets of scans (the osseous tissues and the radiographic
template) with radiographic markers as reference points
(Fig 3, D). The virtual miniscrews were placed in safe
and optimal positions when the roots of teeth were visu-
alized (Fig 4, A), and the placement site and angle were
determined. The drill template was designed with the ra-
diographic guide and the 3D information of the planned
drill paths (Fig 4, B-D), and the stereolithography tem-
plate was fabricated with a CAD/CAM procedure (the
rapid prototyping [RP] apparatus was manufactured
by Xi’an Jiaotong University); the template is shown
in Figure 4, E. To improve the intensity of the template,
the positioning sleeves were cemented in the surgical
template (Fig 4, F). When the bone-teeth and radio-
graphic templates were reconstructed, the thresholds
were chosen carefully, and the thickness of the radio-
graphic template was compared with the stereolithogra-
phy one to assess the reliability of the threshold and the
accuracy of the RP.
When the 3D models of the teeth and the 2 jaws
were reconstructed, we evaluated the osseous tissues
in relation to the position of the teeth by merging the in-
dependent data, and the virtual miniscrews (cylinders)
were placed in the ideal position (proper placement
site and orientation). When the position for the mini-
screw was determined (Fig 5, A), a plane was created
along the cylinder (Fig 5, B). The distance between
the 2 roots for the miniscrew was measured. At this
plane, the minimum distance between the 2 roots was
measured. As we know, the periodontal ligament is
Liu et al 728.e3
about 0.15 to 0.38 mm thick on average,3,27 and the
diameter of the miniscrew in this study was 1.6 mm.
The virtual screw was placed in the midline of the 2
roots, and the safe deviation for the miniscrew could
be calculated by the formula, C 5 A/2 – B – 0.4 mm,
where A is the interradicular distance, B is the radius
of the miniscrew, and C is the safe deviation. The
periodontal ligament was assumed to be 0.4 mm thick
in this study for safe placement. Thus, the allowed
deviation for the miniscrew was obtained and used as
the control for assessment of the accuracy of the
template.
After a local anesthetic was given, the surgical tem-
plate was placed intraorally. The seating of the template
should be confirmed, and the surgical template should
be held in place by the patient’s bite force. Once it
was seated, the patient was asked to bite the template
to expose the surgical sites of the guide; then the self-
drilling miniscrews were placed with a screwdriver
(Fig 6).
The surgical procedures were performed unevent-
fully, and the patients were scanned with CT again.
The postoperative 3D models of the teeth, maxillae,
mandibles, and miniscrews were reconstructed and reg-
istered with the preoperative 3D models by using the
same anatomic sites as landmark points (Fig 7). The
point registration easily moved an STL image to a cer-
tain location. This was done by placing 4 sets of land-
mark points on the STL images, 3D objects, and
images. MIMICS then calculated the transformation
matrix for the best fit between the start and end points
728.e4 Liu et al American Journal of Orthodontics and Dentofacial Orthopedics
June 2010

Fig 4. A and B, In the 3D models, the virtual miniscrews (black arrows) were placed in ideal positions;
C and D, trajectories for miniscrew placement along the cylinders (yellow arrows), and the virtual tem-
plate was exported in sterolithography format; E, templates fabricated by SLA; F, bonded with
guided sleeves in the trajectory and adjusted to ensure proper seating on the cast.

and applied that transformation matrix on the selected
STL images. Because of the radiographic template on
the occucal surface, the mandible’s position on the be-
fore and after CT images was different, so the mandible
and maxilla must be registered separately (Fig 7). After
point registration, the STL registration was performed
to register STL images on masks to improve the accu-
racy of registration. Registrations were performed 3
times in 2 weeks, and we chose the best one for mea-
surements of this study (Fig 8).
To measure the deviation of the center position of
the miniscrews from the planned position (cylinders)
in 3 dimensions, the new 3D coordinate was adjusted
and defined at the apex of the virtual miniscrew in
Magics (Fig 9). The x, y, and z axes were defined: the
x-axis represents the distomesial position, the y-axis
represents the vertical position, and the z-axis represents
the buccopalatal position. The 3D deviation of the ac-
tual miniscrew was calculated at the apex and the place-
ment site (Fig 9). The x, y, and z values at the apex
represented the deviation of the actual miniscrew. In
this way, the deviation was evaluated in 3 directions,
and the distomesial position (x-axis) was more impor-
tant for the security of the miniscrew. In this study, we
mainly focused on assessing this axis. As for angle de-
viations, they were hard to evaluate, since the angle be-
tween the actual miniscrew and the simulated one
showed a twisted relationship. Therefore, in this study,
both central axes were projected to the mesiodistal
axis, and the deviation of the angle between them was
calculated with the formula, q 5 tan – 1 (b – a)/c, where
a is the deviation at the tail, b is the deviation at the
head, and c is the length of the miniscrew in the bone.
At the placement sites, there was little deviation, so
the deviation there was measured with linear CT mea-
surements instead of 3D assessment.
Statistical analysis
All measurements were repeated for 15 randomly
selected subjects, with a 1-week interval, to assess intra-
examiner reliability, which showed no statistical
American Journal of Orthodontics and Dentofacial Orthopedics Liu et al 728.e5
Volume 137, Number 6

Fig 5. When the position of the miniscrew was determined, the minimum distance between the roots
was measured at the new plane.

Fig 6. A-C, Local anesthetic was administered, and the miniscrews were placed with the aid of the
surgical template (screwdriver shown as black arrows); D, the miniscrews (red arrows) were placed in
the proper positions.

differences (P .0.05) from the paired t test. The method RESULTS

error according to Dahlberg’s formula was 93.2.34 The
means and standard deviations of the measurements
were calculated. To compare the template deviation
with the allowed deviation, a paired t test was used,
and 2-way analysis of variance (ANOVA) was used to
analyze the deviations in 3 direction (SPSS for Win-
dows, version 11.5, SPSS, Chicago, Ill). P \0.05 was
considered to be statistically significant.
The interradicular safe zones for miniscrews in the
11 patients ranged from 3.7 to 4.5 mm, with an average
of 4.12 6 0.247 mm (mean 6 SD). The allowed devia-
tion ranged from 0.65 to 1.05 mm, with an average of
0.86 6 0.125 mm (mean 6 SD).
The templates were adapted to the patients in a satis-
factory and stable manner. All miniscrews were placed
smoothly without problems. Some miniscrews did not
728.e6 Liu et al
Fig 7. A, Pretreatment; and B, posttreatment models registered with the same anatomic sites as
landmarks (maxillary [black arrows], mandibular [red arrows]); C and D, registrations of the 2 models.
touch the adjacent roots (Fig 8, B). The accuracy of dril-
ling, and the deviations of the positions and angles of the
actual miniscrew from the simulations, were examined
in 3 directions.
The position deviations at the distomesial, vertical,
and buccopalatal directions were 0.42 6 0.13, 0.47 6
0.12, and 0.59 6 0.26 mm at the tip, respectively, and
0.10 6 0.012 mm at the placement sites. The miniscrew
deviations of the angles from the planned position at the
distomesial, vertical, and buccopalatal directions were
1.2 6 0.43 , 1.3 6 0.41 , and 1.6 6 0.79 , respec-
tively. No statistically significant differences were ob-
served between the deviations at the distomesial and
vertical directions. The buccopalatal deviation was
greater than the other 2 directions, with a significant dif-
ference (Fig 10, A). In this study, the deviations at the
vertical and buccopalatal directions did not influence
the security of miniscrew; we focused mainly on the di-
stomesial deviations. All deviations of the miniscrews
were in the safe zone, and each actual deviation was
smaller than the allowed one. As seen in Figure 10,
the deviation of the template guide group was signifi-
cantly smaller than that of the control group (allowed
deviation); the difference was statistically significant
(P \0.05).
DISCUSSION
CT is an important diagnostic tool for the craniofa-
cial region and is used for many applications including
the study of its various components, growth, develop-
American Journal of Orthodontics and Dentofacial Orthopedics
June 2010
mental anomalies, impacted teeth, management of max-
illofacial trauma, treatment planning for orthognathic
and reconstructive surgery, bone grafting, distraction
osteogenesis, and dental implantology. Qualitative and
quantitative findings and measurements from CT tech-
niques are accurate and reproducible, and offer greater
and more reliable assessment of deeper anatomic struc-
tures than systems involving biplanar radiography.5,7-12,30
Yet there are many reports on the use of CT to measure
interradicular spaces for placement of miniscrews.
Poggio et al,27 Park,31 and Carano et al32 measured
the distances between the roots of adjacent teeth using
different methods; they all demonstrated that interra-
dicular spaces for miniscrews are limited, and minis-
crews must be placed accurately. In those studies,
the measurements of interradicular spaces for minis-
crews were based on 2-dimensional (2D) images
(slices) of the CT scans. However, miniscrews are al-
ways placed with an inclined angle, obviously limiting
measurement of the 2D images.3 In this study, the 3D
interpolation technique that transforms 2D images
(slices) into 3D models was used; with 3D software,
the simulated miniscrew can be placed in an ideal
position. Along the axis of the miniscrew, the mesio-
distal distance between adjacent roots can be
measured individually, and the safe zone for the mini-
screw was calculated. By using this method, the safe
zone is more reliable, and the mesiodistal distance
between the 2 roots was shown to be limited for
miniscrew placement (Fig 10, B).
American Journal of Orthodontics and Dentofacial Orthopedics Liu et al 728.e7
Volume 137, Number 6

Fig 8. After registration, the actual miniscrews (red arrows) were matched to the virtual ones (black
arrows): A, pretreatment models; B, posttreatment models; C and D, registrations of the 2 models.

Fig 9. A and B, Registration of virtual and actual miniscrews; C, new 3D coordinate was adjusted and
defined at the apex of the virtual miniscrew in Magics software; D, measurement of the 3D distance of
the virtual and actual miniscrews at the apex.

The CAD/CAM surgical template has been widely
used for implants and prostheses, and its accuracy had
been shown in many studies.24-29 Similar to implants,
miniscrews placed in limited interradicular spaces
need high accuracy. The CAD/CAM template gives
orthodontists another safe way to place miniscrews.
Accuracy and security were evaluated in this study,
and it was demonstrated that the surgical template can
place the miniscrew in the safe zone with limited
deviation. Many reasons were proposed to account for
the deviations observed in the template evaluation, as
follows.
The stability and inherent support of the template is
surely a crucial factor.24,28 In this study, the template
was supported by 2 surfaces—occusal teeth and
buccal mucosa—and the bite force on the template
728.e8 Liu et al American Journal of Orthodontics and Dentofacial Orthopedics
June 2010

Fig 10. A, Deviations in 3 directions; B, allowed and actual distomesial deviations. No statistically
significant differences were observed between the distomesial and vertical deviation groups. The
buccopalatal deviation was greater than other 2 directions. The actual distomesial deviation was sig-
nificantly smaller than that of the control group (allowed deviation) (P \0.05).

provided support to keep it stable. So the interocclusal
record with a rigid vinyl polysiloxane (Access Blue,
Centrix Dental, Shelton, Conn) for the patient to hold
the radiographic template in position during the CT
scan and prevent movement could help hold the CAD/
CAM template in the right position.
The size of the 3D model depends on the threshold
value, which is a specific density on a slice image that
separates the organ of interest and other regions. There-
fore, it is important to select the proper threshold value.
An inadequate threshold value of the radiographic tem-
plate affected the accuracy of the STL model greatly. In
this study, the maxillary, mandibular, teeth, and radio-
graphic templates were reconstructed with different
threshold values (387-1988HU, 415-1988HU, 1430-
2850HU, and -630-690HU in Mimics). When the 3D
models are reconstructed, the size must be compared
to the actual one, so that the proper threshold can be ob-
tained.
During the procedure of template design, the regis-
tration was based on the landmarks that were added on
the radiographic template (Fig 2, A and B). The accu-
racy was assessed after the registration of the preoper-
ative and postoperative models. In this study, the
combination of 2 registration methods improved
the accuracy. The before and after models were the
same, but the miniscrews and the STL images’ regis-
trations achieved better results. Repeated registrations,
choosing the best registration by visual inspection, and
identifying corresponding landmarks ensured the accu-
racy of the registrations. The registrations were per-
formed carefully, and the results were satisfactory
(Figs 8 and 9).
RP is a relatively new technology that produces
physical models by selectively solidifying ultraviolet-
sensitive liquid resin with a laser beam. Choi et al29 in-
vestigated errors generated during the production of
medical RP models and showed that the absolute
mean deviation between the original and RP models
over the 16 linear measurements was 0.56% 6 0.39%;
this had little influence on the accuracy of the template.
In our study, the thickness of the template was mea-
sured, and the mean deviation was about 0.87% 6
0.45%, so that the RP deviation caused little change in
the deviation of miniscrew placement.
The template in the study was designed with CAD/
CAM implant template methods, but there are still some
differences. A miniscrew is placed in the buccopalatal
direction and an implant is in the vertical direction, so
the shape and the support methods are different with
the implant template. To keep the miniscrew stable, at
least 1 anchor pin through the alveolar process is used
for more support of the implant template. The mini-
screw template remains stable from the patient’s bite
force. There are scale markers at the head of the drills
for implant depth control, and we also put a marker
on the screwdriver to control the depth of the minis-
crews in this study; 3D control of miniscrew was
achieved even though the buccopalatal deviation was
greater than in the other 2 directions (Fig 10, A).
The template still has some deficiencies, and im-
provement of its elaborate design and further studies
should be performed to evaluate the reliability, validity,
and global applicability of stereolithographic surgical
guides for miniscrews. The high radiation of a CT
scan and the high cost limit the broad use of this
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 137, Number 6
CAD/CAM guide for miniscrews. But this study
showed a CAD/CAM guide system constructed for or-
thodontic miniscrews similar to prosthetic implant
guides and verified that the accuracy of the CAD/
CAM template was enough for miniscrew control and
safe placement.
CONCLUSIONS
Within the limits of this study, we presented an ac-
curacy evaluation of the CAD/CAM template for minis-
crews, and the registrations of the 3D models
reconstructed with the preoperative and postoperative
CT data were validated. The average measured devia-
tions of the miniscrews were in the safe range. These re-
sults verified the template’s accuracy and security. The
template, manufactured with the Nobel method, can
provide safe placement for miniscrews.
We thank Professor Guang-chun Wang for his assis-
tance.
REFERENCES
1. Cheng SJ, Tseng IY, Lee JJ, Kok SH. A prospective study of the
risk factors associated with failure of mini-implants used for or-
thodontic anchorage. Int J Oral Maxillofac Implants 2004;19:
100-6.
2. Wiechmann D, Meyer U, Büchter A. Success rate of mini- and
micro-implants used for orthodontic anchorage: a prospective
clinical study. Clin Oral Implants Res 2007;18:263-7.
3. Lim JE, Lim WH, Chun YS. Quantitative evaluation of cortical
bone thickness and root proximity at maxillary interradicular sites
for orthodontic mini-implant placement. Clin Anat 2008;21:
486-91.
4. Kravitz ND, Kusnoto B. Risks and complications of orthodontic
miniscrews. Am J Orthod Dentofacial Orthop 2007;131:43-51.
5. Moon CH, Lee DG, Lee HS, Jin JS, Baek SH. Factors associated
with the success rate of orthodontic miniscrews placed in the up-
per and lower posterior buccal region. Angle Orthod 2008;78:
101-6.
6. Yuan-Hou Chen, Hao-Hueng Chang, Yi-Jane Chen, David Lee,
Hsien-Hsiung Chiang, Chung-Chen Jane Yao. Root contact dur-
ing insertion of miniscrews for orthodontic anchorage increases
the failure rate: an animal study. Clin Oral Implants Res 2008;
19:99-106.
7. Kuroda S, Yamada K, Deguchi T, Hashimoto T, Kyung HM,
Takano-Yamamoto T. Root proximity is a major factor for screw
failure in orthodontic anchorage. Am J Orthod Dentofacial Orthop
2007;131(Suppl):S68-73.
8. Park HS, Jeong SH, Kwon OW. Factors affecting the clinical
success of screw implants used as orthodontic anchorage. Am J
Orthod Dentofacial Orthop 2006;130:18-25.
9. Sammartino G, Della Valle A, Marenzi G, Gerbino S,
Martorelli M, di Lauro AE, et al. Stereolithography in oral im-
plantology: a comparison of surgical guides. Implant Dent
2004;13:133-9.
10. Adams GL, Gansky SA, Miller AJ, Harrell WE, Hatcher DC.
Comparison between traditional 2-dimensional cephalometry
and a 3-dimensional approach on human dry skulls. Am J Orthod
Dentofacial Orthop 2004;126:397-409.
Liu et al 728.e9
11. De Smet E, Jacobs R, Gijbels F, Naert I. The accuracy and reliabil-
ity of radiographic methods for the assessment of marginal bone
level around oral implants. Dentomaxillofac Radiol 2002;31:
176-81.
12. Suzuki EY, Suzuki B. A simple three-dimensional guide for safe
miniscrew placement. J Clin Orthod 2007;41:342-6.
13. Maino BG, Bednar J, Pagin P, Mura P. The spider screw for skel-
etal anchorage. J Clin Orthod 2003;37:90-7.
14. Graham JW, Cope JB. Miniscrew troubleshooting—how to
manage potential complications of using temporary anchorage
devices. Orthod Prod 2006;13:26-32.
15. Lal K, White GS, Morea DN, Wright RF. Use of stereolitho-
graphic templates for surgical and prosthodontic implant plan-
ning and placement. Part I. The concept. J Prosthodont 2006;
15:51-8.
16. Tardieu PB, Vrielinck L, Escolano E. Computer-assisted implant
placement. A case report: treatment of the mandible. Int J Oral
Maxillofac Implants 2003;18:599-604.
17. Marchack CB. CAD/CAM-guided implant surgery and fabrica-
tion of an immediately loaded prosthesis for a partially edentulous
patient. J Prosthet Dent 2007;97:389-94.
18. Rosenfeld AL, Mandelaris GA, Tardieu PB. Prosthetically
directed implant placement using computer software to ensure
precise placement and predictable prosthetic outcomes. Part
3: stereolithographic drilling guides that do not require bone
exposure and the immediate delivery of teeth. Int J Periodontics
Restorative Dent 2006;26:493-9.
19. Van Steenberghe D. Interactive imaging for implant planning.
J Oral Maxillofac Surg 2005;63:883-4.
20. Ganz SD. Techniques for the use of CT imaging for the fabrication
of surgical guides. Atlas Oral Maxillofac Surg Clin North Am
2006;14:75-97.
21. van Steenberghe D, Glauser R, Blombäck U, Andersson M,
Schutyser F, Pettersson A, et al. A computed tomographic scan-
derived customized surgical template fixed prosthesis for flapless
surgery immediate loading of implants in fully edentulous maxil-
lae: a prospective multicenter study. Clin Implant Dent Relat Res
2005;7(Suppl 1):S111-20.
22. Hieu LC, Bohez E, Vander Sloten J, Phien HN, Vatcharaporn E,
An PV, et al. Design and manufacturing of personalized implants
and standardized templates for cranioplasty applications. Pro-
ceedings of the 2002 IEEE International Conference on Industrial
Automations; 2002 Dec 11-14; Bangkok, Thailand. Vol. 2. Bang-
kok, Thailand; 2002. p. 1025-30, http://ieeexplore.ieee.org/xpl/
freeabs_all.jsp?arnumber=1189312.
23. Nickenig HJ, Eitner S. Reliability of implant placement after vir-
tual planning of implant positions using cone beam CT data and
surgical (guide) templates. J Craniomaxillofac Surg 2007;35:
207-11.
24. Sarment DP, Sukovic P, Clinthorne N. Accuracy of implant place-
ment with a stereolithographic surgical guide. Int J Oral Maxillo-
fac Implants 2003;18:571-7.
25. Ruppin J, Popovic A, Strauss M, Spüntrup E, Steiner A, Stoll C.
Evaluation of the accuracy of three different computer-aided sur-
gery systems in dental implantology: optical tracking vs. stereoli-
thographic splint systems. Clin Oral Implants Res 2008;19:
709-16.
26. Suzuki EY, Suzuki B. Accuracy of miniscrew implant placement
with a 3-dimensional surgical guide. J Oral Maxillofac Surg 2008;
66:1245-52.
27. Poggio PM, Incorvati C, Velo S, Carano A. ‘‘Safe zones’’: a guide
for miniscrew positioning in the maxillary and mandibular arch.
Angle Orthod 2006;76:191-7.
728.e10 Liu et al
28. Ohtani T, Kusumoto N, Wakabayashi K, Yamada S, Nakamura T,
Kumazawa Y, et al. Application of haptic device to implant
dentistry—accuracy verification of drilling into a pig bone.
Dent Mater J 2009;28:75-81.
29. Choi JY, Choi JH, Kim NK, Kim Y, Lee JK, Kim MK, et al.
Analysis of errors in medical rapid prototyping models. Int J Oral
Maxillofac Surg 2002;31:23-32.
30. Suri S, Utreja A, Khandelwal N, Mago SK. Craniofacial comput-
erized tomography analysis of the midface of patients with re-
paired complete unilateral cleft lip and palate. Am J Orthod
Dentofacial Orthop 2008;134:418-29.
American Journal of Orthodontics and Dentofacial Orthopedics
June 2010
31. Park HS. An anatomical study using CT images for the implanta-
tion of micro-implants. Korean J Orthod 2002;32:435-41.
32. Carano A, Velo S, Incorvati C, Poggio P. Clinical applications of
the mini-screw-anchorage-system (M.A.S.) in the maxillary alve-
olar bone. Prog Orthod 2004;5:212-35.
33. Rudolph H, Luthardt RG, Walter MH. Computer-aided analy-
sis of the influence of digitizing and surfacing on the accuracy
in dental CAD/CAM technology. Comput Biol Med 2007;37:
579-87.
34. Houston WJB. The analysis of errors in orthodontic measure-
ments. Am J Orthod 1983;83:382-90.