Measurable (Minimal) Residual Disease in Myelodysplastic Neoplasms (MDS): Current State and Perspectives.

Myelodysplastic Neoplasms (MDS) have been traditionally studied through the assessment of blood counts, cytogenetics, and morphology. In recent years, the introduction of molecular assays has improved our ability to diagnose MDS. The role of Measurable (minimal) Residual Disease (MRD) in MDS is evolving, and molecular and flow cytometry techniques have been used in several studies. In this review, we will highlight the evolving concept of MRD in MDS, outline the various techniques utilized, and provide an overview of the studies reporting MRD and the correlation with outcomes.

Effect of guided implant placement learning experiences on freehand skills: A pilot study.

OBJECTIVES: Guided implant systems can be used as a training approach for placing implants. This in vitro prospective randomized pilot study evaluated the learning progression and skill development in freehand placement of two implants supporting a three-unit fixed prosthesis on a simulation model among novice operators. MATERIAL AND METHODS: Four senior dental students with no prior implant placement experience participated in the study. As a baseline, each student placed two mandibular and two maxillary implants by freehand technique on a simulation model. Sixteen consecutive guided placements using a static guide, dynamic navigation, and template-based guide followed totaling 32 guided implant placements into maxillary and mandibular models. Freehand implant placements before and after the various guided navigation attempts were compared to assess their impact on freehand skill. Metrics compared included surgical time, horizontal, vertical, and angulation discrepancies between the planned and placed implant positions measured on superimposed CBCT scans and analyzed with repeated measures regression with Tukey's adjusted pairwise comparisons (α = .05). RESULTS: Before training with guided techniques, the average baseline freehand implant placement took 10.2 min and decreased to 8.2 after training but this difference was not statistically significant (p = .1670) There was marginal evidence of a significant difference in the 3D apex deviation with an average improvement of 0.89 mm (95% CI: -0.38, 2.16, p = .1120); and marginal evidence of a significant improvement in the overall angle with an average improvement of 3.74° (95% CI: -1.00, 8.48, p = .0869) between baseline and final freehand placement attempts. CONCLUSIONS: Within the limitations of this pilot study, guided implant placement experiences did not significantly benefit or hinder freehand placement skills. Dental students should be exposed to various placement techniques to prepare them for clinical practice and allow them to make informed decisions on the best technique based on their skills and a given clinical scenario.

Plasmablastic transformation of chronic lymphocytic leukemia: a review of literature and report on 2 cases.

Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is the most common leukemia in adults in Western countries. Transformation of CLL/SLL to plasmablastic lymphoma (PBL) is exceedingly rare and often has an extremely poor response to treatment. A thorough molecular workup may help in determining clonality-relatedness and prognosis. We describe two cases of CLL/SLL that transformed into PBL, with an extensive molecular workup in one case, and a review of the literature.

Specialization in Acute Type A Aortic Dissection Repair: The Outcomes and Challenges.

With increasing specialization within the field of cardiac surgery and a positive relationship between case volume and surgical outcomes in many areas, the concept of dedicated aortic surgeons performing acute type A aortic dissection (ATAAD) repair was investigated. From 1996 to 2014, 436 patients underwent open surgical repair of an ATAAD and were subsequently divided based on surgeon subspecialization, aortic-surgeon (AS, n = 401) vs non-aortic-surgeon (NAS, n = 35). Each aortic surgeon performed an average of 13 ATAAD repair operations per year. Preoperative comorbidities were similar between groups. Intraoperatively, the AS group had 36% aortic root replacement vs 23% in the NAS group, P = 0.12, and 36% zone 1/2/3 arch replacement vs 26% in the NAS group, P = 0.20). Postoperatively, the AS group had significantly better outcomes, including intraoperative mortality (1.2% vs 5.7%), 30-day mortality (6.5% vs 17%), and composite outcomes (23% vs 46%). Multivariable logistic regression showed NAS was a risk factor for 30-day mortality with an odds ratio (OR) of 4.4 (P = 0.03), as were COPD (OR = 4.0, P = 0.046) and cardiogenic shock (OR = 13.4, P < 0.0001). The 10-year survival was 66% in the AS group vs 46% in the NAS group, P = 0.02. NAS (HR = 2.2), Age (hazard ratio (HR) = 1.05), COPD (HR = 1.96), acute stroke (HR = 3.0), and New York Heart Association class III or IV (HR = 1.75) were significant risk factors for long-term mortality. Managing ATAAD by subspecialized aortic surgeons resulted in improved short- and long-term outcomes. Our specialty could consider ATAAD repair by high-volume aortic surgeons for better patient outcomes.

Influence of Metal Guide Sleeves on the Accuracy and Precision of Dental Implant Placement Using Guided Implant Surgery: An In Vitro Study.

PURPOSE: Metal sleeves are commonly used in implant guides for guided surgery. Cost and sleeve specification limit the applications. This in vitro study examined the differences in the implant position deviations produced by a digitally designed surgical guide with no metal sleeve in comparison to a conventional one with a metal sleeve. MATERIALS AND METHODS: The experiment was conducted in two steps for each step: n = 20 casts total, 10 casts each group; Step 1 to examine one guide from each group with ten implant placements in a dental cast, and Step 2 to examine one guide to one cast. Implant placement was performed using a guided surgical protocol. Postoperative cone-beam computed tomography images were made and were superimposed onto the treatment-planning images. The implant horizontal and angulation deviations from the planned position were measured and analyzed using t-test and F-test (p = 0.05). RESULTS: For Step 1 and 2, respectively, implant deviations for the surgical guide with sleeve were -0.3 ±0.17 mm and 0.15 ±0.23 mm mesially, 0.60 ±1.69 mm, and -1.50 ±0.99 mm buccolingual at the apex, 0.20 ±0.47 mm and -0.60 ±0.27 mm buccolingual at the cervical, and 2.73° ±4.80° and -1.49° ±2.91° in the buccolingual angulation. For Step 1 and 2, respectively, the implant deviations for the surgical guide without sleeve were -0.17 ±0.14 mm and -0.06 ±0.07 mm mesially, 0.35 ±1.04 mm and -1.619 ±1.03 mm buccolingual at the apex, 0.10 ±0.27 mm and -0.62 ±0.27 mm buccolingual at the cervical, and 1.73° ±3.66° and -1.64° ±2.26° in the buccolingual angulation. No statistically significant differences were found in any group except for mesial deviation of the Step 2 group (F-test, p < 0.001). CONCLUSIONS: A digitally designed surgical guide with no metal sleeve demonstrates similar accuracy but higher precision compared to a surgical guide with a metal sleeve. Metal sleeves may not be required for guided surgery.

Comparison of Accuracy and Time for Four Implant Placement Techniques Supporting Fixed-Partial Denture.

Various guiding methods are used to place implants. This ex vivo pilot study used a convenience sample to examine time and accuracy for placement of 2 dental implants supporting a 3-unit fixed prosthesis on a simulation model using freehand and 3 guided placement techniques. Four operators with no prior implant placement experiences were randomly assigned placement of 2 maxillary or mandibular implants for a fixed prosthesis. Techniques included dynamic navigation (DN), static guide (SG), template-based guide (TBG), and freehand placement (FH). Preoperative and operative times were recorded. Discrepancies between the planned and placed implant positions were assessed by superimposing preoperative and postoperative cone beam computerized tomography scans. Data were analyzed with repeated-measures regression with Tukey's adjusted pairwise comparisons (α = 0.05). Dynamic navigation was associated with the longest operative time (13.5 minutes vs 5-10.2, P = .0001) but overall fastest when incorporating preoperative time (32.1 minutes vs 143-181.5, P < .0001). All deviation measures were significantly associated with the placement method (P < .05) except apex vertical deviation (P = .3925). Implants placed by SG had significantly lower entry 2-dimensional deviation than the other methods, particularly on the mandible. The DN and SG methods had significantly lower Apex 3D and overall angle deviations, again particularly on the mandible. The mandible had significantly higher deviations than maxilla. Within limitations of this study, implant placement by novice operators is more accurate when using dynamic and static guidance compared to freehand and template-based techniques.

The Clinical Impact of Implementation of a Multidisciplinary Endocarditis Team.

BACKGROUND: Infectious endocarditis is associated with substantial in-hospital mortality of 15%-20%. Effective management requires coordination between multiple medical and surgical subspecialties, which can often lead to disjointed care. Previous European studies have identified multidisciplinary endocarditis teams as a tool for reducing endocarditis mortality. METHODS: The multidisciplinary endocarditis team was formed in May 2018. The group developed an evidence-based algorithm for management of endocarditis that was used to provide recommendations for hospitalized patients over a 1-year period. Mortality outcomes were then retroactively assessed and compared to a historical control utilizing propensity matching. RESULTS: Between June 2018 and June 2019 the team provided guideline-based recommendations on 56 patients with Duke Criteria-definite endocarditis and at least 1 American Heart Association indication for surgery. The historical control included 68 patients with definite endocarditis and surgical indications admitted between July 1, 2014, and June 30, 2015. In-hospital mortality decreased significantly from 29.4% in 2014-2015 to 7.1% in 2018-2019 (P < .0001). There was a non-significant increase in the rate of surgical intervention after implementation of the team (41.2% vs 55.4%; P = 0.12). Propensity score matching demonstrated similar results. CONCLUSIONS: Implementation of a multidisciplinary endocarditis team was associated with a significant 1-year decrease in all-cause in-hospital mortality for patients with definite endocarditis and surgical indications, in the presence of notable differences between the 2 studied cohorts. In conjunction with previous studies demonstrating their effectiveness, these data support the idea that widespread adoption of endocarditis teams in North America could improve outcomes for this patient population.

Odontogenic Keratocyst Is Frequently Misdiagnosed for a Lateral Periodontal Cyst in Premolar and Anterior Tooth-Bearing Areas.

INTRODUCTION: Radiolucent lesions with gingival swelling found in the premolar and intercanine region can elicit a different clinical diagnosis than one confirmed by histologic findings. The purpose of the study is to identify and present the frequency of the unexpected microscopic diagnosis of odontogenic keratocyst (OKC) in a location preoperatively favoring a lateral periodontal cyst (LPC) with similar clinical and radiographic appearance. METHODS: A retrospective analysis of biopsies received from 2011 and 2019 was performed, and the number of LPC and OKC cases was assessed. The alignment of clinical and radiographic diagnosis to histologic findings and anatomic location was analyzed, and the number of OKC cases preoperatively misdiagnosed as LPCs was identified. RESULTS: A total of 79,257 biopsies were received. Of those, 184 were diagnosed as LPCs and 742 as OKCs. For all preoperatively diagnosed LPCs, the clinical and histologic diagnosis aligned; however, 182 of 742 OKCs were submitted with a clinical misdiagnosis of LPCs. The location of these lesions with the unanticipated diagnosis overlapped with those for LPCs, specifically the maxillary and mandibular anterior and premolar regions. CONCLUSIONS: Radiolucent lesions with gingival swelling in the premolar and intercanine region are frequently clinically and radiographically misdiagnosed. A biopsy should be considered in all cases to establish the correct pathologic diagnosis and treatment course.

Tracking Tag Stabilization With a Small-Diameter Implant in an Edentulous Mandible to Assist Dynamically Navigated Surgery: A Case Report.

This report describes the use of a temporary dental implant to secure a radiographic fiducial marker and patient-tracking tag to an edentulous mandible for dynamically guided implant placement into a fibula microvascular free flap. A small-diameter dental implant was placed into the anterior mandible to secure a radiographic fiducial marker followed by a patient tag. The patient tag allowed for tracking of the patient's mandible during placement of endosseous dental implants. Four endosseous dental implants were successfully placed into the edentulous fibula free flap mandibular reconstruction. Dynamic navigation using a small-diameter implant to secure radiographic fiducial markers and patient tags provides a novel technique to place implants into an edentulous microvascular free flap with minimal incision and reflection of soft tissue.

A step-by-step guide to implementing a multidisciplinary endocarditis team.

Over the last several years multiple studies, primarily from European centers have demonstrated the clinical and outcomes benefits of multidisciplinary endocarditis teams. Despite this literature, adoption of this approach to patient care has been slower in the United States. While there is literature outlining the optimal composition of an endocarditis team, there is little information to guide providers as they attempt to transform practice from a fragmented, disjointed process to an efficient, collaborative care model. In this review, the authors will outline the steps they took to create and implement a successful multidisciplinary endocarditis team at the University of Michigan. In conjunction with existing data, this piece can be used as a resource for clinicians seeking to improve the care of patients with endocarditis at their institutions.

Effects of two Postprocessing Methods onto Surface Dimension of in-Office Fabricated Stereolithographic Implant Surgical Guides.

PURPOSE: To evaluate the effects of two postprocessing methods in terms of the overall, intaglio, and cameo surface dimensions of in-office stereolithographic fabricated implant surgical guides. MATERIALS AND METHODS: Twenty identical implant surgical guides were fabricated using a stereolithographic printer. Ten guides were postprocessed using an automated method. The other ten guides were postprocessed using a series of hand washing in combination with ultrasonics. Each guide was then scanned using cone-beam computed tomography to produce a set of digital imaging and communications in medicine (DICOM) files which were converted into standard tessellation language (STL) files. The STL file was then superimposed onto the original STL design file using the best fit alignment. The average positive and negative surface discrepancy differences in terms of means and variances were analyzed using t-test (α = 0.05). RESULTS: For the alternative group, the average positive and negative overall, intaglio, and cameo surface discrepancies were 77.38 ± 10.68 µm and -67.74 ± 6.55 µm; 78.83 ± 8.65 µm and -68.16 ± 5.26 µm; and 70.5 ± 8.48 µm -64.84 ± 5.55 µm, respectively. For the automated group, the average positive and negative overall, intaglio, and cameo surface discrepancies were 51.88 ± 4.38 µm and -170.7 ± 11.49 µm; 64.3 ± 4.44 µm and -89.45 ± 6.25 µm; and 83.59 ± 4.81 µm and -144.26 ± 13.19 µm, respectively. There was a statistical difference between the means of the two methods for the overall, intaglio, and cameo positive and negative discrepancies (p < 0.001). CONCLUSIONS: For a single implant tooth-supported implant guide, using hand washing with ultrasonics appeared to be consistently better than the automated method. The manual method presented with more positive discrepancies, while the automated method presented with more negative discrepancies.

In Vitro Comparison of Time and Accuracy of Implant Placement Using Trephine and Conventional Drilling Techniques Under Dynamic Navigation.

The aim of this randomized in vitro study was to compare the time and accuracy of implant-site preparation and implant placement using a trephine drill versus a conventional drilling technique under dynamic navigation. In total, 42 implants were placed in simulation jaw models with the 2 drilling techniques by 2 operators who had previous experience with dynamic navigation. The timing of each implant placement was recorded, and horizontal, vertical, and angulation discrepancies between the planned and placed implants were compared. There was no significant difference in time or accuracy between the trephine and conventional drilling techniques. Implant-site preparation with a single trephine drill using dynamic navigation was as accurate under in vitro experimental conditions as a conventional drilling sequence.

Oral Soft Tissue Grafting.

The presence of healthy soft tissue at the tooth and implant interface correlates to long-term success and stability in function and esthetics. Grafting procedures utilizing various techniques can be performed during any stage of the implant or restorative therapy. Materials of autogenous, allogeneic, and xenogeneic sources are available for oral soft tissue grafting. This article describes the classifications of soft tissue defects, treatment modalities, and materials used to enhance soft tissue quality and quantity and to achieve optimal esthetics and function around teeth and implants.

Anti-Tumor Effects of Biomimetic Sulfated Glycosaminoglycans on Lung Adenocarcinoma Cells in 2D and 3D In Vitro Models.

Lung cancer development relies on cell proliferation and migration, which in turn requires interaction with extracellular matrix (ECM) components such as glycosaminoglycans (GAGs). The mechanisms through which GAGs regulate cancer cell functions are not fully understood but they are, in part, mediated by controlled interactions with cytokines and growth factors (GFs). In order to mechanistically understand the effect of the degree of sulfation (DS) of GAGs on lung adenocarcinoma (LUAD) cells, we synthesized sulfated alginate (AlgSulf) as sulfated GAG mimics with DS = 0.0, 0.8, 2.0, and 2.7. Human (H1792) and mouse (MDA-F471) LUAD cell lines were treated with AlgSulf of various DSs at two concentrations 10 and 100 µg/mL and their anti-tumor properties were assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), trypan blue exclusion, and wound healing assays for 2D models and sphere formation assay for the 3D model. The proliferation and number of live MDA-F471 cells at the concentration of 100 µg/mL decreased significantly with the increase in the DS of biomimetic GAGs. In addition, the increase in the DS of biomimetic GAGs decreased cell migration (p < 0.001 for DS = 2.0 and 2.7 compared to control) and decreased the diameter and number of spheres formed (p < 0.001). The increased DS of biomimetic GAGs attenuated the expression of cancer stem cell (CSC)/progenitor markers in the 3D cultures. In conclusion, GAG-mimetic AlgSulf with increased DS exhibit enhanced anti-proliferative and migratory properties while also reducing growth of KRAS-mutant LUAD spheres in vitro. We suggest that these anti-tumor effects by GAG-mimetic AlgSulf are possibly due to differential binding to GFs and consequential decreased cell stemness. AlgSulf may be suitable for applications in cancer therapy after further in vivo validation.

The Role of Coronary Catheterization with Angiography in Surgically Managed Infectious Endocarditis.

BACKGROUND: Coronary catheterization with angiography is often performed prior to surgical valve replacement in infectious endocarditis. There are no existing data as to whether this intervention is clinically necessary or leads to a change in surgical management. In order to determine the frequency with which coronary angiography impacts surgical management in infectious endocarditis, we conducted a retrospective review of surgically managed endocarditis cases at a tertiary care medical center. METHODS: Utilizing the institutional Society of Thoracic Surgeon's database, we identified 598 patients with surgically managed endocarditis between April 29, 2011 and December 31, 2018. Patient variables were recorded, including risk factors for coronary artery disease, whether the patient received coronary angiography prior to surgery, and if the patient underwent coronary artery bypass grafting as part of their valve surgery. RESULTS: There were 430 patients who received coronary catheterization with angiography prior to surgical valve replacement for infectious endocarditis, and 168 patients proceeded to surgery without coronary angiography. Nine percent of patients underwent coronary artery bypass grafting at the time of valve replacement as a result of coronary angiography findings. There was no significant difference in 30-day mortality for patients with endocarditis who underwent coronary angiography when compared with those who did not receive coronary angiography (2.6 vs 2.4%; P = 0.89). CONCLUSIONS: Left heart catheterization with coronary angiography prior to surgical valve replacement leads to coronary artery bypass grafting in the minority of infective endocarditis patients.

Intaglio Surface Dimension and Guide Tube Deviations of Implant Surgical Guides Influenced by Printing Layer Thickness and Angulation Setting.

PURPOSE: To measure overall intaglio dimensional and tube deviations of implant guides printed at 50 and 100 µm layer thickness at 0°, 45°, and 90° angulation using a stereolithographic (SLA) printer. MATERIALS AND METHODS: A surgical implant guide design from a subject missing a maxillary right central incisor, used as the original standard tessellation language (STL) were stereolithographically fabricated at each thickness and angulation, 50 and 100 µm layer thickness at 0°, 45°, and 90° angulation (n = 10 each group). The guide was then scanned using cone beam computed tomography. The digital imaging and communications in medicine (DICOM) scanned files were then converted to an STL format. The overall dimensional deviations of the intaglio surface and the positioning of the implant guide tube were then superimposed onto the original designed STL file using best-fitting alignment. A t-test and an F-test as well as ANOVA followed by a post hoc t-test were used to determine statistical significant differences (α = 0.05) for the intaglio surface and guide tube deviation, respectively. RESULTS: The overall intaglio surface discrepancies (µm) printed at 0°, 45°, and 90° were 55.07 ± 1.36, 52.39 ± 2.09, and 61.02 ± 15.96 for 50 µm layer; and 98.38 ± 10.55, 84.47 ± 10.61, and 90.26 ± 5 for 100 µm layer with statistically significant differences for both t-test and F-test, p < 0.001. The maximal guide tube linear deviations (µm) printed at 0°, 45°, and 90° were 10.78 ± 3.84, 8.16 ± 3.68, and 12.57 ± 5.39 for 50 µm layer (ANOVA, p = 0.096); and 10.95 ± 5.23, 16.79 ± 4.97, and 22.63 ± 2.81 for 100 µm layer (ANOVA, p < 0.001). The maximal guide tube angular deviations (°) printed at 0°, 45°, and 90° were 1.29 ± 0.30, 0.64 ± 0.13, and 0.56 ± 0.21 for 50 µm layer (ANOVA, p < 0.001); and 1.57 ± 0.29, 0.86 ± 0.14, and 1.02 ± 0.31 for 100 µm layer (ANOVA, p = 0.034). There was a statistical difference in the deviations between 50 and 100 µm layer printing in all printed angulations except at 0° (t-test, p = 0.05, p = 0.03, and p = 0.001 for 0°, 45°, and 90°) and linear deviations (t-test, p < 0.001, p = 0.009, and p = 0.001 for 0°, 45°, and 90°). CONCLUSION: Printing at 50 µm layer reduces dimensional intaglio deviations in general and reduces tube angular deviations with different angulations of printing. However, the deviations were only ∼60 to 100 µm for the intaglio dimension deviations; and ∼0.04 to 0.26 mm and ∼0.25° to ∼2° for tube deviations.

Physician perceptions of a multidisciplinary endocarditis team.

Infectious endocarditis is a highly morbid infection that requires coordination of care across medical and surgical specialties, often through the use of a multidisciplinary team model. Multiple studies have demonstrated that such conferences can improve clinical outcomes. However, little is known about physicians' impressions of these groups. We surveyed 126 (response rate of 30%) internal medicine, infectious diseases, cardiology, and cardiac surgery providers 1 year after the implementation of an endocarditis team at the University of Michigan. Ninety-eight percent of physicians felt that the endocarditis team improved communication between specialties. Additionally, over 85% of respondents agreed that the group influenced diagnostic evaluation, reduced management errors, increased access to surgery, and decreased in-hospital mortality for endocarditis patients. These results suggest that multidisciplinary endocarditis teams are valued by physicians as a tool to improve patient care and serve an important role in increasing communication between providers.

Accuracy and precision of 3D-printed implant surgical guides with different implant systems: An in vitro study.

STATEMENT OF PROBLEM: Implant guided surgery systems promise implant placement accuracy and precision beyond straightforward nonguided surgery. Recently introduced in-office stereolithography systems allow clinicians to produce implant surgical guides themselves. However, different implant designs and osteotomy preparation protocols may produce accuracy and precision differences among the different implant systems. PURPOSE: The purpose of this in vitro study was to measure the accuracy and precision of 3 implant systems, Tapered Internal implant system (BioHorizons) (BH), NobelReplace Conical (Nobel Biocare) (NB), and Tapered Screw-Vent (Zimmer Biomet) (ZB) when in-office fabricated surgical guides were used. MATERIAL AND METHODS: A cone beam computed tomography (CBCT) data set of an unidentified patient missing a maxillary right central incisor and intraoral scans of the same patient were used as a model. A software program (3Shape Implant Studio) was used to plan the implant treatment with the 3 implant systems. Three implant surgical guides were fabricated by using a 3D printer (Form 2), and 30 casts were printed. A total of 10 implants for each system were placed in the dental casts by using the manufacturer's recommended guided surgery protocols. After implant placement, postoperative CBCT images were made. The CBCT cast and implant images were superimposed onto the treatment-planning image. The implant positions, mesiodistal, labiopalatal, and vertical, as well as implant angulations were measured in the labiolingual and mesiodistal planes. The displacements from the planning in each dimension were recorded. ANOVA with the Tukey adjusted post hoc pairwise comparisons were used to examine the accuracy and precision of the 3 implant systems (α=.05). RESULTS: The overall implant displacements were -0.02 ±0.13 mm mesially (M), 0.07 ±0.14 mm distally (D), 0.43 ±0.57 mm labially (L), and 1.26 ±0.80 mm palatally (P); 1.20 ±3.01 mm vertically in the mesiodistal dimension (VMD); 0.69 ±2.03 mm vertically in the labiopalatal dimension (VLP); 1.69 ±1.02 degrees in mesiodistal angulation (AMD); and 1.56 ±0.92 degrees in labiopalatal angulation (ALP). Statistically significant differences (ANOVA) were found in M (P=.026), P (P=.001), VMD (P=.009), AMD (P=.001), and ALP (P=.001). ZB showed the most displacements in the M and vertical dimensions and the least displacements in the P angulation (P<.05), suggesting statistically significant differences among the M, VMD, VLP, AMD, and ALP. NB had the most M variation. ZB had the least P deviation. NB had the fewest vertical dimension variations but the most angulation variations. CONCLUSIONS: Dimensional and angulation displacements of guided implant systems by in-office 3D-printed fabrication were within clinically acceptable limits: <0.1 mm in M-D, 0.5 to 1 mm in L-P, and 1 to 2 degrees in angulation. However, the vertical displacement can be as much as 2 to 3 mm. Different implant guided surgery systems have strengths and weaknesses as revealed in the dimensional and angulation implant displacements.