Covering skin defects with a xenogeneic collagen matrix in comparison with a skin graft - A multicenter randomized controlled trial.

The objective of this study was to analyze, in a randomized controlled multicenter trial, whether a xenogeneic collagen matrix (XCM) could be used to cover skin defects. Patients with the need for skin excisions were recruited and randomized to treatment with a skin graft after a period of granulation or to treatment with an XCM. The results were evaluated by two independent observers on the Patient and Observer Scar Assessment Scale. On this scale, scars are ranked from 1 to 10 in six different categories. Results range from 6 to 60, with lower scores representing scars closer to normal skin. The results 6 months after reconstruction were used as primary endpoint and compared in a non-inferiority approach. A total of 39 wounds in the head and neck region were analyzed. The mean results were 16.55 (standard deviation 6.8) for XCM and 16.83 (standard deviation 8.21) in the control group. The result of the XCM was not significantly inferior to the result of the skin graft (p = 0.91). Within the limitations of the study, it seems that the use of xenogeneic collagen matrices is a viable alternative to other approaches in small skin defects, and therefore should be taken into account whenever the reduction of patient morbidity to a minimum is the priority. TRIAL REGISTRATION: This trial was registered in the German Clinical Trials Register under registration identification number DRKS00010930 and can be found under the following URLs: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00010930. https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00010930.

A Novel Method for Secondary Mandible Reconstruction to Re-Achieve a Native Condyle Position Comprising a New Design for Cutting Guides and New Positioning Devices.

Secondary mandibular reconstruction using fibular free flaps (FFF) is a technical challenge for surgeons. Appropriate operation planning is crucial for postoperative quality control and is notably necessary for the (re-) achievement of a physiological condylar position, and the sensible expansion and shaping of the transplant. Computer-assisted planning may help to reconstruct mandibular defects in a patient-specific and precise manner. Herein, we present a newly-developed workflow for secondary mandibular reconstruction using FFF; it comprises digital planning and in-house manufacturing to perform precise secondary mandible reconstruction. This method utilizes a newly designed positioning device to ensure the precise positioning of the fibula segments in relation to each other and the mandibular stumps. The presented in-house-printed positioning device made it possible to achieve digital planning with high precision during surgery.

Goldenhar Syndrome: Quality-of-Life Analysis of 43 Consecutive Patients.

Goldenhar syndrome is a rare congenital disease, characterized by the malformation of craniofacial features, spine, and other organs. Its pathogenesis and impact on patients' quality of life (QoL) have not been fully elucidated as yet. Therefore, data of all patients with Goldenhar syndrome, who were treated at Hannover Medical School between 1997 and 2020, were analyzed. Forty-three patients were identified. Their medical records were carefully reviewed for data regarding their age, sex, demographics, Pruzansky classification, surgical history, and affected side. Goldenhar syndrome-associated medical conditions, therapeutic procedures, and the impact of disease on QoL were assessed. Their QoL was assessed using the Oral Health Impact Profile (OHIP)-14 questionnaire. The χ 2 test and Pearson correlation were performed for statistical evaluation. Female sex was positively correlated with OHIP outcomes, whereas male sex had a negative correlation with OHIP outcomes. Therefore, females had significantly worse QoL than males. No significant correlation was observed between the Pruzansky classification and QoL or between surgical history and QoL. Goldenhar syndrome is a rare disease that presents with varying severity. Hence, prospective studies are required to further investigate the impact of Goldenhar syndrome on the QoL.

Dental rehabilitation in irradiated oral cancer patients using patient-specific dental implants - Clinical outcome and oral health-related quality of life.

INTRODUCTION: Dental rehabilitation in oral cancer patients is essential for good oral health-related quality of life (OHRQoL). Patient-specific dental implants are suitable for treating tumor-related bony defects, resulting in satisfactory OHRQoL. However, knowledge concerning the clinical outcome and OHRQoL following tumor irradiation is lacking. MATERIAL AND METHODS: A retrospective analysis was carried out to evaluate clinical outcomes and OHRQoL in eight patients who received patient-specific dental implants and implant-supported dentures after surgical treatment for oral cancer with additional irradiation. OHRQoL assessment was performed using the German long version of the oral health impact profile (OHIP) questionnaire (OHIP-G53). RESULTS: Clinical examination revealed successful dental rehabilitation in all the patients with only minor impairments. Restricted stability and function of implants were not observed. OHIP sum-scores of all the patients indicated acceptable OHRQoL, but this varied between patients treated in the upper or lower jaw. Single-item sum-scores concerning the adverse events "difficulty in chewing," "food catching," "sore jaw," "sore spots," and "unclear speech" were detected to be the worst, and pain-related OHIP dimensions demonstrated the highest scores (followed by functional limitation, physical disability, and psychosocial impact) with a worse OHRQoL following lower jaw treatment. Other dimension sum-scores were overall lower and nearly equally distributed in patients. CONCLUSIONS: Dental rehabilitation of irradiated oral cancer patients using patient-specific dental implants may be suitable, leading to acceptable OHRQoL. However, implant insertion in the upper jaw seems to be more favorable. Further studies on patient-specific dental implants are warranted to validate the current results.

Computer-assisted orbital and midfacial reconstruction.

Objective: Computer assistance has become indispensable in the reconstruction of the orbit and midface. Although these are key areas of an individual's esthetic appearance, defects or deformities of the midface, especially those of the orbit, are treated diversely. Methods: The aim of this article is to present the wide utility of computer-assistance in modern craniomaxillofacial surgery, including virtual planning, computer-aided design, guided surgery, navigational control, patient-specific implants, and quality control via image fusion. Results: There have been rapid advances in both digital planning and manufacturing processes, with continual improvements. Conclusions: Patient-specific implants have pushed the boundaries of reconstructive surgery in all surgical specialties.

Improving instrument detection for a robotic scrub nurse using multi-view voting.

PURPOSE: A basic task of a robotic scrub nurse is surgical instrument detection. Deep learning techniques could potentially address this task; nevertheless, their performance is subject to some degree of error, which could render them unsuitable for real-world applications. In this work, we aim to demonstrate how the combination of a trained instrument detector with an instance-based voting scheme that considers several frames and viewpoints is enough to guarantee a strong improvement in the instrument detection task. METHODS: We exploit the typical setup of a robotic scrub nurse to collect RGB data and point clouds from different viewpoints. Using trained Mask R-CNN models, we obtain predictions from each view. We propose a multi-view voting scheme based on predicted instances that combines the gathered data and predictions to produce a reliable map of the location of the instruments in the scene. RESULTS: Our approach reduces the number of errors by more than 82% compared with the single-view case. On average, the data from five viewpoints are sufficient to infer the correct instrument arrangement with our best model. CONCLUSION: Our approach can drastically improve an instrument detector's performance. Our method is practical and can be applied during an actual medical procedure without negatively affecting the surgical workflow. Our implementation and data are made available for the scientific community ( https://github.com/Jorebs/Multi-view-Voting-Scheme ).

Congenital Mandibular Hypoplasia: Patient-Specific Total Joint Replacement as a Line Extension in the Treatment of Complex Craniofacial Anomalies.

Introduction: Congenital mandibular hypoplasia (CMH) remains challenging because of the underlying combined hard and soft tissue deficiency. Treatment options include craniofacial distraction, orthognathic surgery, and autologous grafts, although the latter produces inadequate results after distraction and autologous grafting. Unsatisfactory long-term stability may cause relapse, necessitating reoperation. Material and Methods: We investigated the feasibility of using alloplastic total joint replacement (TJR) in growing and young adult CMH patients. The primary outcome was long-term reconstruction stability, without implant failure. Secondary outcomes were TMJ function and pain, and jaw movements achieved during surgery. Results: Three patients (age: 9-22 years) were treated by the same surgeon at one institution during 2018-2021. Anamnesis and clinical parameters were obtained from patient records. Preoperative 3D-scans were superimposed with postoperative 3D-scans and preoperative plans, including TJR-implant STL files, to measure jaw movement. All patients underwent prior reconstructive surgery. Mandibular movement of 16.4-20.1 mm in the sagittal direction was achieved. Post-TJR follow-up ranged from 24 to 42 months. No long-term complications occurred. At the latest follow-up, the maximal interincisal opening was between 21 and 40 mm, and all implants were functioning, without failure. Conclusion: In selected CMH cases, alloplastic TJR can deliver satisfactory medium-term results with predictable and stable outcomes, even in growing patients.

Patient-specific implants for reconstruction of orbit and skull following resection of spheno-orbital meningiomas: A two-implant concept.

INTRODUCTION: The surgical treatment of spheno-orbital meningioma (SOM) is challenging. In addition to anatomical constraints that lead to a difficult resection, the reconstruction of the resulting defect is demanding. Uniform recommendations concerning the best reconstruction technique are not available in the existing literature. We propose a novel two-piece concept for reconstructing post-ablative defects using patient-specific implants. MATERIAL AND METHODS: Between 2018 and 2021, seven patients underwent SOM resection using two digitally planned patient-specific implants for orbit and skull reconstruction. To analyze the accuracy of the reconstruction, preoperative plans were merged with postoperative data sets. The clinical outcome was evaluated by comparing the pre- and postoperative exophthalmos index (EI). RESULTS: In all cases, adequate reconstruction and a satisfactory match between the final implant position and preoperative planning were achieved. The EI was reduced in all cases from a mean of 1.27 to 1.09 (p = 0.003). CONCLUSIONS: The proposed concept of a two-piece reconstruction after SOM resection is an excellent way to manage the concern around post-ablative defects. The current technical conditions allow for a precise, safe, and predictable reconstruction.

Time is crucial in malignant tumor cases: Speeding up the process of patient-specific implant creation.

Purpose: Patient-specific implants are commonly used to reconstruct lower jaw defects following surgical treatment for head and neck squamous cell carcinoma. The planning process of surgery is time-consuming and can delay the "time to surgery," which should be as short as possible. Therefore, this study aimed to evaluate the planning process to speed up and identify any sources of problems. Patients and methods: In this retrospective study, we enrolled patients who underwent continuous resection of the mandible in combination with reconstruction with a patient-specific implant between 2016 and 2021. The predictor variables were in-house training of the engineers and implant complexity (complex [with additional features] vs. less complex [resembling standard reconstruction plates]). The outcome variables were the duration of communication, message length, and the need for synchronous communication or modifications to the original design. Descriptive and univariate statistics were computed, and statistical significance was set at P < 0.05. Results: The data from 83 patients were included in this study. The mean duration of communication was 14.05 ± 13.58 days. The implant complexity and training status of the engineer had no statistically significant influence on the primary outcome variables. As for the secondary outcome variables, the implant complexity significantly influenced the chance that the planned operation had to be postponed (15/16 [93.75%] were complex cases, P = 0.001). The most frequent cause of problems in the planning process was an insufficient dataset, which was not dependent on the type of imaging. Conclusions: The overall duration of the patient-specific implant creation process is too long to meet oncological requirements. Therefore, standardization of the planning process to accelerate implant creation is of utmost importance. In addition, a common standard imaging format (independent of the type of imaging) for oncological cases could eliminate all delays caused by insufficient datasets in the future.

Socio-demographic aspects and treatment-related factors on oral cancer patients' participation in rehabilitation.

Objectives: After resection of an oral carcinoma, patients are faced with physical, psychological, and socioeconomic challenges. Rehabilitation plays an essential role in patients' reintegration into their social and professional environment. This study evaluated whether socioeconomic aspects affect oral cancer patients' participation in rehabilitation treatment. Materials and methods: A retrospective analysis was conducted with 1,532 patients following surgical treatment of oral cancer during an international multicenter rehabilitation study of the German-Swiss-Austrian Cooperative Working Group on Maxillofacial Tumors using a questionnaire comprising disease-related and psychosocial items postoperatively and at least 6 months after surgery. Results: Only 35.4% of patients participated in rehabilitation. Age (p<0.001), sex (p<0.001), and marital status (p<0.05) significantly influenced participation in rehabilitation. Postoperative impairment (p<0.05) as well as quality of life (p<0.01) were significantly worse in patients who participated in rehabilitation. Nevertheless, this group of patients returned to work significantly more often, although later, than those who did not participate in rehabilitation (p<0.05). Conclusions: The findings show social inequalities and suggest a general undersupply of rehabilitative follow-up treatment in patients with oral cancer. More patients, especially older people and women should be referred to rehabilitation.

Prospective Clinical Multicenter Study Evaluating the 5-Year Performance of Zirconia Implants in Single-Tooth Gaps.

PURPOSE: In recent years, ceramic implants made of zirconia have secured a niche position next to established titanium implants, due partly to new scientific findings and positive clinical experience with the handling of ceramic implants. The aim of this study was to assess the clinical and radiographic data for monotype ceramic implants that have remained in place for 60 months under masticatory loading. MATERIALS AND METHODS: In 2011, this prospective clinical study included patients with a single-tooth gap in the maxilla and mandible. Monotype ceramic implants (Straumann) were used according to a standard protocol. Provisional prostheses were placed after 3 months, followed by final prostheses 3 months later. Patients were invited for a 60-month follow-up. Implant survival was analyzed from lifetime data. Success rates and crestal bone levels were evaluated from implant placement to 6, 12, 36, and 60 months after surgery. RESULTS: From the initial 44 patients recruited, 36 were analyzable for the 60-month follow-up. With one implant lost before the 6-month followup, the survival rate after 60 months was 97.7%, and the mean survival time was 58.7 months. Sixty months after implant placement, the success rate was 97.2% (95% confidence interval = 84.6% to > 99.9%). Mean bone loss after 60 months was 0.99 (± 0.59) mm. CONCLUSION: After 60 months, monotype ceramic implants made of zirconia achieved success and survival rates comparable with those reported for titanium implants in selected patient populations. Ceramic implants can be used as an alternative to titanium implants at the request of patients and if specifically indicated, for example, due to titanium intolerance.

Deep-learning-based instrument detection for intra-operative robotic assistance.

PURPOSE: Robotic scrub nurses have the potential to become an attractive solution for the operating room. Surgical instrument detection is a fundamental task for these systems, which is the focus of this work. We address the detection of the complete surgery set for wisdom teeth extraction, and propose a data augmentation technique tailored for this task. METHODS: Using a robotic scrub nurse system, we create a dataset of 369 unique multi-instrument images with manual annotations. We then propose the Mask-Based Object Insertion method, capable of automatically generating a large amount of synthetic images. By using both real and artificial data, different Mask R-CNN models are trained and evaluated. RESULTS: Our experiments reveal that models trained on the synthetic data created with our method achieve comparable performance to that of models trained on real images. Moreover, we demonstrate that the combination of real and our artificial data can lead to a superior level of generalization. CONCLUSION: The proposed data augmentation technique is capable of dramatically reducing the labelling work required for training a deep-learning-based detection algorithm. A dataset for the complete instrument set for wisdom teeth extraction is made available for the scientific community, as well as the raw information required for the generation of the synthetic data ( https://github.com/Jorebs/Deep-learning-based-instrument-detection-for-intra operative-robotic-assistance ).

Outcome and Quality of Life after Individual Computer-AssistedReconstruction of the Midface. / Ergebnisse und Lebensqualität nach individueller computer-gestützter Rekonstruktion des Mittelgesichtes.

Often, midfacial defects are not only relevant regarding functional aspects but also esthetics of such congenital or acquired deformities impair significantly the patients' quality of life. Reconstructions of the midface do not only include replacing lost or non-developed tissue but moreover to achieve predictable results with regard to esthetics as well as function for the individual patient. Digital planning modalities including different surface and volume data in combination with modern additive manufacturing techniques for biomodel and implant production and intraoperative support by using real and virtual 3D volume data for navigation and intraoperative imaging, but also securing the outcome based on postoperative analysis have been implemented in modern midface reconstruction and represent new standards for medical care. The objective of this paper is to describe modern options of patient-specific midfacial reconstruction with integration of computer-assisted planning and production techniques.

Prelamination of the Radial Forearm Free Flap Using Free Full-Thickness Eyelid Skin Grafts: A New Approach for Intraoral Defect Reconstruction.

ABSTRACT: Free flap transfer for reconstruction of intraoral defects is a common procedure in oral and maxillofacial surgery. For tumor-related defects, the radial forearm flap is widely used for soft tissue restoration. However, transfer of free skin grafts to the donor site region is often required for wound closure after free flap harvesting, resulting in esthetic disturbances due to shrinkage of the grafted skin, attendant scarring, or mismatches in skin texture or color. Furthermore, free flap transfer may result in hair follicle transfer into the oral cavity, causing unfavorable intraoral hair growth in adult men in particular. Free flap prelamination can help reduce the potential disadvantages of free flaps, in terms of both flap design and size and donor site morbidity. For surgical treatment of oral cancer in middle-aged and elderly patients, eyelid dermatochalasis may present as a comorbidity leading to esthetic impairments or, in cases involving the upper eyelid, even a reduced field of view. In these cases, bilateral blepharoplasty can reduce the excess eyelid skin. The present study is the first to attempt to use excised skin after bilateral blepharoplasty as full-thickness skin grafts for radial forearm free flap prelamination. This approach combined surgical therapy of eyelid dermatochalasis with free flap prelamination, thereby avoiding the need to harvest free skin grafts from other anatomically healthy regions to close the donor site defect and preventing the accompanying disadvantages. The reconstruction results and clinical outcomes of patients revealed that radial forearm free flap prelamination using bilateral free full-thickness eyelid skin grafts was an easy and feasible method for intraoral defect reconstruction. In particular, this approach could avoid intraoral hair growth and additional skin grafting from other healthy anatomical regions, yielding good esthetic and functional results at the flap's recipient and donor sites.

Novel approach for treating challenging implant-borne maxillary dental rehabilitation cases of cleft lip and palate: a retrospective study.

PURPOSE: Dental restoration in cleft lip and palate (CLP) patients is demanding and often results in bone loss and dental implant failure. Furthermore, unfavorable conditions of hard and soft tissues as well as skeletal deformities aggravate surgical and dental treatment. Therefore, this study was designed to assess the feasibility of using a new type of patient-specific implant (IPS-preprosthetic®) in CLP patients. METHODS: Of the 63 patients who received a IPS-preprosthetic® implant in the Department of Oral and Maxillofacial Surgery at the Hannover Medical School, Germany, six patients were treated for a CLP deformity with significant soft and hard tissue impairment. Two patients were partially edentulous, whereas four patients were edentulous for the maxilla. All implants were inserted in a single-step outpatient surgery and were followed up for up to 40 months. RESULTS: Within the observation period, no implant failed and no screw loosening or change in stability of the implant to recipient site occurred (mean number of screws: 21). This study demonstrates, for the first time, the efficient use of a one-piece multivector screw primarily retained a stable patient-specific implant for implant-borne prosthodontic rehabilitation of CLP patients with deformities and challenging initial situations. CONCLUSIONS: IPS-preprosthetic® implants offer a novel approach to implant dentistry treatment protocols, especially in difficult cases of unusual anatomy, even when previous conventional treatment fails.

Quantitative ultrasonographic diagnostics for midface and mandible fractures.

The aim of this study was to examine whether ultrasonography and three-dimensional radiological procedures produce significantly different measurement results with respect to fracture dislocation. This was a retrospective study of patients who were admitted to the department for oral and maxillofacial surgery of the Medical Highschool Hannover with facial skull fracture and underwent high-resolution computed tomography and ultrasonography imaging during a period from 1 January 2019 to 31 August 2019. A 10 mHz transducer was used for fracture imaging, and the largest dislocation of each fracture was measured. A paired t-test for dependent samples was used for statistical evaluation of the measured differences, and the p-value was set at 0.05. A total of 16 patients with 29 fractures were included. The fractures were characterized as follows: zygomatic arch (n = 7), lateroorbital region (n = 4), maxilla/zygomatic bone (n = 15), mandible (n = 2), and frontal sinus (n = 1). Regardless of the fracture location, we found no statistical difference in fracture measurements between the ultrasonography and the computed tomography (p = 0.17 (fractures of the zygomatic arch) to p = 0.85 (all fractures)). The study findings suggest that ultrasonography not only allows basic detection but also a quantification of the dislocation in facial skull fractures. The ultrasonography results are not significantly different from those of the computed tomography. In everyday clinical practice, ultrasonography of facial fractures can be considered an adequate imaging procedure. If used correctly, additional radiation exposure to the patient can be avoided, thus representing a diagnostic alternative to computed tomography.

Gender-specific differences concerning psychosocial aspects and functional impairments that influence quality of life in oral cancer treatment.

PURPOSE: Patients with oral cancer have gender-specific differences with respect to health-related quality of life (HRQoL) and psychosocial variables (PV). The aim of the present study was to evaluate HRQoL and PV outcomes in patients treated for oral squamous cell carcinoma. METHODS: Data of 1234 patients were collected from a multicenter rehabilitation study of the German-Austrian-Swiss Cooperative Group on Tumours of the Maxillofacial Region (DÖSAK). Patient characteristics, oncological variables, post-treatment impairments, general quality of life (QoL), and PV (coping strategies, control beliefs, personal traits, perceived social support, depression, anxiety, and fear of tumor recurrence) were recorded. RESULTS: After treatment, HRQoL was similar between genders concerning general QoL, but men experienced significantly more treatment-related functional impairments influencing HRQoL. PV revealed gender-specific coping strategies, with women reporting significantly more "depressive coping," "religiosity," "fatalistic externality," and higher "social burden." Owing to their religious coping strategies, fatalistic attitude, and perceived higher social integration, women demonstrated superior disease acceptance, despite higher depression, anxiety, and lower psychosocial resilience. Conversely, men reported more introverted personal traits and lower social integration. CONCLUSION: Interventions during oral cancer treatment should address PV and have gender-specific elements to improve HRQoL after therapy.

Pitfalls of Surgeon-Engineer Communication and the Effect of In-House Engineer Training During Digital Planning of Patient-Specific Implants for Orbital Reconstruction.

PURPOSE: The use of patient-specific implants for reconstruction of complex orbital floor defects is increasing and requires communication with an industry partner, which warrants investigation. Therefore, the aim of this study was to evaluate the effects of in-house training of engineers on such communication as well as to identify frequent sources of problems and their solutions for improvement of the implant-planning workflow. METHODS: We conducted a retrospective cross-sectional study and enrolled a sample of patients who had undergone orbital reconstruction with patient-specific implants between 2017 and 2020. The predictor variables were in-house training (additional training completed in hospital or not) and implant complexity (complex [multiwalled implants] vs less complex [isolated orbital floor reconstructions]). The outcome variables were duration of communication, message length, and need for synchronous communication or modifications to the original design. Descriptive, univariate, and multivariate statistics were computed, and statistical significance was set at a P value of < 0.05. RESULTS: This study included the data of 66 patients (48 men and 18 women, average age: 42.27 years). The complexity of the implant statistically significantly increased the duration of the communication (8.76 vs 16.03 days; P = .004). In 72.73%, the initial design had to be changed. Engineers trained in house required less communication to plan less-complex implants and generally needed fewer corrections to the original design (P = .020 and P = .036, respectively). Problems during planning were observed in 25.76% of the cases, with an insufficient diagnostic 3-dimensional data set being the most common (15.15%). CONCLUSIONS: In-house training of engineers is time-saving while planning the workflow for patient-specific implants, especially in less-complex cases, given that design changes are not needed often. The high rate of data sets that were insufficient for planning patient-specific implants suggests that diagnostic 3-dimensional data sets should already meet the requirements for such planning.

Comparison of conventional and digital workflow for dental rehabilitation with a novel patient-specific framework implant system: an experimental dataset evaluation.

PURPOSE: This study aimed to evaluate the efficiency of a digital workflow by comparing the accuracy of prosthetic teeth positioning between virtual standard-size digitally constructed and conventional dental laboratory-fabricated prostheses. METHODS: Twenty-five computed tomography datasets with a dentate upper jaw were selected after applying inclusion criteria to 100 random datasets obtained from the institutional library, and partially edentulous maxillae were constructed virtually. Digital datasets of temporary prostheses were fabricated on these virtually constructed edentulous maxillae in two ways: one dataset comprised prostheses that were fabricated conventionally using prosthetic teeth and wax in the dental laboratory and then scanned using a model scanner, whereas the other dataset was designed virtually using standardized virtual dental arches. The digital datasets of both prostheses were compared for differences at six dental-based measurement points with the original patient dentition. RESULTS: Overall, the conventional design pathway was more accurate than the digital one (conventional 2.915 ± 1.388 mm, digital 3.609 ± 2.052 mm, P < 0.001). However, when all six measurement points were evaluated individually, only three points showed significant differences in the tooth positions. Compared with the original dentition, the deviations were less in the anterior teeth region than in the molar region, fulfilling the esthetic expectations of the patients. Standardized virtual dental arches were practically adequate because virtual reconstruction of every edentulous case using these virtual arches was possible without any additional modifications. CONCLUSION: It is possible to fabricate clinically acceptable temporary prostheses using a comprehensive digital workflow based on standardized digital dental arches.