Guided Endodontic Surgery ? Case Series

This case report describes three cases in which periapical surgeries were carried out using a new surgical endodontic technique by using a three?dimensional (3D) printed template for guided osteotomy and root resection. In Case 1, the data obtained from preoperative CT scan and cast scan were transferred to a surgical planning software. The surgical template was printed using a 3D printer. Using the template, osteotomy and root?end resection were precisely carried out. In Case 2, after CBCT imaging, data were transferred to stereolithography and a 3D model was fabricated. With the help of the 3D model, a template was fabricated using tray material. This guided surgical template minimized the extent of osteotomy and enabled precise targeting of the apex. In Case 3, a preoperative CT scan aided in the fabrication of a surgical 3D template. The template assisted in the precise removal of the overlying cortical bone.

Reconstrucción de Fracturas Orbitarias Utilizando Tecnología Digital Tridimensional: Una forma de Optimizar Resultados

RESUMEN: La reconstrucción de las paredes orbitarias fracturadas es compleja debido a la gran cantidad de parámetros volumétricos que posee. Una restitución inadecuada de ellas habitualmente está asociada a secuelas postquirúrgicas en el paciente. El contar con herramientas que optimicen la restitución de la forma anatómica de la órbita en su reconstrucción es de vital importancia, y la utilización de nuevas tecnologías ha permitido mejorar los resultados quirúrgicos, tanto anatómicos como funcionales. El objetivo de este artículo es mostrar dos herramientas quirúrgicas que permiten optimizar los resultados terapéuticos en pacientes con fractura de órbita, que son el modelo estereolitográfico con imagen en espejo y la tomografía computada intraoperatoria. Se presentan las características de estas herramientas, su utilización en tres casos de pacientes con fractura orbitaria y los resultados obtenidos en el post operatorio.

ABSTRACT: The reconstruction of fractured orbital walls is complex due to the many volumetric parameters involved. An inadequate restitution of these walls may be associated with postsurgical sequelae in the patient. Is vitally important to count with tools that optimize the restitution of the orbit's anatomic shape during its reconstruction, and the use of new technologies has allowed the improvement of the surgical results, both anatomical and functional. The aim of this article is to show two surgical tools that allow to optimize the therapeutic results in patients with orbital fracture, which are stereolithographic models with mirror image technique, and intraoperative computed tomography. Their characteristics, their use in three cases of patients with orbital fractures, and the postoperative results are shown.

Impresión 3D de modelos estereolitográficos con protocolo abierto / 3D Printing of Stereolithographic Models with Open Protocol

RESUMEN: Se realizó un estudio descriptivo y exploratorio con el objetivo de proponer y validar un protocolo abierto para hacer impresiones 3D de modelos estereolitográficos, que esté a disposición de profesionales en el área de la Odontología. Se capacitó mediante sesiones teórico prácticas, a nueve personas operadoras (estudiantes de último año de la carrera de Odontología), sin previa experiencia en el uso de software y hardware para impresión 3D, divididos en dos grupos; el A trabajó con tres tomografías helicoidales (TAC) y el B con tres Tomografías Computarizadas de Haz Cónico (CBCT), todas en formato DICOM, convertidas en archivos STL. En total se aplicó el protocolo en 99 estructuras óseas correspondientes a 33 mandíbulas, 33 axis y 33 macizos faciales-bases de cráneo, y se imprimieron un total de 33 mandíbulas en filamento PLA (ácido poliláctico). Al finalizar el estudio, no se encontró diferencia estadísticamente significativa en la implementación del protocolo propuesto entre los operadores, las mediciones de las piezas impresas por cada uno de ellos, el patrón de oro, la TAC y el CBCT, con lo cual no solo se validó el protocolo, sino que se logró determinar los recursos necesarios para realizar este tipo de impresiones 3D.

ABSTRACT: A descriptive and exploratory study was carried out with the aim of proposing and validating an open protocol for making 3D impressions of stereolithographic models, which is available to professionals in the area of Dentistry. Nine operators (senior students of the Dentistry degree), without previous experience in the use of software and hardware for 3D printing, divided into two groups were trained through theoretical and practical sessions. The A worked with three helical tomographies (TAC) and the B with three cone beam computed tomography (CBCT), all in DICOM format, converted to STL files. In total, 99 bone structures corresponding to 33 jaws, 33 axis and 33 facial masses-skull bases were analyzed, and a total of 33 jaws were printed in PLA (polylactic acid filament). At the end of the study, no statistically significant difference was found in the implementation of the proposed protocol between the operators, the measurements of the pieces printed by each of them, the gold standard, the TAC and the CBCT, with which not only validated the protocol, but it was possible to determine the resources necessary to carry out this type of 3D printing.

Three-dimensional printing in healthcare / Impresión 3D en cuidado de la salud

ABSTRACT This work aims to briefly present the cutting edge of 3D printing innovation in healthcare. This technology is used for surgical planning, medical education, bioprinting of tissues, and medical equipment spare parts in fields like pharmacology, prosthetics, surgery, and regenerative medicine. A review of the last decade was made in the search engines of PubMed and Espacenet. Three authors reviewed titles, abstracts, and keywords separately to identify studies appropriate to the topic. After the initial examination, complete texts of identified relevant studies were obtained and classified according to the authors. Results were synthesized in a narrative literature review. The revision showed that 3D printing has become of common use in the healthcare system since it allows medical personnel to implement customized solutions for each patient, thus reducing the probability of a false diagnostic or treatment. Major applications among the advantages and disadvantages of 3D printing in healthcare were presented. Nowadays, the main challenge in 3D printing is the cost of the equipment and its manufacturing. In the future, the challenges in cost could be reduced, but processing requirements and limited materials may still need further work.

RESUMEN Este artículo pretende mostrar breve y rápidamente la vanguardia del empleo de la impresión 3D en salud. La impresión 3D se utiliza para planificación quirúrgica, educación médica, bioimpresión de tejidos e impresión de repuestos de equipos médicos en campos como farmacología, prótesis, cirugía, ingeniería de tejidos y medicina regenerativa. Se realizó una revisión de publicaciones en la última década en los motores de búsqueda PubMed y Espacenet. Tres autores examinaron de forma independiente títulos y resúmenes para identificar estudios relevantes. Se obtuvieron los textos completos y se clasificaron de acuerdo con todos los autores. Los resultados se sintetizaron en una revisión narrativa de la literatura. La revisión mostró que la impresión 3D se ha vuelto de uso común en el sistema de atención médica, ya que permite al personal médico implementar soluciones personalizadas para cada paciente, lo que reduce la probabilidad de un diagnóstico o tratamiento falso. Se presentaron las principales aplicaciones, así como ventajas y desventajas de la impresión 3D en salud. Hoy en día, el principal desafío en la impresión 3D es el costo del equipo y su fabricación. En el futuro, los desafíos en costos podrían reducirse, pero los desafíos de procesamiento y materiales requieren mayor desarrollo.

The Use of Customised Surgical Guide for Bilateral Inferior Mandibulectomy in a Case of Monostotic Fibrous Dysplasia

@#Fibrous dysplasia (FD) is a benign pathological condition of bone in which normal cancellous bone is replaced by immature woven bone and fibrous tissue. Surgical recontouring aims to remove the excess fibrous bone and achieve acceptable symmetry. Conventional surgery which depends on visual exposure and the surgeon’s assessment during the procedure poses a great challenge in obtaining a predictable surgical outcome especially in bilateral presentation. Recent advances in surgical technology may overcome this challenge. Herein, we present a case of 23 years old Chinese lady who underwent bilateral inferior mandibulectomy for monostotic fibrous dysplasia. The aims of this surgery were to recontour the mandible symmetrically via extraoral approach while preserving the inferior alveolar nerves and mental nerves with the aid of a surgical guide. A stereolithography model of the patient’s mandible was produced using the computed tomography (CT) scan data in Digital Imaging and Communications in Medicine (DICOM) format to assist in the surgery. Simulation with SurgiCase software (Materialise, Leuven, Belgium) was utilised in creating the customised surgical guide. The autoclavable surgical guide was manufactured by rapid prototyping technology and used intraoperatively to define the osteotomy line for mandibular recontouring. Virtual surgical planning greatly assists surgeons to deliver a good surgical result.

Planificación virtual y modelo de impresión en 3D para reconstrucción mandibular con colgajo libre de peroné en ameloblastoma mandibular / Virtual planning and 3D printing model for mandibular reconstruction with free fibular flap in mandibular ameloblastoma

El ameloblastoma es un tumor benigno, localmente agresivo, que ocasiona deformidades faciales y con tendencia a la recurrencia. El objetivo del tratamiento del ameloblastoma es la remoción completa del tumor, la restauración de la función y el mantenimiento del aspecto estético. Se presenta el caso de un varón de 19 años que presenta tumoración en región mandibular y acude a consulta para tratamiento quirúrgico. Se realizó planificación virtual y modelo de impresión en 3D para reconstrucción mandibular con colgajo libre de peroné y modelo estereolitográfico para el manejo de su patología. Se observó una evolución post operatoria favorable; y una patología compatible con ameloblastoma mandibular intraóseo de patrón plexiforme. Si bien la cirugía es el tratamiento de elección para el diagnóstico de ameloblastoma; la planificación virtual y el modelo de impresión en 3D para la reconstrucción son herramientas útiles en el manejo de esta patología.

Ameloblastoma is a benign, locally aggressive tumor that causes facial deformities and a tendency to recur. The objective of the treatment of ameloblastoma is the complete elimination of the tumor, the restoration of function and the maintenance of the aesthetic appearance. The case of a 19-year-old male presenting a tumor in the mandibular region is presented and a consultation for surgical treatment is accessed. Virtual planning and 3D printing model were performed for mandibular reconstruction with fibula-free flap and stereolithographic model for the management of its pathology. A favorable post-operative evolution evolved; and a pathology compatible with intraosseous mandibular ameloblastoma of the plexiform pattern. Although surgery is the treatment of choice for the diagnosis of ameloblastoma; Virtual planning and the 3D printing model for reconstruction are useful tools in the management of this pathology.

An in vitro comparative evaluation between virtually planned implant positions on interactive implant software versus actual implant positions achieved using sterolithographic open guide system

Purpose: To evaluate and compare the positional and angular accuracy of virtual implant positions planned on cone-beam computed tomography and final implant positions achieved using a universal open guide system. Materials and Methods: A dual scan of a partially edentulous jaw model along with prosthesis was done, and virtual implant planning was performed. Three implant positions in relation to 35, 36, and 37 were simulated (Group A). In total, 24 implants were placed in eight replaceable bone blocks (Group B) in the same region on the model using an open stereolithographic template. The linear positions and angulation of the placed implants were determined using Vision Measuring Machine. Deviations between virtually planned and surgically placed implants were analyzed in terms of linear and angular measurements. Data were analyzed with the independent-sample t-test with differences P ≤ 0.05 being considered statistically significant. Results: The linear distance (mean ± standard deviation [SD]) in mesiodistal direction between implants in relation to 35 and 36, 36 and 37, 35 and 37 in Group A was 8.79 ± 0 mm, 8.71 ± 0 mm, and 17.50 ± 0 mm, respectively, and in Group B was 7.70 ± 0.58 mm, 8.11 ± 0.30 mm, and 15.80 ± 0.48 mm. All these above values were found to be statistically significant (P ≤ 0.05). The linear distance (mean ± SD) in the vertical direction (mesial) for implants placed in the region of 35, 36, 37 for Group A was 1.51 ± 0 mm, 1.51 ± 0 mm, and 2.47 ± 0 mm, respectively, and for Group B was 1.37 ± 0.32 mm, 1.65 ± 0.48 mm, and 1.79 ± 0.36 mm, respectively. The linear distance (mean ± SD) in the vertical direction (distal) for implants placed in the region of 35, 36, 37 for Group A was 3.37 ± 0 mm, 1.51 ± 0 mm, and 1.51 ± 0 mm, respectively, and for Group B was 1.86 ± 0.48 mm (P ≤ 0.05), 1.56 ± 0.23 mm, and 1.29 ± 0.39 mm (P ≤ 0.05), respectively. The angular deviation (perpendicularity) values for virtually planned implants (Group A) were 90.00° ± 0° and for implants placed in the region of 35, 36, and 37 (Group B) were 84.52° ± 5.4°, 83.57° ± 1.52°, and 80.41° ± 2.37°, respectively, which are highly significant (P ≤ 0.05). Conclusions: The stereolithographic universal open guide used in the study may be considered accurate for placement of implants in mesiodistal position and also in terms of perpendicularity but not in the vertical position. Stereolithographic open guide may be recommended for more accurate implant position, especially for the placement of multiple implants.

Prosthetic Rehabilitation of an Orbital Defect Using Computer Aided Designing and Rapid Prototyping

Introduction: The conventional methods of fabrication oforbital prosthesis by facial moulage fabrication and handsculpting are time consuming, error-prone and very muchsubjective in terms of quality. Prosthesis development usingcontemporary technologies like computer aided designing andrapid prototyping is simple, cost effective and also improvesproductivity ensuring enhancement of the technical quality ofcare.Case report: The present case report describes rehabilitationof a patient of left anophthalmic residual defect with a custommade silicone orbital prosthesis retained with spectacle,developed with the help of computer aided designing andrapid prototyping technology.Conclusion: Consistent good quality prosthesis may beobtained using advanced digital technologies that includeoptical scanning, computer-aided designing and rapidprototyping which are more objective in nature.

Accuracy of provisional crowns made using stereolithography apparatus and subtractive technique

PURPOSE: To compare and analyze trueness and precision of provisional crowns made using stereolithography apparatus and subtractive technology. MATERIALS AND METHODS: Digital impressions were made using a master model and an intraoral scanner and the crowns were designed with CAD software; in total, 22 crowns were produced. After superimposing CAD design data and scan data using a 3D program, quantitative and qualitative data were obtained for analysis of trueness and precision. Statistical analysis was performed using normality test combined with Levene test for equal variance analysis and independent sample t-test. Type 1 error was set at 0.05. RESULTS: Trueness for the outer and inner surfaces of the SLA crown (SLAC) were 49.6±9.3 µm and 22.5±5.1 µm, respectively, and those of the subtractive crown (SUBC) were 31.8±7.5 µm and 14.6±1.2 µm, respectively. Precision values for the outer and inner surfaces of the SLAC were 18.7±6.2 µm and 26.9±8.5 µm, and those of the SUBC were 25.4±3.1 µm and 13.8±0.6 µm, respectively. Trueness values for the outer and inner surfaces of the SLAC and SUBC showed statistically significant differences (P < .001). Precision for the inner surface showed significance (P < .03), whereas that for the outer surface showed no significance (P < .58). CONCLUSION: The study demonstrates that provisional crowns produced by subtractive technology are superior to crowns fabricated by stereolithography in terms of accuracy.

Solid Freeform Techniques Application in Bone Tissue Engineering for Scaffold Fabrication

Solid freeform techniques are revolutionising technology with great potential to fabricate highly organized biodegradable scaffolds for damaged tissues and organs. Scaffolds fabricated via Solid freeform (SFF) techniques have more pronounced effect in bone tissue engineering. SFF techniques produce various types of scaffolds from different biomaterials with specific pore size, geometries, orientation, interconnectivity and anatomical shapes. Scaffolds needs to be designed from such biomaterials which can attach directly to natural tissues and mimic its properties, so ideally mechanical properties of scaffolds should be same as that of regenerating tissues for best results. The scaffolds designed without optimized mechanical properties would lead to the reduced nutrition diffusion within tissue engineered constructs (TECs) causing tissue necrosis. These scaffolds are mainly processed from ceramics and polymers like calcium phosphate, polydioxane, €-polycaprolactone, polylactic and polyglycolic acids etc. While, hydrogel scaffolds provide bridge for encapsulated cells and tissues to integrate with natural ECM. Likewise, 2D images from radiography were not sufficient for the prediction of the brain structure, cranial nerves, vessel and architecture of base of the skull and bones, which became possible using the 3D prototyping technologies. Any misrepresentation can lead to fatal outcomes. Biomodelling from these techniques for spinal surgery and preoperative planning are making its way toward successful treatment of several spinal deformities and spinal tumor. In this review we explored laser based and printing SFF techniques following its methodologies, principles and most recent areas of application with its achievements and possible challenges faced during its applications.

New fabrication method using additive manufacturing technologies for the pattern of pressed lithium disilicate onlay restorations / Novo método de fabricação, usando tecnologia aditiva, do padrão de restaurações do tipo onlay em dissilicato de lítio injetado

The digital workflow in dentistry allows for complete digital processing of the restoration starting with the digital impression using an intraoral scanner to until the fabrication of final reconstruction. Recent advances in 3D printing technologies opened new possibilities also for dental technicians through which wax-up and casting procedures in the laboratories could be eliminated. In this clinical report, a technique is described where the pattern was fabricated using additive manufacturing for pressed lithium disilicate onlay restorations. (AU)

O fluxo de trabalho digital em odontologia permite o processamento digital completo da restauração começando com a impressão digital usando um scanner intraoral até a fabricação da peça final. Os avanços recentes nas tecnologias de impressão 3D abriram novas possibilidades também para os técnicos em prótese dentária através dos quais os procedimentos de cera e fundição nos laboratórios poderiam ser eliminados. Neste relato de caso clínico, descreve-se uma técnica onde o padrão foi fabricado usando a fabricação de aditivos para restaurações do tipo onlay em dissilicato de lítio injetadas. (AU)

Evaluation of marginal and internal gaps in single and three-unit metal frameworks made by micro-stereolithography

PURPOSE: The purpose of this study is to compare single and three-unit metal frameworks that are produced by micro-stereolithography. MATERIALS AND METHODS: Silicone impressions of a selected molar and a premolar were used to make master abutments that were scanned into a stereolithography file. The file was processed with computer aided design software to create single and three-unit designs from which resin frameworks were created using micro-stereolithography. These resin frameworks were subjected to investment, burnout, and casting to fabricate single and three-unit metal ones that were measured under a digital microscope by using the silicone replica technique. The measurements were verified by means of the Mann-Whitney U test (α=.05). RESULTS: The marginal gap was 101.9 ± 53.4 µm for SM group and 104.3 ± 62.9 µm for TUM group. The measurement of non-pontics in a single metal framework was 93.6 ± 43.9 µm, and that of non-pontics in a three-unit metal framework was 64.9 ± 46.5 µm. The dimension of pontics in a single metal framework was 110.2 ± 61.4 µm, and that of pontics in a three-unit metal framework was 143.7 ± 51.8 µm. CONCLUSION: The marginal gap was smaller for the single metal framework than for the three-unit one, which requires further improvement before it can be used for clinical purposes.

Evaluation of marginal and internal gap of three-unit metal framework according to subtractive manufacturing and additive manufacturing of CAD/CAM systems

PURPOSE: To evaluate the fit of a three-unit metal framework of fixed dental prostheses made by subtractive and additive manufacturing. MATERIALS AND METHODS: One master model of metal was fabricated. Twenty silicone impressions were made on the master die, working die of 10 poured with Type 4 stone, and working die of 10 made of scannable stone. Ten three-unit wax frameworks were fabricated by wax-up from Type IV working die. Stereolithography files of 10 three-unit frameworks were obtained using a model scanner and three-dimensional design software on a scannable working die. The three-unit wax framework was fabricated using subtractive manufacturing (SM) by applying the prepared stereolithography file, and the resin framework was fabricated by additive manufacturing (AM); both used metal alloy castings for metal frameworks. Marginal and internal gap were measured using silicone replica technique and digital microscope. Measurement data were analyzed by Kruskal-Wallis H test and Mann-Whitney U-test (α=.05). RESULTS: The lowest and highest gaps between premolar and molar margins were in the SM group and the AM group, respectively. There was a statistically significant difference in the marginal gap among the 3 groups (P < .001). In the marginal area where pontic was present, the largest gap was 149.39 ± 42.30 µm in the AM group, and the lowest gap was 24.40 ± 11.92 µm in the SM group. CONCLUSION: Three-unit metal frameworks made by subtractive manufacturing are clinically applicable. However, additive manufacturing requires more research to be applied clinically.

A Novel Patient-Specific Drill Guide Template for Pedicle Screw Insertion into the Subaxial Cervical Spine Utilizing Stereolithographic Modelling: An In Vitro Study

STUDY DESIGN: Cadaveric study. PURPOSE: The purpose of this study was to assess the accuracy and feasibility of cervical pedicle screw (CPS) insertion into the subaxial cervical spine placed using a patient-specific drill guide template constructed from a stereolithographic model. OVERVIEW OF LITERATURE: CPS fixation is an invaluable tool for posterior cervical fixation because of its biomechanical advantages. The major drawback is its narrow corridor that allows very little clearance for neural and vascular injuries. METHODS: Fifty subaxial pedicles of the cervical vertebrae from five cadavers were scanned into thin slices using computed tomography (CT). Digital imaging and communications in medicine images of the cadaver spine were digitally processed and printed to scale as a three-dimensional (3D) model. Drill guide templates were manually moulded over the 3D-printed models incorporating pins inserted in the pedicles. The drill guide templates were used for precise placement of the drill holes in the pedicles of cadaveric specimens for pedicle screw fixation. RESULTS: The instrumented cadaveric spines were subjected to CT to assess the accuracy of our pedicle placement by an external observer. Our patient-specific drill guide template had an accuracy of 94%. CONCLUSIONS: The use of a patient-specific drill guide constructed using stereolithography improved the accuracy of CPS placement in a cadaveric model.

Diagnóstico y tratamiento de plagiocefalia: presentación de caso clínico y revisión de literatura / Diagnosis and treatment of plagiocephaly: clinical case presentation and clinical review

La plagiocefalia se define como el cierre prematuro de la sutura frontoparietal o coronal unilateral, la cual es causada por una sinostosis frontoparietal (unicoronal) y/o fusiones a lo largo de la sutura coronal, se caracteriza por asimetría facial en la región frontal, inclinación de la cabeza hacia el lado afectado y desviación del mentón hacia el lado no afectado. Se presenta el caso de un infante de género femenino de cinco meses de edad con plagiocefalia, asimetría facial de predominio derecho, el reborde supraorbitario y ceja están desplazados posterior y superior, tratado mediante avance frontoorbitario ipsilateral, llevado a cabo en el Hospital Regional <

Plagiocephaly can be defined as the premature closing of the frontal-parietal suture or unilateral coronal suture which is caused by a frontal-parietal (unicoronal) synostosis, and/or fusions along the coronal suture. Plagiocephaly is characterized by facial asymmetry in the frontal region, inclination of the head towards the affected side as well as deviation of the chin towards the non-affected side. We herein present the case of a five month old female infant with plagiocephaly, facial asymmetry with right side predominance, posterior and superior displacement of the eyebrow and supra-orbital ridge. The case was treated with ipsilateral frontal-orbital advancement, at the Regional Hospital <

Quando a satisfação autorrelatada do paciente com a prótese implantossuportada mandibular influencia na colocação de uma prótese total fixa na maxila: os benefícios do planejamento e colocação 3D baseados na TCFC e nos guias estereolitográficos – acompanhamento de dois anos e 11 meses / When the self-reported patient satisfaction with implant-supported mandibular denture influences on the use of implant-supported maxillary prostheses: the benefi ts of a 3-D implant planning and placement based on CBCT and stereolithographic guides – two year and 11-month follow-up

Este relato mostra um paciente de 72 anos de idade onde sua prótese total inferior sobre implantes motivou-a para usar uma prótese total fixa na maxila. Após os procedimentos de TCFC e protéticos no plano de tratamento, guias estereolitográficos foram construídos para uma colocação de implantes dentários sem levantamento de retalho. Cinco implantes foram colocados nas regiões 14, 13, 11, 22, e 24 com torque de inserção de 32 Ncm. A prótese total fixa definitiva foi entregue em até 48 horas. Após dois anos e 11 meses, não foram registradas complicações. Quando adequadamente indicada, a cirurgia virtual guiada tem se tornado uma realidade efetiva para pacientes idosos.

This case reports on a 72 years-old patient whose complete mandibular implant-supported prosthesis motivated her to use a fi xed appliance in the maxilla. After CBCT and prosthodontic procedures for treatment planning, stereolithographic guides were constructed for a flapless dental implant placement. Five implants were placed in the regions of 14, 13, 11, 22 and 24 with a 32 Ncm insertion torque. The final maxillary implant-supported prosthesis was delivered until 48 hours. After two years and 11 months, no complications were reported. When properly indicated, virtual guided surgery has become an effective possibility for elderly patients.

Precisão da instalação de implantes com guias cirúrgicos obtidos por estereolitografia / On the accuracy of stereolithographic-guided dental implant placement: a clinical study

O presente estudo in vivo propôs avaliar a precisão de instalação de 23 implantes sem retalhos empregando guias cirúrgicos obtidos por estereolitografia em quatro pacientes com maxilas totalmente desdentadas. Após duplo escaneamento com tomografia computadorizada tipo cone-beam, o planejamento pré-cirúrgico foi realizado com o programa Procera. Depois da cirurgia, realizou-se a comparação entre as posições dos implantes planejados e executados através de tomografia computadorizada pós-operatória. Para comparação da posição e dos longos eixos das imagens dos implantes foram eleitos três pontos em cada implante planejado e executado: no centro do limite coronário (D1), no centro da porção central (D2), no centro do limite apical (D3). Assim, as distâncias e o ângulo (A1) formado entre os longos eixos dos implantes planejados e executados foram numericamente calculados. De acordo com a análise tomográfica, os implantes executados em relação aos implantes planejados apresentaram desvios médios de 0,72 mm para a posição D1; 0,98 mm para a posição D2; 1,45 mm para a posição D3; 1,92 graus para o ângulo A1. Concluiu-se que houve desempenho adequado para a utilização de protocolos de cirurgia guiada baseados no método empregado em associação com guias cirúrgicos produzidos pelo processo de estereolitografia. A transferência do planejamento protético-cirúrgico para o campo operatório foi considerada satisfatória, visto que viabilizou a instalação de implantes dentários nas situações propostas...

The aim of this in vivo study was to evaluate the placement accuracy of 23 dental implants with fl apless surgery using stereolithographic guides in four completely edentulous maxillary patients. After double scanning with cone beam computerized tomography (CBCT), the presurgical planning was performed using appropriate software (Procera). After surgery, executed and planned implant positions were compared using CBCT superimposing. Measurements were made at the center of three pre-selected points: coronal (D1), central (D2), and apical (D3) portions. Thus, the distances among points and the angle (A1) formed between the long axes of the planned/executed implants were calculated. Mean deviations were as the following: 0.72 mm at D1, 0.98 mm at D2, and 1.45 mm at D3 positions. The mean angular deviaton (A1) was 1.92 degrees. It was concluded that there was adequate performance with surgical guides produced by stereolithographic process. The transfer of prosthetic-surgical planning for the surgical area was considered satisfactory, since it allowed for implant placement in proposed situations...

Cirurgia guiada sem retalho para implante unitário em região estética / Single-tooth, flapless-guided dental implant surgery in the esthetic zone

A cirurgia guiada sem retalho, associada a um planejamento computadorizado, realizada por meio de guia cirúrgico prototipado representa um dos grandes avanços da Implantodontia moderna, no sentido de melhorar a previsibilidade estético-funcional na colocação de implantes, proporcionando grande precisão no tratamento. Suas principais vantagens incluem a redução do tempo cirúrgico, maior preservação dos tecidos, diminuição dos sintomas pós-operatórios, como dor, edema e inflamação, permitindo uma cicatrização mais rápida. Portanto, essa técnica oferece ganho estético imediato, redução da morbidade do paciente, maior precisão cirúrgica, conforto ao paciente e segurança do profissional. O objetivo desse trabalho foi descrever cada etapa da técnica da cirurgia guiada sem retalho, ilustrado por um caso clínico com reabilitação unitária em área estética.

The computer-planned, flapless surgery along with a stereolithographic-guided dental implant placement represents one of the great achievements of contemporary Implant Dentistry to improve esthetics and precision. Its main advantages include chairside time reduction, more tissue preservation, less postoperative symptoms such as pain, edema, and inflammation, which allows for a faster healing process. Thus, there are immediate esthetic benefits, less patient morbidity, more patient comfort, and safety for the dental practitioner. The aim of this paper is to describe each surgical step in flapless-guided surgery through a clinical case of a single unit in the esthetic zone.

Use of the surface-based registration function of computer-aided design/computer-aided manufacturing software in medical simulation software for three-dimensional simulation of orthognathic surgery

Three-dimensional (3D) computed tomography image models are helpful in reproducing the maxillofacial area; however, they do not necessarily provide an accurate representation of dental occlusion and the state of the teeth. Recent efforts have focused on improvement of dental imaging by replacement of computed tomography with other detailed digital images. Unfortunately, despite the advantages of medical simulation software in dentofacial analysis, diagnosis, and surgical simulation, it lacks adequate registration tools. Following up on our previous report on orthognathic simulation surgery using computer-aided design/computer-aided manufacturing (CAD/CAM) software, we recently used the registration functions of a CAD/CAM platform in conjunction with surgical simulation software. Therefore, we would like to introduce a new technique, which involves use of the registration functions of CAD/CAM software followed by transfer of the images into medical simulation software. This technique may be applicable when using various registration function tools from different software platforms.

Virtual Surgical Planning and Stereolithography-guided Osteotomy for 3 Dimensional Mandibular Reconstruction with Free Fibula Osseous Flaps: A Case Report