SlicerPIT: software development and implementation for planning and image-guided therapy in photoimmunotherapy.

BACKGROUND: Photoimmunotherapy is a treatment modality that induces targeted cell death by binding a molecular-targeted drug activated by infrared light to the tumor cells and subsequently illuminating the lesion with infrared light. For deep lesions, a needle catheter is used to puncture the tumor, and an illumination fiber (cylindrical diffuser) is inserted into the catheter lumen for internal illumination. However, it can be challenging to place the cylindrical diffusers in an appropriate position as the deep lesions cannot be often confirmed accurately during surgery. MATERIALS AND METHODS: We have developed "SlicerPIT", a planning simulation software for photoimmunotherapy. SlicerPIT allows users to place the cylindrical diffuser with its illumination range on preoperative images in 2D and 3D and export the planning data to external image-guided surgical navigation systems. We performed seven cycles of photoimmunotherapy with SlicerPIT in three patients with recurrent head and neck cancer. RESULTS: Preoperative planning for photoimmunotherapy was conducted using SlicerPIT, which could be imported into the navigation system. During the operation, we punctured the needle catheters along with the treatment plan on the navigation screen. Subsequently, intraoperative CT imaging was performed and overlaid with the preoperative treatment plan to confirm the alignment of the cylindrical diffusers as planned, followed by infrared light illumination. Postoperative imaging showed necrosis and shrinkage of the entire tumor in all cycles. CONCLUSION: SlicerPIT allows for detailed preoperative treatment planning and accurate puncture. It may be a valuable tool to improve the accuracy of photoimmunotherapy for deep lesions and improve patient outcomes.

Application of HIPEC simulations for optimizing treatment delivery strategies.

INTRODUCTION: Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) aims to treat microscopic disease left after CytoReductive Surgery (CRS). Thermal enhancement depends on the temperatures achieved. Since the location of microscopic disease is unknown, a homogeneous treatment is required to completely eradicate the disease while limiting side effects. To ensure homogeneous delivery, treatment planning software has been developed. This study compares simulation results with clinical data and evaluates the impact of nine treatment strategies on thermal and drug distributions. METHODS: For comparison with clinical data, three treatment strategies were simulated with different flow rates (1600-1800mL/min) and inflow temperatures (41.6-43.6 °C). Six additional treatment strategies were simulated, varying the number of inflow catheters, flow direction, and using step-up and step-down heating strategies. Thermal homogeneity and the risk of thermal injury were evaluated. RESULTS: Simulated temperature distributions, core body temperatures, and systemic chemotherapeutic concentrations compared well with literature values. Treatment strategy was found to have a strong influence on the distributions. Additional inflow catheters could improve thermal distributions, provided flow rates are kept sufficiently high (>500 mL/min) for each catheter. High flow rates (1800 mL/min) combined with high inflow temperatures (43.6 °C) could lead to thermal damage, with CEM4310 values of up to 27 min. Step-up and step-down heating strategies allow for high temperatures with reduced risk of thermal damage. CONCLUSION: The planning software provides valuable insight into the effects of different treatment strategies on peritoneal distributions. These strategies are designed to provide homogeneous treatment delivery while limiting thermal injury to normal tissue, thereby optimizing the effectiveness of HIPEC.

Accuracy of reverse shoulder arthroplasty angle according to the size of the baseplate.

BACKGROUND: Glenoid inclination must be assessed precisely during preoperative planning for reverse shoulder arthroplasty (RSA) to position the glenoid baseplate correctly. We hypothesized that a more dynamic measurement method would better match the diversity of glenoid heights in the population and the variety of commercialized glenoid baseplates. Our purpose was to describe a new method to measure the RSA angle accounting for the baseplate size. METHODS: Computed tomography scans of 50 shoulders that underwent RSA for primary osteoarthritis or cuff tear arthropathy between June 2019 and February 2020 were included (mean age, 76 years). Three variants of the RSA angle were measured: the RSA angle as originally described by Boileau et al, the relative RSA 25 angle (which simulates the implantation of a 25-mm baseplate), and the relative RSA 29 angle (which simulates the implantation of a 29-mm baseplate). Measurements in the 2-dimensional true reformatted scapular plane were made by 3 independent operators. RESULTS: The mean R-S distance (ie, distance between point R [intersection of supraspinatus fossa line with glenoid surface] and point S [inferior border of glenoid]) was 24.2 ± 4.0 mm. The mean RSA angle was 20.3° ± 8.4°, whereas the mean relative RSA 25 angle was 19.3° ± 7.8° and the mean relative RSA 29 angle was 15.6° ± 7.6°. The mean difference between the RSA angle and the relative RSA 25 angle was 1.0° ± 4.1° (P = .16). The mean difference between the RSA angle and the relative RSA 29 angle was 4.7° ± 3.8° (P < .0001). In half of the shoulders in our series, the difference between the RSA angle and the RSA 29 angle exceeded 5°. CONCLUSION: The RSA angle is a reproducible measure of the inclination of the inferior part of the glenoid that is reliable in most cases for glenoid baseplates of 24-25 mm in height. However, surgeons should be aware that the RSA angle may overestimate the superior orientation of the inferior glenoid for baseplates of different sizes or for small- or large-stature patients. In these cases, the relative RSA angle adapted to the size of the baseplate more accurately evaluates the inclination of the inferior glenoid.

Guided endodontics versus conventional access cavity preparation: an ex vivo comparative study of substance loss.

BACKGROUND: To compare the outcomes of conventional access cavity preparation (CONV) versus guided endodontics (GE) for access cavity preparation in anterior teeth with pulp canal calcification (PCC) regarding root canal detection, substance loss, procedural time, and need for additional radiographs. METHODS: Extracted, sound human teeth with PCC (n = 108) were matched in pairs, divided into two groups and used to produce 18 models. An independent endodontist and a general dentist performed access cavity preparation under simulated clinical conditions on nine models each (54 teeth). The endodontist used the conventional technique and the general dentist GE. Time needed to access the root canals and the number of additional radiographs were recorded. Pre- and postoperative cone-beam computed tomography scans were obtained to measure substance loss. Statistical significance was tested by examining the overlap of 95% confidence intervals (CIs) between the groups. RESULTS: All root canals were successfully accessed by both methods. There were no significant differences in substance loss (CI: CONV 15.9-29.6 mm3 vs. GE 17.6-27.5mm3) or procedural time (CI: CONV 163.3-248.5 s vs. GE 231.9-326.8 s). However, 31 additional radiographs were required for GE compared to none for CONV. CONCLUSIONS: For access cavity preparation in teeth with PCC, both CONV by a specialist and GE by a general dentist produce good results in terms of substance loss and time requirements.

Acceptability of fully guided virtual implant planning software among dental undergraduate students.

BACKGROUND: Fully guided implant surgery as a technique is gaining popularity. It has been observed that use of surgical guides improves precision and predictability for dental implant placement. However, like any other newer technology, the acceptance of fully guided dental implant technology among users is based upon its perceived usability. This study aimed at evaluating the perception about using Virtual Implant Planning Software (VIPS) among undergraduate dental students at the university of Sharjah. METHODS: Ninety-Six dental surgery students from the University of Sharjah were included in the study. One week after the Virtual Implant Planning Software (Planmeca Romexis version 6.2 procedure, students were asked to complete a Combined technology acceptance model and the theory of planned behaviour (C-TAM TPB) questionnaire. Sixty-six students responded to the questionnaire. RESULTS: Cronbach's alpha surpassed 0.7 for perceived usefulness, perceived ease of use, perceived behavioral control, and subjective norm. Attitude and behavioural intention reported Cronbach's alpha values less than 0.7. Spearman's correlation coefficient was significant for all the constructs. Perceived ease of use explained 49%, 33%, and 42% of the variance of perceived usefulness (R2 = 0.49), attitude (R2 = 0.33), and perceived behavioral control (R2 = 0.42) respectively. Perceived usefulness explained 25%, 18%, and 23% of the variance of attitude (R2 = 0.25), behavioral intention (R2 = 0.18), and perceived behavioral control (R2 = 0.23) respectively. Attitude accounted for 25%, 33%, and 29% of the variance of behavioral intention (R2 = 0.25), perceived behavioral control (R = 0.33), and subjective norm (R = 0.29) respectively. CONCLUSION: The fully guided VIPS was acceptable by dental students specifically because of its usability. This makes VIPS a very effective tool for teaching implantology for dental students. VIPS also allows students to perform multiple repetitions of the implant planning procedure which enhances understanding and content retention.

Robotic-guided placement of cervical pedicle screws: feasibility and accuracy.

INTRODUCTION: It has been shown that pedicle screw instrumentation in the cervical spine has superior biomechanical pullout strength and stability. However, due to the complex and variable anatomy of the cervical pedicles and the risk of catastrophic complications, cervical pedicle screw placement is not widely utilized. STUDY DESIGN: A retrospective, consecutive patient review. OBJECTIVE: To review and report our experience with robotic guided cervical pedicle screw placement. METHODS: We retrospectively reviewed preoperative and postoperative CT scans of 12 consecutive patients who underwent cervical pedicle screw fixation with robotic guidance. Screw placement and deviation from the preoperative plan were assessed using the robotic system's planning software by fusing the preoperative CT (with the planned cervical pedicle screws) to the post-op CT. This process was carried out by manually aligning the anatomical landmarks on the two CTs. Once a satisfactory fusion was achieved, the software's measurement tool was used manually to compare the planned vs. actual screw placements in the axial, sagittal and coronal planes within the instrumented pedicle in a resolution of 0.1 mm. Medical charts were reviewed for technical issues and intra-operative complications. RESULTS: Eighty-eight cervical pedicle screws were reviewed in 12 patients; mean age = 65 years, M:F = 2:1, and mean BMI = 27.99. No intra-operative complications related to the cervical pedicle screw placement were reported. Robotic guidance was successful in all 88 screws: eight in C2, 14 in C3, 16 in each of C4 and C5, 19 in C6, and 15 at C7. There were 14 pedicle screw breaches (15.9%); all were medial, less than 1 mm, and with no clinical consequences. In the axial plane, the screws deviated from the preoperative plan by 1.32 ± 1.17 mm and in the sagittal plane by 1.27 ± 1.00 mm. In the trajectory view, the overall deviation was 2.20 ± 1.17 mm. Although differences were observed in screw deviation from the pre-op plan between the right and left sides, they were not statistically significant (p > 0.05). CONCLUSION: This study indicates that robotic-guided cervical pedicle screw placement is feasible and safe. The medial breaches did not result in any clinical consequences.

Implementation of secondary reconstructions of flat-panel volume computed tomography (fpVCT) and otological planning software for anatomically based cochlear implantation.

PURPOSE: For further improvements in cochlear implantation, the measurement of the cochlear duct length (CDL) and the determination of the electrode contact position (ECP) are increasingly in the focus of clinical research. Usually, these items were investigated by multislice computed tomography (MSCT). The determination of ECP was only possible by research programs so far. Flat-panel volume computed tomography (fpVCT) and its secondary reconstructions (fpVCTSECO) allow for high spatial resolution for the visualization of the temporal bone structures. Using a newly developed surgical planning software that enables the evaluation of CDL and the determination of postoperative ECP, this study aimed to investigate the combination of fpVCT and otological planning software to improve the implementation of an anatomically based cochlear implantation. METHODS: Cochlear measurements were performed utilizing surgical planning software in imaging data (MSCT, fpVCT and fpVCTSECO) of patients with and without implanted electrodes. RESULTS: Measurement of the CDL by the use of an otological planning software was highly reliable using fpVCTSECO with a lower variance between the respective measurements compared to MSCT. The determination of the inter-electrode-distance (IED) between the ECP was improved in fpVCTSECO compared to MSCT. CONCLUSION: The combination of fpVCTSECO and otological planning software permits a simplified and more reliable analysis of the cochlea in the pre- and postoperative setting. The combination of both systems will enable further progress in the development of an anatomically based cochlear implantation.

What is the deviation in 3D preoperative planning software? A systematic review of concordance between plan and actual implant in reverse total shoulder arthroplasty.

BACKGROUND: Three-dimensional (3D) preoperative planning software for reverse total shoulder arthroplasty (rTSA) has been implemented in recent years in order to increase accuracy, improve efficiency, and add value to the outcome. A comprehensive literature review is required to determine the utility of preoperative 3D planning software in guiding orthopedic surgeons for implant placement in rTSA. We hypothesize that implementation of 3D preoperative planning software in the setting of rTSA leads to high concordance with minimal deviation from the preoperative plan. METHODS: A comprehensive and iterative literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the PubMed, Embase, OVID Medline, Scopus, Cinahl, Web of Science, and Cochrane databases for original English-language studies evaluating the impact of preoperative planning software usage on rTSA outcomes published from January 1, 2000, to present. Blinded reviewers conducted multiple screens. All included studies were graded based on level of evidence, and data concerning patient demographics and postoperative outcomes were extracted. RESULTS: Nine articles met inclusion criteria (1 level II, 3 level III, and 5 level IV articles), including 415 patients and 422 shoulders. Of the patients who underwent rTSA, 235 were female and 140 were male, although 3 studies (n = 40) did not report sex breakdowns for rTSA patients. The average age was 72.7 years. Four studies (79 shoulders) reported implant final position as mean deviation from planned version and planned inclination. Six studies (n = 236) reported screw angle deviation, fixation, length, and concordance. Concordance with the preoperative plan was measured in 3 studies (n = 178), resulting in complete concordance of 90% (n = 100), arthroplasty type concordance (rTSA vs. TSA) of 100% (n = 100), and glenosphere size concordance between 93% (n = 100) and 88% (n = 76). For screw length concordance, baseplate screw matched by 81% (n = 76) and 100% (n = 2), and upper (n = 35) and lower (n = 35) screw length concordance was observed as 74% and 69%, respectively. The use of preoperative planning (n = 178) was associated with low deviation from preoperative plan, more 2-screw fixations, and longer average screw length in comparison with an unplanned cohort. CONCLUSION: The use of preoperative planning software in the setting of rTSA results in minimal deviation from preoperative plan. High levels of concordance in screw angle, screw length, and glenosphere size were observed. Further prospective studies should be conducted to further substantiate these results.

Digital transformation: analog expertise and digital optimization.

Digital tools now enable an effective and efficient workflow even for complex implant-prosthetic restorations such as the immediate restoration of the edentulous maxilla. Planning predictability due to high process reliability, time saving, cost reduction due to shortened therapy sequences, high patient satisfaction due to predictable results, and high patient comfort are the advantages of the digitally supported therapy phases - from digital volume tomography of the bony structures to planning software to CAD/CAM-generated temporaries and prototypes to all-ceramic restorations. However, the use of digital procedures and techniques alone is no guarantee for a successful, indication-appropriate, and patient-specific restoration. In addition to having digital knowledge, the conditio sine qua non for the dental technician team is still analog competence coupled with corresponding experience to be able to interpret the various influencing factors. Using an immediately loaded maxillary restoration as an example, an analog-digital workflow is presented that is geared to surgical, prosthetic, and patient-specific requirements. (Int J Comput Dent 2022;25(4):407-0; doi: 10.3290/j.ijcd.b3555715).

Demonstration of treatment planning software for hyperthermic intraperitoneal chemotherapy in a rat model.

BACKGROUND: Hyperthermic intraperitoneal chemotherapy (HIPEC) is administered to treat residual microscopic disease after cytoreductive surgery (CRS). During HIPEC, fluid (41-43 °C) is administered and drained through a limited number of catheters, risking thermal and drug heterogeneities within the abdominal cavity that might reduce effectiveness. Treatment planning software provides a unique tool for optimizing treatment delivery. This study aimed to investigate the influence of treatment-specific parameters on the thermal and drug homogeneity in the peritoneal cavity in a computed tomography based rat model. METHOD: We developed computational fluid dynamics (CFD) software simulating the dynamic flow, temperature and drug distribution during oxaliplatin based HIPEC. The influence of location and number of catheters, flow alternations and flow rates on peritoneal temperature and drug distribution were determined. The software was validated using data from experimental rat HIPEC studies. RESULTS: The predicted core temperature and systemic oxaliplatin concentration were comparable to the values found in literature. Adequate placement of catheters, additional inflow catheters and higher flow rates reduced intraperitoneal temperature spatial variation by -1.4 °C, -2.3 °C and -1.2 °C, respectively. Flow alternations resulted in higher temperatures (up to +1.5 °C) over the peritoneal surface. Higher flow rates also reduced the spatial variation of chemotherapy concentration over the peritoneal surface resulting in a more homogeneous effective treatment dose. CONCLUSION: The presented treatment planning software provides unique insights in the dynamics during HIPEC, which enables optimization of treatment-specific parameters and provides an excellent basis for HIPEC treatment planning in human applications.

Does commercially available shoulder arthroplasty preoperative planning software agree with surgeon measurements of version, inclination, and subluxation?

BACKGROUND: Preoperative planning with commercially available imaging software in shoulder arthroplasty may allow for improved decision-making and more accurate placement of the glenoid component. METHODS: A total of 81 consecutive shoulder computed tomography scans obtained for preoperative planning purposes for shoulder arthroplasty were analyzed by commercially available software from 4 companies (Blueprint: Wright Medical, Memphis, TN, USA; GPS: Exactech, Gainesville, FL, USA; Materialise: DJO, Vista, CA, USA; and VIP: Arthrex, Naples, FL, USA) and by 5 fellowship-trained sports medicine/shoulder surgeons. Inclination, version, and subluxation of the humerus were measured in a blinded fashion on axial and coronal sequences at the mid-glenoid. Surgeon measurements were analyzed for agreement and were compared with the 4 commercial programs. RESULTS: Surgeon reliability was acceptable for version (intraclass correlation coefficient [ICC]: 0.876), inclination (ICC: 0.84), and subluxation (ICC: 0.523). Significant differences were found between surgeon and commercial software measurements in version (P = .03), inclination (P = .023), and subluxation (P < .001). Software measurements tended to be more superiorly inclined (average -2° to 2° greater), more retroverted (average 2°-5° greater), and more posteriorly subluxed (average 7°-10° greater) than surgeon measurements. In comparing imaging software measurements, only Blueprint was found to produce significantly different version measurements than surgeon measurements (P = .02). CONCLUSION: Preoperative planning software for shoulder arthroplasty has limited agreement in measures of version, inclination, and subluxation measurements, whereas surgeons have high inter-reliability. Surgeons should be cautious when using commercial software planning systems and when comparing publications that use different planning systems to determine preoperative glenoid deformity measurements.

Is preoperative planning effective for intraoperative glenoid implant size and type selection during anatomic and reverse shoulder arthroplasty?

INTRODUCTION: Preoperative 3D planning programs for anatomic (TSA) and reverse total shoulder arthroplasty (RSA) allow the analysis of glenohumeral joint pathoanatomy and templating for implant size selection and placement. The aim of this multicenter study was to compare the preoperative glenoid implant type and size planned to the final glenoid implant type and size used intraoperatively. METHODS: Two hundred patients (100 TSA and 100 RSA) with a mean age of 72 years who had undergone preoperative planning and subsequent shoulder arthroplasty (100 TSA and 100 RSA) were included. All preoperative plans were saved and were analyzed for arthroplasty type (TSA vs. RSA), implant type (augment vs. nonaugment), and size (ie, polyethylene size, polyethylene radius of curvature, glenoid baseplate diameter, baseplate post length, and baseplate lateralization). The preoperative plan was available during surgery and was compared to the final implants inserted by the surgeon. RESULTS: There were no intraoperative conversions of TSA to RSA or vice versa. In patients planned for a TSA, complete concordance between the preoperative plan and final implant selection was 85%. A complete mismatch for TSA glenoid size, backside radius of curvature, and augmentation occurred in 2%. For RSA, complete concordance was found in 90% of cases. A complete mismatch for implant type, size, post length, and glenosphere size occurred in 3%. CONCLUSION: A high concordance was found between preoperative 3D planning implant selection and the glenoid component inserted at surgery for TSA and RSA. This high concordance may assist with surgical preparedness, implant stocks, and possibly future implant production.

Accuracy of Guided Implant Surgery in 25 Edentulous Arches: A Laboratory Observational Study.

PURPOSE: To assess the accuracy of template-guided implant surgery for edentulous arches. MATERIALS AND METHODS: The stone master casts of 25 edentulous arches treated with either 4 or 6 implants with CBCT generated template-guided surgery were included in this observational cohort study. The stone casts generated from the surgical templates (group one) prior to implant placement were digitized into Standard Tesselation (STL) files with a reference scanner. For comparison, the stone master casts derived from intraoral complete-arch impressions after implant placement (group two) were also digitized. The resultant STL files were superimposed and best-fit-alignment algorithm was used to quantify the 3D deviations present between the two groups. Descriptive statistics were computed for all categorical variables. Due to the presence of nonindependent samples between maxillary and mandibular casts, a mixed-effects model was used. RESULTS: Deviations between the implant analogs of the stone casts representing digitally planned versus actually placed implants were found. The mean root-mean-square error (RMSE) between all 25 arches was found to be 0.2 mm (SD ± 0.15). The mean RMSE between presurgical and postsurgical maxillary stone casts were 0.19 ± 0.15 mm, while between mandibular stone casts were 0.21 ± 0.16 mm and were not significant (p = 0.67). The mean RMSE between presurgical and postsurgical stone casts arches with 4 versus 6 implants were found to be significant (p = 0.01). CONCLUSIONS: According to the results of the study and based on the amount of 3D deviations between the digitally planned implant positions and the actually placed implants, template-guided surgery is a safe treatment modality for implant placement in edentulous arches.

Localization of Deep Brain Stimulation Electrode by Image Registration Is Software Dependent: A Comparative Study between Four Widely Used Software Programs.

BACKGROUND: The control of the anatomic position of the active contacts is essential to understand the effects and adapt the settings of the neurostimulation. The localization is commonly assessed by a registration between the preoperative MRI and the postoperative CT scan. However, its accuracy depends on the quality of the registration algorithm and many software programs are available. OBJECTIVE: To compare the localization of implanted deep brain stimulation (DBS) leads in the subthalamic nucleus (STN) between four registration devices. METHODS: The preoperative stereotactic MRI was co-registered and fused with the 3-month postoperative CT scan in 27 patients implanted in the STN for Parkinson's disease (53 leads). Localizations of the active contacts were calculated in the stereotactic frame space and compared between software programs. RESULTS: The coordinates of the active contacts were different between software programs in the 3 axes (p < 0.001) with a mean vectorial error between the deepest contact locations of 1.17 mm (95% CI 1.09-1.25). CONCLUSION: We found a small but significant difference in the coordinates calculated on four different devices. These results have to be considered when performing studies comparing active contact locations or when following patients with an implanted DBS lead.

How Precise Are Preinterventional Measurements Using Centerline Analysis Applications? Objective Ground Truth Evaluation Reveals Software-Specific Centerline Characteristics.

PURPOSE: To evaluate different centerline analysis applications using objective ground truth from realistic aortic aneurysm phantoms with precisely defined geometry and centerlines to overcome the lack of unknown true dimensions in previously published in vivo validation studies. METHODS: Three aortic phantoms were created using computer-aided design (CAD) software and a 3-dimensional (3D) printer. Computed tomography angiograms (CTAs) of phantoms and 3 patients were analyzed with 3 clinically approved and 1 research software application. The 3D centerline coordinates, intraluminal diameters, and lengths were validated against CAD ground truth using a dedicated evaluation software platform. RESULTS: The 3D centerline position mean error ranged from 0.7±0.8 to 2.9±2.5 mm between tested applications. All applications calculated centerlines significantly different from ground truth. Diameter mean errors varied from 0.5±1.2 to 1.1±1.0 mm among 3 applications, but exceeded 8.0±11.0 mm with one application due to an unsteady distortion of luminal dimensions along the centerline. All tested commercially available software tools systematically underestimated centerline total lengths by -4.6±0.9 mm to -10.4±4.3 mm (maximum error -14.6 mm). Applications with the highest 3D centerline accuracy yielded the most precise diameter and length measurements. CONCLUSION: One clinically approved application did not provide reproducible centerline-based analysis results, while another approved application showed length errors that might influence stent-graft choice and procedure success. The variety and specific characteristics of endovascular aneurysm repair planning software tools require scientific evaluation and user awareness.

Reliability and scientific use of a surgical planning software for anterior cervical discectomy and fusion (ACDF).

PURPOSE: Software-based planning of a spinal implant inheres in the promise of precision and superior results. The purpose of the study was to analyze the measurement reliability, prognostic value, and scientific use of a surgical planning software in patients receiving anterior cervical discectomy and fusion (ACDF). METHODS: Lateral neutral, flexion, and extension radiographs of patients receiving tailored cages as suggested by the planning software were available for analysis. Differences of vertebral wedging angles and segmental height of all cervical segments were determined at different timepoints using intraclass correlation coefficients (ICC). Cervical lordosis (C2/C7), segmental heights, global, and segmental range of motion (ROM) were determined at different timepoints. Clinical and radiological variables were correlated 12 months after surgery. RESULTS: 282 radiographs of 35 patients with a mean age of 53.1 ± 12.0 years were analyzed. Measurement of segmental height was highly accurate with an ICC near to 1, but angle measurements showed low ICC values. Likewise, the ICCs of the prognosticated values were low. Postoperatively, there was a significant decrease of segmental height (p < 0.0001) and loss of C2/C7 ROM (p = 0.036). ROM of unfused segments also significantly decreased (p = 0.016). High NDI was associated with low subsidence rates. CONCLUSIONS: The surgical planning software showed high accuracy in the measurement of height differences and lower accuracy values with angle measurements. Both the prognosticated height and angle values were arbitrary. Global ROM, ROM of the fused and intact segments, is restricted after ACDF.

Selection of Dental Implants and Restorations Among Dentists in the Kingdom of Saudi Arabia: A Cross-Sectional, Questionnaire-Based Survey.

Background Dental implants play a crucial role in modern dentistry, offering a durable and aesthetic option for tooth replacement. Understanding the preferences and practices of dentists regarding implant selection and restoration can provide critical insights into current trends and potential areas for improvement. As such, the objective of this study was to discover characteristics determining the selection criteria and preferences for dental implants and restorations among Saudi Arabian dentists. Methodology A cross-sectional, questionnaire-based survey was conducted among Saudi Arabian dentists to assess their practices and preferences for dental implant selection and restoration. The survey explored variables, including age, gender, educational status, regional practice distribution, implant-related experience, loading protocols, and implant system preferences. Results A total of 742 dental professionals responded to our questionnaire. The study revealed that a significant majority of Saudi Arabian dentists had placed (78.7%) and restored (72.9%) implants. Most dentists (78.6%) had participated in implant treatment planning. However, consistent usage of implant planning software was relatively low (29.8%). Loading protocol preferences varied, with early loading favored for anterior teeth and immediate loading for posterior teeth and edentulous patients. The main deterrents to immediate loading were patient type (27.0%), lack of training (19.9%), additional surgeries (19.9%), and administrative restrictions (17.8%). Straumann was the most preferred implant system, with aesthetic outcomes considered the most important factor in system selection. Conclusions The study provides a comprehensive overview of dental implant practices among Saudi Arabian dentists. It highlights a strong emphasis on aesthetic outcomes, a diverse approach to loading protocols, and room for increased usage of implant planning software. The findings suggest potential areas for further training and support, particularly in the use of immediate loading and implant planning software.

Advanced technology in shoulder arthroplasty.

Background: Glenoid component positioning is an important and challenging aspect of total shoulder arthroplasty. The use of freehand technique with standard instrumentation or preoperative planning based on 2-dimensional computed tomography (CT) scans provides an opportunity for improvement in terms of component accuracy, precision, and deformity correction. These techniques have produced varying outcomes. Methods: Preoperative planning software (PPS), patient specific instrumentation (PSI), and intraoperative navigation (NAV) have been developed to improve the accuracy of implant placement and deformity correction with the ultimate goals of improved patient outcomes and implant longevity. Literature search was conducted on published and available studies comparing the accuracy of glenoid component placement and improvements in surgical and patient outcomes amongst the aforementioned techniques. Results: PPS, PSI, and NAV have demonstrated improved accuracy over freehand techniques with standard instrumentation. However, data demonstrating the clinical benefit and cost effectiveness of these new technologies are lacking. Discussion: In this paper, we reviewed the evidence available to answer the question of whether or not advanced shoulder arthroplasty technologies have been beneficial and reviewed future technologies in development such as virtual/mixed-reality and robotic assisted shoulder surgery. Level of Evidence: 4.

Use of pre-operative 3D planning software for revision shoulder arthroplasty: clinical experience data from a survey in a real-world setting.

Background: Preoperative 3D planning is routinely used in primary shoulder arthroplasty, while specific challenges in the revision setting make such approaches more cumbersome and less accessible. Recently, an established preoperative planning software (Blueprint; Stryker, Tornier SAS, Montbonnot-Saint-Martin, France) was expanded to offer a capability for planning of revision and complex primary shoulder arthroplasty cases. The aim of this study was to survey experienced surgeons on their perception of the new software feature for preoperative 3D planning in the setting of revision shoulder arthroplasty. Methods: An observational survey was conducted from January 2022 to October 2022 among orthopedic surgeons performing revision shoulder arthroplasty cases. The survey was part of the Early Product Surveillance program, with the primary goal of obtaining observational data from surgical experience in a real-world setting. A two-staged survey process was applied with separate questionnaires to seek voluntary feedback on the preoperative planning phase as well as on the intraoperative evaluation of the software planning features in revision shoulder arthroplasty. Results: Twenty-five fellowship-trained orthopedic surgeons from the USA and Canada participated in the survey and reported their feedback on 34 revision shoulder arthroplasty cases that were preoperatively planned with the use of Blueprint revision planning software. The surgeons were largely in favor of the revision software planning features and confirmed perceived benefits of its use in the preoperative planning stage of revision shoulder arthroplasty cases. Reported benefits in the preoperative planning phase included increased efficiency and improved ease of creating an appropriate surgical plan as well as increased confidence to execute revision shoulder arthroplasty cases. Surgeons also noted improvements in translation of preoperative planning to intraoperative execution of revision cases, including more appropriate implant selection and improved accuracy of implant placement. Conclusion: The feedback from fellowship-trained shoulder arthroplasty surgeons on the use of the new software feature for preoperative 3D planning of revision shoulder arthroplasty is largely favorable. Further research should be conducted to investigate whether these surgeon-perceived benefits can lead to improved clinical outcomes for patients.

Effect of osteophyte removal on simulated range of motion using 3-dimensional preoperative planning software for reverse total shoulder arthroplasty.

Background: Glenohumeral osteophytes (OPs) can adversely influence postoperative range of motion (ROM) following shoulder arthroplasty due to mechanical impingement. Though commercial three-dimensional preoperative planning software (3D PPS) is available to simulate ROM before and after OP resection, little is known about the magnitude of effect OPs and their subsequent removal have on simulated glenohumeral ROM. Methods: Included patients were 1) indicated for reverse total shoulder arthroplasty (rTSA) using 3D PPS and 2) presented with glenoid and/or humeral head OPs on preoperative two-dimensional computed tomography (2D-CT) imaging. Thirty patients met the inclusion criteria (9 females, 21 males; mean age 70.45 ± 4.99 years, range 63-80 years). All subjects (n = 30) presented with humeral OPs (mean volume: 2905.16 mm3, range 109.1-11,246 mm3), while 11 subjects also presented with glenoid OPs (mean volume 108.06 mm3, range 37.59-791.4 mm3). Preoperative CTs were used to calculate OP volume (mm3) and OP circumferential extent (clockface). Mean clockface position for circumferential humeral OPs originated at 6:09 (range 4:30-7:15) and extended to 8:51 (range 8:15-10:15). Mean clockface position for glenoid OPs originated at 3:00 (range 2:00-5:00) and extended to 6:16 (range 3:00-7:30). 3D implants on PPS were standardized to achieve 0° of version, 0° of inclination and 4 mm of net lateralization. Thirty-nine and thirty-six mm glenospheres were used for males and females, respectively. 3D PPS was used to evaluate simulated ROM differences before and after OP removal in the planes of adduction (ADD), abduction, internal rotation (IR), external rotation (ER), extension, and flexion. Impact of OP volume and circumferential extent on pre and postop removal ROM were also analyzed. Results: Humeral OP removal significantly increased impingement-free ADD, IR, ER, extension, and flexion. Removal of larger (mm3) humeral OPs positively correlated with improvement in IR (R = 0.452, P = .011), ER (R = 0.394, P = .033), and flexion (R = 0.500, P < .01). Greater circumferential extent of humeral OPs correlated with worse preremoval ROM in the planes of ADD (R = 0.364, P = .02) and extension (R = 0.403, P = .04), and improvements in ER postop removal (R = 0.431, P = .03). Conclusion: Humeral OP removal significantly increases impingement-free ADD, IR, ER, extension, and flexion in simulated 3D PPS models following rTSA. Magnitude of simulated ROM improvement is influenced by initial humeral OP volume and circumferential clockface extent. Surgeons should consider these effects when using 3D PPS for rTSA planning to optimize postoperative ROM prognostics.