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Marginal bone loss around immediately placed implants may compromise esthetic outcomes in the anterior maxilla. The relatively recent socket-shield technique of partial extraction therapy has been described as being useful to maintain the structure of peri-implant tissues. The present technique report introduced a digital workflow to perform image-guided implant placement after partial extraction therapy. In this technique, digital 3-dimensional images are used to plan and orient the flapless surgical procedure and to digitally design a custom abutment based on the natural emergence profile as segmented from the tooth to be extracted.
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Implantes Dentários para Um Único Dente , Implantes Dentários , Carga Imediata em Implante Dentário , Carga Imediata em Implante Dentário/métodos , Alvéolo Dental/diagnóstico por imagem , Alvéolo Dental/cirurgia , Fluxo de Trabalho , Estética Dentária , Extração Dentária , Maxila/diagnóstico por imagem , Maxila/cirurgia , Resultado do TratamentoRESUMO
ABSTRACT: The use of hyaluronic acid (HA) fillers in lip augmentation represents today 1 of the most widely used nonsurgical aesthetic procedures in the world. Regarding the severe complications are rare, insufficient professional experience for recognizing signs of vascular impairment and inadequate technique could lead to severe lip skin necrosis complications. Several of existing treatment protocols in the literature to treat vascular complication are mainly based on the use of hyaluronidase. Nevertheless, there is no consensus on dosage, interval between doses and complementary protocol among the aforementioned studies. This case aims to present a conservative approach for the clinical management of serious vasculature complications with HA injection. A high dose of hyaluronidase(11500 IU) with additional multimodal treatment was performed to the upper lip, nasolabial fold, and nose that successfully reversed a vascular complication process. The present findings suggest that the use of high doses of hyaluronidase with the complementary protocol used herein might be a promising approach in the treatment of severe vascular complication in the lips caused by HA filling.
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Técnicas Cosméticas , Preenchedores Dérmicos , Técnicas Cosméticas/efeitos adversos , Preenchedores Dérmicos/efeitos adversos , Estética Dentária , Humanos , Ácido Hialurônico/efeitos adversos , Hialuronoglucosaminidase , LábioRESUMO
Several protocols have been used with computer-aided design and computer-aided manufacture (CAD-CAM) prostheses after image-guided implant surgery based on a prosthetically driven surgical plan. For delayed approaches, a CAD-CAM custom healing abutment can be manufactured before the surgery and installed immediately after implant placement. However, information on the use of emergence profile segmentation on which to base the digital design and on the use of low-cost 3-dimensional printers to produce custom healing abutments are lacking. The purpose of this article was to present a fully digital workflow to digitally design and 3-dimensionally print custom healing abutments with a biocompatible light-polymerizing resin based on the natural emergence profile of the tooth to be replaced.
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STATEMENT OF PROBLEM: The digital waxing of single crowns can be affected by the quality of intraoral scans and use of computer-aided design (CAD) software programs. However, clinical outcomes of the resulting crowns are also affected by computer-aided manufacturing (CAM) methodologies. Studies on the effect of different levels of expertise on digital waxing are lacking. PURPOSE: The purpose of this in vitro study was to assess the impact of different levels of expertise on the reliability and reproducibility of margin outlining during digital waxing. MATERIAL AND METHODS: Thirty analogs of implant stock abutments (Ø4.8×4 mm) were embedded into resin blocks. To simulate different clinical situations, abutments were divided into 3 groups: 10 abutments (group GOS) received artificial gingiva and were scanned with an open system intraoral scanner, while 10 abutments with (group GIS) and 10 abutments without artificial gingiva (group IS) were scanned with an intraoral scanner within an integrated CAD-CAM system. All resulting standard tessellation language (STL) files were used by 2 different observers (an experienced CAD professional and a clinician with basic CAD knowledge) to digitally design a left mandibular central incisor in the same software program. All resulting digital crown designs were exported to STL files to assess crown margin accuracy at the coupling interface by superimposition with the control STL file of the scan body designed for the same abutment by the manufacturer. For this purpose, a CAD software program was used to automatically calculate median, minimum, and maximum deviations of margins in millimeters. Statistically significant pairwise differences among groups and between observers were assessed with the Wilcoxon signed-rank test (α=.05). RESULTS: For the CAD professional, median deviations between designed crown STL files and the control STL of the scan body were 0.08 mm (range: 0.04 to 0.15) for group GOS; 0.10 mm (range: 0.06 to 0.18) for group GIS; and 0.05 mm (range: 0.03 to 0.08) for group IS. For the clinician, median deviations were 0.08 mm (range: 0.04 to 0.12) for group GOS; 0.11 mm (range: 0.07 to 0.17) for group GIS; and 0.05 mm (range: 0.04 to 0.11) for group IS. There were no significant differences between observers (P>.05). However, statistically significant differences were found between group IS and the other 2 groups (P=.001) but not between groups GOS and GIS (P>.05). CONCLUSIONS: The present findings suggest that a digital wax pattern made with a dental CAD software program is not affected by varying levels of expertise but might be affected by subgingival margins.
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Desenho Assistido por Computador , Coroas , Planejamento de Prótese Dentária , Gengiva , Reprodutibilidade dos TestesRESUMO
This article presents a rapid technique for the accurate transfer of implant positions immediately after image-guided surgery to enable the immediate installation of a definitive complete-arch implant-supported prosthesis with an implant biological width of 3 mm within 3 appointments. A sleeveless copy of the implant surgical guide is magnetically connected to a reference guide to ensure the accurate capture of cylindrical titanium transfer abutments. In the laboratory, the sleeveless guide with the splinted transfer abutments attached is used to generate a definitive cast to be scanned with a desktop scanner. The resulting digital definitive cast is then combined with the original meshes of the prosthetically driven virtual treatment plan to enable a definitive computer-aided design and computer-aided manufactured prosthesis to be fabricated and installed with passive fit.
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AIM: There is controversy in the literature regarding clinical outcomes of CAD/CAM laminate veneers. The aim of the present study was to assess the impact of different levels of CAD expertise and different software programs on the reliability and reproducibility of digital wax patterns of laminate veneers and single crowns. MATERIALS AND METHODS: The present preliminary in vitro study was performed on 10 prepared maxillary central incisors available in dental study models. Of the total, five central incisors were prepared with shoulder finish lines for single crowns, whereas the other five underwent incisal shoulder preparation for laminate veneers. The models were scanned using an intraoral scanner. Four dentists (group DENT) and four CAD dental technicians (group CAD) with expertise in different software programs performed digital diagnostic waxing on all prepared teeth. The resulting digital wax patterns (n = 80) were exported as standard tessellation language (STL) files and superimposed on gold standard digital wax patterns (obtained from the original shape of the teeth before preparations). 3D mesh deviations at the cervical margins as well as distal, mesial, and incisal/palatal surfaces between each STL and the gold standard digital wax patterns were calculated in millimeters using a CAD software program. The mean time required by each operator to perform digital waxing was also recorded. Paired comparisons between groups DENT and CAD as well as between nondental and dental software programs were performed for the crowns and laminate veneers using the Wilcoxon signed-rank and paired t tests (α = 0.05). RESULTS: For group DENT, median deviations for single crowns were 0.15 mm (range: 0.08 to 1.05 mm) and for laminate veneers they were 0.15 mm (range: 0.08 to 0.76 mm). For group CAD, median deviations for single crowns were 0.16 mm (range: 0.09 to 0.73 mm) and for laminate veneers they were 0.10 mm (range: 0.06 to 0.53 mm). The Wilcoxon signed-rank test revealed a statistically significant difference between groups DENT and CAD (P = 0.041) and between the software programs (P = 0.029) for laminate veneers, but not for single crowns (P > 0.05). Furthermore, mean times required for group CAD and for dental software programs were significantly shorter than those for group DENT (P = 0.001) and for nondental software programs (P = 0.001), respectively. CONCLUSION: Within the limitations of the present study, the findings suggest that CAD expertise and the software program significantly affect digital wax patterns for laminate veneers, but not for single crowns. (Int J Comput Dent 2022;25(4):361-0; doi: 10.3290/j.ijcd.b3555819).
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Planejamento de Prótese Dentária , Facetas Dentárias , Humanos , Reprodutibilidade dos Testes , Planejamento de Prótese Dentária/métodos , Porcelana Dentária , Desenho Assistido por Computador , CoroasRESUMO
ABSTRACT: Nose augmentation with Hyaluronic acid (HA) fillers has been considered the preferred technique for minimally invasive cosmetic procedures. Despite severe complications related to HA injection are rare, none of the existing treatment protocols has been established as standard. The aim of this report is to present an alternative approach to treat nasal skin necrosis related to HA injection. A high dose of hyaluronidase - 6000 IU was applied in the nose, for the purpose of reversing a necrotic process. The present findings suggest that a high dose of hyaluronidase could be a promising approach to treat severe nasal skin necrosis caused by HA filler.
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Técnicas Cosméticas , Preenchedores Dérmicos , Técnicas Cosméticas/efeitos adversos , Preenchedores Dérmicos/efeitos adversos , Humanos , Ácido Hialurônico/efeitos adversos , Hialuronoglucosaminidase , Necrose/induzido quimicamente , PeleRESUMO
The aim of this report is to present a digital workflow technique to design a customized abutment for provisionalization of an immediate-placed implant based on the natural emergence profile of the tooth to be extracted. The workflow involves the combination of intraoral and CBCT scans, from which three-dimensional (3D) reconstructions of soft tissue and alveolar bone, as well as of the tooth to be extracted are obtained and exported as STL files. The files are imported to a computer-aided design (CAD) software, in which a virtual wax-up and custom abutment design are performed considering the natural emergence profile of the patient's tooth prior to extraction. Since the customized abutment is digitally designed, it can also be used as a scan body, to be directly scanned intraorally after soft tissue healing around an interim implant restoration. The custom abutment digitally designed can be then produced by milling zirconia with an optimally chosen color, in accordance with the aesthetic needs of the patient.
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The full digital workflow involves the combination of intraoral and cone beam computerized tomography scans. In the present case report, a second intraoral scan is performed after soft tissue management facilitated by the use of a 3-dimensional-printed interim implant restoration. The new STL file resulting from the second intraoral scan can be associated with the previous STL from the initial intraoral scan. The custom abutment was also digitally designed as an STL file, and no implant scan bodies were required for intraoral scanning.
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Implantes Dentários , Desenho Assistido por Computador , Dente Suporte , Prótese Dentária Fixada por Implante , Humanos , Fluxo de TrabalhoRESUMO
A technique using a digital workflow for performing crown lengthening by using a free software program is presented to digitally design a single surgical guide. The technique consists of obtaining standard tessellation language (STL) files from intraoral scans from a digital design of the new tooth shape and from a cone beam computed tomography (CBCT) scan, after which Digital Imaging and Communications in Medicine (DICOM) files are converted to the STL format. These files are then superimposed and used for surgical planning of the crown-lengthening procedure. The main component of the surgical guide is a labial upper band representing the biological width measurement based on the predicted digitally designed future gingival margin position. Accordingly, the lower edge of the band indicates the level of the main marginal incision, whereas the top of the band indicates the level where the alveolar bone crest must be repositioned by alveolotomy during the surgical crown-lengthening procedure. By performing an adequate diagnosis of the potential restorative outcome, the new position of the gingival margin and the crown shape can be predicted, and whether osteoplasty is needed can be determined.
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Aumento da Coroa Clínica , Dente , Coroas , Coroa do Dente , Fluxo de TrabalhoRESUMO
The present technique report describes a digital workflow for flapless implant surgery after onlay block bone graft healing in the esthetic area. Virtual removal of block fixation screws and optimal single-tooth implant position and digital crown waxing were planned from cone beam computed tomography (CBCT) and intraoral scans. Two different surgical guides were digitally designed and 3D-printed to allow for flapless implant surgery. The first surgical guide was used to remove all 3 fixation screws from a healed onlay block graft, whereas the second guide was used to determine the implant position and direction. The present methodology may be considered a time-efficient flapless approach for placing implants in sites with block grafts.
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Implantes Dentários , Cirurgia Assistida por Computador , Transplante Ósseo , Tomografia Computadorizada de Feixe Cônico , Implantação Dentária Endóssea , Estética Dentária , Impressão TridimensionalRESUMO
AIM: To describe a method of digitally customizing 3D-printed face mask designs using 3D face scans and free software. MATERIALS AND METHODS: The procedure of creating customized face masks initially involved importing and aligning STL files of face scans and mask components in free CAD software. The imported mask described in this article is composed of three different STL files (body, filter structure, and grid). The body of the mask was then edited to fit precisely into the face scan STL by using the software's offset tool, followed by adjustments and smoothening of the surfaces of the edges. The resulting customized body of the mask plus the filter and grid STL files were exported and 3D printed with polylactic acid (PLA) filament using a fused deposition modeling (FDM) 3D printer. For the purposes of comparison, a conventional 3D-printed mask (from the original STL files, without being customized for the face scan) was also 3D printed from the original STL files. Both face masks were tested on the same two volunteers. RESULTS: The customized 3D-printed face mask presented a higher adaptation compared with the conventional face mask. The area of facial contact matched the one digitally designed in the software. The 3D-printed grid could clip exactly into the filter, which in turn could be precisely screwed into the body of the face mask. CONCLUSION: Within the limitations of this technical report, the present findings suggest that customized 3D-printed face masks with enhanced adaptation can be digitally designed using face scans and free CAD software.
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Impressão Tridimensional , Software , HumanosRESUMO
This technique report describes a fully digital workflow in which two surgical guides (i.e. one for alveolar bone reduction and the other for implant placement) are magnetically connected to ensure stability during full-arch implant surgery following guided bone reduction. Digital prosthesis design as well as virtual bone reduction and implant planning are developed from the superimposition of facial, intraoral and CBCT scans. With this technique, different surgical guides and interim poly(methylmethacrylate) (PMMA) fixed prosthesis are precisely connected with magnets after being digitally designed and 3D-printed. As a result, such magnetic connection allows for satisfactory stability of the implant surgical guide, as well as of the interim fixed PMMA fixed prosthesis during capture of screw-retained abutments.
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Implantes Dentários , Cirurgia Assistida por Computador , Processo Alveolar , Desenho Assistido por Computador , Implantação Dentária Endóssea , Prótese Dentária Fixada por Implante , Impressão Tridimensional , Fluxo de TrabalhoRESUMO
Despite the advent of stereolithography in craniofacial surgery for creating surgical guides and custom synthetic scaffolds, little is known about the feasibility of computer-aided design/computer-aided manufacturing (CAD/CAM) milling of freeze-dried allogeneic bone blocks following previously designed volumetric graft plans. The aim of this technical report is to present a methodology for CAD/CAM milling to achieve the volume and shape of allogeneic bone blocks as estimated by using a virtual planning software. To perform the current methodology, an ex vivo simulation was performed. The milled allogeneic block presented satisfactory dimensional accuracy as compared with the respective three-dimensional virtual model.
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Desenho Assistido por Computador , Imageamento Tridimensional , Maxila/transplante , Humanos , Transplante HomólogoRESUMO
PURPOSE: Temporomandibular disorders lead to parafunctional activity that may alter bone remodeling of mandibular components. This animal study aimed to assess the impact of temporomandibular joint discectomy on condylar bone microarchitecture. MATERIALS AND METHODS: A total of 30 one-month-old Wistar rats were assessed and divided into 3 equal groups (2 test groups and 1 control group) of 10. The first test group underwent disc removal, the second test group underwent disc and condylar cartilage removal, and the 10 remaining rats were analyzed as sham-operated controls, following a split-mouth design. The rats were killed humanely 2 months after surgery, and the respective mandibles were scanned with micro-computed tomography for quantitative morphometric analysis. RESULTS: There were significant differences among the 3 groups analyzed (disc removal, disc and condylar cartilage removal, and sham-operated control) for bone volume fraction (ratio of bone volume to total volume, P = .044), structure model index (P < .001), fractal dimension (P = .024), and porosity (P = .023). In addition, operated and contralateral nonoperated sides significantly differed for all variables in at least 1 of the test groups (P < .05) but not in the control group (P > .05). CONCLUSIONS: Within the limitations of this study, our results suggest that discectomy may lead to alterations of the mandibular condylar morphology.
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Côndilo Mandibular/patologia , Disco da Articulação Temporomandibular/cirurgia , Animais , Remodelação Óssea , Masculino , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/cirurgia , Ratos , Ratos Wistar , Disco da Articulação Temporomandibular/diagnóstico por imagem , Disco da Articulação Temporomandibular/patologia , Microtomografia por Raio-XRESUMO
OBJECTIVES: The present study aimed to present 4 cases and to undertake a systematic review on the current knowledge of the impact of cone beam computed tomographic (CBCT) artifacts on oral and maxillofacial surgical planning and follow-up. METHODS: The MEDLINE (PubMed) database was searched for the period from February 2004 to February 2017, for studies on the impact of CBCT artifacts on surgical planning of oral and maxillofacial surgeries. The PRISMA statement was followed during data assessment and extraction. As a result, data extraction included information regarding: the use of CBCT to plan or follow-up oral and maxillofacial surgeries, presence and type identification of a CBCT artifact, and details on the impact of artifacts on image quality and/or surgical planning. Four cases were selected to illustrate the topic. RESULTS: The search strategy yielded 408 publications in MEDLINE (PubMed). An initial screening of the publications was performed using abstracts and key words. After application of exclusion criteria, a total of 11 studies were finally identified as eligible to be discussed. Studies revealed 3 main types of artifact: beam hardening, streak, and motion artifacts. Most of the studies suggest that artifacts significantly affect oral and maxillofacial surgical planning and follow-up, despite of allowing for identification of metal projectiles in cases of maxillofacial trauma. CONCLUSION: CBCT artifacts have a significant impact on oral and maxillofacial surgical planning and follow-up.
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Artefatos , Tomografia Computadorizada de Feixe Cônico , Cirurgia Bucal , Humanos , MetaisRESUMO
PURPOSE: Pixel values from cone-beam computed tomography (CBCT) are proportional to bone density. This study aimed to correlate and compare pixel values of healed maxillary sinus grafts and adjacent native bone (NB). MATERIAL AND METHODS: This study was conducted on CBCT scan patients referred for maxillary sinus floor augmentation with biphasic calcium phosphate (n = 31). Graft height and width measurements were performed. In addition, mean pixel values were calculated in 3 different regions: NB, sinus graft close to NB (CNB), and sinus graft far from NB (FNB). Micro-CT and histological analyses of bone specimens of a representative case were also performed. RESULTS: Significant correlations were found between CNB and graft height (r = 0.41; P < 0.021); and FNB and graft width (r = 0.519, P < 0.003). In addition, pixel values from both graft groups (CNB and FNB) differed significantly (P < 0.001). Finally, histological sections revealed smaller areas with newly formed bone in the FNB area. CONCLUSIONS: Within the limitations of this study, the present findings suggest that pixel values of sinus grafted areas are directly correlated with the extension of the grafted area.