2,809 research outputs found

    Interactive design of dental implant placements through CAD-CAM technologies: from 3D imaging to additive manufacturing

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    In the field of oral rehabilitation, the combined use of 3D imaging technologies and computer-guided approaches allows the development of reliable tools to be used in preoperative assessment of implant placement. In particular, the accurate transfer of the virtual planning into the operative field through surgical guides represents the main challenge of modern dental implantology. Guided implant positioning allows surgical and prosthetic approaches with minimal trauma by reducing treatment time and decreasing patient’s discomfort. This paper aims at defining a CAD/CAM framework for the accurate planning of flapless dental implant surgery. The system embraces three major applications: (1) freeform modelling, including 3D tissue reconstruction and 2D/3D anatomy visualization, (2) computer-aided surgical planning and customised template modelling, (3) additive manufacturing of guided surgery template. The tissue modelling approach is based on the integration of two maxillofacial imaging techniques: tomographic scanning and surface optical scanning. A 3D virtual maxillofacial model is created by matching radiographic data, captured by a CBCT scanner, and surface anatomical data, acquired by a structured light scanner. The pre-surgical planning process is carried out and controlled within the CAD application by referring to the integrated anatomical model. A surgical guide is then created by solid modelling and manufactured by additive techniques. Two different clinical cases have been approached by inserting 11 different implants. CAD-based planned fixture placements have been transferred into the clinical field by customised surgical guides, made of a biocompatible resin and equipped with drilling sleeves

    3D-printing techniques in a medical setting : a systematic literature review

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    Background: Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. Methods: Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. Results: 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. Conclusion: 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D- printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis

    “Evidence-Based Dentistry in Oral Surgery: Could We Do Better?”

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    Evidence-based Dentistry (EBD), like Evidence-based Medicine (EBM), was born in order to seek the “best available research evidence” in the field of dentistry both in research and clinical routine

    Digital Workflow for Immediate Implant Placement and Chairside Provisionalization in the Esthetic Zone

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    Introduction: Immediate implant placement and immediate chairside provisionalization in the esthetic zone require meticulous treatment planning. A digital workflow that combines intraoral scans and a cone beam computed tomography scan can be used to visualize the surgical and restorative aspects of the treatment and to plan a prosthetically driven implant position. A digital workflow in implant dentistry enables the prefabrication of an individualized CAD/CAM temporary restoration, based on the planned implant position. This could be a predictable method to deliver a screw-retained temporary restoration, directly after static computer-assisted immediate implant surgery. Interventions. Three patients with a failing tooth in the maxillary esthetic zone were treated with immediate implant placement and chairside provisionalization using this digital workflow. After 3 months, a final restoration was placed. Clinical, radiographic, and patient-reported outcome measures were collected prior to implant treatment, 6 weeks after placing the temporary restoration and then 1 month and 1 year after placing the final restoration. Outcomes. At the 1-year follow-up, healthy soft tissues were observed, and peri-implant bone levels were stable. Patient satisfaction after the treatment was high. Conclusion: The three reported cases demonstrate the potential for predictable immediate implant placement and chairside provisionalization using a digital workflow

    Clinical and radiological outcomes of novel digital workflow and dynamic navigation for single-implant immediate loading in aesthetic zone: 1-year prospective case series

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    Objectives To evaluate clinical, radiological performance of novel digital workflow integrating dynamic navigation to streamline in one-visit single-implant immediate loading in aesthetic zone. Material and methods Consecutive patients requiring one single-implant in aesthetic zone of both jaws were treated between May and September 2017. Primary outcomes were implant and prosthetic success rates, surgical and prosthetic complications, marginal bone loss (MBL), final pink aesthetic score (PES-f), and implant stability quotient (ISQ-f). Secondary outcomes were ISQ-0 and PES-0 at implant positioning and PES-p at definitive prosthesis placement. Potential effect of jaw (maxilla vs mandible), biotype (thin vs thick), type of incision (flap vs flapless), and implant site (healed vs. post-extractive) on the primary outcomes (MBL, PES-f, and ISQ-f) was evaluated through a multivariable analysis. Results Fifty-two implants were placed (follow-up 18.6, 15-20 months). One post-extractive implant failed. No other surgical, biological complications occurred, accounting for 98.10% cumulative success rate (CSR). No definitive prostheses failed. Mean MBL was -0.63 +/- 0.25 mm (-1.69 to -0.06). PES-f was 12.34 +/- 1.41 (9-14). ISQ-f was 78.1 +/- 3.2 (70-84). Age had significantly negative effect on MBL and PES-f (p = .0058 and p = .0052). No other variables significantly affected primary outcomes. Conclusions Within study limitations, investigated digital workflow integrating dynamic navigation was reliable for single-implant immediate loading in aesthetic zone in one visit. No statistically significant difference was found for MBL, PES-f, and ISQ-f, considering type of incision (flap vs. flapless), implant site (healed vs post-extractive), jaw (maxilla vs. mandible), and biotype (thick vs. thin). Live-tracked dynamic navigation may have contributed to improve operator clinical performance regardless of implant site characteristics. Further investigations are needed to confirm positive outcomes

    Current Trends and Future Directions in Prosthetic and Implant Dentistry in the Digital Era

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    Advancements in digital technologies are reshaping the world of dentistry, from prosthodontics to implant dentistry. Intraoral scanners, facial scanners, 3D printers, and milling machines have revolutionized the clinical approach and operative workflow in daily practice. However, digital dentistry brings several challenges to clinicians due to the rapid evolution of new technologies and the lack of evidence-based guidelines for their correct use. The aim of this Special Issue is to cover the latest advances in the development and application of digital technologies in prosthetic and implant dentistry. We wish to provide both clinicians and researchers with a comprehensive and up-to-date source of information on current trends, limitations, and potential future applications of digital technologies in daily clinical practice

    Can computer-guided surgery help orthodontics in miniscrew insertion and corticotomies? A narrative review

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    Orthodontics has considerably increased the use of technology combined with surgery as a tool to improve dental movements in terms of predictability, acceleration of movement, and fewer side effects. To achieve these goals miniscrews and corticotomy were introduced. The digital workflow permits an increase in the accuracy of surgical and orthodontic setups. The tool that transfers the information is the CAD/CAM (Computer-Aided Design/ Computer-Aided Manufacturing) template. The aim of this review is to illustrate the use of computer-guided surgery in orthodontics regarding miniscrews and piezocision. The search strategy was a combination of Medical Subject Headings (Mesh) and free text words for PubMed. A total of 27 articles were included in this review: 16 concerned miniscrews and 11 concerned corticotomy. The current need for faster treatments, the improved systems of anchorage, and the evolution of imaging technologies require operators to be knowledgeable of the digital workflow. CAD/CAM templates allow greater precision and predictability of miniscrew insertion even if in the hands of less experienced clinicians and permit a better orientation and depth of the cortical incision. In conclusion, digital planning makes surgery faster and easier and allows for the identification and correction of any potential problem before the procedure

    Evaluation of Autonomous Robotic Milling Methodology for Natural Tooth-Shaped Implants Based on SKO Optimization

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    Robotic surgery is one of the most demanding and challenging applications in the field of automatic control. One of the conventional surgeries, the dental implantation, is the standard methodology to place the artificial tooth root composed of titanium material into the upper or lower jawbone. During the dental implant surgery, mechanical removal of the bone material is the most critical procedure because it may affect the patient\u27s safety including damage to the mandibular canal nerve and/or piercing the maxillary sinus. With this problem, even though short term survival rates are greater than 95%, long term success rate of the surgery is as low as 41.9% in 5 years. Since criteria of bone loss should be less than 0.2 mm per year, a high degree of anatomical accuracy is required. Considering the above issues leads to the employment of more precise surgery using computer assisted medical robots. In this dissertation, a computer-aided open-loop intra-operative robotic system with pre-operative planning is presented to improve the success rate of the dental implantation using different types of milling algorithms that also incorporate natural root-shaped implants. This dissertation also presents the refinement and optimization of three-dimensional (3D) dental implants with the complex root shapes of natural teeth. These root shapes are too complex to be drilled manually like current commercial implants and are designed to be conducive to robotic drilling utilizing milling algorithms. Due to the existence of sharp curvatures and undercuts, anatomically correct models must be refined for 3D robotic milling, and these refined shapes must be shown to be optimized for load bearing. Refinement of the anatomically correct natural tooth-shaped models for robotic milling was accomplished using Computer-Aided-Design (CAD) tools for smoothing the sham curvatures and undercuts. The load bearing optimization algorithm is based on the Soft-Kill Option (SKO) method, and the geometries are represented using non-uniform rational B-spline (NURBS) curves and surfaces. Based on these methods, we present optimized single and double root-shaped dental implants for use with robotic site preparation. Evaluation of phantom experiment has led us to investigate how the position, orientation, and depth of the robotic drilling defined with the dental tool exhibit accuracy and efficiency
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