Computer-aided position planning of miniplates to treat facial bone defects

In this contribution, a software system for computer-aided position planning of miniplates to treat facial bone defects is proposed. The intra-operatively used bone plates have to be passively adapted on the underlying bone contours for adequate bone fragment stabilization. However, this procedure can lead to frequent intra-operatively performed material readjustments especially in complex surgical cases. Our approach is able to fit a selection of common implant models on the surgeon's desired position in a 3D computer model. This happens with respect to the surrounding anatomical structures, always including the possibility of adjusting both the direction and the position of the used osteosynthesis material. By using the proposed software, surgeons are able to pre-plan the out coming implant in its form and morphology with the aid of a computer-visualized model within a few minutes. Further, the resulting model can be stored in STL file format, the commonly used format for 3D printing. Using this technology, surgeons are able to print the virtual generated implant, or create an individually designed bending tool. This method leads to adapted osteosynthesis materials according to the surrounding anatomy and requires further a minimum amount of money and time.Comment: 19 pages, 13 Figures, 2 Table

A 3D environment for surgical planning and simulation

The use of Computed Tomography (CT) images and their three-dimensional (3D) reconstruction has spread in the last decade for implantology and surgery. A common use of acquired CT datasets is to be handled by dedicated software that provide a work context to accomplish preoperative planning upon. These software are able to exploit image processing techniques and computer graphics to provide fundamental information needed to work in safety, in order to minimize the surgeon possible error during the surgical operation. However, most of them carry on lacks and flaws, that compromise the precision and additional safety that their use should provide. The research accomplished during my PhD career has concerned the development of an optimized software for surgical preoperative planning. With this purpose, the state of the art has been analyzed, and main deficiencies have been identified. Then, in order to produce practical solutions, those lacks and defects have been contextualized in a medical field in particular: it has been opted for oral implantology, due to the available support of a pool of implantologists. It has emerged that most software systems for oral implantology, that are based on a multi-view approach, often accompanied with a 3D rendered model, are affected by the following problems: unreliability of measurements computed upon misleading views (panoramic one), as well as a not optimized use of the 3D environment, significant planning errors implied by the software work context (incorrect cross-sectional planes), and absence of automatic recognition of fundamental anatomies (as the mandibular canal). Thus, it has been defined a fully 3D approach, and a planning software system in particular, where image processing and computer graphic techniques have been used to create a smooth and user-friendly completely-3D environment to work upon for oral implant planning and simulation. Interpolation of the axial slices is used to produce a continuous radiographic volume and to get an isotropic voxel, in order to achieve a correct work context. Freedom of choosing, arbitrarily, during the planning phase, the best cross-sectional plane for achieving correct measurements is obtained through interpolation and texture generation. Correct orientation of the planned implants is also easily computed, by exploiting a radiological mask with radio-opaque markers, worn by the patient during the CT scan, and reconstructing the cross-sectional images along the preferred directions. The mandibular canal is automatically recognised through an adaptive surface-extracting statistical-segmentation based algorithm developed on purpose. Then, aiming at completing the overall approach, interfacing between the software and an anthropomorphic robot, in order to being able to transfer the planning on a surgical guide, has been achieved through proper coordinates change and exploiting a physical reference frame in the radiological stent. Finally, every software feature has been evaluated and validated, statistically or clinically, and it has resulted that the precision achieved outperforms the one in literature

Applications of 3D printing in the management of severe spinal conditions

The latest and fastest-growing innovation in the medical field has been the advent of three-dimensional printing technol- ogies, which have recently seen applications in the production of low-cost, patient-specific medical implants. While a wide range of three-dimensional printing systems has been explored in manufacturing anatomical models and devices for the medical setting, their applications are cutting-edge in the field of spinal surgery. This review aims to provide a com- prehensive overview and classification of the current applications of three-dimensional printing technologies in spine care. Although three-dimensional printing technology has been widely used for the construction of patient-specific ana- tomical models of the spine and intraoperative guide templates to provide personalized surgical planning and increase pedicle screw placement accuracy, only few studies have been focused on the manufacturing of spinal implants. Therefore, three-dimensional printed custom-designed intervertebral fusion devices, artificial vertebral bodies and disc substitutes for total disc replacement, along with tissue engineering strategies focused on scaffold constructs for bone and cartilage regeneration, represent a set of promising applications towards the trend of individualized patient care

Integration of 3D anatomical data obtained by CT imaging and 3D optical scanning for computer aided implant surgery

<p>Abstract</p> <p>Background</p> <p>A precise placement of dental implants is a crucial step to optimize both prosthetic aspects and functional constraints. In this context, the use of virtual guiding systems has been recognized as a fundamental tool to control the ideal implant position. In particular, complex periodontal surgeries can be performed using preoperative planning based on CT data. The critical point of the procedure relies on the lack of accuracy in transferring CT planning information to surgical field through custom-made stereo-lithographic surgical guides.</p> <p>Methods</p> <p>In this work, a novel methodology is proposed for monitoring loss of accuracy in transferring CT dental information into periodontal surgical field. The methodology is based on integrating 3D data of anatomical (impression and cast) and preoperative (radiographic template) models, obtained by both CT and optical scanning processes.</p> <p>Results</p> <p>A clinical case, relative to a fully edentulous jaw patient, has been used as test case to assess the accuracy of the various steps concurring in manufacturing surgical guides. In particular, a surgical guide has been designed to place implants in the bone structure of the patient. The analysis of the results has allowed the clinician to monitor all the errors, which have been occurring step by step manufacturing the physical templates.</p> <p>Conclusions</p> <p>The use of an optical scanner, which has a higher resolution and accuracy than CT scanning, has demonstrated to be a valid support to control the precision of the various physical models adopted and to point out possible error sources. A case study regarding a fully edentulous patient has confirmed the feasibility of the proposed methodology.</p

Virtual Planning for Dental Implant Placement Using Guided Surgery

1. Introduction Technical and scientific advances in diagnostic and therapeutic methods in the biomedical field have substantially increased the predictability and longevity of the outcomes of restorative surgical procedures. In contemporary oral implantology, bioprototyping techniques based on computer-aided design and computer-aided manufacturing (CAD/CAM) technology have proven to be valuable aids in diagnosis, treatment planning, and surgical intervention. Among other aspects, use of these technologies improves preoperative planning, makes it easier for patients to understand proposed procedures, increases the predictability of treatment, and may reduce surgical morbidity. The preliminary stages that precede dental implant surgery are as important as the actual operative intervention itself, or even more so. Inadequate placement of implants may injure important anatomical structures or lead to aesthetic or functional compromise of the prosthetic stage of oral rehabilitation. Implant planning and placement can be based solely on computed tomography data and surgical guides fashioned after diagnostic models. However, direct three-dimensional visualization of the surgical site and real-model simulation of the intended surgical procedure can play a significant role in obtaining outcomes that are more consistent with the original treatment plan. Biomedical prototypes, or biomodels, provide faithful reproductions of the patient’s bone condition, thus enabling this type of assessment. Likewise, the surgery itself can be made safer and less invasive with use of individualized surgical guides for implant placement. The development of software programs for implant placement planning and the integration of these software packages with rapid prototyping methods have made fabrication of such guides possible. The process of obtaining and reformatting computed tomography (CT) data, planning implant placement over a virtual model, fabricating a surgical guide with prototyping methods, and using this guide or template during dental implant surgery with specifically designed systems may be referred to as guided implant surgery

Virtual and minimally traumatic surgery in bucomaxillofacial procedures: a concise systematic review

Introduction: In recent years, maxillary atrophy is an increasingly frequent clinical condition and the causes that lead to focal or generalized atrophy are multiple factors. Based on the histological concept in which living tissues are formed by cells joined by thin elastic tissue and with nerve fibrils, capillaries, lymphatic and blood vessels. The disruption of these cells by surgical trauma provides the release of enzymes that delay healing. For this reason, surgical trauma should be minimized. Objective: Aimed to perform a brief review of the main considerations of virtual and minimally traumatic surgery in the context of maxillofacial surgery. Methods: The model used for the review was PRISMA. We used databases such as Scielo, Lilacs, Google Scholar, PubMed. The Cochrane Instrument was used to assess the risk of bias of the included studies. Results and Conclusion: A total of 118 articles were found involving virtual and minimally invasive surgery in maxillofacial procedures. A total of 56 articles were fully evaluated and 28 were included in this study. the main considerations regarding minimally traumatic surgery are the attempt to minimize the professional's effort, reduce surgical time and alleviate bleeding and inflammatory processes, edema, pain, and ecchymosis that can affect patients. Thus, the maximum preservation of the integrity of the soft tissues adjacent to the prosthetic spaces and the preservation of the level of the ridge of the alveolar bone to achieve a minimization of surgical trauma must be sought

Guided surgery in dental implant: a systematic review

Introduction: In the context of implant dentistry, dental implants represent about 1,000,000 procedures per year worldwide. Virtual implant planning systems integrate cone beam computed tomography (CT) data to assess the amount of bone and virtual models for the project of a dental implant. Objective: It presented, through a systematic review, the main considerations of guided surgery in implant dentistry through evidence from clinical studies and important systematic reviews on the subject. Methods: The research was carried out from May 2021 to June 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the Systematic Review-PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 112 articles were found on guided surgery and implantology. Initially, duplication of articles was excluded. In total, 54 articles were fully evaluated and 23 were included and evaluated in this study. In the GS scenario, advances in technology have contributed to the improvement of models with favorable positioning of implants in aesthetic terms. This provides the predictability of techniques and difficulties that may be encountered during surgical intervention, reducing time and the possibility of errors, allowing for an overall reduction in the costs of oral rehabilitation. Conclusion: Guided surgery is considered accurate and reliable compared to free implant surgery. However, the learning curve is undeniable and a clinician with basic surgical skills, including conventional implant dentistry

Recent trends, technical concepts and components of computer-assisted orthopedic surgery systems: A comprehensive review

Computer-assisted orthopedic surgery (CAOS) systems have become one of the most important and challenging types of system in clinical orthopedics, as they enable precise treatment of musculoskeletal diseases, employing modern clinical navigation systems and surgical tools. This paper brings a comprehensive review of recent trends and possibilities of CAOS systems. There are three types of the surgical planning systems, including: systems based on the volumetric images (computer tomography (CT), magnetic resonance imaging (MRI) or ultrasound images), further systems utilize either 2D or 3D fluoroscopic images, and the last one utilizes the kinetic information about the joints and morphological information about the target bones. This complex review is focused on three fundamental aspects of CAOS systems: their essential components, types of CAOS systems, and mechanical tools used in CAOS systems. In this review, we also outline the possibilities for using ultrasound computer-assisted orthopedic surgery (UCAOS) systems as an alternative to conventionally used CAOS systems.Web of Science1923art. no. 519

Dental health care technologies: factors affecting technology adoption and latest information technology solutions

The thesis studies the factors affecting information technology adoption in dental health care. The scope is on information systems used in diagnostics and clinical work. Besides the factors affecting technology adoption, the possibilities and challenges of two important technologies, 3D virtual workflow and CAD/CAM are introduced. The 3D technologies are studied further through a case study, Planmeca Romexis 3D applications. Through the thesis, the effects of the technologies for the whole value chain from the technology vendor to the patient are evaluated. Also, the economical side of the technologies is discussed. The thesis is based on a broad literature review. At first, dental clinical workflow is introduced to understand what kind of environment the information systems are facing. Second, a theoretical framework for technology adoption including Technology Acceptance Model by Davis (1989) and related theories is constructed, followed by a more throughout literature review on the factors characteristic to clinical environment and dental health care. The literature review is supported with the case study and interviews of specialists. The literature review finds various factors for technology adoption in dental health care. These factors are divided into usability and functional factors, work efficiency factors, learning curve factors and social & organisational factors. The general theoretical framework can be seen rather applicable for dental health care scope, but some factors such as patient safety or dental team’s sociocultural relationships are very characteristic to dentistry. 3D virtual workflow and CAD/CAM are seen to provide advantages into dentistry, and they’re bringing solutions to the factors discussed in the thesis. The thesis founds also challenges and problems arising from these technologies. Planmeca’s solutions are providing further insight on the possibilities of real-life solutions for 3D virtual workflow. The thesis has limitations since it’s based on a literature review, but a similar Information System Management-view for information systems in dentistry is rather rare. Thus, it can provide information on which factors to take into consideration for vendors designing dental information systems as well as for organizations that are considering investing in new information systems