Evaluation of the accuracy of surgical reconstruction of mandibular defects when using navigation templates and patient-specific titanium implants

The management of patients with post-traumatic and post-operative mandibular defects is a major challenge even for experienced surgeons. Performing traditional reconstructive interventions with the use of bone autografts is always confronted with the problem of inconsistency between the shape, architecture, a biological. An alternative to conventional bone grafting is the use of digital protocol and CAD /CAMtechnology, which allows fabricating different types of customised medical devices. All patients underwent reconstructive and restoring interventions with the use of patient-specific titanium implants guided by a full digital protocol.Patients were examined in compliance with the standard scheme. To repair the defects, PSIs were fabricated with the use of selective laser sintering of titanium.The introduction of digital technologies and computer technique of diagnosing, planning and implementation of surgical interventions has been the main direction aimed at the improving the accuracy and predictability of reconstructive restorative surgery. Among the main achievements in this direction are the improvement of software and methods of computer modeling, as well as the introduction of CAD /CAMtechnology.The use of CAD /CAMtechnologies, in particular, navigational surgical templates and patient-specific implants for the repair of mandibular defects ensures a high level of accuracy and predictability

A Textbook of Advanced Oral and Maxillofacial Surgery

The scope of OMF surgery has expanded; encompassing treatment of diseases, disorders, defects and injuries of the head, face, jaws and oral cavity. This internationally-recognized specialty is evolving with advancements in technology and instrumentation. Specialists of this discipline treat patients with impacted teeth, facial pain, misaligned jaws, facial trauma, oral cancer, cysts and tumors; they also perform facial cosmetic surgery and place dental implants. The contents of this volume essentially complements the volume 1; with chapters that cover both basic and advanced concepts on complex topics in oral and maxillofacial surgery

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery

New frontiers and emerging applications of 3D printing in ENT surgery: A systematic review of the literature

3D printing systems have revolutionised prototyping in the industrial field by lowering production time from days to hours and costs from thousands to just a few dollars. Today, 3D printers are no more confined to prototyping, but are increasingly employed in medical disci- plines with fascinating results, even in many aspects of otorhinolaryngology. All publications on ENT surgery, sourced through updated electronic databases (PubMed, MEDLINE, EMBASE) and published up to March 2017, were examined according to PRISMA guidelines. Overall, 121 studies fulfilled specific inclusion criteria and were included in our systematic review. Studies were classified according to the specific field of application (otologic, rhinologic, head and neck) and area of interest (surgical and preclinical education, customised surgical planning, tissue engineering and implantable prosthesis). Technological aspects, clinical implications and limits of 3D printing processes are discussed focusing on current benefits and future perspectives

Gene Therapy of Bone Morphogenetic Protein for Periodontal Tissue Engineering

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141217/1/jper0202.pd

Using deep learning to assess new bone formation after bone grafting

BACKGROUND: The ultrasonic vibrations from the piezoelectric knife may amplify the natural response to surgical injury. This may lead to different clinical and biological outcomes when using the piezoelectric knife versus a surgical bur to create selective cortical penetrations for alveolar ridge augmentation surgeries. The first aim of this study was to analyze the differences in bone graft healing when selective cortical penetrations are created with a surgical bur and with a piezoelectric knife. The second aim of this pilot study was to see if enhanced new bone formation during bone regeneration procedures can be achieved with the use of a piezoelectric knife versus the conventional bur or onlay grafting techniques utilizing deep learning, a subset of machine learning. MATERIALS & METHODS: he project was approved by the Boston University Medical Center Institutional Animal Care and Use Committee (IACUC). Twenty, 9-10 week male Sprague Dawley rats, weighing approximately 300g, were used in this study. The rats were randomly divided into three groups: Xenograft, Alloplast, and Collagen. These groups were further divided by surgical technique: Bur, Piezo, and Onlay. For the Bur and Piezo groups, four equally-spaced selective cortical penetrations were made prior to bone graft stabilization. Three rats served as controls (Control group). Microcomputed tomography scans (µCT) were acquired for each sample, containing approximately 1,000 slices of data each. After 28 days of healing the volumes of and density of the newly formed bone were extracted and analyzed for each group. This was achieved with an innovative deep learning algorithm designed for multi-level segmentation and regional feature detection utilizing convolutional neural networks (CNN). RESULTS: Microcomputed tomography (µCT) of our samples yielded very localized, high-resolution scans of our surgical samples. The innovative deep learning algorithm was able to reliably produce highly accurate, unbiased segmentations of our samples. This study demonstrated that new bone formation was possible with all nine of the tested surgical techniques, however the differences were not statistically significant. Selective cortical penetrations with a piezoelectric knife (PIEZO) resulted in significantly more “cortical-like” new bone formation at 28 days. CONCLUSION: Within the limitations of this preliminary study, it is possible to conclude that the piezoelectric knife is a valid alternative to conventional carbide burs when making selective cortical penetrations prior to bone grafting surgery. Additionally, our deep learning algorithm successfully segmented thousands of slices of data and allowed for the calculation of porosity and new bone volume in our samples

DESIGN, MANUFACTURE, AND IMPLEMENTATION OF 3D-PRINTED TISSUE ENGINEERING SCAFFOLDS USED WITH STROMAL VASCULAR CELLS FOR CRANIOFACIAL BONE REGENERATION

Craniofacial bone defects have poor outcomes under current treatments: implants become infected, loosen, and displace; bone grafts resorb and weaken over time; and there are no satisfactory pediatric options. To improve outcomes, this thesis develops a novel osteoinductive biomaterial, the methods to 3D-print the biomaterial, and the tools to design of that 3D-printed scaffold for the mechanical loads of the craniofacial skeleton. Further, it combines the scaffold with key regenerative agents – autologous stem cells – to facilitate boney regeneration in the implanted scaffold. The feasibility of the scaffold and cells approach is tested by implementation in preclinical models and assessment of bone and vascular outcomes. Aim 1: To create an osteoinductive biomaterial, trabecular bone was decellularized, cryo-milled, and mixed with polycaprolactone. This thermoplastic material mixture was then 3D-printed and demonstrated osteoinductive effects on cells. Aim 2: As regenerative autologous cells, the stromal vascular fraction of adipose tissue was isolated in a point-of-care manner and timeframe and the stem cell yield, surface markers, in vitro and in vivo regenerative potential for vascular and bone tissue was demonstrated. Aim 3: Then the means to design 3D-print the biomaterial with controlled tissue engineering properties – pore size and porosity – at human craniofacial scales and for human physiologic loads was developed and tested. Aim 4: Finally, the biomaterial, cells, and design and manufacturing were implemented in a patient-specific, large-animal, preclinical model of zygomatic arch regeneration in swine. Implant design and manufacture was successfully validated, and the implanted scaffolds and cells showed a substantial bone regenerating response compared to untreated controls

Brachial Plexus Injury

In this book, specialists from different countries and continents share their knowledge and experience in brachial plexus surgery. It discusses the different types of brachial plexus injury and advances in surgical treatments

Oral and Maxillofacial Surgery

Oral and maxillofacial surgery is a specialized branch of dentistry that deals with the surgical management of various head and neck pathologies. The specialty focuses on reconstructive surgery of the oro-facial region, surgery of facial trauma, the oral cavity and jaws, dental implants as well as cosmetic surgery. As such, surgeons in this field require extensive knowledge of not only these various surgical procedures but also head and neck anatomy. This book provides comprehensive information on both. Its goal is to educate oral and maxillofacial surgeons to enable them to treat a wide range of conditions and diseases using the most current surgical trends