Learning about tooth removal with robot technology

Deze PhD-thesis richt zich op een fundamenteel onderzoek van de extractieleer en maakt daarbij gebruik van robottechnologie. Het onderzoek omvat zes inhoudelijke hoofdstukken, waarin verschillende aspecten van dit onderwerp worden behandeld. Het tweede hoofdstuk analyseert de literatuur over robottechnologie in de tandheelkunde en wijst op de matige kwaliteit van beschikbare literatuur, zeker als het op klinische toepassingen aankomt. Hoofdstuk 3 biedt een overzicht van robotsystemen in alle deelgebieden van de tandheelkunde sinds 1985. Hoofdstuk 4 introduceert een meetopstelling om krachten en bewegingen bij tandextracties nauwkeurig vast te leggen, terwijl hoofdstuk 5 de resultaten van een serie experimenten voor wat betreft krachten en momenten weergeeft. Hoofdstuk 6 beschrijft het bewegingsbereik en de snelheden tijdens tandheelkundige extracties, zoals gemeten met een robotarm. Hoofdstuk 7 beschrijft de ontwikkeling en eigenschappen van een classificatiemodel voor extracties op basis van kracht- en bewegingsgegevens. De conclusie benadrukt de toenemende interesse in robotinitiatieven in de tandheelkunde, de behoefte aan wetenschappelijke validatie van de toegevoegde waarde daarvan en het potentieel van robottechnologie om ons fundamentele begrip van de extractieleer te vergroten. De studies benadrukken het belang van gegevensverzameling, analyse en samenwerking tussen verschillende disciplines om ons fundamentele begrip van extracties te verbeteren, met een focus op tandheelkundig onderwijs en uiteindelijk de patiëntenzorg

Accuracy of Surgical Robot System Compared to Surgical Guide for Dental Implant Placement: A Pilot Study

Purpose: This study aimed to evaluate the tracking accuracy of a robot-guided implant surgery system and compare the spatial accuracy of robot-assisted implant surgery with that of static stentguided implant surgery for implant placement. Materials and Methods: The tracking accuracy of the robot system was evaluated by measuring the discrepancy between the robot arm and actual programmed position. Dental implants were placed on 3D printed human phantom models using static stent-guided and robot-assisted surgeries. The top, apex, angular, and depth deviations of the placed implant positions were measured relative to the planned position, and the values were compared between the robot and surgical guide groups. The results were analyzed using the Mann-Whitney U test (α = .05). Results: The tracking accuracy of the robot system showed a linear deviation of 0.13 ± 0.04 mm and an angular deviation of 0.77 ± 0.02° at the drill tip. Deviations at the top and apex of the implants were 0.61 ± 0.29 mm and 0.50 ± 0.14 mm in the robot group and of 0.49 ± 0.39 mm and 0.72 ± 0.39 mm in the surgical guide group, respectively. Angular and depth deviations were of 2.38 ± 0.62° and 0.17 ± 0.12 mm, respectively, in the robot group, and of 3.16 ± 2.36° and 0.15 ± 0.11 mm, respectively, in the surgical guide group. No statistically significant differences were found between the robotic and surgical guide groups (p > .05). Conclusion: The accuracy in implant placement using robot-assisted implant surgery was comparable to that of static-guided surgery. Robot-assisted implant surgery and static-guided surgery tended to result in minor deviations at the apex and top of the implants, respectively.ope

Use of Model-Free and Zero-Setup Computer-Guided Implant Surgical Template for Partial Edentulous Cases

This case report presents the cases of single anterior missing and posterior free-end edentulous ridge with computer-guided implant placement on the day of visit through a special tray containing fiducial markers without model scan or intraoral scan data. Cone beam CT was taken after fixing the marker embedded ready-made tray with a photopolymerized resin material by light-curing in the patient's mouth. The implant location was planned on the registered CT data in the planning software. The tool path calculation for the milling machine was conducted in the computer-aided manufacture (CAM) software. The guide was completed by milling the drill hole in the special tray as designed. Although the preparation for the conventional implant guide surgery takes considerable time, including data acquisition and 3D printing, it was possible to produce a guide on the day of the patient visit without a separate procedure other than a CT scan through this protocol. Also, the transfer of the implant surgery plan, the process of scanning and 3D printing, was omitted, thereby reducing the positional error between the CT data and the actual guide.ope

Removal of Endodontic Fiber Posts Using Robot-Assisted Haptic Guidance: A Novel Approach

Introduction: Fiber posts are frequently used for the restoration of endodontically treated teeth. Such posts are typically bonded to the tooth using a composite resin system. These posts often need to be removed during endodontic retreatment. While there are many techniques to remove fiber posts, most include drilling through the post itself which can be challenging and result in a perforation or excessive tooth structure being removed. Static and dynamic guided endodontic techniques have been proposed to safely remove fiber posts. Yomi (Neocis, Inc, Miami, FL) is a haptic robot guidance system has been FDA approved to assist in placing dental implants and may be able to be used for endodontic applications. This system combines the advantages of both static and dynamic guidance. The purpose of this study was to investigate the ability and efficiency of a robot-assisted haptic guidance system to remove bonded fiber posts in endodontically treated teeth. Methods: Forty-six natural extracted single-rooted maxillary anterior teeth with straight canals were selected and endodontically treated. Following obturation, a post space was created, and fiber posts placed and bonded with resin. The teeth were then mounted in acrylic blocks simulating a maxillary arch form. Preoperative CBCT volumes were acquired. The teeth were divided into 3 groups for fiber post removal. In Group 1 the fiber posts were removed by an endodontic resident using robot-assisted haptic guidance. In Group 2 the fiber posts were removed by an experienced endodontist using a freehand technique. In Group 3 the fiber posts were removed by the endodontic resident using a freehand technique. The volume of removed tooth structure was measured and time to remove the fiber posts recorded. Post-operative CBCT volumes were acquired. ITK-SNAP semiautomatic segmentation software was used to compare pre- and post-operative CBCT images for volumetric analysis in determining the amount of tooth structure removal. The data was statistically analyzed using independent samples t-tests, one-way ANOVA, and the Tukey post-hoc procedure. Results: All teeth were included for final analyses. The mean time to remove a post in Group 1 was 33.3 seconds, Group 2 was 446.2 seconds, and Group 3 was 607.2 seconds. There was a significant difference between each group regarding the time to remove the fiber post. The mean volume of tooth structure removed in Group 1 was 10.9 mm3, Group 2 was 15.6 mm3, and Group 3 was 24.3 mm3. The difference in volume of tooth structure removed was significant between Group 1 and the two other groups. Conclusions: The removal of resin bonded fiber posts in single canal maxillary teeth is possible using a robot-assisted haptic guidance system. The robot guided system is more time efficient and results in less volume removed when removing fiber posts compared to freehand techniques. An experienced endodontist is more conservative in removing a fiber post than an endodontic resident when considering the amount of tooth structure removed

Image-guided surgery and medical robotics in the cranial area

Surgery in the cranial area includes complex anatomic situations with high-risk structures and high demands for functional and aesthetic results. Conventional surgery requires that the surgeon transfers complex anatomic and surgical planning information, using spatial sense and experience. The surgical procedure depends entirely on the manual skills of the operator. The development of image-guided surgery provides new revolutionary opportunities by integrating presurgical 3D imaging and intraoperative manipulation. Augmented reality, mechatronic surgical tools, and medical robotics may continue to progress in surgical instrumentation, and ultimately, surgical care. The aim of this article is to review and discuss state-of-the-art surgical navigation and medical robotics, image-to-patient registration, aspects of accuracy, and clinical applications for surgery in the cranial area

Image-Guided Robotic Dental Implantation With Natural-Root-Formed Implants

Dental implantation is now recognized as the standard of the care for tooth replacement. Although many studies show high short term survival rates greater than 95%, long term studies (\u3e 5 years) have shown success rates as low as 41.9%. Reasons affecting the long term success rates might include surgical factors such as limited accuracy of implant placement, lack of spacing controls, and overheating during the placement. In this dissertation, a comprehensive solution for improving the outcome of current dental implantation is presented, which includes computer-aided preoperative planning for better visualization of patient-specific information and automated robotic site-preparation for superior placement and orientation accuracy. Surgical planning is generated using patient-specific three-dimensional (3D) models which are reconstructed from Cone-beam CT images. An innovative image-guided robotic site-preparation system for implants insertion is designed and implemented. The preoperative plan of the implant insertion is transferred into intra-operative operations of the robot using a two-step registration procedure with the help of a Coordinate Measurement Machine (CMM). The natural-root implants mimic the root structure of natural teeth and were proved by Finite Element Method (FEM) to provide superior stress distribution than current cylinder-shape implants. However, due to their complicated geometry, manual site-preparation for these implants cannot be accomplished. Our innovative image-guided robotic implantation system provides the possibility of using this advanced type of implant. Phantom experiments with patient-specific jaw models were performed to evaluate the accuracy of positioning and orientation. Fiducial Registration Error (FRE) values less than 0.20 mm and final Target Registration Error (TRE) values after the two-step registration of 0.36±0.13 mm (N=5) were achieved. Orientation error was 1.99±1.27° (N=14). Robotic milling of the natural-root implant shape with single- and double-root was also tested, and the results proved that their complicated volumes can be removed as designed by the robot. The milling time for single- and double-root shape was 177 s and 1522 s, respectively

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

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

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

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

The Use of Tactile Sensors in Oral and Maxillofacial Surgery: An Overview

Background: This overview aimed to characterize the type, development, and use of haptic technologies for maxillofacial surgical purposes. The work aim is to summarize and evaluate current advantages, drawbacks, and design choices of presented technologies for each field of application in order to address and promote future research as well as to provide a global view of the issue. Methods: Relevant manuscripts were searched electronically through Scopus, MEDLINE/PubMed, and Cochrane Library databases until 1 November 2022. Results: After analyzing the available literature, 31 articles regarding tactile sensors and interfaces, sensorized tools, haptic technologies, and integrated platforms in oral and maxillofacial surgery have been included. Moreover, a quality rating is provided for each article following appropriate evaluation metrics. Discussion: Many efforts have been made to overcome the technological limits of computed assistant diagnosis, surgery, and teaching. Nonetheless, a research gap is evident between dental/maxillofacial surgery and other specialties such as endovascular, laparoscopic, and microsurgery; especially for what concerns electrical and optical-based sensors for instrumented tools and sensorized tools for contact forces detection. The application of existing technologies is mainly focused on digital simulation purposes, and the integration into Computer Assisted Surgery (CAS) is far from being widely actuated. Virtual reality, increasingly adopted in various fields of surgery (e.g., sino-nasal, traumatology, implantology) showed interesting results and has the potential to revolutionize teaching and learning. A major concern regarding the actual state of the art is the absence of randomized control trials and the prevalence of case reports, retrospective cohorts, and experimental studies. Nonetheless, as the research is fast growing, we can expect to see many developments be incorporated into maxillofacial surgery practice, after adequate evaluation by the scientific community