Clinical Computing in Dentistry

Machines can seldom replace dentists in rightly handling the patients with optimistic human insight, considerations, creative planning and the monitoring of psychological acceptance and comfort experienced by any patient with the rehabilitation done. Intelligent computer related armamentarium with software can still help dental practitioners detect typical medical and dental signs and classify them according to certain rules more effectively. Based on image analysis algorithms, CAD systems can be used to look for signs of any tooth pathology that can be spotted in dental X-ray or cone beam computed tomography (CBCT) images. Applying computer vision algorithms to high-resolution CBCT slices helps to a great extent in diagnosing periapical lesions like granulomas, cysts, etc., and can help creating 3-D model of a root canal that reflects its shape with sufficient precision facilitating an optimum endodontic treatment planning. Hence, computer vision systems are already able to speed up the diagnostic process and provide a valuable second opinion in doubtful cases. This can lead a dentist and the patient thoroughly experience an optimistic acceptance and satisfaction of the treatment done

Virtual Articulator – Aid Simulator at Diagnosis, Pre-Surgical Planning and Monitoring of Bucomaxilofacial Treatment

This work presents a system for use in dentistry and medicine, that allows advance in diagnosis and planning of treatments and surgical procedures, in cases that involves the Temporomandibular Joint, TMJ. Construction of Virtual Articulator includes related research areas of computer graphics, virtual reality and medicine and tends to become a new paradigm as a tool because it will simulate and reproduce the movements of the TMJ in a realistic way, allowing a complete analysis of the case under treatment. It is a software which comes to replace and increase in an innovative way the work done by mechanical articulators. Initially Virtual Articulator reconstructs the TMJ virtually, generating a 3D model, starting from exams such as Computed Tomography and Magnetic Ressonance. Once it is obtained a virtual copy of the TMJ, software simulates real mandible movements, with great flexibility and facility of parameterization. Virtual joints model is based on points captured from the motion curve of lower incisor point. Contribution of each muscle in temporomandibular movement is approached from Hill actuators model and the new concept of curves of insertion. It will be possible to analyze in depth a particular case in a diagnostic phase or predict the results of the surgical procedure

АНАЛІЗ ПРОБЛЕМ ТА МОЖЛИВОСТЕЙ ВІДТВОРЕННЯ АРТИКУЛЯЦІНИХ РУХІВ ЩЕЛЕПИ У ЦИФРОВОМУ СЕРЕДОВИЩІ

Introduction. The use of virtual articulators, which are essentially software, greatly enhances the effectiveness of planning and implementing stages of complex dental rehabilitation with the ability to completely translate patient data (not only anatomical but also functional) into a digital format.The aim of study. Carry out an analysis of design and simulation systems for jaw kinematic parameters reproduction, basic principles of the architecture of existing software aimed at reproducing articulation components and constructing individualized occlusion patterns during patient-oriented prosthetic treatment.Materials and methods. The search for publications in electronic databases (PubMedCentral (PMC), BioMed Central, InTech, MEDLINE / PubMed, the Public Library of Science One (PloS)) was carried out in accordance with the Medical Subject Headings (MeSH) descriptors, which are peculiar headings categorized by the hierarchy system. Additionally, the analysis of references in already pre-made system reviews related to the objectives of this study and other review publications adjacent to them was provided.Results. The systematic review of the principles of digital modeling of articulation schemes with different initial conditions confirmed the possibility of their practical application during the manufacture of prosthetic elements with individualized occlusive surfaces, thus ensuring the achievement of the best results of dental rehabilitation.Conclusions. A systematic review of the main possibilities for reproduction jaw articulation movements in the digital environment is the primary stage in the development of an own model of a digital atticulator to address specific clinical problems associated with prosthetic retreatment of patients with present occlusive dysfunctions.Введение. Использование виртуальных артикуляторов, которые по сути представляют собой программное обеспечение, значительно повышает эффективность планирования и реализация этапов комплексной стоматологической реабилитации с возможностью полного перевода данных пациента (не только анатомических, но и функциональных) в цифровой формат.Цель исследования. Провести анализ систем дизайна и имитации кинематических параметров челюсти, основных принципов архитектуры имеющегося программного обеспечения направленного на воспроизводство артикуляционных составляющих и построение индивидуализированных окклюзионных схем в ходе пациент-ориентированного ортопедического лечения.Материалы и методы. Поиск публикаций в электронных базах данных (PubMedCentral (PMC), BioMed Central, InTech, MEDLINE / PubMed, Public Library of Science One (PloS)) осуществлялся согласно дескрипторов Medical Subject Headings (MeSH), представляющих собой своеобразные заголовки, категоризированных по системе иерархии. Дополнительно проводился анализ ссылок в уже предварительно проведенных системных обзорах, касающихся цели данного исследования, и других обзорных публикациях, смежных с ними.Результаты исследования. Проведенный системный обзор принципов цифрового моделирования артикуляционных схем с различными исходными условиями подтвердил возможность их практического применения при изготовлении протетических элементов с индивидуализированными окклюзионными поверхностями, обеспечивая таким образом достижение наиболее оптимальных результатов стоматологической реабилитации.Выводы. Системный обзор основных возможностей воспроизведения артикуляционных движений челюсти в цифровой среде является первичным этапом разработки собственной модели цифрового атикулятора для решения конкретных клинических проблем, связанных с повторным протезированием пациентов с имеющимися окклюзионными дисфункциями.Вступ. Використання віртуальних артикуляторів, що по суті представляють собою програмне забезпечення, значно підвищує ефективність планування та реалізація етапів комплексної стоматологічної реабілітації з можливістю повного переведення даних пацієнта (не тільки анатомічних, а й функціональних) у цифровий формат.Мета дослідження. Провести аналіз систем дизайну та імітації кінематичних параметрів щелепи, основних принципів архітектури наявного програмного забезпечення спрямованого на відтворення артикуляційних складових та побудову індивідуалізованих оклюзійних схем в ході пацієнт-орієнтованого ортопедичного лікування.Матеріали та методи. Пошук публікацій у електронних базах даних (PubMedCentral (PMC), BioMed Central, InTech, MEDLINE/ PubMed, Public Library of Science One (PloS)) здійснювався згідно дескрипторів Medical Subject Headings (MeSH), що становлять собою своєрідні заголовки, категоризовані за системою ієрархії. Додатково проводився аналіз посилань в уже попередньо проведених системних оглядах, що стосувалися мети даного дослідження, та інших оглядових публікаціях, суміжних із ними.Результати дослідження. Проведений системний огляд принципів цифрового моделювання артикуляційних схем з різними вихідними умовами підтвердив можливість їх практичного застосування під час виготовлення протетичних елементів з індивідуалізованими оклюзійними поверхнями, забезпечуючи таким чином досягнення найбільш оптимальних результатів стоматологічної реабілітації.Висновки. Системний огляд основних можливостей відтворення артикуляційних рухів щелепи в цифровому середовищі є первинним етапом розробки власної моделі цифрового атикулятора для вирішення конкретних клінічних проблем пов’язаних із повторним протезуванням пацієнтів із наявними оклюзійними дисфункціями

O planeamento de reabilitações orais utilizando um articulador virtual

Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas MonizO articulador é um dispositivo mecânico que simula as articulações temporomandibulares, a mandíbula e a maxila. Os modelos superiores e inferiores das arcadas dentárias do paciente são montados neste dispositivo para simular alguns ou todos os movimentos mandibulares. Devido à impossibilidade de o paciente estar presente em todas as fases do estudo (diagnóstico, planeamento e execução laboratorial dos trabalhos), os articuladores foram criados com o objetivo de auxiliar os profissionais na pesquisa, no estudo, na análise funcional das relações estáticas e dinâmica, na oclusão dentária, na articulação temporomandibular e na confeção de próteses dentárias dentro da complexidade do aparelho estomatognático. Vários modelos de articuladores foram criados para estas finalidades, sendo que esta variedade de modelos torna possível a seleção de um instrumento que satisfaça, dentro de limitações específicas, as necessidades clínicas de cada caso. Com a atual tendência para medicina dentária digital, o “digital clinician” deve perceber como implementar e manusear um articulador digital na prática diária. No campo da medicina dentária reabilitadora e restauradora, o articulador digital apresenta aplicações da realidade virtual no mundo da prática clínica para a análise do complexo estático e dinâmico das relações oclusais. O articulador virtual tem a capacidade de simular movimentos específicos de mastigação do paciente. O programa prevê os locais onde os dentes oponentes vão estar em contato. É de referir que, sem os dados específicos do paciente inseridos no programa, um articulador digital vai ter o mesmo comportamento que um articulador tradicional. Estudos feitos para verificar a veracidade do articulador virtual apresentam correspondência positiva na simulação do número e posições dos contactos dinâmicos dos dentes. É um instrumento preciso para a análise da oclusão em pacientes, podendo ajudar o profissional a estabelecer um diagnóstico e planear a melhor opção de tratamento.The articulator is a mechanical device that replicates the temporomandibular joints, the mandible and the maxilla. The upper and lower models of the patient's dental arches are mounted on this device to simulate some or all the mandibular movements. Due to the impossibility of the patient to be present in all phases of the study (diagnosis, planning and laboratory execution of the work), the articulators were created with the objective of assisting the professionals in the research, in the study, in the functional analysis of the static and dynamic relationships, in the dental occlusion, in the temporomandibular joint and in the confection of dental prostheses within the complexity of the stomatognathic apparatus. Several articulator models have been created for these purposes, and this variety of models makes it possible to select an instrument that meets, within specific limitations, the clinical needs of each case. With the current trend towards digital dental medicine, the "digital clinician" should understand how to implement and handle a digital articulator in its daily practice. In the field of rehabilitative and restorative dental medicine, the digital articulator presents applications of virtual reality in the world of clinical practice for the analysis of the static and dynamic complex of occlusal relationships. The virtual articulator can simulate specific mastication movements of the patient. The program predicts the locations where the opposing teeth will be in contact. It should be noted that without the specific patient data inserted in the program, a digital articulator will have the same behavior as a traditional articulator. Several studies to verify the veracity of the virtual articulator show positive correspondence in the simulation of the number and positions of dynamic contacts of teeth. It is an accurate instrument for occlusion analysis in patients and can help the professional establish a diagnosis and plan the best treatment option

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

A pilot study for the digital replacement of a distorted dentition acquired by Cone Beam Computed Tomography (CBCT)

Abstract Introduction: Cone beam CT (CBCT) is becoming a routine imaging modality designed for the maxillofacial region. Imaging patients with intra-oral metallic objects cause streak artefacts. Artefacts impair any virtual model by obliterating the teeth. This is a major obstacle for occlusal registration and the fabrication of orthognathic wafers to guide the surgical correction of dentofacial deformities. Aims and Objectives: To develop a method of replacing the inaccurate CBCT images of the dentition with an accurate representation and test the feasibility of the technique in the clinical environment. Materials and Method: Impressions of the teeth are acquired and acrylic baseplates constructed on dental casts incorporating radiopaque registration markers. The appliances are fitted and a preoperative CBCT is performed. Impressions are taken of the dentition with the devices in situ and subsequent dental models produced. The models are scanned to produce a virtual model. Both images of the patient and the model are imported into a virtual reality software program and aligned on the virtual markers. This allows the alignment of the dentition without relying on the teeth for superimposition. The occlusal surfaces of the dentition can be replaced with the occlusal image of the model. Results: The absolute mean distance of the mesh between the markers in the skulls was in the region of 0.09mm ± 0.03mm; the replacement dentition had an absolute mean distance of about 0.24mm ± 0.09mm. In patients the absolute mean distance between markers increased to 0.14mm ± 0.03mm. It was not possible to establish the discrepancies in the patient’s dentition, since the original image of the dentition is inherently inaccurate. Conclusion: It is possible to replace the CBCT virtual dentition of cadaveric skulls with an accurate representation to create a composite skull. The feasibility study was successful in the clinical arena. This could be a significant advancement in the accuracy of surgical prediction planning, with the ultimate goal of fabrication of a physical orthognathic wafer using reverse engineering

Computer-assisted dental implant placement following free flap reconstruction: virtual planning, CAD/CAM templates, dynamic navigation and augmented reality

Image-guided surgery, prosthetic-based virtual planning, 3D printing, and CAD/CAM technology are changing head and neck ablative and reconstructive surgical oncology. Due to quality-of-life improvement, dental implant rehabilitation could be considered in every patient treated with curative intent. Accurate implant placement is mandatory for prosthesis long-term stability and success in oncologic patients. We present a prospective study, with a novel workflow, comprising 11 patients reconstructed with free flaps and 56 osseointegrated implants placed in bone flaps or remnant jaws (iliac crest, fibula, radial forearm, anterolateral thigh). Starting from CT data and jaw plaster model scanning, virtual dental prosthesis was designed. Then prosthetically driven dental implacement was also virtually planned and transferred to the patient by means of intraoperative infrared optical navigation (first four patients), and a combination of conventional static teeth supported 3D-printed acrylic guide stent, intraoperative dynamic navigation, and augmented reality for final intraoperative verification (last 7 patients). Coronal, apical, and angular deviation between virtual surgical planning and final guided intraoperative position was measured on each implant. There is a clear learning curve for surgeons when applying guided methods. Initial only-navigated cases achieved low accuracy but were comparable to non-guided freehand positioning due to jig registration instability. Subsequent dynamic navigation cases combining highly stable acrylic static guides as reference and registration markers result in the highest accuracy with a 1-1.5-mm deviation at the insertion point. Smartphone-based augmented reality visualization is a valuable tool for intraoperative visualization and final verification, although it is still a difficult technique for guiding surgery. A fixed screw-retained ideal dental prosthesis was achieved in every case as virtually planned. Implant placement, the final step in free flap oncological reconstruction, could be accurately planned and placed with image-guided surgery, 3D printing, and CAD/CAM technology. The learning curve could be overcome with preclinical laboratory training, but virtually designed and 3D-printed tracer registration stability is crucial for accurate and predictable results. Applying these concepts to our difficult oncologic patient subgroup with deep anatomic alterations ended in comparable results as those reported in non-oncologic patients.This work was supported by grant PI18/01625 (Ministerio de Ciencia e Innovación-Instituto de Salud Carlos III and European Regional Development Fund "Una manera de hacer Europa"). This study was also supported by Ticare® implants (Mozo-Grau, Valladolid, Spain). The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication

Digital Workflows and Material Sciences in Dental Medicine

The trend of digitalization is an omnipresent phenomenon nowadays – in social life and in the dental community. Advancement in digital technology has fostered research into new dental materials for the use of these workflows, particularly in the field of prosthodontics and oral implantology.CAD/CAM-technology has been the game changer for the production of tooth-borne and implant-supported (monolithic) reconstructions: from optical scanning, to on-screen designing, and rapid prototyping using milling or 3D-printing. In this context, the continuous development and speedy progress in digital workflows and dental materials ensure new opportunities in dentistry.The objective of this Special Issue is to provide an update on the current knowledge with state-of-the-art theory and practical information on digital workflows to determine the uptake of technological innovations in dental materials science. In addition, emphasis is placed on identifying future research needs to manage the continuous increase in digitalization in combination with dental materials and to accomplish their clinical translation.This Special Issue welcomes all types of studies and reviews considering the perspectives of the various stakeholders with regard to digital dentistry and dental materials