3D Innovations in Personalized Surgery

Current practice involves the use of 3D surgical planning and patient-specific solutions in multiple surgical areas of expertise. Patient-specific solutions have been endorsed for several years in numerous publications due to their associated benefits around accuracy, safety, and predictability of surgical outcome. The basis of 3D surgical planning is the use of high-quality medical images (e.g., CT, MRI, or PET-scans). The translation from 3D digital planning toward surgical applications was developed hand in hand with a rise in 3D printing applications of multiple biocompatible materials. These technical aspects of medical care require engineers’ or technical physicians’ expertise for optimal safe and effective implementation in daily clinical routines.The aim and scope of this Special Issue is high-tech solutions in personalized surgery, based on 3D technology and, more specifically, bone-related surgery. Full-papers or highly innovative technical notes or (systematic) reviews that relate to innovative personalized surgery are invited. This can include optimization of imaging for 3D VSP, optimization of 3D VSP workflow and its translation toward the surgical procedure, or optimization of personalized implants or devices in relation to bone surgery

Surgical Guide Preparation from Computed Tomography Data for Placement of Dental Implants

SUMMARY AND CONCLUSION: The conclusions drawn from this study conducted to simulate the virtual implant placement with computed tomography data using implant simulation software (IMPLANT 3D) and to construct a surgical guide with progressively diameter sleeves to accurately place implants, were that extensive pre operative planning and accurate execution of the plan is crucial for precise placement of implants which is necessary for long term treatment success. Imaging tools, implant planning software, precise surgical guide, good understanding of anatomy, surgical principles and post operative care are essential. Students paired-t test was done to compare the variables (Pan angle & Sect. angle) between pre operative and post operative positions of all the implants. No statistically significant difference were found between pre and post operative conditions which concludes that the surgical guide with progressive 316L stainless steel sleeves helped in accurate transfer of virtual implant position. This method of treatment planning may not be necessary in simpler cases, as much planning is not required in cases having good ridge with adequate bone height and width. Conventional technique may be used in such cases as cost of treatment will be reduced

Advanced Applications of Rapid Prototyping Technology in Modern Engineering

Rapid prototyping (RP) technology has been widely known and appreciated due to its flexible and customized manufacturing capabilities. The widely studied RP techniques include stereolithography apparatus (SLA), selective laser sintering (SLS), three-dimensional printing (3DP), fused deposition modeling (FDM), 3D plotting, solid ground curing (SGC), multiphase jet solidification (MJS), laminated object manufacturing (LOM). Different techniques are associated with different materials and/or processing principles and thus are devoted to specific applications. RP technology has no longer been only for prototype building rather has been extended for real industrial manufacturing solutions. Today, the RP technology has contributed to almost all engineering areas that include mechanical, materials, industrial, aerospace, electrical and most recently biomedical engineering. This book aims to present the advanced development of RP technologies in various engineering areas as the solutions to the real world engineering problems

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

The value of medical 3D printing : hope versus hype

3D printing has been growing fast in the medical field. While preliminary clinical results have been reported in the literature, it’s health economic value has not been analyzed yet. Medical 3D printing has found its main applications in surgery; especially orthopedics and reconstructive surgery. Its applications rage from anatomic models to surgical guides and implants. All of these can be seen as consecutive levels of integration. While papers often report improved clinical results, a great accuracy and an acceptable price, few of these are backed with numbers. We performed 3 health economic analyses using Markov models using a payer perspective on each of these 3 levels of integration. As a first level, we analyzed the impact of using anatomic models as a tool for surgical planning in congenital heart diseases for 9 different procedures. Results varied from not being cost effective for atrial septum defects, to being highly cost-effective in highly complex procedures such as a Norwood repair. Second, we analyzed the already well integrated use of surgical guides for primary total knee arthroplasty using Belgian registry data. The database approach showed an significantly reduced revision rate in the group using custom guides compared to the conventional approach. The Markov models showed the technology to be cost-effective if CT-based guides are used. At last, we analyzed the use of custom 3D printed acetabular implants for revision surgery in patients with acetabular defects compared to non-3D printed custom implants. The 3D printed implants showed to be cost effective, especially in younger patients. The final chapter gives an overview of the pitfalls encountered during these preliminary analyses and gives a glance at possible solutions to allow better analysis and faster adoption of medical innovations

Anatomical and functional custom made restoration techniques with Direct Metal Laser Forming technology: systematic workflow and CAD-CAM

Introduction Bone defects are usually repaired by the body’s healing process itself. If severe fracture, tumor or infection occur on large bones, it poses a serious challenge to the regeneration ability of the bones. One of the latest advancement in medical science is the rapid prototyping technologies. Therefore, the aim of the present study was the developing and testing of a reliable workflow to fabricate custom-made grafts in the field craniofacial surgery. Material and Methods In this study 14 patients with different cranio-facial bone defects were enrolled. Two evaluation methods were associated to test the results of the workflow. Surveys were given to patients undergone surgery and their surgeons to have a subjective analysis of the workflow. For each patient the produced prosthesis was superimposed on the original prosthesis design, the displacement between was evaluated. Results Significant level of discomfort at 4 weeks after surgery compared to 2 days after surgery, aesthetic improvement significant improved 1 year after surgery compared to 4 weeks after surgery. Aesthetic improvement 1 year after surgery and aesthetic improvement according to expectations showed correlation, aesthetic improvement 1 year after surgery and aesthetic improvement according to expectations showed correlation. The mean distance of the printed model was significant smaller than the virtual model, with a mean difference of -0.075 mm. Conclusion According to the results of the present study custom made bone graft made with laser sintering technique represents a valid alternative to traditional bone grafts with high clinical accuracy and the advantage to avoid morbidity of the donor site or of the patient due to animal grafting

Outcomes of implant based prosthetic oral rehabilitation of head and neck oncology patients

Aims: To conduct a systematic review on dental implant survival in autogenous bone grafts and flaps in head and neck (H&N) oncology patients. Thereafter, to retrospectively report a service evaluation on implant- and prosthetic-outcomes of implant based oral rehabilitation in H&N oncology patients in a regional centre. Method: For the systematic review, various databases were searched (01/1980-08/2017). Retrospective analysis of implant- and prosthetic- outcomes of 167 patients treated within service from 2012-2017 was also undertaken, applying Kaplan-Meier survival curves and Cox proportional-hazards models. Results: For the systematic review, 20 articles were reviewed, reporting on 1905 implants. Implant survival varied from 54-100%. The service evaluation revealed implant survival estimates of 95.7% [95%CI 94.3-97.2%] at 3-years and 95.5% [95%CI 93.9-97.0%] at 5-years. Higher implant failure rates were shown in autogenous bone grafts/flaps in comparison to native bone (p=<0.001). Fixed implant prostheses had a higher 5-year survival and 5-year complication-free survival, with fewer complications compared to removable implant prostheses. Conclusion: The systematic review revealed implant survival in autogenous bone grafts in H&N oncology patients to be promising. The service evaluation supported the use of dental implants in the rehabilitation of H&N cancer patients, whilst demonstrating the risk of prosthetic failure and complications

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

Management of bone defects with Bio-oss

Introduction: The defects in the alveolar bone might appear as a result of congenital malformations, traumatic injuries, periodontal disease, surgical traumas, chronic periapical changes and tumors from benign or malignant origin. The aim of this study was to provide solid and healthy area with application of Bio-Oss in the defect. Materials and methods: Based on the clinical diagnosisestablished by previously taken history, clinical examination and radiographic images oral-surgery interventions was made. To realize the aim of this work, augmentative material was implicated in the bone defects made in the patients after removal of follicular cyst, chronic periapical lesion, and parodontopathia. During the first and seventh day of the interventions, the patients have been followed through from aspect of possible development of local and general complications after the oral-surgery intervention. After period of one, three and six mount control x-ray was made. Results: Obtained results confirmed that: volume of the socket and defect of the bone was kept, fast revascularization was achieved, bone formation and slow resorption of the augmentative material was achieved, and period of normal healing without infection was also achieved. Conclusions: The augmentative materials used for treatment of bone defects besides their basic chemical and physical characteristics referring to their solubility in the body fluids, the transformation, modulation and resorption must be completely safe or secure, i.e. not to bring any risk of infection, immunological risk, physiological intolerance or inhibition of the process of restitutio ad integrum. In our study Bio-Oss was confirmed as augmentative material who had this characteristics. Keywords: bone defect, resorption of the bone, augmentative material, Bio-Os