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Fan X, Feng Y, Tao B, Shen Y, Wu Y, Chen X. A hybrid robotic system for zygomatic implant placement based on mixed reality navigation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 249:108156. [PMID: 38555744 DOI: 10.1016/j.cmpb.2024.108156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUNDS Zygomatic implant (ZI) placement surgery is a viable surgical option for patients with severe maxillary atrophy and insufficient residual maxillary bone. Still, it is difficult and risky due to the long path of ZI placement and the narrow field of vision. Dynamic navigation is a superior solution, but it presents challenges such as requiring operators to have advanced skills and experience. Moreover, the precision and stability of manual implantation remain inadequate. These issues are anticipated to be addressed by implementing robot-assisted surgery and achieved by introducing a mixed reality (MR) navigation-guided hybrid robotic system for ZI placement surgery. METHODS This study utilized a hybrid robotic system to perform the ZI placement surgery. Our first step was to reconstruct a virtual 3D model from preoperative cone-beam CT (CBCT) images. We proposed a series of algorithms based on coordinate transformation, which includes image-phantom registration, HoloLens-tracker registration, drill-phantom calibration, and robot-implant calibration, to unify all objects within the same coordinate system. These algorithms enable real-time tracking of the surgical drill's position and orientation relative to the patient phantom. Subsequently, the surgical drill is directed to the entry position, and the planned implantation paths are superimposed on the patient phantom using HoloLens 2 for visualization. Finally, the hybrid robot system performs the processed of drilling, expansion, and placement of ZIs under the guidance of the MR navigation system. RESULTS Phantom experiments of ZI placement were conducted using 10 patient phantoms, with a total of 40 ZIs inserted. Out of these, 20 were manually implanted, and the remaining 20 were robotically implanted. Comparisons between the actual implanted ZI paths and the preoperatively planned ZI paths showed that our MR navigation-guided hybrid robotic system achieved a coronal deviation of 0.887 ± 0.213 mm, an apical deviation of 1.201 ± 0.318 mm, and an angular deviation of 3.468 ± 0.339° This demonstrates significantly better accuracy and stability than manual implantation. CONCLUSION Our proposed hybrid robotic system enables automated ZI placement surgery guided by MR navigation, achieving greater accuracy and stability compared to manual operations in phantom experiments. Furthermore, this system is expected to apply to animal and cadaveric experiments, to get a good ready for clinical studies.
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Affiliation(s)
- Xingqi Fan
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Feng
- Institute of Mechatronics and Logistics Equipment, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Baoxin Tao
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yihan Shen
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqun Wu
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China; Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China.
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Wang W, Zhuang M, Tao B, Wang F, Wu Y. Learning curve of dynamic navigation-assisted zygomatic implant surgery: An in vitro study. J Prosthet Dent 2024:S0022-3913(24)00233-6. [PMID: 38609763 DOI: 10.1016/j.prosdent.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024]
Abstract
STATEMENT OF PROBLEM Dynamic computer-assisted zygomatic implant surgery (dCAZIS) has been reported to provide clinical efficacy with high accuracy and low risk of complications. However, the learning curve before performing dCAZIS effectively is unknown. PURPOSE The purpose of this in vitro study was to explore the learning curve of dCAZIS in dentists with different levels of experience in implant dentistry and navigation surgery. MATERIAL AND METHODS Six senior dental students were randomly divided into 3 groups for initial training (FH-CI group: pretraining on freehand conventional implant surgery; FH-ZI group: pretraining on freehand ZI surgery; DN-CI group: pretraining on conventional implant surgery under dynamic navigation). Then, every operator conducted 6 repeated dCAZIS training sessions on edentulous 3-dimensional (3D) printed skull models and was asked to complete a self-report questionnaire after each training session. A total of 36 postoperative cone beam computed tomography (CBCT) scans with 144 ZI osteotomy site preparations were obtained and superimposed over the preoperative design for accuracy measurements. The operation time, 3D deviations, and results of the self-reports were recorded. Comparisons among groups were analyzed with independent-sample Kruskal-Wallis tests (α=.05), and correlations between study outcomes and the number of practices were calculated. RESULTS Operator experience and increased practice times did not significantly affect the accuracy of dCAZIS (P>.05). However, the operation time varied among groups (P<.001), and significantly shortened with more practice, reaching 11.51 ±1.68 minutes at the fifth attempt in the FH-CI group (P<.001 compared with the first practice), 14.48 ±3.07 minutes at the third attempt in the FH-ZI group (P=.038), and 8.68 ±0.58 minutes at the sixth attempt in the DN-CI group (P<.001). All groups reached their own learning curve plateau stage within 6 practice sessions. As the number of practice sessions increased, the results from the self-report questionnaires gradually improved. CONCLUSIONS Among dentists with different levels of experience in implant dentistry and navigation surgery, dCAZIS was found to have a learning curve with respect to operation time but not implant accuracy. Experience in ZI surgery had little impact on the learning curve of dCAZIS, but experience in navigation surgery was a key factor.
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Affiliation(s)
- Wenying Wang
- Graduate student, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Minjie Zhuang
- Graduate student, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Baoxin Tao
- Graduate student, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Feng Wang
- Professor, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Yiqun Wu
- Professor, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China.
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Hao X, Cheng Q, Xu J, Sun T, Wang Y, Liu Z. Rigid flexible coupling contact mechanism for oral and maxillofacial skin and soft tissues. J Mech Behav Biomed Mater 2024; 150:106329. [PMID: 38113825 DOI: 10.1016/j.jmbbm.2023.106329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND AND OBJECTIVES The existing medical clinical treatment institutions mostly use rigid structures to come into contact with flexible skin. The rigid flexible coupled contact biomechanical model for the skin is the first step that urgently needs to be considered in the process of medical clinical operations. However, there has been currently no effective biomechanical contact model available. METHODS Based on the principle of elastic interface deformation, the basic biomechanical characteristics of oral and maxillofacial skin and soft tissues were analyzed to address the unknown mechanism of rigid body and maxillofacial contact in oral imaging operations. A nonlinear characterization method for the mechanical properties of oral and maxillofacial skin soft tissues was proposed by deriving a general contact force model that takes into account energy dissipation. However, the problem of the inability to obtain analytical solutions for the parameters of the dynamic model exists. It is necessary to perform particle swarm parameter identification on different nonlinear contact models and verify the accuracy of the algorithm through numerical simulation. A maxillofacial contact experiment was conducted to verify the operation process of an oral imaging robot. RESULTS After experimental analysis, it was found that the comprehensive average error between the model and the actual contact force was 0.13325 N. The absolute error of the maximum deformation displacement was below 0.18 N, which verified the effectiveness and safety of the contact model in the contact process of the oral imaging robot system. CONCLUSIONS The results indicate that the output force of the model has been in good agreement with the actual contact force.
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Affiliation(s)
- Xiaolong Hao
- Institute of Advanced Manufacturing and Intelligent Technology, Beijing University of Technology, Beijing, 100124, China; Beijing Key Laboratory of Advanced Manufacturing Technology, Beijing University of Technology, Beijing, 100124, China
| | - Qiang Cheng
- Institute of Advanced Manufacturing and Intelligent Technology, Beijing University of Technology, Beijing, 100124, China; Beijing Key Laboratory of Advanced Manufacturing Technology, Beijing University of Technology, Beijing, 100124, China.
| | - Jingjing Xu
- Institute of Advanced Manufacturing and Intelligent Technology, Beijing University of Technology, Beijing, 100124, China; Beijing Key Laboratory of Advanced Manufacturing Technology, Beijing University of Technology, Beijing, 100124, China
| | - Ting Sun
- Institute of Advanced Manufacturing and Intelligent Technology, Beijing University of Technology, Beijing, 100124, China; Beijing Key Laboratory of Advanced Manufacturing Technology, Beijing University of Technology, Beijing, 100124, China
| | - Yi Wang
- Department of Stomatology, First Medical Center, Chinese PLA General Hospital, Beijing, 100141, China.
| | - Zhifeng Liu
- Key Laboratory of CNC Equipment Reliability, Ministry of Education, Jilin University, Jilin, 130015, China
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Wang W, Yu X, Wang F, Wu Y. Clinical efficacy of computer-assisted zygomatic implant surgery: A systematic scoping review. J Prosthet Dent 2023:S0022-3913(23)00717-5. [PMID: 38007293 DOI: 10.1016/j.prosdent.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/27/2023]
Abstract
STATEMENT OF PROBLEM Digital technology can improve the success of zygomatic implant (ZI) surgery. However, the reliability and efficacy of computer-assisted zygomatic implant surgery (CAZIS) need further analysis. PURPOSE The purpose of this scoping review was to provide an overview of the placement accuracy, implant survival, and complications of CAZIS. MATERIAL AND METHODS A systematic search of English and Mandarin Chinese publications up to May 2023 was conducted in PubMed, Web of Science, Embase, and Wanfang database. The nonpeer-reviewed literature was searched in the trial register (clinicaltrials.gov). Clinical studies and cadaver studies on CAZIS were included. After data extraction and collection, the findings were critically reviewed, analyzed, interpreted, and discussed. RESULTS Forty-one studies met the inclusion criteria. After excluding publications with duplicate data, retaining the most recent, 28 articles were included in this scoping review. Of these, 18 were on static computer-assisted zygomatic implant surgery (sCAZIS), 8 on dynamic computer-assisted zygomatic implant surgery (dCAZIS), and 2 on robot-assisted zygomatic implant surgery (rAZIS). Excluding the outliers, the mean deviations of ZIs in the sCAZIS group (with 8 articles reporting implant placement accuracy, 183 ZIs involved) were: 1.15 ±1.37 mm (coronal deviation), 2.29 ±1.95 mm (apical deviation), and 3.32 ±3.36 degrees (angular deviation). The mean deviations of dCAZIS (3 articles, 251 ZIs) were: 1.60 ±0.74 mm (coronal), 2.27 ±1.05 mm (apical), and 2.89 ±1.69 degrees (angular). The mean deviations of rAZIS (2 articles, 5 ZIs) were: 0.82 ±0.21 mm (coronal), 1.25 ±0.52 mm (apical), and 1.46 ±0.35 degrees (angular). Among the CAZIS reported in the literature, the implant survival rate was high (96.3% for sCAZIS, 98.2% for dCAZIS, and 100% for rAZIS, specified in 14 of 21 clinical studies). The incidence of complications was low, but, because of the few relevant studies (4/21 specified), valid conclusions regarding complications could not be drawn. CONCLUSIONS CAZIS has demonstrated clinical efficacy with high implant survival rates and placement accuracy. Of the 3 guided approaches, rAZIS showed the smallest 3-dimensional deviation.
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Affiliation(s)
- Wenying Wang
- Graduate student, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Xinbo Yu
- Undergraduate student, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Feng Wang
- Professor, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Yiqun Wu
- Professor, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China.
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Fan X, Tao B, Tu P, Shen Y, Wu Y, Chen X. A novel mixed reality-guided dental implant placement navigation system based on virtual-actual registration. Comput Biol Med 2023; 166:107560. [PMID: 37847946 DOI: 10.1016/j.compbiomed.2023.107560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/14/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUNDS The key to successful dental implant surgery is to place the implants accurately along the pre-operative planned paths. The application of surgical navigation systems can significantly improve the safety and accuracy of implantation. However, the frequent shift of the views of the surgeon between the surgical site and the computer screen causes troubles, which is expected to be solved by the introduction of mixed-reality technology through the wearing of HoloLens devices by enabling the alignment of the virtual three-dimensional (3D) image with the actual surgical site in the same field of view. METHODS This study utilized mixed reality technology to enhance dental implant surgery navigation. Our first step was reconstructing a virtual 3D model from pre-operative cone-beam CT (CBCT) images. We then obtained the relative position between objects using the navigation device and HoloLens camera. Via the algorithms of virtual-actual registration, the transformation matrixes between the HoloLens devices and the navigation tracker were acquired through the HoloLens-tracker registration, and the transformation matrixes between the virtual model and the patient phantom through the image-phantom registration. In addition, the algorithm of surgical drill calibration assisted in acquiring transformation matrixes between the surgical drill and the patient phantom. These algorithms allow real-time tracking of the surgical drill's location and orientation relative to the patient phantom under the navigation device. With the aid of the HoloLens 2, virtual 3D images and actual patient phantoms can be aligned accurately, providing surgeons with a clear visualization of the implant path. RESULTS Phantom experiments were conducted using 30 patient phantoms, with a total of 102 dental implants inserted. Comparisons between the actual implant paths and the pre-operatively planned implant paths showed that our system achieved a coronal deviation of 1.507 ± 0.155 mm, an apical deviation of 1.542 ± 0.143 mm, and an angular deviation of 3.468 ± 0.339°. The deviation was not significantly different from that of the navigation-guided dental implant placement but better than the freehand dental implant placement. CONCLUSION Our proposed system realizes the integration of the pre-operative planned dental implant paths and the patient phantom, which helps surgeons achieve adequate accuracy in traditional dental implant surgery. Furthermore, this system is expected to be applicable to animal and cadaveric experiments in further studies.
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Affiliation(s)
- Xingqi Fan
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Baoxin Tao
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Puxun Tu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yihan Shen
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yiqun Wu
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China; Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China.
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Mampilly M, Kuruvilla L, Tash Niyazi AA, Shyam A, Thomas PA, Ali AS, Pullishery F. Accuracy and Self-Confidence Level of Freehand Drilling and Dynamic Navigation System of Dental Implants: An In Vitro Study. Cureus 2023; 15:e49618. [PMID: 38161848 PMCID: PMC10755335 DOI: 10.7759/cureus.49618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The impact of the experience of the clinician on learning a new skill or equipment was still an intriguing subject. The goal of this research is to determine the accuracy level of a dynamic navigation system to that of freehand drilling by expert and novice practitioners with varied levels of experience. Additionally, the duration of the surgical procedure and the self-confidence level of the surgeons were also evaluated. MATERIALS AND METHODS An analog impression of the patient was used to make 20 polyurethane simulation models of the maxilla. Five expert and five inexperienced surgeons prepared the site and placed the implants at random on ten models each. Two different techniques were used to insert dental implants: freehand and dynamic navigation systems. Dental implants were placed in Group 1 utilizing a computer-assisted dynamic navigation device. The implants in Group 2 were secured using free-hand drilling. The dental implants were inserted first in the maxillary right first molar, then in the maxillary right lateral incisor, and the maxillary left second premolar. Preoperative and postoperative CBCT scans were superimposed by employing the Evalunav software and contrasted. The coronal 3-D, apex 3-D, apex vertical depth, and angular deviations for both procedures were evaluated. A pre-tested self-confidence questionnaire was also administered to assess the self-confidence of the practitioners. The duration of the surgical time was also documented for each strategy. The t-test was used to measure the difference in accuracy and confidence levels between freehand and dynamic navigation systems among expert and novice surgeons using SPSS software (IBM Corp., Armonk, NY, USA). RESULTS A total of 60 implants were used (three insertion sites, two methods, and 10 practitioners). Each of the five expert and novice clinicians implanted 15 implants (five models each). Except for entry 3-D, there was a statistically significant difference between the two approaches in all of the primary outcome variables. The apex 3-D (5.89±1.08 mm) and apex vertical (2.08±1.27 mm) dimensions of the dynamic navigation system were significantly smaller than those of the freehand drilling approach (p<005). Dynamic navigation and freehand drilling had angular deviations of 7.16±1.76ᵒ and 9.06±2.18ᵒ, respectively (p=0.0004). The apex vertical deviation was reduced in the navigation technique (2.07±1.5 mm) than in the freehand drilling (2.86±1.4 mm) by experienced practitioners (p=0.04). The difference in time between the two procedures was determined to be statistically highly significant (p<0.001) by both expert and novice surgeons. Furthermore, when contrasting with experienced practitioners, novice practitioners had an overall increase in surgery time (p<0.001) for both approaches. CONCLUSION The current in vitro study found that the dynamic navigation system enables more accurate implant placement than the freehand drilling technique, irrespective of the experience of the surgeons. However, this technique appears to benefit novice practitioners more, as they can profoundly minimize their deviations while accomplishing results comparable to those of expert surgeons.
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Affiliation(s)
- Mathew Mampilly
- Oral and Maxillofacial Surgery, Esic Medical college and PG Institute, Bengaluru, IND
| | - Leelamma Kuruvilla
- Dentistry, Dr. Suzanne Caudry Implant Dentistry and Periodontics, Toronto, CAN
| | | | - Arun Shyam
- Conservative Dentistry and Endodontics, Kannur Dental College, Anjarakkandy, IND
| | | | - Anzil S Ali
- Public Health Dentistry, Royal Dental College, Palakkad, IND
| | - Fawaz Pullishery
- Community Dentistry and Research, Batterjee Medical College, Jeddah, SAU
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Gallo F, Zingari F, Bolzoni A, Barone S, Giudice A. Accuracy of Zygomatic Implant Placement Using a Full Digital Planning and Custom-Made Bone-Supported Guide: A Retrospective Observational Cohort Study. Dent J (Basel) 2023; 11:dj11050123. [PMID: 37232774 DOI: 10.3390/dj11050123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
The aim of the study was to evaluate the accuracy of zygomatic implant placement using customized bone-supported laser-sintered titanium templates. Pre-surgical computed tomography (CT) scans allowed to develop the ideal virtual planning for each patient. Direct metal laser-sintering was used to create the surgical guides for the implant placement. Post-operative CT scans were taken 6 months after surgery to assess any differences between the planned and placed zygomatic implants. Qualitative and quantitative three-dimensional analyses were performed with the software Slicer3D, recording linear and angular displacements after the surface registration of the planned and placed models of each implant. A total of 59 zygomatic implants were analyzed. Apical displacement showed a mean movement of 0.57 ± 0.49 mm on the X-axis, 1.1 ± 0.6 mm on the Y-axis, and 1.15 ± 0.69 mm on the Z-axis for the anterior implant, with a linear displacement of 0.51 ± 0.51 mm on the X-axis, 1.48 ± 0.9 mm on the Y-axis, and 1.34 ± 0.9 mm on the Z-axis for the posterior implant. The basal displacement showed a mean movement of 0.33 ± 0.25 mm on the X-axis, 0.66 ± 0.47 mm on the Y-axis, and 0.58 ± 0.4 mm on the Z-axis for the anterior implant, with a linear displacement of 0.39 ± 0.43 mm on the X-axis, 0.42 ± 0.35 mm on the Y-axis, and 0.66 ± 0.4 mm on the Z-axis for the posterior implant. The angular displacements recorded significative differences between the anterior implants (yaw: 0.56 ± 0.46°; pitch: 0.52 ± 0.45°; roll: 0.57 ± 0.44°) and posterior implants (yaw: 1.3 ± 0.8°; pitch: 1.3 ± 0.78°; roll: 1.28 ± 1.1°) (p < 0.05). Fully guided surgery showed good accuracy for zygomatic implant placement and it should be considered in the decision-making process.
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Affiliation(s)
- Francesco Gallo
- Istituto Stomatologico Italiano, Via Pace, 21, 20161 Milano, Italy
| | - Francesco Zingari
- Ospedale Galeazzi-Sant'Ambrogio, Via Belgioioso 173, 20161 Milano, Italy
| | | | - Selene Barone
- Unit of Oral Surgery and Pathology, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Amerigo Giudice
- Unit of Oral Surgery and Pathology, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
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González Rueda JR, Galparsoro Catalán A, de Paz Hermoso VM, Riad Deglow E, Zubizarreta-Macho Á, Pato Mourelo J, Montero Martín J, Hernández Montero S. Accuracy of computer-aided static and dynamic navigation systems in the placement of zygomatic dental implants. BMC Oral Health 2023; 23:150. [PMID: 36918837 PMCID: PMC10015906 DOI: 10.1186/s12903-023-02856-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/04/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Zygomatic implants are widely used in the rehabilitation of severely atrophic maxillae, but implant placement is not without risks, and it can potentially cause damage to related anatomical structures. The aim of this study was to perform a comparative analysis of the accuracy of static navigation systems in placing zygomatic dental implants in comparison to dynamic navigation systems. METHODS Sixty zygomatic dental implants were randomly allocated to one of three study groups, categorized by which implant placement strategy was used: A: computer-aided static navigation system (n = 20) (GI); B: computer-aided dynamic navigation system (n = 20) (NI); or C: free-hand technique (n = 20) (FHI). For the computer-aided study groups, a preoperative cone-beam computed tomography (CBCT) scan of the existing situation was performed in order to plan the approach to be used during surgery. Four zygomatic dental implants were inserted in each of fifteen polyurethane stereolithographic models (n = 15), with a postoperative CBCT scan taken after the intervention. The pre- and postoperative CBCT scans were then uploaded to a software program used in dental implantology to analyze the angular deviations, apical end point, and coronal entry point. Student's t-test was used to analyze the results. RESULTS The results found statistically significant differences in apical end-point deviations between the FHI and NI (p = 0.0053) and FHI and GI (p = 0.0004) groups. There were also statistically significant differences between the angular deviations of the FHI and GI groups (p = 0.0043). CONCLUSIONS The manual free-hand technique may enable more accurate placement of zygomatic dental implants than computer-assisted surgical techniques due to the different learning curves required for each zygomatic dental implant placement techniques.
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Affiliation(s)
- Juan Ramón González Rueda
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
| | - Agustín Galparsoro Catalán
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
| | | | - Elena Riad Deglow
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
| | - Álvaro Zubizarreta-Macho
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
- grid.11762.330000 0001 2180 1817Department of Surgery, Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain
| | - Jesús Pato Mourelo
- grid.5924.a0000000419370271Department of Surgery, Faculty of Dentistry, University of Navarra, 31009 Pamplona, Navarra Spain
| | - Javier Montero Martín
- grid.11762.330000 0001 2180 1817Department of Surgery, Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain
| | - Sofía Hernández Montero
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
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Sverzut TFV, Sverzut AT, Trivellato AE, Sverzut CE. Retrospective analysis of the predictability of using three-dimensional models for preoperative planning of the length of zygomatic implants. Oral Maxillofac Surg 2023; 27:53-58. [PMID: 35166998 DOI: 10.1007/s10006-022-01047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE This present study aimed to retrospectively evaluate the predictability of using three-dimensional models (TDMs) to plan the preoperative lengths of zygomatic implants (ZIs). METHODS The records of all patients that received such implants between March 2007 and March 2019 were evaluated. The ZI lengths predicted on the TDMs were compared to the lengths of the implants the patients received. RESULTS In total, the records of 74 patients were evaluated, of which 37 records met the criteria of inclusion, and were included in the study. Twenty-seven (73%) of the patients were female and 10 (27%) were male, ranging from 34 to 80 years of age, with the average age being 55.7 years. Seventeen (43.2%) of these patients were classified as ASA I and 21 (56.8%) as ASA II. A total of 142 ZIs were planned and installed in the time frame mentioned. Without distinguishing the region of the maxilla, the implants used were, on average, 1.1 mm larger in length than those initially planned. CONCLUSION Overall, the data indicates moderate agreement between the planned and surgical lengths of the ZIs and indicates that using TDMs is a predictable and reliable preoperative planning technique of the length of posterior ZIs.
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Affiliation(s)
- Thales Fabro Vanzela Sverzut
- Residency Training Program in Oral and Maxillofacial Surgery, School of Dentistry of Ribeirão Preto of the University of São Paulo, Avenida Do Café, s/n, Monte Alegre, Ribeirão Preto, São Paulo, 14040-904, Brazil
| | - Alexander Tadeu Sverzut
- Department of Oral Diagnosis, Maxillofacial Surgery Division, Piracicaba Dental School of the University of Campinas, Av. Limeira, 901, Bairro Areião, Piracicaba, São Paulo, 13414-903, Brazil
| | - Alexandre Elias Trivellato
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto of the University of São Paulo, Avenida Do Café, s/n, Monte Alegre, Ribeirão Preto, São Paulo, 14040-904, Brazil
| | - Cássio Edvard Sverzut
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto of the University of São Paulo, Avenida Do Café, s/n, Monte Alegre, Ribeirão Preto, São Paulo, 14040-904, Brazil.
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Dynamic navigation for zygomatic implant placement: A randomized clinical study comparing the flapless versus the conventional approach. J Dent 2023; 130:104436. [PMID: 36736529 DOI: 10.1016/j.jdent.2023.104436] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The assessment of the accuracy of flapless placement of zygomatic implants in edentulous maxilla using dynamic navigation. METHODS A randomized controlled trial was carried out on 20 patients. Patients were randomized into two groups, the flapless (Group 1; n=10) and the conventional (Group 2; n=10). In each case two zygomatic implants were inserted under local anaesthesia, one on the right and one on the left side guided by a dynamic navigation system. The surgical procedure was identical in the two groups except for the reflection of the mucoperiosteal flap which was eliminated in the flapless cases. Postoperative CBCT scans were used to assess the accuracy of the placement of zygomatic implants. RESULTS Osseointegration was achieved for all the implants, except one case in the flapless group. Statistically significant differences in the accuracy of the position of the zygomatic implants was found between the flapless and the conventional groups, measured at the apex and the entry points of the implants (p < 0.01). The average apical and coronal deviations were 5 mm and 3 mm, respectively; the angular deviation was 6°, and 2 mm vertical apical disparity was detected between the planned and the achieved surgical position. Perforation of the Schneiderian membrane was noted in three cases, one in flapless group and two in the conventional group. CONCLUSIONS Flapless placement of zygomatic implants guided by dynamic navigation offered satisfactory safety and accuracy. CLINICAL SIGNIFICANCE This is the first clinical trial to prove the feasibility and accuracy of flapless placement of zygomatic implant with minimal morbidity. The study highlights the innovative reflection of the Schneiderian membrane under guided surgical navigation. The procedure can be performed under local anaesthesia, which offers clinical advantages. Adequate training on the use of dynamic navigation is mandatory before its use in clinical cases.
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Assessment of the Accuracy of Two Different Dynamic Navigation System Registration Methods for Dental Implant Placement in the Posterior Area: An In Vitro Study. J Pers Med 2023; 13:jpm13010139. [PMID: 36675800 PMCID: PMC9865499 DOI: 10.3390/jpm13010139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
Purpose: To compare the U-tube and cusp dynamic navigation system registration methods in the use of dental implant placement, and to assess the influence of the location of missing teeth on these registrations. Methods: 32 resin mandible models and 64 implants were utilized, with implants being placed using one of the two registration methods selected at random. Accuracy was measured through the superimposition of the final and planned implant positions. Angular deviation, 3D entry deviation, and 3D apex deviation were analyzed. Results: The overall mean 3D deviation was 1.089 ± 0.515 mm at the entry point and 1.174 ± 0.531 mm at the apex point, and mean angular deviation was 1.970 ± 1.042 degrees. No significant difference (p > 0.05) was observed when comparing these two registration methods. However, the U-tube method showed significant difference when assessing the location of missing teeth (without distal-extension absence and distal-extension absence), whereas cusp registration was unaffected. Conclusions: Both the U-tube and cusp dynamic navigation system registration methods are accurate when implemented in vitro. Besides, the cusp registration technique can also overcome several of the limitations of the U-tube approach and the accuracy of it was not influenced by the location of the missing teeth, highlighting it as a method worthy of further clinical research.
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González Rueda JR, García Ávila I, de Paz Hermoso VM, Riad Deglow E, Zubizarreta-Macho Á, Pato Mourelo J, Montero Martín J, Hernández Montero S. Accuracy of a Computer-Aided Dynamic Navigation System in the Placement of Zygomatic Dental Implants: An In Vitro Study. J Clin Med 2022; 11:jcm11051436. [PMID: 35268527 PMCID: PMC8910948 DOI: 10.3390/jcm11051436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this in vitro study was to evaluate and compare the accuracy of zygomatic dental implant (ZI) placement carried out using a dynamic navigation system. Materials and Methods: Forty (40) ZIs were randomly distributed into one of two study groups: (A) ZI placement via a computer-aided dynamic navigation system (n = 20) (navigation implant (NI)); and (B) ZI placement using a conventional free-hand technique (n = 20) (free-hand implant (FHI)). A cone-beam computed tomography (CBCT) scan of the existing situation was performed preoperatively to plan the surgical approach for the computer-aided study group. Four zygomatic dental implants were placed in anatomically based polyurethane models (n = 10) manufactured by stereolithography, and a postoperative CBCT scan was performed. Subsequently, the preoperative planning and postoperative CBCT scans were added to dental implant software to analyze the coronal entry point, apical end point, and angular deviations. Results were analyzed using the Student’s t-test. Results: The results showed statistically significant differences in the apical end-point deviations between FHI and NI (p = 0.0018); however, no statistically significant differences were shown in the coronal entry point (p = 0.2617) or in the angular deviations (p = 0.3132). Furthermore, ZIs placed in the posterior region showed more deviations than the anterior region at the coronal entry point, apical end point, and angular level. Conclusions: The conventional free-hand technique enabled more accurate placement of ZIs than the computer-assisted surgical technique. In addition, placement of ZIs in the anterior region was more accurate than that in the posterior region.
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Affiliation(s)
- Juan Ramón González Rueda
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.R.G.R.); (I.G.Á.); (E.R.D.); (S.H.M.)
| | - Irene García Ávila
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.R.G.R.); (I.G.Á.); (E.R.D.); (S.H.M.)
| | | | - Elena Riad Deglow
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.R.G.R.); (I.G.Á.); (E.R.D.); (S.H.M.)
| | - Álvaro Zubizarreta-Macho
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.R.G.R.); (I.G.Á.); (E.R.D.); (S.H.M.)
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain;
- Correspondence:
| | - Jesús Pato Mourelo
- Department of Surgery, Faculty of Dentistry, University of Navarra, 31009 Pamplona, Spain;
| | - Javier Montero Martín
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain;
| | - Sofía Hernández Montero
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.R.G.R.); (I.G.Á.); (E.R.D.); (S.H.M.)
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Wu Y, Tao B, Lan K, Shen Y, Huang W, Wang F. Reliability and accuracy of dynamic navigation for zygomatic implant placement. Clin Oral Implants Res 2022; 33:362-376. [PMID: 35113463 PMCID: PMC9305866 DOI: 10.1111/clr.13897] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/19/2021] [Accepted: 01/24/2022] [Indexed: 11/29/2022]
Abstract
Objectives To assess the accuracy of a real‐time dynamic navigation system applied in zygomatic implant (ZI) surgery and summarize device‐related negative events and their management. Material and methods Patients who presented with severely maxillary atrophy or maxillary defects and received dynamic navigation‐supported ZI surgery were included. The deviations of entry, exit, and angle were measured after image data fusion. A linear mixed‐effects model was used. Statistical significance was defined as p < .05. Device‐related negative events and their management were also recorded and analyzed. Results Two hundred and thirty‐one zygomatic implants (ZIs) with navigation‐guided placement were planned in 74 consecutive patients between Jan 2015 and Aug 2020. Among them, 71 patients with 221 ZIs received navigation‐guided surgery finally. The deviations in entry, exit, and angle were 1.57 ± 0.71 mm, 2.1 ± 0.94 mm and 2.68 ± 1.25 degrees, respectively. Significant differences were found in entry and exit deviation according to the number of ZIs in the zygomata (p = .03 and .00, respectively). Patients with atrophic maxillary or maxillary defects showed a significant difference in exit deviation (p = .01). A total of 28 device‐related negative events occurred, and one resulted in 2 ZI failures due to implant malposition. The overall survival rate of ZIs was 98.64%, and the mean follow‐up time was 24.11 months (Standard Deviation [SD]: 12.62). Conclusions The navigation‐supported ZI implantation is an accurate and reliable surgical approach. However, relevant technical negative events in the navigation process are worthy of attention.
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Affiliation(s)
- Yiqun Wu
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Baoxin Tao
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Kengliang Lan
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yihan Shen
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Wei Huang
- Department of Oral Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Feng Wang
- Department of Oral Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
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14
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Feng Y, Fan J, Tao B, Wang S, Mo J, Wu Y, Liang Q, Chen X. An image-guided hybrid robot system for dental implant surgery. Int J Comput Assist Radiol Surg 2021; 17:15-26. [PMID: 34449036 DOI: 10.1007/s11548-021-02484-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Dental implant surgery is an effective method for remediating the loss of teeth. Robot is expected to increase the accuracy of dental implant surgery. However, most of them are industrial serial robot, with low stiffness and non-unique inverse kinematic solution, which may reduce the success rate and safety of robotic surgery. Compared to serial robot, parallel robot is more stiffness and has unique inverse kinematic. However, its workspace is small, which may not meet surgical requirements. Therefore, a novel hybrid robot dedicated to dental implant is proposed. METHODS The hybrid robot is composed of three translation joints, two revolute joints, and Stewart parallel manipulator. Stewart is used for performing surgical operation, while the joints are used for enlarging the workspace of Stewart. In order to ensure the safety of robot motion, physical human-robot interaction based on a variable admittance controller is applied in the robotic system. In addition, considering the small workspace of Stewart, an optimal model is proposed to minimize the joint movement of Stewart in adjusting the orientation of drill bit. RESULTS Phantom experiments were carried out based on the prototype robot. In the experiments, the optimal model could be solved after 20 iterations, finding an ideal joint configuration. The proposed variable admittance controller could enhance comfort level effectively. The accuracy of robot is evaluated by angle, entry and exit deviation, which are 0.74 ± 0.25°, 0.93 ± 0.28 mm, and 0.96 ± 0.23 mm, respectively. CONCLUSION The phantom experiments validate the functionality of the proposed hybrid robot. The satisfactory performance makes it more widely used in the practical dental implant surgery in the future.
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Affiliation(s)
- Yuan Feng
- School of Mechanical Engineering, Shanghai Jiao Tong University, Room 901, Dongchuan Road 800, Minhang District, Shanghai, 200240, China
| | - JiaCheng Fan
- School of Mechanical Engineering, Shanghai Jiao Tong University, Room 901, Dongchuan Road 800, Minhang District, Shanghai, 200240, China
| | - BaoXin Tao
- Department of Second Dental Center, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University, School of Medicine, National Clinical Research Center for Oral Disease, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, 639, Zhizaoju Road, Shanghai, 200011, China
| | - ShiGang Wang
- School of Mechanical Engineering, Shanghai Jiao Tong University, Room 901, Dongchuan Road 800, Minhang District, Shanghai, 200240, China
| | - JinQiu Mo
- School of Mechanical Engineering, Shanghai Jiao Tong University, Room 901, Dongchuan Road 800, Minhang District, Shanghai, 200240, China
| | - YiQun Wu
- Department of Second Dental Center, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University, School of Medicine, National Clinical Research Center for Oral Disease, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, 639, Zhizaoju Road, Shanghai, 200011, China
| | - QingHua Liang
- School of Mechanical Engineering, Shanghai Jiao Tong University, Room 901, Dongchuan Road 800, Minhang District, Shanghai, 200240, China.
| | - XiaoJun Chen
- School of Mechanical Engineering, Shanghai Jiao Tong University, Room 901, Dongchuan Road 800, Minhang District, Shanghai, 200240, China.
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A hybrid feature-based patient-to-image registration method for robot-assisted long bone osteotomy. Int J Comput Assist Radiol Surg 2021; 16:1507-1516. [PMID: 34176070 DOI: 10.1007/s11548-021-02439-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study is to provide a simple, feasible and effective patient-to-image registration method for robot-assisted long bone osteotomy, which has rarely been systematically reported. The practical requirement is to meet the accuracy of 1 mm or even higher without bone-implanted markers. METHODS A hybrid feature-based registration method termed CR-RAMSICP is proposed. Point-based coarse registration (CR) is accomplished relying on the optical retro-reflective markers attached to the tracked rigid body fixed out of the bone. In surface-based fine registration, an improved iterative closest point (ICP) algorithm based on the range-adaptive matching strategy (termed RAMSICP) is presented to cope with the robust precise matching between the asymmetric patient and image point clouds, which avoids converging to a local minimum. RESULTS A series of registration experiments based on the isolated porcine iliums are carried out. The results illustrate that CR-RAMSICP not only significantly outperforms CR and CR-ICP in the accuracy and reproducibility, but also exhibits better robustness to the CR errors and less sensitiveness to the distribution and number of fiducial points located in the patient point cloud than CR-ICP. CONCLUSION The proposed registration method CR-RAMSICP can stably satisfy the desired registration accuracy without the use of bone-implanted markers like fiducial screws. Besides, the RAMSICP algorithm used in fine registration is convenient for programming because any complex metrics or models are not involved.
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Dynamic-Assisted Navigational System in Zygomatic Implant Surgery: A Qualitative and Quantitative Systematic Review of Current Clinical and Cadaver Studies. J Oral Maxillofac Surg 2021; 79:799-812. [DOI: 10.1016/j.joms.2020.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023]
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Chen X, Li Y, Xu L, Sun Y, Politis C, Jiang X. A real time image-guided reposition system for the loosed bone graft in orthognathic surgery. Comput Assist Surg (Abingdon) 2021; 26:1-8. [PMID: 33503382 DOI: 10.1080/24699322.2021.1874535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
In traditional orthognathic surgery, the dental splint technique is typically used to assist surgeons to reposition the maxilla or mandible. However, the design and manufacturing of dental splints is time-consuming and labor-intensive, and the templates may not applicable for some complicated cases due to the anatomic intricacies in the maxillofacial region. During recent years, computer-aided navigation technology has been widely used in oral and maxillofacial surgery. However, due to the limitation of current calibration and registration methods, it has been rarely reported for the motion tracking of intraoperative reposition for the loosed bone graft. In this study, a novel surgical navigation system was developed. With the use of this system, not only the surgical saw can be tracked in real-time, but also the loosed bone graft can be navigated under the guidance of the interactive 2D and 3D views until it is aligned with the preoperatively planned position. The phantom experiments validated the feasibility of our surgical navigation system, and the mean error of image-guided reposition was 1.03 ± 0.10 mm, which was significantly more accurate than the mean error of 5.57 ± 1.40 mm based on the non-navigated methods.
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Affiliation(s)
- Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Li
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Lu Xu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Sun
- Faculty of Medicine, OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- Faculty of Medicine, OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Xiaoyi Jiang
- Faculty of Mathematics and Computer Science, University of Münster, Münster, Germany
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Dynamic Navigation for Zygomatic Implants: A Case Report about a Protocol with Intraoral Anchored Reference Tool and an Up-To-Date Review of the Available Protocols. Methods Protoc 2020; 3:mps3040075. [PMID: 33167345 PMCID: PMC7711909 DOI: 10.3390/mps3040075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023] Open
Abstract
Dynamic Navigation is a computer-aided technology that allows the surgeon to track the grip instruments while preparing the implant site in real time based on radiological anatomy and accurate pre-operative planning. The support of this technology to the zygoma implant placement aims to reduce the risks and the errors associated with this complex surgical and prosthetic treatment. Various navigation systems are available to clinicians currently, distinguished by handling, reliability, and the associated economic and biological benefits and disadvantages. The present paper reports on the different protocols of dynamic navigations following a standard workflow in correlation with zygomatic implant supported rehabilitations and describes a case of maxillary atrophy successfully resolved with this technology. An innovative and minimally invasive dynamic navigation system, with the use of an intraoral anchored trust marker plate and a patient reference tool, has been adopted to support the accurate insertion of four zygomatic implants, which rapidly resolved maxillary atrophy from a 75-year-old male system. This approach provided an optimal implant placement accuracy reducing surgical invasiveness.
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Pilot study of a surgical robot system for zygomatic implant placement. Med Eng Phys 2019; 75:72-78. [PMID: 31677890 DOI: 10.1016/j.medengphy.2019.07.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 07/09/2019] [Accepted: 07/28/2019] [Indexed: 01/02/2023]
Abstract
Zygomatic implant technology has been regarded as an alternative treatment to massive grafting surgery in the severe atrophic maxillary. Nowadays, the assistant method with a real-time surgical navigation has been applied to reduce the risks of zygomatic implant placement. However, the accuracy of the complex operation is highly dependent on the experience of the surgeon. In order to avoid disadvantages of traditional surgical navigation systems, a novel surgical robot system for the zygomatic implant placement has been designed and developed. Firstly, the drilling trajectory of the zygomatic implant placement is designed through the pre-operative planning system. Secondly, the real-time positions of the surgical instruments are constantly updated with the guidance of the optical tracker. Finally, through a coordinate transformation algorithm, the drilling performance can be conducted with the control of a six degree of freedom robot. In order to evaluate the accuracy of the robot, phantom experiments had been carried out. The angle, entry point and exit point deviation of the robotic system are 1.52 ± 0.58°, 0.79 ± 0.19 mm, and 1.49 ± 0.48 mm, respectively. Meanwhile, a comparison between the robotic and manual operation demonstrates that the use of the surgical robot system for the zygomatic implant placement can improve the accuracy of the operation.
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Wu Y, Wang F, Huang W, Fan S. Real-Time Navigation in Zygomatic Implant Placement. Oral Maxillofac Surg Clin North Am 2019; 31:357-367. [DOI: 10.1016/j.coms.2019.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lee CY, Chan H, Ujiie H, Fujino K, Kinoshita T, Irish JC, Yasufuku K. Novel Thoracoscopic Navigation System With Augmented Real-Time Image Guidance for Chest Wall Tumors. Ann Thorac Surg 2018; 106:1468-1475. [PMID: 30120940 DOI: 10.1016/j.athoracsur.2018.06.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/24/2018] [Accepted: 06/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND We developed a thoracoscopic surgical navigation system with real-time augmented image guidance to assess the potential benefits for minimally invasive resection of chest wall tumors. The accuracy of localization of tumor and resection margin and the effect on task workload and confidence were evaluated in a chest wall tumor phantom. METHODS After scanning a realistic tumor phantom by cone-beam computed tomography and registering the data into the system, three-dimensional contoured tumor and resection margin was displayed. Fifteen surgeons were asked to localize the tumor margin and surgical margins with the thoracoscope alone. The same procedure was performed with the surgical navigation system activated, and results were compared between each attempt. A questionnaire and National Aeronautics and Space Administration Task Load Index were completed after. RESULTS The surgical navigation system significantly reduced localization error for the medial (p = 0.002) and superior tumor margin (p < 0.001), which was difficult to visualize by thoracoscopy alone. All surgical resection margins were improved circumferentially, including margins that were readily visible by thoracoscopy. National Aeronautics and Space Administration Task Load Index response scores showed a statistically significant reduction in workload in all subscales. There was a more than 50% mean reduction in workload for performance (10.1 vs 4.4, p = 0.001) and frustration (13.0 vs 5.4, p = 0.001). CONCLUSIONS This study showed that the thoracoscopic surgical navigation system providing augmented image guidance decreased tumor localization error for regions difficult to visualize thoracoscopically and also reduced surgical margin error circumferentially, regardless of thoracoscopic visibility. This system also reduced workload and increased surgeon's confidence in localizing challenging chest wall tumors.
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Affiliation(s)
- Chang Young Lee
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Harley Chan
- Princess Margaret Cancer Centre and Guided Therapeutics Program-TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kosuke Fujino
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tomonari Kinoshita
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Princess Margaret Cancer Centre and Guided Therapeutics Program-TECHNA Institute, University Health Network, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre and Guided Therapeutics Program-TECHNA Institute, University Health Network, Toronto, Ontario, Canada.
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Chen X, Xu L, Wang H, Wang F, Wang Q, Kikinis R. Development of a surgical navigation system based on 3D Slicer for intraoperative implant placement surgery. Med Eng Phys 2017; 41:81-89. [PMID: 28109564 PMCID: PMC5549678 DOI: 10.1016/j.medengphy.2017.01.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 11/08/2016] [Accepted: 01/01/2017] [Indexed: 11/29/2022]
Abstract
Implant placement has been widely used in various kinds of surgery. However, accurate intraoperative drilling performance is essential to avoid injury to adjacent structures. Although some commercially-available surgical navigation systems have been approved for clinical applications, these systems are expensive and the source code is not available to researchers. 3D Slicer is a free, open source software platform for the research community of computer-aided surgery. In this study, a loadable module based on Slicer has been developed and validated to support surgical navigation. This research module allows reliable calibration of the surgical drill, point-based registration and surface matching registration, so that the position and orientation of the surgical drill can be tracked and displayed on the computer screen in real time, aiming at reducing risks. In accuracy verification experiments, the mean target registration error (TRE) for point-based and surface-based registration were 0.31±0.06mm and 1.01±0.06mm respectively, which should meet clinical requirements. Both phantom and cadaver experiments demonstrated the feasibility of our surgical navigation software module.
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Affiliation(s)
- Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Lu Xu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Huixiang Wang
- Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Wang
- Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiugen Wang
- Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ron Kikinis
- Surgical Planning Laboratory, Harvard Medical School, Boston, United States
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Hung KF, Wang F, Wang HW, Zhou WJ, Huang W, Wu YQ. Accuracy of a real-time surgical navigation system for the placement of quad zygomatic implants in the severe atrophic maxilla: A pilot clinical study. Clin Implant Dent Relat Res 2017; 19:458-465. [PMID: 28219120 DOI: 10.1111/cid.12475] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/30/2016] [Accepted: 01/08/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Kuo-feng Hung
- Department of Oral-Maxillofacial Implantology; Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai 200011 China
| | - Feng Wang
- Department of Oral-Maxillofacial Implantology; Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai 200011 China
| | - Hao-wei Wang
- Department of Oral-Maxillofacial Implantology; Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai 200011 China
| | - Wen-jie Zhou
- Department of Oral-Maxillofacial Implantology; Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai 200011 China
| | - Wei Huang
- Department of Oral-Maxillofacial Implantology; Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai 200011 China
| | - Yi-qun Wu
- Department of Oral-Maxillofacial Implantology; Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai 200011 China
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Kim YM, Delen D. Medical informatics research trend analysis: A text mining approach. Health Informatics J 2016; 24:432-452. [PMID: 30376768 DOI: 10.1177/1460458216678443] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The objective of this research is to identify major subject areas of medical informatics and explore the time-variant changes therein. As such it can inform the field about where medical informatics research has been and where it is heading. Furthermore, by identifying subject areas, this study identifies the development trends and the boundaries of medical informatics as an academic field. To conduct the study, first we identified 26,307 articles in PubMed archives which were published in the top medical informatics journals within the timeframe of 2002 to 2013. And then, employing a text mining -based semi-automated analytic approach, we clustered major research topics by analyzing the most frequently appearing subject terms extracted from the abstracts of these articles. The results indicated that some subject areas, such as biomedical, are declining, while other research areas such as health information technology (HIT), Internet-enabled research, and electronic medical/health records (EMR/EHR), are growing. The changes within the research subject areas can largely be attributed to the increasing capabilities and use of HIT. The Internet, for example, has changed the way medical research is conducted in the health care field. While discovering new medical knowledge through clinical and biological experiments is important, the utilization of EMR/EHR enabled the researchers to discover novel medical insight buried deep inside massive data sets, and hence, data analytics research has become a common complement in the medical field, rapidly growing in popularity.
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Chen X, Xu L, Sun Y, Politis C. A review of computer-aided oral and maxillofacial surgery: planning, simulation and navigation. Expert Rev Med Devices 2016; 13:1043-1051. [DOI: 10.1080/17434440.2016.1243054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Chen X, Xu L, Wang W, Li X, Sun Y, Politis C. Computer-aided design and manufacturing of surgical templates and their clinical applications: a review. Expert Rev Med Devices 2016; 13:853-64. [DOI: 10.1080/17434440.2016.1218758] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Chen X, Xu L, Wang Y, Hao Y, Wang L. Image-guided installation of 3D-printed patient-specific implant and its application in pelvic tumor resection and reconstruction surgery. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 125:66-78. [PMID: 26652978 DOI: 10.1016/j.cmpb.2015.10.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/29/2015] [Accepted: 10/29/2015] [Indexed: 06/05/2023]
Abstract
Nowadays, the diagnosis and treatment of pelvic sarcoma pose a major surgical challenge for reconstruction in orthopedics. With the development of manufacturing technology, the metal 3D-printed customized implants have brought revolution for the limb-salvage resection and reconstruction surgery. However, the tumor resection is not without risk and the precise implant placement is very difficult due to the anatomic intricacies of the pelvis. In this study, a surgical navigation system including the implant calibration algorithm has been developed, so that the surgical instruments and the 3D-printed customized implant can be tracked and rendered on the computer screen in real time, minimizing the risks and improving the precision of the surgery. Both the phantom experiment and the pilot clinical case study presented the feasibility of our computer-aided surgical navigation system. According to the accuracy evaluation experiment, the precision of customized implant installation can be improved three to five times (TRE: 0.75±0.18 mm) compared with the non-navigated implant installation after the guided osteotomy (TRE: 3.13±1.28 mm), which means it is sufficient to meet the clinical requirements of the pelvic reconstruction. However, more clinical trials will be conducted in the future work for the validation of the reliability and efficiency of our navigation system.
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Affiliation(s)
- Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Lu Xu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yiping Wang
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yongqiang Hao
- Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liao Wang
- Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Chen X, Xu L, Wang Y, Wang H, Wang F, Zeng X, Wang Q, Egger J. Development of a surgical navigation system based on augmented reality using an optical see-through head-mounted display. J Biomed Inform 2015; 55:124-31. [PMID: 25882923 DOI: 10.1016/j.jbi.2015.04.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 03/20/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
The surgical navigation system has experienced tremendous development over the past decades for minimizing the risks and improving the precision of the surgery. Nowadays, Augmented Reality (AR)-based surgical navigation is a promising technology for clinical applications. In the AR system, virtual and actual reality are mixed, offering real-time, high-quality visualization of an extensive variety of information to the users (Moussa et al., 2012) [1]. For example, virtual anatomical structures such as soft tissues, blood vessels and nerves can be integrated with the real-world scenario in real time. In this study, an AR-based surgical navigation system (AR-SNS) is developed using an optical see-through HMD (head-mounted display), aiming at improving the safety and reliability of the surgery. With the use of this system, including the calibration of instruments, registration, and the calibration of HMD, the 3D virtual critical anatomical structures in the head-mounted display are aligned with the actual structures of patient in real-world scenario during the intra-operative motion tracking process. The accuracy verification experiment demonstrated that the mean distance and angular errors were respectively 0.809±0.05mm and 1.038°±0.05°, which was sufficient to meet the clinical requirements.
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Affiliation(s)
- Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Lu Xu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yiping Wang
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Huixiang Wang
- Shanghai First People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Wang
- Shanghai First People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangsen Zeng
- Shanghai First People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiugen Wang
- Shanghai First People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jan Egger
- Faculty of Computer Science and Biomedical Engineering, Institute for Computer Graphics and Vision, Graz University of Technology, Graz, Austria
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Neugebauer J, Stachulla G, Ritter L, Dreiseidler T, Mischkowski RA, Keeve E, Zöller JE. Computer-aided manufacturing technologies for guided implant placement. Expert Rev Med Devices 2014; 7:113-29. [DOI: 10.1586/erd.09.61] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Weber JR, Baribeau F, Grenier P, Émond F, Dubois S, Duchesne F, Girard M, Pope T, Gallant P, Mermut O, Moghadam HG. Towards a bimodal proximity sensor for in situ neurovascular bundle detection during dental implant surgery. BIOMEDICAL OPTICS EXPRESS 2013; 5:16-30. [PMID: 24466473 PMCID: PMC3891329 DOI: 10.1364/boe.5.000016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/15/2013] [Accepted: 11/18/2013] [Indexed: 05/24/2023]
Abstract
Proof of concept results are presented towards an in situ bimodal proximity sensor for neurovascular bundle detection during dental implant surgery using combined near infrared absorption (NIR) and optical coherence tomography (OCT) techniques. These modalities are shown to have different sensitivity to the proximity of optical contrast from neurovascular bundles. NIR AC and DC signals from the pulsing of an artery enable qualitative ranging of the bundle in the millimeter range, with best sensitivity around 0.5-3mm distance in a custom phantom setup. OCT provides structural mapping of the neurovascular bundle at sub-millimeter distances in an ex vivo human jaw bone. Combining the two techniques suggests a novel ranging system for the surgeon that could be implemented in a "smart drill." The proximity to the neurovascular bundle can be tracked in real time in the range of a few millimeters with NIR signals, after which higher resolution imaging OCT to provide finer ranging in the sub-millimeter distances.
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Affiliation(s)
- Jessie R. Weber
- Institut national d’optique (INO), 2740 rue Einstein, Québec, QC G1P 4S4, Canada
| | - François Baribeau
- Institut national d’optique (INO), 2740 rue Einstein, Québec, QC G1P 4S4, Canada
| | - Paul Grenier
- Institut national d’optique (INO), 2740 rue Einstein, Québec, QC G1P 4S4, Canada
| | - Frédéric Émond
- Institut national d’optique (INO), 2740 rue Einstein, Québec, QC G1P 4S4, Canada
| | - Sylvain Dubois
- Institut national d’optique (INO), 2740 rue Einstein, Québec, QC G1P 4S4, Canada
| | - François Duchesne
- Institut national d’optique (INO), 2740 rue Einstein, Québec, QC G1P 4S4, Canada
| | - Marc Girard
- Institut national d’optique (INO), 2740 rue Einstein, Québec, QC G1P 4S4, Canada
| | - Timothy Pope
- Institut national d’optique (INO), 2740 rue Einstein, Québec, QC G1P 4S4, Canada
| | - Pascal Gallant
- Institut national d’optique (INO), 2740 rue Einstein, Québec, QC G1P 4S4, Canada
| | - Ozzy Mermut
- Institut national d’optique (INO), 2740 rue Einstein, Québec, QC G1P 4S4, Canada
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A Bone-Thickness Map as a Guide for Bone-Anchored Port Implantation Surgery in the Temporal Bone. MATERIALS 2013; 6:5291-5301. [PMID: 28788390 PMCID: PMC5452769 DOI: 10.3390/ma6115291] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 10/20/2013] [Accepted: 11/11/2013] [Indexed: 11/17/2022]
Abstract
The bone-anchored port (BAP) is an investigational implant, which is intended to be fixed on the temporal bone and provide vascular access. There are a number of implants taking advantage of the stability and available room in the temporal bone. These devices range from implantable hearing aids to percutaneous ports. During temporal bone surgery, injuring critical anatomical structures must be avoided. Several methods for computer-assisted temporal bone surgery are reported, which typically add an additional procedure for the patient. We propose a surgical guide in the form of a bone-thickness map displaying anatomical landmarks that can be used for planning of the surgery, and for the intra-operative decision of the implant’s location. The retro-auricular region of the temporal and parietal bone was marked on cone-beam computed tomography scans and tridimensional surfaces displaying the bone thickness were created from this space. We compared this method using a thickness map (n = 10) with conventional surgery without assistance (n = 5) in isolated human anatomical whole head specimens. The use of the thickness map reduced the rate of Dura Mater exposition from 100% to 20% and suppressed sigmoid sinus exposures. The study shows that a bone-thickness map can be used as a low-complexity method to improve patient’s safety during BAP surgery in the temporal bone.
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Lloréns R, Naranjo V, López F, Alcañiz M. Jaw tissues segmentation in dental 3D CT images using fuzzy-connectedness and morphological processing. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2012; 108:832-843. [PMID: 22789466 DOI: 10.1016/j.cmpb.2012.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 01/12/2012] [Accepted: 05/27/2012] [Indexed: 06/01/2023]
Abstract
The success of oral surgery is subject to accurate advanced planning. In order to properly plan for dental surgery or a suitable implant placement, it is necessary an accurate segmentation of the jaw tissues: the teeth, the cortical bone, the trabecular core and over all, the inferior alveolar nerve. This manuscript presents a new automatic method that is based on fuzzy connectedness object extraction and mathematical morphology processing. The method uses computed tomography data to extract different views of the jaw: a pseudo-orthopantomographic view to estimate the path of the nerve and cross-sectional views to segment the jaw tissues. The method has been tested in a groundtruth set consisting of more than 9000 cross-sections from 20 different patients and has been evaluated using four similarity indicators (the Jaccard index, Dice's coefficient, point-to-point and point-to-curve distances), achieving promising results in all of them (0.726±0.031, 0.840±0.019, 0.144±0.023 mm and 0.163±0.025 mm, respectively). The method has proven to be significantly automated and accurate, with errors around 5% (of the diameter of the nerve), and is easily integrable in current dental planning systems.
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Affiliation(s)
- Roberto Lloréns
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
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Olszewski R. Surgical Engineering in Cranio-Maxillofacial Surgery: A Literature Review. JOURNAL OF HEALTHCARE ENGINEERING 2012. [DOI: 10.1260/2040-2295.3.1.53] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Chrcanovic BR, Pedrosa AR, Neto Custódio AL. Zygomatic implants: a critical review of the surgical techniques. Oral Maxillofac Surg 2012; 17:1-9. [PMID: 22274763 DOI: 10.1007/s10006-012-0316-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 01/10/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the present study is to identify and describe the different surgical techniques for placement of zygomatic implants reported in the literature and discuss the differences between them. METHODS An electronic search was undertaken in July 2011. The titles and abstracts from these results (n = 130) were read for identifying studies, which reported different surgical techniques for placement of zygomatic implants, which resulted in 41 articles. RESULTS Five different surgical approaches were identified: (1) the classical approach, (2) the sinus slot technique, (3) the exteriorized approach, (4) the minimally invasive approach by the use of custom-made drill guides, and (5) the computer-aided surgical navigation system approach. When the maxilla is severely resorbed, the concavity formed by the ridge crest is small, and the original classical technique should be used. When maxillary resorption generates a large concavity, it would be better to exteriorize the zygomatic implant. The externalized technique has fewer surgical steps than the classical and sinus slot methods, is less invasive, and reduces surgical time. It is recommended that utilization of the sinus slot technique together with the CT-based drilling guide would enhance the final results. Although the technique that uses the computer-aided surgical navigation system approach may produce an improved precision in the clinical procedure, its use is expensive, prolongs the operation time, and is limited to centers that have the necessary equipment for the surgery. CONCLUSIONS Preference for one technique over the other should take into consideration the concavity formed by the ridge crest, maxillary sinus, and region of implant insertion in the zygomatic bone.
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Schiroli G, Angiero F, Silvestrini-Biavati A, Benedicenti S. Zygomatic implant placement with flapless computer-guided surgery: a proposed clinical protocol. J Oral Maxillofac Surg 2011; 69:2979-89. [PMID: 21835528 DOI: 10.1016/j.joms.2011.03.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 02/25/2011] [Accepted: 03/29/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of the present report is to describe a procedure for zygomatic implant placement using image-guided implant surgery. This is an innovative technique and includes a new clinical approach to provide the direction to guide drilling. MATERIALS AND METHODS The ethical committee of the University of Genoa approved the study. All patients had clinical indications of severe maxillary atrophy (Class 4 Cadwood-Howell). A total of 25 implants were placed, of which 17 were in the premaxilla, 7 in the zygomatic area, and 1 in the pterygoid bone. The treatment was performed in 2 phases. The first phase included cone-beam acquisition to exclude sinus disease and evaluate the anatomy of the residual premaxillary bone in 3 dimensions. The success of osseointegration achieved by the primary implants (PIs) was confirmed after temporary loading and before proceeding with the second phase, in which all patients were scheduled for zygomatic implants. A total of 3 or 4 regular platform MK III implants (17 in all) were placed in the premaxilla using conventional implant surgery. A model within the analogs of the PIs was prepared (master model), taking a conventional impression. Next, a radiologic template was prepared on the same master model and stabilized on the PIs, using dedicated prosthetic components. The guide was screwed onto the PIs during computed tomography acquisition to determine a fixed and repeatable position of the guide. In the second phase, after routine planning, a mucosa-supported stereolithographic SurgiGuide with sleeves for the zygomatic implants and the corresponding stereolithographic model, including the mucosa, were received from the manufacturers. The guide was repositioned on the master model to replace the sleeves for the PIs in the same position. With an original customized surgical kit, including an innovative intrasinus device, we next simulated surgery on the stereolithographic model to determine and control the direction of the osteotomies and the final depth of drilling. The SurgiGuide was anchored onto the PIs before the zygomatic osteotomy, after which flapless surgery was performed to place the zygomatic implants according to the plan. RESULTS Two PIs in the premaxillary area failed (and were replaced before the zygomatic step). No zygomatic implants failed. The follow-up examinations at 4 to 39 months showed good esthetic, phonetic, and functional results. CONCLUSIONS The results of the proposed surgical procedure appear to be encouraging. Although it is difficult to achieve the correct driven angle of osteotomies for zygomatic implants, in all patients we achieved correct zygomatic positioning, in agreement with previous planning. Additional research and randomized clinical trials are needed to assess the predictability of the procedure.
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Affiliation(s)
- Guido Schiroli
- University of Genoa, Department of Medical, Biophysical, Dental Science and Technologies, DISTIBIMO, Genoa, Italy.
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Automated dental implantation using image-guided robotics: registration results. Int J Comput Assist Radiol Surg 2011; 6:627-34. [PMID: 21221831 DOI: 10.1007/s11548-010-0543-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE One of the most important factors affecting the outcome of dental implantation is the accurate insertion of the implant into the patient's jaw bone, which requires a high degree of anatomical accuracy. With the accuracy and stability of robots, image-guided robotics is expected to provide more reliable and successful outcomes for dental implantation. Here, we proposed the use of a robot for drilling the implant site in preparation for the insertion of the implant. METHODS An image-guided robotic system for automated dental implantation is described in this paper. Patient-specific 3D models are reconstructed from preoperative Cone-beam CT images, and implantation planning is performed with these virtual models. A two-step registration procedure is applied to transform the preoperative plan of the implant insertion into intra-operative operations of the robot with the help of a Coordinate Measurement Machine (CMM). Experiments are carried out with a phantom that is generated from the patient-specific 3D model. Fiducial Registration Error (FRE) and Target Registration Error (TRE) values are calculated to evaluate the accuracy of the registration procedure. RESULTS FRE values are less than 0.30 mm. Final TRE values after the two-step registration are 1.42 ± 0.70 mm (N = 5). CONCLUSIONS The registration results of an automated dental implantation system using image-guided robotics are reported in this paper. Phantom experiments show that the practice of robot in the dental implantation is feasible and the system accuracy is comparable to other similar systems for dental implantation.
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Chen X, Lin Y, Wang C, Shen G, Zhang S, Wang X. A surgical navigation system for oral and maxillofacial surgery and its application in the treatment of old zygomatic fractures. Int J Med Robot 2010; 7:42-50. [DOI: 10.1002/rcs.367] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2010] [Indexed: 11/11/2022]
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Yanping L, Xiaojun C, Ming Y, Xudong W, Guofang S, Chengtao W. A pilot application of image-guided navigation system in mandibular angle reduction surgery. J Plast Reconstr Aesthet Surg 2010; 63:e593-6. [DOI: 10.1016/j.bjps.2009.11.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 11/17/2009] [Accepted: 11/29/2009] [Indexed: 10/20/2022]
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