Mandibular fibular graft reconstruction with CAD/CAM technology: A clinical report and literature review

A one-piece CAD-CAM printed custom implant healing abutment: A dental technique

This clinical technique describes a method of fabricating a 1-piece computer-aided design and computer-aided manufacturing (CAD-CAM) printed custom healing abutment. A digital surgical guide and a virtual model based on the proposed implant position were generated. Then, a digitally designed healing abutment was fabricated using the Dental Designer software program. The definitive abutment design was printed from an interim crown resin material. The described method combines the guided implant placement and a 1-piece CAD-CAM printed custom healing abutment to develop appropriate tissue contours.

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

The success of free vascularized fibular bone graft (FVFBG) has accelerated the osteo reconstruction which results from trauma, resection of a tumor or an infectious bone segment, or correction of congenital deformity. But the complication behind should not be overlooked. The failure could necessitate a second surgery, which prolong the rehabilitation period and produce further health cost. Worst, the patients may suffer a permanent impaired ankle function, or a sustained morpho-functional loss on reconstructive area which are hard to save. To provide an overview of the complication related to reconstruction by FVFBG, a narrative review is conducted to identify the complications including their types and rates, the contributing factors, the approaches to measure and the techniques to avoid. Methodologically, by quick research on Pubmed and abstract reading of reviews, we characterize five reconstructive areas where FVFBG were most frequently applied: extremities, mandible, spine, osteonecrosis of femoral head, and penile. Following, the complications on different reconstructive areas are retrieved, studied and presented in five (or more specifically, six) separate sections. By the way, meaningful difference between FVFBG and other bone flap was presented in a few words if necessary. Donor-site morbidities were studied and summarized as a whole. In these literatures, the evidences documented on limb and mandibular reconstruction have the fullest detail, followed by the spine and lastly the penile. In conclusion, FVFBG, though a mature technique, needs further deep and comprehensive study and maybe device-based assistance to achieve better reconstructive effect and minimize donor-site damage.

Investigation of pelvic symmetry using CAD software

Severe pelvic fractures often prove difficult for surgeons as they require patient-specific surgical treatment plans and customized equipment. Developing virtual patient-specific 3D pelvis models would ease the surgical planning process and enable development of custom fixation plates. This paper aims to examine pelvic symmetry to conclude whether the contralateral side may be used as a reference model for the fractured side of the pelvis. Fourteen subjects with intact pelvises were involved in this study. CT scans of the pelvises were converted to 3D models and the right sides of the pelvises were reflected and aligned with the left sides. A deviation analysis was then performed for each set of models and results showed that the average root mean square (RMS) of values was 1.14 ± 0.26 mm and the average percentage of points below a deviation threshold of ± 2 mm was 91.9 ± 5.55%. The deviation color maps (DCMs) showed that the largest deviations were on the non-articular surfaces. The volume and surface area of each model were also examined and showed no significant differences between left and right sides. These results indicate that the pelvis displays bilateral symmetry and this concept can be used to develop fully intact patient-specific 3D pelvis models for fracture reconstruction using the unfractured contralateral side. Graphical Abstract.

The diagnostic value of three-dimensional CT angiography for patients with acute coronary artery disease

Computed tomography angiography (CTA) is an efficient method for the diagnosis of heart disease. However, few contemporary studies have evaluated the prognostic value of three-dimensional (3D)-CTA for patients with acute coronary artery disease. The aim of the present study was to investigate the diagnostic value of 3D-CTA for patients with acute coronary artery disease. A total of 136 patients with suspected acute coronary artery disease were recruited and received conventional coronary angiography (CCA) and 3D-CTA. 3D-CTA was used to assess calcified plaques in the coronary arteries (CCTA), the ratio of calcified plaque volume to vessel circumference (RVTC) and diagnostic accuracy. The results revealed that 3D-CTA was a more effective diagnostic method for identifying calcified plaques in patients with acute coronary artery disease compared with CCA. 3D-CTA demonstrated a significantly better area under curve, sensitivity, specificity, positive predictive value and negative predictive value compared with CCA (P<0.01). In the present study, 3D-CTA was used to successfully diagnose 86 patients with acute coronary artery disease, 34 with myocardial infarction and 16 with stable angina. 3D-CTA images clearly showed global noise levels and target-to-background ratios determined by manually delineated coronary plaque lesions compared with CCA. Furthermore, 3D-CTA was significantly better for discriminating ischemia compared with CCA (P<0.01). In conclusion, the results of the present study suggest that 3D-CTA provides superior diagnostic performance compared with CCA alone in patients with acute coronary artery disease.

Is it cost-beneficial to society? Measuring the economic worth of dental residency training

This study estimated whether continued programming of a highly specialized four-year dentistry residency training in Saudi Arabia was cost-beneficial. We utilized a purposive sampling to administer a survey to trainees in major cities. Additionally, we used publically available market information about general practitioners. We employed Benefit-Cost Analysis accounting approach as a conceptual framework. Using general practitioners as the base category, we grouped overall social analytical perspectives into resident trainees and rest of society. The residency program was cost-beneficial to trainees, realizing an estimated return of SR 4.07 per SR 1 invested. The overall societal return was SR 0.98 per SR 1 invested, slightly shy of a bang for the buck, in part because the public sector largely runs the training. Benefits included increased earnings and enhanced restorative dentistry skills accruing to trainees; increased charitable contributions and programming-related payments accruing to programs and the public; and practice-related payments accruing to governmental, professional, and insurance agencies. Rest of society, notably government underwrote much of the cost of programming. A sensitivity analysis revealed the results were robust to uncertainties in the data and estimation. Our findings offer evidence to evaluate whether continued residency training is cost-beneficial to trainees and potentially to overall society.

Prosthetic rehabilitation following lateral resection of the mandible with a long cantilever implant-supported fixed prosthesis: A 3-year clinical report

This clinical report describes the prosthetic management of the surgical reconstruction of a patient after mandibular resection. Complete oral rehabilitation was achieved with a maxillary complete denture and a mandibular implant-supported fixed prosthesis with a custom titanium framework and a long unilateral cantilever.