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Al-Jarsha MY, Ayoub AF, Almgran MM, Liu CH, Robertson DP, Naudi KB. The precision of drill calibration for dynamic navigation. J Dent 2024; 146:105032. [PMID: 38703809 DOI: 10.1016/j.jdent.2024.105032] [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: 11/07/2023] [Revised: 04/24/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVES To quantify the reproducibility of the drill calibration process in dynamic navigation guided placement of dental implants and to identify the human factors that could affect the precision of this process in order to improve the overall implant placement accuracy. METHODS A set of six drills and four implants were calibrated by three operators following the standard calibration process of NaviDent® (ClaroNav Inc.). The reproducibility of the position of each tip of a drill or implant was calculated in relation to the pre-planned implants' entry and apex positions. Intra- and inter-operator reliabilities were reported. The effects of the drill length and shape on the reproducibility of the calibration process were also investigated. The outcome measures for reproducibility were expressed in terms of variability range, average and maximum deviations from the mean distance. RESULTS A satisfactory inter-rater reproducibility was noted. The precision of the calibration of the tip position in terms of variability range was between 0.3 and 3.7 mm. We noted a tendency towards a higher precision of the calibration process with longer drills. More calibration errors were observed when calibrating long zygomatic implants with non-locking adapters than with pointed drills. Flexible long-pointed drills had low calibration precision that was comparable to the non-flexible short-pointed drills. CONCLUSION The clinicians should be aware of the calibration error associated with the dynamic navigation placement of dental and zygomatic implants. This should be taken in consideration especially for long implants, short drills, and long drills that have some degree of flexibility. CLINICAL SIGNIFICANCE Dynamic navigation procedures are associated with an inherent drill calibration error. The manual stability during the calibration process is crucial in minimising this error. In addition, the clinician must never ignore the prescribed accuracy checking procedures after each calibration process.
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Affiliation(s)
- Mohammed Y Al-Jarsha
- Department of Oral Surgery, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom; Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Ashraf F Ayoub
- Department of Oral Surgery, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
| | - Mohammed M Almgran
- Department of Oral Surgery, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Chieh-Han Liu
- Department of Oral Surgery, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Douglas P Robertson
- Department of Restorative Dentistry, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Kurt B Naudi
- Department of Oral Surgery, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Liu Q, Liu Y, Chen D, Wu X, Huang R, Liu R, Chen Z, Chen Z. Placement accuracy and primary stability of implants in the esthetic zone using dynamic and static computer-assisted navigation: A retrospective case-control study. J Prosthet Dent 2024; 131:427-435. [PMID: 36473750 DOI: 10.1016/j.prosdent.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
STATEMENT OF PROBLEM Both the placement accuracy and primary stability of implants are important to implant therapy in the esthetic zone. The effect of dynamic and static computer-assisted navigation on the primary stability of implants in the esthetic zone remains uncertain. PURPOSE The purpose of this case-control study was to investigate the effect of dynamic and static computer-assisted navigation on the placement accuracy and primary stability of implants in the esthetic zone. MATERIAL AND METHODS Partially edentulous participants who received at least 1 implant in the anterior maxilla using either fully guided static or dynamic computer-assisted implant surgery (s-CAIS, d-CAIS) from January 2020 to February 2022 were screened. Participant demographic information, timing of implant placement, primary stability represented by the insertion torque value (ITV) in Ncm, and implant survival were collected from the treatment record. Bone quality at the implant sites was determined according to the Lekholm and Zarb classification. The accuracy of implant placement represented by the linear (platform: Dpl, mm; apex: Dap, mm) and angular deviations (axis: Dan, degree) between the planned and placed implants was evaluated based on the preoperative surgical plan and postoperative cone beam computed tomography (CBCT) data. A statistical analysis of the data was completed by using the chi-squared, Fisher exact, Student t, and Mann-Whitney U tests (α=.05). RESULTS A total of 32 study participants (38 implants) were included. The groups of s-CAIS (16 participants, 18 implants) and d-CAIS (16 participants, 20 implants) were statistically comparable in sex (P=.072), age (P=.548), bone quality (P=.671), and timing of implant placement (P=.719). All implants survived during an average follow-up period of 13 months. The d-CAIS group showed close linear deviations (Dpl 1.07 ±0.57 mm, Dap 1.26 ±0.53 mm) but lower angular deviation (Dan 2.14 ±1.20 degrees) and primary stability (ITV 25.25 ±7.52 Ncm) than the s-CAIS group (Dpl 0.92 ±0.46 mm, Dap 1.31 ±0.43 mm, Dan 3.31 ±1.61 degrees, ITV 30.56 ±11.23 Ncm, PDpl=.613, PDap=.743, PDan=.016, PITV=.028). CONCLUSIONS Comparable linear positioning accuracy and higher angular deviation were found for implants placed in the esthetic zone by using s-CAIS than when using d-CAIS. Higher primary stability of implants may be achieved by using s-CAIS, as s-CAIS seemed to have higher osteotomy accuracy than d-CAIS.
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Affiliation(s)
- Quan Liu
- Research Assistant, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Yuanxiang Liu
- Research Assistant, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Danying Chen
- Research Assistant, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Xiayi Wu
- Research Assistant, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Ruoxuan Huang
- Graduate student, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Runheng Liu
- Research Assistant, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Zetao Chen
- Professor, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Zhuofan Chen
- Professor, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China.
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Zhang J, Yang Z, Jiang S, Zhou Z. A spatial registration method based on 2D-3D registration for an augmented reality spinal surgery navigation system. Int J Med Robot 2023:e2612. [PMID: 38113328 DOI: 10.1002/rcs.2612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/27/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND In order to provide accurate and reliable image guidance for augmented reality (AR) spinal surgery navigation, a spatial registration method has been proposed. METHODS In the AR spinal surgery navigation system, grayscale-based 2D/3D registration technology has been used to register preoperative computed tomography images with intraoperative X-ray images to complete the spatial registration, and then the fusion of virtual image and real spine has been realised. RESULTS In the image registration experiment, the success rate of spine model registration was 90%. In the spinal model verification experiment, the surface registration error of the spinal model ranged from 0.361 to 0.612 mm, and the total average surface registration error was 0.501 mm. CONCLUSION The spatial registration method based on 2D/3D registration technology can be used in AR spinal surgery navigation systems and is highly accurate and minimally invasive.
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Affiliation(s)
- Jingqi Zhang
- School of Mechanical Engineering, Tianjin University, Tianjin, China
| | - Zhiyong Yang
- School of Mechanical Engineering, Tianjin University, Tianjin, China
| | - Shan Jiang
- School of Mechanical Engineering, Tianjin University, Tianjin, China
| | - Zeyang Zhou
- School of Mechanical Engineering, Tianjin University, Tianjin, China
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Cristofaro MG, Kallaverja E, Ferragina F, Barca I. Design and Simulate Intracranial Support to Guide Maxillo Surgery: A Study Based on Bioengineering. Diagnostics (Basel) 2023; 13:3672. [PMID: 38132256 PMCID: PMC10742407 DOI: 10.3390/diagnostics13243672] [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: 10/19/2023] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Intraoperative navigation allows for the creation of a real-time relationship between the anatomy imagined during diagnosis/planning and the site of surgical interest. This procedure takes place by identifying and registering trustworthy anatomical markers on planning images and using a point locator during the operation. The locator is calibrated in the workspace by placing a Dynamic Reference Frame (DRF) sensor. OBJECTIVE This study aims to calculate the localization accuracy of an electromagnetic locator of neuro-maxillofacial surgery, moving the standard sensor position to a different position more suitable for maxillofacial surgery. MATERIALS AND METHODS The upper dental arch was chosen as an alternative fixed point for the positioning of the sensor. The prototype of a bite support device was designed and generated via 3D printing. CT images of a skull phantom with 10 anatomical landmarks were acquired. The testing procedure consisted of 10 measurements for each position of the sensor: precisely 10 measurements with the sensor placed on the forehead and 10 measurements with the sensor placed on the bite support device. It also evaluated the localization error by comparing the two procedures. RESULTS The localization error, when the sensor was placed on the bite support device, was lower in the sphere located on the temporal bone. It was the same in the spheres located on the maxillary bone. The test analysis of the data of the new device showed that it is reliable; the tests are reproducible and can be considered as accurate as the traditional ones. In addition, the sensor mounted on this device has proven to be slightly superior in terms of accuracy and accuracy in areas such as the middle third of the face and jaw. DISCUSSION AND CONCLUSION The realization of the bite support device allowed the sensor to change position concerning its natural site. This procedure allows us to explore structures, such as the frontal site, which were initially difficult to approach with neuronavigation and improves the approach to midface structures, already studied with neuronavigation. The new calibration, with the position of the sensor on the support device in the same reference points sphere, highlighted the reduction in the location error. We can say that the support proposed in this study lays the foundations for a new navigation approach for patients in maxillofacial surgery, by changing the position of the sensor. It has strong points in improving the localization error for some reference points without determining disadvantages both in the calibration and in the surgical impediment.
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Affiliation(s)
- Maria Giulia Cristofaro
- Maxillofacial Surgery Unit, Department of Experimental and Clinical Medicine, “Magna Graecia” University, 88100 Catanzaro, Italy; (E.K.); (F.F.); (I.B.)
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Feng Y, Yao Y, Yang X. Effect of a dynamic navigation device on the accuracy of implant placement in the completely edentulous mandible: An in vitro study. J Prosthet Dent 2023; 130:731-737. [PMID: 35000696 DOI: 10.1016/j.prosdent.2021.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 02/08/2023]
Abstract
STATEMENT OF PROBLEM A less invasive and more convenient workflow is needed for dynamic navigation-guided implant surgery for the edentulous arch. PURPOSE The purpose of this in vitro study was to evaluate the accuracy of a novel dynamic navigation device developed for the completely edentulous mandible. MATERIAL AND METHODS Two temporary 1-piece mini-implants were placed in the anterior region of a completely edentulous mandibular model for fixation of the navigation device. A total of 40 implants were inserted in 10 completely edentulous mandibular models with the aid of the dynamic navigation device. The accuracy of placement was determined by overlapping the preoperative plan with the postoperative cone beam computed tomography (CBCT) scans. The difference in the accuracy at different implant positions was compared by MANOVA and Bonferroni-corrected ANOVAs. The difference in accuracy between implants #1-20 and #21-40 was assessed for learning progression. RESULTS The deviation of the implants (mean ±standard deviation) was 1.14 ±0.50 mm at the entry point and 1.29 ±0.48 mm at the apex. The mean ±standard deviation angular deviation was 3.02 ±1.32 degrees. No significant difference was seen between the planned and the placed deviation among the 4 implant positions. After repeated placement with this dynamic approach, implant accuracy at the entry (P=.001) and apex (P=.017) improved significantly. CONCLUSIONS The navigation device achieved acceptable implant placement accuracy in the edentulous mandible. Deviations between the planned and placed locations were not affected by different implant positions. After repeated operations with this dynamic approach, accuracy at the entry and apex improved significantly.
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Affiliation(s)
- Yuzhang Feng
- Graduate student, Graduate Prosthodontics, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan Province, PR China
| | - Yufei Yao
- Predoctoral student, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan Province, PR China
| | - Xingmei Yang
- Associate Professor, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan Province, PR China.
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Wang J, Ge Y, Mühlemann S, Pan S, Jung RE. The accuracy of dynamic computer assisted implant surgery in fully edentulous jaws: A retrospective case series. Clin Oral Implants Res 2023; 34:1278-1288. [PMID: 37642206 DOI: 10.1111/clr.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/28/2023] [Accepted: 08/13/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES To evaluate the accuracy of implant placement using a dynamic navigation system in fully edentulous jaws and to analyze the influence of implant distribution on implant position accuracy. MATERIALS AND METHODS Edentulous patients who received implant placement using a dynamic navigation system were included. Four to six mini screws were placed in the edentulous jaw under local anesthesia as fiducial markers. Then patients received CBCT scans. Virtual implant positions were designed in the planning software based on CBCT data. Under local anesthesia, implants were inserted under the guidance of the dynamic navigation system. CBCTs were taken following implant placement. The deviation between the actual and planned implant positions was measured by comparing the pre- and postsurgery CBCT. RESULTS A total of 13 edentulous patients with 13 edentulous maxillae and 7 edentulous mandibles were included, and 108 implants were placed. The average linear deviations at the implant entry point and apex were 1.08 ± 0.52 mm and 1.15 ± 0.60 mm, respectively. The average angular deviation was 2.85 ± 1.20°. No significant difference was detected in linear and angular deviations between the maxillary and mandibular implants, neither between the anterior and posterior implants. CONCLUSIONS The dynamic navigation system provides high accuracy for implant placement in fully edentulous jaws, while the distribution of the implants showed little impact on implant position accuracy.
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Affiliation(s)
- Jiayi Wang
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Yanjun Ge
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Shaoxia Pan
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Wang Z, Chen C, Qin L, Li F, Chen Y, Meng L. Accuracy and Efficiency of Endodontic Microsurgery Assisted by Dynamic Navigation Based on Two Different Registration Methods: An In Vitro Study. J Endod 2023; 49:1199-1206. [PMID: 37356477 DOI: 10.1016/j.joen.2023.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION This study aimed to compare the accuracy and efficiency of dynamic navigation-assisted endodontic microsurgery (DN-EMS) using two different registration methods. METHODS Three-dimensional-printed jaw models, including 40 teeth, were divided into two groups (n = 20). Cone-beam computed tomography images of all teeth were scanned under the same exposing parameters. An endodontic dynamic navigation system (DHC-ENDO1) was used to plan the drilling paths. Dynamic navigation-assisted endodontic microsurgery (DN-EMS) was performed using either U-shaped tube (UT) or tooth cusp (TC) registration method. The accuracy was determined by platform deviation, end deviation, angular deviation, resection angle, and resection length deviation. The registration efficiency was defined as the time required to complete the registration procedure. Osteotomy volume of each resection was calculated by Mimics 21.0. Statistical analyses were performed using IBM SPSS Statistics 24.0. Comparisons between groups were performed using the independent sample t test or Mann-Whitney U test. P < .05 was adopted as significant difference. RESULTS The UT group was significantly more accurate in terms of mean platform deviation, end deviation, angular deviation, and resection angle (P < .05). Resection length deviation did not differ significantly between the registration groups. The UT group was significantly more efficient than the TC group (P < .05). No significant differences were found in the osteotomy volumes between the two groups. CONCLUSIONS In the model-based surgical simulation comparison, DN-EMS based on UT registration is more accurate and efficient than the TC method but requires an additional registration device. TC technique may be a reasonable alternative to UT registration in certain clinical tasks.
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Affiliation(s)
- Zan Wang
- The State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Cariology and Endodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Chen Chen
- The State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Cariology and Endodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Li Qin
- The State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Cariology and Endodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fangzhe Li
- The State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Cariology and Endodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yun Chen
- Suzhou Digital-health Care Co. Ltd, Suzhou, China
| | - Liuyan Meng
- The State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Cariology and Endodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
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Fan S, Sáenz-Ravello G, Diaz L, Wu Y, Davó R, Wang F, Magic M, Al-Nawas B, Kämmerer PW. The Accuracy of Zygomatic Implant Placement Assisted by Dynamic Computer-Aided Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5418. [PMID: 37629460 PMCID: PMC10455221 DOI: 10.3390/jcm12165418] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE The present systematic review aimed to investigate the accuracy of zygomatic implant (ZI) placement using dynamic computer-aided surgery (d-CAIS), static computer-aided surgery (s-CAIS), and a free-hand approach in patients with severe atrophic edentulous maxilla and/or deficient maxilla. METHODS Electronic and manual literature searches until May 2023 were performed in the PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases. Clinical trials and cadaver studies were selected. The primary outcome was planned/placed deviation. Secondary outcomes were to evaluate the survival of ZI and surgical complications. Random-effects meta-analyses were conducted and meta-regression was utilized to compare fiducial registration amounts for d-CAIS and the different designs of s-CAIS. RESULTS A total of 14 studies with 511 ZIs were included (Nobel Biocare: 274, Southern Implant: 42, SIN Implant: 16, non-mentioned: 179). The pooled mean ZI deviations from the d-CAIS group were 1.81 mm (95% CI: 1.34-2.29) at the entry point and 2.95 mm (95% CI: 1.66-4.24) at the apex point, and angular deviations were 3.49 degrees (95% CI: 2.04-4.93). The pooled mean ZI deviations from the s-CAIS group were 1.19 mm (95% CI: 0.83-1.54) at the entry point and 1.80 mm (95% CI: 1.10-2.50) at the apex point, and angular deviations were 2.15 degrees (95% CI: 1.43-2.88). The pooled mean ZI deviations from the free-hand group were 2.04 mm (95% CI: 1.69-2.39) at the entry point and 3.23 mm (95% CI: 2.34-4.12) at the apex point, and angular deviations were 4.92 degrees (95% CI: 3.86-5.98). There was strong evidence of differences in the average entry, apex, and angular deviation between the navigation, surgical guide, and free-hand groups (p < 0.01). A significant inverse correlation was observed between the number of fiducial screws and the planned/placed deviation regarding entry, apex, and angular measurements. CONCLUSION Using d-CAIS and modified s-CAIS for ZI surgery has shown clinically acceptable outcomes regarding average entry, apex, and angular deviations. The maximal deviation values were predominantly observed in the conventional s-CAIS. Surgeons should be mindful of potential deviations and complications regardless of the decision making in different guide approaches.
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Affiliation(s)
- Shengchi Fan
- Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center Mainz, 55131 Mainz, Germany
- Second Dental Clinic, 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, Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Gustavo Sáenz-Ravello
- Center for Epidemiology and Surveillance of Oral Diseases (CESOD), Faculty of Dentistry, Universidad de Chile, Santiago 8380420, Chile
| | - Leonardo Diaz
- Postgraduate School, Faculty of Dentistry, Universidad de Chile, Santiago 8380420, Chile
| | - Yiqun Wu
- Second Dental Clinic, 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, Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Rubén Davó
- Department of Implantology and Maxillofacial Surgery, Vithas Davó Instituto Dental, 03016 Alicante, Spain
| | - Feng Wang
- Second Dental Clinic, 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, Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Marko Magic
- School of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center Mainz, 55131 Mainz, Germany
| | - Peer W. Kämmerer
- Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center Mainz, 55131 Mainz, Germany
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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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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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11
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Tao B, Feng Y, Fan X, Lan K, Zhuang M, Wang S, Wang F, Chen X, Wu Y. The accuracy of a novel image-guided hybrid robotic system for dental implant placement: An in vitro study. Int J Med Robot 2023; 19:e2452. [PMID: 35946497 DOI: 10.1002/rcs.2452] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/31/2022] [Accepted: 08/08/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND This in vitro study aims to evaluate the accuracy of dental implant placement by a novel image-guided hybrid robotic system for dental implant surgery (HRS-DIS). METHODS The HRS-DIS with a 5 degree of freedom (DOF) serial manipulator and a 6 DOF Stewart platform was developed. To evaluate the accuracy of repeated drilling, the holes were prepared twice with a 2.2 mm drill. To evaluate the accuracy of dental implant placement, the entry, exit and angle deviations of dental implants were measured. RESULTS Twenty-four holes were prepared twice, and mean (±SD) of diameters were measured as 2.2 ± 0.02 mm. A total of 160 dental implants were placed in 32 phantoms by HRS-DIS. The mean (±SD) of the entry, exit and angle deviation were 0.8 ± 0.54 mm, 0.87 ± 0.54 mm and 1.0 1 ± 0.44°, respectively. CONCLUSIONS The results of the in vitro study preliminarily validated that the HRS-DIS could provide a high accuracy for dental implant surgery.
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Affiliation(s)
- Baoxin Tao
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China.,Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yuan Feng
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - 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
| | - Kengliang Lan
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China.,Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Minjie Zhuang
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China.,Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Shigang Wang
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Wang
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China.,Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.,Department of Oral Implantology, 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
| | - Yiqun Wu
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China.,Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
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12
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Kang HG, Kang SH, Kim HK, Son YD. Target registration errors in navigation-assisted mandibular surgery according to the tracking methods and the type of markers: experiments using human dry mandibular bone. Oral Radiol 2023; 39:180-190. [PMID: 35578091 DOI: 10.1007/s11282-022-00619-w] [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: 12/19/2021] [Accepted: 04/20/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study was conducted to evaluate the accuracy of navigation process according to the type of tracking methods and registration markers. The target registration errors (TREs) were measured at seven anatomical landmarks of the mandible. METHODS Four different experiments were performed to obtain the TREs using two tracking methods, the optical tracker (Polaris) and the electromagnetic (EM) tracker (Aurora), and two types of registration markers, invasive and noninvasive markers. All comparisons of TREs were statistically analyzed using SPSS and Python-based statistical package. RESULTS The average TRE values obtained from the four experiments were as follows: (1) 0.85 mm (± 0.07) using invasive marker and Aurora, (2) 1.06 mm (± 0.12) using invasive marker and Polaris, (3) 1.43 mm (± 0.15) using noninvasive marker and Aurora, and (4) 1.57 mm (± 0.23) using noninvasive marker and Polaris. Comparisons between all the experimental results revealed statistically significant differences except for the type of tracking system. Although the comparison between the modality of the tracking system showed no significant differences, the EM-based approach consistently demonstrated better performances than the optical type in all comparisons. CONCLUSIONS This study demonstrates that irrespective of the tracking modality, using invasive marker is a better choice in terms of accuracy. When using noninvasive marker, it is important to consider the increased TREs. In this study, the noninvasive marker caused a maximum increment of TREs of 0.81 mm compared with the invasive marker. Furthermore, using an EM-based tracker with invasive marker may result in the best accuracy for navigation.
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Affiliation(s)
- Hee-Guen Kang
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, South Korea
| | - Sang-Hoon Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Hang-Keun Kim
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, South Korea.
- Neuroscience Research Institute, Gachon University, Incheon, Korea.
- Department of Biomedical Engineering, College of IT Convergence, Gachon University, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si, 13120, Korea.
| | - Young-Don Son
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, South Korea
- Neuroscience Research Institute, Gachon University, Incheon, Korea
- Department of Biomedical Engineering, College of IT Convergence, Gachon University, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si, 13120, Korea
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"Image to patient" equal-resolution surface registration supported by a surface scanner: analysis of algorithm efficiency for computer-aided surgery. Int J Comput Assist Radiol Surg 2023; 18:319-328. [PMID: 35831549 PMCID: PMC9889449 DOI: 10.1007/s11548-022-02704-1] [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: 02/21/2022] [Accepted: 06/10/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The "image to patient" registration procedure is crucial for the accuracy of surgical instrument tracking relative to the medical image while computer-aided surgery. The main aim of this work was to create an equal-resolution surface registration algorithm (ERSR) and analyze its efficiency. METHODS The ERSR algorithm provides two datasets with equal, high resolution and approximately corresponding points. The registered sets are obtained by projection of a user-designed rectangle(s)-shaped uniform clouds of points on DICOM and surface scanner datasets. The tests of the algorithm were performed on a phantom with titanium microscrews. We analyzed the influence of DICOM resolution on the effect of the ERSR algorithm and compared the ERSR to standard paired-points landmark transform registration. The methods of analysis were Target Registration Error, distance maps, and their histogram evaluation. RESULTS The mean TRE in case of ERSR equaled 0.8 ± 0.3 mm (resolution A), 0.8 ± 0.5 mm (resolution B), and 1.0 ± 0.7 mm (resolution C). The mean values were at least 0.4 mm lower than in the case of landmark transform registration. The distance maps between the model achieved from the scanner and the CT-based model were analyzed by histogram. The frequency of the first bin in a histogram of the distance map for ERSR was about 0.6 for all three resolutions of DICOM dataset and three times higher than in the case of landmark transform registration. The results were statistically analyzed using the Wilcoxon signed-rank test (alpha = 0.05). CONCLUSION The tests proved a statistically significant higher efficiency of equal resolution surface registration related to the landmark transform algorithm. It was proven that the lower resolution of the CT DICOM dataset did not degrade the efficiency of the ERSR algorithm. We observed a significantly lower response to decreased resolution than in the case of paired-points landmark transform registration.
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14
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Preliminary Study of the Treatment Strategy for Retaining Traumatic Foreign Bodies Involving the Carotid Artery. J Craniofac Surg 2023; 34:475-479. [PMID: 36138542 PMCID: PMC9944749 DOI: 10.1097/scs.0000000000008858] [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: 02/27/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Craniomaxillofacial trauma is usually accompanied by indwelling foreign bodies, and some of those are close to the carotid artery, which increases the risks and difficulties of surgical treatment. The introduction of interventional radiology combined with image-guided surgical navigation may be a good solution for precise surgery to remove foreign bodies. PATIENTS AND METHODS Four patients were included in the study. All patients underwent digital subtraction angiography and enhanced computed tomography before surgery. The patients were divided into 3 categories (A, B, and C) according to the presence of carotid artery damage and its positional relationship with the foreign body, and 3 corresponding treatment strategies were developed. Treatments were completed using interventional radiology and surgical navigation systems. RESULTS All foreign bodies were completely removed, except for 1 remaining in the jugular foramen in a patient. The prognosis of all patients was good, and no systemic complications occurred. CONCLUSION The combined interventional radiology and surgical navigation method proposed in this study is an effective method to improve the accuracy and safety of foreign body removal surgery.
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15
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Nieminen AE, Nieminen JO, Stenroos M, Novikov P, Nazarova M, Vaalto S, Nikulin V, Ilmoniemi RJ. Accuracy and precision of navigated transcranial magnetic stimulation. J Neural Eng 2022; 19. [PMID: 36541458 DOI: 10.1088/1741-2552/aca71a] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022]
Abstract
Objective.Transcranial magnetic stimulation (TMS) induces an electric field (E-field) in the cortex. To facilitate stimulation targeting, image-guided neuronavigation systems have been introduced. Such systems track the placement of the coil with respect to the head and visualize the estimated cortical stimulation location on an anatomical brain image in real time. The accuracy and precision of the neuronavigation is affected by multiple factors. Our aim was to analyze how different factors in TMS neuronavigation affect the accuracy and precision of the coil-head coregistration and the estimated E-field.Approach.By performing simulations, we estimated navigation errors due to distortions in magnetic resonance images (MRIs), head-to-MRI registration (landmark- and surface-based registrations), localization and movement of the head tracker, and localization of the coil tracker. We analyzed the effect of these errors on coil and head coregistration and on the induced E-field as determined with simplistic and realistic head models.Main results.Average total coregistration accuracies were in the range of 2.2-3.6 mm and 1°; precision values were about half of the accuracy values. The coregistration errors were mainly due to head-to-MRI registration with average accuracies 1.5-1.9 mm/0.2-0.4° and precisions 0.5-0.8 mm/0.1-0.2° better with surface-based registration. The other major source of error was the movement of the head tracker with average accuracy of 1.5 mm and precision of 1.1 mm. When assessed within an E-field method, the average accuracies of the peak E-field location, orientation, and magnitude ranged between 1.5 and 5.0 mm, 0.9 and 4.8°, and 4.4 and 8.5% across the E-field models studied. The largest errors were obtained with the landmark-based registration. When computing another accuracy measure with the most realistic E-field model as a reference, the accuracies tended to improve from about 10 mm/15°/25% to about 2 mm/2°/5% when increasing realism of the E-field model.Significance.The results of this comprehensive analysis help TMS operators to recognize the main sources of error in TMS navigation and that the coregistration errors and their effect in the E-field estimation depend on the methods applied. To ensure reliable TMS navigation, we recommend surface-based head-to-MRI registration and realistic models for E-field computations.
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Affiliation(s)
- Aino E Nieminen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland.,AMI Centre, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland
| | - Jaakko O Nieminen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Matti Stenroos
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Pavel Novikov
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland.,Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia
| | - Maria Nazarova
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland.,Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States of America
| | - Selja Vaalto
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland.,HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vadim Nikulin
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
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16
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Feng Y, Su Z, Mo A, Yang X. Comparison of the accuracy of immediate implant placement using static and dynamic computer-assisted implant system in the esthetic zone of the maxilla: a prospective study. Int J Implant Dent 2022; 8:65. [PMID: 36512162 PMCID: PMC9747989 DOI: 10.1186/s40729-022-00464-w] [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: 11/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study aimed to compare the accuracy of fully guided between dynamic and static computer-assisted implant surgery (CAIS) systems for immediate implant placement in the esthetic zone. METHODS A total of 40 qualified patients requiring immediate implant placement in the esthetic zone were randomly and equally assigned to either static CAIS group (n = 20) or dynamic CAIS groups (n = 20). Global deviations at entry, apex, and angular deviation between placed and planned implant position were measured and compared as primary outcomes. Secondary outcomes were the deviation of implant placement at mesial-distal, labial-palatal, and coronal-apical directions. RESULTS For the immediate implant placement, the mean global entry deviations in static and dynamic CAIS groups were 0.99 ± 0.63 mm and 1.06 ± 0.55 mm (p = 0.659), while the mean global apex deviations were 1.50 ± 0.75 mm and 1.18 ± 0.53 mm (p = 0.231), respectively. The angular deviation in the static and dynamic CAIS group was 3.07 ± 2.18 degrees and 3.23 ± 1.67 degrees (p = 0.547). No significant differences were observed for the accuracy parameters of immediate implant placement between static and dynamic CAIS systems, except the deviation of the implant at entry in the labial-palatal direction in the dynamic CAIS group was significantly more labial than of the static CAIS (p = 0.005). CONCLUSIONS This study demonstrated that clinically acceptable accuracy of immediate implant placement could be achieved using static and dynamic CAIS systems. Trial registration ChiCTR, ChiCTR2200056321. Registered 3 February 2022, http://www.chictr.org.cn/showproj.aspx?proj=151348.
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Affiliation(s)
- Yuzhang Feng
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section, Renmin Nan Road, Chengdu, Sichuan People’s Republic of China
| | - Zhenya Su
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section, Renmin Nan Road, Chengdu, Sichuan People’s Republic of China
| | - Anchun Mo
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section, Renmin Nan Road, Chengdu, Sichuan People’s Republic of China
| | - Xingmei Yang
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section, Renmin Nan Road, Chengdu, Sichuan People’s Republic of China
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17
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Micko A, Minchev G, Wurzer A, Kronreif G, Wolfsberger S. A Patient-Specific Reference Tracker for Noninvasive Electromagnetic Navigation of Endoscopic Skull Base Surgery. Oper Neurosurg (Hagerstown) 2022; 23:499-504. [DOI: 10.1227/ons.0000000000000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/05/2022] [Indexed: 11/16/2022] Open
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18
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Lan K, Tao B, Wang F, Wu Y. Accuracy evaluation of 3D-printed noninvasive adhesive marker for dynamic navigation implant surgery in a maxillary edentulous model: An in vitro study. Med Eng Phys 2022; 103:103783. [PMID: 35500986 DOI: 10.1016/j.medengphy.2022.103783] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/30/2022] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
Abstract
Dynamic computer-aided implant surgery (DCAIS) can improve dental implantation accuracy and reduce surgical risks. In the registration procedure of DCAIS, the type and the number of registration markers significantly impact the accuracy of DCAIS. One problem of DCAIS in clinical application is that only invasive screw markers can be used for implantation in edentulous patients. It could cause additional trauma, scar formation and usually increase patient discomfort. In this experiment, a personalized 3D-printed edentulous maxillary model was used for simulating clinical situations, and a 3D-printed noninvasive adhesive marker (3D-PNAM) was designed to figure out the above problem. In this research, six target screws were implanted into the model's maxillary alveolar ridge as targets for accuracy analysis. This study used target registration error (TRE) as an index to evaluate the accuracy of invasive screw makers and noninvasive adhesive markers. Results showed that 3D-PNAMs had the same accuracy as screw markers, and placing at least six registration markers in the maxilla was needed for good registration accuracy. The registration markers should be further improved and designed according to application areas' clinical needs and anatomical characteristics in future clinical studies.
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Affiliation(s)
- Kengliang Lan
- Graduate student, 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
- Graduate student, 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
| | - Feng Wang
- Associated Professor, 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
| | - Yiqun Wu
- Professor, 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.
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19
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de Boutray M, Cavalcanti Santos J, Bourgeade A, Ohayon M, Chammas PE, Garrel R, Poignet P, Zemiti N. Fibular registration using surface matching in navigation-guided osteotomies: a proof of concept study on 3D-printed models. Int J Comput Assist Radiol Surg 2022; 17:1321-1331. [DOI: 10.1007/s11548-022-02608-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 03/10/2022] [Indexed: 01/17/2023]
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20
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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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21
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Apostolakis D, Michelinakis G, Kamposiora P, Papavasiliou G. The current state of Computer Assisted Orthognathic Surgery: A narrative review. J Dent 2022; 119:104052. [DOI: 10.1016/j.jdent.2022.104052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 12/23/2022] Open
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Dge T, L S, J G, B AN, M G, Pw K. Marker-free registration for intraoperative navigation using the transverse palatal rugae. Int J Med Robot 2021; 18:e2362. [PMID: 34972255 DOI: 10.1002/rcs.2362] [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: 12/05/2021] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Registration is most important in navigation-assisted-surgery including the matching between the coordinates of the actual patient space and the medical image. Marker-based techniques mostly include marker application with subsequent radiography. In the edentulous patient, maker-free methods are generally less accurate and reproducible. This new method of a marker-free registration uses the transverse palatal rugae as registration structures. METHODS (1)Segmentation of bone and hard palatal mucosa from initial 3D imaging (DICOM), (2)Maxillary intraoral-scan (IOS) with transfer to the 3D imaging using an Iterative-Closest-Point-Algorithm (ICP), (3)Marking digital registration points with holes within IOS-stl, (4)Transformation of the spatially aligned IOS-stl to LabelMap and storage in DICOM (IOS-DICOM), (5)Alignment of DICOM and IOS-DICOM, (6)Controlled positioning of digital reg.points and clinical correlation. RESULTS Fiducial localization error (0.48mm) and target registration error (0.65mm) is comparable to those of tooth-supported registration methods. CONCLUSION This methodology is a promising approach to marker-free navigation-assisted-surgery in the edentulous patient. This approach of marker-free registration for navigation-assisted-surgery could improve the treatment in edentulous patients avoiding additional imaging and invasive marker insertion. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Thiem Dge
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Seifert L
- Department of Oral and Maxillofacial surgery, Facial Plastic Surgery, Goethe University Medical Centre Frankfurt, 60590, Frankfurt, Germany
| | - Graef J
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Al-Nawas B
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Gielisch M
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Kämmerer Pw
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
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Registration-free workflow for electromagnetic and optical navigation in orbital and craniofacial surgery. Sci Rep 2021; 11:18080. [PMID: 34508161 PMCID: PMC8433137 DOI: 10.1038/s41598-021-97706-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 08/13/2021] [Indexed: 11/25/2022] Open
Abstract
The accuracy of intra-operative navigation is largely dependent on the intra-operative registration procedure. Next to accuracy, important factors to consider for the registration procedure are invasiveness, time consumption, logistical demands, user-dependency, compatibility and radiation exposure. In this study, a workflow is presented that eliminates the need for a registration procedure altogether: registration-free navigation. In the workflow, the maxillary dental model is fused to the pre-operative imaging data using commercially available virtual planning software. A virtual Dynamic Reference Frame on a splint is designed on the patient’s fused maxillary dentition: during surgery, the splint containing the reference frame is positioned on the patient’s dentition. This alleviates the need for any registration procedure, since the position of the reference frame is known from the design. The accuracy of the workflow was evaluated in a cadaver set-up, and compared to bone-anchored fiducial, virtual splint and surface-based registration. The results showed that accuracy of the workflow was greatly dependent on tracking technique used: the workflow was the most accurate with electromagnetic tracking, but the least accurate with optical tracking. Although this method offers a time-efficient, non-invasive, radiation-free automatic alternative for registration, clinical implementation is hampered by the unexplained differences in accuracy between tracking techniques.
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A Novel Precise Optical Navigation System for Craniomaxillofacial Surgery Registered With an Occlusal Splint. J Craniofac Surg 2021; 33:344-349. [PMID: 34260445 PMCID: PMC8694255 DOI: 10.1097/scs.0000000000007833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND An augmented reality tool allows visual tracking of real anatomical structures and superimposing virtual images, so it can be used for navigation of important structures during surgery. OBJECTIVES The authors have developed a new occlusal splint-based optical navigation system for craniomaxillofacial surgery. In this study, the authors aim to measure the accuracy of the system and further analyze the main factors influencing precision. METHODS Ten beagle dogs were selected and a three-dimensional model was established through computed tomography scanning, dental model making, and laser scanning, and then registration was performed according to the tooth marking points. The bilateral mandibular osteotomy was performed on Beagle dogs under navigation system based on the occlusal splint. The left side was taken to compare the deviation between the preoperative plan and the surgical results, and the accuracy of distance and angle and the stability of the system were analyzed. RESULTS The average position deviation between the preoperative design and intraoperative navigation was: 0.01 ± 0.73 mm on the lateral height of the mandibular ramus, 0.26 ± 0.57 mm on the inner height of the mandibular ramus, and 0.20 ± 0.51 mm on the osteotomy length. The average angle deviation is 0.94° ± 1.38° on the angle between the mandibular osteotomy plane and ramus plane and 0.66° ± 0.97° on the angle of the retained mandibular angle. And most of the data showed good consistency. CONCLUSIONS In summary, the accuracy of the system can meet clinical requirements and can be used as a useful tool to improve the accuracy of craniomaxillofacial surgery.
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Virtual splint registration for electromagnetic and optical navigation in orbital and craniofacial surgery. Sci Rep 2021; 11:10406. [PMID: 34001966 PMCID: PMC8128880 DOI: 10.1038/s41598-021-89897-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/06/2021] [Indexed: 11/08/2022] Open
Abstract
In intra-operative navigation, a registration procedure is performed to register the patient's position to the pre-operative imaging data. The registration process is the main factor that determines accuracy of the navigation feedback. In this study, a novel registration protocol for craniofacial surgery is presented, that utilizes a virtual splint with marker points. The accuracy of the proposed method was evaluated by two observers in five human cadaver heads, for optical and electromagnetic navigation, and compared to maxillary bone-anchored fiducial registration (optical and electromagnetic) and surface-based registration (electromagnetic). The results showed minimal differences in accuracy compared to bone-anchored fiducials at the level of the infra-orbital rim. Both point-based techniques had lower error estimates at the infraorbital rim than surface-based registration, but surface-based registration had the lowest loss of accuracy over target distance. An advantage over existing point-based registration methods (bone-anchored fiducials, existing splint techniques) is that radiological imaging does not need to be repeated, since the need for physical fiducials to be present in the image volume is eradicated. Other advantages include reduction of invasiveness compared to bone-achnored fiducials and a possible reduction of human error in the registration process.
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Schreurs R, Becking AG, Jansen J, Dubois L. Advanced Concepts of Orbital Reconstruction: A Unique Attempt to Scientifically Evaluate Individual Techniques in Reconstruction of Large Orbital Defects. Atlas Oral Maxillofac Surg Clin North Am 2020; 29:151-162. [PMID: 33516536 DOI: 10.1016/j.cxom.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ruud Schreurs
- Orbital Research Group (ACOR), 3D Laboratory, Department of Oral and Maxillofacial Surgery, University Medical Center Amsterdam, University of Amsterdam, Academic Center of Dentistry Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Alfred G Becking
- Orbital Research Group (ACOR), Department of Oral and Maxillofacial Surgery, University Medical Center Amsterdam, University of Amsterdam, Academic Center of Dentistry Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Jesper Jansen
- Orbital Research Group (ACOR), Department of Oral and Maxillofacial Surgery, University Medical Center Amsterdam, University of Amsterdam, Academic Center of Dentistry Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Leander Dubois
- Orbital Research Group (ACOR), Department of Oral and Maxillofacial Surgery, University Medical Center Amsterdam, University of Amsterdam, Academic Center of Dentistry Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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27
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Tao B, Shen Y, Sun Y, Huang W, Wang F, Wu Y. Comparative accuracy of cone-beam CT and conventional multislice computed tomography for real-time navigation in zygomatic implant surgery. Clin Implant Dent Relat Res 2020; 22:747-755. [PMID: 33112508 DOI: 10.1111/cid.12958] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/04/2020] [Accepted: 10/04/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cone-beam computed tomography (CBCT) and conventional multislice CT (MSCT) are both used in zygomatic implant navigation surgery but the superiority of one technique versus the other remains unclear. PURPOSE This study compared the accuracy of CBCT and MSCT in zygomatic implant navigation surgery by calculating the deviations of implants. MATERIAL AND METHODS Patients with severely atrophic maxillae were classified into two groups according to the use of CBCT- or MSCT-guided navigation system. The entry and apical distance deviation, and the angle deviation of zygomatic implants were measured on fused operation images. A linear effect model was used for analysis, with statistical significance set at P < .05. RESULTS A total of 72 zygomatic implants were inserted as planned in 23 patients. The comparison of deviations in CBCT and MSCT groups showed a mean (± SD) entry deviation of 1.69 ± 0.59 mm vs 2.04 ± 0.78 mm (P = .146), apical deviation of 2 ± 0.68 mm vs 2.55 ± 0.85 (P < .001), and angle deviation of 2.32 ± 1.02° vs 3.23 ± 1.21° (P = .038). CONCLUSION Real-time zygomatic implant navigation surgery with CBCT may result in higher values for accuracy than MSCT.
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Affiliation(s)
- 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 Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yihan Shen
- 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 Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yuanyuan Sun
- 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 Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Wei Huang
- Department of Oral Implantology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Feng Wang
- Department of Oral Implantology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 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 Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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A novel extraoral registration method for a dynamic navigation system guiding zygomatic implant placement in patients with maxillectomy defects. Int J Oral Maxillofac Surg 2020; 50:116-120. [PMID: 32499080 DOI: 10.1016/j.ijom.2020.03.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/17/2020] [Accepted: 03/05/2020] [Indexed: 11/20/2022]
Abstract
Zygomatic implants (ZIs) are used for the oral rehabilitation of patients with maxillectomy defects as an alternative to extensive bone grafting surgeries. New technologies such as computer-assisted navigation systems can improve the accuracy and safety of ZI placement. The intraoral anchorage of fiducial markers necessary for navigation registration is not possible in the case of a severe maxillary defect and lack of residual bone. This technical note presents a novel extraoral registration method for a dynamic navigation system guiding ZI placement in patients with maxillectomy defects. Titanium microscrews were inserted in the mastoid process, supraorbital ridge, and posterior zygomatic arch as registration markers. The mean fiducial registration error (FRE) was 0.53 ± 0.20 and the deviations between the planned and placed ZIs were 1.56 ± 0.54 mm (entry point), 1.87 ± 0.63 mm (exit point), and 2.52 ± 0.84° (angulation). The study results indicate that the placement of fiducial markers at extraoral sites can be used as a registration technique to overcome anatomical limitations in patients after maxillectomy, with a clinically acceptable registration accuracy.
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29
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Valdec S, Schiefersteiner M, Rücker M, Stadlinger B. Guided biopsy of osseous pathologies in the jaw bone using a 3D-printed, tooth-supported drilling template. Int J Oral Maxillofac Surg 2019; 48:1028-1031. [PMID: 31036396 DOI: 10.1016/j.ijom.2019.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/21/2019] [Accepted: 04/09/2019] [Indexed: 11/17/2022]
Abstract
Suspicious radiological findings in the jaw bone require histopathological examination for the confirmation of a diagnosis. As pathologies in this region are difficult to reach or are in close proximity to relevant anatomical structures, e.g. tooth roots or nerves, they often represent a challenge. Such factors may adversely affect the predictability of the surgical outcome of a biopsy of the osseous tissues. This technical note introduces a novel method for performing a digitally planned, guided biopsy. For this purpose, a cone beam computed tomography scan and an intraoral scan are superimposed using specific planning software. The resulting three-dimensionally printed, tooth-supported drilling template is designed for a trephine biopsy. It allows a precise, minimally invasive approach, with an exact three-dimensional determination of the biopsy location prior to surgery. The risk of devitalization of the neighbouring teeth or possible damage to the nerve structures can be minimized. Furthermore, a small access flap can be sufficient. In summary, the method of bone biopsy presented here allows high precision and greater predictability for biopsy sampling and is minimally invasive for the patient.
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Affiliation(s)
- Silvio Valdec
- Clinic of Cranio-Maxillofacial and Oral Surgery, Centre of Dental Medicine, University of Zurich, University Hospital, Zurich, Switzerland.
| | - Mona Schiefersteiner
- Clinic of Cranio-Maxillofacial and Oral Surgery, Centre of Dental Medicine, University of Zurich, University Hospital, Zurich, Switzerland
| | - Martin Rücker
- Clinic of Cranio-Maxillofacial and Oral Surgery, Centre of Dental Medicine, University of Zurich, University Hospital, Zurich, Switzerland
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, Centre of Dental Medicine, University of Zurich, University Hospital, Zurich, Switzerland
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30
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van Steenbergen TRF, van der Geest ICM, Janssen D, Rovers MM, Fütterer JJ. Feasibility study of intraoperative cone-beam CT navigation for benign bone tumour surgery. Int J Med Robot 2019; 15:e1993. [PMID: 30767360 PMCID: PMC6593425 DOI: 10.1002/rcs.1993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/10/2019] [Accepted: 02/08/2019] [Indexed: 12/18/2022]
Abstract
Background Intraoperative cone‐beam computed tomography (CBCT) offers the advantage of navigation on the current anatomical situation and the possibility to take a control scan. We assessed the feasibility of using intraoperative CBCT for navigated intralesional curettage. Methods Nine benign bone tumour patients were studied. Feasibility was assessed by describing the workflow and indications for navigation, scoring CBCT image quality and registration accuracy, and measuring scan and navigation set‐up times. Short‐term follow‐up was described. Results CBCT navigation was successful in all patients. Median tumour visibility, tumour delineation, and vital structure visibility scores were good. Median registration accuracy score was very good. Median scan and verification times were 5 and 3 minutes, respectively. One patient had a tumour recurrence after 6 months. Conclusions Intraoperative CBCT navigation is feasible and safe. Indications for use of navigation in clinical practice are closeness to vital structures, complexly shaped tumours or bone, minimally invasive surgery, and repeated surgery.
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Affiliation(s)
- Thomas R F van Steenbergen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands
| | - Ingrid C M van der Geest
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Orthopaedics, Nijmegen, The Netherlands
| | - Dennis Janssen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Orthopaedics, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Operating Rooms, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands
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31
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Li MZ, Wang XX, Li ZL, Yi B, Liang C, He W. [Accuracy analysis of computer assisted navigation for condylectomy via intraoral approach]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:182-186. [PMID: 30773565 DOI: 10.19723/j.issn.1671-167x.2019.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore the application accuracy of virtual preoperative plan after the condylectomy via intraoral approach under computer assisted surgical navigation, and to analyze the location and cause of the surgical deviation to provide reference for the surgical procedure improvement in the future. METHODS In the study, 23 cases with condylar hypertrophy (11 with condylar osteochondroma and 12 with condylar benign hypertrophy) in Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Atomatology from December 2012 to December 2016 were treated by condylectomy via intraoral approach under computer assisted surgical navigation. The patient's spiral CT data were imported into ProPlan software before operation, and the affected mandibular ramus was reconstructed three-dimensionally. The condylar osteotomy line was designed according to the lesion range, and the preoperative design model was generated and introduced into the BrainLab navigation system. Under the guidance of computer navigation, the intraoral approach was used to complete the condylar resection according to the preoperative design of the osteotomy line. Cranial spiral CT of the craniofacial region was taken within one week after operation. three-dimensional reconstruction of the mandibular ramus at the condylectomy side was performed, and the condylar section was divided into six segments (anterolateral, anterior, anteromedial, posteromedial, posterior, and posterolateral) and the corresponding regional measurement points P1 to P6 were defined. Then the preoperative virtual model and the postoperative actual model were matched by Geomagic studio 12.0 to compare the differences and to analyze the accuracy of the operation. RESULTS All the patients had successfully accomplished the operation and obtained satisfactory results. Postoperative CT showed that the condyle lesion was completely resected, and the condylar osteotomy line was basically consistent with the surgical design. No tumor recurrence or temporomandibular joint ankylosis during the follow-up period. The postoperative accuracy analysis of the condylar resection showed that the confidence intervals measured by the six groups of P1 to P6 were (-2.26 mm, -1.89 mm), (-2.30 mm, -1.45 mm), (-3.37 mm, -2.91 mm), (-2.83 mm, -1.75 mm), (-1.13 mm, 0.99 mm), and(-1.17 mm, 0.17 mm), where P3 group was different from the other 5 groups. There was no significant difference between the P5 and P6 groups and the difference between the other four groups was statistically significant. CONCLUSION Under the guidance of computer navigation, the intraoral approach can be performed more accurately. The surgical deviation of each part of the osteotomy surface is mainly due to excessive resection. The anterior medial area of the anterior medial condyle represents the most excessive resection. The posterior and posterior lateral measurement points represent the posterior condylar area. The average deviation is not large, but the fluctuation of the deviation value is larger than that of the other four groups. The accuracy of computer-assisted subtotal resection has yet to be improved.
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Affiliation(s)
- M Z Li
- Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.,Department of Stomatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - X X Wang
- Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Z L Li
- Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - B Yi
- Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - C Liang
- Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - W He
- Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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Hwang YE, Kang SH, Kim HK. Errors according to the number of registered markers used in navigation-assisted surgery of the mandible. Head Face Med 2019; 15:6. [PMID: 30736796 PMCID: PMC6368779 DOI: 10.1186/s13005-019-0190-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/31/2019] [Indexed: 12/05/2022] Open
Abstract
Background The aim of this study was to evaluate the accuracy of navigation according to the number of markers in terms of target registration errors (TREs) at each anatomical location during the registration process of the navigation system for the mandible. Methods The TREs were measured in five different experiments, varying only in the number of registration reference markers, which ranged from three to seven. To measure the TREs according to the number of registration reference markers, two experimental navigation devices were used: 1) Cbyon navigation surgery equipment 2) Polaris optical tracker. Both experiments were conducted to obtain the TREs at the anatomical locations of the mandible according to the number of registration markers during the navigation process. Statistical analysis was performed using the SPSS 23.0 software. Results At all anatomical locations, errors were 2 mm or less. Further, significant differences in the target errors measured by the Cbyon system were found according to the number of registration markers. Significant differences in the target errors measured by the Polaris optical tracker were found according to the registration markers at the posterior border only. In both groups, the target errors did not decrease as the number of registration markers increased. Conclusions This study demonstrates that an increase in the number of registration markers is not associated with a decrease in the TRE, and that a specific number of registration markers could reduce the TREs at each anatomical site. It is important to determine the minimum number of image registration markers at which the smallest TRE would be observed for different surgical sites.
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Affiliation(s)
- Young-Eun Hwang
- Department of Biomedical Engineering, College of Health Science, Gachon University, Incheon, South Korea
| | - Sang-Hoon Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.,Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Hang-Keun Kim
- Department of Biomedical Engineering, College of Health Science, Gachon University, Incheon, South Korea. .,Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, South Korea.
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Jiang T, Zhu M, Chai G, Li Q. Precision of a Novel Craniofacial Surgical Navigation System Based on Augmented Reality Using an Occlusal Splint as a Registration Strategy. Sci Rep 2019; 9:501. [PMID: 30679507 PMCID: PMC6345963 DOI: 10.1038/s41598-018-36457-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/14/2018] [Indexed: 11/30/2022] Open
Abstract
The authors have developed a novel augmented reality (AR)-based navigation system (NS) for craniofacial surgery. In this study, the authors aimed to measure the precision of the system and further analyze the primary influencing factors of the precision. The drilling of holes into the mandibles of ten beagle dogs was performed under the AR-based NS, and the precision was analyzed by comparing the deviation between the preoperational plan and the surgical outcome. The AR-based NS was successfully applied to quickly and precisely drill holes in the mandibles. The mean positional deviation between the preoperative design and intraoperative navigation was 1.29 ± 0.70 mm for the entry points and 2.47 ± 0.66 mm for the end points, and the angular deviation was 1.32° ± 1.17°. The precision linearly decreased with the distance from the marker. In conclusion, the precision of this system could satisfy clinical requirements, and this system may serve as a helpful tool for improving the precision in craniofacial surgery.
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Affiliation(s)
- Taoran Jiang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai, 200011, People's Republic of China
| | - Ming Zhu
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, No. 180 Feng Lin Road, Shanghai, 200032, People's Republic of China
| | - Gang Chai
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai, 200011, People's Republic of China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai, 200011, People's Republic of China.
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Schieferbein V, Bredemann J, Schmitt R, Stenin I, Klenzner T, Schipper J, Kristin J. Influence of patient-specific anatomy on medical computed tomography and risk evaluation of minimally invasive surgery at the otobasis. Eur Arch Otorhinolaryngol 2018; 276:375-382. [PMID: 30554360 DOI: 10.1007/s00405-018-5249-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/12/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE With the increasing use of new minimally invasive approaches in temporal bone surgery, the need arises for evaluation of the risk of injury to sensitive anatomical structures. The factors that influence the measurement uncertainty (variation in representation of position and shape of anatomical structures) of imaging are of relevance. We investigate the effect of patients' anatomy on the measurement uncertainty of medical CT. METHODS Six formalin-fixed temporal bones were used, fiducial markers were bone-implanted, and 20 CT scans of each temporal bone were generated. Surgically threatened anatomical structures of importance were defined. Manual segmentation was performed to create 3D surface models, and different Gaussian filters were applied. Analysis points were established along the border of the superior semicircular canal to determine the deviation between the 3D images of the labyrinth. The standard uncertainty was calculated, and one-way analysis of variance was performed (significance level = 5%) to evaluate the effect of certain factors (patient, side, Gaussian filter) on the measurement uncertainty. RESULTS The influence of patient-specific anatomy on the measurement uncertainty of medical CT (p = 0.049) was demonstrated for the first time. The applied Gaussian filter (p = 0.622) and the patient's side (p = 0.341) showed no significant effect. CONCLUSION The applied method and the results of the statistical analysis suggest that the patient's individual anatomical conditions affect the measurement uncertainty of medical CT. Thus, the patient's anatomy must be considered as an important influencing factor during risk evaluation concerning minimally invasive and image-guided surgery.
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Affiliation(s)
- Vanessa Schieferbein
- Department of Otorhinolaryngology, University Hospital Duesseldorf, Duesseldorf, Germany.
| | - Judith Bredemann
- Laboratory for Machine Tools and Production Engineering WZL, Chair of Production Metrology and Quality Management, RWTH Aachen University, Aachen, Germany
| | - R Schmitt
- Laboratory for Machine Tools and Production Engineering WZL, Chair of Production Metrology and Quality Management, RWTH Aachen University, Aachen, Germany
| | - I Stenin
- Department of Otorhinolaryngology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - T Klenzner
- Department of Otorhinolaryngology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Jörg Schipper
- Department of Otorhinolaryngology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Julia Kristin
- Department of Otorhinolaryngology, University Hospital Duesseldorf, Duesseldorf, Germany
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Ramakonar H, Quirk BC, Kirk RW, Li J, Jacques A, Lind CRP, McLaughlin RA. Intraoperative detection of blood vessels with an imaging needle during neurosurgery in humans. SCIENCE ADVANCES 2018; 4:eaav4992. [PMID: 30585293 PMCID: PMC6300404 DOI: 10.1126/sciadv.aav4992] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/20/2018] [Indexed: 05/05/2023]
Abstract
Intracranial hemorrhage can be a devastating complication associated with needle biopsies of the brain. Hemorrhage can occur to vessels located adjacent to the biopsy needle as tissue is aspirated into the needle and removed. No intraoperative technology exists to reliably identify blood vessels that are at risk of damage. To address this problem, we developed an "imaging needle" that can visualize nearby blood vessels in real time. The imaging needle contains a miniaturized optical coherence tomography probe that allows differentiation of blood flow and tissue. In 11 patients, we were able to intraoperatively detect blood vessels (diameter, >500 μm) with a sensitivity of 91.2% and a specificity of 97.7%. This is the first reported use of an optical coherence tomography needle probe in human brain in vivo. These results suggest that imaging needles may serve as a valuable tool in a range of neurosurgical needle interventions.
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Affiliation(s)
- Hari Ramakonar
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
| | - Bryden C. Quirk
- ARC Centre of Excellence for Nanoscale Biophotonics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Institute for Photonics and Advanced Sensing, University of Adelaide, Adelaide, South Australia, Australia
| | - Rodney W. Kirk
- ARC Centre of Excellence for Nanoscale Biophotonics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Institute for Photonics and Advanced Sensing, University of Adelaide, Adelaide, South Australia, Australia
| | - Jiawen Li
- ARC Centre of Excellence for Nanoscale Biophotonics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Institute for Photonics and Advanced Sensing, University of Adelaide, Adelaide, South Australia, Australia
| | - Angela Jacques
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Christopher R. P. Lind
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
| | - Robert A. McLaughlin
- ARC Centre of Excellence for Nanoscale Biophotonics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Institute for Photonics and Advanced Sensing, University of Adelaide, Adelaide, South Australia, Australia
- Corresponding author.
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Stamatakis HC, Steegman R, Dusseldorp J, Ren Y. Head positioning in a cone beam computed tomography unit and the effect on accuracy of the three-dimensional surface mode. Eur J Oral Sci 2018; 127:72-80. [DOI: 10.1111/eos.12582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Harry C. Stamatakis
- Department of Orthodontics; University of Groningen; University Medical Centre Groningen; Groningen the Netherlands
| | - Ralph Steegman
- Department of Orthodontics; University of Groningen; University Medical Centre Groningen; Groningen the Netherlands
| | - Joost Dusseldorp
- Department of Orthodontics; University of Groningen; University Medical Centre Groningen; Groningen the Netherlands
| | - Yijin Ren
- Department of Orthodontics, W. J. Kolff Institute of Biomedical Engineering and Materials Science; University of Groningen; University Medical Centre Groningen; Groningen the Netherlands
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Lee SJ, Yang HJ, Choi MH, Woo SY, Huh KH, Lee SS, Heo MS, Choi SC, Hwang SJ, Yi WJ. Real-time augmented model guidance for mandibular proximal segment repositioning in orthognathic surgery, using electromagnetic tracking. J Craniomaxillofac Surg 2018; 47:127-137. [PMID: 30447987 DOI: 10.1016/j.jcms.2018.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/17/2018] [Accepted: 10/18/2018] [Indexed: 10/28/2022] Open
Abstract
It is essential to reposition the mandibular proximal segment (MPS) as close to its original position as possible during orthognathic surgery. Conventional methods cannot pinpoint the exact position of the condyle in the fossa in real time during repositioning. In this study, based on an improved registration method and a separable electromagnetic tracking tool, we developed a real-time, augmented, model-guided method for MPS surgery to reposition the condyle into its original position more accurately. After virtual surgery planning, using a complex maxillomandibular model, the final position of the virtual MPS model was simulated via 3D rotations. The displacements resulting from the MPS simulation were applied to the MPS landmarks to indicate their final postoperative positions. We designed a new registration body with 24 fiducial points for registration, and determined the optimal point group on the registration body through a phantom study. The registration between the patient's CT image and physical spaces was performed preoperatively using the optimal points. We also developed a separable frame for installing the electromagnetic tracking tool on the patient's MPS. During MPS surgery, the electromagnetic tracking tool was repeatedly attached to, and separated from, the MPS using the separable frame. The MPS movement resulting from the surgeon's manipulation was tracked by the electromagnetic tracking system. The augmented condyle model and its landmarks were visualized continuously in real time with respect to the simulated model and landmarks. Our method also provides augmented 3D coronal and sagittal views of the fossa and condyle, to allow the surgeon to examine the 3D condyle-fossa positional relationship more accurately. The root mean square differences between the simulated and intraoperative MPS models, and between the simulated and postoperative CT models, were 1.71 ± 0.63 mm and 1.89 ± 0.22 mm respectively at three condylar landmarks. Thus, the surgeons could perform MPS repositioning conveniently and accurately based on real-time augmented model guidance on the 3D condyle positional relationship with respect to the glenoid fossa, using augmented and simulated models and landmarks.
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Affiliation(s)
- Sang-Jeong Lee
- Department of Biomedical Radiation Sciences (Head: Sung-Joon Ye, PhD), Graduate School of Convergence Science and Technology, Seoul National University, South Korea
| | - Hoon Joo Yang
- Orthognathic Surgery Center (Head: Soon Jung Hwang, DDS, MD, PhD), Seoul National University Dental Hospital, South Korea
| | - Min-Hyuk Choi
- Department of Biomedical Radiation Sciences (Head: Sung-Joon Ye, PhD), Graduate School of Convergence Science and Technology, Seoul National University, South Korea
| | - Sang-Yoon Woo
- Department of Biomedical Radiation Sciences (Head: Sung-Joon Ye, PhD), Graduate School of Convergence Science and Technology, Seoul National University, South Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology (Head: Min-Suk Heo, DDS, PhD), School of Dentistry and Dental Research Institute, Seoul National University, South Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology (Head: Min-Suk Heo, DDS, PhD), School of Dentistry and Dental Research Institute, Seoul National University, South Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology (Head: Min-Suk Heo, DDS, PhD), School of Dentistry and Dental Research Institute, Seoul National University, South Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology (Head: Min-Suk Heo, DDS, PhD), School of Dentistry and Dental Research Institute, Seoul National University, South Korea
| | - Soon Jung Hwang
- Department of Oral and Maxillofacial Surgery (Head: Jin-Young Choi, DDS, MD, PhD), School of Dentistry, Dental Research Institute, BK21 Plus, Seoul National University, South Korea.
| | - Won-Jin Yi
- Department of Biomedical Radiation Sciences (Head: Sung-Joon Ye, PhD), Graduate School of Convergence Science and Technology, Seoul National University, South Korea; Department of Oral and Maxillofacial Radiology (Head: Min-Suk Heo, DDS, PhD), School of Dentistry and Dental Research Institute, Seoul National University, South Korea.
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Catapano G, Sgulò FG, Acurio Padilla PE, Spennato P, Di Nuzzo G, Boniello V, de Notaris M. Palatal Position of Patient Tracker for Magnetic Neuronavigation System: Technical Note. World Neurosurg 2018; 116:105-109. [PMID: 29753080 DOI: 10.1016/j.wneu.2018.04.221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Recently, the neuronavigation system (NS) has become an essential intraoperative tool for many neurosurgical procedures, allowing for precise lesion localization. It is particularly important to avoid errors during the navigation process. Here we report a novel technique using palatal positioning of the patient tracker to ensure optimal accuracy during magnetic navigation in various neurosurgical procedures. METHODS This retrospective study included a total of 34 patients treated in our institution between June 2017 and January 2018. The patients were split into 2 groups who underwent surgery under general anesthesia: a microscopic transcranial group and an endoscopic endonasal group. Preoperative and postoperative navigation accuracy was assessed by 2 neurosurgeons. RESULTS After our surgical planning navigation protocol was applied, both transcranial and endonasal procedures were successfully performed under navigation guidance in all but 1 patient. There were no intraoperative or postoperative complications related to the tracker mounted under the hard palate. In 33 cases a maximal tracking view and optimal navigation accuracy was achieved, for a success rate of 97%. CONCLUSIONS The positioning of the patient tracker under the hard palate proved safe, accurate, and feasible in 97% of our patients. In our case series, it met the main goal of avoiding device displacement without a sense of invasiveness and postoperative patient discomfort.
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Affiliation(s)
- Giuseppe Catapano
- Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Benevento, Italy
| | | | | | - Pietro Spennato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy; Department of Pediatric Neuroradiology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppe Di Nuzzo
- Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Benevento, Italy
| | - Vincenzo Boniello
- Department of Neuroscience, "G. Rummo" Hospital, Neuro-Intensive Care Unit, Benevento, Italy
| | - Matteo de Notaris
- Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Benevento, Italy.
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Accuracy and feasibility of a dedicated image guidance solution for endoscopic lateral skull base surgery. Eur Arch Otorhinolaryngol 2018; 275:905-911. [DOI: 10.1007/s00405-018-4906-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/09/2018] [Indexed: 11/26/2022]
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Virtual Planning of a Complex Three-Part Bimaxillary Osteotomy. Case Rep Dent 2018; 2017:8013874. [PMID: 29318057 PMCID: PMC5727690 DOI: 10.1155/2017/8013874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/05/2017] [Indexed: 02/08/2023] Open
Abstract
In maxillofacial surgery, every patient presents special problems requiring careful evaluation. Conventional methods to study the deformities are still reliable, but the advent of tridimensional (3D) imaging, especially computed tomography (CT) scan and laser scanning of casts, created the opportunity to better understanding the skeletal support and the soft tissue structures. Nowadays, virtual technologies are increasingly employed in maxillofacial surgery and demonstrated precision and reliability. However, in complex surgical procedures, these new technologies are still controversial. Especially in the less frequent cases of three-part maxillary surgery, the experience is limited, and scientific literature cannot give a clear support. This paper presents the case of a young patient affected by a complex long face dentofacial deformity treated by a bimaxillary surgery with three-part segmentation of the maxilla. The operator performed the surgical study completely with a virtual workflow. Pre- and postoperative CT scan and optical scanning of plaster models were collected and compared. Every postoperatory maxillary piece was superimposed with the presurgical one, and the differences were examined in a color-coded map. Only mild differences were found near the osteotomy lines, when the bony surface and the teeth demonstrated an excellent coincidence.
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Tauscher S, Fuchs A, Baier F, Kahrs LA, Ortmaier T. High-accuracy drilling with an image guided light weight robot: autonomous versus intuitive feed control. Int J Comput Assist Radiol Surg 2017; 12:1763-1773. [DOI: 10.1007/s11548-017-1638-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
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Grauvogel TD, Engelskirchen P, Semper-Hogg W, Grauvogel J, Laszig R. Navigation accuracy after automatic- and hybrid-surface registration in sinus and skull base surgery. PLoS One 2017; 12:e0180975. [PMID: 28700740 PMCID: PMC5507282 DOI: 10.1371/journal.pone.0180975] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 06/24/2017] [Indexed: 11/25/2022] Open
Abstract
Objective Computer-aided-surgery in ENT surgery is mainly used for sinus surgery but navigation accuracy still reaches its limits for skull base procedures. Knowledge of navigation accuracy in distinct anatomical regions is therefore mandatory. This study examined whether navigation accuracy can be improved in specific anatomical localizations by using hybrid registration technique. Study design Experimental phantom study. Setting Operating room. Subjects and methods The gold standard of screw registration was compared with automatic LED-mask-registration alone, and in combination with additional surface matching. 3D-printer-based skull models with individual fabricated silicone skin were used for the experiments. Overall navigation accuracy considering 26 target fiducials distributed over each skull was measured as well as the accuracy on selected anatomic localizations. Results Overall navigation accuracy was <1.0 mm in all cases, showing the significantly lowest values after screw registration (0.66 ± 0.08 mm), followed by hybrid registration (0.83± 0.08 mm), and sole mask registration (0.92 ± 0.13 mm).On selected anatomic localizations screw registration was significantly superior on the sphenoid sinus and on the internal auditory canal. However, mask registration showed significantly better accuracy results on the midface. Navigation accuracy on skull base localizations could be significantly improved by the combination of mask registration and additional surface matching. Conclusion Overall navigation accuracy gives no sufficient information regarding navigation accuracy in a distinct anatomic area. The non-invasive LED-mask-registration proved to be an alternative in clinical routine showing best accuracy results on the midface. For challenging skull base procedures a hybrid registration technique is recommendable which improves navigation accuracy significantly in this operating field. Invasive registration procedures are reserved for selected challenging skull base operations where the required high precision warrants the invasiveness.
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Affiliation(s)
- Tanja Daniela Grauvogel
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- * E-mail:
| | - Paul Engelskirchen
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Wiebke Semper-Hogg
- Department of Oral and Maxillofacial Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Juergen Grauvogel
- Department of Neurosurgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Roland Laszig
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Dagnino G, Georgilas I, Morad S, Gibbons P, Tarassoli P, Atkins R, Dogramadzi S. Intra-operative fiducial-based CT/fluoroscope image registration framework for image-guided robot-assisted joint fracture surgery. Int J Comput Assist Radiol Surg 2017; 12:1383-1397. [PMID: 28474269 PMCID: PMC5541125 DOI: 10.1007/s11548-017-1602-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/25/2017] [Indexed: 11/30/2022]
Abstract
Purpose Joint fractures must be accurately reduced minimising soft tissue damages to avoid negative surgical outcomes. To this regard, we have developed the RAFS surgical system, which allows the percutaneous reduction of intra-articular fractures and provides intra-operative real-time 3D image guidance to the surgeon. Earlier experiments showed the effectiveness of the RAFS system on phantoms, but also key issues which precluded its use in a clinical application. This work proposes a redesign of the RAFS’s navigation system overcoming the earlier version’s issues, aiming to move the RAFS system into a surgical environment. Methods The navigation system is improved through an image registration framework allowing the intra-operative registration between pre-operative CT images and intra-operative fluoroscopic images of a fractured bone using a custom-made fiducial marker. The objective of the registration is to estimate the relative pose between a bone fragment and an orthopaedic manipulation pin inserted into it intra-operatively. The actual pose of the bone fragment can be updated in real time using an optical tracker, enabling the image guidance. Results Experiments on phantom and cadavers demonstrated the accuracy and reliability of the registration framework, showing a reduction accuracy (sTRE) of about \documentclass[12pt]{minimal}
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\begin{document}$$0.88~\pm 0.2\,\hbox {mm}$$\end{document}0.88±0.2mm (phantom) and \documentclass[12pt]{minimal}
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\begin{document}$$1.15\pm 0.8\,\hbox {mm}$$\end{document}1.15±0.8mm (cadavers). Four distal femur fractures were successfully reduced in cadaveric specimens using the improved navigation system and the RAFS system following the new clinical workflow (reduction error \documentclass[12pt]{minimal}
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\begin{document}$$1.2\pm 0.3\,\hbox {mm}$$\end{document}1.2±0.3mm, \documentclass[12pt]{minimal}
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\begin{document}$$2\pm 1{^{\circ }})$$\end{document}2±1∘). Conclusion Experiments showed the feasibility of the image registration framework. It was successfully integrated into the navigation system, allowing the use of the RAFS system in a realistic surgical application.
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Affiliation(s)
- Giulio Dagnino
- Bristol Robotics Laboratory, University of the West of England, Coldharbour Lane, BS161QY, Bristol, UK.
| | - Ioannis Georgilas
- Bristol Robotics Laboratory, University of the West of England, Coldharbour Lane, BS161QY, Bristol, UK
| | - Samir Morad
- Bristol Robotics Laboratory, University of the West of England, Coldharbour Lane, BS161QY, Bristol, UK.,Aston University, B47ET, Birmingham, UK
| | - Peter Gibbons
- Bristol Robotics Laboratory, University of the West of England, Coldharbour Lane, BS161QY, Bristol, UK
| | - Payam Tarassoli
- University Hospitals Bristol, Upper Maudlin Street, BS28HW, Bristol, UK
| | - Roger Atkins
- University Hospitals Bristol, Upper Maudlin Street, BS28HW, Bristol, UK
| | - Sanja Dogramadzi
- Bristol Robotics Laboratory, University of the West of England, Coldharbour Lane, BS161QY, Bristol, UK
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Comparison of time required for traditional versus virtual orthognathic surgery treatment planning. Int J Oral Maxillofac Surg 2016; 45:1065-9. [DOI: 10.1016/j.ijom.2016.03.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/09/2016] [Accepted: 03/15/2016] [Indexed: 11/20/2022]
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Pietruski P, Majak M, Swiatek-Najwer E, Popek M, Szram D, Zuk M, Jaworowski J. Accuracy of experimental mandibular osteotomy using the image-guided sagittal saw. Int J Oral Maxillofac Surg 2016; 45:793-800. [DOI: 10.1016/j.ijom.2015.12.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 11/09/2015] [Accepted: 12/21/2015] [Indexed: 11/16/2022]
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Soteriou E, Grauvogel J, Laszig R, Grauvogel TD. Prospects and limitations of different registration modalities in electromagnetic ENT navigation. Eur Arch Otorhinolaryngol 2016; 273:3979-3986. [PMID: 27149874 DOI: 10.1007/s00405-016-4063-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 04/19/2016] [Indexed: 01/03/2023]
Abstract
The present study examined electromagnetic tracking technology for ENT navigation. Five different registration modalities were compared and navigation accuracy was assessed. Four skull models were individually fabricated with a three-dimensional printer, based on patients' computer tomography datasets. Individual silicone masks were fitted for skin and soft tissue simulation. Five registration modalities were examined: (1) invasive marker, (2) automatic, (3) surface matching (AccuMatch), (4) anatomic landmarks, and (5) oral splint registration. Overall navigation accuracy and accuracy on selected anatomic locations were assessed by targeting 26 titanium screws previously placed over the skull. Overall navigation accuracy differed significantly between all registration modalities. The target registration error was 0.94 ± 0.06 mm (quadratic mean ± standard deviation) for the invasive marker registration, 1.41 ± 0.04 mm for the automatic registration, 1.59 ± 0.14 mm for the surface matching registration, and 5.15 ± 0.66 mm (four landmarks) and 4.37 ± 0.73 mm (five landmarks) for the anatomic landmark registration. Oral splint registration proved itself to be inapplicable to this navigation system. Invasive marker registration was superior on most selected anatomic locations. However, on the ethmoid and sphenoid sinus the automatic registration process revealed significantly lower target registration error values. Only automatic and surface registration met the accuracy requirements for noninvasive registration. Particularly, the automatic image-to-world registration reaches target registration error values on the anterior skull base which are comparable with the gold standard of invasive screw registration.
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Affiliation(s)
- Eric Soteriou
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert-Ludwigs-University Medical School Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| | - Juergen Grauvogel
- Department of Neurosurgery, Albert-Ludwigs-University Medical School Freiburg, Freiburg, Germany
| | - Roland Laszig
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert-Ludwigs-University Medical School Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| | - Tanja Daniela Grauvogel
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert-Ludwigs-University Medical School Freiburg, Killianstr. 5, 79106, Freiburg, Germany.
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Surgical navigation-assisted mandibular reconstruction with fibula flaps. Int J Oral Maxillofac Surg 2016; 45:448-53. [DOI: 10.1016/j.ijom.2015.08.1006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 06/28/2015] [Accepted: 08/25/2015] [Indexed: 11/23/2022]
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Comlekciler IT, Gunes S, Irgin C. Artificial 3-D contactless measurement in orthognathic surgery with binocular stereo vision. Appl Soft Comput 2016. [DOI: 10.1016/j.asoc.2016.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Comparison of digital dental images yielded by digital dental casts, cone-beam computed tomography, and multislice computed tomography for measurement of dental area. Oral Radiol 2016. [DOI: 10.1007/s11282-016-0242-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Real Time Navigation-Assisted Orbital Wall Reconstruction in Blowout Fractures. J Craniofac Surg 2016; 27:370-3. [DOI: 10.1097/scs.0000000000002410] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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