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Alkhayatt NM, Alzahrani HH, Ahmed S, Alotaibi BM, Alsaggaf RM, ALAlmuaysh AM, Alomair AA. Computer-assisted navigation in oral and maxillofacial surgery: A systematic review. Saudi Dent J 2024; 36:387-394. [PMID: 38525182 PMCID: PMC10960148 DOI: 10.1016/j.sdentj.2023.12.002] [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: 07/25/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 03/26/2024] Open
Abstract
Background The term "navigation" describes a device that can pinpoint critical anatomical features, the most direct path to the target, and the optimal surgical orientation. This study aimed to conduct a comprehensive literature search on computer-assisted navigation for use in oral and maxillofacial surgery. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, relevant studies were retrieved from five electronic databases: Medline, Web of Science, PubMed, Google Scholar, and Saudi Digital Library (SDL). The central question was, "Does the computer-assisted navigation system improve the outcome of surgical procedures in the oral and maxillofacial region?" The Cochrane Risk of Bias 2 was used to determine the various types of bias. Results Post-traumatic midfacial reconstruction is one of the many fields that have benefited from the use of computer-assisted navigation because of its reliability. It can also be used to extricate difficult foreign entities from the operative zone. Locating critical anatomical components, communicating the surgical plan to the patient, and verifying surgical success can improve the function and appearance of patients with dentofacial abnormalities. In addition, it decreases the surgical error margin and duration. Conclusion Computer-assisted navigation is promising in surgical practice. The accuracy of surgery can be significantly enhanced by first planning the process in a virtual environment and then performing it under close supervision in real time. In addition, the time required for preoperative planning and surgery can be reduced by creating and improving software programs.
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Affiliation(s)
| | - Hadeel H Alzahrani
- College of Dentistry, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Suhael Ahmed
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Bassam M Alotaibi
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Cebrián Carretero JL, Navarro Cuéllar C. New Technologies for Personalized Medicine in Head and Neck Oncologic and Reconstructive Surgery. J Clin Med 2022; 11:jcm11154261. [PMID: 35893352 PMCID: PMC9329913 DOI: 10.3390/jcm11154261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
The search for standardized protocols has been a constant concern in Head and Neck Reconstructive Surgery [...]
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Affiliation(s)
- José Luis Cebrián Carretero
- Department of Oral and Maxilofacial Surgery, Hospital Universitario La Paz, Universidad Autónoma de Madrid, IDIPAZ, 28046 Madrid, Spain
- Correspondence:
| | - Carlos Navarro Cuéllar
- División of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, 28007 Madrid, Spain;
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Sozzi D, Filippi A, Canzi G, De Ponti E, Bozzetti A, Novelli G. Surgical Navigation in Mandibular Reconstruction: Accuracy Evaluation of an Innovative Protocol. J Clin Med 2022; 11:jcm11072060. [PMID: 35407667 PMCID: PMC8999643 DOI: 10.3390/jcm11072060] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 02/01/2023] Open
Abstract
Aim: the purpose of this work is to present an innovative protocol for virtual planning and surgical navigation in post-oncological mandibular reconstruction through fibula free flap. In order to analyze its applicability, an evaluation of accuracy for the surgical protocol has been performed. Methods: 21 patients surgically treated for mandibular neoplasm have been included in the analysis. The Brainlab Vector Vision 3.0® software for surgical navigation has been used for preoperative surgical planning and intra-operative navigation. A post-operative accuracy evaluation has been performed matching the position of mandibular landmarks between pre-operative and post-operative CT scans. Results: the maximal discrepancy observed was included between −3.4 mm and +3.2 mm, assuming negative values for under correction and positive values for overcorrection. An average grade of accuracy included between 0.06 ± 0.58 mm and 0.43 ± 0.68 mm has been observed for every mandibular landmark examined, except for mandibular angles that showed a mean discrepancy value included between 1.36 ± 1.73 mm and 1.46 ± 1.02 mm when compared to preoperative measurements. Conclusion: a satisfying level of accuracy has been observed in the protocol presented, which appears to be more versatile if compared to closed custom-made systems. The technique described may represent a valid option for selected patients, but it cannot be considered for routine activity because of the complexity of the method, the mobility of the jaw, the necessity of surgical navigator and the long surgical learning curve that is required.
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Affiliation(s)
- Davide Sozzi
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (A.F.); (A.B.); (G.N.)
- Correspondence:
| | - Andrea Filippi
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (A.F.); (A.B.); (G.N.)
- Post-Graduate School of Maxillofacial Surgery, Department of Medicine and Surgery, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Gabriele Canzi
- Maxillofacial Surgery Unit, Emergency Department, ASST-GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy;
| | - Elena De Ponti
- Department of Medical Physics, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy;
| | - Alberto Bozzetti
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (A.F.); (A.B.); (G.N.)
| | - Giorgio Novelli
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (A.F.); (A.B.); (G.N.)
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Application of Rapid Digital Locating Technology in Emergency Treatment of Maxillofacial Space Infection. J Craniofac Surg 2022; 33:e696-e699. [PMID: 35200206 DOI: 10.1097/scs.0000000000008589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT Space infection occurs commonly in the oral and maxillofacial region, and is usually caused by odontogenic infection, resulting in acute symptoms through the maxillofacial space. If timely, correct, and effective treatment is not provided, local infection may quickly spread through the maxillofacial space and cause serious consequences such as suffocation, intracranial infection, and chest infection. A 55-year-old man visited our hospital with obvious swelling and pain in the right maxillofacial region. Maxillofacial computed tomography images showed revealed obvious low-density shadows on the inner side of the right mandibular angle and the right neck. Unlike the usual presentation of maxillofacial space infection, no obvious flushing or fluctuation was seen in the patient's maxillofacial region due to the deep location of the infection. Blind puncture examination and incision exploration may cause unnecessary pain and trauma to the patient. Therefore, to accurately position the infection focus, the operator reconstructed the infection cavity in three-dimensional with digital technology. The puncture point and incision site were quickly determined by three-dimensional measurement and the use of the compass and straightedge construction method, thereby achieving free drainage with an accurate and minimally invasive incision. Following 1 week of routine flushing and dressing changes, the patient recovered and was discharged from hospital. To our knowledge, this is the first precise minimally invasive treatment of a maxillofacial space infection conducted with the aid of digital positioning technology.
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de Geer A, Brouwer de Koning S, van Alphen M, van der Mierden S, Zuur C, van Leeuwen F, Loeve A, van Veen R, Karakullukcu M. Registration methods for surgical navigation of the mandible: a systematic review. Int J Oral Maxillofac Surg 2022; 51:1318-1329. [DOI: 10.1016/j.ijom.2022.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/18/2021] [Accepted: 01/26/2022] [Indexed: 12/20/2022]
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Navigation-assisted maxillofacial reconstruction: accuracy and predictability. Int J Oral Maxillofac Surg 2021; 51:874-882. [PMID: 34862088 DOI: 10.1016/j.ijom.2021.11.008] [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: 02/10/2021] [Revised: 08/17/2021] [Accepted: 11/15/2021] [Indexed: 11/21/2022]
Abstract
The aim of this study was to evaluate the accuracy of navigation-assisted maxillofacial reconstruction and to identify the predictors of the clinical outcomes. A total of 112 patients who underwent navigation-assisted maxillofacial reconstruction with free flaps between 2014 and 2019, performed by a single surgical team, were assessed. Accuracy was evaluated by superimposing the postoperative computed tomography data with the preoperative virtual surgical plan. Predictors of the clinical outcomes affecting the accuracy were identified and analysed. The mean deviation and root mean square (RMS) estimate of the orbital, maxillary, and mandibular reconstructions were 0.88 ± 3.25 mm and 3.38 ± 0.73 mm, 0.77 ± 3.44 mm and 3.69 ± 0.82 mm, and 1.07 ± 4.16 mm and 4.67 ± 3.95 mm, respectively (P < 0.05). There was no significant difference in orbital volume or projection between the preoperative, postoperative, and healthy orbits (P = 0.093 and P = 0.225, respectively). Multivariate linear regression analysis confirmed significant associations between the accuracy of navigation-assisted mandibular reconstruction and preservation of the condyle, type of reconstruction, type of osteosynthesis plate, and number of bony segments. Navigation-assisted midface reconstruction yielded a higher level of accuracy in the final surgical outcome when compared to mandibular reconstruction. Computer-assisted techniques and intraoperative navigation can be an alternative or adjunct to current surgical techniques to improve the final surgical outcome, especially in more complex maxillofacial reconstructions.
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Chen J, Zhang R, Liang Y, Ma Y, Song S, Jiang C. Deviation Analyses of Computer-Assisted, Template-Guided Mandibular Reconstruction With Combined Osteotomy and Reconstruction Pre-Shaped Plate Position Technology: A Comparative Study. Front Oncol 2021; 11:719466. [PMID: 34778034 PMCID: PMC8579124 DOI: 10.3389/fonc.2021.719466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Computer-assisted and template-guided mandibular reconstruction provides higher accuracy and less variation than conventional freehand surgeries. The combined osteotomy and reconstruction pre-shaped plate position (CORPPP) technique is a reliable choice for mandibular reconstruction. This study aimed to evaluate the accuracy of CORPPP-guided fibular flap mandibular reconstruction and analyze the possible causes of the deviations. Patients and Methods From June 2015 to December 2016, 28 patients underwent fibular flap mandibular reconstruction. Virtual planning and personalized CORPPP-guided templates were applied in 15 patients while 13 patients received conventional freehand surgeries. Deviations during mandibulectomy and fibular osteotomy, and overall and triaxial deviation of the corresponding mandibular anatomical landmarks were measured by superimposing the pre- and postoperative virtual models. Results The deviation of the resection line and resection angle was 1.23 ± 0.98 mm and 4.11° ± 2.60°. The actual length of fibula segments was longer than the designed length in 7 cases (mean: 0.35 ± 0.32 mm) and shorter in 22 cases (mean: 1.53 ± 1.19 mm). In patients without ramus reconstruction, deviations of the ipsilateral condylar head point (Co.), gonion point (Go.), and coracoid process point (Cor.) were 6.71 ± 3.42 mm, 5.38 ± 1.71 mm, and 11.05 ± 3.24 mm in the freehand group and 1.73 ± 1.13 mm, 1.86 ± 0.96 mm, and 2.54 ± 0.50 mm in the CORPPP group, respectively, with significant statistical differences (p < 0.05). In patients with ramus reconstruction, deviations of ipsilateral Co. and Go. were 9.79 ± 4.74 mm vs. 3.57 ± 1.62 mm (p < 0.05), and 15.17 ± 6.53 mm vs. 4.36 ± 1.68 mm (p < 0.05) in the freehand group and CORPPP group, respectively. Conclusion Mandibular reconstructions employing virtual planning and personalized CORPPP-guided templates show significantly higher predictability, convenience, and accuracy of mandibular reconstruction compared with conventional freehand surgeries. However, more clinical cases were required for further dimensional deviation analysis. The application and exploration of clinical practice would also continuously improve the design of templates.
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Affiliation(s)
- Jie Chen
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China.,Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, China.,Institute of Oral Cancer and Precancerous Lesions, Central South University, Changsha, China
| | - Ruipu Zhang
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China.,Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, China.,Institute of Oral Cancer and Precancerous Lesions, Central South University, Changsha, China
| | - Ye Liang
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China.,Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, China.,Institute of Oral Cancer and Precancerous Lesions, Central South University, Changsha, China
| | - Yujie Ma
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China.,Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, China.,Institute of Oral Cancer and Precancerous Lesions, Central South University, Changsha, China
| | - Saiwen Song
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China.,Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, China.,Institute of Oral Cancer and Precancerous Lesions, Central South University, Changsha, China
| | - Canhua Jiang
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China.,Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, China.,Institute of Oral Cancer and Precancerous Lesions, Central South University, Changsha, China
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Antúnez-Conde R, Salmerón JI, Díez-Montiel A, Agea M, Gascón D, Sada Á, Navarro Cuéllar I, Tousidonis M, Ochandiano S, Arenas G, Navarro Cuéllar C. Mandibular Reconstruction With Fibula Flap and Dental Implants Through Virtual Surgical Planning and Three Different Techniques: Double-Barrel Flap, Implant Dynamic Navigation and CAD/CAM Mesh With Iliac Crest Graft. Front Oncol 2021; 11:719712. [PMID: 34676161 PMCID: PMC8525397 DOI: 10.3389/fonc.2021.719712] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Vertical discrepancy between the fibula flap and the native mandible results in difficult prosthetic rehabilitation. The aim of this study was to evaluate the outcomes of 3D reconstruction of the mandible in oncologic patients using three different techniques through virtual surgical planning (VSP), cutting guides, customized titanium mesh and plates with CAD/CAM technology, STL models and intraoperative dynamic navigation for implant placement. Material and methods Material and Methods Three different techniques for mandibular reconstruction and implant rehabilitation were performed in 14 oncologic patients. Five patients (36%) underwent VSP, cutting guides, STL models and a customized double-barrel titanium plate with a double-barrel flap and immediate implants. In six patients (43%), VSP, STL models and a custom-made titanium mesh (CAD/CAM) for 3D reconstruction with iliac crest graft over a fibula flap with deferred dental implants were performed. Three patients (21%) underwent VSP with cutting guides and customized titanium plates for mandibular reconstruction and implant rehabilitation using intraoperative dynamic navigation was accomplished. Vertical bone reconstruction, peri-implant bone resorption, implant success rate, effects of radiotherapy in vertical reconstruction, bone resorption and implant failure, mastication, aesthetic result and dysphagia were evaluated. Results Significant differences in bone growth between the double-barrel technique and iliac crest graft with titanium mesh technique were found (p<0.002). Regarding bone resorption, there were no significant differences between the techniques (p=0.11). 60 implants were placed with an osseointegration rate of 91.49%. Five implants were lost during the osseointegration period (8%). Peri-implant bone resorption was measured with a mean of 1.27 mm. There was no significant difference between the vertical gain technique used and implant survival (p>0.385). Implant survival rates were higher in non-irradiated patients (p<0.017). All patients were rehabilitated with a fixed implant-supported prosthesis reporting a regular diet (80%), normal swallowing (85.7%) and excellent aesthetic results. Conclusions Multi-stage implementation of VSP, STL models and cutting guides, CAD/CAM technology, customized plates and in-house dynamic implant navigation for mandibular defects increases bone-to-bone contact, resolves vertical discrepancy and improves operative efficiency with reduced complication rates and minimal bone resorption. It provides accurate reconstruction that optimizes implant placement, thereby improving facial symmetry, aesthetics and function.
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Affiliation(s)
- Raúl Antúnez-Conde
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Ignacio Salmerón
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alberto Díez-Montiel
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marc Agea
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Dafne Gascón
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángela Sada
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ignacio Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Tousidonis
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Santiago Ochandiano
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gema Arenas
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Full-Digital Workflow for Fabricating a Custom-Made Direct Metal Laser Sintering (DMLS) Mandibular Implant: A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082693. [PMID: 32295196 PMCID: PMC7215385 DOI: 10.3390/ijerph17082693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/20/2022]
Abstract
Direct Laser Metal Sintering (DLMS) is an additive manufacturing (AM) technique that is capable of manufacturing metal parts according to a three-dimensional (3D) design made using computer-assisted-design (CAD) software, thanks to a powerful laser beam that melts selectively micro-powder layers, one on top of the other, until the desired object is generated. With DMLS, it is now possible to fabricate custom-made titanium implants for oral and maxillofacial applications. We present the case of a 67-year-old woman diagnosed with a squamous cell carcinoma of the mandible. The patient underwent subtotal mandibular resection; conventional reconstruction procedures failed to rehabilitate the function of the mandible. A prosthesis replacing the resected mandible was designed and fabricated using a digital workflow. The extensive bone defect was rehabilitated with a prosthesis replacing the mandibular bone and supporting a morse-taper dental prosthesis. The masticatory function was reestablished.
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Intraoperative Surgical Navigation Reduces the Surgical Time Required to Treat Acute Major Facial Fractures. Plast Reconstr Surg 2019; 144:923-931. [DOI: 10.1097/prs.0000000000006040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Computerized Navigation for Minimal Invasive Retrieval of Displaced Dental Implants in the Lower Jaw. Oral Maxillofac Surg Clin North Am 2019; 31:447-455. [DOI: 10.1016/j.coms.2019.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Advances in computer-aided design for bony free-flap reconstruction. Curr Opin Otolaryngol Head Neck Surg 2018; 26:319-325. [DOI: 10.1097/moo.0000000000000472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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