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Mao Y, Li X, Wang Q, Zhang J. Application of titanium 3D-printed double-sleeve guide for zygomatic implants: A technique report. J Prosthodont 2023; 32:752-756. [PMID: 37294613 DOI: 10.1111/jopr.13724] [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: 12/05/2022] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023] Open
Abstract
The unique anatomical structure of the atrophic edentulous maxilla limits the placement of endosteal root form dental implants without bone grafting and augmentation. Surgical placement of zygomatic implants in an optimal position remains challenging. This technique report illustrates a novel digital guide technology, including the design workflow, application method, and indications for assisting with the placement of zygomatic implants using a bone-supported titanium double-sleeve guide. In addition, when the implant body reaches the zygomatic bone following an intra-sinus path, including ZAGA type 0 and ZAGA type 1 cases, a matching window osteotomy surgical guide is used to locate the lateral window boundary and protect the sinus membrane. With this technique, the surgical procedure is simplified, and the precision of guided zygomatic implant placement is improved.
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Affiliation(s)
- Yupu Mao
- Department of Oral and Maxillofacial Surgery, Tianjin Stomatological Hospital, Nankai University & Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin, China
| | - Xiaoban Li
- Department of Oral Implantology, Tianjin Stomatological Hospital, Tianjin Stomatological Hospital, School of Medicine, Nankai University & Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin, China
| | - Qingfu Wang
- Department of Oral Implantology, Tianjin Stomatological Hospital, Tianjin Stomatological Hospital, School of Medicine, Nankai University & Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin, China
| | - Jian Zhang
- Department of Oral Implantology, Tianjin Stomatological Hospital, Tianjin Stomatological Hospital, School of Medicine, Nankai University & Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin, China
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Sverzut TFV, Sverzut AT, Trivellato AE, Sverzut CE. Retrospective analysis of the predictability of using three-dimensional models for preoperative planning of the length of zygomatic implants. Oral Maxillofac Surg 2023; 27:53-58. [PMID: 35166998 DOI: 10.1007/s10006-022-01047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE This present study aimed to retrospectively evaluate the predictability of using three-dimensional models (TDMs) to plan the preoperative lengths of zygomatic implants (ZIs). METHODS The records of all patients that received such implants between March 2007 and March 2019 were evaluated. The ZI lengths predicted on the TDMs were compared to the lengths of the implants the patients received. RESULTS In total, the records of 74 patients were evaluated, of which 37 records met the criteria of inclusion, and were included in the study. Twenty-seven (73%) of the patients were female and 10 (27%) were male, ranging from 34 to 80 years of age, with the average age being 55.7 years. Seventeen (43.2%) of these patients were classified as ASA I and 21 (56.8%) as ASA II. A total of 142 ZIs were planned and installed in the time frame mentioned. Without distinguishing the region of the maxilla, the implants used were, on average, 1.1 mm larger in length than those initially planned. CONCLUSION Overall, the data indicates moderate agreement between the planned and surgical lengths of the ZIs and indicates that using TDMs is a predictable and reliable preoperative planning technique of the length of posterior ZIs.
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Affiliation(s)
- Thales Fabro Vanzela Sverzut
- Residency Training Program in Oral and Maxillofacial Surgery, School of Dentistry of Ribeirão Preto of the University of São Paulo, Avenida Do Café, s/n, Monte Alegre, Ribeirão Preto, São Paulo, 14040-904, Brazil
| | - Alexander Tadeu Sverzut
- Department of Oral Diagnosis, Maxillofacial Surgery Division, Piracicaba Dental School of the University of Campinas, Av. Limeira, 901, Bairro Areião, Piracicaba, São Paulo, 13414-903, Brazil
| | - Alexandre Elias Trivellato
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto of the University of São Paulo, Avenida Do Café, s/n, Monte Alegre, Ribeirão Preto, São Paulo, 14040-904, Brazil
| | - Cássio Edvard Sverzut
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto of the University of São Paulo, Avenida Do Café, s/n, Monte Alegre, Ribeirão Preto, São Paulo, 14040-904, Brazil.
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Öztürk Y, Ayazoğlu M, Öztürk Ç, Arabacı A, Solak N, Özsoy S. A new patient-specific overformed anatomical implant design method to reconstruct dysplastic femur trochlea. Sci Rep 2023; 13:3204. [PMID: 36828989 PMCID: PMC9958018 DOI: 10.1038/s41598-023-30341-4] [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: 11/26/2022] [Accepted: 02/21/2023] [Indexed: 02/26/2023] Open
Abstract
Patellar luxation with condylar defect is a challenging situation for reconstruction in humans. Patella reluxation, cartilage damage and pain are the most common complications. This study aims to present a new patient specific method of overformed implant design and clinical implantation that prevents luxation of patella without damaging the cartilage in a dog. Design processes are Computer Tomography, Computer Assisted Design, rapid prototyping of the bone replica, creation of the implant with surgeon's haptic knowledge on the bone replica, 3D printing of the implant and clinical application. The implant was fully seated on the bone. Patella reluxation or implant-related bone problem was not observed 80 days after the operation. However, before the implant application, there were soft tissue problems due to previous surgeries. Three-point bending test and finite element analysis were performed to determine the biomechanical safety of the implant. The stress acting on the implant was below the biomechanical limits of the implant. More cases with long-term follow-up are needed to confirm the success of this method in patellar luxation. Compared with trochlear sulcoplasty and total knee replacement, there was no cartilage damage done by surgeons with this method, and the implant keeps the patella functionally in sulcus. This is a promising multidisciplinary method that can be applied to any part of the bone and can solve some orthopaedic problems with surgeon's haptic knowledge.
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Affiliation(s)
- Yetkin Öztürk
- Molecular Biology and Genetics Department, Science and Literature Faculty, Istanbul Technical University, Maslak, 34469, Istanbul, Turkey.
| | - Murat Ayazoğlu
- grid.10516.330000 0001 2174 543XFaculty of Manufacturing Engineering, Istanbul Technical University, Gumussuyu, 34437 Istanbul, Turkey
| | - Çağrı Öztürk
- grid.10516.330000 0001 2174 543XMetallurgical and Materials Engineering Department, Chemical, and Metallurgical Engineering Faculty, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Atakan Arabacı
- grid.10516.330000 0001 2174 543XMetallurgical and Materials Engineering Department, Chemical, and Metallurgical Engineering Faculty, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Nuri Solak
- grid.10516.330000 0001 2174 543XMetallurgical and Materials Engineering Department, Chemical, and Metallurgical Engineering Faculty, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Serhat Özsoy
- grid.506076.20000 0004 1797 5496Surgery Department, Veterinary Faculty, Istanbul University-Cerrahpasa, Buyukcekmece, 34500 Istanbul, Turkey
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A novel guided zygomatic implant surgery system compared to free hand: a human cadaver study on accuracy. J Dent 2021; 119:103942. [PMID: 34974136 DOI: 10.1016/j.jdent.2021.103942] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 12/19/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The aim of this human cadaver study was to compare the accuracy of guided versus free-hand zygomatic implant placement. For the guided implant placement laser sintered titanium templates were used. METHODS Forty zygomatic implants were placed in ten cadavers heads. For each case two implants were inserted using the guided protocol(Ezgoma guide, Noris Medical, Israel) and the related surgical kit and the other two by using a free hand approach. Post-operative computed tomography (CT) scans were carried out to assess the deviations between planned and inserted implants. The accuracy was measured by overlaying the post-operative Ct scan (with the final position of the achieved implants)with the pre-operative CT scan (with the planned implants). RESULTS The difference of the mean between planned and placed zygomatic implants by using surgical guides or free hand were statistically significant for all the variables evaluated: angular deviation (1.19°±0.40° and 4.92°±1.71° p<0.001), linear distance deviation at coronal point (0.88 mm±0.33 mm and 2.04 mm±0.56 mm p<0.001), at apical point (0.79 mm±0.23 mm and 3.23 mm±1.43 mm p<0.001)and at apical depth (0.35 mm±0.25 mm and 1.02 mm±0.61 mm p<0.001). CONCLUSIONS The proposed surgical guided system exhibited a higher accuracy for all the investigated variables compared to the free hand technique.
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Latimer JM, Maekawa S, Yao Y, Wu DT, Chen M, Giannobile WV. Regenerative Medicine Technologies to Treat Dental, Oral, and Craniofacial Defects. Front Bioeng Biotechnol 2021; 9:704048. [PMID: 34422781 PMCID: PMC8378232 DOI: 10.3389/fbioe.2021.704048] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/29/2021] [Indexed: 01/10/2023] Open
Abstract
Additive manufacturing (AM) is the automated production of three-dimensional (3D) structures through successive layer-by-layer deposition of materials directed by computer-aided-design (CAD) software. While current clinical procedures that aim to reconstruct hard and soft tissue defects resulting from periodontal disease, congenital or acquired pathology, and maxillofacial trauma often utilize mass-produced biomaterials created for a variety of surgical indications, AM represents a paradigm shift in manufacturing at the individual patient level. Computer-aided systems employ algorithms to design customized, image-based scaffolds with high external shape complexity and spatial patterning of internal architecture guided by topology optimization. 3D bioprinting and surface modification techniques further enhance scaffold functionalization and osteogenic potential through the incorporation of viable cells, bioactive molecules, biomimetic materials and vectors for transgene expression within the layered architecture. These computational design features enable fabrication of tissue engineering constructs with highly tailored mechanical, structural, and biochemical properties for bone. This review examines key properties of scaffold design, bioresorbable bone scaffolds produced by AM processes, and clinical applications of these regenerative technologies. AM is transforming the field of personalized dental medicine and has great potential to improve regenerative outcomes in patient care.
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Affiliation(s)
- Jessica M Latimer
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, United States
| | - Shogo Maekawa
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, United States.,Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yao Yao
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI, United States
| | - David T Wu
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, United States.,Laboratory for Cell and Tissue Engineering, Harvard John A. Paulson School of Engineering and Applied Sciences, Boston, MA, United States.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, United States
| | - Michael Chen
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, United States
| | - William V Giannobile
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, United States
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Combined bone- and mucosa-supported 3D-printed guide for sinus slot preparation and prosthetically driven zygomatic implant placement. J Prosthet Dent 2021; 128:1165-1170. [PMID: 33795160 DOI: 10.1016/j.prosdent.2021.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/24/2022]
Abstract
The use of zygomatic implants to rehabilitate the severely atrophic maxilla has been well documented since first being introduced by Brånemark. Placement of zygomatic implants is technically complex, with catastrophic complications and numerous prosthetic challenges resulting from imprecise placement. The purpose of this report was to demonstrate a technique that allows transfer of the preoperatively planned sinus slot position to the surgical field by using cone beam computed tomography (CBCT) and an implant planning software program to fabricate a combined bone- and mucosa-supported 3D-printed surgical guide. This facilitates optimal zygomatic implant positioning and promotes favorable biomechanics with a predictable prosthetic outcome.
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Three-Dimensional Technology Applications in Maxillofacial Reconstructive Surgery: Current Surgical Implications. NANOMATERIALS 2020; 10:nano10122523. [PMID: 33339115 PMCID: PMC7765477 DOI: 10.3390/nano10122523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 12/18/2022]
Abstract
Defects in the oral and maxillofacial (OMF) complex may lead to functional and esthetic impairment, aspiration, speech difficulty, and reduced quality of life. Reconstruction of such defects is considered one of the most challenging procedures in head and neck surgery. Transfer of different auto-grafts is still considered as the “gold standard” of regenerative and reconstructive procedures for OMF defects. However, harvesting of these grafts can lead to many complications including donor-site morbidity, extending of surgical time, incomplete healing of the donor site and others. Three-dimensional (3D) printing technology is an innovative technique that allows the fabrication of personalized implants and scaffolds that fit the precise anatomy of an individual’s defect and, therefore, has attracted significant attention during the last few decades, especially among head and neck surgeons. Here we discuss the most relevant applications of the 3D printing technology in the oral and maxillofacial surgery field. We further show different clinical examples of patients who were treated at our institute using the 3D technology and discuss the indications, different technologies, complications, and their clinical outcomes. We demonstrate that 3D technology may provide a powerful tool used for reconstruction of various OMF defects, enabling optimal clinical results in the suitable cases.
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