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A 63-year-old male patient, who had a severely resorbed edentulous maxillary arch and partially edentulous mandibular arch decided on the implant-supported fixed treatment option to replace the edentulous maxillary arch. The fully guided implant placement that utilizes the computer-generated guide is more accurate than traditional surgical guides and free-hand placements. The researchers have correlated possible implant failure risk factors with age, sex, smoking, type of edentulism, bone quality and volume, implant location, angulation, diameter, length, and various systemic factors. This case report demonstrated the failure cause of virtually planned anterior implants in All-on-4 and how to manage it by free-hand surgery without surgical guides.
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Resumen: La impresión en tres dimensiones (3D) incluye un grupo de tecnologías por medio de las cuales es posible generar objetos tridimensionales a partir de información binaria. La ortopedia y traumatología es uno de los campos de la medicina en los que mayor impacto ha tenido la planificación 3D, en especial en trauma y ortopedia oncológica. Las aplicaciones de esta técnica incluyen el diagnóstico, planificación quirúrgica, creación de guías intraoperatorias, implantes personalizados, entrenamiento quirúrgico, impresión de ortesis y prótesis y la bioimpresión. Se han demostrado ventajas en su uso como la mayor precisión técnica, el acortamiento de tiempos quirúrgicos, disminución de pérdida sanguínea y menor exposición a rayos. Si bien el proceso está cada vez más optimizado y accesible por los avances en software y automatización, es una técnica que requiere un entrenamiento adecuado. El objetivo de esta revisión es ofrecer un acercamiento a esta tecnología y sus principios básicos.
Abstract: Three-dimensional (3D) printing includes a group of technologies by means of which it is possible to generate three-dimensional objects from binary information. Orthopedics and traumatology are fields of medicine in which 3D planning has had the greatest impact, especially in trauma and oncological orthopedics. Applications of this technique include diagnosis, surgical planning, intraoperative guide creation, custom implants, surgical training, orthotic and prosthetic impression, and bioprinting. Advantages have been demonstrated in its use, such as greater technical precision, shorter surgical times, decreased blood loss and less exposure to X-rays. Although the process is increasingly optimized and accessible due to advances in software and automation, it is a technique that requires adequate training. The objective of this review is to offer an approach to this technology and its basic principles.
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Objective: To design osteotomy templates for the construction of mandibular defect by using fibular flap in a reverse engineering technique approach. Methods: Five patients with mandibular defect were enrolled and their treatments were designed in a three-dimensional (3D) virtual planning software package. The 3D printing model with shaped reconstruction plate and titanium-screws were under CT scanning and the image was reconstructed and registered back to the original mandible and fibula in a surface-best-fit method. Then the osteotomy template with screw holes of shaped reconstruction plate was designed and fabricated. The reconstruction of mandible with multiple fibular segments was guided by the osteotomy template. Results: All the five patients were discharged successfully with satisfied outcome. The deviation between virtual plan and actual results were calculated: max deviation (3.53±2.33) mm and the angle deviation 3.31˚±1.48˚. Conclusion: The accuracy of the osteotomy template is satisfied and can be applied to the clinical use.
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Abstract Facial asymmetry is a condition that compromises function and social interactions and, consequently, the quality of life. Orthodontic-surgical treatment may be indicated to achieve a stable occlusion and significant improvement in facial aesthetics. The virtual planning of the maxillary, mandibular and chin movements can be done prior to surgery. These movements can be successfully performed with the use of prototyped guides obtained from virtual planning. The aim of this article is to show the state of the art of treatments of facial asymmetries, and emphasize how important is the multi-disciplinary approach to achieve predictable aesthetic and functionally stable results in a patient with facial asymmetry and chin protrusion.
Resumo A assimetria facial é uma condição capaz de comprometer a função oclusal e as interações sociais e, consequentemente, a qualidade de vida dos indivíduos. Nessas condições, para se obter oclusão estável e melhora significativa na estética facial, o tratamento ortodôntico-cirúrgico pode estar indicado. A simulação virtual da cirurgia permite planejar de forma adequada, e antecipada, os movimentos cirúrgicos a serem efetuados na maxila, mandíbula e mento. Esses movimentos são, então, realizados com sucesso graças ao uso de guias prototipados obtidos a partir do planejamento virtual. Assim, os objetivos do presente artigo consistem em relatar o estado da arte no planejamento virtual do tratamento de um paciente com assimetria facial e protrusão do mento, e enfatizar a importância da abordagem multidisciplinar para se atingir resultados estéticos previsíveis e funcionalmente estáveis.
Subject(s)
Humans , Male , Esthetics , Facial Asymmetry/surgery , Facial Asymmetry/therapy , Orthognathic Surgical Procedures/methods , Orthognathic Surgery/methods , Orthodontics, Corrective , Osteotomy/methods , Patient Care Planning , Cephalometry , Chin/surgery , Osteotomy, Le Fort/methods , Surgery, Computer-Assisted/methods , Dental Occlusion , Facial Asymmetry/diagnostic imaging , Dentofacial Deformities/surgery , Dentofacial Deformities/therapy , Malocclusion/surgery , Malocclusion/therapy , Malocclusion/diagnostic imaging , Mandible/surgery , Mandible/diagnostic imaging , Maxilla/surgery , Maxilla/diagnostic imagingABSTRACT
ABSTRACT Dentofacial deformities usually are surgically treated, and 3D virtual planning has been used to favor accurate outcomes. Cases reported in the present article show that orthognathic surgery carried out to correct facial asymmetries does not comprise only one treatment protocol. 3D virtual planning might be used for surgical planning, but it should also be used to diagnose the deformity, thus allowing for an analysis of the best-recommended possibilities for the orthodontic preparation that suits each individual case.
RESUMO As deformidades dentofaciais são, geralmente, tratadas de forma cirúrgica, e o planejamento virtual 3D tem sido utilizado para aumentar a precisão dos resultados. Os casos exemplificados no presente artigo mostram que a cirurgia ortognática para correção das assimetrias faciais não apresenta um único protocolo de tratamento. O planejamento virtual 3D pode ser adotado para planejar a cirurgia, mas também deve ser utilizado na fase de diagnóstico da deformidade, assim permitindo uma análise das possibilidades mais indicadas para o preparo ortodôntico mais adequado em cada caso.
Subject(s)
Humans , Female , Adult , Patient Care Planning , Imaging, Three-Dimensional , Facial Asymmetry/surgery , Facial Asymmetry/diagnostic imaging , Orthognathic Surgical Procedures/methods , Radiography, Panoramic , Tomography Scanners, X-Ray Computed , Dentofacial Deformities/surgery , Dentofacial Deformities/diagnostic imagingABSTRACT
Introdução: os casos de assimetria facial são considerados os de maior complexidade dentro do âmbito da cirurgia Buco-Maxilo-Facial, devido a alteração esquelético-morfológica nos três planos do espaço (Pitch, Yaw e Roll). Estes planos foram trazidos do posicionamento de uma aeronave no espaço para o mundo da cirurgia, mais especificamente ao planejamento virtual, para romper as limitações do planejamento manual e a plataforma de Erickson, usados durante décadas para correção não só de casos simples envolvendo movimentos puros dos ossos, como também assimetrias. Hoje é sabido que o planejamento manual ainda é usado, porém, vem caindo em desuso devido as suas limitações. A cirurgia virtual vem ganhando muito espaço e se superando a cada dia. Objetivo: relatar um caso de cirurgia ortognática em que a paciente era portadora de assimetria facial, planejada de forma manual (tradicional) e os erros encontrados após 04 anos, levando a uma re-operação baseada em planejamento virtual.
Introduction: the cases of facial asymmetry are considered the most complex within the scope of oral and maxillofacial surgery due to skeletal-morphological changes in the three planes of space (Pitch, Yaw and Roll). These plans were brought from the position of an aircraft in space to the world of surgery, specifically the virtual planning to break the limitations of manual planning and Erickson platform, used for decades to fix not only simple cases involving purê bone's movements as well as asymmetries. Today it is known that manual planning is still used, however, it has fallen into disuse because of its limitations. Virtual surgery is gaining a lot of space and surpassing every day. Objective: this article aims to report a case of orthognathic surgery in which the patient had facial asymmetry, planned manually (traditional) and the errors found after 04 years, leading to a virtual planning-based re-operation.
Subject(s)
Humans , Female , Middle Aged , Orthodontics/classification , Maxillofacial Abnormalities/diagnostic imaging , Orthognathic Surgical Procedures , Orthognathic Surgery , Tomography, X-Ray Computed/instrumentation , Technology, Dental/trends , Orthodontic Appliance Design , Dental Occlusion , Esthetics, Dental , Facial Asymmetry/diagnostic imaging , Genioplasty/rehabilitationABSTRACT
El avance tecnológico de la odontología ha permitido el desarrollo de nuevas técnicas en la implantología y así alcanzar una evolución en el tratamiento de los edéntulos totales. Dentro de estas técnicas se destaca la cirugía guiada, que consiste en la utilización de imágenes de tomografía computadorizada para simular la colocación de implantes en un programa virtual computadorizado, confeccion inicial de una guía quirúrgica y posterior colocación de los implantes oseointegrados sin necesidad de levantar un colgajo. Esta técnica presenta como grandes ventajas: una disminución del tiempo de tratamiento (quirúrgico y protésico), menor sangrado, ofrece una mayor previsibilidad y menor incomodidad en el post-operatorio. Este artículo tiene como objetivo describir en un relato de caso clínico la rehabilitación de un individuo edéntulo total maxilar con la técnica de cirugía guiada
The technological advancement in dentistry has enabled the development of new techniques in implantology and has allowed an evolution in the treatment of edentulous patients. Among these techniques is highlighted guided surgery, which is the use of computed tomography to provide images to a computer program to simulate implant placement and enable the production of a prototyped guide that will allow the correct installation without the need for surgical flap. Besides having as main advantages the shorter duration of surgery and treatment, the decrease in bleeding, provides greater predictability and less discomfort during and after surgery. This article aims to describe a clinical case of oral rehabilitation of an individual edentulous upper jaw with the technique of imediated loaded with guided surgery
Subject(s)
Humans , Male , Middle Aged , Surgery, Oral/methods , Dental Implants , Maxilla/surgery , Guided Tissue Regeneration, Periodontal/methods , Health Planning/methodsABSTRACT