Accuracy and Precision of Haptic Robotic-Guided Implant Surgery in a Large Consecutive Series.

PURPOSE: To determine the accuracy of dental implant placement using haptic robotic guidance in a large clinical series. MATERIALS AND METHODS: In a prospective single-arm clinical study, 108 patients received 273 individual endosteal implants. A virtual preoperative restorative and surgical plan was created from a CBCT scan and matched to the surgical workspace on the day of surgery via either a tooth-based or bone-based fiducial splint. Intraoperatively, the surgeon manipulated a handpiece attached to a haptic robotic guidance arm. A variety of drills and implants were used. Both the osteotomy and the implant placement were guided by 3D haptic constraints according to the virtual plan. Postoperative CBCT scans permitted the calculation of the actual implant placement deviations compared to the plan for accuracy. Precision was calculated by comparing SDs from published literature. RESULTS: The implants were evenly distributed by arch, with 47% placed in the maxilla and 53% in the mandible. The mean ± SD signed depth deviation was 0.14 ± 0.87 mm proud. The global angular deviation averaged 1.42 ± 1.53 degrees, with 95% confidence limits of 1.24 and 1.60 degrees. The crown of the actual placed implant showed an average deviation from the plan of 1.10 ± 0.69 mm and the apex of the placed implant showed a deviation of 1.12 ± 0.69 mm. Haptic robotic guidance showed greater precision than freehand, static computerguided, and dynamic computer-guided implant placement. CONCLUSIONS: This large clinical series of 273 implants shows a high accuracy of implant placement compared to the published accuracy for angular deviations for any technology, as well as demonstrating statistically greater precision. Long-term clinical studies are necessary to establish the true effect of increased accuracy on clinical outcomes. Using haptic robotic guidance provides accurate implant placement while allowing additional benefits compared to computer-guided surgery, namely full visualization of the surgical field and the ability to change the plan intraoperatively.

What Is the Accuracy of Bimaxillary Orthognathic Surgery Using Occlusally-Based Guides and Patient-Specific Fixation in Both Jaws? A Cohort Study and Discussion of Surgical Techniques.

PURPOSE: The development of advanced digital orthognathic surgical protocols requires investigation to determine the accuracy of surgical outcomes. This report's purpose is to quantify 3-dimensional linear discrepancies between simulated and actual results for double-jaw orthognathic surgery utilizing occlusally-based guides in conjunction with patient-specific fixation in both jaws. METHODS: This retrospective cohort study assessed the accuracy of double-jaw orthognathic surgery, in all cases performed by 1 surgeon between May 2019 and January 2021, utilizing occlusally-based guides and patient-specific fixation plates in both maxillary and mandibular surgeries. The primary outcome was absolute linear discrepancy between virtually-planned and surgically-achieved maxillary and mandibular position in 3 dimensions. Secondary outcomes were relative (directional) discrepancy, to assess if protocols erred in 1 direction of each surgical axis. Sequencing of bimaxillary surgery, age, and sex were covariates. Absolute and relative linear differences at A-point, B-point, and pogonion were evaluated using t tests. Descriptive statistics were amassed, and results were analyzed to determine if discrepancies differed from a null hypothesis of 2-mm error. RESULTS: Forty-nine patients were enrolled, consisting of 25 males and 24 females with a mean age of 24.8 years. Thirty-five single-piece and 14 multipiece LeFort I osteotomies, 49 bilateral sagittal splits, and 35 genioplasties were studied; there were 22 maxilla-first and 27 mandible-first surgeries. Mean A-point absolute discrepancies of 0.57 (95% confidence interval: 0.41-0.73), 0.37 (0.24-0.50), and 0.45 (0.33-0.57) mm were observed in horizontal, transverse, and vertical planes, respectively. B-point discrepancies were 1.15 (0.79-1.52), 0.62 (0.47-0.78), and 1.14 (0.91-1.38) mm. Pogonion discrepancies were 1.29 (0.86-1.73), 0.85 (0.64-1.06), and 1.24 (1.00-1.49) mm. All P values were <.001. Sequencing of bimaxillary surgery did not alter absolute differences (P = .2 to >.9) with A-point discrepancies consistently smaller than B-point and pogonion discrepancies regardless of sequencing. Mandible-first surgery was associated with posterior directional error; both sequences were associated with superior directional error at B-point and pogonion. CONCLUSION: Bimaxillary orthognathic surgery utilizing a patient-specific protocol in both jaws produces results highly reproducible to planned simulated surgery and accurate below a 2-mm hypothesis, with maxillary discrepancies approaching 0.5 mm and mandibular discrepancies approaching 1 mm.

Polysomnography-guided mandibular distraction osteogenesis in Pierre Robin sequence patients.

STUDY OBJECTIVES: Craniofacial malformations with micrognathia cause high grades of obstructive sleep apnea (OSA) measured by polysomnography (PSG). Mandibular distraction osteogenesis is a novel procedure for upper airway obstruction relief. Our primary objective was to describe the utilization of PSGs to improve obstruction in patients undergoing mandibular distraction. METHODS: This is a retrospective study. Patients with micrognathia and severe upper airway obstruction, presenting with severe OSA diagnosed by PSG, were included from a single tertiary care center between 2015 and 2019. PSGs were done (1) prior to surgery, (2) once the cosmetic goal was achieved (Post-Op 1), and (3) if residual moderate-to-severe OSA was seen, every 2 nights until mild or no OSA was achieved (Post-Op 2). RESULTS: Thirteen patients were included. The median age at surgery was 1.1 months (10 days-3 months). All 13 patients had baseline severe OSA, with a median obstructive apnea-hypopnea index of 33 events/h and a median O2 nadir of 73%. Post-Op 1 PSG was done at a median of 6 days after surgery. Median first postoperative obstructive apnea-hypopnea index in all 13 patients was 6.8 events/h, with a median O2 nadir of 87%. A median additional distraction of 3 mm was needed beyond the traditionally recommended advancement. Long-term follow-up studies at or after 1 year were done in 5 patients, all showing persistent nonsevere OSA. CONCLUSIONS: This is the first case series utilizing PSGs as a guide for mandibular distraction osteogenesis in patients with micrognathia showing the need for jaw overcorrection to achieve resolution of OSA. CITATION: Kochhar R, Modi V, de Silva N, et al. Polysomnography-guided mandibular distraction osteogenesis in Pierre Robin sequence patients. J Clin Sleep Med. 2022;18(7):1749-1755.

Two Bilateral Zygomatic Implants Placed and Immediately Loaded: A Retrospective Chart Review with Up-to-54-Month Follow-up.

PURPOSE: To report on the outcome of placement of two bilateral zygomatic implants with an immediately loaded prosthesis. MATERIALS AND METHODS: A retrospective chart review was conducted of all patients treated with zygomatic implants between August 1, 2011 and June 6, 2016. All patients had at least two zygomatic implants placed bilaterally and immediately loaded with a provisional prosthesis the same day of implant placement. The implants were Nobel Biocare TiUnite or machined surface with lengths of 30 to 52.5 mm. All patients were treated by a team consisting of one surgeon, a restorative dentist or prosthodontist, an anesthesiologist, and a laboratory technician. Implant success was defined as successful integration of the implant; prosthetic success was defined as retention of the prosthesis under normal function. RESULTS: One hundred five zygomatic implants were placed and immediately loaded in 28 patients over a period of 1 to 60 months. Ages ranged from 46 to 81 years, with 26 female and 2 male patients. All the implants were placed by one surgeon. The immediate load on the day of implant placement was completed by either one of 2 prosthodontists or 11 restorative dentists. Implant success was 96% (101/105). All four failed implants were in one patient and were TiUnite surface coated. CONCLUSION: This study demonstrated that two zygomatic implants bilaterally placed and immediately loaded with a full-arch splinted prosthesis will provide a predictable outcome.

Immediate loading of zygomatic implants: A systematic review of implant survival, prosthesis survival and potential complications.

STATEMENT OF PROBLEM: Zygomatic implants have been utilised for the treatment of the severely atrophic maxilla since 1998. However, few articles exist as to the success of zygomatic implants and immediate loading of its prosthesis. AIM: To systematically review the outcome of immediate loaded zygomatic implants. MATERIALS AND METHODS: An electronic PubMed search was performed to identify case reports, prospective and retrospective studies of immediately loaded zygomatic implants with a mean follow-up of 12 months. Assessment of the identified studies was performed using the Delphi method. Reviewers independently assessed the articles for inclusion, with a facilitator coordinating responses. A consensus was reached on the articles that were included. RESULTS: The search provided 236 titles for immediately loaded zygomatic implants and resulted in 106 abstracts for analysis. Full-text analysis was performed on 67 articles, resulting in the inclusion of 38 articles for this systematic review. CONCLUSION: Based on the present systematic review, the authors report that immediately loading zygomatic implants for the restoration of the severely atrophic maxilla presents a viable alternative for treatment of the atrophic maxilla.

Surgery of the head and neck in patient with Kniest dysplasia: Is wound healing an issue?

Kniest dysplasia is a type II collagen disorder that arises from a genetic mutation of the COL2A1 gene that results in short stature, midface anomalies, tracheomalacia, and hearing loss. Disruption of the normal collagen pathway can lead to many changes given its critical role in the body, and can cause complications with respect to wound healing. We present a case in which a patient with Kniest dysplasia successfully underwent multiple procedures in the head and neck region including cochlear implantation, mandibular distraction, palatoplasty, and laryngotracheal reconstruction. All procedures did not have any associated complications with respect to wound healing, indicating that surgery in this population can take place as indicated and surgery should not be contraindicated or delayed.