Planejamento virtual em cirurgia ortognática de paciente padrão III assimétrico: avanços e limitações / Virtual planning in orthognathic surgery of pattern facial III asymmetric patient: advances and limitations / Planificación virtual en cirugía ortognática para pacientes con patrón asimétrico III: avances y limitaciones

Os avanços dos softwares cirúrgicos e de imagem permitiram a introdução do planejamento em ambiente tridimensional virtual em cirurgia ortognática, o qual tem auxiliado os cirurgiões na tomada de decisões. Nesse contexto, o objetivo deste trabalho é ilustrar um caso clínico de um paciente padrão face III assimétrico utilizando os recursos de diagnóstico e planejamento em ambiente virtual. Neste contexto, a evolução do planejamento virtual auxilia o cirurgião em casos complexos, entretanto é necessária uma curva de aprendizado e melhores estudos clínicos independentes, para avançarmos na obtenção de maior previsibilidade dos resultados em planejamentos em cirurgia ortognática em âmbito virtual... (AU)

Advances in surgical and imaging software allowed the introduction of three-dimensional virtual planning in orthognathic surgery, assisting surgeons in decision making. In this context, the objective was to demonstrate a case report of a facial pattern face III asymmetric patient using diagnostic tools and planning in virtual environment. In this context, the evolution of virtual planning helps the surgeon in complex cases, however, a learning curve and better independent clinical studies are necessary to advance in obtaining greater predictability of results in orthognathic surgery planning in a virtual environment... (AU)

Los avances en software quirúrgico y de imagen han permitido introducir la planificación en un entorno virtual tridimensional en cirugía ortognática, lo que ha ayudado a los cirujanos en la toma de decisiones. En este contexto, el objetivo de este trabajo es ilustrar un caso clínico de un paciente con patrón cara III asimétrico utilizando recursos de diagnóstico y planificación en un entorno virtual. En este contexto, la evolución de la planificación virtual ayuda al cirujano en casos complejos, sin embargo, es necesaria una curva de aprendizaje y mejores estudios clínicos independientes para avanzar en la obtención de una mayor previsibilidad de los resultados en la planificación de la cirugía ortognática en un entorno virtual... (AU)

Cirugía virtual guiada para rehabilitación implantosoportada de maxilar edéntulo con carga inmediata / Virtual guided surgery for implantsupported rehabilitation of the edentulous maxilla with immediate loading

Objetivo: Presentar el relato de un caso clínico de cirugía virtual guiada para rehabilitación implantosoportada de maxilar edéntulo con carga inmediata. Relato del caso: Paciente, edéntulo total en ambos maxilares, expresó su deseo de cambiar la prótesis total superior removible por una prótesis total fija sobre implantes. Durante la evaluación clínica, se observaron condiciones biológicas favorables al tratamiento como, adecuada faja de tejido queratinizado y leve reabsorción ósea. Como tratamiento se le sugiere al paciente, una planificación inversa, asistida por cirugía virtual guiada, utilizando un prototipo de guía quirúrgica para la colocación de seis implantes dentales en el maxilar y la instalación de una prótesis protocolo de carga inmediata. Conclusiones: Los resultados nos permiten concluir que la cirugía virtual guiada por computadora para rehabilitación protésica implantosoportada de maxilar edéntulo, con carga inmediata, proporciona precisión en los procedimientos quirúrgicos, es fundamental para la confección de prótesis inmediatas, representa una alternativa mínimamente invasiva y el resultado complace a los pacientes.

Objective: present the report of a clinical case of a virtual guided surgery for implant-supported rehabilitation of the edentulous maxilla with immediate loading. Case report: Patient, bi-maxillary edentulous expressed the desire to replace the removable upper total prothesis for a total fixed prothesis on implants. During the clinical evaluation, favorable biological conditions for treatment were observed, such as adequate keratinized tissue band and mild bone resorption. As part of the treatment, the patient was recommended a reverse planning approach, assisted by virtual guided surgery. This involved a prototype surgical guide for the fixation of six dental implants in the maxilla and the installation of an immediate loading protocol prosthesis. Conclusions: The results lead us to conclude that computer-guided virtual surgery for implant-supported prosthetic rehabilitation of the edentulous maxilla with immediate loading, provides a high precision in surgical procedures. It is essential to fabrication of immediate prostheses, represents a minimally invasive alternative, and results in patient satisfaction.

Cirurgia guiada em implantodontia: revisão integrativa / Guided surgery in implantodogy: integrative review

A cirurgia guiada estática se caracteriza por utilizar de um guia cirúrgico que tem como objetivo reproduzir a posição virtual ideal do implante, por meio de sítios criados para a inserção de uma série de brocas de acordo com a trajetória pré estabelecida pelo planejamento digital. Realizar uma revisão integrativa da literatura sobre cirurgia guiada estática em implantodontia, demonstrando sua importância, vantagens, desvantagens, limitações e complicações em comparação com técnica convencional. Tratou-se de uma revisão integrativa da literatura de natureza exploratória, realizada durante o período de agosto de 2021 e maio de 2022, a partir das produções científicas indexadas na base eletrônica da PubMed. Um total de 13 estudos foram incluídos após a seleção e suas evidências foram reunidas para esclarecer os objetos propostos. Os estudos demostraram que uma das principais vantagens da técnica guiada estática é a precisão em relação a técnica convencional e melhor pós operatório de dor relatado pelos pacientes. Não se pode confiar totalmente no processo de produção dos guias, devido o fator experiencia está associado, além que o custo e tempo dessa produção são elevados. Como complicação e limitação os estudos citam possibilidades de ocorrer mínimo acesso ao sítio cirúrgico e fratura do guia. A cirurgia guiada é uma excelente alternativa, as vantagens mais citadas são em relação a precisão, redução da dor, no entanto há fatores negativos como custo, a impossibilidade de mudança no transoperatório e possíveis erros de fabricação. Existem ainda limitações como fratura da guia e baixo acesso ao sítio cirúrgico.

Static guided surgery is characterized by using a surgical guide that aims to reproduce the ideal virtual position of the implant, through sites created for the insertion of a series of drills according to the trajectory pre-established by digital planning. Perform an integrative review of the literature on static guided surgery in implantodontia, demonstrating its importance, advantages, disadvantages, limitations and complications compared to conventional technique. This was an integrative review of the exploratory literature, carried out during the period of August 2021 and May 2022, from the scientific productions indexed in pubmed's electronic database. A total of 13 studies were included after selection and their evidence was gathered to clarify the proposed objects. Studies have shown that one of the main advantages of the static guided technique is accuracy in relation to the conventional technique and better postoperative pain reported by patients. One cannot fully trust the production process of the guides, due to the experience factor is associated, and the cost and time of this production are high. As a complication and limitation, studies mention possibilities of minimal access to the surgical site and fracture of the guide. Guided surgery is an excellent alternative, the most cited advantages are in relation to accuracy, pain reduction, however there are negative factors such as cost, the impossibility of change in the transoperative period and possible manufacturing errors. There are also limitations such as fracture of the guide and low access to the surgical site.

Comparison between flapless-guided and conventional surgery for implant placement: a 12-month randomized clinical trial.

OBJECTIVES: The study was aimed at comparing implants installed with guided and conventional surgery. MATERIAL AND METHODS: Twenty-nine total edentulous patients were selected, and maxillary contralateral quadrants were randomly assigned to static computer-aided implant surgery (S-CAIS): flapless computer-guided surgery, and conventional surgery (CS): flap surgery with conventional planning. Tomography scans were performed at baseline and 10 days after the surgery for deviation measurement, and radiography was done at baseline and after 6 and 12 months, for peri-implant bone level (PIBL) analysis. Peri-implant fluid and subgingival biofilm were collected to evaluate bone markers and periodontal pathogens. RESULTS: S-CAIS showed less linear deviation at the apical point and the midpoint and less angular deviation (p < 0.05), with greater depth discrepancy in the positioning of the platform (p < 0.05). Higher values of vertical PIBL were observed for the S-CAIS group at baseline (p < 0.05), while lower values of horizontal PIBL were observed for CS (p < 0.05). Bone markers and Tf presented higher levels in CS (p < 0.05). Flapless S-CAIS allowed smaller linear and angular deviations than the conventional technique. CONCLUSION: However, PIBL was higher in S-CAIS; the conventional technique led to a greater angiogenic and bone remodeling activity by elevating the angiogenic levels and bone markers. CLINICAL RELEVANCE: Evaluating the different implant insertion techniques can guide clinical and surgical regarding the accuracy, the release pattern of bone markers, and the peri-implant bone level. TRIAL REGISTRATION: ReBEC-RBR-8556fzp.

Accuracy of computer-assisted surgery in immediate implant placement: An experimental study.

Purpose: Computer-guided surgery has been increased in recent years. Nonetheless, few data are available on the validation of this technique for immediate implant placement. The purpose of this in vitro study was to evaluate the accuracy of computer-guided surgery in immediate implant placement. Materials and Methods: Cone-beam computed tomography scans (CBCTs) and virtual models were obtained of eight fresh pigs hemi-mandibles to perform the digital planning of implants placement. Fifteen implants were simulated, and surgical guides were designed to transfer the digital planning to the surgical procedure. Postsurgical CBCTs were performed to compare the position of the planned implants versus the real implant position. Paired t-test and the intra-class correlation coefficient (ICC) were used to assess the mean differences and correlations in each outcome variable evaluated twice by one experienced researcher. Furthermore, variations were compared with the results reported in the scientific literature using a one-sample t-test P < 0.05. Results: The measurements of the outcome variables (implants position at the neck and apex level and the angular deviation) showed significant reproducibility (mean difference-0.01 mm, 0.07 mm, and 0.30°, respectively, P > 0.05). The ICC values ranged from 0.888 to 0.949. Furthermore, the mean deviation was 1.43 mm at the implant neck, 2.19 mm at the apex, and 6.81° for the angular deviation. Similarly, significant differences (P < 0.05) were found at the neck and angular deviation when comparing the results with values reported in the literature. Conclusions: Although some variations were observed, they did not have a clinically significant impact. Therefore, computer-guided surgery could be satisfactorily used in immediate implants placement.

Acurácia de implantes imediatos instalados com cirurgia guiada ou convencional na região anterior de acordo com a experiência do cirurgião: estudo in vitro / Accuracy of immediate implants installed with guided or conventional surgery in the previous region according to the surgeon's experience: in vitro study

O objetivo deste estudo foi avaliar acurácia do posicionamento de implantes imediatos instalados na região anterior da maxila por meio de cirurgia guiada ou convencional de acordo com a experiência do cirurgião. Dez cirurgiões inexperientes e 10 cirurgiões experientes instalaram em modelos odontológico, um implante de forma guiada e convencional na região do dente 12 e 22, distribuídos aleatoriamente. A amostra foi composta por 4 grupos: experiente e guiado (EG), experiente e convencional (EC), inexperiente e guiado (IG) e inexperiente e convencional (IC) com 10 casos em cada grupo, totalizando 40 implantes. Foram impressos 20 modelos obtidos a partir do escaneamento de um manequim de treinamento padronizado (MOM). O modelo foi submetido a tomografia por feixe cônico e escaneado para planejamento da posição ideal do implante e obtenção das guias cirúrgicas, utilizando o software coDiagnostiX®. Após a instalação dos implantes foram obtidas novas tomografias dos modelos e a acurácia do posicionamento foi comparada ao planejamento inicial por meio da sobreposição das imagens nos sentidos global, e linear. Os dados obtidos foram tabulados e submetidos à análise estatística. Observamos diferenças estatísticas entre o tipo de cirurgia no grupo experiente no desvio angular e nos desvios lineares: plataforma tridimensional (P-3D), mesio distal (P-MD), vestíbulo palatino (P-VP),apical tridimensional (A-3D), mesio distal (A-MD), vestíbulo palatino (A-VP) e no grupodos cirurgiões inexperientes nos desvios lineares P-3D, P-MD, P-VP, A-3D, A-MD. Ao comparar a acurácia de acordo com a experiência do cirurgião, observamos diferenças significativas apenas na cirurgia convencional para os desvios de P-3D, PAC e A-AC. Concluímos que a acurácia dos implantes instalados de forma guiada foi maior independentemente do grau de experiência do cirurgião. (AU)

The objective of this study was to evaluate the accuracy of the positioning of immediate implants installed in the anterior region of the maxilla through guided or conventional surgery, according to the surgeon's experience. Ten inexperienced surgeons and 10 experienced surgeons installed, in dental models, an implant in a guided and conventional way in the region of tooth 12 and 22, randomly distributed. The sample consisted of 4 groups: experienced and guided (EG), experienced and conventional (EC), inexperienced and guided (IG) and inexperienced and conventional (IC) with 10 cases in each group, totaling 40 implants. Twenty models obtained from the scanning of a standardized training manikin (MOM) were printed. The model was submitted to cone beam tomography and scanned to plan the ideal position of the implant and obtain the surgical guides, using the coDiagnostiX® software. After implant placement, new tomography scans of the models were obtained and the positioning accuracy was compared to the initial planning by superimposing the images in the global and linear directions. The data obtained were tabulated and submitted to statistical analysis. We observed statistical differences between the type of surgery in the group experienced in angular deviation and linear deviations: three-dimensional platform (P-3D), mesiodistal (P-MD), palatal vestibule (P-VP), three-dimensional apical (A-3D), mesiodistal (A-MD), vestibule palatine (A-VP) and in the group of inexperienced surgeons in linear deviations P-3D, P-MD, P-VP, A-3D, A-MD. When comparing the accuracy according to the surgeon's experience, we observed significant differences only in conventional surgery for P-3D, P-AC and A-AC deviations. We concluded that the accuracy of guided implants was higher regardless of the surgeon's experience. (AU)

Total Temporomandibular Joint Replacement and Simultaneous Orthognathic Surgery Using Computer-Assisted Surgery.

BACKGROUND: Disorders of the temporomandibular joint (TMJ) are frequent and are usually associated with other disorders of the facial skeleton. Surgery might be needed to correct TMJ anatomy and function and, in cases where pathologies coexist, a two-stage corrective surgery might be needed. However, the current fashion of single-stage procedures is feasible with the aid of new technologies such as computer-assisted surgery (CAS). This is a step forward toward performing complex procedures such as a TMJ replacement with simultaneous orthognathic surgery. CAS allows designing patient-fitted prosthesis and more predictable and accurate surgeries. Moreover, intraoperative development can be controlled in real time with intraoperative navigation, and postoperative results can be measured and compared afterwards. AIMS: The primary purpose of this article is to present the protocol used in our institution for orthognathic surgery associated with unilateral and bilateral TMJ replacement with patient-fitted prostheses guided with CAS. MATERIALS AND METHODS: We present two cases to illustrate our protocol and its results. RESULTS: In the first case, the difference in millimeters between planning and surgical outcomes was 1.72 mm for the glenoid component and 2.16 mm for the condylar prosthesis; for the second case, differences in the right side were 2.59 mm for the glenoid component and 2.06 mm for the ramus, and in the left side, due to the anatomy the difference was a little greater, without clinical significance. CONCLUSION: Combined surgery of the midface and mandible with total TMJ replacement is feasible and beneficial for the patient. CAS facilitates the planning and design of custom-fit prosthesis and execution of these procedures.

Use of a stackable surgical guide to improve the accuracy of the lateral wall approach for sinus grafting in the presence of a sinus septum.

The identification and management of interfering maxillary sinus septa is essential to anticipate and prevent membrane perforation and other complications during sinus grafting. A computer-guided sinus approach based on a new magnetic stackable surgical guide was planned, to transfer the exact position of the septum and optimize the positioning of the lateral access windows. This technique reduces the risk of sinus membrane injury, thereby increasing the safety and efficacy of the procedure.

Use of a Low-Cost Portable 3D Virtual Reality Simulator for Psychomotor Skill Training in Minimally Invasive Surgery: Task Metrics and Score Validity.

BACKGROUND: The high cost and low availability of virtual reality simulators in surgical specialty training programs in low- and middle-income countries make it necessary to develop and obtain sources of validity for new models of low-cost portable simulators that enable ubiquitous learning of psychomotor skills in minimally invasive surgery. OBJECTIVE: The aim of this study was to obtain validity evidence for relationships to other variables, internal structure, and consequences of testing for the task scores of a new low-cost portable simulator mediated by gestures for learning basic psychomotor skills in minimally invasive surgery. This new simulator is called SIMISGEST-VR (Simulator of Minimally Invasive Surgery mediated by Gestures - Virtual Reality). METHODS: In this prospective observational validity study, the authors looked for multiple sources of evidence (known group construct validity, prior videogaming experience, internal structure, test-retest reliability, and consequences of testing) for the proposed SIMISGEST-VR tasks. Undergraduate students (n=100, reference group), surgical residents (n=20), and experts in minimally invasive surgery (n=28) took part in the study. After answering a demographic questionnaire and watching a video of the tasks to be performed, they individually repeated each task 10 times with each hand. The simulator provided concurrent, immediate, and terminal feedback and obtained the task metrics (time and score). From the reference group, 29 undergraduate students were randomly selected to perform the tasks 6 months later in order to determine test-retest reliability. RESULTS: Evidence from multiple sources, including strong intrarater reliability and internal consistency, considerable evidence for the hypothesized consequences of testing, and partial confirmation for relations to other variables, supports the validity of the scores and the metrics used to train and teach basic psychomotor skills for minimally invasive surgery via a new low-cost portable simulator that utilizes interaction technology mediated by gestures. CONCLUSIONS: The results obtained provided multiple sources of evidence to validate SIMISGEST-VR tasks aimed at training novices with no prior experience and enabling them to learn basic psychomotor skills for minimally invasive surgery.

Use of a Low-Cost Portable 3D Virtual Reality Gesture-Mediated Simulator for Training and Learning Basic Psychomotor Skills in Minimally Invasive Surgery: Development and Content Validity Study.

BACKGROUND: Simulation in virtual environments has become a new paradigm for surgeon training in minimally invasive surgery (MIS). However, this technology is expensive and difficult to access. OBJECTIVE: This study aims first to describe the development of a new gesture-based simulator for learning skills in MIS and, second, to establish its fidelity to the criterion and sources of content-related validity evidence. METHODS: For the development of the gesture-mediated simulator for MIS using virtual reality (SIMISGEST-VR), a design-based research (DBR) paradigm was adopted. For the second objective, 30 participants completed a questionnaire, with responses scored on a 5-point Likert scale. A literature review on the validity of the MIS training-VR (MIST-VR) was conducted. The study of fidelity to the criterion was rated using a 10-item questionnaire, while the sources of content-related validity evidence were assessed using 10 questions about the simulator training capacity and 6 questions about MIS tasks, and an iterative process of instrument pilot testing was performed. RESULTS: A good enough prototype of a gesture-based simulator was developed with metrics and feedback for learning psychomotor skills in MIS. As per the survey conducted to assess the fidelity to the criterion, all 30 participants felt that most aspects of the simulator were adequately realistic and that it could be used as a tool for teaching basic psychomotor skills in laparoscopic surgery (Likert score: 4.07-4.73). The sources of content-related validity evidence showed that this study's simulator is a reliable training tool and that the exercises enable learning of the basic psychomotor skills required in MIS (Likert score: 4.28-4.67). CONCLUSIONS: The development of gesture-based 3D virtual environments for training and learning basic psychomotor skills in MIS opens up a new approach to low-cost, portable simulation that allows ubiquitous learning and preoperative warm-up. Fidelity to the criterion was duly evaluated, which allowed a good enough prototype to be achieved. Content-related validity evidence for SIMISGEST-VR was also obtained.

Accuracy of 3D virtual surgical planning for maxillary positioning and orientation in orthognathic surgery.

OBJECTIVE: This retrospective and observational study evaluated the accuracy of a 3D virtual surgical planning (VSP) for the maxillary positioning and orientation in patients undergoing bimaxillary orthognathic surgery, comparing the planned and postoperative outcomes. SETTING AND SAMPLE POPULATION: Seventy consecutive patients of both sexes, who were submitted to bimaxillary orthognathic surgery between 2015 and 2019 were included in our study. MATERIAL AND METHODS: The patients were evaluated by fusing preoperative planning and postoperative outcome using cone-beam computed tomography scan evaluation. Three-dimensional VSP and postoperative outcomes were compared by using three linear and three angular measurements. The main outcome interest was the difference between the VSP movement, and the surgical movement obtained. The success criterion adopted was a mean linear difference of <2 mm and a mean angular difference of <4°. RESULTS: Results were analysed using a linear mixed model with fixed and random effects, at α = .05. No significant statistical differences were found for linear and angular measurements between the planned and postsurgical outcomes (P > .05). All overlapping points presented values within the range considered clinically irrelevant (<2 mm; <1°). CONCLUSIONS: Three-dimensional VSP was executed with a high degree of accuracy. When comparing the planned and postsurgical outcomes, all overlapping points presented values within the range considered clinically irrelevant.

Clinical and tomographic comparison of dental implants placed by guided virtual surgery versus conventional technique: A split-mouth randomized clinical trial.

AIM: Our objective was to compare guided virtual surgery to conventional surgery in terms of angular deviation of single dental implants placed in the posterior mandible. MATERIALS AND METHODS: Patients with bilateral homologous single teeth missing in the posterior mandible were eligible for this split-mouth randomized clinical trial. Cone beam computed tomography (CBCT) was performed for virtual planning of implant position and manufacturing of the stereolithographic guides. One week after the surgery, a second CBCT scan was superimposed to the initial planning. Primary endpoint was the angular deviation between virtual and clinical implant position. Secondary endpoints were linear deviations and patient-reported outcomes collected with a questionnaire. RESULTS: Data from 12 patients were available for analysis. Angular deviation was significantly lower using stereolithographic guides as compared to conventional guides (2.2 ± 1.1° vs. 3.5 ± 1.6°, p = .042). Linear deviations were similar for both techniques in the coronal (2.34 ± 1.01 vs. 1.93 ± 0.95 mm) and apical (2.53 ± 1.11 vs. 2.19 ± 1.00 mm) dimensions (p Ëƒ .05). The selection of the surgical technique had no significant impact on the patient-reported outcomes. CONCLUSION: Our data suggest that the angular discrepancy between the virtual and the clinical implant position is slightly lower when using stereolithographic guides as compared to conventional guides.

A novel device for greater precision and safety in open-wedge high tibial osteotomy: cadaveric study.

INTRODUCTION: The complications of the open-wedge osteotomy technique (slope, hypo- and hypercorrection and fractures) are related to difficulties in the control of the open-wedge angle during surgery. MATERIALS AND METHODS: In this cadaveric study, we evaluated the safety and precision of a novel system, the Realignment High Control System (RHC), in the correction of knee mechanical axis and slope. The RHC has a fixation plate coupled to a dynamic device that opens the osteotomy continuously, allowing plate fixation before osteotomy wedge opening. RESULTS: All procedures were easily performed, with no fractures. The openings equaled the indicated by the navigation system for 7.5° and 10°, and for 5°, there was a statistically, although not clinically significant, difference of 0.6°. The slope shown by the RHC setting and in the navigation system was significantly different for the 10° setting only, with a mean difference of 0.563°. CONCLUSIONS: RHC facilitates the surgical technique of high tibial osteotomy, with gradual wedge opening, precise correction of the mechanical axis, and appropriate control of the tibial slope, even with larger openings.

Uso do guia cirúrgico duplo periodontal para aumento de coroa clínica ­ relato de caso / Dual periodontal surgical guide use for clinical crown increase ­ case report

Com a evolução da odontologia digital, muitos programas de planejamento virtual, scanners intraorais e métodos CAD-CAM têm sido desenvolvidos com o intuito de auxiliar o desenvolvimento e a confecção de guias cirúrgicos prototipados, tanto para a implantodontia quanto para a periodontia, visando permitir que as terapias de reabilitação dental sejam realizadas com maior segurança e previsibilidade. Uma reabilitação estética de sucesso dos pacientes com excesso de exibição gengival e coroas clínicas curtas requer uma abordagem interdisciplinar e sintonia entre o periodontista e o protesista, pois devolver simetria gengival e harmonia ao sorriso é uma tarefa árdua e minuciosa. Dessa forma, o objetivo deste trabalho é relatar um caso clínico de aumento de coroa, utilizando o fluxo de trabalho digital com o uso do guia duplo periodontal. (AU).

The evolution of digital dentistry, many virtual planning programs, intraoral scanners and CAD-CAM methods have been developed with the purpose of assisting the development and production of prototyped surgical guides for both implantology and periodontics, in order to allow that dental rehabilitation therapies are performed with greater safety and predictability. Successful aesthetic rehabilitation of patients with excessive gingival display and short clinical crowns requires an interdisciplinary approach and attunement between the periodontist and the prosthodontist, as returning gingival symmetry and harmony to the smile is an arduous and meticulous task. Thus, the objective of this work is to report a clinical case of Crow increase, using digital workflow with Double periodontal guide.

Cirurgia guiada de implante dentário ­ relato de caso / Guided dental implant surgery ­ case report

Uma das opções para o tratamento com implantes é o implante dentário guiado, conhecido também como cirurgia guiada por computador, que consiste em uma técnica realizada primeiramente de forma digital, no computador, através de uma tomografia computadorizada cone beam da arcada dentária. Após o planejamento cirúrgico digital, o implante é realizado através de um guia cirúrgico prototipado. Dessa forma, não há necessidade de cortes e incisões na gengiva, apenas pequenas perfurações nos tecidos moles da arcada dentária. Este artigo relata um caso clínico de implante dentário guiado (AU).

One of the options for the treatment with implants is the guided dental implant, also known like computer guided surgery, that consists of a technique realized first of digital form in the computer, through a computed tomography cone beam of the dental arcade. After the digital surgical planning, the implant is performed through a prototype surgical guide. In this way, there is no need for cuts and incisions in the gum, only small perforations in the soft tissues of the dental arch. This paper reports a clinical case of guided dental implant (AU).

Fluxo digital facilitando a cirurgia guiada com implante, pilar personalizado e provisório imediato / Digital workflow in a guided surgery with customized abutment and immediate provisional

Apresentaremos um fluxo de trabalho totalmente digital na reabilitação de um dente anterior que possa ser facilmente reproduzido e com resultados clínico e radiográfico satisfatórios. Será demonstrado como a Odontologia digital pode ajudar os dentistas na reabilitação com implantes, desde a cirurgia guiada até o pilar personalizado e restaurações fresadas. Paciente do sexo feminino, 57 anos, procurou atendimento em uma clínica privada em Porto Alegre, Brasil, para atendimento odontológico. Após avaliação clínica e radiográfica, observou-se fratura da raiz do dente 11 e a necessidade de extração do mesmo, planejando a instalação de um implante na região. Foi realizada impressão digital (Trios, 3 Shape, Copenhague, Dinamarca) e a tomografia computadorizada foi solicitada. As imagens foram importadas para o software coDiagnostiX (Dental Wings, Chemnitz, Alemanha) e uma cirurgia guiada foi planejada. Após o planejamento cirúrgico no software, a imagem STL com posição do implante foi exportada e aberta no software Dental System (3 Shape) para a personalização do pilar em zircônia sobre uma base de titânio (Neodent, Curitiba, Brasil). Além disso, o provisório foi projetado para ser fresado em PMMA. O guia cirúrgico foi impresso no P-Series (Rapidshape, Heimsheim, Alemanha), e o pilar de zircônia e o provisório foram fresados (DM5, Tecnodrill, Brasil). Sob anestesia local, o dente foi extraído com extrator e o implante (GM Drive, Neodent) foi instalado. O gap foi preenchido com Cerabone (Straumann), o pilar foi instalado e o provisório foi cimentado. Um tratamento rápido e confiável foi realizado, permitindo a instalação previsível do implante (AU).

This study presents a fully digital workflow in the rehabilitation of an anterior teeth that can be easily reproduced and shows a great clinical and radiographic outcome. It will be demonstrated how digital Dentistry can help dentists in the rehabilitation with implants, from guided surgery to customized abutment and milled restorations. A 57-year-old woman sought dental care in a private clinic in Porto Alegre, Brazil. After clinical and radiographic assessment, root fracture of an upper right incisor was observed, and the need for its extraction, immediate implant placement was chosen as the treatment plan. Digital impression (Trios, 3 Shape, Denmark) was performed and a CBCT was requested. Images were imported to coDiagnostiX software (Dental Wings, Chemnitz, Alemanha) and a guided surgery was planned. After implant planning in the software, the STL image with the implant position was exported and opened in the Dental System software (3 Shape) for abutment customization in zirconium over a titanium base (Neodent, Curitiba, Brazil). Also, the temporary crown was designed to be milled in PMMA. Surgical guide was printed in P-Series (Rapidshape, Heimsheim, Alemanha), and the zirconium abutment and the provisional were milled (DM5, Tecnodrill, Brazil). Patient was scheduled for surgery and under local anesthesia the tooth was extracted with extractor. Implant (GM Drive, Neodent) was placed and the gap was filled with Cerabone (Straumann), abutment was installed and the provisional was cemented. A fast and reliable treatment was conducted, allowing a predictable implant placement (AU).

Uso do guia cirúrgico duplo periodontal para aumento de coroa clínica ­ relato de caso / Dual periodontal surgical guide use for clinical crown increase ­ case report

Com a evolução da odontologia digital, muitos programas de planejamento virtual, scanners intraorais e métodos CAD-CAM têm sido desenvolvidos com o intuito de auxiliar o desenvolvimento e a confecção de guias cirúrgicos prototipados, tanto para a Implantodontia quanto para a eriodontia, visando permitir que as terapias de reabilitação dental sejam realizadas com maior segurança e previsibilidade. Uma reabilitação estética de sucesso dos pacientes com excesso de exibição gengival e coroas clínicas curtas requer uma abordagem interdisciplinar e sintonia entre o periodontista e o protesista, pois devolver simetria gengival e harmonia ao sorriso é uma tarefa árdua e minuciosa. Dessa forma, o objetivo deste trabalho é relatar um caso clínico de aumento de coroa, utilizando o fluxo de trabalho digital com o uso do guia duplo periodontal (AU).

The evolution of digital Dentistry, many virtual planning programs, intraoral scanners and CAD-CAM methods have been developed with the purpose of assisting the development and production of prototyped surgical guides for both Implantology and Periodontics, in order to allow that dental rehabilitation therapies are performed with greater safety and predictability. Successful aesthetic rehabilitation of patients with excessive gingival display and short clinical crowns requires an interdisciplinary approach and attunement between the periodontist and the prosthodontist, as returning gingival symmetry and harmony to the smile is an arduous and meticulous task. Thus, the objective of this work is to report a clinical case of crown increase, using digital workflow with double periodontal guide (AU).

Osteoma osteoide de cuello femoral. A propósito de un caso / Femoral neck osteoid osteoma: about a case

El osteoma osteoide es un tumor óseo benigno, de pequeño tamaño, sin potencial de crecimiento. Habitualmente se considera a los tumores óseos benignos y malignos como una causa poco frecuente de cojera en apirexia, siendo más frecuentes las patologías inflamatorias inespecíficas como la sinovitis transitoria de cadera, la enfermedad de Perthes y la condropatía conjugal del adolescente. Se presenta el caso clínico de un escolar de 8 años con una cojera dolorosa en apirexia de 4 meses de evolución con sospecha imagenológica de osteoma osteoide de cuello de fémur. Se decide realizar prueba terapéutica con ácido acetilsalicílico. A las 24 horas el niño se encontraba asintomático. Se indicó procedimiento quirúrgico de resección mediante punción bajo tomografía axial computada. El diagnóstico se confirmó mediante anatomía patológica. Se realizó resección completa del tumor con buena evolución. Es importante desde el punto de vista pediátrico realizar un correcto diagnóstico diferencial entre las diferentes causas de cojera dolorosa en apirexia, basándonos en la historia clínica y la imagenología.

Osteoma osteoide de cuello femoral: A propósito de un caso / Femoral neck osteoid osteoma: about a case

El osteoma osteoide es un tumor óseo benigno, de pequeño tamaño, sin potencial de crecimiento. Habitualmente se considera a los tumores óseos benignos y malignos como una causa poco frecuente de cojera en apirexia, siendo más frecuentes las patologías inflamatorias inespecíficas como la sinovitis transitoria de cadera, la enfermedad de Perthes y la condropatía conjugal del adolescente. Se presenta el caso clínico de un escolar de 8 años con una cojera dolorosa en apirexia de 4 meses de evolución con sospecha imagenológica de osteoma osteoide de cuello de fémur. Se decide realizar prueba terapéutica con ácido acetilsalicílico. A las 24 horas el niño se encontraba asintomático. Se indicó procedimiento quirúrgico de resección mediante punción bajo tomografía axial computada. El diagnóstico se confirmó mediante anatomía patológica. Se realizó resección completa del tumor con buena evolución. Es importante desde el punto de vista pediátrico realizar un correcto diagnóstico diferencial entre las diferentes causas de cojera dolorosa en apirexia, basándonos en la historia clínica y la imagenología.

Osteoid osteomas are small benign bone tumors which lack growth potential. All bone tumors, whether benign or malign, are considered a rare cause of apyretic limping, being non-specific inflammatory diseases more frequent, such as transient synovitis of the hip, Perthes disease and adolescent conjugal chondropathy. The study presents the clinical case of an 8 year old school boy with a 4 month evolution painful apyretic limp, being there a suspicion of femoral neck osteoid osteoma according to imaging studies. Therapeutic trial of acetylsalicylic acid was performed. Twenty four hours later the boy was asymptomatic. A tomography-guided puncture was indicated. Clinical diagnosis was pathologically confirmed. Subsequently, complete surgical resection of the tumor was performed, the evolution being favorable. From a pediatric perspective it is important to make an accurate differential diagnosis between the different possible causes of painful apyretic limp, based on clinical history and imaging studies.

Fluxo de trabalho para aplicação da técnica de cirurgia guiada em reabilitação total de maxila / Workflow for guided implant surgery (GIS) in full arch maxillary rehabilitation

A aplicação de um fluxo digital é um recurso cada vez mais utilizado na Implantodontia. A técnica de cirurgia guiada tem evoluído constantemente, acompanhando os avanços de hardwares e softwares aplicados na Odontologia, resultando no aumento da indicação e precisão dos guias cirúrgicos obtidos. O objetivo deste trabalho foi, através de um relato de caso clínico, demonstrar o fluxo de trabalho utilizado para aplicação da técnica de cirurgia guiada em reabilitação total de maxila, utilizando o software coDiagnostiX (Dental Wings, Chemnitz, Alemanha). Após as etapas de preparo pré-tomográfico, obtenção da digitalização de superfície, aquisições tomográficas e planejamento virtual, foram instalados seis implantes cone-morse (Neodent, Curitiba, Brasil), com a utilização de um guia cirúrgico obtido por impressão 3D. Após o período de osseointegração, foi instalada uma prótese fixa implantossuportada. O planejamento virtual em software específico, através da digitalização de superfície associada à tomografia computadorizada de feixe cônico (TCFC), propõe um diagnóstico previsível, seguro e a possibilidade de oferecer maior segurança e precisão nas reabilitações com implantes osseointegrados.

The application of a digital workflow is an increasingly used resource in Implantology. The guided implant surgery (GIS) has constantly evolved, following the advances of hardware and software applied in Dentistry, resulting in an increase in the indication and precision of the surgical guides. The objective of this article is, through a clinical case report, to demonstrate a workflow used to apply guided surgery technique in full-arch maxillary rehabilitation using the coDiagnostiX software (Dental Wings, Chemnitz, Germany). After the pre-tomographic preparation, surface scanning, tomographic acquisitions and virtual planning, six morse taper implants (Neodent, Curitiba, Brazil) were placed using a surgical guide obtained by 3D printing. After a period of osseointegration, a implant supported fixed prosthesis was placed. The virtual planning in specific software, through surface scanning associated with cone beam computed tomography (CBCT), proposes a predictable, safe diagnosis and the possibility of offering greater safety and precision in the rehabilitations with osseointegrated implants.