Does computer-assisted navigation improve baseplate screw configuration in reverse shoulder arthroplasty? A systematic review and meta-analysis of comparative studies.

Introduction: Navigation technologies have improved accuracy and precision in positioning glenoid components during shoulder arthroplasty. The influence of navigation on baseplate screw placement has not been independently investigated. This study aimed to evaluate and synthesize the best scientific evidence on the influence of intraoperative navigation on the length and number of screws for primary baseplate fixation in reverse total shoulder arthroplasty procedures. Methods: In August 2022, PubMed, Scopus, and Embase databases were accessed. We analyzed the screw purchase length, the number of screws required for the fixation of the baseplate, and the proportion of cases fixed with two screws in all clinical trials, comparing navigation to standard instrumentation for reverse shoulder arthroplasty. Following an evaluation of the heterogeneity of the studies, DerSimonian-Laird random-effects models were utilized to merge data from separate studies. Results: The systematic search revealed a total of 2034 articles. After excluding duplicates and irrelevant studies, 633 shoulder arthroplasties from 6 trials were included in the analysis. The pooled mean difference in screw purchase length was 5.839 mm (95 %CI 4.496 to 7. 182) in favor of navigation (P < .001). In addition, significant differences were also found in the number of screws per case (- 0.547, 95 %CI -0.890 to -0.203, P = .002) and in the proportion of cases fixed with two screws (Odds Ratio 3.182 95 %CI 1.057 to 9.579, P = .040) in favor of the navigation group. Conclusions: Intraoperative navigation improves the baseplate screw placement, allowing for a greater screw purchase length and fewer screws to achieve primary fixation of the glenoid component during reverse shoulder arthroplasty. It is unclear whether these improvements will increase the longevity of the prosthesis or the clinical outcomes of the patients.

Planejamento virtual em cirurgia ortognática: relato de caso / Virtual planning for orthognathic surgery: case report / Planificación virtual en cirugía ortognática: reporte de caso

Introdução: A correção das deformidades dentofaciais depende do bom diagnóstico, da precisão do planejamento e da correta execução da técnica cirúrgica. Buscando maior precisão, o planejamento virtual para cirurgia ortognática tem sido uma ferramenta amplamente aplicada pela cirurgia bucomaxilofacial. Este trabalho demonstra, por meio de caso clínico, os benefícios adquiridos pelo planejamento virtual, no que diz respeito a quantificação do movimento, avaliação da predição dos tecidos moles e osteotomias, assim como discorre sobre os cuidados e passos necessários para um correto planejamento. Relato do caso: Paciente de perfil classe II, submetida ao protocolo de planejamento virtual com aquisição de imagens tomográficas, escaneamento intraoral e utilização de software digital para avaliação diagnóstica, planejamento e impressão dos guias cirúrgicos. A mesma foi acompanhada durante 3 meses de pós operatório, apresentando boa precisão e previsibilidade nos movimentos cirúrgicos realizados. Discussão: Ao se realizar uma avaliação clínica acurada, somada a aquisição de imagens tridimensionais, a partir das tomografias de face, escaneamentos intraorais e o manejo da tecnologia CAD/CAM, é possível se alcançar maior precisão no planejamento e predictibilidade cirúrgica, bem como realizar um melhor diagnóstico das deformidades transversas. Contudo, deve-se levar em consideração a necessidade de conhecimento teórico-prático para a correta execução dos passos para o planejamento virtual. Considerações finais: Dado o exposto, foi possível observar precisão no resultado obtido e compatibilidade entre os movimentos planejados e executados. Assim como, demonstrou se aspectos relativos a cada um dos passos para o protocolo virtual, expondo-se suas particularidades e diferenças em relação ao planejamento convencional... (AU)

Introducción: La corrección de las deformidades dentofaciales depende de un buen diagnóstico, de la precisión de la planificación y la correcta ejecución de la técnica quirúrgica . Buscando mayor precisión, la planificación virtual para cirugía ortognática ha sido una herramienta aplicada ampliamente por la cirugia bucomaxilofacial. Este trabajo demuestra, por medio de un caso clínico, los beneficios obtenidos por la planificación virtual, en lo que respecta a la cuantificación del movimiento, evaluación de la predicción de los tejidos blandos y de las osteotomia, así enfatizando los cuidados y pasos necesarios para una correcta planificación. Relato de caso: Paciente con perfil clase II, utilizando protocolo de planificación virtual con adquisición de imágenes tomográficas, escaneamento intra-oral y uso de software digital para evaluación diagnóstica, planificación e impresión 3D de los guías quirúrgicos. La paciente tuvo seguimiento pos operatorio por tres meses, corroborando la precisión y previsibilidad de los movimientos quirúrgicos planificados y ejecutados. Discusión: Al realizarse una evaluación clínica acurada, sumando una adquisición de imágenes tridimensionales, a partir de la tomografía facial, escaneamento intra-oral y el manejo de tecnologia CAD/CAM, es posible alcanzar mayor precisión en la planificación y previsibilidad quirúrgica, así como un diagnóstico más acurado de las alteraciones transversas. Con todo, se debe considerar la necesidad de conocimiento teórico práctico para la correcta elaboración de un proyecto de planificación quirúrgica virtual. Consideraciones finales: Por lo expuesto, se observó precisión en el resultado obtenido considerando los movimientos planificados y ejecutados. Así como se describió aspectos relativos a cada uno de los pasos del protocolo virtual utilizado, exponiendo sus particularidades y diferencias en relación a la planificación quirúrgica convencional... (AU)

Introduction: The correction of dentofacial deformities depends directly on a good diagnosis, the precision of the surgical planning and the correct execution of the technique. Seeking greater precision, virtual planning for orthognathic surgery has been a tool widely applied in oral and maxillofacial surgery. This work demonstrates, through a case report, the benefits acquired by virtual planning, regarding the quantification of movement, evaluation of the prediction of soft tissues and osteotomies, as well as discusses the accuracy and steps necessary for a correct planning. Case report: Class II facial profile patient, submitted to the virtual planning protocol with acquisition of tomographic images, intraoral scanning and use of digital software for diagnostic evaluation, planning and printing of surgical guides. She was followed up for 3 months after the operation, showing good precision and predictability in the surgical movements performed. Discussion: When performing an accurate clinical evaluation, added up to the acquisition of three-dimensional images, from face tomography, intra-oral scans and the management of CAD/CAM technology, it is possible to achieve greater precision in surgical planning and predictability, as well as accomplish a better diagnosis of transverse deformities. However, one must take into account the need for theoretical practical knowledge for the correct execution of the steps for virtual planning. Final considerations: Given the above, it was possible to observe precision in the result obtained and compatibility between the planned and executed movements. As well, aspects related to each of the steps for the virtual protocol were demonstrated, exposing their particularities and differences in relation to conventional planning... (AU)

Accuracy comparison of guided surgery for dental implants according to the tissue of support: a systematic review and meta-analysis.

AIM: To systematically assess the current dental literature comparing the accuracy of computer-aided implant surgery when using different supporting tissues (tooth, mucosa, or bone). MATERIAL AND METHODS: Two reviewers searched PubMed (1972 to January 2015) and the Cochrane Central Register of Controlled Trials (Central) (2002 to January 2015). For the assessment of accuracy, studies were included with the following outcome measures: (i) angle deviation, (ii) deviation at the entry point, and (iii) deviation at the apex. RESULTS: Eight clinical studies from the 1602 articles initially identified met the inclusion criteria for the qualitative analysis. Four studies (n = 599 implants) were evaluated using meta-analysis. The bone-supported guides showed a statistically significant greater deviation in angle (P < 0.001), entry point (P = 0.01), and the apex (P = 0.001) when compared to the tooth-supported guides. Conversely, when only retrospective studies were analyzed, not significant differences are revealed in the deviation of the entry point and apex. The mucosa-supported guides indicated a statistically significant greater reduction in angle deviation (P = 0.02), deviation at the entry point (P = 0.002), and deviation at the apex (P = 0.04) when compared to the bone-supported guides. Between the mucosa- and tooth-supported guides, there were no statistically significant differences for any of the outcome measures. CONCLUSIONS: It can be concluded that the tissue of the guide support influences the accuracy of computer-aided implant surgery.