Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level.

AIM: The objective of this study was to assess marginal bone level around single implants inserted in fresh extraction sockets in the anterior maxillary region and instantly restored with computer-aided design/computer-aided manufacturing customized temporary crowns cemented on the final abutment. MATERIALS AND METHODS: A total of 20 patients (15 females and 5 males, with a mean age of 30 years), where 20 were placed in fresh extraction sockets. After raising a full-thickness flap, atraumatic extraction was performed the implant site was prepared and fixtures were stabilized on the palatal bone wall. The implant location was immediately transmitted to the prepared master model using the pick-up impression coping seated in the surgical guide template. Prefabricated abutments were used as the final abutment on the master model, scanned and the crown was planned using computer-aided manufacturing customized software. Later on 8th weeks, abutments were torqued as per the manufacturer's recommendation, and the final crowns were cemented. Using personalized intraoral radiographs marginal bone level was evaluated mesially and distally to the implant shoulder as a reference at implant placement, 8 weeks, 1, 3, 5, and 10 years after loading. RESULTS: Wholly implants were osteo-integrated positively after 10 years of practical loading, but only 18 were available for clinical and radiological follow-up, and 2 patients with two implants were excluded from the study due to relocation abroad without any implant failure. The average marginal bone loss (MBL) in the current report was 0.16 ± 0.167 mm at crown cementation, 0.275 ± 0.171 mm after 1 year, 0.265 ± 0.171 mm after 3 years, 0.213 ± 0.185 mm after 5 years, and 0.217 ± 0.194 mm at 10 years. CONCLUSION: The strategy of inserting and not removing the final abutment at the time of implant placement facilitates the establishment of adequate attachment of both soft and hard tissues to the abutment surface, ensuring uninterrupted organization of tissue architecture and offers advantages in helping maintain soft tissue maturation and preventing marginal bone level. CLINICAL SIGNIFICANCE: Immediately loaded implants in freshly extracted sockets lead to a significant reduction in marginal ridge resorption. The use of a temporary crown on a prefabricated abutment, exclusive of successive abutment manipulation, proved effective in preserving the primarily founding blood clot and served as a prototype for shaping the soft tissue around the previously wounded gum. How to cite this article: Berberi A, El Zoghbi A, Aad G, et al. Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level. J Contemp Dent Pract 2024;25(3):213-220.

Putting our heads together: The future of craniopagus twin separation.

Computer-assisted design and computer-assisted modeling (CAD/CAM), virtual surgical planning (VSP) and augmented/virtual reality (AR/VR) aid our ability to plan and perform complex craniofacial procedures. This study seeks to define the role of the aforementioned techniques in the separation of craniopagus conjoined twins. Six teams were identified who had successfully performed craniopagus twin separation with the use of CAD/CAM, VSP and/or AR/VR. Surgeons involved in separating craniopagus twins have increasingly utilized tools such as CAD/CAM models, VSP and AR/VR to plan and execute successful separation, and these tools are associated with higher success rates than historical controls.

Practical applications of three-dimensional printing for process improvement in the cytopathology laboratory.

With the increased availability of three-dimensional (3D) printers, innovative teaching and training materials have been created in medical fields. For pathology, the use of 3D printing has been largely limited to anatomic representations of disease processes or the development of supplies during the coronavirus disease 2019 pandemic. Herein, an institution's 3D printing laboratory and staff with expertise in additive manufacturing illustrate how this can address design issues in cytopathology specimen collection and processing. The authors' institutional 3D printing laboratory, along with students and trainees, used computer-aided design and 3D printers to iterate on design, create prototypes, and generate final usable materials using additive manufacturing. The program Microsoft Forms was used to solicit qualitative and quantitative feedback. The 3D-printed models were created to assist with cytopreparation, rapid on-site evaluation, and storage of materials in the preanalytical phase of processing. These parts provided better organization of materials for cytology specimen collection and staining, in addition to optimizing storage of specimens with multiple sized containers to optimize patient safety. The apparatus also allowed liquids to be stabilized in transport and removed faster at the time of rapid on-site evaluation. Rectangular boxes were also created to optimally organize all components of a specimen in cytopreparation to simplify and expedite the processes of accessioning and processing, which can minimize errors. These practical applications of 3D printing in the cytopathology laboratory demonstrate the utility of the design and printing process on improving aspects of the workflow in cytopathology laboratories to maximize efficiency, organization, and patient safety.

Augmented reality in orthodontics for bracket placement using conventional mobile devices: Technical note.

BACKGROUND: Improving bracket placement accuracy through computer-aided design and a bracket navigation set supported by augmented reality (AR). METHODS: A technical workflow was developed for implementing AR-assisted orthodontic bracket positioning through a smartphone application. This innovative approach eliminates the need for three-dimensional radiation imaging or physical guides, making it a safe and convenient option for clinical use by overlapping the digitally planned bracket position over the patient clinical crown for a precise recommendation of bracket positioning. RESULTS: It was found that it is achievable and can be easily recognized from all view angles, and this proves that new techniques with new opportunities could be considered. CONCLUSIONS: AR smartphone applications can potentially be used for the accurate placement of dental brackets; thus, such applications show promise for use in the field of orthodontics.

The Use of 3D Technology in the Management of Residual Asymmetry following Orthognathic Surgery: A Case Report.

The purpose of this case report was to present the aesthetic result of the reconstruction of facial residual asymmetry after orthognathic surgery using a patient-specific three-dimensional (3D) mold and a custom-made polymethyl methacrylate implant. Through computer-aided design (CAD), the healthy contralateral side of the mandible was superimposed onto the side with the defect. Exocad Gallway (exocad GmbH, Darmstadt, Germany) was used to design the patient-specific implants (PSIs) of the right mandibular angle. Next, the implant mold was created using the Meshmixer software (Version 3.5, Autodesk Inc., San Rafael, CA, USA) and fabricated using additive manufacturing. During the surgical procedure, the patient-specific implant (PSI) was cast inside the resin mold using Simplex P bone cement (Stryker, Mahwah, NJ, USA). The implant was fixed using three screws. Combining both indirect (involving the dental laboratory) and direct (with surgical intervention) approaches, this innovative hybrid method, which incorporates both computer-aided design and additive manufacturing (AM), not only enhanced facial aesthetics, functional rehabilitation, and patient quality of life but also mitigated the potential risks linked to conventional grafting methods.

Late Frontal Bone Reconstruction Using Three-Dimensional Printed Models for Titanium Mesh Customization: A Case Series.

BACKGROUND: The convex frontal bone is covered by thin skin, rendering its reconstruction cosmetically challenging. Customized alloplastic implants provide better contouring than autologous bone, yet their high cost and availability limit their application. We assess customized titanium mesh implants precontoured using patient-specific three-dimensional (3D) printed models for late frontal cranioplasty. METHODS: We retrospectively analyzed the prospectively collected cases of unilateral frontal titanium mesh cranioplasty with 3D printing-assisted preplanning from 2017 to 2019. We used two 3D-printed patient-specific skull models for preoperative planning: a mirrored normal model for implant contouring and a defect model for edge trimming and fixation planning. The endoscope was used in 4 cases for percutaneous mesh fixation. We documented postoperative complications. We assessed the reconstruction symmetry clinically, and radiologically on postoperative computed tomography. RESULTS: Fifteen patients were included. The duration after previous surgery ranged from 8 to 24 months. Four patients developed complications, which were managed conservatively. Favorable cosmetic outcomes were achieved in all patients. CONCLUSIONS: Precontouring of titanium mesh implants using in-house 3D-printed models could optimize cosmetic and surgical outcomes in late frontal cranioplasty. Preoperative planning could permit minimal access surgery, which could be aided by the endoscope in select cases.

Sinogram Inpainting with Generative Adversarial Networks and Shape Priors.

X-ray computed tomography is a widely used, non-destructive imaging technique that computes cross-sectional images of an object from a set of X-ray absorption profiles (the so-called sinogram). The computation of the image from the sinogram is an ill-posed inverse problem, which becomes underdetermined when we are only able to collect insufficiently many X-ray measurements. We are here interested in solving X-ray tomography image reconstruction problems where we are unable to scan the object from all directions, but where we have prior information about the object's shape. We thus propose a method that reduces image artefacts due to limited tomographic measurements by inferring missing measurements using shape priors. Our method uses a Generative Adversarial Network that combines limited acquisition data and shape information. While most existing methods focus on evenly spaced missing scanning angles, we propose an approach that infers a substantial number of consecutive missing acquisitions. We show that our method consistently improves image quality compared to images reconstructed using the previous state-of-the-art sinogram-inpainting techniques. In particular, we demonstrate a 7 dB Peak Signal-to-Noise Ratio improvement compared to other methods.

Virtual Surgical Planning in Head and Neck Reconstruction.

Virtual surgical planning is a revolutionary tool for the head and neck reconstructive surgeon. As with any tool, there are strengths and weaknesses. The strengths include shorter operative time, shorter ischemic time, streamlined dental rehabilitation, facilitation of complex reconstruction, non-inferior and possibly superior accuracy, and increased durability. The weaknesses are increased up-front costs, potential delays to operative management, limited flexibility on the day of surgery, and loss of familiarity with conventionally planned surgery.

Spectroelectrochemical sensing of reaction intermediates and products in an affordable fully 3D printed device.

Recent advances in fused deposition modelling 3D printing (FDM 3DP) and synthesis of printable electrically conductive materials enabled the manufacture of customized electrodes and electrochemical devices by this technique. The past couple of years have seen a boom in applying approaches of FDM 3DP in the realm of spectroelectrochemistry (SEC). Despite significant progress, reported designs of SEC devices still rely on conventionally manufactured optical components such as quartz windows and cuvettes. To bridge this technological gap, in this work we apply bi-material FDM 3DP combining electrically conductive and optically translucent filaments to manufacture working electrodes and cells, constituting a fully integrated microfluidic platform for transmission absorption UV-Vis SEC measurements. The cell design enables de-aeration of samples and their convenient handling and analysis. Employing cyclic voltammetric measurements with ruthenium(III) acetylacetonate, ethylviologen dibromide and ferrocenemethanol redox-active probes as model analytes, we demonstrate that the presented platform allows SEC sensing of reactants, intermediates and products of charge transfer reactions, including the inspection of their long-term stability. Approaches developed and presented in this work pave the way for manufacturing customized SEC devices with dramatically reduced costs compared to currently available commercial platforms.

Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report.

BACKGROUND: Complex facial wounds can be difficult to stabilize due to proximity of vital structures. We present a case in which a patient-specific wound splint was manufactured using computer assisted design and three-dimensional printing at the point-of-care to allow for wound stabilization in the setting of hemifacial necrotizing fasciitis. We also describe the process and implementation of the United States Food and Drug Administration Expanded Access for Medical Devices Emergency Use mechanism. CASE PRESENTATION: A 58-year-old female presented with necrotizing fasciitis of the neck and hemiface. After multiple debridements, she remained critically ill with poor vascularity of tissue in the wound bed and no evidence of healthy granulation tissue and concern for additional breakdown towards the right orbit, mediastinum, and pretracheal soft tissues, precluding tracheostomy placement despite prolonged intubation. A negative pressure wound vacuum was considered for improved healing, but proximity to the eye raised concern for vision loss due to traction injury. As a solution, under the Food and Drug Administration's Expanded Access for Medical Devices Emergency Use mechanism, we designed a three-dimensional printed, patient-specific silicone wound splint from a CT scan, allowing the wound vacuum to be secured to the splint rather than the eyelid. After 5 days of splint-assisted vacuum therapy, the wound bed stabilized with no residual purulence and developed healthy granulation tissue, without injury to the eye or lower lid. With continued vacuum therapy, the wound contracted to allow for safe tracheostomy placement, ventilator liberation, oral intake, and hemifacial reconstruction with a myofascial pectoralis muscle flap and a paramedian forehead flap 1 month later. She was eventually decannulated and at six-month follow-up has excellent wound healing and periorbital function. CONCLUSIONS: Patient-specific, three-dimensional printing is an innovative solution that can facilitate safe placement of negative pressure wound therapy adjacent to delicate structures. This report also demonstrates feasibility of point-of-care manufacturing of customized devices for optimizing complex wound management in the head and neck, and describes successful use of the United States Food and Drug Administration's Expanded Access for Medical Devices Emergency Use mechanism.

Design and Simulation of an Autonomous Molecular Mechanism Using Spatially Localized DNA Computation.

As a well-established technique, DNA synthesis offers interesting possibilities for designing multifunctional nanodevices. The micro-processing system of modern semiconductor circuits is dependent on strategies organized on silicon chips to achieve the speedy transmission of substances or information. Similarly, spatially localized structures allow for fixed DNA molecules in close proximity to each other during the synthesis of molecular circuits, thus providing a different strategy that of opening up a remarkable new area of inquiry for researchers. Herein, the Visual DSD (DNA strand displacement) modeling language was used to design and analyze the spatially organized DNA reaction network. The execution rules depend on the hybridization reaction caused by directional complementary nucleotide sequences. A series of DNA strand displacement calculations were organized on the locally coded travel track, and autonomous movement and addressing operations are gradually realized. The DNA nanodevice operates in this manner follows the embedded "molecular program", which improves the reusability and scalability of the same sequence domain in different contexts. Through the communication between various building blocks, the DNA device-carrying the target molecule moves in a controlled manner along the programmed track. In this way, a variety of molecular functional group transport and specific partition storage can be realized. The simulation results of the visual DSD tool provide qualitative and quantitative proof for the operation of the system.

Four-Dimensional Superimposition Techniques to Compose Dental Dynamic Virtual Patients: A Systematic Review.

Four-dimensional virtual patient is a simulation model integrating multiple dynamic data. This study aimed to review the techniques in virtual four-dimensional dental patients. Searches up to November 2022 were performed using the PubMed, Web of Science, and Cochrane Library databases. The studies included were based on the superimposition of two or more digital information types involving at least one dynamic technique. Methodological assessment of the risk of bias was performed according to the Joanna Briggs Institute Critical Appraisal Checklist. Methods, programs, information, registration techniques, applications, outcomes, and limitations of the virtual patients were analyzed. Twenty-seven full texts were reviewed, including 17 case reports, 10 non-randomized controlled experimental studies, 75 patients, and 3 phantoms. Few studies showed a low risk of bias. Dynamic data included real-time jaw motion, simulated jaw position, and dynamic facial information. Three to five types of information were integrated to create virtual patients based on diverse superimposition methods. Thirteen studies showed acceptable dynamic techniques/models/registration accuracy, whereas 14 studies only introduced the feasibility. The superimposition of stomatognathic data from different information collection devices is feasible for creating dynamic virtual patients. Further studies should focus on analyzing the accuracy of four-dimensional virtual patients and developing a comprehensive system.

Custom-made computer-aided-design/ computer-assisted-manufacturing (CAD/CAM) synthetic bone grafts for alveolar ridge augmentation: A retrospective clinical study with 3 years of follow-up.

PURPOSE: To report on the results obtained with computer-aided-design/ computer-assisted-manufacturing (CAD/CAM) custom-made synthetic hydroxyapatite/beta-tricalcium-phosphate (HA/beta-TCP) bone grafts in alveolar ridge augmentation for dental implant placement. METHODS: The procedure included: (1) cone-beam computed tomography (CBCT) of the bone defect; (2) virtual design of the custom-made onlay bone grafts; (3) milling of grafts from a pre-formed block of synthetic HA/beta-TCP; and (4) bone reconstructive surgery. Implants were placed 8 months later. The patients were followed for 3 years. The study outcomes were: (1) intra- and immediate post-operative complications; (2) 8-month vertical and horizontal bone gain; (3) implant survival; (4) implant-crown success; and (5) peri-implant marginal bone loss (MBL). RESULTS: Twenty-six patients underwent ridge augmentation with custom-made CAD/CAM HA/beta-TCP onlay grafts. Eight months later, these patients were rehabilitated with dental implants. During surgery, 25/26 (96.1%) of the grafts adapted well to the bone defect. Immediate post-operative complications were pain and swelling (2/26 patients: 7.6%), and bone graft exposure (3/26: 11.5%); one exposure led to infection, removal of the graft, and failure of the procedure. Excellent integration of the other grafts was observed 8 months after the regenerative procedure, with mean vertical and horizontal bone gains of 2.10 mm (± 0.35) and 2.96 mm (± 0.45), respectively. Twenty-five implants were placed and restored with single crowns. Three years later, all implants were in function. The 3-year implant crown success rate and peri-implant MBL were 92.0% and 0.7 mm (±0.19), respectively. CONCLUSIONS: With custom-made CAD/CAM synthetic HA/beta-TCP onlay grafts reconstruction of small vertical and/or horizontal defects of the alveolar ridge was obtained; this enabled implant placement, with high implant-crown success rate after 3 years. Further studies are needed to validate this technique. STATEMENT OF CLINICAL RELEVANCE: Custom-made CAD/CAM synthetic HA/beta-TCP onlay grafts may represent an option for regeneration of small bone defects prior to implant placement.

Guided implant surgery with R2Gate®: A multicenter retrospective clinical study with 1 year of follow-up.

PURPOSE: To present the results obtained with a novel sleeveless and keyless guided implant surgery system. METHODS: Inclusion criteria for this multicenter clinical retrospective study were fully or partially edentulous patients who had been treated with a sleeveless and keyless guided implant surgery system (R2Gate®, Megagen), and who had been rehabilitated with fixed restorations, with a minimum follow-up of 1 year. All surgeries and prosthetic procedures were conducted following the same protocol, and data were obtained from the patients' medical records. The outcomes were the fit and stability of the surgical guide, any intra-operative and immediate post-operative complications, any biologic and prosthetic complications that occurred during the 1-year follow-up period, implant survival, and prosthetic success. RESULTS: Sixty patients were selected for the installation of 124 implants, through a guided procedure: 66 sleeveless, keyless surgical guides were manufactured. The incidence of immediate intra-operative (lack of space: 12.1%; lack of implant stability 2.6%) and immediate post-operative (pain and discomfort: 6.6%; mild swelling 3.3%) complications was low. In total, 112/124 implants (90.3%) were successfully placed with a guided procedure, in 52 patients; among them, 82 (73.2%) were placed with a flapless procedure. Thirty fixtures supported single crowns (SCs), 42 fixed partial dentures (FPDs) and 52 full-arch (FA) restorations. Sixty-two fixed prosthetic restorations (30 SCs, 22 FPDs and 10 FAs) were delivered; among these restorations, 15 (24.1%) were subjected to immediate functional loading. All implants (100%) survived. Two implants had peri­implant mucositis (1.6%), two SCs had abutment screw loosenings (1.6%), two FAs and one FPD had ceramic chipping/fracture (2.4%), for an overall prosthetic success amounting to 88.7%. CONCLUSIONS: Within the limits of this study, this novel guided surgery system appeared to be clinically reliable; further studies are needed to confirm these results. STATEMENT OF CLINICAL RELEVANCE: The use of sleveless and keyless surgical guides can be clinically reliable and may be represent a valid option for the surgeon.

Computer-assisted design model to evaluate the outcome of combined osteotomies in Legg-Calvé-Perthes disease.

Objective: The current study aims to conduct a quantitative dynamic analysis of hip morphology using a computer-assisted design (CAD) model to evaluate the combined pelvic and femoral osteotomies in the treatment of Legg-Calvé-Perthes disease (LCPD). Materials and methods: CAD models of patients with unilateral LCPD treated by combined pelvic and proximal femoral osteotomies were established based on the data of CT scan, on which morphological parameters were measured. Shape difference analysis of normal hips was adopted to locate the most apparent displacement and the main strain on the surface of the proximal femur. Results: Fifteen patients were included, and the mean age of receiving operation was 6.63 years old. There were 10 hips rated as Herring type C, and the rest were type B. Compared with the normal side, the affected hip joints have a longer distance between femoral head and acetabular sphere. The difference of coverage area of the femoral head surface and femoral head volume between the affected and normal sides was bigger compared with the preoperative model, respectively. The changes in the acetabular radius and the area of the surface were not apparent, pre-, and post-operatively. The displacement was mainly on superior and lateral superior portions of the femoral head where the stresses were concentrated. Conclusion: Combined pelvic and femoral osteotomies could effectively improve the superior and superior-posterior area of acetabulum containment with increased femoral head volume. CAD model and shape difference analysis can provide a better understanding of deformations of LCPD and more information for surgical planning and evaluation of treatment outcomes.

Single-stage cranioplasty with customized polyetheretherketone implant after tumor resection using virtual reality and augmented reality for precise implant customization and placement: illustrative case.

BACKGROUND: Cranioplasties are routinely performed to restore cosmesis and to protect intracranial contents after trauma, resection of tumors, or other pathologies. Traditionally done as a second-stage procedure, new single-stage cranioplasty protocols have been developed to minimize recovery periods, decrease complications, and improve patient satisfaction. These protocols, however, still require the use of larger than planned implants or use larger than ideal incisions to accommodate three-dimensional (3D) templates, which may not be optimal in regions with complex bony anatomy. OBSERVATIONS: A 50-year-old woman with a painful and progressively enlarging hemangioma of the left frontal bone underwent a single-stage resection followed by custom cranioplasty using a new extended reality (XR)-based workflow. Excellent cosmetic results, decreased operative time, and a feasible workflow were achieved. LESSONS: The use of an XR-based visualization platform allows the surgeon to treat lesions and perform custom cranioplasties in one session while avoiding common pitfalls of current single-stage workflows, such as increased operative times for tailoring implants, as well as minimizing the use of 3D overlay models, which may not appropriately conform to complex regional bony anatomy intraoperatively.

Point-of-care computer-assisted design and manufacturing technology and its utility in post-traumatic mandibular reconstruction: An Australian public hospital experience.

Application of load-bearing osteosynthesis plates is the current gold-standard management for complex mandibular fractures. Traditionally, this has required a transcutaneous submandibular approach, carrying with it the risk of damage to the facial nerve and obvious extraoral scarring. The existing literature describes the use of computer-assisted design and manufacturing technology through external vendors to aid transoral mandibular reconstruction. However, the reliance on third-party manufacturers comes with significant drawbacks, notably increased financial costs and manufacturing delays. We describe our experience in using point-of-care three-dimensional-printed surgical models to aid with the application of mandibular reconstruction plates. Utilising a virtual three-dimensional reconstruction of the patient's preoperative computed tomography facial bones, we fabricate a custom model of the patient's mandible with the department's in-house three-dimensional printer. Stock plates are subsequently pre-bent and adapted to the three-dimensional model, with plate and screw position marked and screw lengths measured with callipers. By using a custom three-dimensional-printed surgical model to pre-contour the plates, we are able to position stock reconstruction plates via a transoral approach. Moreover, our unit's utilisation of in-house computer-assisted design and manufacturing software and hardware allows us deliver a same-day turnaround for both surgical planning and performing the operation. Patient-specific surgical planning guides can facilitate the safe and efficient transoral application of mandibular reconstruction plates. Moreover, the use of point-of-care computer-assisted design and manufacturing technology ensures timely and cost-effective manufacturing of the necessary biomodel.

Real-time intraoperative computed tomography can accurize virtual surgical planning on the double-barrel fibular flap for mandibular reconstruction.

Real-time intraoperative computed tomography created the accuracy of less than 1 mm deviation in virtual surgical planning double barrel fibular flap for mandibular reconstruction-the symbiosis of intelligent technology in a digital OR. BACKGROUND: With the intelligent technology of virtual surgical planning, CAD/CAM, and intraoperative CT(iCT) in a digital OR, the secondary mandibular defect or primary amelobalstoma mandibulectomy can be restored using double barrel fibula and be achieved precision medicine purpose. MATERIAL AND METHOD: A series of 7 patients underwent free flap for oral cancers who sustained 5 osteoradionecrosis, 2 segmental mandibular defect, and 2 ameloblastoma. They received 9 double barrel fibula flap and 2 free skin flaptransfers. The fibula flap were reconstructed using a virtual surgical planning including CAD/CAM for simulation 3D model, cutting guides for recipient sites and fibulas osteotomy, and iCT for image fusion in a digital OR. RESULT: The mandibular defect was 5-16 cm (average: 9.56 cm), and 2-5 fibular struts for double barrel fibula (average: 3.67 struts) image fusion. One vein graft for artery was required and all 11 flaps were transferred successfully without reexploration. Six patients had intraoperative revision of the fibula and plate to improve the onlay image fusion volume from 74.71 to 82.57%. The postoperative inter-incisor midline deviation was less than 2 mm in 5 patients, and well reduction image in 4 edentulous patients. Five landmarks including bilateral condyles, bilateral gonions, and gnathion demonstrated deviation less than 1 mm in average. CONCLUSION: CAD/CAM can allow a practical virtual surgery to restore mandibular defect reconstruction using a double barrel fibula. The symbiosis of intelligent technology in a digital OR, the iCT can promote the accuracy of mandibular spatialframework and occlusion plain.

Clinical Performance of Complete-Arch Implant- Supported Rehabilitations Using Monolithic Lithium Disilicate Restorations Bonded to CAD/CAM Titanium and Zirconia Frameworks up to 5 Years.

This clinical study evaluated the survival of monolithic lithium disilicate (ML) (IPS Emax, Ivoclar Vivadent) restorations bonded to complete-arch CAD/CAM made titanium or zirconia frameworks. Between August 2007 and December 2009, 15 patients (7 female, 8 male; mean age: 56.8 years old) received 30 implant-supported screw-retained rehabilitations with ML restorations cemented to CAD/CAM made titanium (T) (n=6) or zirconia (Z) frameworks (n=24) adhesively (Multilink Automix, RelyX Unicem) and followed up until December 2015. The evaluation protocol involved technical failures (chipping, debonding or fracture of crown/framework, screw loosening), Californian Dental Association (CDA) quality criteria (Romeo: Excellent; Sierra: Acceptable; Tango: Retrievable; Victor: Not acceptable) and biological failures (mucositis, peri-implantitis). Mean observation time was 60.3 months. No implants were lost, and all the prostheses were in situ. Four mechanical failures occurred in the form of minor chipping (n=3 in ML-Z, n=1 in ML-T) and major fracture in ML crown (n=1 in ML-Z). Romeo scores (N=370) decreased until final observation (N=347) and 23 Sierra scores were given to the restorations. Mucositis was observed in 3 patients and peri-implantitis in one patient. Complete-arch implant-borne FDPs made of monolithic lithium disilicate bonded to titanium or zirconia frameworks could be a promising alternative.

Customized guide for transmucosal pterygomaxillary disjunction: Proof of concept.

Potential complications related to pterygomaxillary disjunction have been widely described in the literature, most of them being due to the inaccurate and blind approach involved. The present study used preoperative virtual planning to establish a surgical cutting guide for pterygomaxillary osteotomy. It was placed in the maxillary tuberosity supported by molars, and a flapless vertical osteotomy was performed with a piezoelectric saw. Then, maxillary down-fracture was performed with slight pressure through an anterior approach. The use of the surgical guide added accuracy and predictability to the procedure, with no prolongation of the surgery time. There were no undesired fractures or bleeding. Regarding manipulation of the surgical guide in the posterior area, it was found to be easily manageable and very stable over the posterior teeth, due to its small size and precision, respectively. In conclusion, this technique seems to improve the accuracy of pterygomaxillary disjunction without prolonging the surgery time. Furthermore, it reduces potential complications related to the conventional procedure. Nevertheless, a larger body of patient data is needed to confirm the benefits of the technique.