Accuracy of implant placement with computer-aided static, dynamic, and robot-assisted surgery: a systematic review and meta-analysis of clinical trials.

This systematic review explores the accuracy of computerized guided implant placement including computer-aided static, dynamic, and robot-assisted surgery. An electronic search up to February 28, 2023, was conducted using the PubMed, Embase, and Scopus databases using the search terms "surgery", "computer-assisted", "dynamic computer-assisted", "robotic surgical procedures", and "dental implants". The outcome variables were discrepancies including the implant's 3D-coronal, -apical and -angular deviations. Articles were selectively retrieved according to the inclusion and exclusion criteria, and the data were quantitatively meta-analysed to verify the study outcomes. Sixty-seven articles were finally identified and included for analysis. The accuracy comparison revealed an overall mean deviation at the entry point of 1.11 mm (95% CI: 1.02-1.19), and 1.40 mm (95% CI: 1.31-1.49) at the apex, and the angulation was 3.51˚ (95% CI: 3.27-3.75). Amongst computerized guided implant placements, the robotic system tended to show the lowest deviation (0.81 mm in coronal deviation, 0.77 mm in apical deviation, and 1.71˚ in angular deviation). No significant differences were found between the arch type and flap operation in cases of dynamic navigation. The fully-guided protocol demonstrated a significantly higher level of accuracy compared to the pilot-guided protocol, but did not show any significant difference when compared to the partially guided protocol. The use of computerized technology clinically affirms that operators can accurately place implants in three directions. Several studies agree that a fully guided protocol is the gold standard in clinical practice.

Contribution of preoperative ultrasound-guided implantation of a magnetic seed for optimal localization and resection of vulvar angiosarcoma: A case report.

INTRODUCTION: Vulvar cancer is a rare cause of malignancy among women. It is key for surgeons to achieve negative resection margins, as it greatly impacts patient's prognosis. Unfortunately, additional surgical procedures are often performed due to the regional anatomical complexity. Based on non-palpable breast tumors, where image-guided preoperative localization tools have enhanced the complete resection rates, we aimed at evaluating the feasibility of magnetic seed technique for localizing perineal lesions. PRESENTATION OF THE CASE: We present the case of a 40-year-old female patient, who underwent iterative resections for a recurrent epithelioid angiosarcoma of the left labia major. Imaging revealed a suspicious regional involvement at 3 months of follow-up, for which another surgery was planned. We decided to target this non-palpable lesion with the Magnetic Seed technique to guide the intervention. A seed was inserted into the nodule under ultrasound guidance. Resection was then performed, with negative margins and no recurrence on last follow-up. DISCUSSION: Surgical procedures with minimal extension are recommended in vulvar cancer, to limit the aesthetic and functional complication. Unfortunately, recurrences and residual tumors remain frequent, even higher when surgical margin safety is not achieved. Many studies have suggested the benefit of image-guided localization tools in non-palpable breast tumors. By reducing the excising volume and focusing on the lesions, relapse and complications are rarer. We considered Magnetic Seed to be the most appropriated technique for perineal lesions. CONCLUSION: As for breast cancer, Magnetic Seed technique could be appropriate for non-palpable perineal lesions, optimizing resection margins with minimal procedures.

The influence of guide stabilizers and their application sequences on trueness and precision of surgical guides in free end situations: An in vitro analysis.

OBJECTIVES: To evaluate the impact of guide stabilizers and their application sequences on implant placement accuracy of guided implant surgery in multiple teeth loss at free end. MATERIALS AND METHODS: In this study, 96 implants were placed in the regions of #34, #36, and #37 of 32 identical mandibular models. The influence of using guide stabilizers or not (group A and group B) and various guide stabilizers application sequences (group B: #34 → #36 → #37; group C: #36 → #34 → #37; group D: #37 → #34 → #36) on implant placement trueness and precision was investigated. Data were analyzed using T-tests and one-way ANOVA. RESULTS: Group B showed significant benefits in enhancing implant placement precision. Compared to group A, it resulted in reducing 3D-deviation at crest and 2D deviation in vestibular-oral direction at both crest and apex. Furthermore, group D demonstrated greater improvement in global implant placement precision by reducing 2D deviation in mesial-distal direction at both crest and apex. Among the three different stabilizer application sequences, group D exhibited the highest level of implant placement precision. CONCLUSIONS: In cases of missing teeth at distal free end, the use of guide stabilizers and their application sequences does not have a significant impact on implant placement trueness. However, they do improve implant placement precision compared to methods that do not utilize guide stabilizers. Specifically, applying a guide stabilizer first at the furthest implant site to change teeth loss classification from free end to edentulous space with posterior support is the most reliable sequence.

A novel closed technique for ultrasound-guided plantar fascia release with a needle: review of 107 cases with a minimum follow-up of 24 months.

BACKGROUND: This study aims to analyze the clinical outcome of a new ultrasound-guided surgery for partial plantar fasciotomy performed with a needle for treatment of plantar fasciitis. METHODS: We performed a retrospective review of 107 patients diagnosed with plantar fasciitis who underwent ultrasound-guided release of the plantar fascia. The series included 62 males (57.9%) and 45 females (42.1%) treated between April 2014 and February 2018, with a mean follow-up of 21.05 ± 10.96 months (7-66) and a minimum follow-up of 24 months. The mean age was 48.10 ± 10.27 years (27-72). Clinical assessments and ultrasound examination were carried out before treatment, after 1 week, and then after 1, 3, 12, and 24 months. The clinical assessment was based on a visual analog scale and the Foot and Ankle Disability Index. RESULTS: Heel pain improved in 92.5% (99) of patients, but not in 7.4% (8 patients). In the group of patients whose heel pain improved, 9 experienced overload on the lateral column and dorsum of the foot, which improved with the use of plantar orthoses and a rehabilitation program. We recorded no nerve complications (e.g., paresthesia), vascular injuries, or wound-related problems. CONCLUSION: Ultrasound-guided partial plantar fasciotomy with a needle is safe, since structures are under direct visualization of the surgeon and the risk of damage is minimal. Stitches are not necessary, and recovery is fast. Consequently, costs are low, and the patient can return to work quickly. This technique may represent a valid option for treatment of plantar fasciitis.

IR780-loaded folate-targeted nanoparticles for near-infrared fluorescence image-guided surgery and photothermal therapy in ovarian cancer.

Background and purpose: Surgery is regarded as the gold standard for patients with advanced ovarian cancer. However, complete surgical removal of tumors remains extremely challenging; fewer than 40% of patients are cured. Here, we developed a new modality of theranostics for ovarian cancer based on a near-infrared light-triggered nanoparticle. Methods: Nanoparticles loading IR780 iodide on base of folate modified liposomes were prepared and used for theranostics of ovarian cancer. Tumor targeting of FA-IR780-NP was evaluated in vitro and in an ovarian xenograft tumor model. A fluorescence stereomicroscope was applied to evaluate the tumor recognition of FA-IR780-NP during surgery. FA-IR780-NP mediated photothermal therapy effect was compared with other treatments in vivo. Results: FA-IR780-NP was demonstrated to specifically accumulate in tumors. IR780 iodide selectively accumulated in tumors; the enhanced permeability and retention effect of the nanoparticles and the active targeting of folate contributed to the excellent tumor targeting of FA-IR780-NP. With the aid of tumor targeting, FA-IR780-NP could be used as an indicator for the real-time delineation of tumor margins during surgery. Furthermore, photothermal therapy mediated by FA-IR780-NP effectively eradicated ovarian cancer tumors compared with other groups. Conclusion: In this study, we present a potential, effective approach for ovarian cancer treatment through near-infrared fluorescence image-guided resection and photothermal therapy to eliminate malignant tissue.

Um novo conceito na obtenção do guia prototipado em Implantodontia ­ relato de caso / A newconcept in prototyped guide obtaining in implantology - case report

A tomografia computadorizada (TC) em Implantodontia permite planejar virtualmente a posição ideal do implante dentário considerando as características anatômicas e restauradoras. Através desse planejamento, o guia cirúrgico prototipado pode ser confeccionado possibilitando a integração dos determinantes protéticos no posicionamento dos implantes. Nesse contexto, a "técnica da tomografia do molde" para obtenção do guia prototipado consiste na realização da TC do molde do paciente que será vazado virtualmente para a obtenção de um modelo 3D, capaz de reproduzir tecidos moles e elementos dentais. Posteriormente, essa imagem é virtualmente sobreposta à tomografia da boca do paciente, permitindo uma avaliação óssea conjunta com o tecido mole e elementos dentais ausentes. O relato de caso descreve a reabilitação oral com implantes osseointegráveis utilizando um guia prototipado confeccionado através da "técnica da tomografia do molde". Paciente apresentava ausência dos dentes 17, 16, 14, 12, 11, 21, 22 e 26. Devido à presença de qualidade e quantidade óssea adequadas, foi planejada a reabilitação das áreas edêntulas com implantes dentários posicionados utilizando guia prototipado confeccionado pela "técnica da tomografia do molde". Após a obtenção do guia, os implantes dentários foram posicionados. Com a instalação dos provisórios, após 4 meses de osseointegração, constatou-se que a realização da cirurgia guiada com a utilização do guia prototipado obtido através da "técnica da tomografia do molde" garantiu previsibilidade no posicionamento dos implantes dentários trazendo facilidade na execução das próteses, além de sucesso estético/funcional no tratamento restaurador e maior comodidade ao paciente do início ao final do tratamento (AU).

The computed tomography (CT) in implant Dentistry allows virtually plan of the dental implant ideal position considering restorative and anatomical characteristics. Through this planning, a surgical guide can be prototyped for integrate prosthetic aspects in the positioning of the implants. In this context, the "mold tomography technique" for obtaining prototyped guide consists in use the CT of the patient mold to be poured virtually for obtaining a 3D model capable of reproducing soft tissues and dental elements. Then, this image is superimposed on the virtual scan of the patient's mouth, allowing a complete evaluation of bone and soft tissues. This case report describes the oral rehabilitation with dental implants using a prototyped guide made by "mold tomography technique." Patient had no 17, 16, 14, 12, 11, 21, 22, and 26 teeth. Due to the presence of quality and adequate bone quantity, it was planned rehabilitation of edentulous areas with dental implants positioned using prototyped guide made by "mold tomography technique." After obtaining the guide, dental implants were positioned. After 4 months of osseointegration, the final restaurations have been installed. With the installation of the provisory, after 4 months of osseointegration, it has noted that the realization of guided surgery using the guide prototyped obtained by "mold tomography technique" guaranteed predictability in the placement of dental implants bringing ease of application of the prosthesis beyond aesthetic / functional success in restorative treatment and convenience to the patient from beginning to end of treatment (AU).

Guide surgery osteotomy system (GSOS) a new device for treatment in orthognathic surgery.

INTRODUCTION: This article proposes an innovative and revolutionary diagnostic and therapeutic protocol for performing dentoalveolar osteotomies in office under local anaesthesia with piezoelectric surgery using a surgical acrylic guide produced through software-based planning. METHODS: The method was applied in the correction of crossbites, changing in the curve of Spee, incisal decompensations and dental ankylosis. Performing a preoperative CT with a special splint, optical scanning of the models and the subsequent planning with software has enabled us to produce a model with rapid prototyping with the design of the osteotomy on which the surgical guide was shaped, the use of the guide associated with piezoelectric surgery, allowed to perform surgery under local anaesthesia, with minimal invasiveness and high accuracy. RESULTS: Dentoalveolar immediate movements, with preservation of the roots of teeth involved, allow for rapid treatment of malocclusions which would be long and often difficult if not impossible to treat with orthodontics only. Dentoalveolar osteotomies associated to osteodistraction concepts, allow the orthodontist to achieve with accuracy the objectives required by the treatment plan. CONCLUSIONS: GSOS is a new method, which, utilizing 3D optical scanning images of models, software and piezoelectric surgery, allows to perform dentoalveolar movements which may be dangerous to the roots or for the periodontal support, with orthodontics only. It dramatically reduces total surgical-orthodontic treatment time, with obvious great patient satisfaction.

Estereoeletroencefalografia na era da cirurgia guiada por imagem / Stereoelectroencephalography in the era of imaging guide surgery

INTRODUÇÃO: A estereoeletroencefalografia (E-EEG), conforme introduzida na década de 50 por Talairach, é um método invasivo de análise tridimensional da zona epilpeptogênica, baseado na técnica de implantação intracraniana de eletrodos de profundidade (EP). O advento das modernas técnicas de cirurgia guiadas por imagem revolucionaram a técnica de implantação dos EP. OBJETIVO: O objetivo deste artigo é discutir os princípios da E-EEG e sua evolução, desde a era Talairach até a era atual, da cirurgia guiada por imagem, e suas perspectivas futuras. CONCLUSÕES: Embora os princípios gerais da E-EEG tenham permanecidos intactos ao longo dos anos, a implantação de EP, que é a técnica cirúrgica que viabiliza este método, sofreu uma tremenda evolução ao longo das últimas três décadas devido ao advento das modernas técnicas de imagem, de sistemas de computação e das novas técnicas estereotáxicas. O uso de sistemas robotizados, a evolução constante das técnicas de imagem e computação e a utilização de EP com sondas para micro diálise associados a si, abre no futuro uma enorme perspectiva para a aplicação dos EP e da E-EEG, tanto para uso investigativo como terapêutico. A descoberta de novos alvos, em localizações profundas e a fabricação de eletrodos "inteligentes", poderá incrementar, num futuro próximo, a necessidade do uso deste método.

INTRODUCTION: The stereoelectroencephalography (SEEG), introduced by Talairach in 50', is an invasive method of tridimensional analysis of epileptogenic zone based on the intracranial placement of depth electrodes (DE). The advent of modern imaging guided surgery had a tremendous impact in DE implantation techniques. OBJETIVE: The aim of this article is to discuss the main principles of SEEG and its evolution along the years since Talairach era until the imaging guide surgery era, with its new perspectives. CONCLUSIONS: Although the main principles of SEEG have remained intact, the placement of depth electrodes (DE) which is the surgical technique that supports this method has suffered a tremendous evolution along the last three decades due the advent of the modern imaging, the computer systems and the new stereotactic techniques. The use of robotic, the new imaging and computed systems and the use of probes of micro dialise adaptated to EP opened a tremendous perspective to DE and SEEG application as an investigative and therapeutical method. The discovery of new targets in deep brain localization and the manufacturing of "smart" DE, can increment, in a near future, the number of indications to this method.

Cirurgia guiada em função imediata: proposta de técnica sem incisão / This technique is possible with no one incision, less pos operative symptoms and low cost in comparison to other techniques

Neste trabalho, os autores descrevem uma técnica onde foi utilizado um sistema de implantes em forma de parafuso, assim como uma técnica cirúrgica guiada para confecção de próteses totais fixas provisórias implanto-suportadas e parafusadas, indicando para reabilitações do tipo protocolo maxilar e/ou mandibular, recebendo carga imediata. Para tal foi utilizado um software que permite o planejamento guiado em três dimensões partindo-se de uma tomografia. Este planejamento após ter sido concluído, fornece um guia prototipado, tornando possível uma cirurgia sem nenhum tipo de incisão e proporcionando ao cirurgião minimizar o trauma cirúrgico, por conseguinte um efeito pós-operatório mais favorável, e custo reduzido, fator primordial comparado às outras técnicas guiadas existentes

The aim of this study was purpose a clinical case in the author used a bicortical dental implants protocol immediate loading-Theo®, and a guide technique, used after tomography exam, to upper or lower provisional prosthesis, fixed with implants and with immediate loading. For this, one software is used to prepare in 3D a prototypal guide with gets a surgery without incision. This technique does to surgeons one way to minimize the pos-operative trauma for all patients and low cost, comparing to other techniques