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12 pages, 9216 KiB

Open AccessArticle

Proposal and Validation of a New Nonradiological Method for Postoperative Three-Dimensional Implant Position Analysis Based on the Dynamic Navigation System: An In Vitro Study

by Feifei Ma, Mingyue Liu, Xiaoqiang Liu, Tai Wei, Lilan Liu and Feng Sun

J. Pers. Med. 2023, 13(2), 362; https://doi.org/10.3390/jpm13020362 - 18 Feb 2023

Cited by 1 | Viewed by 1056

Abstract

Purpose: To propose a novel, radiation-free method for postoperative three-dimensional (3D) position analysis of dental implants based on the dynamic navigation system (DNS) and evaluate its accuracy in vitro. Methods: A total of 60 implants were digitally planned and then placed in the [...] Read more.

Purpose: To propose a novel, radiation-free method for postoperative three-dimensional (3D) position analysis of dental implants based on the dynamic navigation system (DNS) and evaluate its accuracy in vitro. Methods: A total of 60 implants were digitally planned and then placed in the standardized plastic models with a single-tooth gap and a free-end gap under the guidance of the DNS. Postoperative 3D positions of the inserted implants were evaluated using specially designed navigation-based software, and its datasets were superimposed onto those of cone beam computed tomography (CBCT) for accuracy analyses. Deviations at the coronal, apical, and angular levels were measured and statistically analyzed. Results: The mean 3D deviation was 0.88 ± 0.37 mm at the entry point and 1.02 ± 0.35 mm at the apex point. The mean angular deviation was 1.83 ± 0.79 degrees. No significant differences were noted in the deviations between implants placed in the single-tooth gap and the free-end situation (p > 0.05) or between different tooth positions at distal extensions (p > 0.05). Conclusions: This non-radiographic method provides facile, efficient, and reliable postoperative implant position evaluation and may be a potential substitute for CBCT, particularly for implants placed under the guidance of dynamic navigation. Full article

(This article belongs to the Special Issue Digital Oral and Maxillofacial Medicine)

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19 pages, 5180 KiB

Open AccessArticle

Simultaneous PSI-Based Orthognathic and PEEK Bone Augmentation Surgery Leads to Improved Symmetric Facial Appearance in Craniofacial Malformations

by Valentin Kerkfeld, Lara Schorn, Rita Depprich, Julian Lommen, Max Wilkat, Norbert Kübler, Majeed Rana and Ulrich Meyer

J. Pers. Med. 2022, 12(10), 1653; https://doi.org/10.3390/jpm12101653 - 05 Oct 2022

Cited by 7 | Viewed by 1928

Abstract

(1) The aim of the present study was to compare the outcome of facial symmetry after simultaneous digitally planned patient-specific implant (PSI-) based orthognathic surgery and polyether ether ketone (PEEK) bone augmentation in patients with craniofacial malformations. (2) To evaluate the outcome of [...] Read more.

(1) The aim of the present study was to compare the outcome of facial symmetry after simultaneous digitally planned patient-specific implant (PSI-) based orthognathic surgery and polyether ether ketone (PEEK) bone augmentation in patients with craniofacial malformations. (2) To evaluate the outcome of the two different surgical approaches (conventional PSI-based orthognathic surgery versus simultaneous PSI-based orthognathic surgery with PEEK bone augmentation), a comparison of five different groups with a combination of the parameters (A) with vs. without laterognathia, (B) syndromic vs. non-syndromic, and (C) surgery with vs. without PEEK bone augmentation was conducted. The digital workflow comprised cone beam CT (CBCT) scans and virtual surgery planning for all patients in order to produce patient specific cutting guides and osteosynthesis plates. Additionally, deformed skulls were superimposed by a non-deformed skull and/or the healthy side was mirrored to produce PSI PEEK implants for augmentation. Retrospective analyses included posterior–anterior conventional radiographs as well as en face photographs taken before and nine months after surgery. (3) Simultaneous orthognathic surgery with PEEK bone augmentation significantly improves facial symmetry compared to conventional orthognathic surgery (6.5%P (3.2–9.8%P) (p = 0.001). (4) PSI-based orthognathic surgery led to improved horizontal bone alignment in all patients. Simultaneous PEEK bone augmentation enhanced facial symmetry even in patients with syndrome-related underdevelopment of both soft and hard tissues. Full article

(This article belongs to the Special Issue Digital Oral and Maxillofacial Medicine)

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13 pages, 4968 KiB

Open AccessArticle

Deep Learning on Basal Cell Carcinoma In Vivo Reflectance Confocal Microscopy Data

by Veronika Shavlokhova, Michael Vollmer, Patrick Gholam, Babak Saravi, Andreas Vollmer, Jürgen Hoffmann, Michael Engel and Christian Freudlsperger

J. Pers. Med. 2022, 12(9), 1471; https://doi.org/10.3390/jpm12091471 - 08 Sep 2022

Cited by 3 | Viewed by 1600

Abstract

Background: Extended skin malignancies of the head and neck region are among the most common cancer types and are associated with numerous diagnostic and therapeutical problems. The radical resection of skin cancer in the facial area often leads to severe functional and aesthetic [...] Read more.

Background: Extended skin malignancies of the head and neck region are among the most common cancer types and are associated with numerous diagnostic and therapeutical problems. The radical resection of skin cancer in the facial area often leads to severe functional and aesthetic impairment, and precise margin assessments can avoid the extensive safety margins. On the other hand, the complete removal of the cancer is essential to minimize the risk of recurrence. Reliable intraoperative assessments of the wound margins could overcome this discrepancy between minimal invasiveness and safety distance in the head and neck region. With the help of reflectance confocal laser microscopy (RCM), cells can be visualized in high resolution intraoperatively. The combination with deep learning and automated algorithms allows an investigator independent and objective interpretation of specific confocal imaging data. Therefore, we aimed to apply a deep learning algorithm to detect malignant areas in images obtained via in vivo confocal microscopy. We investigated basal cell carcinoma (BCC), as one of the most common entities with well-described in vivo RCM diagnostic criteria, within a preliminary feasibility study. Patients and Methods: We included 62 patients with histologically confirmed BCC in the head and neck region. All patients underwent in vivo confocal laser microscope scanning. Approximately 382 images with BCC structures could be obtained, annotated, and proceeded for further deep learning model training. Results: A sensitivity of 46% and a specificity of 85% in detecting BCC regions could be achieved using a convolutional neural network model (“MobileNet”). Conclusion: The preliminary results reveal the potential and limitations of the automated detection of BCC with in vivo RCM. Further studies with a larger number of cases are required to obtain better predictability. Full article

(This article belongs to the Special Issue Digital Oral and Maxillofacial Medicine)

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12 pages, 1493 KiB

Open AccessArticle

Accuracy of Three-Dimensional Soft-Tissue Prediction Considering the Facial Aesthetic Units Using a Virtual Planning System in Orthognathic Surgery

by Daniel Awad, Siegmar Reinert and Susanne Kluba

J. Pers. Med. 2022, 12(9), 1379; https://doi.org/10.3390/jpm12091379 - 25 Aug 2022

Cited by 2 | Viewed by 1518

Abstract

Virtual surgical planning (VSP) is commonly used in orthognathic surgery. A precise soft-tissue predictability would be a helpful tool, for determining the correct displacement distances of the maxilla and mandible. This study aims to evaluate the soft-tissue predictability of the VSP software IPS [...] Read more.

Virtual surgical planning (VSP) is commonly used in orthognathic surgery. A precise soft-tissue predictability would be a helpful tool, for determining the correct displacement distances of the maxilla and mandible. This study aims to evaluate the soft-tissue predictability of the VSP software IPS CaseDesigner^® (KLS Martin Group, Tuttlingen, Germany). Twenty patients were treated with bimaxillary surgery and were included in the study. The soft-tissue simulation, done by the VSP was exported as STL files in the engineering software Geomagic Control X^TM (3D systems, RockHill, SC, USA). Four months after surgery, a 3D face scan of every patient was performed and compared to the preoperative simulation. The quality of the soft-tissue simulation was validated with the help of a distance map. This distance map was calculated using the inter-surface distance algorithm between the preoperative simulation of the soft-tissue and the actual scan of the postoperative soft-tissue surface. The prediction of the cranial parts of the face (upper cheek, nose, upper lip) was more precise than the prediction of the lower areas (lower cheek, lower lip, chin). The percentage of correctly predicted soft-tissue for the face in total reached values from 69.4% to 96.0%. The VSP system IPS CaseDesigner^® (KLS Martin Group; Tuttlingen, Germany) predicts the patient’s post-surgical soft-tissue accurately. Still, this simulation has to be seen as an approximation, especially for the lower part of the face, and continuous improvement of the underlying algorithm is needed for further development. Full article

(This article belongs to the Special Issue Digital Oral and Maxillofacial Medicine)

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11 pages, 2049 KiB

Open AccessArticle

Plaster Casts vs. Intraoral Scans: Do Different Methods of Determining the Final Occlusion Affect the Simulated Outcome in Orthognathic Surgery?

by Daniel Awad, Andy Häfner, Siegmar Reinert and Susanne Kluba

J. Pers. Med. 2022, 12(8), 1288; https://doi.org/10.3390/jpm12081288 - 05 Aug 2022

Cited by 3 | Viewed by 1724

Abstract

A virtual occlusal adjustment in orthognathic surgery has many advantages; however, the haptic information offered by plaster casts is missing when using intraoral scans. Feeling the interferences may be helpful in defining the best possible occlusion. Whether the use of a virtual occlusal [...] Read more.

A virtual occlusal adjustment in orthognathic surgery has many advantages; however, the haptic information offered by plaster casts is missing when using intraoral scans. Feeling the interferences may be helpful in defining the best possible occlusion. Whether the use of a virtual occlusal adjustment instead of the conventional approach has a significant effect on the postsurgical position of the jaws is a question that remains unanswered. This study compares a virtual method to the conventional method of defining the final occlusion. Twenty-five orthognathic patients were included. Bimaxillary and single-jaw orthognathic surgery (mandible only) was simulated. The two methods were compared regarding discrepancies in the simulated postsurgical position of the mandible, measured three-dimensionally using MeshLab (MeshLab 2020.12 3D). An analysis using SPSS revealed no significant differences between the tested methods (p-values: 0.580 to 0.713). The mean absolute discrepancies ranged from 0.14 mm to 0.72 mm, laying within the scope of the clinically acceptable inaccuracies of an osteosynthesis in orthognathic surgery. The lack of haptic information in virtual planning had no relevant influence on the definition of the final occlusion and the simulated postsurgical outcome. However, in individual cases, plaster models might still be helpful in finding the adequate occlusion, especially in the sagittal dimension and in cases of patients with an anterior open bite, but this remains to be tested. Full article

(This article belongs to the Special Issue Digital Oral and Maxillofacial Medicine)

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10 pages, 2907 KiB

Open AccessArticle

Prospective Evaluation of Intraorbital Soft Tissue Atrophy after Posttraumatic Bone Reconstruction: A Risk Factor for Enophthalmos

by Cristian Dinu, Tiberiu Tamas, Gabriela Agrigoroaei, Sebastian Stoia, Horia Opris, Simion Bran, Gabriel Armencea and Avram Manea

J. Pers. Med. 2022, 12(8), 1210; https://doi.org/10.3390/jpm12081210 - 25 Jul 2022

Cited by 2 | Viewed by 1372

Abstract

Orbital fractures are a common finding in facial trauma, and serious complications may arise when orbital reconstruction is not performed properly. The virtual planning can be used to print stereolithographic models or to manufacture patient-specific titanium orbital implants (PSIs) through the process of [...] Read more.

Orbital fractures are a common finding in facial trauma, and serious complications may arise when orbital reconstruction is not performed properly. The virtual planning can be used to print stereolithographic models or to manufacture patient-specific titanium orbital implants (PSIs) through the process of selective laser melting. This method is currently considered the most accurate technique for orbital reconstruction. Even with the most accurate techniques of bone reconstruction, there are still situations where enophthalmos is present postoperatively, and it may be produced by intraorbital soft tissue atrophy. The aim of this paper was to evaluate the orbital soft tissue after posttraumatic reconstruction of the orbital walls’ fractures. Ten patients diagnosed and treated for unilateral orbital fractures were included in this prospective study. A postoperative CT scan of the head region with thin slices (0.6 mm) and soft and bone tissue windows was performed after at least 6 months. After data processing, the STL files were exported, and the bony volume, intraorbital fat tissue volume, and the muscular tissue volume were measured. The volumes of the reconstructed orbit tissues were compared with the volumes of the healthy orbit tissues for each patient. Our findings conclude that a higher or a lower grade of fat and muscular tissue loss is present in all cases of reconstructed orbital fractures. This can stand as a guide for primary or secondary soft tissue augmentation in orbital reconstruction. Full article

(This article belongs to the Special Issue Digital Oral and Maxillofacial Medicine)

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9 pages, 632 KiB

Open AccessArticle

Clinical Outcomes and Cost Analysis of Fibula Free Flaps: A Retrospective Comparison of CAD/CAM versus Conventional Technique

by Juan Pablo Rodríguez-Arias, Blanca Tapia, Marta María Pampín, Maria José Morán, Javier Gonzalez, Maria Barajas, Jose Luis Del Castillo, Carlos Navarro Cuéllar and Jose Luis Cebrian

J. Pers. Med. 2022, 12(6), 930; https://doi.org/10.3390/jpm12060930 - 07 Jun 2022

Cited by 5 | Viewed by 1737

Abstract

(1) Background: A decrease in operative time can not only improve patient outcomes through a reduction in the risk of developing complications but can also result in cost savings. The aim of this study is to determine whether there an intraoperative time gain [...] Read more.

(1) Background: A decrease in operative time can not only improve patient outcomes through a reduction in the risk of developing complications but can also result in cost savings. The aim of this study is to determine whether there an intraoperative time gain can be achieved by using the preoperative virtual planning of mandibular reconstruction using a free fibula flap compared with freehand plate bending and osteotomies. (2) Methods: A retrospective comparative study was carried out in the Oral and Maxillofacial Department of La Paz University Hospital, Madrid, Spain. The study compared 18 patients in the CAD/CAM group with 19 patients in the conventional freehand group. A comparison was made between the total surgical time, the comorbidities, and the hospital stay. The resource consumption was estimated using a cost analysis. (3) Results: Although CAD/CAM was a statistically more expensive procedure in the perioperative phase, no significant differences were observed in total health care costs between the two groups. There was a non-significant trend towards an increase in complications with conventional reconstruction plates compared to patient-specific plates (PSI). (4) Conclusions: CAD/CAM technology and a 3D printed cutting guide offer a significantly shorter surgical time, which is associated with a reduction in hospital days, PACU days, and complications. The cost of CAD/CAM technology is comparable to that of the conventional freehand technique. Full article

(This article belongs to the Special Issue Digital Oral and Maxillofacial Medicine)

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15 pages, 5205 KiB

Open AccessArticle

Development of Personalized Non-Invasive Ventilation Interfaces for Neonatal and Pediatric Application Using Additive Manufacturing

by Marit Bockstedte, Alexander B. Xepapadeas, Sebastian Spintzyk, Christian F. Poets, Bernd Koos and Maite Aretxabaleta

J. Pers. Med. 2022, 12(4), 604; https://doi.org/10.3390/jpm12040604 - 08 Apr 2022

Cited by 5 | Viewed by 2429

Abstract

The objective of this study was to present a methodology and manufacturing workflow for non-invasive ventilation interfaces (NIV) for neonates and small infants. It aimed to procure a fast and feasible solution for personalized NIV produced in-house with the aim of improving fit [...] Read more.

The objective of this study was to present a methodology and manufacturing workflow for non-invasive ventilation interfaces (NIV) for neonates and small infants. It aimed to procure a fast and feasible solution for personalized NIV produced in-house with the aim of improving fit and comfort for the patient. Three-dimensional scans were obtained by means of an intraoral (Trios 3) and a facial scanner (3dMd Flex System). Fusion 360 3D-modelling software was employed to automatize the design of the masks and their respective casting molds. These molds were additively manufactured by stereolithography (SLA) and fused filament fabrication (FFF) technologies. Silicone was poured into the molds to produce the medical device. In this way, patient individualized oronasal and nasal masks were produced. An automated design workflow and use of additive manufacturing enabled a fast and feasible procedure. Despite the cost for individualization likely being higher than for standard masks, a user-friendly workflow for in-house manufacturing of these medical appliances proved to have potential for improving NIV in neonates and infants, as well as increasing comfort. Full article

(This article belongs to the Special Issue Digital Oral and Maxillofacial Medicine)

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9 pages, 3083 KiB

Open AccessCommunication

A Holistic Approach for the Identification of Success Factors in Secondary Cleft Osteoplasty

by Tom A. Schröder, Martin Maiwald, Axel Reinicke, Uwe Teicher, André Seidel, Thorsten Schmidt, Steffen Ihlenfeldt, Karol Kozak, Winnie Pradel, Günter Lauer and Anas Ben Achour

J. Pers. Med. 2022, 12(3), 506; https://doi.org/10.3390/jpm12030506 - 21 Mar 2022

Cited by 1 | Viewed by 2251

Abstract

Cleft lip and palate belong to the most frequent craniofacial anomalies. Secondary osteoplasty is usually performed between 7 and 11 years with the closure of the osseus defect by autologous bone. Due to widespread occurrence of the defect in conjunction with its social [...] Read more.

Cleft lip and palate belong to the most frequent craniofacial anomalies. Secondary osteoplasty is usually performed between 7 and 11 years with the closure of the osseus defect by autologous bone. Due to widespread occurrence of the defect in conjunction with its social significance due to possible esthetic impairments, the outcome of treatment is of substantial interest. The success of the treatment is determined by the precise rebuilding of the dental arch using autologous bone from the iliac crest. A detailed analysis of retrospective data disclosed a lack of essential and structured information to identify success factors for fast regeneration and specify the treatment. Moreover, according to the current status, no comparable process monitoring is possible during osteoplasty due to the lack of sensory systems. Therefore, a holistic approach was developed to determine the parameters for a successful treatment via the incorporation of patient data, the treatment sequences and sensor data gained by an attachable sensor module into a developed Dental Tech Space (DTS). This approach enables heterogeneous data sets to be linked inside of DTS, archiving and analysis, and is also for future considerations of respective patient-specific treatment plans. Full article

(This article belongs to the Special Issue Digital Oral and Maxillofacial Medicine)

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11 pages, 7001 KiB

Open AccessArticle

Effects of Artificial Extraoral Markers on Accuracy of Three-Dimensional Dentofacial Image Integration: Smartphone Face Scan versus Stereophotogrammetry

by Hang-Nga Mai and Du-Hyeong Lee

J. Pers. Med. 2022, 12(3), 490; https://doi.org/10.3390/jpm12030490 - 18 Mar 2022

Cited by 5 | Viewed by 2669

Abstract

Recently, three-dimensional (3D) facial scanning has been gaining popularity in personalized dentistry. Integration of the digital dental model into the 3D facial image allows for a treatment plan to be made in accordance with the patients’ individual needs. The aim of this study [...] Read more.

Recently, three-dimensional (3D) facial scanning has been gaining popularity in personalized dentistry. Integration of the digital dental model into the 3D facial image allows for a treatment plan to be made in accordance with the patients’ individual needs. The aim of this study was to evaluate the effects of extraoral markers on the accuracy of digital dentofacial integrations. Facial models were generated using smartphone and stereophotogrammetry. Dental models were generated with and without extraoral markers and were registered to the facial models by matching the teeth or markers (n = 10 in each condition; total = 40). Accuracy of the image integration was measured in terms of general 3D position, occlusal plane, and dental midline deviations. The Mann–Whitney U test and two-way analysis of variance were used to compare results among face-scanning systems and matching methods (α = 0.05). As result, the accuracy of dentofacial registration was significantly affected by the use of artificial markers and different face-scanning systems (p < 0.001). The deviations were smallest in stereophotogrammetry with the marker-based matching and highest in smartphone face scans with the tooth-based matching. In comparison between the two face-scanning systems, the stereophotogrammetry generally produced smaller discrepancies than smartphones. Full article

(This article belongs to the Special Issue Digital Oral and Maxillofacial Medicine)

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13 pages, 2535 KiB

Open AccessCase Report

Three-Dimensional Plotted Calcium Phosphate Scaffolds for Bone Defect Augmentation—A New Method for Regeneration

by Matthias C. Schulz, Stefan Holtzhausen, Berthold Nies, Sascha Heinemann, David Muallah, Lysann Kroschwald, Kristin Paetzold-Byhain, Günter Lauer and Philipp Sembdner

J. Pers. Med. 2023, 13(3), 464; https://doi.org/10.3390/jpm13030464 - 02 Mar 2023

Cited by 3 | Viewed by 1258

Abstract

For sinus grafting, different methods and materials are available. One possible shortcoming of particulate bone grafts is either overfilling or augmenting the planned implant area insufficiently. To overcome this risk and to determine the implant position prior augmentation, we present an approach using [...] Read more.

For sinus grafting, different methods and materials are available. One possible shortcoming of particulate bone grafts is either overfilling or augmenting the planned implant area insufficiently. To overcome this risk and to determine the implant position prior augmentation, we present an approach using three-dimensional printed scaffolds. A patient with a remaining anterior dentition and bilateral severely atrophied posterior maxilla was seeking oral rehabilitation. The cone beam computed tomography (CBCT) showed residual bone heights between one and two millimeters. Following the three-dimensional reconstruction of the CBCT data, the positions of the implants were determined in areas 16 and 26. Three-dimensional scaffolds adapted to the topography of the sinus were virtually designed and printed using a calcium phosphate cement paste. Bilateral sinus floor augmentation applying the printed scaffolds with an interconnecting porosity followed. After nine months, a satisfying integration of the scaffolds was obvious. At the re-entry, vital bone with sufficient blood supply was found. One implant could be placed in positions 16 and 26, respectively. After five months, the implants could be uncovered and were provided with a temporary denture. The application of three-dimensionally printed scaffolds from calcium phosphate cement paste seems to be a promising technique to graft the severely atrophied posterior maxilla for the placement of dental implants. Full article

(This article belongs to the Special Issue Digital Oral and Maxillofacial Medicine)

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