Investigating the Reliability of Novel Nasal Anthropometry Using Advanced Three-Dimensional Digital Stereophotogrammetry

Three-dimensional surface imaging systems (3DSI) provide an effective and applicable approach for the quantification of facial morphology. Several researchers have implemented 3D techniques for nasal anthropometry; however, they only included limited classic nasal facial landmarks and parameters. In our clinical routines, we have identified a considerable number of novel facial landmarks and nasal anthropometric parameters, which could be of great benefit to personalized rhinoplasty. Our aim is to verify their reliability, thus laying the foundation for the comprehensive application of 3DSI in personalized rhinoplasty. We determined 46 facial landmarks and 57 anthropometric parameters. A total of 110 volunteers were recruited, and the intra-assessor, inter-assessor, and intra-method reliability of nasal anthropometry were assessed through 3DSI. Our results displayed the high intra-assessor reliability of MAD (0.012–0.29, 0.003–0.758 mm), REM (0.008–1.958%), TEM (0–0.06), rTEM (0.001–0.155%), and ICC (0.77–0.995); inter-assessor reliability of 0.216–1.476, 0.003–2.013 mm; 0.01–7.552%, 0–0.161, and 0.001–1.481%, 0.732–0.985, respectively; and intra-method reliability of 0.006–0.598°, 0–0.379 mm; 0 0.984%, 0–0.047, and 0–0.078%, 0.996–0.998, respectively. This study provides conclusive evidence for the high reliability of novel facial landmarks and anthropometric parameters for comprehensive nasal measurements using the 3DSI system. Considering this, the proposed landmarks and parameters could be widely used for digital planning and evaluation in personalized rhinoplasty, otorhinolaryngology, and oral and maxillofacial surgery.

Surgical Digitally Guided Planning for the Mini-Screw Assisted Rapid Palatal Expansion (MARPE) and Suture Perforation: MARPE Guide

The surgical planning digitally guided for the mini-screw assisted rapid palatal expansion (MARPE) technique consists of a three-dimensional positioning of MARPE and its mini-implants by a nasomaxillary anatomic evaluation. This technique also includes the simulation of the perforation areas on the midpalatal and transpalatal sutures. This type of planning is performed by superimposing the patients’ files (STL and DICOM). Correct positioning without colliding with the lateral tissues of the palate and the bicortical positioning of each mini-implant are important components of the case study. The MARPE device permits individualization of the height of the mini-implant rings in each region. To avoid incorrect insertion of the drill, the location of the midpalatal and transpalatal sutures was determined using digital planning. A positioning that avoids contact with important structures, such as the nasopalatine canal, while permitting bicortical drilling of the sutures is recommended. Then, a guide that reproduces MARPE positioning and another guide that reproduces the perforations are fabricated, providing exact reproducibility as performed virtually.

Establishing A Virtual Planning Protocol for Functional Maxillomandibular Reconstruction in Oral Cancer Patients

Background: Virtual surgical planning (VSP) helps optimize vascularized bone flap reconstruction and dental rehabilitation in maxillomandibular defects, improving accuracy, reducing errors and reducing the time required for surgery. In this manuscript, we describe a robust but flexible virtual protocol for functional maxillomandibular reconstruction optimized for oral cancer patients using in-house digital planning and provide templates to streamline communication among the team members. Methods: Based on our previous experience of VSP in oral cancer (n=17), we derived a workflow to improve efficiency. It included a virtual surgical template and a protocol focused on the minimal time requirements for three different reconstructive approaches: prefabrication/prelamination, primary implant placement using the SM-ART approach, and digital planning without primary implant placement. We performed a prospective validation (n=4) to determine its validity and if the proposed timelines could be adhered to. Results: The protocol allowed a smooth and coordinated framework for team members to communicate and plan the patient’s treatment. The time period required for VSP was described for patients undergoing bony reconstruction with primary dental placement in those with and without custom plates, drill guides and for patients with prefabrication (Rohner’s procedure). The minimum time required for VSP ranged between 17 and 30 days. The protocol could be reliably applied to the prospective group without any modification. Conclusion: Bony reconstruction with primary dental implant placement in the context of oral cancer can be performed successfully with good functional outcomes. By adopting this protocol, virtual surgical planning can be performed efficiently, avoiding potentially costly delays in treatment.

Digital Planning on Guided Endodontics Technology

The aim of this review is to discuss the digital planning and the use of guided technology in Endodontics. The complexity of the root canals anatomy and the challenges in the microorganism’s control represent risk factors for failure after the infected root canal’s treatment. Scientific improvements associated with technological advances have enabled better predictability of therapeutic procedures results. The development of efficient and modern devices provided safer root canal treatments, with shorter clinical visits and greater patient comfort. Digital endodontics incorporated different tools and developed its own, advancing even further in resolving complex cases. The faithful copy of the internal anatomy provided by the advancement of CBCT devices and software’s, associated with the digital resources of 3D planning and printing, enabled the advent of guided endodontics. This technique is used at different stages of endodontic treatment, with specific indications and greater result predictability. Therefore, this study critically reviewed the potential clinical application of this guided access technique, and the operative steps for its safe performance in managing complex endodontic cases. The main indications are accessing calcified root canals, performing endodontic surgeries in difficult access areas, removing fiberglass posts, and accessing teeth with developmental anomalies. In summary, guided endodontics has been a precise strategy, effective, safe, and clinically applicable. This procedure represents incorporating technological resources and digital planning in the Endodontist clinical practice, increasing predictability to complex cases.

Full Zirconia Implant-Born Prosthetic Rehabilitation with CAD/CAM Technology after Accurate Digital Planning. A Case Report

CAD/CAM technology can enhance the dentistry application of ceramic materials that meet the more relevant biocompatibility and aesthetics demands. In implant-borne prosthesis rehabilitation, yttria-stabilized zirconia appeared to be a valid alternative to metal-alloys and titanium, with comparable mechanical properties and even better interaction with bone and soft tissues. The improvement of monolithic CAD/CAM manufacturing allows for a reliable, predictable, and rapid workflow that can correspond to a holistic treatment philosophy associated with zirconia fixtures. This reported clinical case highlights the advantages of this approach in resolving particularly functionally and aesthetically complex situations. A 40-year-old patient with permanent canine impaction and the persistence of a deciduous tooth compromised by caries was successfully rehabilitated with the surgical removal of the enclosed tooth, the seating of a mono-phase zirconia implant after the deciduous extraction and its loading with a zirconia single crown, without any clinical or radiographical alteration up to seven years follow-up.

Accuracy of digital planning in zygomatic implants

Background Zygomatic implants have been described as a therapeutic alternative for patients with severe maxillary atrophy in order to avoid bone augmentation procedures. Taking that into account, in these treatments, the key factor is the position of the implant, the virtual surgical planning (VSP) is widespread among most clinicians before surgery on the patient. However, there are no studies which evaluate the clinical relevance of these VSP. The aim of this study is to determine whether digital planning on zygomatic implants has any influence on the implant dimensions and position, even when performing conventional surgery afterwards. Results Fourteen zygomatic implants were placed in four patients. Pre-operative and post-operative helicoidal computed tomography were performed to each patient to allow the comparison between the digital planning and the final position of implants. Tridimensional deviation (TD), mesio-distal deviation (MDD), bucco-palatine deviation (BPD), and apico-coronal deviation (ACD) were evaluated as well as angular deviation (AD). Significative differences in apical TD were observed with a mean of 6.114 ± 4.28 mm (p < 0.05). Regarding implant position, only implants placed in the area of the first right molar reported significant differences (p < 0.05) for ACD. Also, implant length larger than 45 mm showed BPD significative differences (p < 0.05). Conclusions Zygomatic implant surgery is a complex surgical procedure, and although VSP is a useful tool which helps the clinician determine the number and the length of zygomatic implants as well as its proper position, surgical experience is still mandatory.

Guided Bilateral Transcanine Implant Placement and Implant-Supported Oral Rehabilitation in a Patient with Progressive Systemic Scleroderma

When faced with a situation where an impacted tooth is in the way of a planned implant, one approach to avoid an invasive surgical procedure and potential associated complications is to place a transcanine implant. The aim of this report was to add a new case of a transimpacted tooth dental implant placement to the existing international literature and to share our experience of transcanine implantation in the maxilla followed by implant prosthodontic rehabilitation of a patient with progressive systemic scleroderma. A 55-year-old woman attended our office for oral cavity assessment and treatment planning for complete oral rehabilitation. Digital planning software was used, and implants were positioned according to a surgical template in regions 13, 16, 23, and 26 (Straumann, Basel, Switzerland) with screw-retained metal-ceramic bridges. Placement of the dental implants through impacted canines and the creation of interfaces other than implant-bone interfaces did not lead to postoperative pain or implant failure. Clinically, overall healing was observed, and the implants were successfully used for implant-supported prosthodontic rehabilitation of the jaw. Within the limitations of this case report, transcanine implantation could represent a valuable alternative to standard implant protocols.

Guided Periodontal Surgery: Digital Workflow for Correction of a Gingival Smile

To promote an effective and predictable treatment planning in cases of gingival smile correction, a periodontal surgical guided from virtual planning could be used. The guide was designed using planning software, based on the patient’s facial aesthetic analysis, photos and intraoral scanning. As a result, the surgical procedure by digital planning provided a more predictable, personalized and safe treatment and outcome to the patient. The present case report describes a gingival smile correction, using digital planning combined with high-power diode laser for periodontal surgery. After 3 months of preservation, there was less exposure of the gingiva in the smile and a high level of patient aesthetic satisfaction. Considering the importance of the correct treatment planning, it may be concluded that use of surgical guided made from a digital planning provided a predictable, personalized and safe treatment to the patient.