A new technique for fabricating hollow prostheses for maxillary defects based on a digital process.

Virtual Surgical Guidance Improves Quality of Life Following Scapular Free-Flap Reconstruction of Maxillary Defects

BackgroundReconstruction of the maxillary defects following tumor ablation remains to be a challenge for surgeons. Virtual surgical planning (VSP), intraoperative cutting guides and stereolithographic models provides the head and neck reconstructive surgeon with powerful tools for complex reconstruction planning. Despite its use in fibular osteocutaneous reconstruction, application to the scapular free flap has not been as widely reported. The aim of this study was to compare aesthetic results and operation time of free scapular flap, with and without computer-aided design and computer-aided manufacturing (CAD/CAM) customized osteotomy guide, for reconstruction of maxillary defects.MethodsIn this prospective randomized controlled clinical trial study, we randomly assigned 22 patients with maxillary defects who were scheduled to undergo maxillary reconstruction with either free scapular flap with CAD/CAM customized osteotomy guide; study group (n = 11) or free scapular flap without CAD/CAM customized osteotomy guide; control group (n = 11). All patients were followed up for 3 months. The aesthetic outcome, operation and ischemic times were evaluated and compared.ResultsAesthetic outcomes were evaluated objectively by means of differential surface area (sagittal and axial) measurement, which showed improved aesthetic outcome (contour symmetry) in the study group with a mean of (241.39 ± 113.74 mm2), compared to patients in control group with a mean of (358.70 ± 143.99 mm2). There were significant differences between the two groups (P < 0.05). Aesthetic outcomes were also evaluated subjectively by means of visual analogue scale (VAS) and patient’s satisfaction score (PSS). The postoperative aesthetic appearance was better in the study group with more patients satisfied than that in control group and there were statistically significant differences (P = 0.039). The mean total operative time was 678.81 min and 777.18 min in the study group and control group respectively (P < 0.05) and the mean ischemia time was 133.18 min and 195.72 min for study group and control group respectively (P < 0.05). The ischemia time and total operative time were shorter in the study group compared to those in the control group and there were no flap losses in both groups.ConclusionThe use of CAD/CAM prefabricated cutting guides facilitates scapular flap molding and placement, minimizes ischemic time and operating time as well as improves aesthetic outcomes.Trialregistration This trial was registered at ClinicalTrials.gov. Registration number: NCT03757286. Registration date: 28/11/2018

ABSTRACTThis article evaluates the design of a variable impedance prosthetic (VIPr) socket for a transtibial amputee using computer-aided design and manufacturing (CAD/CAM) processes. Compliant features are seamlessly integrated into a three-dimensional printed socket to achieve lower interface peak

Preoperative computer-aided design and computer-aided manufacturing (CAD/CAM) revolutionized head and neck reconstruction after extirpative surgery. However, studies performing head-to-head comparison to the conventional technique have limited long-term follow-up. The authors aimed to compare short and long-term outcomes between conventional and CAD/CAM approaches for mandibular reconstruction with free fibula flaps. Patients undergoing free flap reconstruction from 2012 to 2021 were included. Data regarding patient demographics, medical history, surgical details, complications, and reconstructive outcomes were collected. Patients who had CAD/CAM were compared with the patients who underwent reconstruction with the conventional technique. The cumulative incidence of hardware maintenance was displayed using the Kaplan-Meier method. A total of 215 patients (conventional, n = 79; CAD/CAM, n = 136) were included. Both cohorts had similar demographics, but the CAD/CAM cohort was younger ( P = 0.043). The mean operative duration was 54 minutes shorter with the use of CAD/CAM ( P = 0.014). Total and partial flap loss rates were similar. Patients with CAD/CAM had significantly lower rates of early wound dehiscence ( P = 0.037). Median (interquartile range [IQR]) follow-up duration was similar (931 days [IQR, 1854 days] in conventional versus 728 days [IQR, 841 days] days in CAD/CAM; P = 0.084). After excluding patients with major surgical complications in the first 30 days, the CAD/CAM cohort had a lower hardware removal rate (28.8% versus 13.9%; P = 0.011). The significance persisted after including only the patients with more than 2 years of follow-up. The use of preoperative CAD/CAM may reduce operative duration, while allowing for longer maintenance of hardware with reduced removal rates because of complications. Therapeutic, III.

The development of the CAD/CAM (Computer-aided design and computer-aided manufacturing) system has globally changed the fabrication and delivery of prosthetics and orthotics. Furthermore, since the introduction of CAD/CAM in the 1980s, many successful CAD/CAM system are available in the market today. However, less than 20% of amputees have access to digital fabrication technology and large portion of the amputees are from the developing countries. This review designed to examine selected studies from 1980 to 2019 on CAD/CAM systems in the production of transtibial prosthetic sockets. A review was conducted based on articles gathered from Web of Science, Pubmed and Science Direct. From the findings, 92 articles found related to CAD/CAM-derived transtibial prosthetic socket (TPS). After a further screening of the articles, 20 studies were chosen and only one study was done in a developing country. The results showed an increase interest in CAD/CAM application in Transtibial prosthetic socket (TPS) production for both developed and developing countries, yet the technology has not fully utilised in the developing countries. Factors such as resources, accessibility, knowledge-gap and lack of experienced prosthetists remain the major causes of the lack of CAD/CAM system studies. Large-scale trials are required to employ digital fabrication in the developing regions, consequently advancing the production of high-quality CAD-CAM-derived TPS where most prosthetic and orthotics are needed.

Numerous surgical fields have embraced computer-aided design and computer-aided manufacturing (CAD/CAM), including plastic and reconstructive surgery. However, most of the literature and clinical use pertains to reconstruction of the head and neck. Herein, we provide a case series and systematic review of the literature, documenting the use of CAD/CAM in facilitating complex microvascular free tissue transfer for reconstructions involving the extremities, pelvis, and spine (EPS). This study consisted of two components: a case series and a systematic review of the literature. For the case series, the senior author's cases that included CAD/CAM to assist microvascular free tissue transfer reconstructions of the EPS were included. For the systematic review, all PubMed-, Scopus-, and Google Scholar-indexed studies describing the use of CAD/CAM to facilitate free tissue transfer in the EPS were identified and included using PRSMA guidelines. The case series identified 10 patients who received CAD/CAM-assisted microvascular reconstruction. Our systematic review identified 15 articles, representing 124 patients and 133 CAD/CAM-assisted free tissue transfers. Most authors believed that CAD/CAM facilitated a more efficient operation by shifting much of the intraoperative planning to the preoperative phase, ultimately translating to a shorter and more accurate surgery with improved function and cosmesis. CAD/CAM can be used to facilitate microvascular reconstruction of the EPS. Our cases series and systematic review suggest that CAD/CAM for EPS surgery may improve outcomes.

Background: The objective of this study was to investigate the attitude of Saudi dentists towards CAD/CAM (computer-aided design and computer-aided manufacturing) in restorative dentistry, investigate the existing knowledge and improve the practice accordingly. Methods: At random, electronic surveys were distributed to Saudi dental practitioners. The study received 500 questionnaires, with 425 being deemed valid. The following sections were included in the questionnaire: (i) Practitioner demographic information such as gender, practice level, and practice experience; (ii) CAD/CAM knowledge and benefits; (iii) CAD/CAM skills and training required; and (iv) CAD/CAM clinical overview. Descriptive statistics such as numbers and percentages were used to analyze the collected data. The Chi-square and Fisher's Exact tests were used to assess the results. Results: Males accounted for 292 (68.7%) of the participants, while females accounted for 133 (31.3%). General Practitioners accounted for the most subjects (253, or 59.5%), followed by consultants (91, or 21.4%) and specialists (81, or 19.1%). Among 425 dentists, 170 (40%) were aware of CAD/CAM, while 255 (60%) were not. Consultants and specialists demonstrated more significant levels of knowledge than general practitioners. Furthermore, dentists with experience of more than ten years and experience of 5-10 years showed more understanding of CAD/CAM than dentists with less than five years of experience. Most participants (71.5%) do not use CAD/CAM in dental practice, whereas only less than one-third of them use it. Most participants (63.5%) plan to purchase CAD/CAM. Most dentists (74.4%) believe CAD/CAM technology is helpful in clinical procedures, while others believe it is useful in diagnostic and different functions. Most participants assume that CAD/CAM will eventually replace traditional methods. Most dentists assume that the use of CAD/CAM requires skills and training. Conclusion: The findings of this study show a prominent level of satisfaction and a favorable attitude among the surveyed dentists towards the usage of CAD/CAM technology in clinical practice.

Background:The objective of this study was to investigate the attitude of Saudi dentists towards CAD/CAM (computer-aided design and computer-aided manufacturing) in restorative dentistry, investigate the existing knowledge and improve the practice accordingly.Methods:At random, electronic surveys were distributed to Saudi dental practitioners. The study received 500 questionnaires, with 425 being deemed valid. The following sections were included in the questionnaire: (i) Practitioner demographic information such as gender, practice level, and practice experience; (ii) CAD/CAM knowledge and benefits; (iii) CAD/CAM skills and training required; and (iv) CAD/CAM clinical overview. Descriptive statistics such as numbers and percentages were used to analyze the collected data. The Chi-square and Fisher's Exact tests were used to assess the results.Results:Males accounted for 292 (68.7%) of the participants, while females accounted for 133 (31.3%). General Practitioners accounted for the most subjects (253, or 59.5%), followed by consultants (91, or 21.4%) and specialists (81, or 19.1%). Among 425 dentists, 170 (40%) were aware of CAD/CAM, while 255 (60%) were not. Consultants and specialists demonstrated more significant levels of knowledge than general practitioners.Furthermore, dentists with experience of more than ten years and experience of 5-10 years showed more understanding of CAD/CAM than dentists with less than five years of experience. Most participants (71.5%) do not use CAD/CAM in dental practice, whereas only less than one-third of them use it. Most participants (63.5%) plan to purchase CAD/CAM. Most dentists (74.4%) believe CAD/CAM technology is helpful in clinical procedures, while others believe it is useful in diagnostic and different functions. Most participants assume that CAD/CAM will eventually replace traditional methods. Most dentists assume that the use of CAD/CAM requires skills and training.Conclusion:The findings of this study show a prominent level of satisfaction and a favorable attitude among the surveyed dentists towards the usage of CAD/CAM technology in clinical practice.

CAD-CAM in dentistry

Computer-aided design and computer-aided manufacturing (CAD/CAM) denture base manufacturers claim to produce their resin pucks under high heat and pressure. Therefore, CAD/CAM dentures are assumed to have enhanced mechanical properties and, as a result, are often produced with lower denture base thicknesses than conventional, manually fabricated dentures. The aim of this study was to investigate if commercially available CAD/CAM denture base resins have more favourable mechanical properties than conventionally processed denture base resins. For this purpose, a series of three-point bending tests conforming to ISO specifications were performed on a total of 80 standardised, rectangular CAD/CAM denture base resin specimens from five different manufacturers (AvaDent, Baltic Denture System, Vita VIONIC, Whole You Nexteeth, and Wieland Digital Dentures). A heat-polymerising resin and an autopolymerising resin served as the control groups. The breaking load, fracture toughness, and the elastic modulus were assessed. Additionally, the fracture surface roughness and texture were investigated. Only one CAD/CAM resin showed a significantly increased breaking load. Two CAD/CAM resins had a significantly higher fracture toughness than the control groups, and all CAD/CAM resins had higher elastic moduli than the controls. Our results indicate that CAD/CAM denture base resins do not generally have better mechanical properties than manually processed resins. Therefore, the lower minimum denture base thicknesses should be regarded with some caution.

Intraoral scan bodies in implant dentistry: A systematic review

Two techological approaches for fabricating dentures; computer-aided design and computer-aided manufacturing (CAD/CAM) and rapid prototyping (RP), are combined with the conventional techniques of impression and jaw relation recording to determine their feasibility and applicability. Maxillary and mandibular edentulous jaw models were produced using silicone molds. After obtaining a gypsum working model, acrylic bases were crafted, and occlusal rims for each model were fabricated with previously determined standard vertical and centric relationships. The maxillary and mandibular relationships were recorded with guides. The occlusal rims were then scanned with a digital scanner. The alignment of the maxillary and mandibular teeth was verified. The teeth in each arch were fabricated in one piece, or set, either by CAM or RP. Conventional waxing and flasking was then performed for both methods. These techniques obviate a practitioner's need for technicians during design and provide the patient with an opportunity to participate in esthetic design with the dentist. In addition, CAD/CAM and RP reduce chair time; however, the materials and techniques need further improvements. Both CAD/CAM and RP techniques seem promising for reducing chair time and allowing the patient to participate in esthetics design. Furthermore, the one-set aligned artificial tooth design may increase the acrylic's durability.

Traditional dental implant surgery has been challenged by the phenomenal progression in computer-assisted surgery (CAS) that we have been witnessing in recent years. Among the computer-aided technologies, computer-aided design and computer-aided manufacturing (CAD/CAM) techniques represent by far the most attractive and accepted alternatives over their dynamic counterpart, navigational assistance. Based on many years of experience, we have determined that CAD/CAM technology for guiding dental implant surgery is valuable for rehabilitation of the anterior maxillary region and the management of complete or severe partial edentulism. The technology also guarantees the 3D parallelism of implants. The purpose of the present report is to describe indications for use of CAD/CAM dental implant guided surgery. We analyzed the clinical and radiological data of thirteen consecutive edentulous patients treated using CAD/CAM techniques. All of the patients had stable cosmetic results with a high rate of patient satisfaction at the final follow-up examination. No intra- and/or postoperative complications were encountered during any of the steps of the procedure. The application of CAD/CAM techniques produced successful outcomes in the patients presented in this series.

Computer-aided design and computer-aided manufacturing (CAD/CAM) technology is an innovative digital system capable of scanning prepared teeth that are intended to receive crowns, bridges, and inlays and then effectively designing and fabricating restorations. Many dental schools are currently implementing this innovative CAD/CAM technology as part of their curricula and at University of Florida College of Dentistry we created a hands-on elective. The 5-week course requires 2- to 3-hours of time per week for the lectures and labs. The sessions cover an introduction to digital dentistry, technology and systems evaluation, an exercise for scanning, designing, milling, and finishing a single unit ceramic restoration, and a final exam. The students also gave presentations about systems and materials used. The classroom exercises included small-group learning and class debate sessions. In 2015, two 5-week sessions included a total of 16 participants (8 each). The overall course satisfaction from the combined two rounds was 4.7 out of 5. Comments for the course have been generally positive, indicating that the course was a successful introduction to CAD/CAM technology. Students' comments showed that they were very impressed by the new technology and interested in implementing it in their practices. This exercise in the comparison between CAD/CAM and conventional technology resulted in a deeper understanding of digital dentistry systems and ensured that students were prepared in their clinical reasoning to apply their education in real-world decision making after graduation. By integrating this new technology in a core curriculum, preclinical, prosthodontic sophomore course and as a junior elective course, students were provided with the hands-on experience needed to utilize CAD/CAM effectively in patient care.

Effectiveness and efficiency of a CAD/CAM orthodontic bracket system