CAD/CAM-guided vascularized fibula graft for anterior maxillary reconstruction: a case report

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

Accuracy of fibula reconstruction using patient-specific CAD/CAM reconstruction plates and dental implants: A new modality for functional reconstruction of mandibular defects

Porcelain laminate veneers are a popular cosmetic dentistry treatment for correcting discoloured, worn, misaligned, gapped, chipped, or crooked teeth. The restorative material utilized in the indirect method can be processed using CAD/CAM (computer-aided design and computer-aided manufacturing) technology or conventional technique, which is highly sensitive. Due to its multiple benefits, digital technology is growing quickly and has opened up a lot of new opportunities for dental practitioners. These days, CAD/CAM is a helpful technique that enables the creation of monolithic restorations for ceramic materials, which is most recently utilized in the field of ceramic veneers as well as digital impression capturing and digital designing as part of treatment planning. This case study details the methodical process of creating laminate veneers for a patient who wants to enhance the look of their anterior teeth utilizing both traditional and CAD/CAM technology.

The application of computer-aided design and computer-aided manufacturing (CAD/CAM) technology in dentistry has rapidly expanded. This survey aimed to investigate attitudes and current practice of dentists in Riyadh, Saudi Arabia regarding chair-side CAD/CAM technology. An online questionnaire was prepared and sent to a convenience sample of dentists in Riyadh. Questions related to practice aspects of chair-side CAD/CAM system, attitudes and training were presented. A total of 114 questionnaires were completed (77.6% response rate). Study population comprised dentists of a wide range of clinical experience who are working in the various regions of Riyadh city, Saudi Arabia. Of the participants, 27.2% indicated the presence of a chair-side CAD/CAM system at their current workplace and 57% used the chair-side CAD/CAM in the fabrication of dental crowns. The vast majority of participants (81%) believe that the overall quality of chair-side CAD/CAM restorations is at least as good as those fabricated by a lab technician or much better. Most responding dentists considered the chair-side CAD/CAM system as important in terms of time saving, boosting the number of visiting patients and income improvement. The willingness to dedicate the time and effort to learn the chair-side CAD/CAM technology was apparent amid a high proportion of dentists (75.4%). The findings of this pilot survey reflect broad satisfaction and positive attitude among the surveyed dentists towards use and outcome of chair-side CAD/CAM technology in the dental clinical practice. It seems that the CAD/CAM technology has infiltrated into the workflow of Saudi dental practices with speculations of growing implementation among the wider sector of dental practitioners in the future.

A Paradigm Shift in Orthognathic Surgery? A Comparison of Navigation, Computer-Aided Designed/Computer-Aided Manufactured Splints, and “Classic” Intermaxillary Splints to Surgical Transfer of Virtual Orthognathic Planning

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.

Effectiveness and efficiency of a CAD/CAM orthodontic bracket system

Marginal adaptation and CAD-CAM technology: A systematic review of restorative material and fabrication techniques

The objective of this study was to assess the impact of digital waxing expertise on patient satisfaction with anterior interim computer-aided design and computer-aided manufacturing (CAD-CAM) prosthetic rehabilitations designed either by a CAD and dental technician or by a dental clinician with basic CAD-CAM training. This in vivo preliminary study was conducted on a total of 18 patients receiving anterior CAD-CAM rehabilitations (at least from canine to canine) with fixed bridges and/or single crowns. Only patients that had conventional chairside temporary restorations were enrolled. Three within-patient groups were defined at different time points: group CONTROL refers to all 18 patients at their first appointment, when they were using their initial temporary conventional prostheses; group DENT refers to all patients immediately after trying in a set of CAD-CAM prostheses designed by a dental clinician (with basic one-week CAD-CAM training); and group CAD refers to all patients after trying in a set of CAD-CAM prostheses for the same tooth elements but designed by an experienced CAD technician (who was also an experienced dental prosthetic technician). All CAD-CAM restorations were milled in polymethyl methacrylate (PMMA) with high translucency and strength properties (Prime, Zirkonzahn). Satisfaction with comfort and esthetics was assessed for all patients for the three different time points (groups CONTROL, DENT and CAD). Statistically significant differences among groups were assessed with the Friedmann’s test. Group CAD significantly outperformed the other groups in both assessed variables (p = 0.001). The group DENT, in turn, outperformed group CONTROL for satisfaction with esthetics (p = 0.006) but not for comfort (p &gt; 0.05). In conclusion, CAD operator background and expertise level significantly affect patient self-reported outcomes for anterior CAD-CAM rehabilitations. Single crowns and fixed bridges digitally designed by an experienced professional trained in both CAD-CAM and dental technology will likely offer high satisfaction and comfort to patients receiving anterior prosthetic rehabilitations.

Recent advancements in computer-aided design and computer-aided manufacturing (CAD/CAM) technology have led to the development of customized brackets for personalized treatment. Comparing customized CAD/CAM brackets for their efficacy and effectiveness in orthodontic patients using systematic review and meta-analysis of the literature. A comprehensive search was conducted in MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL up to June 2024, with no language or date restrictions. Studies that complied with PICO (population, intervention, comparison, outcome)questions were included, and the Cochrane Risk of Bias 2.0 and Newcastle-Ottawa Scale tools were used to assess the risk of bias in the included studies. Using custom piloted forms, relevant data was retrieved from the included studies. Then a random-effects inverse variance meta-analysis was used to pool the results. The primary outcome was the effectiveness of orthodontic treatment measured by the American Board of Orthodontics cast-radiographic examination (ABO-CRE). Secondary outcomes were overall treatment time and mean number of appointments for CAD/CAM and conventional brackets. Six studies were included in our final review and meta-analysis. Based on the results of meta-analysis, no significant differences between CAD/CAM and conventional brackets for ABO-CRE score (Mean Difference (MD) = -0.49, Confidence Interval (CI)95% = -4.67, 3.68; P = .82) or number of appointments (MD = -1.88, CI95% = -5.91, 2.16; P = .36) could be found. However, significantly shorter overall treatment time for CAD/CAM brackets were reported (MD = -4.07, CI95% = -7.16, -0.99; P = .010). The findings of our meta-analysis indicate that both bracket types perform comparably in terms of treatment results and the number of clinical appointments required during treatment. Nevertheless, a distinct advantage of CAD/CAM brackets emerged concerning overall treatment duration. Notably, patients using CAD/CAM brackets experienced an average treatment period reduction of approximately 4 months, a clinically significant result. The protocol for this systematic review was registered at PROSPERO with the ID CRD42024605257.

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.

To explore a novel method for fabricating removable partial dentures (RPDs) using polyetheretherketone (PEEK) by computer-aided design and computer-aided manufacturing (CAD/CAM) technologies and to evaluate their fits for different assemblies in vitro. A standard stone cast of mandibular partial edentulous jaw was scanned using a lab scanner. Based on the digital cast, thirteen complete RPDs were designed combing dental CAD software and reverse engineering software, and then fabricated using PEEK by milling machine. Fits of assemblies were evaluated quantitatively by measuring the spaces between RPDs and casts. The gaps between RPDs and stone casts in different assemblies were duplicated using light-body silicone impression material and then measured using three-dimensional (3D) digital analysis methods in virtue of a dedicated software. Statistically, one-way analysis of variance (ANOVA) was used to compare the difference of gaps among assemblies in different shapes such as occlusal rest, denture base, and major connector. Paired-samples t test was used to compare the gaps difference for the similar shape assemblies in different areas. One-piece PEEK RPDs were successfully designed and fabricated by CAD/CAM, and all the RPDs were well-seated on stone casts. The gaps between occlusal rests and casts [(84.3±23.6) μm] were significantly larger than those of denture bases [(32.5±27.8) μm] and major connectors [(49.9±47.0) μm], which meant that the fits of denture bases and major connectors were better than that of occlusal rests. However, the fits of all assemblies could be accepted clinically. For the similar shape assemblies in different areas, there were no significantly differences for gaps between distal extension denture bases [(25.1±55.3) μm] and non-extensive denture bases [(41.5±17.7) μm]. The gaps of occlusal rests adjacent and nonadjacent to the edentulous space were (86.1±29.8) μm and (80.8±42.1) μm respectively and there were no significantly difference between them either. These results implied that different locations had no apparent effect on the fits of assemblies. With the computer-aided design and computer-aided manufacturing technology, PEEK can be used to fabricate one-piece removable partial dentures. And all assemblies of the one-piece PEEK RPDs showed satisfying fits in vitro, indicating a promising clinical application in the future.

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

The advancement of digital technology in dentistry signifies an opportunity for the clinician to explore novel techniques in fabricating post and core. Conventional custom-made post and core is constructed in the laboratory with very limited material either gold, nickel-chromium or cobalt-chromium. Apart from higher modulus elasticity compared to dentin, the colour of the conventional custom-made post and core was also unaesthetic making it inferior to be used with all ceramic crown. This article describes post and core fabrication technique using computer-aided design and computer-aided manufacturing (CAD/CAM) technology with acrylic resin pattern build-up and indirect digitalisation method. The same procedure for custom-made metal post and core was adopted in this case to capture the anatomical shape of the root canal before digital technology was incorporated in the fabrication of post and core manufacture using CAD/CAM. With the CAD/CAM approach, an increased in quality, productivity, workflow efficiency and consistency of prosthetic rehabilitation may be obtained. It also enables clinicians to fabricate post and core using tooth colour material with better physical properties and improved mechanical qualities to achieve the best result in restoring endodontically treated teeth.

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.