Computer-Guided Bone Biopsy: A Technical Note with the Description of a Clinical Case.

Federica Altieri,Gianni Di Giorgio,Antonella Polimeni,Michele Cassetta,Valeria Luzzi,Giovanna Iezzi

doi:10.3390/bioengineering8120214

Federica Altieri, Gianni Di Giorgio + Show 4 more

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https://doi.org/10.3390/bioengineering8120214

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Abstract

Aim: The aim of this technical note is to present a computer-aided design–computer-aided manufacturing (CAD–CAM) surgical guide to perform a computer-guided bone biopsy. Traditionally, to diagnose abnormal conditions affecting jawbone, a bone biopsy is performed with the use of a trephine bur. The positioning of the bur, during the biopsy, is based on the skill of the surgeon; therefore, an inaccurate placement of a trephine bur may occur. The use of a guide, however, can minimize this risk and achieve a better result. Materials and Methods: To determine the site and the extension of bone sampling, the stereolithography file (STL) file of cone–beam computed tomography (CBCT) images is acquired using a specific planning software and superimposed with the STL file of a dental cast; a virtual surgical guide is designed, using the same software that allows a 3D (three-dimensional) view of the guide from different perspectives and planes. The number and site of guide tubes are determined on the basis of the width and the extension of the sampling; thanks to a 3D printer, the surgical guide is manufactured. Results: The use of a customized surgical guide realized with CAD–CAM technology allows a precise and minimally invasive approach, with an accurate three-dimensional localization of the biopsy site. Conclusions: The high precision, great predictability, time-effectiveness and versatility of the present guide should encourage the clinician to use this minimally invasive surgical approach, but controlled clinical trials should be conducted to evaluate the advantages as well as any possible complications.

Highlights

An accurate diagnosis and treatment of oral disease is an essential component of the patient’s comprehensive dental care and the foundation of high-quality dentistry
The most precise imaging to perform a thorough evaluation of the maxillary bone structure is cone-beam computed tomography (CBCT), which provides high spatial resolution, accessibility and a lower radiation dosage compared to computed tomography (CT) [4,5]
The coronal portion of the alveolar bone, after split crest, was evident. In this portion the preexisting trabecular bone with small marrow spaces was in contact In this portion the preexisting trabecular bone with small marrow spaces was in contact manyremodeling remodelingand andnew newbone boneformation formationareas

Summary

Introduction

An accurate diagnosis and treatment of oral disease is an essential component of the patient’s comprehensive dental care and the foundation of high-quality dentistry. The reconstruction of cranial and maxillofacial defects is made through the use of bone grafting. This is a surgical procedure that replaces missing bone with autologous bone, or with an artificial, synthetic, or natural substitute [3]. The most common use of bone grafting is in implant-supported rehabilitation, in order to restore the edentulous area of a missing tooth [3]. To evaluate the graft histology characteristics a bone biopsy is necessary [2]. The most precise imaging to perform a thorough evaluation of the maxillary bone structure is cone-beam computed tomography (CBCT), which provides high spatial resolution, accessibility and a lower radiation dosage compared to computed tomography (CT) [4,5]

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