Abstract
This systematic review was aimed at gathering technical and clinical applications of CAD/CAM technology for the preoperative planning of craniofacial implants placement, designing of molds and substructures and fabrication of orbital prostheses. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, an electronic search was executed. Human studies that utilized digital planning systems for the prosthetic rehabilitation of orbital defects were included. A total of 16 studies of 30 clinical cases, which were virtually planned through various digital planning and designing software, were included. The most common preoperative data required for digital planning were CT scans in 15 cases, the 3DSS-STD-II scanning system in 5 cases, an Artec Color 3D scanner in 3 cases and a NextEngine Desktop 3D laser scanner in 2 cases. Meanwhile, the digital designing software were Ease Orbital Implant Planning EOIPlan software in eight cases, Geomagic software in eight cases, Simplant software in four cases and Artec Studio 12 Professional in three cases. Surgical templates were fabricated for 12 cases to place 41 craniofacial implants in the orbital defect area. An image-guided surgical navigation system was utilized for the placement of five orbital implants in two cases. Digital designing and printing systems were reported for the preoperative planning of craniofacial implants placement, designing of molds and substructures and fabrication of orbital prostheses. The studies concluded that the digital planning, designing and fabrication of orbital prostheses reduce the clinical and laboratory times, reduces patient visits and provide a satisfactory outcome; however, technical skills and equipment costs are posing limitations on the use of these digital systems.
Highlights
The aim of this study is to gather the clinical data to respond to the following question: In patients with orbital defects, what are the technical and clinical applications of Computer-aided design and computer-aided manufacturing systems (CAD/computer-aided manufacturing (CAM)) technology for the preoperative planning, designing and manufacturing of orbital prostheses?
776 studies were screened on the basis of the titles and abstracts by following the inclusion and exclusion criteria; an additional
Intraoral implants have been virtually planned and used in computer-guided surgeries since 1997 [39,40]. These digital technology advancements further led to the guided surgeries of craniofacial implants and assisted clinicians and dental technicians in exploring the possibilities of the designing and printing of molds, retentive substructures, customized implants, models, digital wax-ups and prosthesis fabrication [18]
Summary
Orbital defects can arise from acquired or congenital anomalies. Acquired defects of the orbital location can be seen due to tumors and trauma, while congenital defects appear as the result of developmental anomalies. Exenteration of the eye is one of the most aggressive surgical approaches, which is usually seen after orbital tumor resection. The restoration of an exenteration defect is mostly dependent on the prosthetic options to improve the esthetics and quality of life of these patients [1–5]. With the introduction of endosseous implants, the prosthetic rehabilitation of exenteration orbital defects became less challenging, as they provide improved retention, support and stability of orbital prostheses [3,6]. Improper planning and placement of these implants can
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