3D Virtual Planning Research Articles

Customized Genioplasty and Advantages of 3D Virtual Planning: An Updated Literature Review.

Genioplasty is a surgical technique that modifies the projection of the chin in three dimensions to achieve symmetry and facial harmonization. Virtual 3D planning is increasingly used, supplanting the conventional surgical technique due to the precise and predictable results obtained.The definition of the objective of the study was first carried out using the PICO (Patient, Intervention, Comparison, Outcome) question method. Posteriorly, an updated literature review was carried out in the "PubMed" database using the keywords "Genioplasty and Virtual 3D Planning," obtaining 11 articles for the study with the objective of defining the advantages and disadvantages of performing a virtually planned genioplasty, comparing it with the conventional technique.In the results, it is observed that virtually planned genioplasty presents greater precision, a reduction in surgical time, and a lower rate of complications than the conventional technique. Virtual planning using computer-aided design/computer-aided manufacturing technology presents good reproducibility in the patient with <2 mm variations between what was planned and what was obtained postoperatively, with statistically significant results (p < 0.001).In conclusion, virtually planned genioplasty with customized cutting guides and osteosynthesis plates achieves very precise surgery results with good reproducibility, reducing surgical time, intraoperative complications, and the difficulty of the surgical technique.

LEADING-EDGE DEVELOPMENTS IN GUIDED ENDODONTICS: UTILIZING NEXT-GENERATION TOOLS

Guided endodontics has revolutionized root canal therapy by integrating advanced technologies to improve precision, safety, and outcomes. This method combines imaging technologies like cone beam computed tomography (CBCT) with computer-assisted navigation systems to enhance the accuracy of root canal treatments. Key stages include initial diagnostic imaging, 3D virtual treatment planning, and the use of customized guides or templates during procedures. These guides help accurately identify canal orifices, reducing procedural errors and improving access to complex root structures. Benefits include better treatment predictability, reduced procedure time, and lower risk of complications. Recent advancements, such as high-resolution CBCT, advanced 3D printing for custom guides, and improved virtual planning, have enhanced the precision of access cavity preparations. Innovations like low-profile clinical templates address challenges with restricted mouth openings, while improved intraoral scanning and virtual planning streamline preparation processes. Despite higher costs and increased planning time, guided endodontics is increasingly seen as a standard method, offering substantial improvements in clinical practice and patient outcomes. This review consolidates these advancements, emphasizing their impact on precision, efficiency, and future research directions in endodontics.

Analysis of the implementation of a circuit for intra-operative superposition and comparison of the surgical outcomes using ICBCT in maxillofacial surgery.

This paper describes a novel circuit for intraoperative analysis with ICBCT in maxillofacial surgery. The aim is to establish guidelines, define indications, and conduct an analysis of the implementation of the circuit for intraoperative comparison of surgical outcomes in relation to 3D virtual planning in maxillofacial surgery. The study included 150 maxillofacial surgical procedures. Intraoperative actions involved fluoroscopy localization, intraoperative CBCT acquisition, segmentation, and superimposition, among other steps. Surgical times due to intraoperative superposition were measured, including time required for ICBCT positioning and acquisition, image segmentation, and comparison of 3D surfaces from the surgical planning. Successful intraoperative comparison was achieved in all 150 cases, enabling surgeons to detect and address modifications before concluding the surgery. Out of the total, 26 patients (17.33%) required intraoperative revisions, with 11 cases (7.33%) needing major surgical revisions. On average, the additional surgical time with this circuit implementation was 10.66 ± 3.03min (n = 22). The results of our research demonstrate the potential for performing intraoperative surgical revision, allowing for immediate evaluation, enhancing surgical outcomes, and reducing the need for re-interventions.

Is there a difference in surgical accuracy following bimaxillary surgery between cleft and non-cleft patients?

To assess the surgical accuracy of 3D virtually planned orthognathic surgery among patients with and without cleft. This retrospective cohort study included cleft and non-cleft patients with class III malocclusion who underwent bimaxillary surgery. CBCT scans were acquired before and immediately after surgery. 3D virtual surgical planning (VSP) was performed using CBCT and digitalized dentition data. All orthognathic surgeries were performed by the same surgeons using interocclusal splints. The primary outcome variable was surgical accuracy, defined as the difference between the planned and surgically achieved maxillary movements, quantified in six degrees of freedom. Analysis of covariance was used to test for intergroup differences in surgical accuracy after correcting for differences in the magnitude of planned surgical maxillary movements. Twenty-eight cleft and 33 non-cleft patients were enrolled, with mean ages of 18.5 and 25.4 years, respectively (P=0.01). No significant gender difference was present between the groups (P=0.10). After adjustment for small differences in surgical movements, no significant differences in surgical accuracy were observed between cleft and non-cleft patients. The present study demonstrates that high surgical accuracy in maxillary movements can be achieved in both cleft and non-cleft patients using VSP and interocclusal splints. Orthognathic cases with cleft can be performed with 3D VSP to obtain a satisfactory surgical accuracy.

VE59 - Robotic-assisted partial nephrectomy with minimal surgical impact after 3D virtual planning for the treatment of small renal masses

VE59 - Robotic-assisted partial nephrectomy with minimal surgical impact after 3D virtual planning for the treatment of small renal masses

Optimization of Revision Hip Arthroplasty Workflow by Means of Detailed Pre-Surgical Planning Using Computed Tomography Data, Open-Source Software and Three-Dimensional-Printed Models.

In revision hip arthroplasty (RHA), establishing the center of rotation (COR) can be technically challenging due to the acetabular bone destruction that is usually present, particularly in severe cases such as Paprosky type II and III defects. The aim of this study was to demonstrate the use of open-source medical image reconstruction software and low-cost 3D anatomical models in pre-surgical planning of RHA. A total of 10 patients, underwent RHA and were included in the study. Computed tomography (CT) scans were performed for all cases, before surgery and approximately 1 week after the procedure. The reconstruction of CT data, 3D virtual planning of the COR and positioning of acetabular cups, including their inclination and anteversion angles, was carried out using the free open source software platform 3D Slicer. In addition, anatomical models of the pelvis were built on a desktop 3D printer from polylactic acid (PLA). Preoperative and postoperative reconstructed imaging data were compared for each patient, and the position of the acetabular cups as well as the COR were evaluated for each case. Analysis of the pre- and post-op center of rotation position data indicated statistically insignificant differences for the location of the COR on the X-axis (1.5 mm, t = 0.5741, p = 0.5868) with a fairly strong correlation of the results (r = -0.672, p = 0.0982), whilst for the location of the COR in the Y and Z-axes, there was statistical dependence (Y axis, 4.7 mm, t = 3.168 and p = 0.0194; Z axis, 1.9 mm, t = 1.887 and p = 0.1081). A strong correlation for both axes was also observed (Y and Z) (Y-axis, r = 0.9438 and p = 0.0014; Z-axis, r = 0.8829 and p = 0.0084). Analysis of inclination angle values showed a statistically insignificant difference between mean values (3.9 degrees, t = 1.111, p = 0.3092) and a moderate correlation was found between mean values (r = -0.4042, p = 0.3685). Analysis of the anteversion angle showed a statistically insignificant difference between mean values (1.9 degrees, t = 0.8671, p = 0.4192), while a moderate correlation between mean values was found (r = -0.4782, p = 0.2777). Three-dimensional reconstruction software, together with low-cost anatomical models, are very effective tools for pre-surgical planning, which have great potential use in orthopedic surgery, particularly RHA. In up and in- and up and out-type defects, it is essential to establish a new COR and to identify three support points within the revision acetabulum in order to correctly position acetabular cups.

Effectiveness of individualized 3D titanium-printed Orthognathic osteotomy guides and custom plates

BackgroundComputer-aided design/manufacturing (CAD/CAM) technology was developed to improve surgical accuracy and minimize errors in surgical planning and orthognathic surgery. However, its accurate implementation during surgery remains a challenge. Hence, we compared the accuracy and stability of conventional orthognathic surgery and the novel modalities, such as virtual simulation and three-dimensional (3D) titanium-printed customized surgical osteotomy guides and plates.MethodsThis prospective study included 12 patients who were willing to undergo orthognathic surgery. The study group consisted of patients who underwent orthognathic two-jaw surgery using 3D-printed patient-specific plates processed by selective laser melting and an osteotomy guide; orthognathic surgery was also performed by the surgeon directly bending the ready-made plate in the control group. Based on the preoperative computed tomography images and intraoral 3D scan data, a 3D virtual surgery plan was implemented in the virtual simulation module, and the surgical guide and bone fixation plate were fabricated. The accuracy and stability were evaluated by comparing the results of the preoperative virtual simulation (T0) to those at 7 days (T1) and 6 months (T2) post-surgery.ResultThe accuracy (ΔT1‒T0) and stability (ΔT2‒T1) measurements, using 11 anatomical references, both demonstrated more accurate results in the study group. The mean difference of accuracy for the study group (0.485 ± 0.280 mm) was significantly lower than in the control group (1.213 ± 0.716 mm) (P < 0.01). The mean operation time (6.83 ± 0.72 h) in the control group was longer than in the study group (5.76 ± 0.43 h) (P < 0.05).ConclusionThis prospective clinical study demonstrated the accuracy, stability, and effectiveness of using virtual preoperative simulation and patient-customized osteotomy guides and plates for orthognathic surgery.

Quantifying the Differences between 3D Virtual Planning and Attained Postoperative Reduction on CT for Patients with Tibial Plateau Fractures; a Clinical Feasibility Study.

Background: Three-Dimensional Virtual Planning (3DVP) has been proven to be effective for limiting intra-articular screw penetration and improving the quality of reduction for numerous fractures. However, the value of 3DVP for patients with tibial plateau fractures has yet to be determined. Purposes: The research question of this study is: Can Computed Tomography Micromotion Analysis (CTMA) provide a reliable quantification of the difference between 3DVP and the postoperative reduction on CT for tibial plateau fractures? Methods: Nine consecutive adult patients who received surgical treatment for a tibial plateau fracture and received pre- and postoperative CT scans were included from a level I trauma center in the Netherlands. The preoperative CT scans of the patients were uploaded in a 3DVP software. In this software, fracture fragments were reduced and the reduction was saved as a 3D file (STL). The quality of the reduction from the 3DVP software was compared with the postoperative results using CT Micromotion Analysis (CTMA). In this analysis, the translation of the largest intra-articular fragment was calculated by aligning the postoperative CT with the 3DVP. Coordinates and measurement points were defined in the X, Y, and Z axes. The combined values of X and Y were used to define the intra-articular gap. The Z-axis was defined as the line from cranial to caudal and was used to define intra-articular step-off. Results: The intra-articular step-off was 2.4 mm (Range 0.5-4.6). Moreover, the mean translation of the X-axis and Y-axis, which was defined as the intra-articular gap, was 4.2 mm (Range 0.6-10.7). Conclusions: 3DVP provides excellent insight into the fracture and its fragments. Utilizing the largest intra-articular fragment, it is feasible to quantify the difference between 3DVP and a postoperative CT using CTMA. A prospective study to further analyze the use of 3DVP in terms of intra-articular reduction and surgical and patient-related outcomes has been started by our team.

CUSTOM-MADE PATIENT-SPECIFIC HIGH TIBIAL OSTEOTOMY IMPLANTS AND SURGICAL GUIDES SIGNIFICANTLY IMPROVE CLINICAL OUTCOMES: FIRST-IN-MAN CASE SERIES

High tibial osteotomy (HTO) is a joint preserving alternative to knee replacement for medial tibiofemoral osteoarthritis in younger, more active patients. The procedure is technically challenging and limited also by ‘one size fits all’ plates which can result in patient discomfort necessitating plate removal.This clinical trial evaluated A novel custom-made HTO system – TOKA (3D Metal Printing LTD, Bath, UK) for accuracy of osteotomy correction and improvements in clinical outcome scores.The investigation was a single-arm single-centre prospective clinical trial (IRCCS Istituto Ortopedico Rizzoli; ClinicalTrials.gov NCT04574570), with recruitment of 25 patients (19M/6F; average age: 54.4 years; average BMI: 26.8), all of whom received the TOKA HTO 3D planning and surgery. All patients were predominantly diagnosed with isolated medial knee osteoarthritis and with a varus deformity under 20°. Patients were CT scanned pre- and post-operatively for 3D virtual planning and correctional assessment. All surgeries were performed by the lead clinical investigator – a consultant knee surgeon with a specialist interest in and clinical experience of HTO.On average, Knee Society Scores (KSS) improved significantly (p&lt;0.001) by 27.6, 31.2 and 37.2 percentage points respectively by 3-, 6- and 12-months post-surgery respectively. Other measures assessed during the study (KOOS, EQ5D) produced similar increases.Our early experience using custom implants is extremely promising. We believe the reduced profile of the plate, as well as the reduced invasiveness and ease of surgery contributed to faster patient recovery, and improved outcome scores compared to conventional techniques. These clinical outcome results compare very favourably other case-series with published KOOS scores using different devices.

The Accuracy and Stability of Intentional Change of Frontal-Ramal Inclination in Orthognathic Surgery for Facial Asymmetry Patients.

Facial asymmetry can be defined as differences in the left and right sides of the face, and most of the patients with facial asymmetry have different left and right frontal-ramal inclinations (FRIs). Restoring the symmetry of both FRIs is important in the surgery of facial asymmetry patients, but it is very difficult to achieve perfect symmetry through conventional orthognathic surgery. However, by using 3-dimensional (3D) virtual planning and CAD/CAM technolo gies, intentional change of FRIs can be possible so the symmetry can be improved. The purpose of this study is to evaluate the surgical accuracy and long-term stability of intentional change of FRIs by 3D virtual surgery, CAD/CAM-assisted orthognathic surgery for patients with facial asymmetry. The study included 20 patients who had undergone orthognathic surgery for skeletal class III malocclusion from January 2019 to December 2021. To evaluate the accuracy of surgery, 3D facial cone beam computed tomography (CBCT) taken immediately after surgery (T1) and virtual surgery data (Tv) were measured and the difference values were calculated. The evaluation of the long-term stability of intentional change of FRI was performed by measuring T1 and T2 (3D facial cone beam computed tomography images taken 6mo after surgery) and the difference values were calculated. The difference values of FRIs in the left and right proximal segments of each patient were calculated. And then, for comparison depending on the direction of rotation, increased FRI groups (n=20, medial rotation) and decreased FRI groups (n=20, lateral rotation) were analyzed separately. As a result, all difference values at both (ΔT1-Tv) and (ΔT2-T1) were <1 degree. As a result of analyzing the entire FRI by dividing it into decreasing and increasing groups, the mean value of (ΔT1-Tv) was 0.225 degrees for the decreasing group and 0.275 degrees for the increasing group. It means that the proximal segment moved less than the movement implemented by the virtual surgery through actual surgery but it shows a very small error, which means that the overall operation almost accurately implements the virtual surgical planning. Compared with (ΔT1-Tv), the mean value of (ΔT2-T1) showed a much smaller error value, and no specific tendency was observed. This indicates that the stability after surgery is very good. Based on this study, using 3D virtual surgery planning and CAD/CAM technologies for treating patients with facial asymmetry was very useful, and surgery could be performed accurately and predictably. In particular, left-right symmetry was almost perfectly achieved through virtual simulation and could be implemented through actual surgery. Therefore, it can be said that the use of these 3D technologies is recommended for the surgical approach of facial asymmetry.

Three-dimensional planning accuracy and follow-up of Le Fort I osteotomy in cleft lip/palate patients.

ObjectivesOur aim was to determine the accuracy of the three-dimensional (3D) virtual planning and stability of LeFort I osteotomy in cleft lip and/or palate patients (CLP) using a validated 3D method. Materials and methodsEight patients with a history of cleft lip/palate treated with LeFort I osteotomy for maxillary hypoplasia between January 2016 and April 2020 were included in this retrospective study. Three-dimensional virtual planning was performed using Proplan software then transferred to the operation theater via 3D printed occlusal wafers. The accuracy of the 3D planning and the 1-year stability of the maxilla were evaluated by means of a validated semiautomatic stepwise module in Amira software resulting into 3 linear measurements: anterior/posterior, medial/lateral, superior/inferior and 3 rotational measurements: pitch, roll, yaw. ResultsThe largest mean absolute difference (MAD) for accuracy assessment was found in the A/P direction (2.75mm±2.25 mm) and in pitch (3.23°±2.11°). For A/P translation, an error of >2 mm was observed in 5(62.5%), for S/I translation an error of >2 mm was observed in 4(50.0%) of the 8 patients, whereas for pitch 3 patients(37,5%) showed an error >4° At one year follow-up, the largest linear and rotational MAD was found in the A/P direction (1.20mm±0.92 mm) and in pitch (3.31°±2.31°). ConclusionsFindings of this study show that 3D virtual computer-assisted orthognathic surgery enables an accurate repositioning of the hypoplastic maxilla in CLP patients. However, A/P translations and pitch rotations remain challenging to achieve during surgery. These movements were also found to be least stable at one year follow-up.

Scope of PSI in Maxillofacial Region: Our Experience.

Patient-specific implants aided by 3D virtual planning and CAD-CAM technology represents the next frontier in rehabilitation of complex maxillofacial defects slowly replacing the gold standard autografts as the preferred mode of reconstruction. In a first of its kind case series, we describe eight cases of complex maxillofacial defects managed by patient-specific implants at AFDC, New Delhi. All the designs went through stringent FEA analysis and GOM analysis to standardize the implant for achieving optimal functionality. We also added integrated dental implant component in the PSI to achieve immediate postoperative dental rehabilitation. This case series adds to literature the varying scenarios in which PSI's can be used in the maxillofacial region with functional dental rehabilitation thus paving a way for a new era in reconstruction.

Custom-Made 3D Titanium Plate for Mandibular Reconstruction in Surgery of Ameloblastoma: A Novel Case Report

Ameloblastoma is a benign yet locally invasive odontogenic neoplasm, characterised by slow growth and painless swelling. The treatment for ameloblastoma varies from curettage to en bloc resection, with recurrence commonly occurring. The safety margin of resection is hence essential to avoid recurrence. Understanding the three-dimensional anatomy for reconstruction of mandibular defects after tumour resection often poses problems for head and neck surgeons. Historically, various autografts and alloplastic materials have been used in the reconstruction of these types of defects. Over time, advances in technology with computed tomography scanners and three-dimensional images enhance the surgical planning and management of maxillofacial tumours. The development of new prototyping systems provides accurate 3D biomodels on which surgery can be simulated, especially in cases of ameloblastoma, in which the safety margin is vital for the clinical outcome. The objective of this paper was to report a clinical case of employing these methodologies for reconstruction after an extensive mandibular resection. The clinical outcomes were observed. A case of follicular ameloblastoma of the mandible is depicted in the following paper, where a 3D biomodel was used throughout the surgery. A 3D printed patient-specific titanium implant was manufactured and placed intraoperatively for reconstruction. The treatment had satisfactory postoperative results without complications. Titanium implants being bioinert, customisable and easily workable, especially with the help of 3D virtual planning techniques, can be considered as ideal alloplastic materials for mandibular reconstruction.

Surgical Accuracy of 3D Virtual Surgery and CAD/CAM-Assisted Orthognathic Surgery for Skeletal Class III Patients.

Orthognathic surgery is an effective surgical method to achieve functionality and facial esthetics for mandibular prognathism. If surgery is performed with a conventional method, errors may occur in the surgical preparation process and the surgical procedures, and there is a limitation in that the accuracy of surgery is determined according to the surgeon's experience and tactual sense. However, with the recent development of three-dimensional (3D) virtual planning and CAD/CAM technology, more 3D and predictable surgical planning and more accurate and time-saving surgery have become possible. The purpose of this study is to evaluate the surgical accuracy of 3D Virtual Surgery, CAD/CAM-Assisted Orthognathic surgery for Skeletal Class III Patients. The study included 18 patients who had undergone orthognathic surgery for skeletal class III malocclusion from January 2020 to December 2021. To evaluate the accuracy of the virtual planning, 3D facial cone-beam computed tomography taken immediately after surgery (T1) and virtual surgery data (Tv) were superimposed in each patient. Landmarks were set on each of the maxillary segment, mandibular distal segment, and left and right mandibular proximal segment, and the difference between T1 and Tv was compared 3D on the x , y , and z -axis. (ΔT: T1-Tv). As a result, the average distance between Tv and T1 at each landmark, all landmarks except for the posterior nasal spine of the maxillary segment showed <1mm. In particular, the differences across the x and z -axis were very small, while the difference across the y -axis tend to be large. The comparison of the position of each segment in virtual surgery and actual surgery was as follows. It can be seen that all segments were located slightly downward, and the medial pole of the mandibular proximal segment was located posterolateral and the lateral pole was located anteromedial after the actual surgery compared with the virtual planning. It means that the proximal segment was slightly rotated, but the difference was within 1mm, so it can be considered that the surgery was accurate. Base on this study, orthognathic surgery using 3D virtual surgery planning and CAD/CAM technologies was very accurate. By applying these cutting-edge technologies to clinical practice, it was possible not only to increase the predictability of surgery but also to improve the convenience of surgery. Therefore, it is thought that it will be important for clinicians to make continuous efforts to applicate cutting-edge technologies to be developed in the future to patient diagnosis and surgery.

Application of 3D Virtual Scanning Technology in Landscape Planning of Complex Landscape Gardens

In order to solve the problem of technical precision in landscape planning of complex landscape garden topography, the authors propose a research using 3D virtual scanning technology. The main content of this research is based on the overall architecture of the 3D virtual landscape planning system, the construction of the system architecture, and the optimization of VR design scenarios; finally, through experiments, the feasibility of 3D virtual scanning technology is obtained. Experimental results show that the number of landscape connection points measured by the author is more than 1500, and the accuracy is between 0.2 and 0.6 pixels, indicating that for the mutual connection and orientation between models, the system has a good application prospect in the landscape planning of complex landscape garden topography. The research on 3D virtual scanning technology is proven, and it can meet the application in the landscape planning of complex landscape garden topography.

Patient-specific Implants for Treating Atrophic Mandibles.

Summary:Extremely atrophic mandibles are difficult to treat. Most patients choose to live with removable dentures. However, what if the atrophy is so extreme that spontaneous fractures occur? The objective of this report is to offer a single-stage augmentation method, which uses patient-specific crib-shaped implants (PSI) combined with autogenous free bone grafts. PSI were planned using three-dimensional (3D) segmentation and 3D virtual-planning software. Implants were designed according to the patient’s mandible with a mesh-like structure and included large holes for allowing blood supply recovery. During surgery, the PSI fitted perfectly. In cases exhibiting malposition of the mandibular fragments, repositioning was performed using 3D virtual planning. When repositioning mandibular segments, the PSI served as a guide for the correct positioning. Iliac-crest bone graft was harvested and fixed as an onlay over the residual mandibular basal bone. External approach was used to avoid contamination. Six months following surgery, fixation wires were removed, and dental implants were positioned in the newly formed bone. The PSI allowed for rigid fixation, thus leading to optimal incorporation of the iliac-crest bone graft. No further augmentation was required. Bony continuity for future stability and secession of the spontaneous fractures was achieved. Dental implants were placed effortlessly. Treating extremely atrophic mandibles is an entity of its own and is considered one of the most challenging in craniofacial reconstruction. It mostly requires multiple operations with high rates of failure. We offer a novel method of 3D mandibular reconstruction, both vertically and horizontally, showing promising results and achieving enough bone for further dental rehabilitation.

Intra-articular opening wedge osteotomy for varus ankle arthritis with computer-assisted planning and patient-specific surgical guides: a retrospective case series

BackgroundComputer-assisted preoperative planning, combined with PSI has become an effective technique for treating complex limb deformities. The purpose of this study was to evaluate the efficacy and safety of the novel technique in corrective osteotomy for intra-articular varus ankle deformities associated with osteoarthritis and ankle instability.MethodsNineteen patients with intra-articular varus ankle arthritis were reviewed between April 2017 and June 2019, including ten men and nine women with a mean age of 58.3 ± 9.9 years (range, 38 to 76 years). All patients underwent intra-articular opening wedge osteotomy assisted by 3D virtual planning and PSI. Weight-bearing radiographs were used to assess the radiographic results, including TAS angle, TT angle, TMM angle, TC angle, TLS angle, opening-wedge angle, and wedge height. Functional outcomes were assessed by the AOFAS score, VAS score, and ROM of the ankle.ResultsThe average follow-up time was 32.2 ± 9.0 months (range, 22 to 47 months). The average union time was 4.4 ± 0.9 months (range, 3.0 to 6.5 months). The TAS angle significantly changed from 84.1 ± 4.6° preoperatively to 87.7 ± 3.1° at the 1-year follow-up and 86.2 ± 2.6° at the latest follow-up. Similarly, the TT angle, TMM angle and TC angle changed significantly at the 1-year follow-up compared with the preoperative assessment and remained stable until the last follow-up. However, the TLS was not corrected significantly. The postoperative obtained opening-wedge angle, and wedge height showed no significant change with preoperative planning. The overall complication rate was 15.8%. The mean VAS score improved from 5.3 ± 0.6 to 2.7 ± 0.7. The mean AOFAS score improved from 56.2 ± 7.6 to 80.6 ± 4.6. However, the ROM showed no significant change.ConclusionsAccurate correction and satisfactory functional recovery were attained with computer-assisted planning and PSI in the corrective osteotomy of intra-articular varus ankle deformities.

Minimally traumatic implantation and bone regeneration: a systematic review

Introduction: Dental implant procedures have reached about one million dental implants per year worldwide. In this context, it is necessary to establish the state of the art of minimally traumatic procedures for dental implants, especially after bone grafting procedures and/or use of biomaterials for bone elevation. Objective: Conducted a systematic review of the main considerations for optimizing techniques for dental implants by proposing minimally invasive procedures, especially after bone recovery or elevation processes through the use of biomaterials such as FRP and Bio-Oss®. Methods: The survey was conducted from June 2021 to July 2021 and developed based on Scopus, PubMed, Science Direct, Scielo and Google Scholar, following the rules of Systematic Review-PRISMA. Study quality was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: Studies have shown that guided preoperative planning and dental implant-guided jaw reconstruction provide high success rates for implant and dental rehabilitation. Furthermore, the concept of using personalized implants with the help of 3D virtual treatment planning can greatly improve mandibular restoration and help to achieve good facial profile, esthetics and dental rehabilitation, avoiding complications with grafts in general.

A novel 3D-printed patient-specific instrument based on \u201cH-point\u201d for medial opening wedge high tibial osteotomy: a cadaver study

BackgroundOpening wedge high tibial osteotomy (OWHTO) is an effective surgical treatment for knee osteoarthritis. This study aimed to explore the feasibility and accuracy of a novel 3D-printed patient-specific instrument (PSI) based on “H-point” for medial OWHTO in a prospective cadaver study.MethodsTwenty-six fresh-frozen lower limbs were collected and randomly divided into two groups: PSI group treated with 3D virtual preoperative planning and a novel 3D-printed PSI; control group with the standard technique. 3D models were reversely reconstructed for preoperative surgical planning, guide plate design, and simulated osteotomy. Anatomic features of “H-point,” surgical time, fluoroscopic dose, correction accuracy including tibiofemoral angle (FTA) and posterior tibial slope (TS) angle were measured.ResultsFirst, H-point was always described as a bony bulge in the posteromedial to the proximal tibia and had a relatively constant relationship with the osteotomy site. Second, the absolute correction error of mFTA and TS were significantly smaller in the PSI group. The effective rate of TS in the PSI group was more concentrated with absolute correction error within 1° and within 2° for 53.3% and 93.3%, compared to 9.1% and 45.5% in the control group. The total operation time, positioning osteotomy time, distraction correction time and fluoroscopy dose in the PSI group were significantly less than those in the control group.ConclusionsThe novel 3D-printed PSI based on H-point is feasibility and accuracy with advantages in terms of TS, surgery time and radiation dose for OWHTO.

Use Of CAD/CAM-Manufactured Patient-Specific Implants for the Reconstruction of Cranial Defects:Case Report

The purpose of this clinical report is to evaluate the clinical performance of customized titanium implants (PSI) using virtual 3D planning and computer-assisted implant fabrication (CAD/CAM process) and based on preoperative CT data, the placement accuracy and the risk of postoperative complications. This work has shown that 3D printed titanium base implants can significantly improve the outcomes of patients requiring skull reconstruction surgery. By choosing the appropriate design method, manufacturing process, and implant material, you can get a more accurate procedure, reduce surgery time, prevent various complications that can occur with the traditional method, and get predictable results compared to the traditional method.