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This article presents a rapid technique for the accurate transfer of implant positions immediately after image-guided surgery to enable the immediate installation of a definitive complete-arch implant-supported prosthesis with an implant biological width of 3 mm within 3 appointments. A sleeveless copy of the implant surgical guide is magnetically connected to a reference guide to ensure the accurate capture of cylindrical titanium transfer abutments. In the laboratory, the sleeveless guide with the splinted transfer abutments attached is used to generate a definitive cast to be scanned with a desktop scanner. The resulting digital definitive cast is then combined with the original meshes of the prosthetically driven virtual treatment plan to enable a definitive computer-aided design and computer-aided manufactured prosthesis to be fabricated and installed with passive fit.

Objetivo: O objetivo desta revisão bibliográfica foi descrever estudos que buscaram analisar a efetividade da tomografia computadorizada cone beam (TCFC) na análise da densidade mineral óssea (DMO) da região maxilo-mandibular. Foram incluídos nesta revisão artigos referentes ao uso da TCFC na análise da DMO da região maxilo-mandibular de 2009 até 2020, publicados nas base de dados: PUBMED, EMBASE e Scopus.Resultados: Foram selecionados 17 artigos que investigaram o uso da TCFC no estudo da DMO maxilo-mandibular. Muitos pesquisadores utilizaram-se da micro-tomografia, tomografia computadorizada multislice e análise histomorfométrica para realizar comparações com a TCFC.Conclusões: As evidências bibliográficas sugerem que a TCFC, tanto através dos seus valores de escala de cinza quanto pelos seus parâmetros 3D estruturais, se apresenta como um método de relevância clínica, confiável e fácil, de análise proporcional da densidade óssea da região maxilomandibular.

The full digital workflow involves the combination of intraoral and cone beam computerized tomography scans. In the present case report, a second intraoral scan is performed after soft tissue management facilitated by the use of a 3-dimensional-printed interim implant restoration. The new STL file resulting from the second intraoral scan can be associated with the previous STL from the initial intraoral scan. The custom abutment was also digitally designed as an STL file, and no implant scan bodies were required for intraoral scanning.

The present technique report describes a digital workflow for flapless implant surgery after onlay block bone graft healing in the esthetic area. Virtual removal of block fixation screws and optimal single-tooth implant position and digital crown waxing were planned from cone beam computed tomography (CBCT) and intraoral scans. Two different surgical guides were digitally designed and 3D-printed to allow for flapless implant surgery. The first surgical guide was used to remove all 3 fixation screws from a healed onlay block graft, whereas the second guide was used to determine the implant position and direction. The present methodology may be considered a time-efficient flapless approach for placing implants in sites with block grafts.

Digital workflows have been used to enhance the predictability of oral rehabilitations. However, techniques to digitally design and manufacture esthetic space maintainers by following a prosthetically driven treatment plan for young patients are lacking. This technique report describes a full digital workflow to produce computer-aided design and computer-aided manufacturing (CAD-CAM) esthetic space maintainers by using intraoral scans, a dental CAD software program, and a milling machine. CAD-CAM space maintainers can be provided for young patients with satisfactory patient compliance and with minimal chairside adjustment.

Objectives: The aim of this study was to evaluate bone mineral adipose tissue (BMAT) volume in 21 alveolar bone specimens, as determined by 14 T MRI, and correlate them to the radiodensity values obtained pre-operatively of regions of interest (ROIs) by cone beam computed tomography (CBCT), and to the bone-volume-to-tissue-volume ratio values obtained by micro-CT, the gold-standard for morphometric data collection. Methods: Partially edentulous patients were submitted to a CBCT scan, and the radiographic bone densities in each ROI were automatically calculated using coDiagnostiX software. Based on the CBCT surgical planning, a CAD/CAM stereolithographic surgical guide was fabricated to retrieve a bone biopsy from the same ROIs scanned preoperatively, and then to orientate the subsequent implant placement. The alveolar bone biopsies were then collected and scanned using the micro-CT and 14 T MRI techniques. Pearson’s correlation test was performed to correlate the results obtained using the three different techniques. Results: In the 21 eligible bone specimens (6 females, 15 males), age (mean age 52.9 years), micro-CT, and 14 T MRI variables were found to be normally distributed (p > 0.05). The strongest—and only statistically significant (p < 0.05)—correlation was found between micro-CT and 14 T MRI values (r = 0.943), and the weakest, between 14 T MRI and CBCT values (r =–0.068). Conclusions: The findings suggest that 14 T MRI can be used to evaluate BMAT as an indirect marker for bone volume, and that CBCT is not a reliable technique to provide accurate bone density values., peer-reviewed

Marginal bone loss around immediately placed implants may compromise esthetic outcomes in the anterior maxilla. The relatively recent socket-shield technique of partial extraction therapy has been described as being useful to maintain the structure of peri-implant tissues. The present technique report introduced a digital workflow to perform image-guided implant placement after partial extraction therapy. In this technique, digital 3-dimensional images are used to plan and orient the flapless surgical procedure and to digitally design a custom abutment based on the natural emergence profile as segmented from the tooth to be extracted.

PURPOSE Pixel values from cone-beam computed tomography (CBCT) are proportional to bone density. This study aimed to correlate and compare pixel values of healed maxillary sinus grafts and adjacent native bone (NB). MATERIAL AND METHODS This study was conducted on CBCT scan patients referred for maxillary sinus floor augmentation with biphasic calcium phosphate (n = 31). Graft height and width measurements were performed. In addition, mean pixel values were calculated in 3 different regions: NB, sinus graft close to NB (CNB), and sinus graft far from NB (FNB). Micro-CT and histological analyses of bone specimens of a representative case were also performed. RESULTS Significant correlations were found between CNB and graft height (r = 0.41; P < 0.021); and FNB and graft width (r = 0.519, P < 0.003). In addition, pixel values from both graft groups (CNB and FNB) differed significantly (P < 0.001). Finally, histological sections revealed smaller areas with newly formed bone in the FNB area. CONCLUSIONS Within the limitations of this study, the present findings suggest that pixel values of sinus grafted areas are directly correlated with the extension of the grafted area.

Purpose: Little is known regarding the accuracy of clinical magnetic resonance imaging (MRI) protocols with acceptable scan times in sinus graft assessment. The aim of this study was to evaluate the correlations between MRI and cone-beam computed tomographic (CBCT) measurements of maxillary sinus grafts using 2 different clinical MRI imaging protocols. Materials and methods: A total of 15 patients who underwent unilateral sinus lift surgery with biphasic calcium phosphate were included in this study. CBCT, T1-weighted MRI, and T2-weighted MRI scans were taken 6 months after sinus lift surgery. Linear measurements of the maximum height and buccolingual width in coronal images, as well as the maximum anteroposterior depth in sagittal images, were performed by 2 trained observers using CBCT and MRI Digital Imaging and Communication in Medicine files. Microcomputed tomography (micro-CT) was also performed to confirm the presence of bone tissue in the grafted area. Correlations between MRI and CBCT measurements were assessed with the Pearson test. Results: Significant correlations between CBCT and MRI were found for sinus graft height (T1-weighted, r=0.711 and P, peer-reviewed

Despite the advent of stereolithography in craniofacial surgery for creating surgical guides and custom synthetic scaffolds, little is known about the feasibility of computer-aided design/computer-aided manufacturing (CAD/CAM) milling of freeze-dried allogeneic bone blocks following previously designed volumetric graft plans. The aim of this technical report is to present a methodology for CAD/CAM milling to achieve the volume and shape of allogeneic bone blocks as estimated by using a virtual planning software. To perform the current methodology, an ex vivo simulation was performed. The milled allogeneic block presented satisfactory dimensional accuracy as compared with the respective three-dimensional virtual model.

The digital workflow for surgical rehabilitation with dental implants can help prevent complications, achieve more predictable outcomes, and render implant surgery more accessible for dentists and patients alike. The digital workflow for implant surgery consists of three steps, image acquisition, virtual planning, and implant placement using surgical guides. Digital images acquired by cone beam computerized tomography (CBCT) and intraoral scanning can help recreate the patient’s condition in the computer. This information is then used to plan for optimized implant placement. The digital plan is then executed clinically with the aid of a digital surgical guide, a template that help the clinician place the implants at the exact site as planned in the computer. This chapter explains in details how implant surgery is planned and executed using a digital workflow.