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Background: In the maxillary anterior region, differences in bone density along the drilling path can impact the accuracy of implant placement despite the use of a surgical guide. Hence, the aim of this in vitro study was to investigate the accuracy of implant placement using the over-preparation technique in different drilling environments in the maxillary anterior region. Methods: Three experimental models (a, b, and c) were designed and fabricated to simulate the following drilling environments (n = 60 each): unhealed bone, less dense bone, and dense bone after tooth extraction. The models were subjected to implant cavity preparation and placement using the over-preparation technique (group OPT) and conventional surgical guide technique (group CGT). Differences between the actual positions and the planned positions of the implants were calculated. Results: The deviations of the implants in the group OPT in Model a and Model b were significantly smaller than those in the group CGT (P < 0.05). Among the group OPT, Model c presented with the smallest deviation, followed by Model b and Model a (P < 0.05), and the CGT group showed the same trend. Conclusions: In the maxillary anterior region, differences in bone density along the drilling path can adversely affect the accuracy of implant placement. These discrepancies can be significantly minimized using the over-preparation technique. [ABSTRACT FROM AUTHOR]

Background/Objectives: Computer-assisted mandibular reconstruction requires sophisticated technical expertise alongside surgical knowledge. This study aims to establish and validate an efficient collaborative protocol between oral and maxillofacial surgeons and bioengineers for virtual surgical planning in mandibular reconstruction. Methods: We developed a structured protocol with four sequential phases: (1) generation of 3D models from CT data, (2) virtual resection planning, (3) reconstruction design, and (4) surgical guide fabrication. Protocol efficiency was assessed through seven simulation trials measuring planning duration and required revisions. Clinical validation was performed in four mandibular reconstruction cases. Accuracy was evaluated by comparing virtual surgical plans to postoperative outcomes using 3-matic 13.0 software analysis. Results: Protocol implementation showed consistent efficiency across simulations with a mean planning duration of 2.86 working days (SD = 1.35). Only two of seven simulations required design revisions. Clinical application in four cases (three ameloblastomas, one odontogenic myxoma) demonstrated high precision with a mean virtual-to-actual discrepancy of 0.90 mm (SD = 0.34). Successful reconstructions were achieved across varying defect spans (29–53 mm) using both bicortical deep circumflex iliac artery (DCIA) flaps and monocortical iliac block bone grafts. The collaborative workflow resulted in optimized surgical guide design, reduced planning iterations, and improved surgical precision. Conclusions: The established surgeon–bioengineer collaborative protocol enhances the efficiency and accuracy of computer-assisted mandibular reconstruction while making advanced surgical planning techniques more accessible. While initial results are promising, future studies with larger patient cohorts and extended follow-up periods are needed to fully validate the protocol's long-term benefits and broader applicability. [ABSTRACT FROM AUTHOR]

Three-dimensional printing has transformed dentistry by enabling the production of customized dental restorations, aligners, surgical guides, and implants. A variety of polymers and composites are used, each with distinct properties. This review explores materials used in 3D printing for dental applications, focusing on trends identified through a literature search in PubMed, Scopus, and the Web of Science. The most studied areas include 3D-printed crowns, bridges, removable prostheses, surgical guides, and aligners. The development of new materials is still ongoing and also holds great promise in terms of environmentally friendly technologies. Modern manufacturing technologies have a promising future in all areas of dentistry: prosthetics, periodontology, dental and oral surgery, implantology, orthodontics, and regenerative dentistry. However, further studies are needed to safely introduce the latest materials, such as nanodiamond-reinforced PMMA, PLA reinforced with nanohydroxyapatite or magnesium, PLGA composites with tricalcium phosphate and magnesium, and PEEK reinforced with hydroxyapatite or titanium into clinical practice. [ABSTRACT FROM AUTHOR]

Continuous advancements in technology have made it possible to integrate clear aligner therapy (CAT) with orthognathic surgery. This case report presents a novel, individually-planned workflow, combining CAT with a surgery-first orthognathic approach (SFOA) in collaborating with engineers for an in-house production of surgical guides and customized titanium plates. The patient was evaluated subjectively, using the Oral Health-Related Quality of Life-14 (OHIP-14) questionnaire and Orthognathic Quality of Life questionnaire (OQLQ), and objectively with the Peer Assessment Rating (PAR) index. The patient displayed the planned occlusal relationship with no report of discomfort in the temporomandibular joint (TMJ) or post-surgical complications. The surgical and occlusal outcomes have remained consistent and stable after debonding. A decreased score was reported in both questionnaires and the PAR after treatment, thereby indicating improvements in both subjective and objective evaluations. This case report demonstrates that with proper individual planning, satisfactory subjective and objective outcomes can be achieved when combining SFOA with CAT. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Materials and Methods Results Conclusion Technology improvement and a better understanding of sinus anatomy and wound healing in the past decade have allowed the development of minimally invasive surgical techniques. This systematic review focused on identifying and describing these techniques for vertical and lateral sinus augmentation (VSA and LSA).Electronic and hand search were conducted to screen the literature published from January 2003 to May 2024. The selected studies had to include detailed techniques for minimally invasive SA. Data extraction included the study types, sample size, technique/instrument details, and outcome measurements.A total of 36 articles (27 VSA, 8 LSA with an additional 1 article included both procedures) with 2732 sinus augmentation met the inclusion criteria. Minimally invasive VSA includes the use of modified rotary instruments with stopper, balloon, hydraulic pressure, digital planning, endoscope, and operating microscope. These techniques aim for conservative flap reflection, precise sinus window preparation, and/or controlled sinus membrane elevation. Most of the selected studies (n = 15) did not report the incidence of sinus membrane perforation.Within the limitations of this review, minimally invasive VSA and LSA achieved sufficient sinus augmentation and implant success with the potential advantages of reduced surgical complications and morbidity. Comparative studies with defined outcomes are encouraged to further validate these useful minimally invasive techniques for SA. [ABSTRACT FROM AUTHOR]

Background/Objectives: 3D patient-specific corrective osteotomies are optimized for use with oscillating saws, thereby rendering it incapable of executing curved osteotomies. The aim of this technical note is to introduce and evaluate the Panflute technique, which facilitates curved osteotomies with precise depth control for intra-articular corrective osteotomies in posttraumatic tibial plateau malunions. Methods: A 33-year-old male patient with an intra-articular malunion was treated one year after index surgery of a lateral split-depression tibial plateau fracture with the Panflute technique. The guide design allowed for multiple drill trajectories in a curved path, recreating the original fracture lines. Cylindrical drill tubes in the guide were tailored to match bone trajectory length. This resulted in a patient-specific Panflute-like design enabling precise depth control, safeguarding posterior neurovascular structures. Secondly, the recreated fragment was reduced with a reduction guide, applied to the plate in situ, to facilitate reposition using the plate as tool and reference. Results: The procedure went without technical drawbacks or surgical complications. Postoperative assessment showed that repositioning of the osteotomized articular fragment was performed accurately: pre- to postoperative translational corrections were 5.4 to 0.5 mm posterior displacement for AP deformity (x-axis); 2.9 to 1.0 mm lateral to medial reduction (y-axis); and 5.9 to 0.6 mm cranial-caudal correction (z-axis). Clinically, at 3 months, the fracture united, the patient regained full flexion, and valgus defect-laxity resolved. Conclusions: The presented Panflute-osteotomy guide allows for a pre-planned curved osteotomy. Additionally, for every drill trajectory, the depth could be controlled. The proposed method may expand our surgical armamentarium of patient-specific 3D techniques and solutions for complex intra-articular osteotomies. [ABSTRACT FROM AUTHOR]

Introduction: Surgical guides are commonly used to assist with dental implant placement. This study investigated the effects of five sterilization and disinfection methods on the accuracy of implant guides. Methods: Thirty surgical guides (five in each group) were designed and printed (with digital light processing technology) using different sterilization or disinfection methods categorized into six groups: hydrogen peroxide sterilization (group one); glutaraldehyde sterilization (group two); autoclaving (group three); plasma sterilization (group four); iodophor disinfection (group five); and blank group (group six). Verification was determined using three methods: distance and angle between the cross‐shaped marks, deformation after superimposing the guides, and displacement and axial changes in the virtual implant. Results: After disinfection and sterilization, the guides in the autoclaving and iodophor groups showed a more pronounced color change and the guide in the autoclaving group had visible cracks. More significant changes were observed in the H2O2, glutaraldehyde, autoclaving, and iodophor groups regarding deformation after superimposing the guides and the distance and angle between the cross‐shaped marks. The average labial deformation values (mm) of the first through fifth groups of guides were 0.283, 0.172, 0.289, 0.153, and 0.188, respectively. All groups were statistically different from the blank group for displacement and axial changes of the virtual implant (p < 0.05). Conclusion: The sizes of almost all surgical guides changed after sterilization and disinfection treatments, with between‐group differences. Plasma sterilization was more suitable for surgical guide sterilization because of the smaller deformations after treatment. [ABSTRACT FROM AUTHOR]

Genioglossus advancement is a surgical technique performed to treat obstructive sleep apnea. The genial tubercle, where the genioglossus muscle attaches, is not visible during dissection due to its location on the posterior mandible. Computer-aided design, particularly for the production of cutting guides, has arisen as a modern modification in the procedure to support accurate location of the tubercle. This study aims to demonstrate the utility of cutting guides designed by virtual surgical planning in a series of 7 genioglossus advancement cases. Computed Tomography (CT) data were preoperatively collected and rendered in three-dimension. The surgeon designed patient-specific cutting guides, registered to the occlusion, to ensure the genial tubercle was included in the osteotomy and stayed below the incisor tooth roots. These surgical guides were then 3D-printed. All the virtual surgical planning-designed guides fit appropriately, the genial tubercle was successfully included in the osteotomy in all cases, and no tooth roots were injured. We conclude that occlusal-based 3D printed cutting guides are a useful adjunct to help guide a genioglossus advancement procedure by accurately incorporating the genial tubercle. This provides a safe way to concurrently address correction of obstructive sleep apnea in patients undergoing other procedures. [ABSTRACT FROM AUTHOR]

In orthopedic surgery and maxillofacial there is a growing use of augmented reality (AR) as a technology to increase the visual perception of the surgeon in the operating room. The objective of this review is to analyze the state of the art in the use of AR for osteotomies, highlighting the advantages and the most-known open issues to be addressed in the future research. Scopus, Web of Science, Pubmed and IEEE Xplore databases have been explored with a keyword search, setting the time limits from January 2017 to January 2023, inclusive. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines has been used in this review, focusing on anatomical districts, real-virtual environment interaction, advantaged and limitations of existing AR-based applications. 49 articles met the inclusion criteria and have been selected in the final analysis. For the sake of clarity, works have been grouped according to the anatomical district, but also the real-virtual environment interaction methodology was reported, as well as information regarding accuracy assessment. A Quality Function Deployment (QFD) has been used to assess the AR-based solutions with regards to the more traditional freehand (FH) and Patient Specific Template (PST) approaches. Finally, some suggestions to foster the AR-based solution adoption in osteotomies treatment have been drawn, considering the highlighted advantages and limitations of this technology. The AR resulted to meet the surgeons' needs more than other traditional approaches. Among the emerged advantages, AR can lead to a better surgical field accessibility, more flexible solutions and lower the management effort. Nonetheless, future research should address some well-known issues, among which the calibration time, the robustness of the tracking, and the HMDs discomfort. [ABSTRACT FROM AUTHOR]

Background: Immediate implant restoration by prefabricated prosthesis has multiple benefits. However, the design and insertion workflow of the prosthesis may influence the seating. Purpose: Evaluation of seating accuracy of prefabricated interim prosthesis of different designs and insertion workflows for immediate restoration of implants placed via static computer‐assisted implant surgery (sCAIS). Materials and Methods: A maxillary model without incisors was used to plan for two implants at the lateral incisor locations. According to the planned implants, sCAIS surgical template and a four‐unit interim prosthesis were designed. Four prostheses were fabricated based on the design and insertion workflow. The first prosthesis involved complete fabrication (CF) of the interim prosthesis, where the interim prosthesis is fabricated for laboratory attachment to abutments. The other three prostheses were produced by partial fabrication (PF), where the interim prosthesis shell was produced with internal spacing between the fitting surface and the abutments. The PF prostheses were cemented on abutments attached to the inserted implants. Three different PF prosthesis designs were included with different levels of internal spacing: 100 μm (PF.1), 200 μm (PF.2), and 300 μm (PF.3). A total of 15 surgical models received implants on which each prosthesis was seated and scanned by a laboratory scanner. The vertical, horizontal, and proximal contact errors were measured. Results: Although all prostheses were seated on every model, the CF prostheses had greater vertical error, followed by PF.1, PF.2, and PF.3 prostheses, respectively. A similar pattern was observed for proximal contact error, where PF.3 was most superior. PF.3 prostheses had the least horizontal error than the other prostheses. Conclusions: All interim prostheses experienced errors at the vertical, horizontal, and proximal surfaces, which can be attributed to deviations of the inserted implants. The PF of interim prosthesis with increased internal spacing for intraoral insertion appeared to reduce seating errors. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to investigate the cooling performance of three different surgical methods for bone splitting during implant dentistry procedures. Methods: An in vitro study was conducted on bovine ribs to test the cooling performance of three osteotomy methods: conventional osteotomy with standard cooling irrigation, template-assisted osteotomy with standard cooling irrigation, and modified template-assisted osteotomy with additional cooling fluid through internal irrigation channels in the surgical guide. A negative control group without cooling was also included. Temperature measurements were taken during the procedures using a contactless infrared thermometer. Results: The results showed that the conventional osteotomy without cooling resulted in the highest mean of the peak temperatures (114.7 °C ± 45.4), while the modified template-assisted osteotomy with additional cooling achieved the lowest mean of the peak temperatures (29.4 °C ± 7). Statistically significant differences in temperature were observed among the groups (p < 0.001). Conclusion: The study rejected the null hypothesis and demonstrated that the cooling method used during bone splitting procedures significantly affected the temperature development at the surgical site. The modified template-assisted osteotomy with additional cooling provided the best cooling performance. However, caution should be exercised in interpreting the results due to the limitations of the in vitro study. Further research with stronger external validity is needed to confirm these findings and explore their applicability in clinical settings to benefit patients. [ABSTRACT FROM AUTHOR]

Background/Objectives: Computer-assisted mandibular reconstruction requires sophisticated technical expertise alongside surgical knowledge. This study aims to establish and validate an efficient collaborative protocol between oral and maxillofacial surgeons and bioengineers for virtual surgical planning in mandibular reconstruction. Methods: We developed a structured protocol with four sequential phases: (1) generation of 3D models from CT data, (2) virtual resection planning, (3) reconstruction design, and (4) surgical guide fabrication. Protocol efficiency was assessed through seven simulation trials measuring planning duration and required revisions. Clinical validation was performed in four mandibular reconstruction cases. Accuracy was evaluated by comparing virtual surgical plans to postoperative outcomes using 3-matic 13.0 software analysis. Results: Protocol implementation showed consistent efficiency across simulations with a mean planning duration of 2.86 working days (SD = 1.35). Only two of seven simulations required design revisions. Clinical application in four cases (three ameloblastomas, one odontogenic myxoma) demonstrated high precision with a mean virtual-to-actual discrepancy of 0.90 mm (SD = 0.34). Successful reconstructions were achieved across varying defect spans (29–53 mm) using both bicortical deep circumflex iliac artery (DCIA) flaps and monocortical iliac block bone grafts. The collaborative workflow resulted in optimized surgical guide design, reduced planning iterations, and improved surgical precision. Conclusions: The established surgeon–bioengineer collaborative protocol enhances the efficiency and accuracy of computer-assisted mandibular reconstruction while making advanced surgical planning techniques more accessible. While initial results are promising, future studies with larger patient cohorts and extended follow-up periods are needed to fully validate the protocol’s long-term benefits and broader applicability.

Aims: Proper preoperative planning benefits fracture reduction, fixation, and stability in tibial plateau fracture surgery. We developed and clinically implemented a novel workflow for 3D surgical planning including patient-specific drilling guides in tibial plateau fracture surgery. Methods: A prospective feasibility study was performed in which consecutive tibial plateau fracture patients were treated with 3D surgical planning, including patient-specific drilling guides applied to standard off-the-shelf plates. A postoperative CT scan was obtained to assess whether the screw directions, screw lengths, and plate position were performed according the preoperative planning. Quality of the fracture reduction was assessed by measuring residual intra-articular incongruence (maximum gap and step-off) and compared to a historical matched control group. Results: A total of 15 patients were treated with 3D surgical planning in which 83 screws were placed by using drilling guides. The median deviation of the achieved screw trajectory from the planned trajectory was 3.4° (interquartile range (IQR) 2.5 to 5.4) and the difference in entry points (i.e. plate position) was 3.0 mm (IQR 2.0 to 5.5) compared to the 3D preoperative planning. The length of 72 screws (86.7%) were according to the planning. Compared to the historical cohort, 3D-guided surgery showed an improved surgical reduction in terms of median gap (3.1 vs 4.7 mm; p = 0.126) and step-off (2.9 vs 4.0 mm; p = 0.026). Conclusion: The use of 3D surgical planning including drilling guides was feasible, and facilitated accurate screw directions, screw lengths, and plate positioning. Moreover, the personalized approach improved fracture reduction as compared to a historical cohort. Cite this article: Bone Jt Open 2024;5(1):46–52.

Abstract Purpose This in vivo study aims to assess the pink esthetic score in the anterior maxilla after computer-guided immediate implant installation and fully digital immediate temporalization with and without grafting the jumping gap with a mixture of 1:1 autogenous and xenograft particulates. Materials and methods Twenty-four patients with non-restorable upper anterior teeth in the aesthetic zone have undergone a traumatic extraction for the non-restorable tooth followed by immediate implant placement using a 3D-printed surgical guide according to prosthetically driven implant placement. The patients were divided into two groups. The study group received the dental implant after grafting the jumping gap with 1:1 autogenous and xenograft particulates, while the control group received the dental implant without grafting the jumping gap. Each patient received a digitally fabricated, immediate, nonfunctional temporary prosthesis. The esthetic outcome was compared between the two groups using the pink esthetic score at implant insertion and after 6 months of follow-up. Statistical comparisons were carried out between the studied groups using the Mann-Whitney U test. Results Immediately postoperatively, there was no statistically significant difference between the median PES in the two groups (P-value = 0.746). After six months, the study group showed a statistically significantly higher median PES than the control group (P-value = 0.048). Conclusions Grafting the jumping distance in the immediate implant protocol helps achieve a better esthetic outcome. Clinical relevance The use of immediate guided implant placement along with grafting the jumping gap followed by immediate digital temporalization guarantees a better esthetic outcome while preserving time, cost, and the number of clinical visits. Trial registration The study was registered on clinicaltrials.gov with registration number NCT04096209. (19/9/2019)

Abstract Purpose This review aimed to reveal the influence of implant guides on surgical accuracy with regard to supporting types, manufacturing methods and design (including fixation screws and sleeves). Methods A literature search related to accuracy of surgical guides for dental implantation was performed in Web of Science and PubMed. Studies with in vivo or in vitro deviation data published in recent 5 years (2018–2022) were included and assessed by Newcastle–Ottawa Scale with regard to risk of bias and reliability degree of clinical studies. Accuracy-related deviation data were summarized as forest plots and normal distributions. Results Forty-one articles were included with high degree of credibility. Data showed that implant surgery accuracy can be achieved with mean distance deviation

The digital transformation has revolutionized various sectors, including dentistry. Dentistry has emerged as a pioneer in embracing digital technologies, leading to advancements in surgical and prosthetic oral healthcare. Immediate loading for full-arch edentulous dental implants, once debated, is now widely accepted. This case report describes a 74-year-old patient with dental mobility and significant bone loss who was rehabilitated using a Toronto Bridge protocol on four dental implants with immediate loading. Digital planning, surgical guides, 3D printing, and precision techniques were employed. The surgery involved implant placement and prosthetic procedures. The patient reported minimal post-operative discomfort, and after four months, the definitive prosthesis was successfully placed. This case demonstrates the efficacy of immediate loading in complex dental scenarios with digital innovation, resulting in improved patient outcomes. The full digital workflow, including 3D printing and the use of modern materials, enhances the efficiency and predictability of oral rehabilitation, marking a transformative era in dental care. The integration of digital technology in all phases of treatment, from diagnosis to finalization, makes this approach safer, reliable, and efficient, thereby benefiting both patients and clinicians. [ABSTRACT FROM AUTHOR]

Due to dental diseases, anatomical restrictions, and mixed dentition, the reduction in the number of teeth and the displacement of tooth germs pose challenges in orthodontic treatment, limiting anchorage options. The presented case demonstrates an advanced treatment solution using digital CAD/CAM-technologies and medical imaging for the creation of a mini-implant template. A 12-year-old male patient experiencing delayed tooth eruption, multiple impacted germs, and maxillary constriction underwent intraoral scanning and CBCT. Utilizing coDiagnostiXTM Version 10.2 software, the acquired data were merged to determine the mini-implant placement and to design the template. The template was then manufactured through stereolithography using surgical-guide material. Mini-implants were inserted using the produced appliance, enabling safe insertion by avoiding vital structures. Surgically exposed displaced teeth were aligned using a Hyrax screw appliance anchored on the mini-implants for rapid palatal expansion (RPE) and subsequently used as fixed orthodontics to align impacted teeth. The screw was activated daily for 10 weeks, resulting in a 7 mm posterior and 5 mm anterior maxillary transversal increase. Skeletal anchorage facilitated simultaneous RPE and tooth alignment, ensuring accuracy, patient safety, and appliance stability. The presented case shows a scenario in which computer-aided navigation for mini-implant positioning can enhance precision and versatility in challenging anatomical cases. [ABSTRACT FROM AUTHOR]

Oral and maxillofacial surgery is a specialized surgical field devoted to diagnosing and managing conditions affecting the oral cavity, jaws, face and related structures. In recent years, the integration of 3D printing technology has revolutionized this field, offering a range of innovative surgical devices such as patient-specific implants, surgical guides, splints, bone models and regenerative scaffolds. In this comprehensive review, we primarily focus on examining the utility of 3D-printed surgical devices in the context of oral and maxillofacial surgery and evaluating their efficiency. Initially, we provide an insightful overview of commonly utilized 3D-printed surgical devices, discussing their innovations and clinical applications. Recognizing the pivotal role of materials, we give consideration to suitable biomaterials and printing technology of each device, while also introducing the emerging fields of regenerative scaffolds and bioprinting. Furthermore, we delve into the transformative impact of 3D-printed surgical devices within specific subdivisions of oral and maxillofacial surgery, placing particular emphasis on their rejuvenating effects in bone reconstruction, orthognathic surgery, temporomandibular joint treatment and other applications. Additionally, we elucidate how the integration of 3D printing technology has reshaped clinical workflows and influenced treatment outcomes in oral and maxillofacial surgery, providing updates on advancements in ensuring accuracy and cost-effectiveness in 3D printing-based procedures. [ABSTRACT FROM AUTHOR]

We designed a 3D-printed extracorporeal positioning guide for assisting ultrasound-guided microwave ablation of the liver and observed its effectiveness. 13 patients with liver cancer were selected, and their CT data were obtained. The CT data is reconstructed in 3D by computer software Mimics to create a 3D model. The 3D-printed in vitro positioning guides were designed by 3-Matic and fabricated using 3D printing technology. Finally, it is applied to the clinic, and its effect is observed. The preliminary design of a 3D printed extracorporeal positioning guide was applied to the clinic, and the efficiency of assisted ultrasound positioning was 76.92% (10/13), with three patients requiring repositioning. The efficiency of the 3D printed extracorporeal positioning guide technique was 76.92%, a CT examination was performed one month after surgery, and three patients had residual lesions. 3D-printed extracorporeal positioning guides can assist ultrasound in localizing tumors during liver microwave ablation and reduce repeated punctures. It makes percutaneous microwave ablation of the liver more precise and safe. However, the current study sample is small, there are still apparent shortcomings, and long-term clinical studies are needed to prove its effectiveness. [ABSTRACT FROM AUTHOR]

Abstract Background/objective Disinfection of a 3D-printed surgical guide is of utmost importance as it comes into contact with hard and soft tissue during implant placement so it poses a potential risk of pathogenic transmission. Methods used for disinfection in the surgical field should be reliable, practical, and safe for the instruments and the patients. The objectives of this study were to compare the antimicrobial potential of 100% Virgin Coconut Oil, 2% Glutaraldehyde, and 70% Ethyl Alcohol used to decontaminate 3D-printed surgical guides. Materials and methods Thirty identical surgical guides were printed and cut into two halves (N = 60). Both halves were then contaminated with a defined amount of human saliva samples (2 ml). The first half (n = 30) was sub-grouped into three study groups which were immersed in one of the three disinfectants for 20 min as follows; group VCO was immersed in 100% Virgin Coconut Oil, group GA was immersed in 2% Glutaraldehyde, and group EA was immersed in 70% Ethyl Alcohol. The second half (n* = 30) was sub-grouped into three control groups which were immersed in sterile distilled water as follows group VCO*, group GA*, and group EA*. The microbial count was expressed as colony-forming units per plate and the comparison of the antimicrobial potential of the three tested disinfectants between the three study and three control groups was done using the One-Way ANOVA test. Results The culture results of three study groups revealed no bacterial growth with the highest % of reduction in the mean microbial count of the oral microorganisms (about100%) and an uncountable bacterial growth was shown between the three control groups (more than 100 CFU/plate) representing the baseline of the oral microorganisms. Therefore; statistically significant differences were found between the three control and three study groups (P

Purpose: This in vivo study aims to assess the pink esthetic score in the anterior maxilla after computer-guided immediate implant installation and fully digital immediate temporalization with and without grafting the jumping gap with a mixture of 1:1 autogenous and xenograft particulates. Materials and methods: Twenty-four patients with non-restorable upper anterior teeth in the aesthetic zone have undergone a traumatic extraction for the non-restorable tooth followed by immediate implant placement using a 3D-printed surgical guide according to prosthetically driven implant placement. The patients were divided into two groups. The study group received the dental implant after grafting the jumping gap with 1:1 autogenous and xenograft particulates, while the control group received the dental implant without grafting the jumping gap. Each patient received a digitally fabricated, immediate, nonfunctional temporary prosthesis. The esthetic outcome was compared between the two groups using the pink esthetic score at implant insertion and after 6 months of follow-up. Statistical comparisons were carried out between the studied groups using the Mann-Whitney U test. Results: Immediately postoperatively, there was no statistically significant difference between the median PES in the two groups (P-value = 0.746). After six months, the study group showed a statistically significantly higher median PES than the control group (P-value = 0.048). Conclusions: Grafting the jumping distance in the immediate implant protocol helps achieve a better esthetic outcome. Clinical relevance: The use of immediate guided implant placement along with grafting the jumping gap followed by immediate digital temporalization guarantees a better esthetic outcome while preserving time, cost, and the number of clinical visits. Trial registration: The study was registered on clinicaltrials.gov with registration number NCT04096209. (19/9/2019) [ABSTRACT FROM AUTHOR]

Background: This study examines post‐surgical outcomes of maxillary position using virtual surgical planning (VSP) with computer designed and manufactured surgical splints, without the use of costly patient specific implants (PSI), in the treatment of routine nonsyndromic orthognathic patients. The cost of these personalized medical devices and their impact in the setting of cranio‐maxillofacial surgery is currently under review by The Department of Health and Aged Care in Australia. Methods: This is a single‐centre retrospective analysis of 49 patients who underwent bimaxillary orthognathic surgery by a single surgeon at Epworth Richmond Hospital (Victoria, Australia) over a period spanning 2016 to 2020. Patients were included in the study provided their surgery was facilitated using VSP with manufacture of computer designed occlusal splints. Results: Use of computer designed and manufactured splints were highly reliable in reproducing the virtual surgical plan, when using palatal plane, upper incisor angulation, and anterior upper facial height. Conclusion: Use of computer designed and manufactured splints provide a method of leveraging the accuracy of VSP methods, without the additional costs associated with PSI. These findings may assist in appropriate resource allocation and case stratification in patients undergoing orthognathic surgery. [ABSTRACT FROM AUTHOR]

Three-Dimensional Printing has advanced throughout the years in the field of biomedical science with applications, especially in spine surgeries. 3D printing has the ability of fabricating highly complex structures with ease and high dimensional accuracy. The complexity of the spine's architecture and the inherent dangers of spinal surgery bring the evaluation of 3D printed models into consideration. This article summarizes the benefits of 3D printing based models for application in spine pathology. 3D printing technique is extensively used for fabrication of anatomical models, surgical guides and patient specific implants (PSI). The 3D printing based anatomical models assist in preoperative planning and training of students. Furthermore, 3D printed models can be used for improved communication and understanding of patients about the spinal disorders. The use of 3D printed surgical guides help in the stabilization of the spine during surgery, improving post procedural outcomes. Improved surgical results can be achieved by using PSIs that are tailored for patient specific needs. Finally, this review discusses the limitations and potential future scope of 3D printing in spine pathologies. 3D printing is still in its infancy, and further research would provide better understanding of the technology's true potential in spinal procedures. [ABSTRACT FROM AUTHOR]

Purpose: This review aimed to reveal the influence of implant guides on surgical accuracy with regard to supporting types, manufacturing methods and design (including fixation screws and sleeves). Methods: A literature search related to accuracy of surgical guides for dental implantation was performed in Web of Science and PubMed. Studies with in vivo or in vitro deviation data published in recent 5 years (2018–2022) were included and assessed by Newcastle–Ottawa Scale with regard to risk of bias and reliability degree of clinical studies. Accuracy-related deviation data were summarized as forest plots and normal distributions. Results: Forty-one articles were included with high degree of credibility. Data showed that implant surgery accuracy can be achieved with mean distance deviation < 2 mm (most < 1 mm) and angular deviation < 8° (most < 5°). Conclusions: Bilateral tooth-supported guides exhibited highest in vitro accuracy and similar in vivo accuracy to unilateral tooth-supported guides; mucosa-supported guides exhibit lowest in vivo accuracy, while its in vitro data showed low credibility due to mechanical complexity of living mucosa tissue. Milling exhibited higher in vivo accuracy of guides than 3d-printing, though further data support was needed. Design of fixation screws and sleeves of implant guides affected the surgical accuracy and might remain a research focus in near future. However, lack of universal evaluation standards for implantation accuracy remained a major problem in this field. The influence of implant guides on surgical accuracy revealed in this review might shed light on future development of dental implantology. [ABSTRACT FROM AUTHOR]

Abstract Background Surgical guides restrict the flow of cooling agent to osteotomy site, which will lead to a temperature rise that provokes tissue injury. Few studies compared differences in the temperature changes between non-limiting ‘conventional’ and limiting ‘guided’ surgical guides during implant site preparation. The objective of this study was to investigate the difference in temperature changes during bone drilling for implant placement using non-limiting and limiting surgical guides at cortical and cancellous bone levels. Methods Forty-four bovine rib samples were used for implant bed preparation in this study with a minimum thickness of 11 mm was chosen for the ribs. The bone was stored in a freezer at 10 °C until it was used. On the day of the study, the bone was defrosted and soaked in water at 21 °C for three hours before embarking on drilling to make sure each sample was at the same temperature when tested. Forty-four bone specimens were prepared and randomly allocated to receive either a limiting or a non-limiting surgical guides (22 for each group). The osteotomy site was prepared by one operator following the manufacturer’s instructions, using limiting and non-limiting surgical guides. Temperature changes were recorded during implant bed preparation using thermocouples that fit into 7 mm-horizontal channels at two different depths (Coronally) and (Apically) at 1 mm distance from the osteotomy site. The data were tested for homogeneity of variances using Levene’s test, then data were analyzed using an Independent sample t-test and the significance level was set at P ≤ 0.05. Results The mean temperature rise for all samples was 0.55 °C. The mean temperature rises for the limiting and non-limiting surgical guides were 0.80 °C and 0.33 °C respectively. There was a statistically significant difference in temperature rise between the limiting and non-limiting surgical guides (P = 0.008). In relation to position of temperature recording (coronal vs. apical), there was no significant difference (P > 0.05). No significant difference was noted between the two groups at cancellous bone level (P = 0.68), but the difference was significant at cortical bone level (P = 0.036). Conclusion Limiting surgical guides showed higher readings than non-limiting. However, for both techniques, temperature rise was not significant clinically and within a safe range.

In medicine, 3D printing represents one of the fastest-growing fields, which has awakened the highest expectations in biomedicine. It is predominantly used when replacing autografts and xenografts with alloplastic personalized tissue substitutes and constructs. This publication will present an overview of contemporary literature dealing with acellular 3D printing in reconstructing bone defects. It will also describe the 3D printing technology, the scope and the main problems it faces in reconstructing bone defects. This review will include the application of 3D printing technology in preoperative surgical planning, the creation of personalized medical models and surgical guides, as well as acellular 3D printing in bone tissue engineering, i.e. in the production of bone scaffolds. It will briefly refer to the application of 3D printing in our country since the available literature indicates a contrast between the current needs and the use of this technology in reconstructive skeletal surgery in Serbia. The neglected and unused benefits of modern 3D printing methods burden the health system with significant socio-economic consequences for public health.

Abstract Background/objectives Disinfection of surgical guides is mandatory for intraoperative use. Virgin Coconut Oil may be a potent alternative disinfectant; however, its effect has not been fully discussed in dentistry. The objectives of this study were to compare the morphological and the volumetric dimensional changes of 3D printed surgical guides after immersion in three disinfectants: 100%Virgin Coconut Oil, 2% Glutaraldehyde, and 70% Ethyl Alcohol and to assess the antimicrobial effectiveness of the tested disinfectants. Materials and methods A surgical guide was designed using open platform software to print thirty guides and then cut them into two halves (N = 60). Pre-disinfection scans of the first half of the three study groups (n = 30) were performed using Cone-beam Computed Tomography, then immersed for 20 min in three disinfectants as follows: group VCO was immersed in 100% Virgin Coconut Oil, group GA was immersed in 2% Glutaraldehyde, and group EA was immersed in 70% Ethyl Alcohol. Post-disinfection scans of the first half of the three study groups (n = 30) were performed and then compared morphologically and volumetrically using an analyzing software program The second half of the three control groups (n* = 30) were soaked for 20 min in sterile distilled water as follows: group VCO*, group GA*, and group EA* for the assessment of the antimicrobial effectiveness of the three tested disinfectants. Results At the morphological assessment of the dimensional changes, group VCO were the most accurate with the lowest mean deviation value of 0.12 ± 0.02 mm and root mean square value of 0.12 mm, group GA and group EA were less accurate with mean deviation value of = 0.22 ± 0.05 mm and = 0.19 ± 0.03 mm and root mean square value of 0.22 and 0.20 respectively (p

This study was conducted to evaluate the accuracy of 3D-printed surgical guides before and after sterilization in a steam sterilizer. A test-model incorporating three implant replicas was customized. A total of forty guides were printed from five printable resins. A group made from a self-curing composite served as control group. The guides were checked for fit. Vertical discrepancies between the model and guides were measured at standardized points at a load of 500 g (P1). The guides were connected to implant replicas and scanned, and their angles were digitally measured. The specimens were sterilized in a steam sterilizer at 121 °C for 20 min at 2 bar pressure. Vertical discrepancies (P2) and angulations were remeasured. Additionally, the specimens were repositioned with an increased load, and measurements were repeated (P3). All specimens were repositionable after sterilization. The smallest variation in discrepancy at a 500 g load was 428 µm, whereas the greatest was 1487 µm. Under an increased force, the smallest change was 94 µm, while the greatest was 260 µm. The level of significance α = 0.05 (95% confidence interval) was set for all tests. The variation in the measured angles was not statistically significant (Kruskal–Wallis's test, p > 0.05). The accuracy was affected by the material and sterilization, but it was clinically acceptable when an increased load was applied during repositioning. [ABSTRACT FROM AUTHOR]

Background: The accuracy of surgical guides is a relevant factor in both surgical safety and prosthetic implications. The impact of widespread fabrication technologies (milling and 3D printing) was investigated. Methods: Surgical guides manufactured by means of two specific milling and 3D-printing systems were digitized and compared in a 3D analysis with the digital file of the designed guides. The surface mean 3D distance (at the surface where the teeth and mucosa made contact) and the axial and linear deviations of the sleeves' housings were measured by means of a metrological software program. Univariate and multivariate statistical analyses were used to investigate the effects of the fabrication technology, type of support, and arch type on the surgical guides' accuracy. Results: The median deviations of the intaglio surface in contact with the mucosa were significantly (p < 0.001) lower for the milled surgical guides (0.05 mm) than for the 3D-printed guides (−0.07 mm), in comparison with the reference STL file. The generalized estimated equation models showed that the axial deviations of the sleeves' housings (a median of 0.82 degrees for the milling, and 1.37 degrees for the 3D printing) were significantly affected by the fabrication technology (p = 0.011) (the milling exhibited better results), the type of support (p < 0.001), and the combined effect of the fabrication technology and the sleeve-to-crest angle (p = 0.003). The linear deviation (medians of 0.12 mm for the milling and 0.21 mm for the 3D printing) of their center points was significantly affected by the type of support (p = 0.001), with the milling performing slightly better than the 3D printing. Conclusions: The magnitude of the difference might account for a limited clinical significance. [ABSTRACT FROM AUTHOR]

Medical 3D printing is a complex, highly interdisciplinary, and revolutionary technology that is positively transforming the care of patients. The technology is being increasingly adopted at the Point of Care (PoC) as a consequence of the strong value offered to medical practitioners. One of the key technologies within the medical 3D printing portfolio enabling this transition is desktop inverted Vat Photopolymerization (VP) owing to its accessibility, high quality, and versatility of materials. Several reports in the peer-reviewed literature have detailed the medical impact of 3D printing technologies as a whole. This review focuses on the multitude of clinical applications of desktop inverted VP 3D printing which have grown substantially in the last decade. The principles, advantages, and challenges of this technology are reviewed from a medical standpoint. This review serves as a primer for the continually growing exciting applications of desktop-inverted VP 3D printing in healthcare. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate how precisely implantation can be realized by participants on a phantom head according to preliminary planning. Of particular interest here was the influence of participants' previous knowledge and surgical experience on the precision of the implant placement. The placed implants were scanned using an intraoral scanner, saved as STL files, and superimposed with the 3D-planned implant placement. Deviations from the planning were indicated in millimeters and degrees. We were able to show that on average, the deviations from computer-assisted 3D planning were less than 1 mm for implantologists, and the students also did not deviate more than 1.78 mm on average from 3D planning. This study shows that guided implantology provides predictable and reproducible results in dental implantology. Incorrect positioning, injuries to anatomical structures, and implant positions that cannot be prosthetically restored can thus be avoided. [ABSTRACT FROM AUTHOR]

Background/objective: Disinfection of a 3D-printed surgical guide is of utmost importance as it comes into contact with hard and soft tissue during implant placement so it poses a potential risk of pathogenic transmission. Methods used for disinfection in the surgical field should be reliable, practical, and safe for the instruments and the patients. The objectives of this study were to compare the antimicrobial potential of 100% Virgin Coconut Oil, 2% Glutaraldehyde, and 70% Ethyl Alcohol used to decontaminate 3D-printed surgical guides. Materials and methods: Thirty identical surgical guides were printed and cut into two halves (N = 60). Both halves were then contaminated with a defined amount of human saliva samples (2 ml). The first half (n = 30) was sub-grouped into three study groups which were immersed in one of the three disinfectants for 20 min as follows; group VCO was immersed in 100% Virgin Coconut Oil, group GA was immersed in 2% Glutaraldehyde, and group EA was immersed in 70% Ethyl Alcohol. The second half (n* = 30) was sub-grouped into three control groups which were immersed in sterile distilled water as follows group VCO*, group GA*, and group EA*. The microbial count was expressed as colony-forming units per plate and the comparison of the antimicrobial potential of the three tested disinfectants between the three study and three control groups was done using the One-Way ANOVA test. Results: The culture results of three study groups revealed no bacterial growth with the highest % of reduction in the mean microbial count of the oral microorganisms (about100%) and an uncountable bacterial growth was shown between the three control groups (more than 100 CFU/plate) representing the baseline of the oral microorganisms. Therefore; statistically significant differences were found between the three control and three study groups (P <.001). Conclusion: The antimicrobial potential of Virgin Coconut Oil was comparable and equivalent to Glutaraldehyde and Ethyl Alcohol with a significant inhibitory action against oral pathogens. [ABSTRACT FROM AUTHOR]

As the fibula free flap became the gold standard in mandibular reconstruction that required both hard tissue and soft tissue, various methods have been sought to solve the height discrepancy between the mandible and fibula. The purpose of this paper was to propose a surgical option that combined the microvascular fibula free flap with a 3D-bioprinted, patient-specific polycaprolactone (PCL) implant as a safe and simple novel method that achieved the best functional and aesthetic results in mandibular reconstruction surgery for young patients with malignant tumors. The patient's reconstructed mandible maintained volume symmetry without any deformation or complications for over 6 years. Computer-aided design/computer-aided manufacturing (CAD/CAM) and 3D printing technology enabled accurate and safe surgical results. [ABSTRACT FROM AUTHOR]

Purpose: To analyze, in vitro, the dimensional stability over time of 3D‐printed surgical guides. Materials and methods: Ten surgical guides, manufactured by digital light processing 3D‐printing technology, were scanned immediately after post‐processing and then after 5, 10, 15, and 20 days. The corresponding standard tessellation language (STL) files were used for comparison with the reference CAD project. Mean absolute deviation (MAD) of the intaglio surface, axial, and linear deviations of the sleeves' housings were measured. Generalized estimated equations models (α = 0.05) were used to investigate the effect of time. Results: MAD of the teeth intaglio surface showed less variation (minimum: 0.002, maximum: 0.014 mm) than that of the mucosa (minimum: 0.026, maximum: 0.074 mm). Axial variations of the sleeves' housings on the sagittal (minimum: –0.008°, maximum: –0.577°) and frontal plane (minimum: –0.193°, maximum: 0.525°) changed with similar patterns, but opposite trends (decreasing for the former). Linear deviations of center points of the sleeves' housings had a shifting (minimum: –0.074, maximum: 0.02 mm) pattern with a decreasing tendency. Time after processing had a significant effect, either alone or nested with guides volume, on all outcomes of interest, except for MAD of the mucosa intaglio surface (p < 0.001), which was significantly affected only by the time‐volume nested effect (p = 0.012). Conclusions: Within the limitations of the experimental design, postmanufacturing dimensional variations of surgical guides were statistically significant. Although limited, they are an additional source of variability affecting the overall accuracy of computer‐guided surgery. As such, they should be addressed by further research. [ABSTRACT FROM AUTHOR]

Abstract Background Corrective osteotomies of the upper extremities with patient-specific instruments (PSIs) are increasingly used. In this context, the concordance between planning and postoperative 3D radiographs as well as the association between 3D accuracy and clinical outcome has rarely been evaluated. In this pilot study, we aimed to investigate our clinical mid-term outcome and 3D accuracy as well as their possible correlation, including identifying aspects critical to reaching optimal correction results. Methods From October 2018 to January 2020, we used PSIs for 12 corrective osteotomies of the upper extremity in 11 bones of 8 patients (congenital or posttraumatic deformities in 2 elbows, 3 forearms, 3 distal radii). In follow-up examination (10–25 months postoperatively), patient satisfaction, grip strength, ROM, VAS, and DASH were evaluated. Three-dimensional radiological accuracy was determined with 3D-reconstructed postoperative CT scans. With the software tool “Part Comparison” of Mimics® Innovation Suite Software/Materialise, surface differences of pre-planned and postoperative 3D models were compared. Results Compared to the preoperative situation pain and function were better at follow-up: The average VAS score significantly decreased from 6.5 ± 4.1 cm preoperatively to 2.3 ± 2.6 cm at the follow-up time point (p = 0.008). The average DASH score significantly improved, from 48.4 ± 30.9 to 27.0 ± 25.2 (p = 0.015). In the part comparison analysis “planned vs postoperative comparison”, significantly more points in percent (= 3D accuracy) were in a −3 mm to 3 mm interval than in the “preoperative vs planned comparison” (87.3 ± 13.8% vs 48.9 ± 16.6%, p = 0.004). After surgery, the maximum deviation value over all cases was 4.5 ± 1.1 mm, and the minimum deviation value was − 4.5 ± 1.2 mm vs preoperatively 12.9 ± 6.2 mm (p = 0.004) and − 7.2 ± 2.1 mm (p = 0.02), respectively. Clinically, in all cases with higher accuracy (> 90%), an improvement of either DASH or VAS or both of > 60% to the preoperative values occurred. There was a significant correlation between accuracy (%) and ΔVAS (p = 0.004). There were no method-related complications. Conclusions Our data after PSI-based corrective osteotomy in complex deformities of the upper extremity in a limited number of cases indicate a positive correlation between 3D accuracy and clinical outcomes. Examination of 3D accuracy to analyse sources of error in the hole procedure from initial CT scan to end of surgery even in patients with not fully satisfactory clinical results is required for further development of the method to achieve optimal correction results with nearly 100% congruence between the planned and postoperative 3D bone position. Trial registration This retrospective study was registered in the Center for Translational & Clinical Research Aachen (CTC-A) with the number 20-514 on November 20, 2021

Background: Surgical guides restrict the flow of cooling agent to osteotomy site, which will lead to a temperature rise that provokes tissue injury. Few studies compared differences in the temperature changes between non-limiting 'conventional' and limiting 'guided' surgical guides during implant site preparation. The objective of this study was to investigate the difference in temperature changes during bone drilling for implant placement using non-limiting and limiting surgical guides at cortical and cancellous bone levels. Methods: Forty-four bovine rib samples were used for implant bed preparation in this study with a minimum thickness of 11 mm was chosen for the ribs. The bone was stored in a freezer at 10 °C until it was used. On the day of the study, the bone was defrosted and soaked in water at 21 °C for three hours before embarking on drilling to make sure each sample was at the same temperature when tested. Forty-four bone specimens were prepared and randomly allocated to receive either a limiting or a non-limiting surgical guides (22 for each group). The osteotomy site was prepared by one operator following the manufacturer's instructions, using limiting and non-limiting surgical guides. Temperature changes were recorded during implant bed preparation using thermocouples that fit into 7 mm-horizontal channels at two different depths (Coronally) and (Apically) at 1 mm distance from the osteotomy site. The data were tested for homogeneity of variances using Levene's test, then data were analyzed using an Independent sample t-test and the significance level was set at P ≤ 0.05. Results: The mean temperature rise for all samples was 0.55 °C. The mean temperature rises for the limiting and non-limiting surgical guides were 0.80 °C and 0.33 °C respectively. There was a statistically significant difference in temperature rise between the limiting and non-limiting surgical guides (P = 0.008). In relation to position of temperature recording (coronal vs. apical), there was no significant difference (P > 0.05). No significant difference was noted between the two groups at cancellous bone level (P = 0.68), but the difference was significant at cortical bone level (P = 0.036). Conclusion: Limiting surgical guides showed higher readings than non-limiting. However, for both techniques, temperature rise was not significant clinically and within a safe range. [ABSTRACT FROM AUTHOR]