CBCT IN COMBAT: PIONEERING ANATOMICAL STRATEGIES FOR MAXILLOFACIAL REHABILITATION.

Background: The integration of advanced imaging technologies, such as Cone Beam Computed Tomography (CBCT), has transformed the rehabilitation treatment for military maxillofacial trauma, enhancing care delivery. Despite these advancements, the field lacks a comprehensive anatomical analysis of endosteal, zygomatic, and pterygoid implants, a gap that limits clinical decision-making efficacy. Addressing this research void could significantly improve the selection of implants, tailored to the unique challenges of military-induced injuries. This study underscores the necessity of embracing imaging-driven, personalized anatomical insights, particularly for those afflicted by maxillofacial trauma. Objective: This research aims to leverage the capabilities of CBCT imaging to optimize rehabilitation for military personnel by focusing on anatomically informed clinical decisionmaking for maxillofacial injuries. Through a detailed comparative analysis of different implant types, facilitated by CBCT, the study seeks to guide toward refined clinical practices that accommodate the anatomical uniqueness of each patient, thereby enhancing care in military trauma scenarios. Material and methods: Our analysis involved 50 anonymized CBCT scans, equivalent to 100 hemimaxillae, to study the impact of maxillary morphological variations on implant placement. Advanced software applications such as Planmeca Romexis Viewer (3.5.0.R), Horos for macOS (Horos Project), and Blue Sky Plan 4 were utilized for precise measurements, comprehensive 3D model assessments, and simulations of implant placements. Measurements focused on the height and width of the alveolar process across three main areas: the anterior (premaxilla), middle (at the zygomaticoalveolar crest), and posterior (tuberosity of the maxilla and pterygoid process). Results : Analysis of the CBCT scans revealed significant variability in the dimensions of the maxillary alveolar process, particularly in the anterior region with widths ranging from 2.7 to 11.65 mm and heights from 6.4 to 27.6 mm. The posterior region also showed significant variability, posing challenges for implant placement. Of note, 21 out of 100 hemimaxillae were unsuitable for zygomatic implants ... due to extensive maxillary resorption and 2 due to highly pneumatized zygomatic bones. Additionally, 9 hemimaxillae were unsuitable for pterygoid implants due to significant resorption. Remarkably, one patient was ineligible for both zygomatic and pterygoid implants, highlighting the complexity of selecting appropriate implants in patients with severe conditions. Conclusions: CBCT utilization for pre-surgical planning is indispensable in the anatomically tailored evaluation of patients, especially following maxillofacial combat trauma which can dramatically alter anatomical landscapes. This precise anatomical assessment is crucial for improving clinical decision-making and outcomes, highlighting the paramount importance of individualized imaging in the strategic planning of implant-based reconstructions for personalized patient care. [ABSTRACT FROM AUTHOR]