Name: real-time dynamic navigation system for the precise quad-zygomatic implant placement in a patient with a severely atrophic maxilla
Uploaded: 2021-10-18T13:00:00
Description: Watch this Scientific Journal Video about Real-Time Dynamic Navigation System for the Precise Quad-Zygomatic Implant Placement in a Patient with a Severely Atrophic Maxilla at JoVE.com

Forfatterne takker Dr. Shengchi Fan for venligt at yde værdifuld navigationsteknisk support. Denne case-rapport blev finansieret af nøgleprojektet fra Kinas ministerium for videnskab og teknologi (2017YFB1302904), Natural Science Foundation of Shanghai (nr. 21ZR1437700), den kliniske forskningsplan for SHDC (SHDC2020CR3049B) og det kombinerede ingeniør- og medicinske projekt fra Shanghai Jiao Tong University (YG2021QN72).

Alle de kliniske protokoller blev godkendt af Medical Ethics Review Committee på Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine (SH9H-2020-T29-3).
1. Valg af patient
<ol><li>Kriterierne for inklusion af patienter var som følger (tabel 1).<ol><li>Sørg for, at patienten præsenterer en helt edentulous maxilla eller delvis edentulous maxilla med få ekstremt løse tænder (figur 1A-G<...

<ol>
	<li>Francischone, C. L., Vasconcelos, L. W., Filho, H. N., Francischone, C. E., Sartori, I. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chapter+15.+The+zygoma+fixture.">Chapter 15. The zygoma fixture.</a> The osseointegration book. From calvarium to calcaneus. , 317-320 (2005).</li><li>Weischer, T., Schettler, D., Mohr, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Titanium+implants+in+the+zygoma+as+retaining+elements+after+hemimaxillectomy.">Titanium implants in the zygoma as retaining elements after hemimaxillectomy.</a> The International Journal of Oral &amp; Maxillofacial Implants. 12 (2), 211-214 (1997).</li><li>Jensen, O. T., Brownd, C., Blacker, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nasofacial+prostheses+supported+by+osseointegrated+implants.">Nasofacial prostheses supported by osseointegrated implants.</a> The International Journal of Oral &amp; Maxillofacial Implants. 7 (2), 203-211 (1992).</li><li>Duarte, L. R., Filho, H. N., Francischone, C. E., Peredo, L. G., Branemark, P. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+establishment+of+a+protocol+for+the+total+rehabilitation+of+atrophic+maxillae+employing+four+zygomatic+fixtures+in+an+immediate+loading+system--a+30-month+clinical+and+radiographic+follow-up.">The establishment of a protocol for the total rehabilitation of atrophic maxillae employing four zygomatic fixtures in an immediate loading system--a 30-month clinical and radiographic follow-up.</a> Clinical Implant Dentistry and Related Research. 9 (4), 186-196 (2007).</li><li>Hung, K. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+of+a+real-time+surgical+navigation+system+for+the+placement+of+quad+zygomatic+implants+in+the+severe+atrophic+maxilla:+A+pilot+clinical+study.">Accuracy of a real-time surgical navigation system for the placement of quad zygomatic implants in the severe atrophic maxilla: A pilot clinical study.</a> Clinical Implant Dentistry and Related Research. 19 (3), 458-465 (2017).</li><li>Wu, Y., Wang, F., Huang, W., Fan, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-time+navigation+in+zygomatic+implant+placement:+Workflow.">Real-time navigation in zygomatic implant placement: Workflow.</a> Oral and Maxillofacial Surgery Clinics of North America. 31 (3), 357-367 (2019).</li><li>Wang, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+four+zygomatic+implant-supported+prostheses+for+the+rehabilitation+of+the+atrophic+maxilla:+a+systematic+review.">Reliability of four zygomatic implant-supported prostheses for the rehabilitation of the atrophic maxilla: a systematic review.</a> The International Journal of Oral &amp; Maxillofacial Implants. 30 (2), 293-298 (2015).</li><li>Xiaojun, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+integrated+surgical+planning+and+virtual+training+system.">An integrated surgical planning and virtual training system.</a> IEEE 2010 International Conference on Audio, Language and Image Processing (ICALIP). , 1257-1261 (2010).</li><li>Fan, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+the+configurations+of+fiducial+markers+on+accuracy+of+surgical+navigation+in+zygomatic+implant+placement:+An+in+vitro+study.">The effect of the configurations of fiducial markers on accuracy of surgical navigation in zygomatic implant placement: An in vitro study.</a> The International Journal of Oral &amp; Maxillofacial Implants. 34 (1), 85-90 (2019).</li><li>Xiaojun, C., Ming, Y., Yanping, L., Yiqun, W., Chengtao, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Image+guided+oral+implantology+and+its+application+in+the+placement+of+zygoma+implants.">Image guided oral implantology and its application in the placement of zygoma implants.</a> Computer Methods and Programs in Biomedicine. 93 (2), 162-173 (2009).</li><li>Cawood, J. I., Howell, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+classification+of+the+edentulous+jaws.">A classification of the edentulous jaws.</a> The International Journal of Oral &amp; Maxillofacial Surgery. 17 (4), 232-236 (1988).</li><li>Davo, R., Pons, O., Rojas, J., Carpio, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immediate+function+of+four+zygomatic+implants:+a+1-year+report+of+a+prospective+study.">Immediate function of four zygomatic implants: a 1-year report of a prospective study.</a> European Journal of Oral Implantology. 3 (4), 323-334 (2010).</li><li>Jensen, O. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complete+arch+site+classification+for+all-on-4+immediate+function.">Complete arch site classification for all-on-4 immediate function.</a> The Journal of Prosthetic Dentistry. 112 (4), 741-751 (2014).</li><li>Triplett, R. G., Schow, S. R., Laskin, D. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oral+and+maxillofacial+surgery+advances+in+implant+dentistry.">Oral and maxillofacial surgery advances in implant dentistry.</a> The International Journal of Oral &amp; Maxillofacial Implants. 15 (1), 47-55 (2000).</li><li>Aparicio, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+proposed+classification+for+zygomatic+implant+patient+based+on+the+zygoma+anatomy+guided+approach+(ZAGA):+a+cross-sectional+survey.">A proposed classification for zygomatic implant patient based on the zygoma anatomy guided approach (ZAGA): a cross-sectional survey.</a> European Journal of Oral Implantology. 4 (3), 269-275 (2011).</li><li>Hung, K. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measurement+of+the+zygomatic+region+for+the+optimal+placement+of+quad+zygomatic+implants.">Measurement of the zygomatic region for the optimal placement of quad zygomatic implants.</a> Clinical Implant Dentistry and Related Research. 19 (5), 841-848 (2017).</li><li>Kahnberg, K. E., Nystrom, E., Bartholdsson, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combined+use+of+bone+grafts+and+Br+fixtures+in+the+treatment+of+severely+resorbed+maxillae.">Combined use of bone grafts and Br fixtures in the treatment of severely resorbed maxillae.</a> The International Journal of Oral &amp; Maxillofacial Implants. 4 (4), 297-304 (1989).</li><li>Nystrom, E., Kahnberg, K. E., Gunne, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bone+grafts+and+Br+implants+in+the+treatment+of+the+severely+resorbed+maxilla:+A+2-year+longitudinal+study.">Bone grafts and Br implants in the treatment of the severely resorbed maxilla: A 2-year longitudinal study.</a> The International Journal of Oral &amp; Maxillofacial Implants. 8 (1), 45-53 (1993).</li><li>Jensen, S. S., Terheyden, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bone+augmentation+procedures+in+localized+defects+in+the+alveolar+ridge:+Clinical+results+with+different+bone+grafts+and+bone-substitute+materials.">Bone augmentation procedures in localized defects in the alveolar ridge: Clinical results with different bone grafts and bone-substitute materials.</a> The International Journal of Oral &amp; Maxillofacial Implants. 24, 218-236 (2009).</li><li>Bedrossian, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rehabilitation+of+the+edentulous+maxilla+with+the+zygoma+concept:+A+7-year+prospective+study.">Rehabilitation of the edentulous maxilla with the zygoma concept: A 7-year prospective study.</a> The International Journal of Oral &amp; Maxillofacial Implants. 25 (6), 1213-1221 (2010).</li><li>Dhamankar, D., Gupta, A. R., Mahadevan, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immediate+implant+loading:+A+case+report.">Immediate implant loading: A case report.</a> Journal of Indian Prosthodontic Society. 10 (1), 64-66 (2010).</li><li>Aparicio, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Zygomatic+implants:+indications,+techniques+and+outcomes,+and+the+zygomatic+success+code.">Zygomatic implants: indications, techniques and outcomes, and the zygomatic success code.</a> Periodontol 2000. 66 (1), 41-58 (2014).</li><li>Chrcanovic, B. R., Abreu, M. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Survival+and+complications+of+zygomatic+implants:+A+systematic+review.">Survival and complications of zygomatic implants: A systematic review.</a> Journal of Oral and Maxillofacial Surgery. 17 (2), 81-93 (2013).</li><li>Br&#229;nemark, P. I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Zygoma+fixture+in+the+management+of+advanced+atrophy+of+the+maxilla:+Technique+and+long-term+results.">Zygoma fixture in the management of advanced atrophy of the maxilla: Technique and long-term results.</a> Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. 38 (2), 70-85 (2004).</li><li>Balshi, T. J., Wolfinger, G. J., Petropoulos, V. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quadruple+zygomatic+implant+support+for+retreatment+of+resorbed+iliac+crest+bone+graft+transplant.">Quadruple zygomatic implant support for retreatment of resorbed iliac crest bone graft transplant.</a> Implant Dentistry. 12 (1), 47-53 (2003).</li><li>Chrcanovic, B. R., Oliveira, D. R., Cust&#243;dio, A. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+evaluation+of+computed+tomography-derived+stereolithographic+surgical+guides+in+zygomatic+implant+placement+in+human+cadavers.">Accuracy evaluation of computed tomography-derived stereolithographic surgical guides in zygomatic implant placement in human cadavers.</a> The Journal of Oral Implantology. 36 (5), 345-355 (2010).</li><li>Gellrich, N. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Computer-assisted+secondary+reconstruction+of+unilateral+posttraumatic+orbital+deformity.">Computer-assisted secondary reconstruction of unilateral posttraumatic orbital deformity.</a> Plast and Reconstructive Surgery. 110 (6), 1417-1429 (2002).</li><li>Watzinger, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Placement+of+endosteal+implants+in+the+zygoma+after+maxillectomy:+A+Cadaver+study+using+surgical+navigation.">Placement of endosteal implants in the zygoma after maxillectomy: A Cadaver study using surgical navigation.</a> Plast and Reconstructive Surgery. 107 (3), 659-667 (2001).</li><li>Wagner, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Computer-aided+placement+of+endosseous+oral+implants+in+patients+after+ablative+tumour+surgery:+Assessment+of+accuracy.">Computer-aided placement of endosseous oral implants in patients after ablative tumour surgery: Assessment of accuracy.</a> Clinical Oral Implants Research. 14 (3), 340-348 (2003).</li><li>Casap, N., Wexler, A., Tarazi, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Application+of+a+surgical+navigation+system+for+implant+surgery+in+a+deficient+alveolar+ridge+postexcision+of+an+odontogenic+myxoma.">Application of a surgical navigation system for implant surgery in a deficient alveolar ridge postexcision of an odontogenic myxoma.</a> The Journal of Oral &amp; Maxillofacial Surgery. 63 (7), 982-988 (2005).</li><li>Pellegrino, G., Tarsitano, A., Basile, F., Pizzigallo, A., Marchetti, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Computer-aided+rehabilitation+of+maxillary+oncological+defects+using+zygomatic+implants:+A+defect-based+classification.">Computer-aided rehabilitation of maxillary oncological defects using zygomatic implants: A defect-based classification.</a> The Journal of Oral &amp; Maxillofacial Surgery. 73 (12), 1-11 (2015).</li><li>Fan, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+the+configurations+of+fiducial+markers+on+accuracy+of+surgical+navigation+in+zygomatic+implant+placement:+An+in+vitro+study.">The effect of the configurations of fiducial markers on accuracy of surgical navigation in zygomatic implant placement: An in vitro study.</a> The International Journal of Oral &amp; Maxillofacial Implants. 34 (1), 85-90 (2019).</li><li>D'Haese, J., Van De Velde, T., Elaut, L., De Bruyn, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+prospective+study+on+the+accuracy+of+mucosally+supported+stereolithographic+surgical+guides+in+fully+edentulous+maxillae.">A prospective study on the accuracy of mucosally supported stereolithographic surgical guides in fully edentulous maxillae.</a> Clinical Implant Dentistry and Related Research. 14 (2), 293-303 (2012).</li><li>St&#252;binger, S., Buitrago-Tellez, C., Cantelmi, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deviations+between+placed+and+planned+implant+positions:+an+accuracy+pilot+study+of+skeletally+supported+stereolithographic+surgical+templates.">Deviations between placed and planned implant positions: an accuracy pilot study of skeletally supported stereolithographic surgical templates.</a> Clinical Implant Dentistry and Related Research. 16 (4), 540-551 (2014).</li></ol>

Rekonstruktiv rehabilitering af den atrofiske maxilla ved hjælp af transplantater er vanskelig, fordi det kræver god kirurgisk teknik, dækning af blødt væv af høj kvalitet over transplantatet, en betydelig mængde patientsamarbejde og patienter med sundhed, der er gunstig for den endelige restaurering17,18. Placeringen af tandimplantater til rekonstruktion hos patienter med maksillær atrofi udgør en betydelig klinisk udfordring. Mønsteret af ansigtsbenre...

I 1990'erne introducerede Branemark en alternativ teknik til knogletransplantation, det zygomatiske implantat (ZI), som også er blevet kaldt zygomaticus armatur1. Det blev oprindeligt brugt til behandling af traumeofre og patienter med tumorresektion, hvor der var en defekt i den maksillære struktur. Efter maxillektomi bevarede mange patienter kun forankring i zygomaens krop eller i frontforlængelsen af den zygomatiske knogle 1,2,3.
For nylig er ZI-teknikken blevet udbredt hos edentulous- og dentatpatienter med en alvorligt resorberet maxilla. Hovedindikationen for ZI-implantater er en atrofisk maxilla. Brugen af fire ZI'er i et øjeblikkeligt belastningssystem (fast protese) er praktisk for kirurger med bred klinisk erfaring, og det ser ud til at repræsentere en fremragende alternativ metode til knogletransplantatteknikker 2,4. Der er dog risici ved at placere ZI'er, enten ved frihånd eller ved hjælp af en kirurgisk skabelon til vejledning. Risici omfatter unøjagtig placering i alveolus, penetration af orbitalhulen eller infra-temporal fossa og uhensigtsmæssig placering inden for den zygomatiske fremtrædende plads5. Placeringen af flere ZI'er gør denne operation risikabel og vanskelig at udføre. Derfor er forbedring af præcisionen af ZI-placering afgørende for dets kliniske anvendelse og sikkerhed.
Det kirurgiske navigationssystem i realtid giver en anden tilgang. Det giver realtid og fuldstændigt visualiserede baner gennem analyse af præoperative og intraoperative computertomografibilleder. Med navigationssystemet i realtid er både præcision og sikkerhed blevet forbedret med sofistikeret kirurgi og behandling 5,6. En praktisk, gennemførlig og reproducerbar protokol blev udviklet ved hjælp af det kirurgiske navigationssystem i realtid til præcist at placere ZI'er i den alvorligt atrofiske maxilla 5,7,8,9,10. Med denne protokol har vi behandlet hundredvis af patienter med tilfredsstillende kliniske resultater 5,6,7,8,9,10. Her præsenterer vi protokollen med de detaljerede oplysninger om behandlingsproceduren.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Bistoury scalpel</td>
			<td>Hufriedy Group</td>
			<td>10-130-05</td>
			<td></td>
		</tr>
		<tr>
			<td>Branemark system zygoma TiUnite RP 35mm</td>
			<td>Nobel Biocare AB</td>
			<td>34724</td>
			<td>TiUnite implant with overlength to place from the maxilla to the zygoma</td>
		</tr>
		<tr>
			<td>Branemark system zygoma TiUnite RP 40mm</td>
			<td>Nobel Biocare AB</td>
			<td>34735</td>
			<td>TiUnite implant with overlength to place from the maxilla to the zygoma</td>
		</tr>
		<tr>
			<td>Branemark system zygoma TiUnite RP 42.5mm</td>
			<td>Nobel Biocare AB</td>
			<td>34736</td>
			<td>TiUnite implant with overlength to place from the maxilla to the zygoma</td>
		</tr>
		<tr>
			<td>Branemark system zygoma TiUnite RP 45mm</td>
			<td>Nobel Biocare AB</td>
			<td>34737</td>
			<td>TiUnite implant with overlength to place from the maxilla to the zygoma</td>
		</tr>
		<tr>
			<td>Branemark system zygoma TiUnite RP 47.5mm</td>
			<td>Nobel Biocare AB</td>
			<td>34738</td>
			<td>TiUnite implant with overlength to place from the maxilla to the zygoma</td>
		</tr>
		<tr>
			<td>Branemark system zygoma TiUnite RP 50mm</td>
			<td>Nobel Biocare AB</td>
			<td>34739</td>
			<td>TiUnite implant with overlength to place from the maxilla to the zygoma</td>
		</tr>
		<tr>
			<td>Branemark system zygoma TiUnite RP 52.5mm</td>
			<td>Nobel Biocare AB</td>
			<td>34740</td>
			<td>TiUnite implant with overlength to place from the maxilla to the zygoma</td>
		</tr>
		<tr>
			<td>CBCT</td>
			<td>Planmeca Oy,Helsinki, Finland</td>
			<td>Pro Max 3D Max</td>
			<td></td>
		</tr>
		<tr>
			<td>connection to handpiece</td>
			<td>Nobel Biocare AB</td>
			<td>29081</td>
			<td>the accessories to connect the intrument</td>
		</tr>
		<tr>
			<td>Drill guard</td>
			<td>Nobel Biocare AB</td>
			<td>29162</td>
			<td>the accessories to protect the lips and soft tissue during the surgery</td>
		</tr>
		<tr>
			<td>Drill guard short</td>
			<td>Nobel Biocare AB</td>
			<td>29162</td>
			<td>the accessories to protect the lips and soft tissue during the surgery</td>
		</tr>
		<tr>
			<td>Handpiece zygoma 20:1</td>
			<td>Nobel Biocare AB</td>
			<td>32615</td>
			<td>the basic instrument for implant drill</td>
		</tr>
		<tr>
			<td>Instrument adapter array size L</td>
			<td>BRAINLAB AG</td>
			<td>41801</td>
			<td></td>
		</tr>
		<tr>
			<td>Instrument adapter array size M</td>
			<td>BRAINLAB AG</td>
			<td>41798</td>
			<td></td>
		</tr>
		<tr>
			<td>Instrument calibration matrix</td>
			<td>BRAINLAB AG</td>
			<td>41874</td>
			<td>a special tool for drill to calibration</td>
		</tr>
		<tr>
			<td>I-plan automatic image fusion software STL data import/export for I-plan VectorVision2&#174;, (I-plan CMF software)</td>
			<td>BRAINLAB AG</td>
			<td>inapplicability</td>
			<td>the software for navigation surgery planning</td>
		</tr>
		<tr>
			<td>Multi-unit abutment 3mm</td>
			<td>Nobel Biocare AB</td>
			<td>32330</td>
			<td>the connection accessory between the implant and the titanium base</td>
		</tr>
		<tr>
			<td>Multi-unit abutment 5mm</td>
			<td>Nobel Biocare AB</td>
			<td>32331</td>
			<td>the connection accessory between the implant and the titanium base</td>
		</tr>
		<tr>
			<td>Periosteal elevator</td>
			<td>Hufriedy Group</td>
			<td>PPR3/9A</td>
			<td>the instrument for open flap surgery</td>
		</tr>
		<tr>
			<td>Pilot drill</td>
			<td>Nobel Biocare AB</td>
			<td>32630</td>
			<td>the drill for the surgery</td>
		</tr>
		<tr>
			<td>Pilot drill short</td>
			<td>Nobel Biocare AB</td>
			<td>32632</td>
			<td>the drill for the surgery measuring the depth of the implant holes</td>
		</tr>
		<tr>
			<td>Pointer with blunt tip for cranial/ENT</td>
			<td>BRAINLAB AG</td>
			<td>53106</td>
			<td></td>
		</tr>
		<tr>
			<td>Reference headband star</td>
			<td>BRAINLAB AG</td>
			<td>41877</td>
			<td></td>
		</tr>
		<tr>
			<td>Round bur</td>
			<td>Nobel Biocare AB</td>
			<td>DIA 578-0</td>
			<td>the drill for the surgery</td>
		</tr>
		<tr>
			<td>Screwdriver manual</td>
			<td>Nobel Biocare AB</td>
			<td>29149</td>
			<td></td>
		</tr>
		<tr>
			<td>Skull reference array</td>
			<td>BRAINLAB AG</td>
			<td>52122</td>
			<td>a special made metal reference for navigation camera to receive the signal</td>
		</tr>
		<tr>
			<td>Skull reference base</td>
			<td>BRAINLAB AG</td>
			<td>52129</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture vicryl 4-0</td>
			<td>Johnson &#38;Johnson, Ethicon</td>
			<td>VCP310H</td>
			<td></td>
		</tr>
		<tr>
			<td>Temporary copping multi-unit titanium (with prosthetic screw)</td>
			<td>Nobel Biocare AB</td>
			<td>29046</td>
			<td>the temporary titanium base to fix the teeth</td>
		</tr>
		<tr>
			<td>Titanium mini-screw</td>
			<td>CIBEI</td>
			<td>MB105-2.0*9</td>
			<td>the mini-screw for navigation registration</td>
		</tr>
		<tr>
			<td>Twist drill</td>
			<td>Nobel Biocare AB</td>
			<td>32628</td>
			<td>the drill for the surgery</td>
		</tr>
		<tr>
			<td>Twist drill short</td>
			<td>Nobel Biocare AB</td>
			<td>32629</td>
			<td>the drill for the surgery</td>
		</tr>
		<tr>
			<td>Zygoma depth indicator angled</td>
			<td>Nobel Biocare AB</td>
			<td>29162</td>
			<td></td>
		</tr>
		<tr>
			<td>Zygoma depth indicator straight</td>
			<td>Nobel Biocare AB</td>
			<td>29162</td>
			<td>the measurement scale for</td>
		</tr>
		<tr>
			<td>Zygoma handle</td>
			<td>Nobel Biocare AB</td>
			<td>29162</td>
			<td>the instrument for zygomatic implant placement</td>
		</tr>
	</tbody>
</table>

real-time dynamic navigation system for the precise quad-zygomatic implant placement in a patient with a severely atrophic maxilla

Zygomatiske implantater (ZI'er) er en ideel måde at løse tilfælde af en alvorligt atrofisk edentulous maxilla og maxilla defekter, fordi de erstatter omfattende knogleforstørrelse og forkorter behandlingscyklussen. Der er dog risici forbundet med placeringen af ZI'er, såsom penetration af orbitalhulen eller infra-temporal fossa. Desuden gør placeringen af flere ZI'er denne operation risikabel og vanskeligere at udføre. Potentielle intraoperative komplikationer er ekstremt farlige og kan forårsage uoprettelige tab. Her beskriver vi en praktisk, gennemførlig og reproducerbar protokol for et kirurgisk navigationssystem i realtid til præcis placering af quad-zygomatiske implantater i den alvorligt atrofiske maxilla hos patienter med resterende knogle, der ikke opfylder kravene til konventionelle implantater. Hundredvis af patienter har modtaget ZI'er på vores afdeling baseret på denne protokol. De kliniske resultater har været tilfredsstillende, de intraoperative og postoperative komplikationer har været lave, og nøjagtigheden indikeret ved infusion af det designede billede og postoperative tredimensionelle billede har været høj. Denne metode bør anvendes under hele den kirurgiske procedure for at sikre ZI-placeringssikkerhed.

Den tilmeldte patient var en 60-årig kvinde uden systematiske sygdomme (figur 1A-D, F). Efter CBCT-scanning var den alveolære højderyg i den forreste maxilla mindre end 2,9 mm, mens den resterende knoglehøjde i det bageste maxillaområde var mindre end 2,4 mm (figur 1E, G og tabel 1). Bredden og tykkelsen af den zygomatiske knogle var henholdsvis ca. 22,4-23,6 mm og 6,1-8,0 mm (<strong class...

Watch this Scientific Journal Video about Real-Time Dynamic Navigation System for the Precise Quad-Zygomatic Implant Placement in a Patient with a Severely Atrophic Maxilla at JoVE.com

Real-Time Dynamic Navigation System for the Precise Quad-Zygomatic Implant Placement in a Patient with a Severely Atrophic Maxilla

Her præsenterer vi en protokol for at opnå præcis quad-zygomatisk implantatplacering hos patienter med alvorligt atrofisk maxilla ved hjælp af et dynamisk navigationssystem i realtid.

Dynamisk navigationssystem i realtid til præcis quad-zygomatisk implantatplacering hos en patient med en alvorligt atrofisk maxilla

Zygomatic implants (ZIs) are an ideal way to address cases of a severely atrophic edentulous maxilla and maxilla defects because they replace extensive ...

Ved hjælp af navigationskirurgi i realtid kan vi behandle patienter med en alvorligt atrofisk maxilla, der kræver øjeblikkelig implantatbelastning, hurtigt, præcist og sikkert. En af de største fordele ved denne teknik er, at den forbedrede præcisionen af denne zygomatiske implantatplacering, hvilket er afgørende for dets kliniske anvendelse og sikkerhed. Denne teknik tillader behandling af patienter med alvorligt atrofisk maxilla på grund af ektodermal dysplasi, tumor eller svær parodontitis.Med den bedøvede patient liggende på operationsbordet i liggende stilling, skal du stift fastgøre kraniets referencebase til calvaria med en enkelt selvskærende titaniumskrue på 1,5 x 6 millimeter. Fastgør referencearrayet til basen, og saml det med tre markerede reflekterende kugler. Placer navigationssystemets kamera i klokken et for at overvåge kraniereferencen.Til registrering skal du specifikt indstille navigationssystemet til den enkelte patient ved hjælp af en positionssonde med en skræddersyet reflekterende kugle for at komme i kontakt med miniskruernes ydre overflade efter hinanden. Vis derefter de tilgængelige sagittale koronalaksiale og 3D-rekonstruktionsbilleder på navigationsskærmen. For at standardisere boringen, før du bruger den i operationen, skal du bruge en kalibreringsblok med huller med forskellige diametre.Øvelserne skal fastgøres direkte til bunden af blokken af kirurgen, og derefter skal assistenten justere grænsefladen i kalibreringsmodulet. Udstyret producerer en lyd, når processen er afsluttet. Efter at have bestemt omfanget af snittet ved hjælp af kirurgisk navigation, skal du løfte klappen med fuld tykkelse, hvilket giver et passende overblik til at udsætte de planlagte implantatsteder.Området for periosteal højde skal indeholde alveola-kammen, sidevæggen af maxillaen og den nedre grænse af den zygomatiske knogle. Ved hjælp af navigationssonden skal du finde indgangspunktet og bruge zygoma-håndstykket til at rette indgangspunkterne. Find derefter indgangen til den zygomatiske knogle med sonden og brug zygoma-håndstykket til at forberede indgangspunktet for den zygomatiske knogle.Udfør derefter boreproceduren for at sikre, at den følger banerne fra indgangen til udgangspunktet som planlagt. Brugte 2, 9 millimeter boret først til at forberede stien fra indgangspunktet, som var placeret ved hjælp af navigationssonden til indgangen af den zygomatiske knogle. Forbered den mesiale først, efterfulgt af den distale.For at udvide implantatlejet skal du bruge håndstykket og forlænge stien fra indgangen til den zygomatiske knogle til terminalpunktet designet på overfladen af den zygomatiske knogle. Bed assistenten om at lægge en hånd på overfladen af den laterale orbitalvæg for at sikre dens sikkerhed. Forstør derefter banen med en ekspanderende boremaskine med en diameter på 3,5 millimeter.Brug målebjælken og navigationssonden til at kontrollere banens retning og position. Identificer implantatets længde ved hjælp af måleværktøjet. Hvis dybden ikke opfylder kravet om den planlagte længde, skal du forberede den til den indstillede dybde.Derefter implanteres de zygomatiske implantater ved hjælp af et specifikt manuelt værktøj, og brug derefter navigationssonden til at verificere korrekt positionering. Efter at have placeret flere enheder anlæg og helbredende hætter på implantaterne, suturer snittet med polypropylen 4-0 suturen. For billedintegration skal du få postoperative CBCT-scanningsbilleder og et panoramarøntgenbillede for at evaluere den zygomatiske implantatposition inden for 72 timer efter operationen.Eksporter de postoperative data til planlægningssoftwaren for at overlejre billedet af den postoperative CBCT og den præoperative kirurgiske plan. Sammenligning af placeringen af indgangspunktet, slutpunktet og vinkelafvigelsen. Efter operationen modtog patienten ved hjælp af navigationssystemet en midlertidig restaurering inden for tre dage, som behandlede både æstetiske og udtaleproblemer.Postoperativ CBCT-scanning og billedintegration afslørede start- og terminalpositionsfejl samt vinkelafvigelsen. Kontroller placeringen med sonden for at sikre, at boringen er korrekt. Vi kan også bruge vores specielle manuelle værktøj til at måle afstanden fra udgangspunktet til målpunktet.Denne protokol opfordrer forskere til at udforske feltet yderligere. Flere og flere forskerhold forsøger at udvikle nye navigationssystemer til maxilla ansigts- og tandimplantatoperationer for at øge nøjagtigheden og effektiviteten samt forkorte indlæringskurven.

Research

JoVE Journal

Medicine

Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures

Fjernbetjening Magnetic Navigation til præcis, Real-time Kateter Positionering og ablation i Cardiac Elektrofysiologi Procedures

New remote navigation systems have been developed to improve current limitations of conventional manually guided catheter ablation in complex cardiac ...

Intraoperative Detection of Subtle Endometriosis: A Novel Paradigm for Detection and Treatment of Pelvic Pain Associated with the Loss of Peritoneal Integrity

Intraoperativ Påvisning af Subtle Endometriose: et nyt paradigme for påvisning og behandling af bækkensmerter forbundet med tab af Peritoneal Integrity

Endometriosis is a  common disease affecting 40 to 70% of reproductive-aged women with chronic  pelvic pain (CPP) and/or infertility. The purpose of this ...

Development of an Audio-based Virtual Gaming Environment to Assist with Navigation Skills in the Blind

Udvikling af en Audio-based Virtual Gaming Miljø til at hjælpe med Navigation Skills i Blind

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio ...

Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic ...

Evaluation of Lung Metastasis in Mouse Mammary Tumor Models by Quantitative Real-time PCR

Evaluering af lungemetastase i musebrysttumor modeller af kvantitativ real-time PCR

Metastatic disease is the spread of malignant tumor cells from the primary cancer site to a distant organ and is the primary cause of cancer associated ...

Quantitative [18F]-Naf-PET-MRI Analysis for the Evaluation of Dynamic Bone Turnover in a Patient with Facetogenic Low Back Pain

Quantitative [18F]-Naf-PET-MRI Analysis for the Evaluation of Dynamic Bone Turnover in a Patient with Facetogenic Low Back Pain

Kvantitativ [18F]-NAF-Pet-MRI-analyse til vurdering af dynamisk knogleomsætning hos en patient med Facetogen lændesmerter

Imaging techniques that reflect dynamic bone turnover may aid in characterizing a wide range of bone pathologies. Bone is a dynamic tissue undergoing ...

Evaluation of Capnography Sampling Line Compatibility and Accuracy when Used with a Portable Capnography Monitor

Evaluering af capnografi samplinglinje kompatibilitet og nøjagtighed, når de anvendes med en bærbar Capnography Monitor

Capnography is commonly used to monitor patient&#8217;s ventilatory status. While sidestream capnography has been shown to provide a reliable assessment ...

Real-Time Assessment of Spinal Cord Microperfusion in a Porcine Model of Ischemia/Reperfusion

Real-Time Vurdering af SpinalMarvsmikroperfusion i en porcinemodel af iskæmi/reperfusion

Spinal cord injury is a devastating complication of aortic repair. Despite developments for the prevention and treatment of spinal cord injury, its ...

Dynamic Navigation for Dental Implant Placement

Dynamisk navigation til placering af tandimplantater

In modern implantology, the application of surgical navigation systems is becoming increasingly important. In addition to static surgical navigation ...

Dynamic Navigation in Endodontics: Guided Access Cavity Preparation by Means of a Miniaturized Navigation System

Dynamisk navigation i endodonti: Guidet adgang hulrum forberedelse ved hjælp af et miniaturiseret navigationssystem

In the case of teeth with pulp canal calcification (PCC) and apical pathology or pulpitis, root canal treatment can be very challenging. PCC are common ...