Name: dynamic navigation for dental implant placement
Uploaded: 2022-09-13T12:40:00
Description: Watch this Scientific Journal Video about Dynamic Navigation for Dental Implant Placement at JoVE.com

Denne forskningen mottok ingen spesifikk bevilgning fra finansieringsorganer i offentlig, kommersiell eller ikke-for-profit sektor.

Informert samtykke ble innhentet fra hver pasient før operasjonen. Etter intervensjonene ble anonymiserte retrospektive data brukt i denne studien.
1. Trinn i den tradisjonelle arbeidsflyten til dynamiske navigasjonssystemer ved bruk av merket klipskalibreringsmetode (kun for bruk på kjeveben med tenner):
<ol><li>Fest en radiopak fikseringsklemme til tennene i kjevebenet der behandlingen skal utføres (maxilla/mandibel) ved hjelp av et termoplastisk materiale.</li>
	<li>Gj...

<ol>
	<li>Block, M. S., Emery, R. W., Cullum, D. R., Sheikh, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Implant+placement+is+more+accurate+using+dynamic+navigation.">Implant placement is more accurate using dynamic navigation.</a> Journal of Oral and Maxillofacial Surgery. 75 (7), 1377-1386 (2017).</li><li>Kaewsiri, D., Panmekiate, S., Subbalekha, K., Mattheos, N., Pimkhaokham, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+accuracy+of+static+vs.+dynamic+computer-assisted+implant+surgery+in+single+tooth+space:+A+randomized+controlled+trial.">The accuracy of static vs. dynamic computer-assisted implant surgery in single tooth space: A randomized controlled trial.</a> Clinical Oral Implants Research. 30 (6), 505-514 (2019).</li><li>Block, M. S., Emery, R. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Static+or+dynamic+navigation+for+implant+placement-choosing+the+method+of+guidance.">Static or dynamic navigation for implant placement-choosing the method of guidance.</a> Journal of Oral and Maxillofacial Surgery. 74 (2), 269-277 (2016).</li><li>Stefanelli, L. V., 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+novel+trace-registration+method+for+dynamic+navigation+surgery.">Accuracy of a novel trace-registration method for dynamic navigation surgery.</a> International Journal of Periodontics &amp; Restorative Dentistry. 40 (3), 427-435 (2020).</li><li>Mediavilla Guzman, A., Riad Deglow , E., Zubizarreta-Macho, A., Agustin-Panadero, R., Hernandez Montero, S. <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+computer-aided+dynamic+navigation+compared+to+computer-aided+static+navigation+for+dental+implant+placement:+An+in+vitro+study.">Accuracy of computer-aided dynamic navigation compared to computer-aided static navigation for dental implant placement: An in vitro study.</a> Journal of Clinical Medicine. 8 (12), 2123 (2019).</li><li>Sun, T. M., Lan, T. H., Pan, C. Y., Lee, H. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dental+implant+navigation+system+guide+the+surgery+future.">Dental implant navigation system guide the surgery future.</a> Kaohsiung Journal of Medical Sciences. 34 (1), 56-64 (2018).</li><li>Wu, Y., Wang, F., Fan, S., Chow, J. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotics+in+dental+implantology.">Robotics in dental implantology.</a> Oral and Maxillofacial Surgery Clinics of North America. 31 (3), 513-518 (2019).</li><li>Block, M. S., Emery, R. W., Lank, K., Ryan, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Implant+placement+accuracy+using+dynamic+navigation.">Implant placement accuracy using dynamic navigation.</a> International Journal of Oral &amp; Maxillofacial Implants. 32 (1), 92-99 (2017).</li><li>Panchal, N., Mahmood, L., Retana, A., Emery, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dynamic+navigation+for+dental+implant+surgery.">Dynamic navigation for dental implant surgery.</a> Oral and Maxillofacial Surgery Clinics of North America. 31 (4), 539-547 (2019).</li><li>Emery, R. W., Merritt, S. A., Lank, K., Gibbs, J. D. <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+dynamic+navigation+for+dental+implant+placement-model-based+evaluation.">Accuracy of dynamic navigation for dental implant placement-model-based evaluation.</a> Journal of Oral Implantology. 42 (5), 399-405 (2016).</li></ol>

I det merkede klipsbrukte dynamiske navigasjonsimplantatplasseringssystemet gjøres den tradisjonelle arbeidsflyten ved klipskalibrering. Det er tre radioaktive metallkuler på overflaten av klipsen, som er tydelig synlige på CBCT-skanningen. Når det gjelder sporingskalibreringsmetoden, er disse metallkulene som inneholder klips verken nødvendige for CBCT-skanning eller systemkalibrering. I tilfeller med eksisterende tenner kan både merkede og umerkede klips brukes (to forskjellige kalibreringsmetoder). Klipsen er fe...

For å øke nøyaktigheten av tannimplantatplassering og redusere komplikasjonene, er det utviklet en rekke navigasjonsteknikker basert på bildebehandlingsstudier. Preoperativ bildebehandling og spesiell 3D-implantatplanleggingsprogramvare kan brukes til å planlegge den nøyaktige posisjonen til tannimplantatet 1,2.
Målet med navigasjon av implantatkirurgi er å oppnå en mer anatomisk presis plassering av tannimplantatet for å oppnå den mest ideelle posisjonen, for å redusere risikoen for mulige iatrogene komplikasjoner (nerve-, vaskulær-, bein- og bihuleskader). Den navigerte operasjonen reduserer invasiviteten til intervensjonen (klaffløs kirurgi), noe som kan føre til færre klager og raskere utvinning. Den nøyaktige implantatplasseringen er basert på tidligere proteseplanlegging (det er mulig å utføre operasjonen på grunnlag av en preoperativ tanninstallasjon), og den optimale implantatplasseringen kan bidra til å unngå beintransplantasjon.
I dag er det to typer datamaskinassistert implantat (CAI) kirurgiske plasseringsnavigasjonssystemer - statiske og dynamiske navigasjonssystemer. Statisk navigasjon er en kontrollert implantatplasseringsmetode ved hjelp av en forhåndsplanlagt og prefabrikkert kirurgisk mal. Dynamisk navigasjon er en forhåndsplanlagt datastyrt implantatkirurgisk plasseringsmetode uten kirurgisk mal ved hjelp av optisk kontroll. Kontrollprosedyren bruker punktskybasert bilderegistrering til å slå sammen de virtuelle bildene med det virkelige miljøet ved å bruke 3D-bildeoverlegg3.
DCAI-systemer muliggjør sanntids, objektivert instrumentkontroll innenfor et GPS-lignende rammeverk. Vanligvis bruker de optisk sporing for å oppdage og spore posisjonen til (optiske) referansemarkører plassert over pasienten og de kirurgiske instrumentene, og gi kontinuerlig visuell tilbakemelding på implantatets kirurgiske plasseringsprosess 1,2.
Bevegelsen og posisjonen til det kirurgiske instrumentet under operasjonen kan overvåkes live på et tredimensjonalt bilde på en skjerm. Under prosedyren tillater kamerasystemet kontinuerlig overvåking og sammenligning av posisjonen til pasientens kjeveben og posisjonen til det kirurgiske instrumentet.
Det finnes to typer dynamiske navigasjonssystemer: det ene er det passive systemet, i så fall reflekterer registreringsenhetene (referansebasene) lys som sendes ut fra lyskilden tilbake til stereokameraene; Den andre er det aktive systemet, der registreringsenhetene avgir lys som etterfølges av stereokameraer 4,5.
Det neste nivået av dynamiske navigasjonssystemer bruker servomotorer til å lede kirurgens hånd med taktile stimuli, slik at enheten med robotarmer kan bestemme kirurgens bevegelser eller til og med erstatte dem helt i fjern fremtid 4,5,6,7.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>DTX Implant Studio Software</td>
			<td>Nobel Biocare</td>
			<td>106182</td>
			<td>3D surgical planing software</td>
		</tr>
		<tr>
			<td>MeshLab</td>
			<td>ISTI - CNR research center</td>
			<td>2020.12</td>
			<td>3D mesh processing software</td>
		</tr>
		<tr>
			<td>Nobel Replace CC implant</td>
			<td>Nobel Biocare</td>
			<td>37285</td>
			<td>Implant</td>
		</tr>
		<tr>
			<td>X-Guide</td>
			<td>X-Nav - Nobel Biocare</td>
			<td>SN00001310</td>
			<td>dinamic navigation surgery system</td>
		</tr>
		<tr>
			<td>X-Guide - XClip</td>
			<td>X-Nav - Nobel Biocare</td>
			<td>XNVP008381</td>
			<td>3D navigation registration device</td>
		</tr>
		<tr>
			<td>X-Guide planing software</td>
			<td>X-Nav - Nobel Biocare</td>
			<td>XNVP008296</td>
			<td>3D surgical planing and operating software</td>
		</tr>
		<tr>
			<td>X-Mark probe</td>
			<td>X-Nav - Nobel Biocare</td>
			<td>XNVP008886</td>
			<td>3D navigation registration tool</td>
		</tr>
		<tr>
			<td>PaX-i3D Smart</td>
			<td>Vatech</td>
			<td></td>
			<td>CBCT</td>
		</tr>
		<tr>
			<td>Prolene 5.0</td>
			<td></td>
			<td></td>
			<td>5.0 monofilament, nonabsorbable polypropylene suture</td>
		</tr>
	</tbody>
</table>

dynamic navigation for dental implant placement

I moderne implantologi blir anvendelsen av kirurgiske navigasjonssystemer stadig viktigere. I tillegg til statiske kirurgiske navigasjonsmetoder, blir en guideuavhengig dynamisk navigasjonsimplantatplasseringsprosedyre stadig mer utbredt. Prosedyren er basert på datamaskinstyrt tannimplantatplassering ved hjelp av optisk kontroll. Dette arbeidet tar sikte på å demonstrere de tekniske trinnene i et nytt dynamic dataassistert implantat kirurgi (DCAIS) system (design, kalibrering, kirurgi) og sjekke nøyaktigheten av resultatene. Basert på kjeglestråle computertomografi (CBCT) skanninger, bestemmes de nøyaktige posisjonene til implantater med dedikert programvare. Det første trinnet i operasjonen er kalibrering av navigasjonssystemet, som kan utføres på to måter: 1) basert på CBCT-bilder tatt med en markør eller 2) basert på CBCT-bilder uten markører. Implantater settes inn ved hjelp av sanntidsnavigasjon i henhold til de preoperative planene. Nøyaktigheten av intervensjonene kan evalueres basert på postoperative CBCT-bilder. De preoperative bildene som inneholdt de planlagte posisjonene til implantatene og postoperative CBCT-bilder ble sammenlignet basert på implantasjonens vinkling (grad), plattform og apikale avvik (mm). For å evaluere dataene beregnet vi standardavviket (SD), gjennomsnitt og standardfeil for gjennomsnittet (SEM) av avvik innenfor planlagte og utførte implantatposisjoner. Forskjeller mellom de to kalibreringsmetodene ble sammenlignet basert på disse dataene. Basert på inngrepene som er utført så langt, tillater bruk av DCAIS høypresisjons implantatplassering. Et kalibreringssystem som ikke krever merket CBCT-opptak, tillater kirurgisk inngrep med samme nøyaktighet som et system som bruker merking. Nøyaktigheten av intervensjonen kan forbedres ved trening.

For å bruke DCAIS riktig, må systemet kalibreres. Det finnes flere kalibreringsmetoder som kan påvirke nøyaktigheten av implantatplasseringen. Denne studien hadde som mål å vurdere den potensielle effekten av ulike kalibreringsmetoder på nøyaktigheten av DCAIS.
Basert på inngrepene som er utført så langt, tillater bruk av DCAIS en implantatplassering med høy presisjon. I våre tidlige studier sammenlignet vi 41 klipskalibrerte dynamiske navigerte implantatplasseringer med 17 sporka...

Watch this Scientific Journal Video about Dynamic Navigation for Dental Implant Placement at JoVE.com

Dynamic Navigation for Dental Implant Placement

Dynamisk dataassistert implantatkirurgi (DCAIS) er en kontrollert implantatkirurgisk plasseringsmetode utført uten kirurgisk mal ved hjelp av optisk kontroll. Sanntids intraoperativ kontroll av bevegelse og posisjon av kirurgisk enhet forenkler prosedyren og gir mer frihet til kirurgen, noe som gir lignende presisjon som statiske navigasjonsmetoder.

Dynamisk navigasjon for plassering av tannimplantater

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

Digitale datastyrte implantatsystemer muliggjør objektivisert instrumentkontroll i sanntid innenfor et GPS-lignende rammeverk. Instrumentets posisjon under operasjonen kan overvåkes live på et tredimensjonalt bilde på en skjerm. Denne teknikken er presis, minimal invasiv, trenger ikke en kirurgisk veiledningsmal, og enkel å bruke i en liten munn.Planleggingen og operasjonen kan utføres samme dag, og modifikasjon er mulig under operasjonen. Det anbefales å øve metoden på et tannbilde før du bruker det i en levende situasjon. Prosedyren vil bli demonstrert av Tamas Huszar, en assisterende professor fra vår avdeling.Begynn med å feste en radiopakkefikseringsklemme til kjevebenets tenner på behandlingsstedet ved hjelp av et termoplastisk materiale. Lag en kjeglestråle computertomografi eller CBCT-undersøkelse av pasienten med et merket klips i munnen. Planlegg implantatets posisjon i henhold til protesearkitekturen med riktig programvare.Registrer hodestykket ved å kalibrere håndstykkets chuck og den roterende markørskiven, satt inn i håndstykket. Monter deretter armen mellom pasientsporeren og den merkede klipsen og kalibrer den. For å kontrollere enhetskalibreringen, fest det merkede klipset som holder den optiske markøren eller trackeren på tennene som implantatplasseringen vil skje på.Sørg for å sette klipsen i samme posisjon som er registrert på den preoperative CBCT. Berør deretter klipsens metallkuler med dreiningen av sonden for å kalibrere det merkede klipset. For å utføre navigert implantatplassering og lokalbedøvelse, måle borelengden og kontrollere den visuelle nøyaktigheten i sanntid.Bestem inngangspunktet for boring og utforsk operasjonsstedet uten klaffen. Deretter borer du beinet med dynamisk navigasjonskontroll. Etter å ha målt implantatlengden, plasser implantatet med håndstykket iført det dynamiske navigasjonssystemet kontrollert tracker.Lukk såret med 5/0 monofilament ikke-absorberbar polypropylen sutur eller fest det prefabrikkerte protesearbeidet. Skaff deg deretter et kontrollradiologisk bilde. Utfør CBCT på pasienten uten klips i munnen.Bruk passende programvare for å planlegge implantatets posisjon i henhold til protesearkitekturen og kalibrere enheten som beskrevet tidligere. For kalibrering av systemet uten merket klips, overfør planen for kirurgisk plassering av implantatet til navigasjonssystemprogramvaren. Velg deretter arbeidsområdet på det tredimensjonale CT-bildet av navigasjonsprogramvaren.Fest trackeren på tennene med et umerket klips, eller, når det gjelder en edentulous kjeve, fest en spesiell tracker-holdearm. Velg deretter minst tre typiske anatomiske punkter på et 3D CT-bilde av navigasjonssystemet. Identifiser de valgte anatomiske punktene i munnen ved å berøre dem med et sondeverktøy.Utfør raffinementsprosedyren på tre til fire områder ved å tegne på overflaten av den anatomiske strukturen med en sonde. Under lokalbedøvelse, plasser implantatet med navigasjon og mål borelengden. Kontroller tannens visuelle nøyaktighet i sanntid eller på overflaten av beinet før du bestemmer borepunktet og utforsker operasjonsstedet uten klaffen.Bor beinet med dynamisk navigasjonskontroll. Mål implantatlengden før du plasserer implantatet med håndstykket iført den dynamiske navigasjonsstyrte trackeren. Lukk såret med en 5/0 monofilament ikke-absorberbar polypropylen sutur, eller fest det prefabrikkerte protesearbeidet.Start deretter kontroll radiologisk bildebehandling. Dataene fra den tidlige studien viste at det ikke var noen signifikant korrelasjon mellom plattformen og vinkelavvik i buccolingual og mesiodistal retninger. Når den planlagte og endelige plasseringen av implantatene ble sammenlignet, viste klipskalibreringsmetoden seg å være mer nøyaktig sammenlignet med sporingskalibreringsmetoden uten signifikant forskjell.Det er viktig å kontrollere kontinuiteten i kalibreringen og sporingen av prosedyren. Systemet vil signalisere eventuelle feil. Prosedyren tillater en rekke sporede tannbehandlinger, for eksempel rotapexamputasjon, ortognatisk kirurgi, endodontiske prosedyrer eller komplisert fjerning av visdomstann.

dynamic-navigation-for-dental-implant-placement

Research

JoVE Journal

Medicine

Shrinkage of Dental Composite in Simulated Cavity Measured with Digital Image Correlation

Polymerization shrinkage of dental resin composites can lead to restoration debonding or cracked tooth tissues in composite-restored teeth. In order to understand where and how shrinkage strain and stress develop in such restored teeth, Digital Image Correlation (DIC) was used to provide a comprehensive view of the displacement and strain distributions within model restorations that had undergone polymerization shrinkage.
Specimens with model cavities were made of cylindrical glass rods with both diameter and length being 10 mm. The dimensions of the mesial-occlusal-distal (MOD) cavity prepared in each specimen measured 3 mm and 2 mm in width and depth, respectively. After filling the cavity with resin composite, the surface under observation was sprayed with first a thin layer of white paint and then fine black charcoal powder to create high-contrast speckles. Pictures of that surface were then taken before curing and 5 min after. Finally, the two pictures were correlated using DIC software to calculate the displacement and strain distributions.
The resin composite shrunk vertically towards the bottom of the cavity, with the top center portion of the restoration having the largest downward displacement. At the same time, it shrunk horizontally towards its vertical midline. Shrinkage of the composite stretched the material in the vicinity of the &#8220;tooth-restoration&#8221; interface, resulting in cuspal deflections and high tensile strains around the restoration. Material close to the cavity walls or floor had direct strains mostly in the directions perpendicular to the interfaces. Summation of the two direct strain components showed a relatively uniform distribution around the restoration and its magnitude equaled approximately to the volumetric shrinkage strain of the material.

In order to understand the spatial development of polymerization shrinkage stress in dental resin-composite restorations, Digital Image Correlation was used to provide full-field displacement/strain measurement of restored model glass cavities by correlating images of the restoration taken before and after polymerization.

Krymping av Dental Composite i simulert Cavity Målt med Digital Image Korrelasjon

Polymerization shrinkage of dental resin composites can lead to restoration debonding or cracked tooth tissues in composite-restored teeth. In order to ...

Oral Biofilm Formation on Different Materials for Dental Implants

Dental implants and their prosthetic components are prone to bacterial colonization and biofilm formation. The use of materials that provides low microbial adhesion may reduce the prevalence and progression of peri-implant diseases. In view of the oral environment complexity and oral biofilm heterogeneity, microscopy techniques are needed that can enable a biofilm analysis of the surfaces of teeth and dental materials. This article describes a series of protocols implemented for comparing oral biofilm formation on titanium and ceramic materials for prosthetic abutments, as well as the methods involved in oral biofilms analyses at the morphological and cellular levels. The in situ model to evaluate oral biofilm formation on titanium and zirconia materials for dental prosthesis abutments as described in this study provides a satisfactory preservation of the 48 h biofilm, thereby demonstrating methodological adequacy. Multiphoton microscopy allows the analysis of an area representative of the biofilm formed on the test materials. In addition, the use of fluorophores and the processing of the images using multiphoton microscopy allows the analysis of the bacterial viability in a very heterogeneous population of microorganisms. The preparation of biological specimens for electron microscopy promotes the structural preservation of biofilm, images with good resolution, and no artifacts.

Here, we present a protocol to evaluate oral biofilm formation on titanium and zirconia materials for dental prosthesis abutments, including the analysis of bacterial cells viability and morphological characteristics. An in situ model associated with powerful microscopy techniques is used for the oral biofilm analysis.

Muntlig Biofilm formasjon på ulike materialer for tannimplantater

Dental implants and their prosthetic components are prone to bacterial colonization and biofilm formation. The use of materials that provides low ...

Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or excision. Many of these nodules are identified and excised via minimally invasive thoracic surgery; however, subcentimeter and subsolid nodules are frequently difficult to identify intra-operatively. This can be mitigated by the use of electromagnetic transthoracic needle localization. This protocol delineates the step-by-step process of electromagnetic localization from the pre-operative period to the postoperative period and is an adaptation of the electromagnetically guided percutaneous biopsy previously described by Arias et al. Pre-operative steps include obtaining a same day CT followed by the generation of a three-dimensional virtual map of the lung. From this map, the target lesion(s) and an entry site are chosen. In the operating room, the virtual reconstruction of the lung is then calibrated with the patient and the electromagnetic navigation platform. The patient is then sedated, intubated, and placed in the lateral decubitus position. Using a sterile technique and visualization from multiple views, the needle is inserted into the chest wall at the prechosen skin entry site and driven down to the target lesion. Dye is then injected into the lesion and, then, continuously during needle withdrawal, creating a tract for visualization intra-operatively. This method has many potential benefits when compared to the CT-guided localization, including a decreased radiation exposure and decreased time between the dye injection and the surgery. Dye diffusion from the pathway occurs over time, thereby limiting intra-operative nodule identification. By decreasing the time to surgery, there is a decrease in wait time for the patient, and less time for dye diffusion to occur, resulting in an improvement in nodule localization. When compared to electromagnetic bronchoscopy, airway architecture is no longer a limitation as the target nodule is accessed via a transparenchymal approach. Details of this procedure are described in a step-by-step fashion.

Presented here is a protocol for lung nodule localization using dye marking via electromagnetically navigated transthoracic needle access. The technique described here can be accomplished in the peri-operative period to optimize nodule localization and to successful resection when performing minimally invasive thoracic surgery.

Elektromagnetisk navigasjon Transthoracic Nodule Lokalisering for minimalt invasiv thoraxkirurgi

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or ...

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

Zygomatic implants (ZIs) are an ideal way to address cases of a severely atrophic edentulous maxilla and maxilla defects because they replace extensive bone augmentation and shorten the treatment cycle. However, there are risks associated with the placement of ZIs, such as penetration of the orbital cavity or infra-temporal fossa. Furthermore, the placement of multiple ZIs makes this surgery risky and more difficult to perform. Potential intraoperative complications are extremely dangerous and may cause irreparable losses. Here, we describe a practical, feasible, and reproducible protocol for a real-time surgical navigation system for precisely placing quad-zygomatic implants in the severely atrophic maxilla of patients with residual bone that does not meet the requirements of conventional implants. Hundreds of patients have received ZIs at our department based on this protocol. The clinical outcomes have been satisfactory, the intraoperative and postoperative complications have been low, and the accuracy indicated by infusion of the designed image and postoperative three-dimensional image has been high. This method should be utilized during the entire surgical procedure to ensure ZI placement safety.

Here, we present a protocol to achieve precise quad-zygomatic implant placement in patients with severely atrophic maxilla using a real-time dynamic navigation system.

Dynamisk navigasjonssystem i sanntid for presis quad-zygomatisk implantatplassering hos en pasient med en alvorlig 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 ...

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

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 sequelae of dental trauma but can also occur with stimuli such as caries, bruxism, or after placing a restoration. In order to access the root canal as minimally invasive as possible in case of a necessary root canal treatment, dynamic navigation has recently been introduced in endodontics in addition to static navigation. The use of a dynamic navigation system (DNS) requires pre-operative cone-beam computed tomography (CBCT) imaging and a digital surface scan. If necessary, reference markers must be placed on the teeth before the CBCT scan; with some systems, these can also be planned and created digitally afterward. By means of a stereo camera connected to the planning software, the drill can now be coordinated with the help of reference markers and virtual planning. As a result, the position of the drill can be displayed on the monitor in real-time during preparation in different planes. In addition, the spatial displacement, the angular deviation, and the depth position are also displayed separately. The few commercially available DNS mostly consist of relatively large camera-marker-systems. Here, the DNS contains miniaturized components: a low-weight camera (97 g) mounted on the micromotor of the electric handpiece utilizing a manufacturer-specific connecting mechanism and a small marker (10 mm x 15 mm), which can be easily attached to an individually manufactured intraoral tray. For research purposes, a post-operative CBCT scan can be matched with the pre-operative one, and the volume of tooth structure removed can be calculated by the software. This work aims to present the technique of guided access cavity preparation by means of a miniaturized navigation system from imaging to clinical implementation.

Dynamic navigation systems (DNS) provide real-time visualization and guidance to the operator during endodontic access cavities preparation. The planning of the procedure requires three-dimensional imaging utilizing cone beam computed tomography and surface scans. After the export of the planning data to the DNS, access cavities can be prepared with minimal invasion.

Dynamisk navigasjon i endodonti: Klargjøring av tilgangshulrom ved hjelp av et miniatyrisert navigasjonssystem

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 ...

A Retrograde Implantation Approach for Peritoneal Dialysis Catheter Placement in Mice

Murine models are employed to probe various aspects of peritoneal dialysis (PD), such as peritoneal inflammation and fibrosis. These events drive peritoneal membrane failure in humans, which remains an area of intense investigation due to its profound clinical implications in managing patients with end-stage kidney disease (ESKD). Despite the clinical importance of PD and its related complications, current experimental murine models suffer from key technical challenges that compromise the models&#39; performance. These include PD catheter migration and kinking and usually warrant earlier catheter removal. These limitations also drive the need for a greater number of animals to complete a study. Addressing these drawbacks, this study introduces technical improvements and surgical nuances to prevent commonly observed PD catheter complications in a murine model. Moreover, this modified model is validated by inducing peritoneal inflammation and fibrosis using lipopolysaccharide injections. In essence, this paper describes an improved method to create an experimental model of PD.

This article describes modifications of a procedure to implant a peritoneal dialysis catheter in a murine model to avoid major technical issues observed with the conventional techniques.

En retrograd implantasjonstilnærming for peritonealdialysekateterplassering hos mus

Murine models are employed to probe various aspects of peritoneal dialysis (PD), such as peritoneal inflammation and fibrosis. These events drive ...

Guided Endodontics: Three-Dimensional Planning and Template-Aided Preparation of Endodontic Access Cavities

Pulp canal obliterations (PCO) are often a consequence of dental trauma, such as luxation injuries. Even though dentin apposition is a sign of vital pulp, pulpitis or apical periodontitis may develop in the long term. Root canal treatment of teeth with severe PCO and pulpal or periapical pathosis is challenging for general practitioners and even for well-equipped endodontic specialists. To ensure detection of the calcified root canal and avoid excessive loss of tooth structure or root perforation, static navigation using templates ("Guided Endodontics") was introduced a few years ago. The general workflow includes three-dimensional imaging using cone-beam computed tomography (CBCT), a digital surface scan, and superimposition of both in a planning software. This is followed by virtual planning of the access cavity and the design of a template that will guide the drill to the desired target point. To do this, a true-to-scale virtual image of the drill must be placed in a way that the tip of the drill reaches the orifice of the calcified root canal. Once the template has been fabricated using computer-aided design and computer-aided manufacturing (CAD/CAM) or a 3D printer, guided preparation of the access cavity can be performed clinically. For research purposes, a postoperative CBCT image can be used to quantify the accuracy of the access cavity performed. This work aims to present the technique of static guided endodontics from imaging to clinical implementation.

Guided endodontics describes a template-aided approach for access cavity preparation. The procedure requires cone-beam computed tomography and a surface scan to produce a template. An incorporated sleeve guides the drill to the target point. This allows the preparation of minimally invasive endodontic access cavities in calcified teeth.

Veiledet endodonti: Tredimensjonal planlegging og malstøttet forberedelse av endodontiske tilgangshulrom

Pulp canal obliterations (PCO) are often a consequence of dental trauma, such as luxation injuries. Even though dentin apposition is a sign of vital pulp, ...

Augmented Reality Navigation-Guided Core Decompression for Osteonecrosis of Femoral Head

Osteonecrosis of the femoral head (ONFH) is a common joint disease in young and middle-aged patients, which seriously burdens their lives and work. For early-stage ONFH, core decompression surgery is a classical and effective hip preservation therapy. In traditional procedures of core decompression with Kirschner wire, there are still many problems such as X-ray exposure, repeated puncture verification, and damage to normal bone tissue. The blindness of the puncture process and the inability to provide real-time visualization are crucial reasons for these problems.
To optimize this procedure, our team developed an intraoperative navigation system on the basis of augmented reality (AR) technology. This surgical system can intuitively display the anatomy of the surgical areas and render preoperative images and virtual needles to intraoperative video in real-time. With the guide of the navigation system, surgeons can accurately insert Kirschner wires into the targeted lesion area and minimize the collateral damage. We conducted 10 cases of core decompression surgery with this system. The efficiency of positioning and fluoroscopy is greatly improved compared to the traditional procedures, and the accuracy of puncture is also guaranteed.

Augmented reality technology was applied to core decompression for osteonecrosis of the femoral head to realize real-time visualization of this surgical procedure. This method can effectively improve the safety and precision of core decompression.

Augmented Reality navigasjonsstyrt kjernedekompresjon for osteonekrose av lårhode

Osteonecrosis of the femoral head (ONFH) is a common joint disease in young and middle-aged patients, which seriously burdens their lives and work. For ...

Muscle Function Obtained with Motion Mode Ultrasound and Surface Electromyography during Core Endurance Exercise

Motion mode (M-mode) ultrasound allows researchers and clinicians to measure the change of muscle thickness across time. Muscle thickness can be measured between fascial borders at a given time point during an exercise. This selected time point produces a one-dimensional image resulting in real-time, live observation of anatomy. Ultrasound used during functional movement can be referred to as dynamic ultrasound; this is feasible and reliable with the use of a linear transducer, elastic belt, and foam block to secure consistent transducer placement. The lateral abdominal wall is commonly investigated using ultrasound due to the overlapping nature of the muscles. Surface electromyography (sEMG) can complement M-mode ultrasound imaging because it measures the electrical representation of muscle activation. There is minimal evidence using M-mode ultrasound and sEMG simultaneously during core exercise. Exercises that challenge the core musculature involve both isometric holds (e.g., side plank), as well as oscillatory extremity movements (e.g., dead bug). In this study, both instruments will be used simultaneously to measure core muscle function during exercise. Ultrasound measurements will be obtained using a linear transducer and ultrasound unit, and sEMG measurements will be acquired from a wireless sEMG system. To make comparisons between participants and exercises, normalization methods using static, exercise starting positions for both instruments will be used. An activation ratio will be used for ultrasound and calculated by dividing the contracted thickness (thickness during a time point of exercise) by the rested (starting position) thickness. Muscle thickness will be measured in centimeters from the superior inferior fascial border to inferior superior fascial border. These methods aim to offer an innovative and practical measurement of muscle function with M-mode ultrasound and sEMG during core endurance exercises.

This protocol uses motion mode ultrasound and surface electromyography simultaneously to measure muscle function of the core. Muscle thickness and activation of the local stabilizers (e.g., transverse abdominis, internal oblique) and global movers (e.g., external oblique) is achievable during specific time points of the side plank and dead bug exercises.

Muskelfunksjon oppnådd med bevegelsesmodus ultralyd og overflateelektromyografi under Core Endurance Exercise

Motion mode (M-mode) ultrasound allows researchers and clinicians to measure the change of muscle thickness across time. Muscle thickness can be measured ...

Semi-Automated Planimetric Quantification of Dental Plaque Using an Intraoral Fluorescence Camera

Dental plaque accumulation is quantified using clinical indices or, otherwise, the planimetric plaque index (PPI),&#160;which measures the relative area of a tooth that is covered by plaque deposits. Compared to clinical indices, the PPI has a higher discriminatory power, but traditional planimetry is a time-consuming analysis, as the plaque-covered and clean tooth areas have to be determined manually for each image using image-processing software. Here, we present a method for the semi-automated planimetric quantification of dental plaque, which allows for the rapid processing of up to 1,000 images simultaneously. The method exploits the enhanced contrast between disclosed plaque, sound tooth surfaces, and soft tissues in fluorescence images acquired with an intraoral camera. Careful execution of the clinical procedures and accurate image acquisition are crucial steps for the successful semi-automated identification of the plaque-covered areas. The method is suitable for planimetry on sound facial and oral tooth surfaces, on most composite resin restorations, and on teeth with orthodontic brackets, but not on metallic restorations. Compared to traditional PPI recordings, semi-automated planimetry considerably reduces the amount of time spent on the analysis, as well as the subjective human input, thus increasing the reproducibility of planimetric measurements.

This study presents a semi-automated digital image analysis procedure for the planimetric quantification of disclosed dental plaque based on images acquired with an intraoral fluorescence camera. The method allows for the rapid and reliable quantification of dental plaque in the research environment.

Semi-automatisert planimetrisk kvantifisering av tannplakk ved bruk av et intraoralt fluorescenskamera

Dental plaque accumulation is quantified using clinical indices or, otherwise, the planimetric plaque index (PPI),&#160;which measures the relative area ...