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

Esta pesquisa não recebeu nenhuma bolsa específica de agências de fomento dos setores público, comercial ou sem fins lucrativos.

O consentimento informado foi obtido de todos os pacientes antes da cirurgia. Após as intervenções, foram utilizados dados retrospectivos anônimos neste estudo.
1. Etapas no fluxo de trabalho tradicional de sistemas de navegação dinâmica usando o método de calibração de clipe rotulado (apenas para uso em maxilar com dentes):
<ol><li>Anexar um clipe de fixação radiopaca aos dentes do maxilar onde o tratamento deve ser realizado (maxila/mandíbula) usando um materi...

<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>

No sistema de colocação de implante de navegação dinâmica usado por clipe rotulado, o fluxo de trabalho tradicional é feito por calibração de clipe. Existem três esferas metálicas radiopacas na superfície do clipe, que são claramente visíveis na tomografia computadorizada. No caso do método de calibração do traçador, essas esferas metálicas contendo clipes não são necessárias para a varredura CBCT nem para a calibração do sistema. Em casos com dentes existentes, podem ser utilizados clipes rotulado...

Para aumentar a precisão da colocação de implantes dentários e reduzir as complicações, uma série de técnicas de navegação baseadas em estudos de imagem foram desenvolvidas. Imagens pré-operatórias e softwares especiais de planejamento de implantes 3D podem ser utilizados para planejar a posição exata do implante dentário 1,2.
O objetivo da navegação da cirurgia de implante é realizar uma colocação anatomicamente mais precisa do implante dentário para alcançar a posição mais ideal, para reduzir o risco de possíveis complicações iatrogênicas (lesões nervosas, vasculares, ósseas e sinusais). A cirurgia navegada diminui a invasividade da intervenção (cirurgia sem retalhos), o que pode levar a menos queixas e recuperação mais rápida. A colocação precisa do implante é baseada no planejamento protético prévio (é possível realizar a operação com base em uma instalação dentária pré-operatória) e o posicionamento ideal do implante pode ajudar a evitar o enxerto ósseo.
Hoje em dia, existem dois tipos de sistemas de navegação de colocação cirúrgica de implante assistido por computador (CAI) - sistemas de navegação estática e dinâmica. A navegação estática é um método de colocação controlada de implantes usando um modelo cirúrgico pré-planejado e pré-fabricado. A navegação dinâmica é um método de colocação cirúrgica de implante guiado por computador pré-planejado sem um modelo cirúrgico usando controle óptico. O procedimento de controle usa o registro de imagem baseado em nuvem de pontos para mesclar as imagens virtuais com o ambiente real, aplicando a sobreposição de imagem 3D3.
Os sistemas DCAI possibilitam o controle de instrumentos objetivados em tempo real dentro de uma estrutura semelhante a um GPS. Tipicamente, eles usam rastreamento óptico para detectar e rastrear a posição de marcadores de referência (ópticos) colocados sobre o paciente e os instrumentos cirúrgicos, e fornecem feedback visual contínuo sobre o processo de colocação cirúrgica do implante 1,2.
O movimento e a posição do instrumento cirúrgico durante a cirurgia podem ser monitorados ao vivo em uma imagem tridimensional em um monitor. Durante o procedimento, o sistema de câmeras permite o monitoramento contínuo e a comparação da posição do maxilar do paciente e da posição do instrumento cirúrgico.
Existem dois tipos de sistemas de navegação dinâmica: um é o sistema passivo, caso em que os dispositivos de registro (bases de referência) refletem a luz emitida pela fonte de luz de volta para as câmeras estéreo; o outro é o sistema ativo, onde os dispositivos de registro emitem luz que é seguida por câmeras estéreo 4,5.
O próximo nível de sistemas de navegação dinâmica utiliza servomotores para guiar a mão do cirurgião com estímulos táteis, de modo que o dispositivo com braços robóticos possa determinar os movimentos do cirurgião ou mesmo substituí-los completamente em um futuro distante 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

Na implantologia moderna, a aplicação de sistemas de navegação cirúrgica está se tornando cada vez mais importante. Além dos métodos de navegação cirúrgica estática, um procedimento de colocação de implante de navegação dinâmica independente de guia está se tornando mais difundido. O procedimento é baseado na colocação de implantes dentários guiados por computador utilizando controle óptico. Este trabalho tem como objetivo demonstrar as etapas técnicas de um novo sistema decirurgia de implante computadorizado d ynamic (DCAIS) (projeto, calibração, cirurgia) e verificar a acurácia dos resultados. Com base na tomografia computadorizada de feixe cônico (TCFC), as posições exatas dos implantes são determinadas com software dedicado. A primeira etapa da operação é a calibração do sistema de navegação, que pode ser realizada de duas maneiras: 1) com base em imagens CBCT tiradas com um marcador ou 2) com base em imagens CBCT sem marcadores. Os implantes são inseridos com o auxílio da navegação em tempo real de acordo com os planos pré-operatórios. A acurácia das intervenções pode ser avaliada com base em imagens de TCFC pós-operatórias. As imagens pré-operatórias contendo as posições planejadas dos implantes e as imagens pós-operatórias de TCFC foram comparadas com base na angulação (grau), plataforma e desvio apical (mm) dos implantes. Para avaliar os dados, foram calculados o desvio padrão (DP), a média e o erro padrão da média (EPM) dos desvios dentro das posições de implante planejadas e realizadas. As diferenças entre os dois métodos de calibração foram comparadas com base nesses dados. Com base nas intervenções realizadas até o momento, o uso do DCAIS permite a colocação de implantes de alta precisão. Um sistema de calibração que não requer registro CBCT rotulado permite a intervenção cirúrgica com precisão semelhante a um sistema que usa rotulagem. A precisão da intervenção pode ser melhorada pelo treinamento.

Para usar o DCAIS corretamente, o sistema deve ser calibrado. Existem vários métodos de calibração que podem afetar a precisão da colocação do implante. Este estudo teve como objetivo avaliar o impacto potencial de diferentes métodos de calibração na acurácia do DCAIS.
Com base nas intervenções realizadas até o momento, o uso do DCAIS permite a colocação de implantes de alta precisão. Em nossos primeiros estudos, comparamos 41 posicionamentos de implantes dinâmicos navegados ...

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

Dynamic Navigation for Dental Implant Placement

A cirurgia dinâmica de implante auxiliada por computador (DCAIS) é um método de colocação cirúrgica de implante controlado realizado sem um molde cirúrgico usando controle óptico. O controle intraoperatório em tempo real do movimento e da posição do dispositivo cirúrgico simplifica o procedimento e dá mais liberdade ao cirurgião, proporcionando precisão semelhante aos métodos de navegação estática.

Navegação dinâmica para colocação de implantes dentários

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

Os sistemas de implantes computadorizados digitais permitem o controle de instrumentos objetivados em tempo real dentro de uma estrutura semelhante a um GPS. A posição do instrumento durante a cirurgia pode ser monitorada ao vivo em uma imagem tridimensional em um monitor. Esta técnica é precisa, minimamente invasiva, não precisa de um modelo de guia cirúrgico e fácil de usar em uma boca pequena.O planejamento e a cirurgia podem ser realizados no mesmo dia, e a modificação é possível durante a cirurgia. Recomenda-se praticar o método em uma imagem dentária antes de usá-lo em uma situação ao vivo. O procedimento será demonstrado por Tamas Huszar, professor assistente do nosso departamento.Comece anexando um clipe de fixação de pacote de rádio aos dentes do maxilar no local do tratamento com a ajuda de um material termoplástico. Faça uma tomografia computadorizada de feixe cônico ou exame de TCFC do paciente com um clipe marcado na boca. Planeje a posição do implante de acordo com a arquitetura protética com o software apropriado.Registre o cabeçote calibrando o mandril da peça de mão e o disco marcador rotativo, inseridos na peça de mão. Em seguida, monte o braço entre o rastreador do paciente e o clipe rotulado e calibre-o. Para verificar a calibração do dispositivo, fixe o clipe rotulado que contém o marcador óptico ou o rastreador nos dentes nos quais a mandíbula a colocação do implante ocorrerá.Certifique-se de inserir o clipe na mesma posição registrada na TCFC pré-operatória. Em seguida, toque nas esferas de metal do clipe com o pivô da sonda para calibrar o clipe rotulado. Para realizar a colocação do implante navegado e a anestesia local, meça o comprimento da broca e verifique a precisão visual em tempo real.Determine o ponto de entrada da perfuração e explore o local de operação sem o retalho. Em seguida, perfure o osso com controle de navegação dinâmico. Depois de medir o comprimento do implante, coloque-o com a peça de mão usando o rastreador controlado pelo sistema de navegação dinâmica.Feche a ferida com sutura de polipropileno não absorvível monofilamentar 5/0 ou fixe o trabalho protético pré-fabricado. Em seguida, adquira uma imagem radiológica de controle. Realizar TCFC no paciente sem clipe na boca.Use o software apropriado para planejar a posição do implante de acordo com a arquitetura protética e calibrar o dispositivo conforme descrito anteriormente. Para calibrar o sistema sem um clipe rotulado, transfira o plano de colocação cirúrgica do implante para o software do sistema de navegação. Em seguida, selecione a área de trabalho na imagem de TC tridimensional do software de navegação.Fixe o rastreador nos dentes com um clipe não rotulado ou, no caso de uma mandíbula desdentada, fixe um braço de retenção especial do rastreador. Em seguida, selecione um mínimo de três pontos anatômicos típicos em uma imagem de TC 3D do sistema de navegação. Identifique os pontos anatômicos selecionados na boca tocando-os com uma ferramenta de sonda.Execute o procedimento de refinamento em três a quatro áreas, desenhando na superfície da estrutura anatômica com uma sonda. Sob anestesia local, coloque o implante com navegação e meça o comprimento da broca. Verifique a precisão visual em tempo real do dente ou na superfície do osso antes de determinar o ponto de perfuração e explorar o local da operação sem o retalho.Perfure o osso com controle de navegação dinâmico. Meça o comprimento do implante antes de colocá-lo com a peça de mão usando o rastreador controlado por navegação dinâmica. Feche a ferida com uma sutura de polipropileno não absorvível de monofilamento 5/0 ou fixe o trabalho protético pré-fabricado.Em seguida, inicie o controle de imagens radiológicas. Os dados do estudo inicial mostraram que não houve correlação significativa entre a plataforma e o desvio angular nas direções buccolingual e mesiodistal. Quando a posição planejada e final dos implantes foi comparada, o método de calibração do clipe mostrou-se mais preciso em comparação com o método de calibração do traçador, sem diferença significativa.É essencial verificar a continuidade da calibração e o rastreamento do procedimento. O sistema sinalizará qualquer mau funcionamento. O procedimento permite uma série de tratamentos odontológicos rastreados, como amputação do ápice da raiz, cirurgia ortognática, procedimentos endodônticos ou remoção complicada do dente do siso.

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.

Encolhimento da Dental Composite no Simulado Cavity Medida com Correlação Digital de Imagem

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

Medicina

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.

Formação de biofilme oral em diferentes materiais para implantes dentários

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.

Localização do nódulo transtorácico de navegação eletromagnética para cirurgia torácica minimamente invasiva

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.

Sistema de navegação dinâmica em tempo real para a colocação precisa de implantes quádruplos zigomáticos em um paciente com maxila severamente atrófica

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.

Navegação Dinâmica em Endodontia: Preparação de Cavidade de Acesso Guiado por Meio de um Sistema de Navegação Miniaturizado

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.

Uma abordagem de implante retrógrado para a colocação de cateter de diálise peritoneal em camundongos

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.

Endodontia Guiada: Planejamento Tridimensional e Preparação Auxiliada por Modelos de Cavidades de Acesso Endodôntico

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.

Descompressão do núcleo guiada pela navegação de realidade aumentada para osteonecrose da cabeça femoral

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.

Função Muscular Obtida com Ultrassonografia em Modo de Movimento e Eletromiografia de Superfície durante o Exercício de Resistência do Núcleo

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.

Quantificação Planimétrica Semi-Automatizada de Placa Dentária Utilizando Câmera de Fluorescência Intraoral

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