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

Denna forskning fick inget specifikt bidrag från finansieringsorgan inom den offentliga, kommersiella eller ideella sektorn.

Informerat samtycke erhölls från varje patient före operationen. Efter interventionerna användes anonymiserade retrospektiva data i denna studie.
1. Steg i det traditionella arbetsflödet för dynamiska navigationssystem med märkt klippkalibreringsmetod (endast för användning på käkben med tänder):
<ol><li>Fäst en radioaktiv fixeringsklämma på tänderna på käkbenet där behandlingen ska utföras (maxilla/underkäke) med hjälp av ett termoplastiskt material.</...

<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 märkta klippanvända dynamiska navigeringsimplantatplaceringssystemet görs det traditionella arbetsflödet genom klippkalibrering. Det finns tre radiopaque metallsfärer på ytan av klämman, som är tydligt synliga på CBCT-skanningen. När det gäller spårkalibreringsmetoden är dessa metallsfärer som innehåller klämmor varken nödvändiga för CBCT-skanning eller systemkalibrering. I fall med befintliga tänder kan både de märkta och omärkta klämmorna användas (två olika kalibreringsmetoder). Klämma...

För att öka noggrannheten i tandimplantatplaceringen och minska komplikationerna har en rad navigeringstekniker baserade på bildstudier utvecklats. Preoperativ avbildning och speciell 3D-implantatplaneringsprogramvara kan användas för att planera den exakta positionen för tandimplantatet 1,2.
Syftet med implantatkirurginavigering är att uppnå en mer anatomiskt exakt placering av tandimplantatet för att uppnå den mest idealiska positionen, för att minska risken för möjliga iatrogena komplikationer (nerv-, kärl-, ben- och sinusskador). Den navigerade operationen minskar interventionens invasivitet (klafflös kirurgi), vilket kan leda till färre klagomål och snabbare återhämtning. Den exakta implantatplaceringen baseras på tidigare protesplanering (det är möjligt att utföra operationen på grundval av en preoperativ tandinstallation) och den optimala implantatpositioneringen kan hjälpa till att undvika bentransplantation.
Numera finns det två typer av datorassisterade implantat (CAI) kirurgiska placeringsnavigeringssystem-statiska och dynamiska navigationssystem. Statisk navigering är en kontrollerad implantatplaceringsmetod med hjälp av en förplanerad och prefabricerad kirurgisk mall. Dynamisk navigering är en förplanerad datorstyrd implantatkirurgisk placeringsmetod utan en kirurgisk mall med optisk kontroll. Kontrollproceduren använder punktmolnbaserad bildregistrering för att slå samman de virtuella bilderna med den verkliga miljön genom att använda 3D-bildöverlägg3.
DCAI-system möjliggör objektifierad instrumentkontroll i realtid inom ett GPS-liknande ramverk. Vanligtvis använder de optisk spårning för att upptäcka och spåra positionen för (optiska) referensmarkörer placerade över patienten och de kirurgiska instrumenten och ge kontinuerlig visuell feedback på implantatets kirurgiska placeringsprocess 1,2.
Det kirurgiska instrumentets rörelse och position under operationen kan övervakas live på en tredimensionell bild på en bildskärm. Under proceduren möjliggör kamerasystemet kontinuerlig övervakning och jämförelse av positionen för patientens käkben och det kirurgiska instrumentets position.
Det finns två typer av dynamiska navigationssystem: en är det passiva systemet, i vilket fall registreringsanordningarna (referensbaser) reflekterar ljus som emitteras från ljuskällan tillbaka till stereokamerorna; Det andra är det aktiva systemet, där registreringsanordningarna avger ljus som följs av stereokameror 4,5.
Nästa nivå av dynamiska navigationssystem använder servomotorer för att styra kirurgens hand med taktila stimuli så att enheten med robotarmar kan bestämma kirurgens rörelser eller till och med ersätta dem helt i en avlägsen framtid 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 modern implantologi blir tillämpningen av kirurgiska navigationssystem allt viktigare. Förutom statiska kirurgiska navigeringsmetoder blir ett guideoberoende dynamiskt navigeringsimplantatplaceringsförfarande mer utbrett. Förfarandet är baserat på datorstyrd tandimplantatplacering med optisk kontroll. Detta arbete syftar till att demonstrera de tekniska stegen i ett nytt dynamic datorstödd implantatkirurgi (DCAIS) system (design, kalibrering, kirurgi) och kontrollera noggrannheten i resultaten. Baserat på konstråle datortomografi (CBCT) skanningar bestäms de exakta positionerna för implantat med dedikerad programvara. Det första steget i operationen är kalibreringen av navigationssystemet, som kan utföras på två sätt: 1) baserat på CBCT-bilder tagna med en markör eller 2) baserat på CBCT-bilder utan markörer. Implantat sätts in med hjälp av realtidsnavigering enligt de preoperativa planerna. Noggrannheten i interventionerna kan utvärderas baserat på postoperativa CBCT-bilder. De preoperativa bilderna som innehåller implantatens planerade positioner och postoperativa CBCT-bilder jämfördes baserat på implantatens vinkling (grad), plattform och apikala avvikelse (mm). För att utvärdera data beräknade vi standardavvikelsen (SD), medelvärdet och standardfelet för medelvärdet (SEM) för avvikelser inom planerade och utförda implantatpositioner. Skillnaderna mellan de två kalibreringsmetoderna jämfördes baserat på dessa data. Baserat på de ingrepp som hittills utförts möjliggör användningen av DCAIS implantatplacering med hög precision. Ett kalibreringssystem som inte kräver märkt CBCT-inspelning möjliggör kirurgisk ingrepp med liknande noggrannhet som ett system som använder märkning. Interventionens noggrannhet kan förbättras genom träning.

För att använda DCAIS korrekt måste systemet kalibreras. Det finns flera kalibreringsmetoder som kan påverka noggrannheten i implantatplaceringen. Denna studie syftade till att bedöma den potentiella effekten av olika kalibreringsmetoder på noggrannheten hos DCAIS.
Baserat på de ingrepp som hittills utförts möjliggör användningen av DCAIS en implantatplacering med hög precision. I våra tidiga studier jämförde vi 41 klippkalibrerade dynamiska navigerade implantatplaceringar med 1...

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

Dynamic Navigation for Dental Implant Placement

Dynamisk datorstödd implantatkirurgi (DCAIS) är en kontrollerad implantatkirurgisk placeringsmetod som utförs utan en kirurgisk mall med optisk kontroll. Den intraoperativa kontrollen i realtid av rörelse och position för den kirurgiska enheten förenklar proceduren och ger kirurgen mer frihet, vilket ger liknande precision som statiska navigeringsmetoder.

Dynamisk navigering för placering av tandimplantat

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

Digitala datoriserade implantatsystem möjliggör objektifierad instrumentkontroll i realtid inom en GPS-liknande ram. Instrumentets position under operationen kan övervakas live på en tredimensionell bild på en bildskärm. Denna teknik är exakt, minimal invasiv, behöver inte en kirurgisk guidemall och lätt att använda i en liten mun.Planeringen och operationen kan utföras samma dag, och modifiering är möjlig under operationen. Det rekommenderas att öva metoden på en tandbild innan du använder den i en levande situation. Förfarandet kommer att demonstreras av Tamas Huszar, en biträdande professor från vår institution.Börja med att fästa ett radiopaketfixeringsklämma på käkbenets tänder på behandlingsstället med hjälp av ett termoplastiskt material. Gör en konstråle datortomografi eller CBCT-undersökning av patienten med en märkt klämma i munnen. Planera implantatets position enligt protesarkitekturen med lämplig programvara.Registrera huvudstycket genom att kalibrera handstyckets chuck och den roterande markeringsskivan, som sätts in i handstycket. Montera sedan armen mellan patientspåraren och den märkta klämman och kalibrera den. För att kontrollera enhetens kalibrering, fixa det märkta klämman som håller den optiska markören eller spåraren på tänderna på vilken käke implantatplaceringen kommer att ske.Se till att sätta in klippet i samma position som är registrerat på den preoperativa CBCT. Tryck sedan på klämmans metallsfärer med sondens vridning för att kalibrera det märkta klippet. För att utföra den navigerade implantatplaceringen och lokalbedövningen, mät borrlängden och kontrollera den visuella noggrannheten i realtid.Bestäm ingångspunkten för borrning och utforska operationsplatsen utan klaffen. Borra sedan benet med dynamisk navigeringskontroll. Efter mätning av implantatets längd, placera implantatet med handstycket med den dynamiska navigationssystemstyrda trackern.Stäng såret med 5/0 monofilament icke-absorberbar polypropen sutur eller fixa det prefabricerade protesarbetet. Skaffa sedan en kontrollradiologisk bild. Utför CBCT på patienten utan klämma i munnen.Använd lämplig programvara för att planera implantatets position enligt protesarkitekturen och kalibrera enheten enligt beskrivningen ovan. För att kalibrera systemet utan ett märkt klipp, överför planen för kirurgisk placering av implantatet till navigationssystemets programvara. Välj sedan arbetsytan på den tredimensionella CT-bilden av navigationsprogramvaran.Fixa spåraren på tänderna med ett omärkt klipp, eller, i fallet med en edentulous käke, fixa en speciell tracker-hållarm. Välj sedan minst tre typiska anatomiska punkter på en 3D-CT-bild av navigationssystemet. Identifiera de valda anatomiska punkterna i munnen genom att röra dem med ett sondverktyg.Utför förfiningsproceduren på tre till fyra områden genom att rita på ytan av den anatomiska strukturen med en sond. Under lokalbedövning placerar du implantatet med navigering och mäter borrlängden. Kontrollera tandens eller benets yta i realtid innan du bestämmer borrpunkten och utforskar operationsplatsen utan klaffen.Borra benet med dynamisk navigeringskontroll. Mät implantatets längd innan du placerar implantatet med handstycket med den dynamiska navigeringsstyrda trackern. Stäng såret med en 5/0 monofilament icke-absorberbar polypropensutur, eller fixa det prefabricerade protesarbetet.Börja sedan kontrollera radiologisk avbildning. Data från den tidiga studien visade att det inte fanns någon signifikant korrelation mellan plattformen och vinkelavvikelsen i buccolingual och mesiodistal riktning. När implantatens planerade och slutliga position jämfördes visade sig klippkalibreringsmetoden vara mer exakt jämfört med spårkalibreringsmetoden utan signifikant skillnad.Det är viktigt att kontrollera kontinuiteten i kalibreringen och spårningen av förfarandet. Systemet signalerar eventuella fel. Förfarandet möjliggör ett antal spårade tandbehandlingar, såsom rotapexamputation, ortognatisk kirurgi, endodontiska procedurer eller komplicerad borttagning av visdomstandar.

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.

Krympning av Dental Composite i Simulerad Cavity Mätt med Digital Image Korrelation

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.

Oral Biofilm bildning på olika material för tandimplantat

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 navigering Transthoracic Nodule Localization för 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.

Dynamiskt navigationssystem i realtid för exakt quad-zygomatisk implantatplacering hos en patient med en allvarligt 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 navigering i endodonti: guidad förberedelse av åtkomsthålighet med hjälp av ett miniatyriserat 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 ...

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 implantationsmetod för placering av peritonealdialyskateter hos möss

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.

Guidad endodonti: Tredimensionell planering och mallstödd beredning av endodontiska åtkomsthåligheter

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 Navigation-guidad kärndekompression för osteonekros av lårbenshuvudet

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.

Muskelfunktion erhållen med rörelseläge ultraljud och ytelektromyografi under kärnuthållighetsövning

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.

Halvautomatisk planimetrisk kvantifiering av tandplack med hjälp av en intraoral fluorescenskamera

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