“Three‐in‐one” patient‐specific surgical guides for simultaneous dental implants in fibula flap jaw reconstruction: A prospective case series

Background: Free-handed, flaplessly placed mini dental implants (MDIs) are a valuable, more affordable and minimally invasive treatment to support overdentures in fully edentulous jaws, especially for medically compromised patients. However, critical 3D radiographic evaluation is lacking. This multicenter prospective case series assessed clinical outcome and carried out 3D- cone-beam computerized tomography (CBCT) analysis of free-handed flaplessly placed one-piece maxillary MDIs by an experienced maxillofacial surgeon. Methods: Thirty-one patients suffering from an ill-fitting maxillary denture relating to compromised bone volume (as confirmed on CBCT), with a dentate mandible, were selected. They received 5–6 MDIs free-hand flaplessly placed and mentally guided with preoperative CBCT. Final connection and attachment activation took place six months later. After two years each implant was individually assessed with CBCT for perforations on eight sites. Implant survival, prosthetic failure, clinical stability and sinus/nasal complaints were registered after three years. Results: 32/185 (17.3%) MDIs failed during the provisional loading with non-activated attachments; 17 replacements in 10 patients were performed. Of the 170 actively loaded 170 MDIs, 82.3% survived and 27/31 prostheses (87%) were fully functional. In total 98/170 MDIs showed no perforation. Based on 1360 CBCT observations, 231 perforations (16.9%) were registered. Of most perforations 37 (25%) were observed at the apical tip and 37 were positioned (21%) into the sinus/nasal cavity, although without clinical complaints. Conclusions: Given the compromised population, the minimally invasive procedure and the low treatment cost involved, a failure rate of 17% is substantial, however clinically acceptable given the critical bone condition. However, even in experienced surgical hands, freehanded and flapless placement yield a high risk for implant perforation, although this did not necessarily lead to complications.

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Assessment of an ECG‐Based System for Localizing Ventricular Arrhythmias in Patients With Structural Heart Disease

Journal of the American Heart Association ◽

10.1161/jaha.121.022217 ◽

2021 ◽

Author(s):

Shijie Zhou ◽

Amir AbdelWahab ◽

John L. Sapp ◽

Eric Sung ◽

Konstantinos N. Aronis ◽

...

Keyword(s):

Heart Disease ◽

Case Series ◽

Premature Ventricular Contraction ◽

Structural Heart Disease ◽

Patient Specific ◽

Localization Error ◽

Localization Accuracy ◽

Accurate Localization ◽

Prospective Case Series ◽

Pace Mapping

Background We have previously developed an intraprocedural automatic arrhythmia‐origin localization (AAOL) system to identify idiopathic ventricular arrhythmia origins in real time using a 3‐lead ECG. The objective was to assess the localization accuracy of ventricular tachycardia (VT) exit and premature ventricular contraction (PVC) origin sites in patients with structural heart disease using the AAOL system. Methods and Results In retrospective and prospective case series studies, a total of 42 patients who underwent VT/PVC ablation in the setting of structural heart disease were recruited at 2 different centers. The AAOL system combines 120‐ms QRS integrals of 3 leads (III, V2, V6) with pace mapping to predict VT exit/PVC origin site and projects that site onto the patient‐specific electroanatomic mapping surface. VT exit/PVC origin sites were clinically identified by activation mapping and/or pace mapping. The localization error of the VT exit/PVC origin site was assessed by the distance between the clinically identified site and the estimated site. In the retrospective study of 19 patients with structural heart disease, the AAOL system achieved a mean localization accuracy of 6.5±2.6 mm for 25 induced VTs. In the prospective study with 23 patients, mean localization accuracy was 5.9±2.6 mm for 26 VT exit and PVC origin sites. There was no difference in mean localization error in epicardial sites compared with endocardial sites using the AAOL system (6.0 versus 5.8 mm, P =0.895). Conclusions The AAOL system achieved accurate localization of VT exit/PVC origin sites in patients with structural heart disease; its performance is superior to current systems, and thus, it promises to have potential clinical utility.

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Long-Term Outcomes of Dental Implants with a Titanium Plasma-Sprayed Surface: A 20-Year Prospective Case Series Study in Partially Edentulous Patients

Clinical Implant Dentistry and Related Research ◽

10.1111/cid.12056 ◽

2013 ◽

Vol 15 (6) ◽

pp. 780-790 ◽

Cited By ~ 81

Author(s):

Vivianne Chappuis ◽

Ramona Buser ◽

Urs Brägger ◽

Michael M. Bornstein ◽

Giovanni E. Salvi ◽

...

Keyword(s):

Dental Implants ◽

Case Series ◽

Long Term Outcomes ◽

Case Series Study ◽

Prospective Case Series ◽

Edentulous Patients ◽

Plasma Sprayed ◽

Series Study

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Use of a Novel In Situ Hardening Biphasic Alloplastic Bone Grafting Material for Guided Bone Regeneration around Dental Implants – A Prospective Case Series

Clinical Advances in Periodontics ◽

10.1002/cap.10141 ◽

2020 ◽

Author(s):

Liran Levin ◽

Danielle Clark‐Perry

Keyword(s):

Bone Regeneration ◽

Dental Implants ◽

Bone Grafting ◽

Case Series ◽

Guided Bone Regeneration ◽

Prospective Case Series

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Computer-Guided Inferior Alveolar Nerve Lateralization With Simultaneous Implant Placement: A Preliminary Report

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-17-00141 ◽

2018 ◽

Vol 44 (3) ◽

pp. 192-197

Author(s):

Mohamed Atef ◽

Mohamed Mounir

Keyword(s):

Dental Implants ◽

Fused Deposition Modeling ◽

Inferior Alveolar Nerve ◽

Case Series ◽

Rectangular Window ◽

Fused Deposition ◽

Implant Placement ◽

Surgical Guides ◽

Case Series Study ◽

Bone Height

Placement of dental implants in the posterior mandibular alveolar ridges may become a challenging procedure because of limited bone height between the crest of the ridge and the inferior alveolar canal. The aim of this study was to introduce an innovative, less invasive, highly accurate, and easy surgical technique of inferior alveolar nerve lateralization in the posterior deficient mandible using a special customized 3-dimensional–printed surgical guide to enhance the bone height for implant placement. This case series study included 7 patients with unilateral edentulous mandibular alveolar ridges. Customized surgical guides were manufactured using fused deposition modeling technology to accurately place a rectangular window to uncover the canal and also for immediate placement of dental implants in all cases. The results of this limited study provided information on an innovative technique that decreased intraoperative time and demonstrated decreased risks for (1) inferior alveolar nerve injury and (2) postoperative nerve dysfunction.

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A Comparative Study on a Novel Fibula Malleolus Cap to Increase the Accuracy of Oncologic Jaw Reconstruction

Frontiers in Oncology ◽

10.3389/fonc.2021.743389 ◽

2022 ◽

Vol 11 ◽

Author(s):

Jingya Jane Pu ◽

Wing Shan Choi ◽

Wai Kan Yeung ◽

Wei-Fa Yang ◽

Wang-Yong Zhu ◽

...

Keyword(s):

Comparative Study ◽

Dental Implants ◽

Control Group ◽

Computer Assisted ◽

Distal Fibula ◽

Average Deviation ◽

Jaw Reconstruction ◽

Fibula Flap ◽

Significant Difference ◽

Dental Rehabilitation

ObjectivesAlthough computer-assisted surgery using fibula flap has been widely applied for oncologic jaw reconstruction in recent years, the inaccurate positioning of the fibula harvest guide brings sliding and rotational errors, which leads to compromised accuracy in simultaneous implant placement and dental rehabilitation. This study aimed to develop a novel three-dimensional (3D)-printed patient-specific fibula malleolus cap to increase oncologic reconstruction accuracy.MethodsIn this prospective comparative study with a recent historical control cohort, patients in need of oncologic jaw reconstruction with fibula free flaps were recruited. In the study group, the fibula was harvested with the guide of the malleolus cap, whereas in the control group, without the malleolus cap. Deviations of location and angulation of distal fibula osteotomies, jaw reconstruction segments, and simultaneous dental implants were compared.ResultsTwenty patients were recruited, with 10 in each arm. The application of the malleolus cap significantly reduced the deviations in locations and angles of distal fibula osteotomies, from 9.5 to 4.1 mm and 25.3° to 8.7°. For the simultaneous dental implants placed in the fibula flaps, there was a significant increase in the accuracy of implant platform locations (the average deviation from 3.2 to 1.3 mm), apex locations (from 3.8 to 1.5 mm), and angles (from 11.3° to 4.6°). No significant difference was detected in the accuracy of fibula reconstruction segments.ConclusionsWe developed a novel fibula malleolus cap to overcome the sliding and rotational errors during fibula flap harvesting for oncologic jaw reconstruction, with increased accuracy in simultaneous dental implants. This is a step forward to achieve a satisfactory functional outcome of jaw reconstruction with dental rehabilitation.

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