Digital Dental Implantology: From Treatment Planning to Guided Surgery

Prologue
Contents
Part I: Digital Workflow in Dental Surgery
	1.1	 CAI/CAD/CAM Concept
	1: CAI: Computer-Assisted Imaging
		1.1	 Introduction
		1.2	 Surface Scans (STL Files)
			1.2.1	 Intraoral Scanners
				1.2.1.1	 Scanning Technique. Tips and Recommendations
			1.2.2	 Extraoral Scanners
		1.3	 CBCT Images (DICOM Files)
			1.3.1	 General Considerations for Justified Imaging Prescription
			1.3.2	 Techniques to Improve CBCT Imaging
				1.3.2.1	 Interarch Distance
				1.3.2.2	 Soft Tissue Separation
				1.3.2.3	 Field of View
				1.3.2.4	 Voxel Size
			1.3.3	 Segmentation and 3D Reconstruction
		References
	2: CAD: Computer-Assisted Design
		2.1	 Introduction
		2.2	 Planning Software
			2.2.1	 Available Software
			2.2.2	 Interactions Between Software Programs
			2.2.3	 CAD Workflow
		2.3	 Image Merging Process
			2.3.1	 3-Point Recognition (Automatic Alignment)
			2.3.2	 Manual Adjustment
			2.3.3	 Extra Radiopaque Indicators
			2.3.4	 Image Merging Process in Edentulous Patients
				2.3.4.1	 Radiopaque Point Alignment
				2.3.4.2	 Triple Scan Technique
		2.4	 Digital Wax-Up
			2.4.1	 Direct Wax-Up
			2.4.2	 Indirect Wax-Up
		References
	3: CAM: Computer-Assisted Manufacturing
		3.1	 Introduction
		3.2	 Subtractive Methods
			3.2.1	 Types of Milling Machines
				3.2.1.1	 3-Axes Vs. Multi-Axes Machines
			3.2.2	 Milling Materials
		3.3	 Additive Methods
			3.3.1	 3D Printer Types
				3.3.1.1	 Laser-Based Stereolithography (SLA Printer)
				3.3.1.2	 Digital Light Processing (DLP Printer)
				3.3.1.3	 LCD Screen Based (LCD Printer)
				3.3.1.4	 Fused Deposition Material (FDM) Printers
				3.3.1.5	 Selective Laser Sintering (SLS) Printers
				3.3.1.6	 PolyJet and Multijet (Material Jetting) Printers
			3.3.2	 Printing Material Requirements (For Surgery)
			3.3.3	 Printing Tips
		References
Part II: Guided Surgery in Implantology
	1.1	 History and Evolution of Digital Technology in Implant Surgery
	4: Templates
		4.1	 Introduction
		4.2	 General Considerations
		4.3	 Tooth-Supported Templates
			4.3.1	 Specific Considerations
			4.3.2	 Template Design and Manufacturing
		4.4	 Muco-Supported Templates
			4.4.1	 Specific Considerations
			4.4.2	 Template Design and Manufacturing
		4.5	 Bone-Supported Templates
			4.5.1	 Specific Considerations
			4.5.2	 Template Design and Manufacturing
		4.6	 Combined Templates
			4.6.1	 Tooth-Supported Templates with Extended Edentulous Ridges or Distal Extensions
			4.6.2	 Muco-Supported Templates with Remaining Dentition
			4.6.3	 Templates with Bone Fitting
		4.7	 Mini-Implant Supported Templates
		References
	5: Implant Drilling Systems
		5.1	 Introduction
		5.2	 General Considerations
		5.3	 Sleeved Surgical Guides
			5.3.1	 GUIDED DRILL Systems (for Sleeved Surgical Guides)
			5.3.2	 DRILL HANDLE Systems (for Sleeved Surgical Guides)
		5.4	 Sleeveless Surgical Guides
			5.4.1	 DRILL HANDLE Systems (for Sleeveless Surgical Guides)
			5.4.2	 GUIDED DRILL Systems (for Sleeveless Surgical Guides)
		5.5	 Pilot Drill Surgical Guides
		References
	6: Implant Placement, Accuracy Assessment and Literature Review
		6.1	 Introduction
		6.2	 Implant Driving Options
			6.2.1	 Pilot Drilling Protocol
			6.2.2	 Free-Handed Implant Placement (Guided Protocol)
			6.2.3	 Fully Guided Protocol
			6.2.4	 Accuracy Assessment
		6.3	 Considerations for Achieving Accuracy During Virtual Planning
			6.3.1	 Considerations for CAI Procedures
			6.3.2	 Considerations for CAD Procedures
			6.3.3	 Considerations for CAM Procedures
		6.4	 Considerations for Achieving Accuracy During Clinical Procedures
			6.4.1	 Template Accuracy
			6.4.2	 Drilling System Accuracy
			6.4.3	 Patient Anatomy Considerations
		6.5	 Literature Review Conclusions
			6.5.1	 Accuracy Related Tips
			6.5.2	 New Tendencies for Accuracy Assessment
		References
	7: Implant Navigation System: Dynamic Guided Surgery
		7.1	 Introduction
		7.2	 Implant Navigation System
			7.2.1	 General Considerations
			7.2.2	 Advantages of Dynamic Surgical Navigation
			7.2.3	 System Design
				7.2.3.1	 Principles of Operation
					Registration
					Calibration
					Tracking
			7.2.4	 Implant Placement Workflow
				7.2.4.1	 Dynamic Navigation with a Radiologic Stent
				7.2.4.2	 Dynamic Navigation with the Trace and Place Protocol
					Dynamic Surgery: Place
				7.2.4.3	 Fully Edentulous Patients
				7.2.4.4	 Surgical Accuracy Verification
		7.3	 Clinical Applications
			7.3.1	 Dynamic Surgical Navigation and Pterygoid Implants
			7.3.2	 Dynamic Surgical Navigation in Transcrestal Sinus Augmentation
				7.3.2.1	 Dynamic Surgical Navigation (DSN) in Transcrestal Sinus Augmentation (TSA) Workflow
					Planning
					Surgery
			7.3.3	 Emerging Applications
		7.4	 Challenges with their Solutions
		References
Part III: Guided Bone Regeneration
	8: Clinical Applications of Digital Technologies for Combined Regenerative Procedures
		8.1	 Introduction
		8.2	 Lab Evolution
		8.3	 Case Series
			8.3.1	 Diagnosis and Development of Different Treatment Options
				8.3.1.1	 Patient #1
				8.3.1.2	 Patient #2
			8.3.2	 Staged Surgery: Guided Implant Placement Following Analog Regenerative Procedures
				8.3.2.1	 Patient #3
				8.3.2.2	 Patient #4
			8.3.3	 Staged Surgery: Stereolithographic Model from CBCT Rendering for Analog GBR Pre-surgical Planning
				8.3.3.1	 Patient #5
				8.3.3.2	 Patient #6
			8.3.4	 Staged Surgery: Virtual GBR Planning and CAM of Surgical Materials
				8.3.4.1	 Patient #7
			8.3.5	 Immediate Restoration Following Immediate Guided Implant Placement
				8.3.5.1	 Patient #8
			8.3.6	 Virtual Outcome Assessment
				8.3.6.1	 Patient #9
				8.3.6.2	 Patient #10
	9: Digital Reconstructive Surgery
		9.1	 Introduction
		9.2	 Biology of Bone Grafting. Current Concepts
			9.2.1	 Basic Concepts
			9.2.2	 Reconstructive Parameters
			9.2.3	 Biological Bases of Bone Regeneration
			9.2.4	 Guided Bone Regeneration
			9.2.5	 Onlay Grafting
		9.3	 Digital Techniques
			9.3.1	 Digital Workflow Concept
			9.3.2	 Digital Reconstructive Surgery Concept
			9.3.3	 CAI Stage
			9.3.4	 CAD Stage
				9.3.4.1	 Step 1 Virtual Model
				9.3.4.2	 Step 2 Visualization of Treatment Objectives (VTO)
				9.3.4.3	 Step 3 Project
				9.3.4.4	 Step 4 Periodontal Approach
				9.3.4.5	 Step 5 Definitive Design
			9.3.5	 CAM and Clinical Stages
		9.4	 Conclusions
		Bibliography
Part IV: Guided Maxillofacial Surgery
	10: 3D Virtual Planning in Orthognathic Surgery
		10.1	 Introduction
		10.2	 3D Virtual Planning
			10.2.1	 “Think more, less mistakes” Concept
			10.2.2	 Data Acquisition (CAI)
				10.2.2.1	 The Patient
				10.2.2.2	 Facial Photos and 3D Scan
				10.2.2.3	 Dental Cast Models, Scanners, and CBCT
				10.2.2.4	 Imaging Modality
		10.3	 The Planning Process Itself (CAD)
		10.4	 3D Printing (CAM)
		10.5	 Osteotomies Surgical Guides Making Process
		10.6	 Other Indications and Limitations
		10.7	 Conclusion
		References