1
|
Shu Q, Chen D, Wang X, Liu Q, Ge Y, Su Y. Accuracy of flapless surgery using an autonomous robotic system in full-arch immediate implant restoration: A case series. J Dent 2024; 145:105017. [PMID: 38657725 DOI: 10.1016/j.jdent.2024.105017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES This observational study aimed to evaluate the accuracy of robotic computer-assisted implant surgery (r-CAIS) for full-arch immediate restoration and to analyse possible factors contributing to deviations. METHODS Three edentulous patients (five arches) underwent r-CAIS. Osteotomies were performed using an autonomous robot under the surgeon's supervision, and implant placement was performed in a freehand or robotic manner. Prefabricated provisional prostheses were delivered immediately after surgery. Postoperative cone beam computed tomography scans were performed to assess the deviations between the planned and placed implants. Statistics were compared with deviations of s-CAIS outlined in a meta-analysis. RESULTS A sum of 28 implants were used. The mean global coronal and apical deviations measured 0.91 ± 0.43 mm and 1.01 ± 0.45 mm, respectively, and the mean angular deviation measured 1.21 ± 1.24 º. The r-CAIS showed significantly better precision than the s-CAIS in full-arch cases (P < 0.001). The implants inserted using the robotic arm exhibited fewer deviations than those placed in the freehand manner. Eighty percent of prefabricated provisional prostheses were successfully delivered. CONCLUSIONS Within the limitations of the present study, our data suggest that autonomous r-CAIS is a feasible approach for simultaneous immediate restoration in edentulous patients, showing better accuracy than s-CAIS. Further large-scale studies are necessary to verify the advantages and disadvantages of this novel technique and to explore possible factors that influence its accuracy. CLINICAL SIGNIFICANCE Autonomous r-CAIS can provide clinically acceptable implant placement accuracy in edentulous patients, significantly surpassing s-CAIS. This level of accuracy may represent a viable therapeutic approach for simultaneous immediate full-arch restoration.
Collapse
Affiliation(s)
- Qianyi Shu
- Department of Stomatology, Chinese Academy of Medical Science & Peking Union Medical College Hospital, Beijing, China
| | - Deping Chen
- Beijing Citident Stomatology Hospital, Beijing, China
| | - Xia Wang
- Beijing Citident Stomatology Hospital, Beijing, China
| | - Qian Liu
- Beijing Citident Stomatology Hospital, Beijing, China
| | - Yi Ge
- Department of Stomatology, Chinese Academy of Medical Science & Peking Union Medical College Hospital, Beijing, China; Beijing Citident Stomatology Hospital, Beijing, China.
| | - Yucheng Su
- Department of Stomatology, Chinese Academy of Medical Science & Peking Union Medical College Hospital, Beijing, China; Beijing Citident Stomatology Hospital, Beijing, China.
| |
Collapse
|
2
|
Sun Z, Lou Y, Liu Z, Wang B, Yu M, Wang H. Anatomy and function of the canalis sinuosus and its injury prevention and treatment strategies in implant surgery. Zhejiang Da Xue Xue Bao Yi Xue Ban 2024:1-8. [PMID: 38763767 DOI: 10.3724/zdxbyxb-2023-0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
The canalis sinuosus, a canal containing the anterior superior alveolar nerve bundle, originates from the infraorbital canal and extends along the maxillary sinus and nasal cavity edges to the anterior maxilla. It was once regarded as an anatomical variation. However, with the widespread application of cone beam computed tomography (CBCT), the detection rate of canalis sinuosus in the population has increased. The canalis sinuosus exhibits diverse courses, branching into multiple accessory canals and terminating at the nasal floor or the anterior tooth region, with the majority traversing the palatal side of the central incisor. The anterior superior alveolar nerve bundle within the canalis sinuosus not only innervates and nourishes the maxillary anterior teeth, their corresponding soft tissues, and the maxillary sinus mucosa, but also relates to the nasal septum, lateral nasal wall, and parts of the palatal mucosa. To minimize surgical complications, implantologists need to investigate strategies for preventing and treating canalis sinuosus injuries. Preoperatively, implantologists should use CBCT to identify the canalis sinuosus and virtually design implant placement at a distance of more than 2 mm from the canalis sinuosus. Intraoperatively, implantologists should assess bleeding and patient comfort, complemented by precision surgical techniques such as the use of implant surgical guide plates. Postoperatively, CBCT can be employed to examine the relationship between the implant and the canalis sinuosus, and treatment of canalis sinuosus injuries can be tailored based on the patient's symptoms. This review summarizes the detection of canalis sinuosus in the population, its anatomical characteristics, and its physiological functions in the anterior maxilla, and discusses strategies for effectively avoiding canalis sinuosus injuries during implant surgery, thereby enhancing implantologists' awareness and providing references for clinical decision-making.
Collapse
Affiliation(s)
- Zheyuan Sun
- The Stomatology Hospital, Zhejiang University School of Medicine, Zhejiang University School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Zhejiang Provincial Key Laboratory of Oral Biomedical Research, Zhejiang University Cancer Center, Hangzhou 310006, China.
| | - Yiting Lou
- The Stomatology Hospital, Zhejiang University School of Medicine, Zhejiang University School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Zhejiang Provincial Key Laboratory of Oral Biomedical Research, Zhejiang University Cancer Center, Hangzhou 310006, China
| | - Zhichao Liu
- The Stomatology Hospital, Zhejiang University School of Medicine, Zhejiang University School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Zhejiang Provincial Key Laboratory of Oral Biomedical Research, Zhejiang University Cancer Center, Hangzhou 310006, China
| | - Baixiang Wang
- The Stomatology Hospital, Zhejiang University School of Medicine, Zhejiang University School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Zhejiang Provincial Key Laboratory of Oral Biomedical Research, Zhejiang University Cancer Center, Hangzhou 310006, China
| | - Mengfei Yu
- The Stomatology Hospital, Zhejiang University School of Medicine, Zhejiang University School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Zhejiang Provincial Key Laboratory of Oral Biomedical Research, Zhejiang University Cancer Center, Hangzhou 310006, China
| | - Huiming Wang
- The Stomatology Hospital, Zhejiang University School of Medicine, Zhejiang University School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Zhejiang Provincial Key Laboratory of Oral Biomedical Research, Zhejiang University Cancer Center, Hangzhou 310006, China.
| |
Collapse
|
3
|
宋 宣, 向 大, 刘 代, 刘 一. [Application of mixed reality technology in free fibular flap transplantation for repairing mandibular defects]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:588-592. [PMID: 38752246 PMCID: PMC11096888 DOI: 10.7507/1002-1892.202402027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/18/2024]
Abstract
Objective To explore the feasibility and effectiveness of mixed reality technology for localizing perforator vessels in the repair of mandibular defects using free fibular flap. Methods Between June 2020 and June 2023, 12 patients with mandibular defects were repaired with free fibular flap. There were 8 males and 4 females, with an average age of 61 years (range, 35-78 years). There were 9 cases of ameloblastomas and 3 cases of squamous cell carcinomas involving the mandible. The disease duration ranged from 15 days to 2 years (median, 14.2 months). The length of mandibular defects ranged from 5 to 14 cm (mean, 8.5 cm). The area of soft tissue defects ranged from 5 cm×4 cm to 8 cm×6 cm. Preoperative enhanced CT scans of the maxillofacial region and CT angiography of the lower limbs were performed, and the data was used to create three-dimensional models of the mandible and lower limb perforator vessels. During operation, the mixed reality technology was used to overlay the three-dimensional model of perforator vessels onto the body surface for harvesting the free fibular flap. The length of the fibula harvested ranged from 6 to 15 cm, with a mean of 9.5 cm; the size of the flap ranged from 6 cm×5 cm to 10 cm×8 cm. The donor sites were sutured directly in 7 cases and repaired with free skin grafting in 5 cases. Results Thirty perforator vessels were located by mixed reality technology before operation, with an average of 2.5 vessels per case; the distance between the exit point of the perforator vessels located before operation and the actual exit point ranged from 1 to 4 mm, with a mean of 2.8 mm. All fibular flaps survived; 1 case had necrosis at the distal end of flap, which healed after dressing changes. One donor site had infection, which healed after anti-inflammatory dressing changes; the remaining incisions healed by first intention, and the grafts survived smoothly. All patients were followed up 8-36 months (median, 21 months). The repaired facial appearance was satisfactory, with no flap swelling. Among the patients underwent postoperative radiotherapy, 2 patients had normal bone healing and 1 had delayed healing at 6 months. Conclusion In free fibular flap reconstruction of mandibular defects, the use of mixed reality technology for perforator vessel localization can achieve three-dimensional visualization, simplify surgical procedures, and reduce errors.
Collapse
Affiliation(s)
- 宣 宋
- 武警四川省总队医院口腔科(四川乐山 614000)Dental Department, Armed Police Forces Hospital of Sichuan, Leshan Sichuan, 614000, P. R. China
| | - 大兰 向
- 武警四川省总队医院口腔科(四川乐山 614000)Dental Department, Armed Police Forces Hospital of Sichuan, Leshan Sichuan, 614000, P. R. China
| | - 代德 刘
- 武警四川省总队医院口腔科(四川乐山 614000)Dental Department, Armed Police Forces Hospital of Sichuan, Leshan Sichuan, 614000, P. R. China
| | - 一秀 刘
- 武警四川省总队医院口腔科(四川乐山 614000)Dental Department, Armed Police Forces Hospital of Sichuan, Leshan Sichuan, 614000, P. R. China
| |
Collapse
|
4
|
Shusterman A, Nashef R, Tecco S, Mangano C, Lerner H, Mangano FG. Accuracy of implant placement using a mixed reality-based dynamic navigation system versus static computer-assisted and freehand surgery: An in Vitro study. J Dent 2024; 146:105052. [PMID: 38734298 DOI: 10.1016/j.jdent.2024.105052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
PURPOSE This in vitro study aimed to compare the accuracy of dental implant placement in partially edentulous maxillary models using a mixed reality-based dynamic navigation (MR-DN) system to conventional static computer-assisted implant surgery (s-CAIS) and a freehand (FH) method. METHODS Forty-five partially edentulous models (with teeth missing in positions #15, #16 and #25) were assigned to three groups (15 per group). The same experienced operator performed the model surgeries using an MR-DN system (group 1), s-CAIS (group 2) and FH (group 3). In total, 135 dental implants were placed (45 per group). The primary outcomes were the linear coronal deviation (entry error; En), apical deviation (apex error; Ap), XY and Z deviations, and angular deviation (An) between the planned and actual (post-surgery) position of the implants in the models. These deviations were computed as the distances between the stereolithographic (STL) files for the planned implants and placed implants captured with an intraoral scanner. RESULTS Across the three implant sites, the MR-DN system was significantly more accurate than the FH method (in XY, Z, En, Ap and An) and s-CAIS (in Z, Ap and An), respectively. However, S-CAIS was more accurate than MR-DN in XY, and no difference was found between MR-DN and s-CAIS in En. CONCLUSIONS Within the limits of this study (in vitro design, only partially edentulous models), implant placement accuracy with MR-DN was superior to that of FH and similar to that of s-CAIS. STATEMENT OF CLINICAL RELEVANCE In vitro, MR-DN showed greater accuracy in implant positioning than FH, and similar accuracy to s-CAIS: it could, therefore, represent a new option for the surgeon. However, clinical studies are needed to determine the feasibility of MR-DN.
Collapse
Affiliation(s)
| | - Rizan Nashef
- Oral and Maxillofacial Surgery Unit, Shaare Zedek Medical center, Jerusalem Israel.
| | - Simona Tecco
- Department of Dental Sciences, San Raffaele University, Milan Italy
| | - Carlo Mangano
- Department of Dental Sciences, San Raffaele University, Milan Italy
| | - Henriette Lerner
- Academic Teaching and Research Institution of Johann Wolfgang Goethe University, Frankfurt, Germany.
| | - Francesco Guido Mangano
- Department of Pediatric, Preventive Dentistry and Orthodontics, I. M. Sechenov First State Medical University, Moscow, Russian Federation.
| |
Collapse
|
5
|
Fudalej PS, Garlicka A, Dołęga-Dołegowski D, Dołęga-Dołegowska M, Proniewska K, Voborna I, Dubovska I. Mixed reality-based technology to visualize and facilitate treatment planning of impacted teeth: Proof of concept. Orthod Craniofac Res 2024. [PMID: 38712682 DOI: 10.1111/ocr.12803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE We propose a method utilizing mixed reality (MR) goggles (HoloLens 2, Microsoft) to facilitate impacted canine alignment, as planning the traction direction and force delivery could benefit from 3D data visualization using mixed reality (MR). METHODS Cone-beam CT scans featuring isometric resolution and low noise-to-signal ratio were semi-automatically segmented in Inobitec software. The exported 3D mesh (OBJ file) was then optimized for the HoloLens 2. Using the Unreal Engine environment, we developed an application for the HoloLens 2, implementing HoloLens SDK and UX Tools. Adjustable pointers were added for planning attachment placement, traction direction, and point of force application. The visualization was presented to participants of a course on impacted teeth treatment, followed by a 10-question survey addressing potential advantages (5-point scale: 1 = totally agree, 5 = totally disagree). RESULTS Out of 38 respondents, 44.7% were orthodontists, 34.2% dentists, 15.8% dental students, and 5.3% dental technicians. Most respondents (44.7%) were between 35 and 44 years old, and only 1 (2.6%) respondent was 55-64 years old. Median answers for six questions were 'totally agree' (25th percentile 1, 75th percentile 2) and for four questions 'agree' (25th percentile 1, 75th percentile 2). No correlation was found between age, profession, and responses. CONCLUSION Our method generated substantial interest among clinicians. The initial responses affirm the potential benefits, supporting the continued exploration of MR-based techniques for the treatment of impacted teeth. However, the recommendation for widespread use awaits validation through clinical trials.
Collapse
Affiliation(s)
- Piotr S Fudalej
- Department of Orthodontics, Jagiellonian University Medical College, Jagiellonian University in Cracow, Krakow, Poland
- Department of Orthodontics and Dentofacial Orthopedics, Medical Faculty, School of Dental Medicine, University of Bern, Bern, Switzerland
- Faculty of Medicine and Dentistry, Institute of Dentistry and Oral Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Agnieszka Garlicka
- Department of Orthodontics, Jagiellonian University Medical College, Jagiellonian University in Cracow, Krakow, Poland
| | | | | | - Klaudia Proniewska
- Jagiellonian University Medical College, Jagiellonian University in Cracow, Krakow, Poland
| | - Iva Voborna
- Faculty of Medicine and Dentistry, Institute of Dentistry and Oral Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Ivana Dubovska
- Faculty of Medicine and Dentistry, Institute of Dentistry and Oral Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| |
Collapse
|
6
|
Al-Jarsha MY, Ayoub AF, Almgran MM, Liu CH, Robertson DP, Naudi KB. The precision of drill calibration for dynamic navigation. J Dent 2024; 146:105032. [PMID: 38703809 DOI: 10.1016/j.jdent.2024.105032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/24/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVES To quantify the reproducibility of the drill calibration process in dynamic navigation guided placement of dental implants and to identify the human factors that could affect the precision of this process in order to improve the overall implant placement accuracy. METHODS A set of six drills and four implants were calibrated by three operators following the standard calibration process of NaviDent® (ClaroNav Inc.). The reproducibility of the position of each tip of a drill or implant was calculated in relation to the pre-planned implants' entry and apex positions. Intra- and inter-operator reliabilities were reported. The effects of the drill length and shape on the reproducibility of the calibration process were also investigated. The outcome measures for reproducibility were expressed in terms of variability range, average and maximum deviations from the mean distance. RESULTS A satisfactory inter-rater reproducibility was noted. The precision of the calibration of the tip position in terms of variability range was between 0.3 and 3.7 mm. We noted a tendency towards a higher precision of the calibration process with longer drills. More calibration errors were observed when calibrating long zygomatic implants with non-locking adapters than with pointed drills. Flexible long-pointed drills had low calibration precision that was comparable to the non-flexible short-pointed drills. CONCLUSION The clinicians should be aware of the calibration error associated with the dynamic navigation placement of dental and zygomatic implants. This should be taken in consideration especially for long implants, short drills, and long drills that have some degree of flexibility. CLINICAL SIGNIFICANCE Dynamic navigation procedures are associated with an inherent drill calibration error. The manual stability during the calibration process is crucial in minimising this error. In addition, the clinician must never ignore the prescribed accuracy checking procedures after each calibration process.
Collapse
Affiliation(s)
- Mohammed Y Al-Jarsha
- Department of Oral Surgery, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom; Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Ashraf F Ayoub
- Department of Oral Surgery, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
| | - Mohammed M Almgran
- Department of Oral Surgery, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Chieh-Han Liu
- Department of Oral Surgery, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Douglas P Robertson
- Department of Restorative Dentistry, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Kurt B Naudi
- Department of Oral Surgery, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
7
|
Lanis A, Peña-Cardelles JF, Negreiros WM, Hamilton A, Gallucci GO. Impact of digital technologies on implant surgery in fully edentulous patients: A scoping review. Clin Oral Implants Res 2024. [PMID: 38613432 DOI: 10.1111/clr.14268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/09/2024] [Accepted: 03/27/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND For over three decades, digital technologies have been used in Implant Dentistry, beginning with the introduction of planning software for Static Computer-Assisted Implant Surgery (S-CAIS). During this time, this field has witnessed the emergence of diverse methodologies and a proliferation of technological advancements. Today, S-CAIS is a widely adopted procedure for the placement of dental implants in both partially and fully edentulous patients, with Dynamic Computer-Assisted Surgery (D-CAIS) and Robotic-Assisted Implant Surgery (RAIS) rapidly gaining attention among dental professionals. The continuous advancements in this arena are not merely indicative of technological progress; they represent a steadfast dedication to refining precision, enhancing efficiency, and fostering innovation with the goal of optimizing patient outcomes in dental implantology. AIMS The purpose of the following review is to meticulously examine the spectrum of digital technologies available and to describe their protocols, advantages, and shortcomings as well as to evaluate their accuracy in implant surgery in patients with complete edentulism. MATERIALS AND METHODS A scoping review was performed following the Joanna Briggs Institute (JBI) protocols, leveraging the population, concept, and context (PCC) framework to construct the research question and determine the inclusion and exclusion criteria. RESULTS Two hundred and sixty-seven records were identified for screening. After applying all the screening criteria, 41 articles were included for review and qualitative data analysis. DISCUSSION S-CAIS, D-CAIS, and RAIS were identified as the main technologies for computer assisted implant surgery. Their applications, characteristics, protocols and levels of accuracy were compared and described. CONCLUSION Taking into consideration the limitations of this study, S-CAIS appears to be the most applied and validated technology in implant surgery for fully edentulous patients followed by D-CAIS and RAIS being these last two promising initiatives in the field. Despite having similar levels of accuracy, the overall comparison showed a slightly higher values in RAIS followed by D-CAIS and S-CAIS.
Collapse
Affiliation(s)
- Alejandro Lanis
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Juan Francisco Peña-Cardelles
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - William Matthew Negreiros
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Adam Hamilton
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Oral Health Center of WA, University of Western Australia Dental School, Perth, Australia
| | - German O Gallucci
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Tyndall DA, Price JB, Gaalaas L, Spin-Neto R. Surveying the landscape of diagnostic imaging in dentistry's future: Four emerging technologies with promise. J Am Dent Assoc 2024:S0002-8177(24)00056-4. [PMID: 38520421 DOI: 10.1016/j.adaj.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Advances in digital radiography for both intraoral and panoramic imaging and cone-beam computed tomography have led the way to an increase in diagnostic capabilities for the dental care profession. In this article, the authors provide information on 4 emerging technologies with promise. TYPES OF STUDIES REVIEWED The authors feature the following: artificial intelligence in the form of deep learning using convolutional neural networks, dental magnetic resonance imaging, stationary intraoral tomosynthesis, and second-generation cone-beam computed tomography sources based on carbon nanotube technology and multispectral imaging. The authors review and summarize articles featuring these technologies. RESULTS The history and background of these emerging technologies are previewed along with their development and potential impact on the practice of dental diagnostic imaging. The authors conclude that these emerging technologies have the potential to have a substantial influence on the practice of dentistry as these systems mature. The degree of influence most likely will vary, with artificial intelligence being the most influential of the 4. CONCLUSIONS AND PRACTICAL IMPLICATIONS The readers are informed about these emerging technologies and the potential effects on their practice going forward, giving them information on which to base decisions on adopting 1 or more of these technologies. The 4 technologies reviewed in this article have the potential to improve imaging diagnostics in dentistry thereby leading to better patient care and heightened professional satisfaction.
Collapse
|
9
|
Mai HN, Ngo HC, Cho SH, Duong CP, Mai HY, Lee DH. Effectiveness of virtual reality interactive simulation practice in prosthodontic education: A systematic review and meta-analysis. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024. [PMID: 38433575 DOI: 10.1111/eje.12997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/04/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Virtual reality-based interactive simulation (VRIS) provides a safe and controlled environment for dental students and professionals to develop skills and knowledge. This study aimed to investigate the effectiveness of using the VRIS for prosthodontic practice and to explore the trends, application areas, and users' attitudes towards VRIS. MATERIALS AND METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for searching studies published until 21 March 2023 that reported quantitative or qualitative learning outcomes related to the use of VRIS for dental prosthodontic practice and clinical training. The quality of the included studies was assessed using the Medical Education Research Study Quality Instrument (MERSQI) and Newcastle-Ottawa Scale-Education (NOS-E) tools. A random-effects meta-analysis was conducted to compare the intervention group (utilizing VRIS) and the control group (employing conventional prosthodontic training methods) based on performance skill scores and task completion time, with a significance level set at <.05. RESULTS The meta-analysis revealed that the utilization of VRIS generally improves students' performance scores (SMD = 1.04; 95% CI, -0.35 to 2.44; I2 > 50%; p = .13) and reduces task completion time (SMD = -0.03; 95% CI, 1.39-7.72; I2 > 50%; p = .93). Notably, using VRIS significantly enhanced the performance scores in implant surgery practice (SMD = 0.26; 95% CI, 0.09-0.42; p < .05). Additionally, the VRIS method significantly reduced task completion time in the cavity restorative preparation task (SMD = -1.19; 95% CI, -1.85 to -0.53; p < .05). CONCLUSION Engaging in practice with VRIS has the potential to enhance learning proficiency in prosthodontic education. The advantages associated with VRIS encompass the provision of immediate feedback, decreased task completion time, heightened confidence and motivation, accelerated skill acquisition, improved performance scores, and increased learning engagement.
Collapse
Affiliation(s)
- Hang-Nga Mai
- Institute for Translational Research in Dentistry, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
- Dental School of Hanoi University of Business and Technology, Hanoi, Vietnam
| | - Hien Chi Ngo
- UWA Dental School, University of Western Australia, Perth, Western Australia, Australia
| | - Seok-Hwan Cho
- Department of Prosthodontics, University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa, USA
| | - Chau Pham Duong
- Dental School of Hanoi University of Business and Technology, Hanoi, Vietnam
| | - Hai Yen Mai
- School of Dentistry, Hanoi Medical University, Hanoi, Vietnam
| | - Du-Hyeong Lee
- Institute for Translational Research in Dentistry, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
- Department of Prosthodontics, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| |
Collapse
|
10
|
Yang X, Zhang Y, Chen X, Huang L, Qiu X. Limitations and Management of Dynamic Navigation System for Locating Calcified Canals Failure. J Endod 2024; 50:96-105. [PMID: 37890613 DOI: 10.1016/j.joen.2023.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/28/2023] [Accepted: 10/01/2023] [Indexed: 10/29/2023]
Abstract
Nonsurgical endodontic teeth treatment with severe pulp canal obliteration poses challenges, primarily locating canals. By combining 3-dimensional reconstruction and spatial location registration, the dynamic navigation technique uses an optical tracking system to guide the clinician to drill in real time according to the predesigned path until access to the canal is established. Several in vitro studies and case reports have shown that calcified canal location with dynamic navigation system (DNS) is more accurate and efficient, yet the technique has limitations. In 4 cases with 7 teeth, this work presents manipulation process and clinical outcomes of DNS helping in calcified canal location. We performed handpiece adaptation and elucidated the failure to locate the canals with DNS in 2 teeth, resulting in canal geometry alteration and canal path deviation. Subsequently, the more experienced endodontist located the canals by combining cone-beam computed tomographic imaging and dental operating microscopy. All patients were completely asymptomatic after treatment. At the 1-year follow-up visit, the bone healing of periapical lesions progressed well according to the periapical radiography or cone-beam computed tomographic imaging. These findings indicate that DNS is a promising technique for locating calcified canals; however, it needs to be refined before clinical use.
Collapse
Affiliation(s)
- Xiaoxia Yang
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Yinchun Zhang
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Xuan Chen
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China.
| | - Lei Huang
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Xiaoling Qiu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China.
| |
Collapse
|
11
|
Tao B, Fan X, Wang F, Chen X, Shen Y, Wu Y. Comparison of the accuracy of dental implant placement using dynamic and augmented reality-based dynamic navigation: An in vitro study. J Dent Sci 2024; 19:196-202. [PMID: 38303816 PMCID: PMC10829549 DOI: 10.1016/j.jds.2023.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/05/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose Augmented reality has been gradually applied in dental implant surgery. However, whether the dynamic navigation system integrated with augmented reality technology will further improve the accuracy is still unknown. The purpose of this study is to investigate the accuracy of dental implant placement using dynamic navigation and augmented reality-based dynamic navigation systems. Materials and methods Thirty-two cone-beam CT (CBCT) scans from clinical patients were collected and used to generate 64 phantoms that were allocated to the augmented reality-based dynamic navigation (ARDN) group or the conventional dynamic navigation (DN) group. The primary outcomes were global coronal, apical and angular deviations, and they were measured after image fusion. A linear mixed model with a random intercept was used. A P value < 0.05 was considered to indicate statistical significance. Results A total of 242 dental implants were placed in two groups. The global coronal, apical and angular deviations of the ARDN and DN groups were 1.31 ± 0.67 mm vs. 1.18 ± 0.59 mm, 1.36 ± 0.67 mm vs. 1.39 ± 0.55 mm, and 3.72 ± 2.13° vs. 3.1 ± 1.56°, respectively. No significant differences were found with regard to coronal and apical deviations (P = 0.16 and 0.6, respectively), but the DN group had a significantly lower angular deviation than the ARDN group (P = 0.02). Conclusion The augmented reality-based dynamic navigation system yielded a similar accuracy to the conventional dynamic navigation system for dental implant placement in coronal and apical points, but the augmented reality-based dynamic navigation system yielded a higher angular deviation.
Collapse
Affiliation(s)
- Baoxin Tao
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xingqi Fan
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Wang
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yihan Shen
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yiqun Wu
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| |
Collapse
|
12
|
Obispo C, Gragera T, Giovannini G, Zubizarreta-Macho Á, Aragoneses Lamas JM. Influence of Augmented Reality Appliances on Tooth Preparation Designs-An In Vitro Study. J Pers Med 2023; 14:37. [PMID: 38248738 PMCID: PMC10821306 DOI: 10.3390/jpm14010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/23/2024] Open
Abstract
The aim of this work was to analyze and compare the tooth structure removal between a free-hand preparation technique and a computer-aided preparation technique using an augmented reality appliance for complete-crowns preparation designs and "root mean square" (RMS) alignment value. Ten upper teeth representatives of all dental sectors were selected from a generic model library as "Standard Tessellation Language" (STL-1) digital files and 3D-printed in an anatomically based acrylic resin experimental model. Then these were randomly assigned to the following tooth preparation techniques: Group A: free-hand preparation technique (n = 5) (FHT) and Group B: computer-aided preparation technique using an augmented reality appliance (n = 5) (AR). Experimental models were submitted to a digital impression through an intraoral scan and (STL-2) uploaded into a reverse engineering morphometric software to measure the volumetric reduction in the planned and performed tooth structure (mm3) and RMS using the Student's t-test and the Mann-Whitney non-parametric test. Statistically significant differences were observed between the volumetric reduction in the planned and performed tooth structure (mm3) of the AR and FHT study groups (p = 0.0001). Moreover, statistically significant differences were observed between the RMS of the planned and performed tooth preparations in both the AR and FHT study groups (p = 0.0005). The augmented reality appliance provides a more conservative and predictable complete-crowns preparation design than the free-hand preparation technique.
Collapse
Affiliation(s)
- Cristina Obispo
- Department of Medicine and Medical Specialties, Faculty of Health Sciences, Universidad Alcalá de Henares, 28801 Madrid, Spain;
- Faculty of Dentistry, Universidad Alfonso X el Sabio, 28801 Madrid, Spain; (T.G.); (G.G.); or (J.M.A.L.)
| | - Teresa Gragera
- Faculty of Dentistry, Universidad Alfonso X el Sabio, 28801 Madrid, Spain; (T.G.); (G.G.); or (J.M.A.L.)
| | - Giovanni Giovannini
- Faculty of Dentistry, Universidad Alfonso X el Sabio, 28801 Madrid, Spain; (T.G.); (G.G.); or (J.M.A.L.)
| | - Álvaro Zubizarreta-Macho
- Faculty of Dentistry, Universidad Alfonso X el Sabio, 28801 Madrid, Spain; (T.G.); (G.G.); or (J.M.A.L.)
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain
| | - Juan Manuel Aragoneses Lamas
- Faculty of Dentistry, Universidad Alfonso X el Sabio, 28801 Madrid, Spain; (T.G.); (G.G.); or (J.M.A.L.)
- Department of Dentistry, Universidad Federico Henríquez y Carvajal, Santo Domingo 11114, Dominican Republic
| |
Collapse
|
13
|
Takács A, Hardi E, Cavalcante BGN, Szabó B, Kispélyi B, Joób-Fancsaly Á, Mikulás K, Varga G, Hegyi P, Kivovics M. Advancing accuracy in guided implant placement: A comprehensive meta-analysis: Meta-Analysis evaluation of the accuracy of available implant placement Methods. J Dent 2023; 139:104748. [PMID: 37863173 DOI: 10.1016/j.jdent.2023.104748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 10/22/2023] Open
Abstract
OBJECTIVES This meta-analysis aimed to determine the accuracy of currently available computer-assisted implant surgery (CAIS) modalities under in vitro conditions and investigate whether these novel techniques can achieve clinically acceptable accuracy. DATA In vitro studies comparing the postoperative implant position with the preoperative plan were included. Risk of bias was assessed using the Quality Assessment Tool For In Vitro Studies (QUIN Tool) and a sensitivity analysis was conducted using funnel plots. SOURCES A systematic search was performed on April 18, 2023, using the following three databases: MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials. No filters or restrictions were applied during the search. RESULTS A total of 5,894 studies were included following study selection. Robotic- and static CAIS (sCAIS) had the most accurate and clinically acceptable outcomes. sCAIS was further divided according to the guidance level. Among the sCAIS groups, fully guided implant placement had the greatest accuracy. Augmented reality-based CAIS (AR-based CAIS) had clinically acceptable results for all the outcomes except for apical global deviation. Dynamic CAIS (dCAIS) demonstrated clinically safe results, except for horizontal apical deviation. Freehand implant placement was associated with the greatest number of errors. CONCLUSIONS Fully guided sCAIS demonstrated the most predictable outcomes, whereas freehand sCAIS demonstrated the lowest accuracy. AR-based and robotic CAIS may be promising alternatives. CLINICAL SIGNIFICANCE To our knowledge, this is the first meta-analysis to evaluate the accuracy of robotic CAIS and investigate the accuracy of various CAIS modalities.
Collapse
Affiliation(s)
- Anna Takács
- Department of Community Dentistry, Semmelweis University, Szentkirályi utca 40. 1088 Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary
| | - Eszter Hardi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary; Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Mária utca 52. 1085 Budapest, Hungary
| | - Bianca Golzio Navarro Cavalcante
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary; Department of Oral Biology, Semmelweis University, Nagyvárad tér 4. 1089 Budapest, Hungary
| | - Bence Szabó
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary
| | - Barbara Kispélyi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary; Department of Prosthodontics, Semmelweis University, Szentkirályi utca 47. 1088 Budapest, Hungary
| | - Árpád Joób-Fancsaly
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary; Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Mária utca 52. 1085 Budapest, Hungary
| | - Krisztina Mikulás
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary; Department of Prosthodontics, Semmelweis University, Szentkirályi utca 47. 1088 Budapest, Hungary
| | - Gábor Varga
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary; Department of Oral Biology, Semmelweis University, Nagyvárad tér 4. 1089 Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary; Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Szigeti út 12. 7624 Pécs, Hungary; Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Városmajor utca 68. 1122 Budapest, Hungary
| | - Márton Kivovics
- Department of Community Dentistry, Semmelweis University, Szentkirályi utca 40. 1088 Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary.
| |
Collapse
|
14
|
Shi Y, Wang J, Ma C, Shen J, Dong X, Lin D. A systematic review of the accuracy of digital surgical guides for dental implantation. Int J Implant Dent 2023; 9:38. [PMID: 37875645 PMCID: PMC10597938 DOI: 10.1186/s40729-023-00507-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023] Open
Abstract
PURPOSE This review aimed to reveal the influence of implant guides on surgical accuracy with regard to supporting types, manufacturing methods and design (including fixation screws and sleeves). METHODS A literature search related to accuracy of surgical guides for dental implantation was performed in Web of Science and PubMed. Studies with in vivo or in vitro deviation data published in recent 5 years (2018-2022) were included and assessed by Newcastle-Ottawa Scale with regard to risk of bias and reliability degree of clinical studies. Accuracy-related deviation data were summarized as forest plots and normal distributions. RESULTS Forty-one articles were included with high degree of credibility. Data showed that implant surgery accuracy can be achieved with mean distance deviation < 2 mm (most < 1 mm) and angular deviation < 8° (most < 5°). CONCLUSIONS Bilateral tooth-supported guides exhibited highest in vitro accuracy and similar in vivo accuracy to unilateral tooth-supported guides; mucosa-supported guides exhibit lowest in vivo accuracy, while its in vitro data showed low credibility due to mechanical complexity of living mucosa tissue. Milling exhibited higher in vivo accuracy of guides than 3d-printing, though further data support was needed. Design of fixation screws and sleeves of implant guides affected the surgical accuracy and might remain a research focus in near future. However, lack of universal evaluation standards for implantation accuracy remained a major problem in this field. The influence of implant guides on surgical accuracy revealed in this review might shed light on future development of dental implantology.
Collapse
Affiliation(s)
- Yiting Shi
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, People's Republic of China
| | - JunKai Wang
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, People's Republic of China
| | - Chao Ma
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, People's Republic of China
| | - Jiayi Shen
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, People's Republic of China
| | - Xian Dong
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, People's Republic of China.
| | - Dan Lin
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, People's Republic of China.
| |
Collapse
|
15
|
Remschmidt B, Rieder M, Gsaxner C, Gaessler J, Payer M, Wallner J. Augmented Reality-Guided Apicoectomy Based on Maxillofacial CBCT Scans. Diagnostics (Basel) 2023; 13:3037. [PMID: 37835780 PMCID: PMC10572956 DOI: 10.3390/diagnostics13193037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Implementation of augmented reality (AR) image guidance systems using preoperative cone beam computed tomography (CBCT) scans in apicoectomies promises to help surgeons overcome iatrogenic complications associated with this procedure. This study aims to evaluate the intraoperative feasibility and usability of HoloLens 2, an established AR image guidance device, in the context of apicoectomies. Three experienced surgeons carried out four AR-guided apicoectomies each on human cadaver head specimens. Preparation and operating times of each procedure, as well as the subjective usability of HoloLens for AR image guidance in apicoectomies using the System Usability Scale (SUS), were measured. In total, twelve AR-guided apicoectomies on six human cadaver head specimens were performed (n = 12). The average preparation time amounted to 162 (±34) s. The surgical procedure itself took on average 9 (±2) min. There was no statistically significant difference between the three surgeons. Quantification of the usability of HoloLens revealed a mean SUS score of 80.4 (±6.8), indicating an "excellent" usability level. In conclusion, this study implies the suitability, practicality, and simplicity of AR image guidance systems such as the HoloLens in apicoectomies and advocates their routine implementation.
Collapse
Affiliation(s)
- Bernhard Remschmidt
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, 8010 Graz, Austria
| | - Marcus Rieder
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, 8010 Graz, Austria
| | - Christina Gsaxner
- Institute of Computer Graphics and Vision, Graz University of Technology, 8010 Graz, Austria
| | - Jan Gaessler
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, 8010 Graz, Austria
| | - Michael Payer
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, 8010 Graz, Austria
| | - Juergen Wallner
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria
| |
Collapse
|