Paradigm Shift in Materials for Skull Reconstruction Facilitated by Science and Technological Integration

Innovative hybrid approach: digital and analog fabrication of orbital prosthesis for post-COVID-19 mucormycosis defects using photogrammetry technique

In addition to anatomical loss, removal of the full or portion of the orbit results in a facial deformity and psychological distress for the patient. This article details a practical case of prosthetic rehabilitation using digital workflow for an orbital deformity caused by post-COVID-19 Mucor mycosis. The main goal of this case study was to create a maxillofacial orbital prosthesis that is well-retained, simple to use, and accurate in terms of appearance. The study addresses the problems involved in fabricating the orbital prosthesis, particularly the unique dimensions and form of the defect, replicating the natural skin tone, and accomplishing retention by the most prudent and patient-friendly approach. Through this article, a digitised algorithm, using photogrammetry technique for facial scan, is suggested for fabricating the prosthesis.

Full Mouth Rehabilitation With All-on-Six Concept With Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) Milled Bar Retained Zirconia Prosthesis

Full-mouth rehabilitation, also known as full-mouth reconstruction or restoration, is the comprehensive process of restoring and rehabilitating the function, aesthetics, and health of all teeth in the upper and lower jaws. This involves a multidisciplinary approach, addressing issues such as occlusion (bite), tooth wear, tooth loss, and periodontal (gum) health to achieve optimal dental function and appearance. This treatment provides a stable and reliable solution for dental problems associated with the complete or partial loss of dental elements. This case report discusses the management of a 72-year-old male patient who came with a chief complaint of decayed, missing, and mobility of his teeth. His medical history included drug-regulated diabetes and chronic periodontitis, which remained a reason behind his deteriorating dental health. The treatment plan encompassed a comprehensive approach, starting with the full-mouth extraction and progressing to the placement of six implants in both the mandibular and maxillary arches for complete restoration. After allowing eight weeks for healing, the impressions for the implants were recorded with the polyvinyl siloxane material. The case demonstrates the application of the all-on-six concept; whereby full arch rehabilitation is possible with the strategic placement of six implants. By employing the latest in advanced computer-aided design/computer-aided manufacturing (CAD/CAM), a zirconia prosthesis that was retained on a milled bar was fabricated-yielding a very high degree of accuracy and excellent aesthetics in the restoration. Restorations with zirconium were done, as it is excellent in aesthetics and functioning. This article considers the importance of precision planning, correct implant placement, and advances in dental science and technology. Most importantly, the conclusion that can be drawn is that the end outcome of total rehabilitation with all-on-six should not only be an affirmation that difficult cases can be managed very well but also the patient's quality of life is improved by using the latest dental procedures.

Crafting Confidence: A Comprehensive Case Study of Full-Mouth Reconstruction Utilizing Implant-Supported Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) Zirconia Restorations

A 67-year-old male patient reported to the department with a chief complaint of tooth mobility. The patient presented with a medical history of diabetes for which he was on medication, and he also reported a history of chronic periodontitis. After a thorough assessment of the patient, a proper treatment plan was designed, which included full-mouth rehabilitation, prior to which the patient was advised full-mouth extraction. Six implants were inserted into the mandibular and maxillary arches as part of the treatment. After the implant was placed, zirconia was the preferred choice for the restoration because of its superior aesthetic results. Polyvinyl siloxane impression material was used to make implant impressions after an eight-week healing period. The case report provides the technique for the current approach to full-mouth rehabilitation with all six concepts of implant placement. In these situations, it is crucial to plan and insert implants correctly and adhere to the entire treatment plan. Restorations were performed using the latest computer-aided design/computer-aided manufacturing (CAD/CAM) technologies for a more aesthetically pleasing result. The case study highlights the significance of meticulous preparation and implementation for the accomplishment of successful full-mouth rehabilitation.

Digitalization in Cranial Reconstruction: Revolutionizing Precision and Innovation

Cranioplasty for cranial defects can be complex and challenging in composite defects. The intricate 3D structure of the craniofacial skeleton poses various difficulties encountered in surgical reconstruction. The continuous progress in computer-aided design and computer-aided manufacturing design, and fabrication technology has led to a growing array of applications for visual analog scale and 3D printing in craniofacial surgery, encompassing preoperative assessment, the creation of cutting guides, and the development of custom implants and stereolithographic models. Within this review, the authors detail the present and developing applications of virtual surgical planning, 3D bioprinting, augmented reality, and virtual reality in craniofacial reconstruction.

In vivo validation of highly customized cranial Ti-6AL-4V ELI prostheses fabricated through incremental forming and superplastic forming: an ovine model study

Cranial reconstructions are essential for restoring both function and aesthetics in patients with craniofacial deformities or traumatic injuries. Titanium prostheses have gained popularity due to their biocompatibility, strength, and corrosion resistance. The use of Superplastic Forming (SPF) and Single Point Incremental Forming (SPIF) techniques to create titanium prostheses, specifically designed for cranial reconstructions was investigated in an ovine model through microtomographic and histomorphometric analyses. The results obtained from the explanted specimens revealed significant variations in bone volume, trabecular thickness, spacing, and number across different regions of interest (VOIs or ROIs). Those regions next to the center of the cranial defect exhibited the most immature bone, characterized by higher porosity, decreased trabecular thickness, and wider trabecular spacing. Dynamic histomorphometry demonstrated differences in the mineralizing surface to bone surface ratio (MS/BS) and mineral apposition rate (MAR) depending on the timing of fluorochrome administration. A layer of connective tissue separated the prosthesis and the bone tissue. Overall, the study provided validation for the use of cranial prostheses made using SPF and SPIF techniques, offering insights into the processes of bone formation and remodeling in the implanted ovine model.

Composite grafts made of polycaprolactone fiber mats and oil-based calcium phosphate cement pastes for the reconstruction of cranial and maxillofacial defects

OBJECTIVES

Synthetic bone substitutes which can be adapted preoperatively and patient specific may be helpful in various bony defects in the field of oral- and maxillofacial surgery. For this purpose, composite grafts made of self-setting and oil-based calcium phosphate cement (CPC) pastes, which were reinforced with 3D-printed polycaprolactone (PCL) fiber mats were manufactured.

MATERIALS AND METHODS

Bone defect models were acquired using patient data from real defect situations of patients from our clinic. Using a mirror imaging technique, templates of the defect situation were fabricated via a commercially available 3D-printing system. The composite grafts were assembled layer by layer, aligned on top of these templates and fitted into the defect situation. Besides, PCL-reinforced CPC samples were evaluated regarding their structural and mechanical properties via X-ray diffraction (XRD), infrared (IR) spectroscopy, scanning electron microscopy (SEM), and 3-point-bending testing.

RESULTS

The process sequence including data acquisition, template fabrication, and manufacturing of patient specific implants proved to be accurate and uncomplicated. The individual implants consisting mainly of hydroxyapatite and tetracalcium phosphate displayed good processability and a high precision of fit. The mechanical properties of the CPC cements in terms of maximum force and stress load to material fatigue were not negatively affected by the PCL fiber reinforcement, whereas clinical handling properties increased remarkably.

CONCLUSION

PCL fiber reinforcement of CPC cements enables the production of very freely modelable three-dimensional implants with adequate chemical and mechanical properties for bone replacement applications.

CLINICAL RELEVANCE

The complex bone morphology in the region of the facial skull often poses a great challenge for a sufficient reconstruction of bony defects. A full-fledged bone replacement here often requires the replication of filigree three-dimensional structures partly without support from the surrounding tissue. With regard to this problem, the combination of smooth 3D-printed fiber mats and oil-based CPC pastes represents a promising method for fabricating patient specific degradable implants for the treatment of various craniofacial bone defects.