Comprehensive functional outcome analysis and importance of bone remodelling on personalized cranioplasty treatment using Poly(methyl methacrylate) bone flaps

Cranioplasty involves the surgical reconstruction of cranial defects arising as a result of various factors, including decompressive craniectomy, cranial malformations, and brain injury due to road traffic accidents. Most of the modern decompressive craniectomies (DC) warrant a future cranioplasty surgery within 6-36 months. The conventional process of capturing the defect impression and polymethyl methacrylate (PMMA) flap fabrication results in a misfit or misalignment at the site of implantation. Equally, the intra-operative graft preparation is arduous and can result in a longer surgical time, which may compromise the functional and aesthetic outcomes. As part of a multicentric pilot clinical study, we recently conducted a cohort study on ten human subjects during 2019-2022, following the human ethics committee approvals from the participating institutes. In the current study, an important aspect of measuring the extent of bone remodelling during the time gap between decompressive craniectomy and cranioplasty was successfully evaluated. The sterilised PMMA bone flaps were implanted at the defect area during the cranioplasty surgery using titanium mini plates and screws. The mean surgery time was 90 ± 20 min, comparable to the other clinical studies on cranioplasty. No signs of intra-operative and post-operative complications, such as cerebrospinal fluid leakage, hematoma, or local and systemic infection, were clinically recorded. Importantly, aesthetic outcomes were excellent for all the patients, except in a few clinical cases, wherein the PMMA bone flap was to be carefully customized due to the remodelling of the native skull bone. The extent of physiological remodelling was evaluated by superimposing the pre-operative and post-operative CT scan data after converting the defect morphology into a 3D model. This study further establishes the safety and efficacy of a technologically better approach to fabricate patient-specific acrylic bone flaps with improved surgical outcomes. More importantly, the study outcome further demonstrates the strategy to address bone remodelling during the patient-specific implant design.

Quantitate evaluation of photogrammetry with CT scanning for orbital defect

Facial deformities can be caused by cancer, tumours, trauma, infections, congenital or acquired defects and may lead to alteration in basic functions such as communication, breathing, and mastication and aesthetic thereby affecting quality of life. Traditional processes for manufacturing maxillofacial prostheses involve complicated, time-consuming and tedious processes for the patient and the operator. Impression of the defect area, which is the one of the crucial step in fabrication of prosthesis, is the longest and most difficult process as it requires a long contact with the patient. The digital revolution is now changing the landscape of prosthetic production and making the impression making procedure simpler. Digital technology reduces patient chair side time by providing more accurate display data in less time (3-5 min) than traditional methods. Digital impressions eliminate the need for bulky impression materials and provide a more comfortable patient experience.

Two Rooted Mandibular Second Premolar: An Unusual Finding

Understanding the root and canal anatomy is pivotal before initiating endodontic surgical procedures. Any missed canal will cause treatment failure and ultimately lead to tooth extraction in this era of tooth conservation. Mandibular second premolars have attracted researchers and clinicians for having aberrant anatomy. Variations in the number of roots or canals may not be discerned on 2D radiographs and may become apparent during treatment procedures. The occurrence of two roots in the lower second premolar has been reported in the current case. Here, in this case, the authors have described the clinical course of the patient along with the management of these two rooted mandibular second premolars.

Development of customized implant and customized surgical osteotomy guide in ablative tumor surgery for accurate mandibular reconstruction

OBJECTIVES

The objective of this study was to provide the generalized methodology for design and development of a customized implant and customized surgical osteotomy guide (CSOG) for precise mandibular tumor resection and placement of a customized implant in ablative tumor surgery for accurate mandibular reconstruction.

METHODS

Medical imaging technique, image processing, virtual surgical planning (VSP), biomedical computer-aided design (CAD), and rapid prototyping (RP) were used to develop CSOG and customized implant. A mock surgical test and an experimental analysis were performed on the biomodel (RP assisted diseased model) to check the effectiveness of the CSOG.

RESULTS

The paired t test showed the statistically significant result with the use of CSOG as compared to the without using CSOG in ablative mandibular tumor surgery.

CONCLUSIONS

A mock test and an experimental analysis proved that, the precise tumor resection and customized implant placement with minimal gap between bone-implant junctions in mandibular reconstruction using CSOG.