Aula Fluxo Digital PDF

FLUXO DE TRABALHO DIGITAL NA REABILITAÇÃO COM IMPLANTES
FACULDADE DE MEDICINA DENTÁRIA, UNIVERSIDADE CATÓLICA PORTUGUESA
CBCT
FLUXO DE TRABALHO DIGITAL NA Cone-Beam Computed Tomography
REABILITAÇÃO COM IMPLANTES DENTÁRIOS
GUIDED SURGERY CAD-CAM

Computorized surgical guides Chairside ; In-Lab ; Milling Center
1 2
FLUXO DE TRABALHO DIGITAL NA REABILITAÇÃO COM IMPLANTES FLUXO DE TRABALHO DIGITAL NA REABILITAÇÃO COM IMPLANTES
FACULDADE DE MEDICINA DENTÁRIA, UNIVERSIDADE CATÓLICA PORTUGUESA FACULDADE DE MEDICINA DENTÁRIA, UNIVERSIDADE CATÓLICA PORTUGUESA
1 2 3 4
Data acquisition Planning Guide production Surgical procedure
• CB(CT) scan • Stereolithography
or
• CT scan
• Polyjet
+
• « Medical Image Data • Thermoforming
• IOS scan + drilling
Conversion » software
or • Guided instruments
• CADCAM scan • Milling • Guided implants
or
• Scan template Validation
required
▪ Dentist ▪ Dentist ▪ Dentist

▪ Lab ▪ Lab ▪ Lab DENTIST
▪ 3rd party ▪ 3rd party ▪ 3rd party
CBCT = Cone Beam Computed Tomography

DICOM = Digital imaging and communication in medicine
STL format = STereoLithography file format,, backronyms such as "Standard Triangle Language" and "Standard Tessellation Language
Stereolithography = (lso known as SL or SLA)
3 4
Software with algorithms that allow to generate 3D data, that may be used in image reconstruction in 3 plans…
• AXIAL
CBCT scanners are based on • SAGITAL
volumetric tomography. • CORONAL
The cone-beam technique … and 3D VOLUMETRIC RECONSTRUCTION

involves a single 360° scan in
which the x-ray source and a
PARADIGM SHIFT
reciprocating area detector
synchronously move around the
patient’s head, which is
stabilized with a head holder.
Scarfe W, 2006
CONE-BEAM FAN-BEAM
2D 3D
5 6
1 WHY TO
USE?
PARAMETERS
1 WHY TO
USE? 2 RADIATION
DOSE LEVEL 3 INFLUENCE
IMAGE
QUALITY
The overall advantage of using CBCT in implant dentistry
is related to its ability to acquire detailed volumetric
image data of the maxillofacial region for diagnostic and
HOW TO VIRTUAL
presurgical planning purposes.
4 INDICATIONS
5 OPTIMIZE
CBCT?
6 PATIENTS &
SURGICAL
GUIDES
Jacobs et al. Cone-beam computed tomography in implant dentistry: recommendations for clinical use. BMC Oral Health (2018) 18:88
Fokas G, Vaughn VM, Scarfe WC, Bornstein MM. Accuracy of linear measurements on CBCT images related to presurgical implant treatment planning: A systematic review. Clin Oral Impl Res. 2018;29(Suppl. 16):393– 415.
7 8
1 WHY TO
USE? 1 WHY TO
USE?
It should therefore be stated that research findings

in-House
Jacobs et al. BMC Oral Health (2018) 18:88 Page 5 of 16
Relative low-cost Ease of use Volumetric 3D cannot simply be generalized as published evidence
Compact
may often refer to one CBCT machine and not

considered as a true advantage. It should preferably be Which parameters influence image quality in CBCT?
capabilities of volumetric jaw bone imaging at reasonable costs and doses, with a
an equivalent of 2 to maximally 10 panoramic radio- Image quality performance of CBCT devices may vary
relative advantage of having a compact, affordable, and nearby or in-house equipment
graphs (20–100 μSv) [1, 5, 8]. Unfortunately, commercially widely, similar to, but not only related to exposure pro- necessarily apply to other equipment
available CBCT systems seem to vary enormously. Radi- tocols and radiation dose ranges [1, 7, 8]. CBCT images
ation dose levels differ according to the CBCT device being are usually considered offering a high spatial resolution
assessed, from around 10 μSv to 1000 μSv (which is an with voxel sizes of reconstructed CBCT datasets ranging
equivalent of 2–200 panoramic radiographs) (Fig. 4). It is between 0.08 and 0.4 mm [1]. Small voxel sizes could be
noteworthy that even one CBCT may present with a huge diagnostically useful for cases in which small structures
there is a enormous variation in radiation doses
range in parameter settings, likewise creating an enormous such as root canals and periodontal tissues need to be
variation in dose and image quality output [1, 5, 8]. depicted. Variation is also observed when it comes to and image quality and attributed to machine- and
Low dose protocols have been recommended to assist segmentation accuracy. The latter is a crucial factor
practitioners in optimisation [7, 8]. This has been picked when going for an integrated virtual planning including
up by manufacturers of CBCT equipment, who intro- jaw bone models, fabrication of radiographic and surgi-
protocol-dependent variables
duced low-dose protocols that might even get into the cal guides as well as further prosthetic models. Depending
dose ranges of panoramic images. Nevertheless, there is on the CBCT and the parameter settings, a 200 μm
still acomputed
Jacobs et al. Cone-beam need tomography
to design studies
in implant defining
dentistry: the forrequired
recommendations image
clinical use. BMC Oral Healthaccuracy
(2018) 18:88 level should be feasible [1, 5]. However, larger in-
Fokas G, Vaughn VM, Scarfe WC, Bornstein MM. Accuracy of linear measurements on CBCT images related to presurgical implant treatment planning: A systematic review. Clin Oral Impl Res. 2018;29(Suppl. 16):393– 415. Jacobs et al. Cone-beam computed tomography in implant dentistry: recommendations for clinical use. BMC Oral Health (2018) 18:88
quality in relation to implant dentistry, meanwhile fully accuracies may apply (up to 1000 μm and above) [1, 5].
balancing the radiation dose output of such image qual- Multi-slice CT often has a better contrast resolution,
9 10
ity requirements [9]. Furthermore, medical imaging is aiding segmentation and bringing error rates down as
constantly on the move, and thus it should be realised compared to CBCT.
that the dose advantage frequently cited for CBCT Another shortcoming of CBCT is the lack of diagnos-
FLUXO DE compared
TRABALHO with mulitslice
DIGITAL CT NA is relative.
REABILITAÇÃODepending on COMtically distinct soft tissue contrast, narrowing down the
IMPLANTES FLUXO DE TRABALHO DIGITAL NA REABILITAÇÃO COM IMPLANTES
the CT generation and the applied exposure protocol, diagnostic potential and hampering applications for soft
FACULDADE DE MEDICINA
radiation levels DENTÁRIA,
for multislice UNIVERSIDADE
CTs may even CATÓLICAbe lower PORTUGUESA tissue integration in the presurgical planning. Further- FACULDADE DE MEDICINA DENTÁRIA, UNIVERSIDADE CATÓLICA PORTUGUESA
than for CBCT scans [8, 10]. This progress in dose opti- more, Hounsfield units do not apply to CBCT images,
misation for 2D and 3D technologies demonstrates yielding it impossible to compare grey values among or
clearly that radiation dose and related risks are dynamic within patients over time [11]. This lack of standardized
1 WHY TO
1 WHY TO
entities, that need to be frequently monitored and grey value distribution is complicating the use of CBCT
reconsidered. for clinical bone density assessment and follow-up of
USE?
Furthermore, radiation dose levels should be regarded bone density changes. Hounsfield units (HU) have been USE?
as indication-oriented and patient-specific. Only when designed for medical CT, but do not apply for CBCT
respecting the strategy of time-dependent monitoring of [11]. Compared to HU units for medical CT, the reliability
indication-oriented and patient-specific radiation doses, of CBCT-based jaw bone density assessment has been
a dental practitioner may really RADIATION
comply to ALADIP DOSE prin-VSfound IMAGE QUALITY
unreliable over time and with significant variations
ciples for optimisation and radiation protection in daily influenced by CBCT devices, imaging parameters and po-
It would
practice (Fig. be simple and straightforward to reduce
5) [9]. sitioning radiation
[11]. This lack doses
of HU to extremelyislow
standardization a major
Eﬀective radiation dose: should be
levels, but… such extreme low dose levels may render images diagnostically useless. equivalent to 20–100 μSv 
(2-10 panoramics)
Nowadays, the variation is huge!

10 μSv-1000 μSv 
(2–200 panoramics)
Fig. 4 Variation in radiation doses of dental CBCT in relation to dose ranges of other orofacial imaging modalities and natural background radiation
Jacobs et al. Cone-beam computed tomography in implant dentistry: recommendations for clinical use. BMC Oral Health (2018) 18:88 Jacobs et al. Cone-beam computed tomography in implant dentistry: recommendations for clinical use. BMC Oral Health (2018) 18:88
11 12
PARAMETERS
2 RADIATION
DOSE 3 INFLUENCE
IMAGE
QUALITY
MAXIMUM INFORMATION & LOW RADIATION

HOUNSFIELD UNITS:
ALARA: as low as reasonable achievable Help but… do not apply to CBCTs !
ALADA: as low as diagnostically acceptable HU have been designed for Medical CTs (MDCT)
Compared to HU units for medical CT, the reliability of CBCT-based jaw
bone density assessment has been found unreliable over time and with
ALADAIP: as low as diagnostically acceptable being
significant variations influenced by CBCT devices, imaging parameters
indication-oriented and patient-specific
and positioning
Oenning AC, Jacobs R, Pauwels R, Stratis A, Hedesiu M, Salmon B, Dimitra Research Group. Cone-beam CT in paediatric dentistry: DIMITRA project position statement. Pediatr Radiol. 2018;48(3):308–16. Jacobs et al. Cone-beam computed tomography in implant dentistry: recommendations for clinical use. BMC Oral Health (2018) 18:88
Fokas G, Vaughn VM, Scarfe WC, Bornstein MM. Accuracy of linear measurements on CBCT images related to presurgical implant treatment planning: A systematic review. Clin Oral Impl Res. 2018;29(Suppl. 16):393– 415. Fokas G, Vaughn VM, Scarfe WC, Bornstein MM. Accuracy of linear measurements on CBCT images related to presurgical implant treatment planning: A systematic review. Clin Oral Impl Res. 2018;29(Suppl. 16):393– 415.
13 14
PARAMETERS
3 INFLUENCE UNIDADES DE HOUNSFIELD VS

4 INDICATIONS
PO
IMAGE ANÁLISE ESTRUTURAL DO OSSO
QUALITY
S-
O
P
A evolução da qualidade de imagem dos CBCTs permite
visualizar padrões de osso trabecular, o que parece indicar
que se podem aplicar métodos de análise estrutural do osso
(como nos micro-CTs ou na histologia) PRE-SURGICAL
S
N
IO
TESE DOUTORAMENTO SCHNEIDER D. (PUCRS, 11/2018) -
AT
CONCLUSÕES:
IC
Os parâmetros de análise de textura do osso trabecular Matriz
PL
de Co-Ocorrência de Níveis de Cinza (Gray Level Co-
M
occurrence Matrix – GLCM) foram preditores de perda óssea O
marginal de implantes curtos na região posterior. C
Jacobs et al. Cone-beam computed tomography in implant dentistry: recommendations for clinical use. BMC Oral Health (2018) 18:88 Jacobs et al. Cone-beam computed tomography in implant dentistry: recommendations for clinical use. BMC Oral Health (2018) 18:88
15 16
4 INDICATIONS PRE-SURGICAL INDICATIONS

4 INDICATIONS PRE-SURGICAL INDICATIONS
IMPLANT PLANNING 1.Identification of critical anatomic boundaries
2.Prevention of neurovascular trauma

• Radiographic fidelity of the bone structure anatomy
3.Specific challenges for the anterior esthetic zones
• Accuracy of linear measurements
4.Borderline cases related to inadequate bone morphology, volume and quality
5.Augmentation procedures
6.Special techniques (grafting, distraction, zygoma implants)
7.Suspected trauma history of jaws and teeth
8.Doubtful prognosis of neighboring teeth
9.Pre-surgical planning and transfer
10.The virtual patient
17 18
4 INDICATIONS POST-OPERATIVE INDICATIONS / COMPLICATIONS

4 INDICATIONS FOLLOW-UP
CBCT: not the ideal tool (still)

‣ Evaluate healing of more complex surgical procedures (e.g. GBR)
2D: still is the primary imaging modality
‣ Neuro-vascular trauma (e.g. IAN)
‣ Implant removal (e.g. infections, mechanical complications…) no consensus conference has ever questioned the
2D intra-oral peri-implant bone level measures
(Jacobs, 2018)
19 20
How to Como
How to
5 optimize
CBCT…
5 optimizar o
optimize
CBCT…
CBCT?
‣ FOV & ROI (field of view & region of interest)
‣ Stressed patient should close the eyes during the CBCT
‣ Higher resolutions (<200μm) can produce more artifacts, noise in

the image, if there are several restorations in the mouth (metal,
zirconia, etc.)
‣ Cotton-roll to separate teeth (maxila / mandible)
To instruct
‣ Cotton-roll to separate the lips (or lip retractor) dental
assistants
21 22
Como
How to Como
How to
5 optimizar o
optimize
CBCT…
CBCT?
5 optimizar o
optimize
CBCT…
CBCT?
Scanned model SCANNED CBCT IMPLANT

WAX-UP PLANNING
IMAGE VIRTUAL 3D DATA
CBCT DIAGNOSIS DATA ANALYSIS
SEGMENTATION PLANNING FUSION
SEVERAL STEPS…
POTENTIAL ERROR IN EACH STEP…
3D reconstruction of the CBCT
SCANNED MODEL
Jacobs et al. Cone-beam computed tomography in implant dentistry: recommendations for clinical use. BMC Oral Health (2018) 18:88 2012
23 24
VIRTUAL
6 PATIENT &
SURGICAL
GUIDES
VIRTUAL PATIENT
Digital record used in the planification of the ideal position of the implants in relation to
several surgical, prosthetical and esthetical parameters.
It integrates information from several data sets: CBCTs, 3D models, facial scanners, etc.
PROSTHETICALLY-DRIVEN SURGERY
INTRA-ORAL SCANNER
Excellent accuracy, up to 10x better than CBCT
?More comfortable for the patient than conventional impressions?
More efficient for digital integration
PROSTHETICALLY-DRIVEN SURGERY
25 26
VIRTUAL Paciente
6 PATIENT &
SURGICAL
GUIDES
6 Virtual &
Guias
Cirúrgicas
Dental restorations / < Visibility of teeth in

Radiological Artifacts
prosthesis the CBCT
Artefacts are even worse with denser material

MAR - metal artefact reduction
and thus more pronounced with implants in
Pouca evidência científica clínica
zirconium than in titanium (Jacobs, 2018)
References in Teeth or x correct Integration

< Accuracy Guided Surgery
Radiological Guides (merge) of data 2011
Jacobs et al. Cone-beam computed tomography in implant dentistry: recommendations for clinical use. BMC Oral Health (2018) 18:88 RADIOLOGICAL ARTIFACTS
27 28
Paciente Paciente
6 Virtual &
Guias
Cirúrgicas
6 Virtual &
Guias
Cirúrgicas
2011 2011
ARTEFACTOS
RADIOLOGICAL
RADIOLÓGICOS
ARTIFACTSVS
VSMODELO
SCANNED
ESCANEADO
MODEL SCANNED MODEL
29 30
31 32
VIRTUAL It’s essential to separate the “dental arch / jaw of VIRTUAL It’s essential to separate the “dental arch / jaw of
6 PATIENT &
SURGICAL
GUIDES
interest”, in order to superimpose more easily and with
more accuracy the 3D model (.STL).
6 PATIENT &
SURGICAL
GUIDES
33 34
VIRTUAL It’s essential to separate the “dental arch / jaw of VIRTUAL It’s essential to separate the “dental arch / jaw of
6 PATIENT &
SURGICAL
GUIDES
6 PATIENT &
SURGICAL
GUIDES
2007...
...2019
35 36
VIRTUAL It’s essential to separate the “dental arch / jaw of Paciente O isolamento da arcada de interesse no CBCT é
6 PATIENT &
SURGICAL
GUIDES
6 Virtual &
Guias
Cirúrgicas
fundamental, para que o modelo 3D (.STL) se possa
sobrepor com mais precisão.
37 38
39 40
DAY 0 12 years
8 months after implant placement (Q1)

41 42
• Pre-op and Post-op analysis, including complications.

• Radiation dose is significantly lower than medical CT, but superior to
2D imaging.
CONCLUSIONS
• The decision to perform a CBCT must be based always in the specific
patient’s needs.
• It may be considered a primary image modality in specific situations
…
(e.g. multiple treatments, oral pathology in the sinus, bone, etc.)
• The Field of View (FOV) must be restricted to the Region of
Interest (ROI).
• ?It is recommendable the use of a radiological stent to maximize
the surgical/prosthetical information.?
ITI CONSENSUS STATEMENT 5th ITI CONSESUS CONFERENCE
43 44
The majority of studies are ex. vivo, so the accuracy of the linear
• Primary imaging modality for 3D analysis to place dental
measurements may ‘not be exactly the same’ in the “real daily
implants.
practice”.
• Minimum safe distance of 2mm to relevant anatomical structures.
Lack of homogeneity in the analyzed studies
• Smaller voxel size do not increase the precision of linear measurement (no meta-analysis).
in the CBCT.
• Voxel with a size of 0,3-0,4 mm, smaller FOV and, if possible, In general, computerized guided-surgery may be
partial rotations, should be used in the PRE-OP planning to reduce considered precise if carefully executed.
patient exposure to radiation: image quality similar to CBCT with However, errors during CBCT, in the planning, in the surgical
smaller voxel and larger FOV.
guide, may cause un-acceptable clinical deviations.
45 46
1 2 3 4 1 2 3 4
Data acquisition Planning Guide production Surgical procedure Data acquisition Planning Guide production Surgical procedure
• CB(CT) scan • Stereolithography • Stereolithography
or
• CT scan
• Polyjet • Polyjet
+
• « Medical Image Data • Thermoforming • « Medical Image Data • Thermoforming
• IOS scan + drilling + drilling
Conversion » software Conversion » software
or • Guided instruments • Guided instruments
• CADCAM scan • Milling • Guided implants • Milling • Guided implants
or
• Scan template Validation Validation
required required
▪ Dentist ▪ Dentist ▪ Dentist ▪ Dentist ▪ Dentist

▪ Lab ▪ Lab ▪ Lab DENTIST ▪ Lab ▪ Lab DENTIST
▪ 3rd party ▪ 3rd party ▪ 3rd party ▪ 3rd party ▪ 3rd party
CBCT = Cone Beam Computed Tomography CBCT = Cone Beam Computed Tomography
DICOM = Digital imaging and communication in medicine DICOM = Digital imaging and communication in medicine
STL format = STereoLithography file format,, backronyms such as "Standard Triangle Language" and "Standard Tessellation Language STL format = STereoLithography file format,, backronyms such as "Standard Triangle Language" and "Standard Tessellation Language
Stereolithography = (lso known as SL or SLA) Stereolithography = (lso known as SL or SLA)
47 48
1,2mm
‣ Implants placed utilizing computer-guided surgery with a follow-up

period of at least 12 months demonstrate a mean survival rate of
97.3% (n = 1,941) (comparable to conventional procedures). (2014)
‣ More data to support the accuracy of computer-guided implant
(STATIC) COMPUTER-AIDED IMPLANT SURGERY ‣ Meta-analysis of the accuracy revealed:
ITI CONSENSUS REPORT (GROUP 5) ‣ Mean error of 1.2 mm at the entry point (2014: 1,12mm / 2009 - 0,74mm)
‣ Mean error of 1.5 mm at the implant apex (2014: 1,39mm / 2009 - 0,85)
‣ Mean angular deviation of 3.5 degrees (2014; 3,89º)
‣ After template osteotomy preparation, the accuracy of template
implant insertion was superior to freehand implant insertion.
1,5 3,5º
Future long-term clinical data are necessary to identify clinical indications and to justify additional
radiation doses, effort, and costs associated with computer-assisted implant surgery.
49 50
‣ Guided surgery should always be prosthetically driven.

‣ Information to be gathered from the combination of high-quality CBCT images and digital
planning should include locations of vital structures, desired implant positions and
dimensions, the need for augmentation therapy, and the planned prostheses.
Super-imposition of the diagnostic

wax-up to “real” case
51 52
‣ Due to the reported mean deviations, an additional 2 mm should be taken into consideration
when planning implant position with relation to vital structures and adjacent implants in all
directions. In borderline cases, an intraoperative periapical radiograph should be taken as ‣ Guided surgery may be utilized with a flapless or raised flap approach.
a safety measure. ‣ For improved accuracy, implants should be inserted in a fully guided manner (versus
guided implant bed preparation alone) whenever possible.
53 54
Periodontology Post-Graduation Course / UCP (Dec-2019): Clinical Case Dr CS |& Dr ES ; Mentors: Dr. Tiago Marques & Prof. André Correia Periodontology Post-Graduation Course / UCP (Dec-2019): Clinical Case Dr CS |& Dr ES ; Mentors: Dr. Tiago Marques & Prof. André Correia
55 56
1. MAIN INDICATIONS / ADVANTAGES

1.1. Partial edentulous patients
1.2. Extensive prosthetic rehabilitations, that require a previous wax-up and modifications of
teeth position/alignment.
1.3. Enough bone quality/quantity and queratinized gingiva to allow flapless surgery
1.4. Anatomical boundaries (e.g. sinus, IAN, tilted teeth/roots).
1.5. One-piece dental implants. E.g. Straumann® Pure Ceramic Implant
1.6. Prosthetical spaces with M-D limitations (e.g. lateral incisors, lower incisors).
1.7. Rehabilitation with screwed prosthesis over implants
Periodontology Post-Graduation Course / UCP (Dec-2019): Clinical Case Dr CS |& Dr ES ; Mentors: Dr. Tiago Marques & Prof. André Correia
57 58
2. MAIN LIMITATIONS / DISADVANTAGES

2.1. Complete edentulism
2.2. Soft-tissue or bone-support
2.3. Lack of queratinized gingiva.
2.4. The perforation holes in the guide cannot be
adjusted during the surgery
59 60
? Computer guided-surgery VS Brain guided-surgery ?

LIMITATIONS / COMPLICATIONS
Tahmaseb Ali et al. Computer technology applications in surgical implant dentistry: a systematic review.
Int J Oral Maxillofac Implants. 2014;29 Suppl:25-42..
Several limitations / complication reported in the literature
‣ 36.4% of technical/surgical/prosthetic complications (e.g. fracture

of the guide during surgery, change of plans, lack of primary
stability of the implant)
‣ The inter-occlusal distance is limited and may limit the use of the
surgical burs…
Clinical case by Dr. Tiago Marques and Prof. André Correia
61 62
LIMITATIONS / COMPLICATIONS
CLINICAL RECOMMENDATIONS
‣ s-CAIS: aditional tool to improve diagnosis, treatment plan and
surgical procedure.
‣ s-CAIS must be PROSTHETICALLY-DRIVEN!
‣ s-CAIS requires surgical experience and previous training to

obtain more favourable and accurate results.
‣ Keep a “safe distance” of 2mm.
‣ Recommend the alignment of the models (from the 3D scanner), and

inclusive of the planification, to improve the anatomical position of
the implant.
‣ s-CAIS must be designed in a 3D model obtained from the jaw

surface, correctly alligned with the 3D rendering of the DICOM
data (more accurate than only the DICOM)
‣ Follow the manufacturer instructions in regard to the calibration

protocols in order to achieve the best/optimal results.
Kennedy Class I and II Limitation of Mouth Opening
63 64
CLINICAL RECOMMENDATIONS CLINICAL RECOMMENDATIONS
CASO CLÍNICO - IMPLANTE STRAUMANN® Bone-level 14
Tiago Marques André Correia
65 66
67 68
FLUXO DE TRABALHO DIGITAL NA REABILITAÇÃO COM IMPLANTES FLUXO
FLUXO DIGITALDIGITAL
DE TRABALHO EM IMPLANTOLOGIA
NA REABILITAÇÃO COM IMPLANTES
69 70
FLUXO DE TRABALHO DIGITAL NA REABILITAÇÃO COM IMPLANTES FLUXO

FLUXO DIGITALDIGITAL
DE TRABALHO EM IMPLANTOLOGIA
NA REABILITAÇÃO COM IMPLANTES
FACULDADE DE MEDICINA DENTÁRIA, UNIVERSIDADE CATÓLICA PORTUGUESA Study Club Porto
FACULDADE 2, MaioDENTÁRIA,
DE MEDICINA 2019 UNIVERSIDADE CATÓLICA PORTUGUESA
71 72
A IMPORTÂNCIA DA COMUNICAÇÃO COM O LABORATÓRIO DE

PRÓTESE DENTÁRIA - TEAM WORK!
Sr. Zsolt Kovacs (HU / PT) PS PROTESIS DENTAL IDEAL PROTESE

INOVESMILE LAB Sr. Raul Pereira (PT) Sr. Fernando Sanchez (ES) Sr. Michel Morais (PT)
ITI SECTION IBERIA
73 74
Fellows 2019
Portuguese Catholic University
75 76
‘CURRENT PROJECTS’
What reality?!
Present & Future?
Cost-benefit?
Optimization
WORKFLOW
DMD & CDT
77 78
79 80
FLUXO DE TRABALHO DIGITAL NA REABILITAÇÃO COM IMPLANTES
FACULDADE DE MEDICINA DENTÁRIA, UNIVERSIDADE CATÓLICA PORTUGUESA
81

Aula Fluxo Digital PDF

Caricato da

Informazioni sul documento

Titolo originale

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

Aula Fluxo Digital PDF

Caricato da

Copyright:

Formati disponibili

FLUXO DE TRABALHO DIGITAL NA REABILITAÇÃO COM IMPLANTES

FACULDADE DE MEDICINA DENTÁRIA, UNIVERSIDADE CATÓLICA PORTUGUESA

REABILITAÇÃO COM IMPLANTES DENTÁRIOS

GUIDED SURGERY CAD-CAM

• CB(CT) scan • Stereolithography

▪ Dentist ▪ Dentist ▪ Dentist

CBCT = Cone Beam Computed Tomography

The cone-beam technique … and 3D VOLUMETRIC RECONSTRUCTION

It should therefore be stated that research findings

may often refer to one CBCT machine and not

Nowadays, the variation is huge!

MAXIMUM INFORMATION & LOW RADIATION

3 INFLUENCE UNIDADES DE HOUNSFIELD VS

4 INDICATIONS PRE-SURGICAL INDICATIONS

IMPLANT PLANNING 1.Identification of critical anatomic boundaries

2.Prevention of neurovascular trauma

6.Special techniques (grafting, distraction, zygoma implants)

7.Suspected trauma history of jaws and teeth

8.Doubtful prognosis of neighboring teeth

9.Pre-surgical planning and transfer

10.The virtual patient

4 INDICATIONS POST-OPERATIVE INDICATIONS / COMPLICATIONS

CBCT: not the ideal tool (still)

‣ FOV & ROI (field of view & region of interest)

‣ Stressed patient should close the eyes during the CBCT

‣ Higher resolutions (<200μm) can produce more artifacts, noise in

‣ Cotton-roll to separate teeth (maxila / mandible)

Scanned model SCANNED CBCT IMPLANT

POTENTIAL ERROR IN EACH STEP…

3D reconstruction of the CBCT

Dental restorations / < Visibility of teeth in

Artefacts are even worse with denser material

References in Teeth or x correct Integration

8 months after implant placement (Q1)

• Pre-op and Post-op analysis, including complications.

ITI CONSENSUS STATEMENT 5th ITI CONSESUS CONFERENCE

• CB(CT) scan • Stereolithography • Stereolithography

▪ Dentist ▪ Dentist ▪ Dentist ▪ Dentist ▪ Dentist

‣ Implants placed utilizing computer-guided surgery with a follow-up

‣ Guided surgery should always be prosthetically driven.

Super-imposition of the diagnostic

1. MAIN INDICATIONS / ADVANTAGES

2. MAIN LIMITATIONS / DISADVANTAGES

? Computer guided-surgery VS Brain guided-surgery ?

Several limitations / complication reported in the literature

‣ 36.4% of technical/surgical/prosthetic complications (e.g. fracture

Clinical case by Dr. Tiago Marques and Prof. André Correia

‣ s-CAIS must be PROSTHETICALLY-DRIVEN!

‣ s-CAIS requires surgical experience and previous training to

‣ Keep a “safe distance” of 2mm.

‣ Recommend the alignment of the models (from the 3D scanner), and

‣ s-CAIS must be designed in a 3D model obtained from the jaw

‣ Follow the manufacturer instructions in regard to the calibration

CLINICAL RECOMMENDATIONS CLINICAL RECOMMENDATIONS

CASO CLÍNICO - IMPLANTE STRAUMANN® Bone-level 14

Tiago Marques André Correia

CLINICAL RECOMMENDATIONS CLINICAL RECOMMENDATIONS

FLUXO DE TRABALHO DIGITAL NA REABILITAÇÃO COM IMPLANTES FLUXO

A IMPORTÂNCIA DA COMUNICAÇÃO COM O LABORATÓRIO DE

Sr. Zsolt Kovacs (HU / PT) PS PROTESIS DENTAL IDEAL PROTESE

ITI SECTION IBERIA

Portuguese Catholic University

Present & Future?