JofIMAB-2016-vol22-issue3

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[CrossRef] 27. Wesley RK, Cullen CL, Bloom WS. Gardner’s syndrome with bilateral osteomas of coronoid process resulting in limited opening. Pediatr Dent. 1987 Mar;9(1):53-7. [PubMed] 28. Sondergaard JO, Rusmussen MS, Videbak H, Bernstein IT, Myrhoj T, Kristensen VB, et al. Mandibular osteomas in sporadic colorectal carcinoma. A genetic marker. Scad J Gastroenterol. 1993;28:23-4. 29. Pereira DL, Carvalho PA, Achatz MI, Rocha A, Tardin Torrezan G, Alves FA. Oral and maxillofacial considerations in Gardner’s syndrome: a report of two cases. Ecancermedicalscience. 2016 Feb 24;10:623. [PubMed] [CrossRef]. 30. Panjwani S, Bagewadi A, Keluskar V, Arora S. Gardner’s Syndrome, J Clin Imaging Sci. 2011; 1:65. [PubMed] [CrossRef]. Please cite this article as: Deliverska E. Peripheral Osteoma of Mandible - a case report and analysis of literature. J of IMAB. 2016 Jul-Sep;22(3):1274-1278. DOI: http://dx.doi.org/10.5272/jimab.2016223.1274 Received: 18/05/2016; Published online: 01/09/2016 Corresponding author: Associate prof. Elitsa Deliverska, PhD Department of Oral and Maxillofacial surgery, Faculty of Dental medicine, Medical University Sofia 1, St. Georgi Sofiiski Str., 1431 Sofia, Bulgaria. E-mail: elitsadeliverska@yahoo.com 1278 http://www.journal-imab-bg.org / J of IMAB. 2016, vol. 22, issue 3/
Journal of IMAB ISSN: 1312-773X http://www.journal-imab-bg.org http://dx.doi.org/10.5272/jimab.2016223.1279 Journal of IMAB - Annual Proceeding (Scientific Papers) 2016, vol. 22, issue 3 USE OF PLASTIC MATERIAL AND TRIPLE SCAN IN THE PREPARATION OF SURGICAL GUIDES FOR THE DENTAL IMPLANT TREATMENT - CASE REPORT Rosen Borisov, Department of Oral and diagnostic imaging, Faculty of Dental Medicine, Medical University – Sofia, Bulgaria Summary: The use of surgical guides in implant treatment increases the accuracy of the dental implant positioning compared with manual methods. Regardless of how they are made, deviations of implants from their intended position are established in all kinds of surgical guides. This article considers the use of plastic material and new scanning technique for the production of CAD/CAM surgical guides that aim to overcome the deficiencies of the currently applied technologies in the production of surgical guides. Materials and methods: The study shows the techniques used to overcome degraded by metal artifacts CBCT images in implant treatment of patients with partial edentulism, and located medially to the defect metal-ceramic crowns. When planning implant treatment, a triple scan method has been implied. At the beginning, CBCT scan of the patient with a silicone impression material is made in the zone of interest. Secondly, CBCT scan only of the silicon impression is made, and thirdly - intraoral scanning of the patient with an intraoral scanner. Virtual analogues have been created of images from the three scans and have been repositioned one over another; as thereby an intraoral image have been accurately positioned over the CBCT image of the patient. Virtual planning of the implant positioning has been performed, and a model of surgical guide has been made for their placement. The guide has been printed with an SLA 3D printer technology of photopolymer with dualistic characteristics-rigid in the working part and plastic in the fixing part. Through it, implants have been placed to the treatment planning. Postoperative CBCT has been done on the patient to measure the implant deviation to their position in the treatment planning. Results: Axes angular deviation of the planned and placed implants has not been established. Average linear displacement of 240 µ (+/- 40 µ) has been found. Conclusions: Using the triple scan method is possible to overcome the poor image quality of the metal (metalceramic) structures artifacts in CBTC scan of patients for implant treatment. Using semi-plastic material for printing of the surgical guide allows its good fixation intraoperative and the accurate guidance of the implant drill that provides the implant placement with clinically negligible deviation from their intended position. Keywords: CAD/CAM surgical guides, CBCT, dental implant, intraoral scanner, INTRODUCTION With the increasingly widespread use of implant treatment, the expectations of its results increase. Its planning takes substantial part of it and largely determines the final result [1]. Modern digital technology allows this process to be performed entirely in the digital environment without the need for physical models. Future prosthetic constructions are generated with software, and the position of the future implants is planned according to them, and the available bone tissue. Their position is translated intraoperative with surgical guides, as with virtual 3D printing, their virtual model becomes a physical one. The use of surgical guides when inserting the dental implants leads to their more accurate positioning in comparison with manual methods [2, 3, 4]. The production of these CAD/CAM surgical guides include the use of so called double scan method [5], its virtual creation based on CBCT images of the patient, its plastic model and its printing. Although this approach is a qualitatively new level compared to laboratory methods of surgical guides’ production, it has several drawbacks: Detail of CBCT images is low - they are used to create a virtual anatomical model for planning the implant positioning and a contact surface of the surgical guide is carried out on them (Fig.1) Detail of the CBCT depends on the scan resolution and varies between 150 and 600 µ. The uneven absorption of X-rays from different hard tissue (bone, enamel, and dentin) is an additional complication. Therefore, virtual models, created directly from X-ray images of patients, have uneven surface and guides created on them could not be adjusted exactly on their real anatomical analogue. This is compensated by the double scan technique whereby a gypsum cast from the patient is scanned, and positioned on the X-ray images of the patient. Spatial variations that could occur from possible deformation of the patient’s impression and its cast can not be avoided. An alternative to casts could be the use of intraoral scanners whose images are superimposed on the CBCT study. Scientific data on the use of this approach are scarce. In fact, only 3 articles have been found describing individual cases [6, 7, 8]. Here again two scans are performed, / J of IMAB. 2016, vol. 22, issue 3/ http://www.journal-imab-bg.org 1279
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APPLICATION OF 3D DIGITAL SCANNING
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