Digital Workflow in Oral and Maxillofacial Surgery
Daniel Negrelle, Alexandre M. Borba, Isabella Romão Candido, Shaban M. Burgoa, Luiz F. Palma, and Arthur R.G. Cortes
7.1 Image‐Guided Surgical Removal of Impacted Teeth
With current technology in digital dentistry, different types of surgical guides can be designed. CAD software enables the digital planning of the entire surgical procedure and then the digital design of guides that can be printed or milled in order to orientate the procedures. Surgical planning of procedures involving osteotomies allows for designing surgical guides to provide precise access to the anatomical location and for calculating the amount of bone to be removed. This is particularly useful in cases of retrieval of foreign bodies or impacted teeth. In addition, digital workflow allows for sharing treatment plan data immediately with a network of other professionals, enhancing communication among patients and professionals .
Among the most important requirements for planning an image‐guided surgery is the combination of STL files from intraoral scans (IOS) and DICOM files from cone beam computed tomography (CBCT). Such combination allows for considering conditions of hard and soft tissues during virtual surgical planning . In cases involving oral rehabilitation following surgery, prosthetically driven virtual implant planning can also be carried out . Furthermore, digital workflow methodologies have also been described for orientating bone grafting procedures [4, 5]. However, despite new types of surgical guides which have recently been designed and used in dentistry [4, 6], it was not possible to find any article in the literature describing the use of a sleeveless surgical guide for orientating surgical removal of supernumerary tooth impacted between adjacent roots.
A surgical technique using a CAD‐CAM surgical guide for removal or retrieval of impacted objects in the maxilla is presented and illustrated with the following clinical case: an 18‐year‐old male patient who presented for orthodontic treatment was referred for surgical removal of a supernumerary tooth. The patient signed an informed consent to present his treatment data in this report.
7.2 Surgical Planning of Orthognathic Surgeries
Accurate presurgical planning is essential for the treatment of dentofacial deformities, especially in orthognathic surgeries. Virtual surgical planning is the current gold standard method to achieve greater precision for bone and dental movements as well as to gain a reliable perspective of postsurgical changes to facial soft tissues.
7.2.1 Virtual Skull Construction
All virtual planning software programs, regardless of their particularities, are based on the same steps (image importation; virtual skull composition and orientation; osteotomy design; cephalometric landmarks definition; bone segment movement;splint construction). Case Report 7.3 will show these steps using Dolphin 3D v12.0 software.