Work-flow beyond the guided implantology: 3D templates in oral surgery

Background: computer-guided technologies are adopted in various fields of surgery to limit invasiveness and obtain patient benefits in terms of surgery duration and post-operative course. Surgical templates realized through computer-aid- ed design (caD) and computer-aided manufacturing (caM) technologies are widely diffused in implant dentistry. the aim of this work is to propose, beyond implantology, the feasibility of application of 3D printed surgical templates in oral surgery procedures requiring osteotomies like maxillary cyst enucleation, tooth disimpaction and tooth transplantation in order to obtain accurate surgeries, avoide anatomical damage of surrounding structures and decrease patient’s morbidity. Methods: a stereolithography (Stl) file of maxillary structures is obtained by the use of a 3D medical image pro- cessing software (Materialise mimics 20.0) a segmentation toolbox acquiring rX volumes by cone-beam computed tomography (cbct). Digital models of teeth, acquired as Stl files directly by the use of an intra-oral scanner or indirectly by using the desktop scanners, are imported in the same 3D medical image processing software (Materialise mimics 20.0) and obtained Stl files of maxillary structures and teeth are superimposed. Data are transported into Blue Sky Plan 4.0 (Blue Sky Bio, llc), a software for 3D implant guides fabrication, together with the DicoM images package of maxillary volumes to carry out the pre-surgical treatment planning. anatomical structures (nerves, dental roots, etc.) at risk are identified; a contour of ideal incision shape and bone oste otomy extent is drawn. Once the settings are confirmed, file of the three-dimensional guide is generated and the document created is used to fabricate the surgical guide either through additive methods (3D printing) or subtractive methods (milling machines). the resulting 3D template is fabricated with the following major features: teeth support, flap incision design, bone osteotomy design. Results: the proposed work-flow assist the surgeon in both pre-operative and intra-operative work phases through accurate virtual planning and the fabrication of precise surgical guides to be used in oral surgery practice. the use of CAD-CAM technologies in 3D oral surgery planning allows a better control of the osteotomy planes and flap management. 3D templates in oral surgery could be employed in order to safeguard adjacent healthy tissues and guarantee minimum tissue damage and good coverage. Conclusions: objective of the study was to present a specific workflow to be applied by oral Surgery Units when planning surgical oral treatments. in oral surgery the preparation of the osteotomy window is crucial, its size, design, and position may affect the intra- and post-surgical complication rates. to apply the concept of computer guided surgery could decrease the risks of surgical complications related to incision size and extent of the osteotomy. the use of 3D system techniques in oral surgery can provide useful intra-operative guidance and may help to further increase accuracy of the surgery and patient safety. clinical trials are needed to evaluate the efficacy of the proposed protocol.