.jpg)
The innovation of 3D printing in Implantology
The OralMED Aveiro clinic was the stage for one of the most innovative treatments in oral rehabilitation, allowing patients who cannot have conventional implants to have fixed teeth again. We spoke with Dr. Nuno Cintra, a specialist in Oral Surgery and Director of the Scientific Council of the OralMED Saúde Group, to learn more about this technique that is already being used, when indicated, by some oral surgeons of the OralMED Clinical Staff.
Dr. Nuno Cintra was the surgeon responsible for this procedure. Can you explain what it consists of?
This procedure is called Fixed Rehabilitation with Customized Implant. It involves placing an individualized implant specific to the patient. This implant is made through 3D printing obtained by reading a computerized axial tomography of the available bone quantity and according to the location of nervous and vascular structures to be avoided. This allows not only to design the implant in accordance with the patient's anatomy but also to find the ideal fixation points for the implant, as it is fixed to the bone with osteosynthesis screws, which necessarily implies a minimum amount of available bone.
Before placing the implant, a 3D example of the piece is sent to the surgeon before it is completed, which allows for some alterations to be made as desired, as long as the existing anatomical conditions allow it.
What are the objectives of these types of procedures?
With the entry of 3D printers into Dental Medicine, which happened around 2012, it became possible, using already known biomaterials, namely titanium powder, to construct implants according to the patient's bone availability. These are indicated in cases of severe bone atrophy, that is, cases where fixed oral rehabilitation, whether total or partial, is not possible using conventional unitary implants.
Thus, and according to the patient's anatomy, it is possible to construct a single piece or several that we call the individualized implant, for the patient's fixed oral rehabilitation even in cases with high bone loss, which would have been resolved until then using more invasive techniques with greater risks and complications such as bone transplants, inferior dental nerve lateralization, zygomatic or extra-maxillary implants.
In this specific case, it was a totally edentulous patient with great bone resorption of the upper jaw, who aspired to have fixed teeth again. After the initial clinical and radiographic diagnosis, as well as discussion of the case among colleagues, it was concluded that an individualized implant would be the best solution to achieve this goal.
Why did you opt for this procedure?
I started using individualized implants about 5 years ago after participating in a congress where an Israeli colleague presented an approach technique to this topic that seemed quite interesting to me, using implants manufactured in Israel. I trained in it and used it for some time with excellent results. This was until I became aware of the existence of a Portuguese company working in the area of individual implants, with a slightly different concept. Which, in my opinion, makes sense for certain and specific cases. I should emphasize that this type of solution is indicated when all other conventional solutions are exhausted, that is, it should be considered as a last resort solution.
This is what happened in this case, the patient did not have sufficient bone structure for a total fixed rehabilitation using conventional implants.
How did this intervention go?
The intervention went well, within expectations. It was possible to place and fix the implant with the necessary passivity, which, for me, is one of the main factors in terms of success. If the implant is not passive during placement, which can happen due to discrepancy in the CT scan reading, it may not be possible to place it. On the other hand, even if it is possible to place, if it is not completely passive, we run the risk of it fracturing during placement or in the short term. To minimize this risk, it is essential that the area where the implant will be placed is free of any dental piece, root, or any other artifact that may influence either the CT scan reading or the implant design.
Even with all intraoperative care, the patient developed paresthesia of the right infraorbital nerve, which is certainly transient because for implant placement it is always possible to identify the nerve and have a notion of its integrity. These paresthesias are one of the most frequent complications due to the detachment and traction of tissues necessary for the placement and fixation of the implant, disappearing after a few days or weeks. To date, I have no case with permanent infraorbital nerve paresthesia nor knowledge of any case described in the literature.
Since we achieved good implant stability, it was possible to load it with a fixed provisional prosthesis, just as in a total fixed rehabilitation on unitary implants, which will be replaced in approximately 6 months, as soon as the soft tissues allow, by a definitive prosthesis.
Given the level of complexity of this treatment, could it be performed by a Junior Dentist or without specific training?
Like any surgical technique, this requires training and especially precise anatomical knowledge of the surgical bed, as it involves greater detachment involving various tissues and anatomical structures. More or less serious complications can happen both intraoperatively and postoperatively, of which I highlight bone fractures, intra and postoperative hemorrhage, injury to anatomical structures, fracture of instruments, namely screws or the implant itself if it is not passive, as I have already had the opportunity to mention.
However, it has the advantage of working within the anatomical limits of our specialty, oral surgery, which does not happen at all with other techniques that often give rise to complications outside our clinical spectrum, which can be very difficult to justify legally.
It is a technique that should preferably be performed by three participants: the surgeon, the assistant, and an assistant, plus a floating assistant. In my opinion, this is one of the interventions that, due to the complexity and associated risks, the surgeon should be a specialist in oral surgery by the Order of Dental Practitioners and not just claim to be.
I am aware that this does not happen, as several non-specialist colleagues apply it and do it well, but one of the roles of the specialty is precisely to protect both patients and doctors from the risks and complications associated with certain techniques. And this is undoubtedly one of them.
About the OralMED Saúde Group
Remember that the OralMED Saúde Group is the first Portuguese group specialized in Dental Medicine. With over 10 years of experience in the sector, it already has more than 50 of its own clinical units, three dedicated laboratories, and a contact center, the first specialized in the Health area in Portugal.aúde em Portugal.
Comments