Altieri Federica, Iezzi Giovanna, Luzzi Valeria, Di Giorgio Gianni, Polimeni Antonella, Cassetta Michele
Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, 00100 Rome, Italy.
Department of Medical, Oral, Biotechnological Sciences, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy.
Bioengineering (Basel). 2021 Dec 15;8(12):214. doi: 10.3390/bioengineering8120214.
The aim of this technical note is to present a computer-aided design-computer-aided manufacturing (CAD-CAM) surgical guide to perform a computer-guided bone biopsy. Traditionally, to diagnose abnormal conditions affecting jawbone, a bone biopsy is performed with the use of a trephine bur. The positioning of the bur, during the biopsy, is based on the skill of the surgeon; therefore, an inaccurate placement of a trephine bur may occur. The use of a guide, however, can minimize this risk and achieve a better result.
To determine the site and the extension of bone sampling, the stereolithography file (STL) file of cone-beam computed tomography (CBCT) images is acquired using a specific planning software and superimposed with the STL file of a dental cast; a virtual surgical guide is designed, using the same software that allows a 3D (three-dimensional) view of the guide from different perspectives and planes. The number and site of guide tubes are determined on the basis of the width and the extension of the sampling; thanks to a 3D printer, the surgical guide is manufactured.
The use of a customized surgical guide realized with CAD-CAM technology allows a precise and minimally invasive approach, with an accurate three-dimensional localization of the biopsy site.
The high precision, great predictability, time-effectiveness and versatility of the present guide should encourage the clinician to use this minimally invasive surgical approach, but controlled clinical trials should be conducted to evaluate the advantages as well as any possible complications.
本技术说明旨在介绍一种用于计算机引导骨活检的计算机辅助设计-计算机辅助制造（CAD-CAM）手术导板。传统上，为诊断影响颌骨的异常情况，使用环钻进行骨活检。活检过程中环钻的定位依赖于外科医生的技术；因此，可能会出现环钻放置不准确的情况。然而，使用导板可以将这种风险降至最低并取得更好的效果。
为确定骨采样的部位和范围，使用特定的规划软件获取锥束计算机断层扫描（CBCT）图像的立体光刻文件（STL），并将其与牙模的STL文件叠加；使用同一软件设计虚拟手术导板，该软件可从不同视角和平面提供导板的三维（3D）视图。根据采样的宽度和范围确定导孔管的数量和位置；借助3D打印机制造手术导板。
使用CAD-CAM技术制作的定制手术导板可实现精确且微创的方法，对活检部位进行准确的三维定位。
本导板的高精度、高可预测性、时效性和多功能性应促使临床医生采用这种微创外科手术方法，但应进行对照临床试验以评估其优势以及任何可能的并发症。
