Gerald T. Grant

Creation of a 3-dimensional virtual dental patient for computer-guided surgery and CAD-CAM interim complete removable and fixed dental prostheses: A clinical report

This clinical report proposes a digital workflow using 2-dimensional (2D) digital photographs, a 3D extraoral facial scan, and cone beam computed tomography (CBCT) volumetric data to create a 3D virtual patient with craniofacial hard tissue, remaining dentition (including surrounding intraoral soft tissue), and the realistic appearance of facial soft tissue at an exaggerated smile under static conditions. The 3D virtual patient was used to assist the virtual diagnostic tooth arrangement process, providing patient with a pleasing preoperative virtual smile design that harmonized with facial features. The 3D virtual patient was also used to gain patients pretreatment approval (as a communication tool), design a prosthetically driven surgical plan for computer-guided implant surgery, and fabricate the computer-aided design and computer-aided manufacturing (CAD-CAM) interim prostheses.

Digital approach to planning computer-guided surgery and immediate provisionalization in a partially edentulous patient

This report describes a digital approach for computer-guided surgery and immediate provisionalization in a partially edentulous patient. With diagnostic data obtained from cone-beam computed tomography and intraoral digital diagnostic scans, a digital pathway of virtual diagnostic waxing, a virtual prosthetically driven surgical plan, a computer-aided design and computer-aided manufacturing (CAD/CAM) surgical template, and implant-supported screw-retained interim restorations were realized with various open-architecture CAD/CAM systems. The optional CAD/CAM diagnostic casts with planned implant placement were also additively manufactured to facilitate preoperative inspection of the surgical template and customization of the CAD/CAM-fabricated interim restorations.

CBCT and Additive Manufacturing Technology

Stereolithography (SLA), the foundational computer-assisted manufacturing (CAM) technology, was introduced by Charles Hull nearly three decades ago. Since then, numerous terms have been used to broadly describe the group of related processes and techniques used to fabricate physical scale models directly from three-dimensional (3D) computer-assisted design (CAD) data.

Craniomaxillofacial Reconstruction Based on 3D Modeling

Current treatment planning and reconstruction of craniofacial trauma has been advanced greatly due to the increase in the use of software to convert medical image files in the form of Digital Imaging and Communications in Medicine (DICOM) to 3D reconstructions and ultimately files which can be converted for fabrication of medical models and surgical guides using additive or subtractive manufacturing technologies. In addition, advances in photogrammetry systems allow for capture of the surface of the head and neck using camera systems that can be registered to medical images to help in the surgical planning for head and neck reconstructions.

The Dentoalveolar Prosthesis: A Novel Approach in the Reconstruction of Hard and Soft Tissue Deficiencies: The Dentoalveolar Prosthesis

A clinical problem commonly encountered by the advanced restorative dentist is a requirement to replace missing teeth and the supporting alveolus in areas adjacent to healthy or manageable dentition. A potential solution could utilize a dentoalveolar prosthesis fabricated on two or more implants in the edentulous area. The implant substructure, or framework, may be cast, milled, or selectively laser melted from a variety of metals. A superstructure, or ceramic overlay incorporating a ceramic or composite resin gingival tissue component, is constructed to fit over the implant substructure and luted to the substructure with resin cement. This implant-supported fixed dental prosthesis identifies a solution for the replacement of both teeth and supporting alveolar bone. It restores comfort, function, and esthetics to the patient.

3D Volume Rendering and 3D Printing (Additive Manufacturing)

Three-dimensional (3D) volume-rendered images allow 3D insight into the anatomy, facilitating surgical treatment planning and teaching. 3D printing, additive manufacturing, and rapid prototyping techniques are being used with satisfactory accuracy, mostly for diagnosis and surgical planning, followed by direct manufacture of implantable devices. The major limitation is the time and money spent generating 3D objects. Printer type, material, and build thickness are known to influence the accuracy of printed models. In implant dentistry, the use of 3D-printed surgical guides is strongly recommended to facilitate planning and reduce risk of operative complications.

Craniofacial Applications of 3D Printing

Current advances in imaging technology, virtual surgical planning, and 3D printing have potentially changed how we will use patient-specific information for treatment planning and customized treatment. Medical providers can not only view a 3D rendering of the patient’s anatomy on digital display, but that image can now be transferred as a physical model which not only aids in treatment planning but in patient education. The use of these technologies in craniofacial reconstruction is reported in the early 1990s (Gronet et al. 2003). These techniques have proven to provide surgeons confidence in executing their plan, reducing operating times, follow-up surgical revisions, and poor outcomes. In addition, they provide patient-centered care and better esthetic and functional outcomes (Grant et al. 2013) (Fig. 1). In this chapter, we will review some of the areas of application in craniofacial reconstruction and dentistry.

The Dentoalveolar Prosthesis: A Novel Approach in the Reconstruction of Hard and Soft Tissue Deficiencies

A clinical problem commonly encountered by the advanced restorative dentist is a requirement to replace missing teeth and the supporting alveolus in areas adjacent to healthy or manageable dentition. A potential solution could utilize a dentoalveolar prosthesis fabricated on two or more implants in the edentulous area. The implant substructure, or framework, may be cast, milled, or selectively laser melted from a variety of metals. A superstructure, or ceramic overlay incorporating a ceramic or composite resin gingival tissue component, is constructed to fit over the implant substructure and luted to the substructure with resin cement. This implant-supported fixed dental prosthesis identifies a solution for the replacement of both teeth and supporting alveolar bone. It restores comfort, function, and esthetics to the patient.