Facial devices

Dr. Robert Brockett: Oral and Facial Health | Health

I first did an article on three-dimensional imaging in 2017. We have had four more years of use of our three-dimensional scanner; this is an update on those four years.

Uncovering underlying pathology is probably the greatest benefit of the three-

dimensional scanner. The facial bones are the most complex collection of bones in the body. There is even a recognized specialty of oral and maxillofacial radiology, just for the interpretation of these complex structures.

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We have been able to see in clear detail what can only be surmised with a flat X-ray. Being able to visualize a tumor or a mass that has displaced normal anatomy is vital to not only an accurate surgery, but preservation of the healthy surrounding tissues.

Planning for surgical reconstruction when there has been trauma, pathology, or the loss of multiple teeth has been greatly accentuated by being able to visualize in three dimensions the area of the jaws that need to be rebuilt.

We can see the extent of bone loss, and therefore plan for proper bone grafting. Also, a surgical guide can be constructed utilizing a 3D printer from these same three-dimensional films, which many times is crucial for an accurate reconstructive effort.

Typically, my partner and I will sit in front of a computer screen and do a mock surgery on this three-dimensional image. We may then direct the construction of surgical guides, or even replacement parts.

In the not-too-distant past, if we knew that a large surgical deficiency would be created, that part of the jaw may have to be replaced with sterilize cadaver bone which would have to be shaped at the time of surgery, or a reconstruction plate which would have to be bent by hand during surgery to rejoin a section of jaw that has been removed.

This was extremely time-consuming and kept the patient asleep for a longer period of time.

My partner, Dr. Rushi Patel, trained with these 3D modalities, which did not exist in my residency in their modern form. He has taken several patients to surgery with pre-constructed titanium mandibles, created by a 3D printer, to replace segments that had to be removed because of tumors.

The time in surgery is dramatically reduced, and therefore the trauma of surgery is dramatically reduced. The contour of these premade elements is perfect and requires no time during surgery to make them fit.

In the office, we utilize three-dimensional radiography to plan the precise placement of implants and replacement of bone, so that your teeth can be replaced most accurately. This is called “guided surgery,” whereby a 3D printer is utilized to create a guide which is used during surgery for the absolute accurate placement of an implant.

As you can imagine, your teeth must match up properly. Doing virtual surgery, transferring that information to a physical model, and utilizing a guide at the time of surgery made from that model ensures that reconstruction of missing teeth and bone can be done not only in the most accurate way, but in the least amount of time, which translates into a quicker and easier postoperative recovery.

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