Guided biopsy of osseous pathologies in the jaw bone using a 3D-printed, tooth-supported drilling template

Abstract

Suspicious radiological findings in the jaw bone require histopathological examination for the confirmation of a diagnosis. As pathologies in this region are difficult to reach or are in close proximity to relevant anatomical structures, e.g. tooth roots or nerves, they often represent a challenge. Such factors may adversely affect the predictability of the surgical outcome of a biopsy of the osseous tissues. This technical note introduces a novel method for performing a digitally planned, guided biopsy. For this purpose, a cone beam computed tomography scan and an intraoral scan are superimposed using specific planning software. The resulting three-dimensionally printed, tooth-supported drilling template is designed for a trephine biopsy. It allows a precise, minimally invasive approach, with an exact threedimensional determination of the biopsy location prior to surgery. The risk of devitalization of the neighbouring teeth or possible damage to the nerve structures can be minimized. Furthermore, a small access flap can be sufficient. In summary, the method of bone biopsy presented here allows high precision and greater predictability for biopsy sampling and is minimally invasive for the patient.

Clinical, Radiological, and Pathological Diagnosis of Fibro-Osseous Lesions of the Oral and Maxillofacial Region: A Retrospective Study

“…In addition, conducting a regression analysis to investigate a possible cause-effect relationship could be interesting, as it is essential to consider possible confounding variables. Nevertheless, the following recommendations can be proposed to optimize and modernize decision making in clinical and radiological workflows: The recent introduction of digitally guided bone biopsies has greatly reduced the risk of damage to adjacent anatomical structures and the overall invasiveness of the procedure [ 37 , 38 ]. As a result, bone biopsies have become more common in recent years, which could lead to an increase in the effective number of histopathologic reports of FOLs.…”

Computer‐guided core needle biopsy of the jaws: A technical report

“…In a recent similar study, Valdec et al 12 reported a successful case of a computer‐guided biopsy using a trephine bur. We consider that even though it is a valid technique, especially in radiopaque lesions, the use of CNBT provides additional advantages because it avoids the need for manoeuvres for incisions, flaps and sutures.…”

Cooperation between ENT surgeon and dentist in head and neck oncology

“…Bone biopsy indications mainly include those lesions that do not heal through traditional dental therapies, lesions that apparently have no correlation with dentition, and lesions not specifically identified by clinical and radiographic findings; these lesions can range from benign to malignant (i.e., maxillary sinus carcinomas to myxomas, ameloblastomas, sarcomas, keratocysts and odontogenic cysts). As pathologies in this region are difficult to reach or are in close proximity to important anatomic structures, e.g., tooth roots or nerves, they often represent a challenge 14 to perform a correct biopsy without damaging those structures. Two types of biopsy technique can be used for diagnosing endosseous lesions according to their radiological aspect.…”

“…Radiopaque lesions can be biopsied with special cylindrical drills (trephine drill) capable of coring the bone itself, with a depth indicator to reach the correct depth, and based on an earlier computed ENT: Ear Nose Throat Doctor tomography (CT) scan. At present, guided biopsy of osseous pathologies in the jawbone using a 3D-printed drilling template 14 allows a precise, minimally invasive approach, with an exact three-dimensional determination of the biopsy location before surgery. Moreover, an intraoral approach can easily be performed for intraosseous lesions of the maxillary sinus 15 through the execution of the biopsy on an outpatient basis with local anesthesia (Fig.…”