3D computer‐aided treatment planning in periodontology: A novel approach for evaluation and visualization of soft tissue thickness

Abstract

ObjectiveCurrent approaches for soft tissue thickness evaluation and visualization still represent a challenge for full extent evaluation and visualization. The aim of this clinical technique article is to introduce a novel approach for comprehensive visualization and precise evaluation of oral soft tissue thickness utilizing a fusion of optical 3D and cone‐beam computed tomography (CBCT) images.Clinical considerations3D models of the maxilla were obtained by CBCT imaging and intraoral scanning. The CBCT images were reconstructed to standard tessellation language (STL) file format models by segmentation of teeth and bone using implants planning software. 3D soft tissues and teeth models were obtained by intraoral scanning and were exported in STL file format as well. 3D multimodal models were then superimposed using best‐fit matching on teeth. Soft tissue thickness was then visualized and evaluated with a 3D color‐coded thickness map of gingival and palatal areas created by surface comparison of both 3D models. Additionally, threshold color‐coding was used to increase comprehensibility. Palatal areas were further visualized and evaluated for the optimal donor site.ConclusionsA novel approach for 3D evaluation and visualization of masticatory mucosa thickness presents all available 3D data in a comprehensible, “clinician‐friendly” manner, using threshold regions and clinically relevant views.Clinical significanceProposed approach could provide comprehensive presurgical treatment planning in periodontal plastic surgery and implantology without additional invasive procedures for the patient, resulting in more predictable treatment, improved outcomes, and reduced risk for complications.

The precision of gingival recession measurements is increased by an automated curvature analysis method

“…Further research is required to explore novel possibilities analysing whole 3D models. Nonetheless, cross-sections are widely used to evaluate tissue dynamics in periodontal plastic surgery [34,[38][39][40][41][42] and implantology [43][44][45], enabling great standardisation regarding the selection of measuring site and direction of measurement. Measurement site selection, e.g., selecting a representative cross-section, is also one of the possible variabilities in the measurement of recession depth.…”

Dynamic navigation guided surgery and prosthetics for immediate loading of complete‐arch restoration

“…The segmented multiple interrelated STL files were then exported to the prosthetic software (DTX StudioLab, Nobel Biocare AG) to design the DyNav immediate complete arch temporary FDP and plan the dynamic navigation assisted bone reduction in case it's needed (Figures 6 and 7). The soft‐bone tissue interface could be digitally designed in order to simulate the ideal ridge form to house the overall prosthetic framework, considering at the same time the minimum soft tissue thickness required to protect the underlining bone 20‐22,25‐27 . A well‐fitting perio‐restorative interface was designed, adapting the prosthetic contour of the temporary FDP to the digitally designed soft and bone tissue architecture regardless the type of restorative interface (FDP‐1, −2, and −3) 28 .…”

“…The soft-bone tissue interface could be digitally designed in order to simulate the ideal ridge form to house the overall prosthetic framework, considering at the same time the minimum soft tissue thickness required to protect the underlining bone. [20][21][22][25][26][27] A well-fitting perio-restorative interface was designed, adapting the prosthetic contour of the temporary FDP to the digitally designed soft and bone tissue architecture regardless the type of restorative interface (FDP-1, −2, and −3). 28 The prosthetic software allowed a clear visualization of the relationship between the soft and bone tissues and the prosthetic contour at the cervical area, facilitating the digitally assisted soft-bone tissue sculpturing (DASS) technique.…”

“…Currently, the original dynamic navigation concept was implemented to orchestrate the surgical and prosthetic aspects to achieve ideal site‐specific results and meet patient expectations of anticipate a natural‐appearing with an immediate temporary FDP 9,18 . The sophisticated algorithms of the 3D implant planning software allowed the digital design of a prefabricated biologically driven prosthesis, whose contours take into account the distance to the bone and the advised soft tissue height to maintain a healthy restorative interface and the marginal bone loss (MBL) within the criteria of implant success over time 19‐22 . This previously published protocol named digitally assisted soft tissue sculpturing (DASS) can be integrated with the dynamic navigation technology to sculpture the restorative interface, in order to allocate the immediate DyNav temporary prosthesis in the 3D planned position, and act as a prosthetic scaffold to enhance soft tissue interface scalloping and maturation 10 .…”

“…9,18 The sophisticated algorithms of the 3D implant planning software allowed the digital design of a prefabricated biologically driven prosthesis, whose contours take into account the distance to the bone and the advised soft tissue height to maintain a healthy restorative interface and the marginal bone loss (MBL) within the criteria of implant success over time. [19][20][21][22] This previously published protocol named digitally assisted soft tissue sculpturing (DASS) can be integrated with the dynamic navigation technology to sculpture the restorative interface, in order to allocate the immediate DyNav temporary prosthesis in the 3D planned position, and act as a prosthetic scaffold to enhance soft tissue interface scalloping and maturation. 10 Today, the main challenge still remains how to precisely position the immediate temporary prosthesis the day of the implant positioning in the same coordinates as digitally planned.…”