Page 135 - Craniomaxillofacial Implant Surgery - Jeroen P.J. Dings

General discussion and future perspectives
FUTURE PERSPECTIVES
With respect to CMF implants, over the past few decades, numerous enhancements in the area of design, materials and the manufacturing process have been made to improve the physical retention of facial prostheses.
The development of computer-aided (CAD) and computer-aided manufacturing (CAM) systems has upgraded the accuracy of implant treatment planning and subsequent placement. Furthermore, 3D-modeling and virtual-, as well as augmented reality have opened compelling perspectives for precise preoperative planning, the creation of physical replica models, the use of surgical guides and navigational surgery. Aside from the aforementioned advantages, 3D-software may also serve patients in education prior to reconstructive procedures62.
Due to exponential advancement in medical imaging techniques (such as multidetector
computed tomography and cone-beam computed tomography), reduced size of
scanners, better image resolution with a low radiation dose are to be expected against
lower costs. Innovations in both imaging modalities and ‘3D-image based planning’
software are likely to increase the accuracy in determination of true clinical bony
dimensions. Future developments in reconstruction algorithms of software packages
are also mandatory in improving the representations of the available bone volume.
Both software as manufacturing of 3D-printed surgical guides used to be expensive.
However, due to the increased popularity of 3D-printing technologies, improvement in
accuracy, quality of materials, faster printing times and lower costs are to be expected63. 7 Open-source software platforms may contribute to the development of new surgical
protocols and the possibility of comparing different guide designs.
Virtual preoperative planning of possible implant locations, retention design and future prosthetic rehabilitation shortens the operation time, eliminates the need for a physical surgical guide, reduces the risk of damaging vital structures, and is likely to improve the restorative outcome20. Transfer of the virtual treatment planning can be achieved passively by the use of bone-, tooth- or soft tissue- supported templates. However, virtual planning with navigational technology is already widely described in literature to be efficient and effective, with regard to the complex geometric anatomy of the orbital-, nasal- and auricular regions64,65. As surgical guides demand extra drill length, normal drill lengths can be used during navigation, which is especially
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