Search Results (55)

Contemporary patient-specific subperiosteal implants (SPIs) have re-emerged as digitally planned, additively manufactured solutions for oral and maxillofacial rehabilitation when conventional endosseous implants are limited by severe atrophy, anatomical constraints, or reconstructive defects. Unlike conventional implants, SPIs behave as fixation-based skeletal frameworks whose performance depends on passive fit, screw fixation, anchorage, framework architecture, material properties, manufacturing accuracy, and prosthetic load transfer. This scoping review evaluated the maturity of mechanical design and validation evidence for contemporary SPIs. Following a predefined internal protocol and PRISMA-ScR, MEDLINE/PubMed, Scopus, Web of Science, Embase, and the Cochrane Library were searched from inception to 13 June 2026. Reference-list screening and citation tracking supplemented the electronic search. Two reviewers independently screened records against predefined eligibility criteria. Data were charted using a predefined extraction form and synthesized descriptively by evidence type, engineering domain, validation stage, and translational status. No meta-analysis was undertaken because of methodological heterogeneity, and no formal risk-of-bias grading was applied. Across 65 included records, the evidence was dominated by descriptive technical studies and comparative computational analyses, whereas direct mechanical testing, fatigue assessment, manufacturing verification, and clinical correlation were limited. Finite element analysis was useful for comparing design alternatives and identifying stress concentrations, but models were heterogeneous and often insufficiently validated. Design modifications generally redistributed stress across the implant–prosthesis–bone system rather than reducing it globally. Titanium and Ti6Al4V were the most established framework materials, whereas polymeric, ceramic, and scaffold-assisted strategies remained preliminary. The principal contribution of this review is a cross-domain appraisal of progression from anatomical feasibility and comparative modeling to manufacturing verification, experimental testing, and clinical validation. An evidence map, minimum reporting checklist, and integrated validation pathway are provided to support reproducible device development. Full article

Background: Open-flap immediate loading full-arch rehabilitation of the atrophic edentulous maxilla remains clinically demanding because flap elevation modifies the soft-tissue anatomy and stable anatomical landmarks for digital registration are limited. The Impression Reference (IR) technique was developed as a workflow-oriented strategy to provide a recognizable spatial reference during dataset matching and prosthetic transfer. This case series evaluated the feasibility of completing an IR-assisted digital workflow in patients undergoing open-flap immediate full-arch rehabilitation of the atrophic maxilla. Methods: This feasibility case series included 26 completely edentulous patients with severe maxillary atrophy treated with immediate full-arch implant-supported rehabilitation using an Impression Reference-assisted digital workflow. No control group was included and no quantitative accuracy analysis was performed. Workflow-related and prosthetic-transfer outcomes were evaluated descriptively, including completion of dataset matching, prosthetic transfer, IR coupling within the predefined 0.2 mm tolerance, delivery of the immediate prosthesis, clinically acceptable passive fit, prosthetic congruence with the pre-surgical digital plan, and surgical complications. Results: The IR-assisted workflow, dataset matching, prosthetic transfer, and immediate prosthetic delivery were completed in all 26 patients. All patient-specific digital projects complied with the nominal 0.2 mm CAD coupling tolerance, and the associated components could be completely seated and remained clinically stable during use. Clinically acceptable prosthesis fit and prosthetic congruence with the pre-surgical project were recorded in all immediate restorations according to the predefined clinical criteria. No intraoperative surgical complications were documented in the available records. Conclusions: Within the limitations of this descriptive case series, the IR-assisted workflow was feasible in all the included patients undergoing open-flap immediate loading full-arch rehabilitation of the atrophic maxilla. Successful workflow completion should not be interpreted as quantitative evidence. Full article

Background/Objective: Accurate digital recording of implant position is essential for achieving passive fit and predictable outcomes in complete-arch implant-supported prostheses. However, complete-arch cases remain challenging because of increased inter-implant distances, limited anatomical landmarks, soft tissue mobility, scan body-related variables, and cumulative errors during data acquisition and file registration. This narrative review aims to evaluate current intraoral and extraoral digital implant position recording techniques from a clinical decision-making perspective. Methods: A structured narrative literature search was conducted in PubMed from database inception to 15 May 2026 and was supplemented by manual screening of reference lists of key systematic reviews and eligible articles. Systematic reviews, meta-analyses, clinical studies, comparative in vitro studies, dental technique articles, and clinical reports relevant to complete-arch digital implant position recording were considered. Higher-level and clinically relevant evidence was prioritized, whereas technique reports were included primarily for emerging workflows with limited clinical evidence. Results: Intraoral techniques include non-splinted and splinted scan body protocols, calibrated implant scan bodies, calibrated frameworks, and auxiliary reference strategies. These methods may be clinically efficient but remain sensitive to scan path, scanner technology, landmark availability, scan body design, implant distribution, and operator-related factors. Extraoral techniques include stereophotogrammetry, camera- or smartphone-assisted photogrammetric systems, reverse impression workflows, and laboratory scanner-based digitization. These approaches may reduce intraoral stitching errors in complex edentulous arches, but usually require complementary datasets for soft tissue morphology, prosthetic contours, antagonist dentition, and maxillomandibular relationships. Conclusions: Direct intraoral scanner (IOS) protocols may be appropriate in favorable complete-arch situations with accessible scan bodies, limited inter-implant distances, and stable reference geometry. In clinically demanding cases requiring greater cross-arch accuracy, stereophotogrammetry, intraoral photogrammetry, or calibrated scanning approaches may provide more controlled implant position recording. Reverse impression and model-based workflows are particularly useful when a verified interim prosthesis, verification jig, or cast-based reference is available. Regardless of the selected technique, accurate integration of implant coordinates with soft tissue, prosthetic contour, antagonist arch, and occlusal data remains essential. Full article

Background/Objectives: Permanent pacemaker implantation (PPI) remains one of the most common complications following transcatheter aortic valve replacement (TAVR). Identifying patients at increased risk for post-procedural conduction disturbances is clinically important for procedural planning and patient management. The aim of this study was to develop and evaluate a machine learning-based model for predicting the risk of PPI after TAVR. Methods: This prospective study was conducted between 2019 and 2025, and included 179 patients with severe aortic stenosis who underwent TAVR. Patient eligibility was determined by a multidisciplinary Heart Team based on clinical, echocardiographic, and imaging criteria. The primary endpoint was PPI occurring during hospitalization or within 30 days after the procedure. Statistical analyses were performed using RStudio (v. 2024.09.1+394)and Python (v.3.12.3), including comparative tests for continuous and categorical variables, receiver operating characteristic analysis to assess model performance, and SHapley Additive exPlanations (SHAP) to evaluate feature importance and model interpretability. Results: A total of 179 patients undergoing TAVR were included in the analysis. PPI occurred in 17 patients (9.5%) within 30 days after the procedure. A machine learning model was developed to predict post-TAVR PPI. The model demonstrated good predictive performance, with an overall accuracy of 0.944 and a weighted F1-score of 0.947. The confusion matrix showed that the model correctly classified 155 patients without PPI and 14 patients with PPI, with only a small number of false predictions. Explainability analyses using SHAP and permutation feature importance revealed that anatomical and procedural variables had the greatest impact on model predictions. The most influential predictors included valve size, right coronary sinus diameter, prosthetic valve diameter, and mean aortic annulus diameter. In contrast, baseline clinical variables such as left ventricular ejection fraction, previous myocardial infarction, and mean transaortic gradient showed a comparatively lower contribution to the prediction of PPI after TAVR. Conclusions: This study demonstrates that machine learning models can effectively predict the risk of PPI after TAVR. Anatomical characteristics of the aortic root and prosthesis-related parameters were the main determinants of PPI, whereas baseline clinical variables had a lower impact. The use of explainable artificial intelligence methods, such as SHAP analysis, may improve risk stratification and support procedural planning in patients undergoing TAVR. Full article

Patellar maltracking is among the most common causes of anterior knee pain after total knee arthroplasty (TKA), underscoring the need for accurate prevention and treatment. Therefore, the purpose of this narrative review is to provide a comprehensive overview of current evidence on post-TKA tracking, focusing on component alignment, preoperative patient assessment, and revision treatment options. A PubMed database search was performed, leveraging the literature from the last 20 years, and the results were qualitatively synthesized. According to current studies, several precautions should be taken to prevent patellofemoral stress and, consequently, patellar maltracking, such as avoiding internal rotation, valgus alignment, and excessive flexion of the femoral component and internal rotation of the tibial component. Regarding alignment strategies, kinematic alignment appears to offer potential benefits over mechanical alignment in certain functional outcomes and patient satisfaction scores. However, these differences should be interpreted cautiously as they may not always exceed the minimal clinically important difference. Furthermore, recent evidence indicates that quadriceps biomechanics influence TKA outcomes, potentially suggesting that conventional surgical approaches may need to be individualized, though these preliminary findings require prospective validation. Currently, robotic-assisted surgery represents a developmental direction for patient-tailored interventions and offers great promise for better prosthesis customization to the individual patient. Integration of imaging data with dynamic soft-tissue assessment enables more predictable reconstruction of joint kinematics. Regarding surgical treatment, the selection of specific methods requires a prior clinical and radiographic assessment. Indications range from patellar maltracking direction and component malrotation to patient preferences and rehabilitation potential. Ultimately, the future of TKA relies on personalized interventions to prevent complications and improve patient outcomes. This evolution is driven by the shift from mechanical alignment to kinematic alignment, alongside quadriceps tendon assessment and intraoperative robotic-assisted measurement, all aimed at optimizing the accuracy of implant positioning. Full article

By using virtual surgical planning (VSP) and 3D printed guides, complex maxillofacial defects can be reconstructed with high accuracy and predictability. A fully digital workflow resulting in a modular all-in-one 3D printed guide system for fibula osteotomies, bone segment positioning, fully guided dental implant placement and dental prosthesis fixation for mandibular reconstruction was developed at Ghent University Hospital. A follicular ameloblastoma of the left mandible was resected in a 28-year-old male. The defect was reconstructed with a two-segment fibular free flap with immediate placement of three dental implants and immediate implant loading with a screw-retained bridge. A split thickness skin graft and Elemental PerioPlast were used as wound dressing. Comparison of the preoperative planning with the postoperative CT-scan showed a deviation immediately after surgery, which was no longer present at the 6-month follow-up. The patient achieved a stable occlusion and 44 mm mouth opening and reported high satisfaction. This case illustrates that fully digital, immediate mandibular reconstruction with simultaneous implant placement and prosthetic rehabilitation is feasible and accurate and enhances early functional recovery. Future improvements in intraoperative validation may further refine accuracy and reproducibility in complex oncologic reconstructions. Full article

Background/Objectives: One key objective in temporomandibular joint replacement is to precisely position the implant according to the virtual surgical plan, utilizing drilling and osteotomy guides for accuracy. However, implementing this process can be challenging, as—even though the drilling and osteotomy guides should only fit in one position—there often are still multiple potential positions for both guides and implants on smooth bony surfaces. Even minor deviations in the implant’s placement can affect wear, influence biomechanical behavior, and lead to adverse outcomes. Intraoperative navigation has emerged to verify the alignment of implants with the preoperatively planned ideal position. While the use of navigation systems in TMJ surgery is well documented for certain procedures, its application in TMJ replacement cases has been limited. Methods: In this study, two methods to improve the accuracy of TMJ replacement are introduced: a new marker-based navigation workflow and the use of orientation screws in two patients. Results: Unlike conventional navigation methods, the marker-based system provides a more intuitive method for assessing the 3D orientation of the TMJ implant concerning the planned position, enhancing surgical accuracy. The addition of a guiding screw provides a reference point to enhance the accuracy of guide placement. Conclusions: The accurate placement of the prosthesis largely relies on the precise positioning of the guides. Even slight inaccuracies in the position of the TMJ prosthesis, resulting from suboptimal guide placement, can lead to significant negative clinical outcomes. Marker-based navigation and the use of guiding screws may potentially improve the precision of TMJ replacement procedures. Full article

Background/Objectives: It is essential to test the accuracy of artificial intelligence-assisted tools that detect dental pathologies from radiographs. This study aimed to evaluate the test characteristics of an artificial intelligence-assisted convolutional neural network-based prototype used for automated radiographic detection. Methods: A total of 300 panoramic and 100 intraoral periapical radiographs were collected between January 2020 and 2024 and then analyzed by two trained, independent specialist evaluators. The diagnostic consensus, “ground truth”, was labeled as follows: BL: bone loss; C: caries; F: filling; I: implants; IT: impacted teeth; P: prosthesis; PC: post-core; PR: periapical radiolucency; RF: root fillings; and RR: retained roots. The radiographs were uploaded to the prototype, and the results were compared. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated using Stata version 15.0 (StataCorp). Results: Overall, most of the outcomes demonstrated sensitivity greater than 82%, with values ranging from 66.41% (65.47,67.36) for BL to 100% (100.00,100.00) for I. For all outcomes, specificity was greater than 93%, with values ranging from 93.61% (93.12,94.10) for BL to 100% for I. The overall values for all the test characteristics for the periapical radiographs were above 85%. The key errors identified in the qualitative analysis were errors in tooth identification, failure to detect recurrent caries under fillings and crowns, impacted canines, and inaccurate identification of extensive fillings as crowns. Conclusions: The prototype demonstrated high sensitivity and specificity in identifying dental pathologies. Accuracy in identifying bone loss, teeth that have migrated, including impacted canines, secondary caries, and differentiating extensive fillings from crowns requires further improvement. Full article

Objectives: This prospective cohort study aimed to evaluate the accuracy and precision of static computer-guided, flapless implant surgery in partially edentulous patients, comparing the virtually planned and clinically achieved implant positions. Materials and Methods: From 2017 to 2022, 40 patients (20 males and 20 females) received a total of 129 implants across 59 partial rehabilitations, with 62 implants placed in the maxilla and 67 in the mandible. All interventions were performed by a single experienced operator using dental-supported stereolithographic guides and a flapless protocol. The discrepancy between planned and actual implant positions was measured using reverse engineering software, assessing linear deviations at the implant Platform (coronal) and apex, as well as angular deviations. Subgroup analyses were conducted based on the jaw (maxilla vs. mandible) and the type of surgical guide support (Kennedy classes I–IV). Results: The mean linear deviation was 1.16 ± 0.58 mm at the apex and 0.80 ± 0.41 mm at the implant Platform (coronal). The mean angular deviation was 3.23° ± 1.86°. Slightly higher deviations were observed in the mandible than in the maxilla. Group-wise analysis showed minor variations depending on the type of guide support. Conclusions: Static computer-guided surgery demonstrated measurable linear and angular deviations between planned and achieved implant positions. These discrepancies should be considered during treatment planning, especially in narrow ridges or Class I configurations. Full article

Background and aim: Artificial intelligence (AI) is gaining increasing relevance in orthopaedic surgery, particularly in prosthetic surgery, due to its ability to support preoperative planning through advanced imaging analysis, implant size prediction, and outcome forecasting. However, recent literature shows considerable variability in employed models, evaluated outcomes, and clinical applicability. The objective of this scoping review is to map AI applications in preoperative planning for orthopaedic arthroplasties and to assess their impact on radiographic and clinical outcomes, also discussing key ethical and medicolegal implications within both Italian and international contexts. Materials and methods: A literature review was conducted following scoping review methodology. The bibliographic search (10 September 2025) was performed in PubMed and Scopus using the query “preoperative planning WITH artificial intelligence AND prosthesis orthopaedic surgery AND outcomes”, restricted to the years 2020–2025, English-language studies, and research focused specifically on real-world AI techniques applied to preoperative planning in prosthetic surgery, reporting radiographic and/or clinical outcomes related to planning. Exclusion criteria included intra/postoperative studies, non-orthopaedic applications, robotic surgery, studies lacking clinical outcomes, case reports, and articles without full-text availability. After PRISMA screening and selection, 42 primary studies were included. Results: Of the 42 studies included, 20 focused on the hip, 19 on the knee, and 3 on the shoulder. Available evidence indicates that AI may improve templating accuracy and prosthetic component positioning, with more robust results in hip and knee arthroplasty, while applications in shoulder arthroplasty remain emerging. Nonetheless, important methodological limitations persist, including algorithm heterogeneity. Discussion: Overall, the findings suggest a promising role for AI in preoperative planning; however, the heterogeneity and variable quality of the evidence call for caution in interpretation and highlight the need for more rigorous prospective research. These considerations also carry relevant medicolegal implications, as the reliability and standardisation of AI-based tools represent essential prerequisites for their safe and conscious integration within diverse regulatory frameworks. Conclusions: AI appears to be a promising tool in the preoperative planning of orthopaedic arthroplasties, although further clinical validation and methodological standardisation are required. The evidence gathered also provides a useful foundation for addressing the associated medicolegal and regulatory implications, particularly in light of evolving Italian and European regulations and their differences from U.S. models. Full article

Background. Accurate anatomical assessment is essential for pre-procedural planning in structural heart disease. Advanced 3D imaging could offer improved visualization for more accurate reconstruction. We assessed the performance of a novel immersive 3D virtual reality (VEA) for the pre-procedural planning of transcatheter aortic valve implantation (TAVI) candidates. Methods. Measurement of cardiac-gated contrast-enhanced computed tomography (CT) scans was performed with the novel VEA and established tools: 3Mensio and Horos. Results. 50 consecutive patients were included. Annular and LVOT measurements obtained with VEA were strongly correlated with those derived from standard CT analysis. The intraclass correlation coefficient (ICC) confirmed excellent consistency for annular measurements (ICC = 0.93), while the concordance correlation coefficient indicated very good overall agreement (CCC = 0.83, 95% CI 0.73–0.90). Similarly, LVOT measurements obtained with VEA showed strong correlation with CT values, with good consistency (ICC = 0.90) and good overall agreement (CCC = 0.77, 95% CI 0.64–0.86). VEA-based planning improved prosthesis size selection accuracy, achieving higher concordance with implanted valves and a significant net reclassification gain over conventional CT. Conclusions. Given the increasing use of advanced 3D cardiac imaging technologies, understanding their diagnostic accuracy to guide pre-procedural planning of TAVI is paramount. In our study, VEA provided reliable assessment of aortic root anatomy for TAVI planning. This novel 3D software provides accurate, patient-specific reconstructions of the aortic root and surrounding structures that may optimize valve sizing, improve procedural safety and enhance procedural outcomes. This provides a rationale for future studies to assess the procedural benefit derived from a three-dimensional assessment of the aortic valve geometry. Full article

Total knee replacement (TKR) is a reliable treatment for end-stage degenerative conditions of the knee. Patient-reported outcome measures (PROMs) are central to assessing TKR outcomes, but they have limitations. Activities of daily living (ADLs) in the early post-operative period complement PROMs for holistic patient assessment. This study presents a method for capturing ADL parameters from data generated by inertial measurement unit (IMU) devices embedded in TKR prosthesis. A conventional posterior stabilized TKR was modified to create chambers in the femoral and tibial components. The prosthesis was implanted into a cadaver knee and movement was simulated using a hydraulic actuated knee simulator (AMTI, VIVO, MA, USA). A powered IMU device was placed in each of the chambers. The simulator was activated for various ADLs and the generated data was collected wirelessly. The pre-processed data was fed into a novel multimodal deep learning artificial intelligence model created to recognize specific ADL (trained on 70% of the data, with 30% reserved for validation and testing). The model achieved 95.68% overall accuracy, with 100% for sitting, standing, stance, and knee bending. Walking, stair navigation, and jogging showed F1 scores of 0.98, 0.92, 0.91, and 0.89, respectively. This technology enables seamless knee activity recognition and reporting with positive implications for patient-specific rehabilitation protocols. Full article

Background: Cadaveric specimens used in research are commonly frozen when stored and may undergo multiple freeze–thaw cycles during experimental procedures. To streamline workflows and minimize potential tissue degradation from repeated thawing, this study evaluated whether a frozen cadaver wrist can be reliably used to model a scaphoid for the development of a patient-specific prosthesis design method in a preclinical setting. Additionally, we assessed the impact of segmentation smoothing techniques on the accuracy of the prosthesis model. Methods: High-resolution computed tomography (CT) scans were performed on a cadaver wrist in both frozen and thawed states. Scaphoid bones were segmented using two approaches: a tight (native surface) segmentation and a smoothened version optimized for prosthetic articulation. The resulting 3D models were registered, and volume and shape differences between frozen and thawed states, as well as between segmentation methods, were quantified. Results: No statistically significant volume differences were observed between scaphoid models segmented from frozen and thawed conditions (p = 0.46). The average difference was 0.14% (SD 0.55). Furthermore, smoothing segmentation had minimal impact on the overall dimensions of the scaphoid model. Conclusions: Frozen cadaver wrists can be used to accurately model scaphoid bones for patient-specific prosthesis design without introducing significant volumetric deviations. Segmentation smoothing, which is necessary for prosthesis fabrication, does not compromise anatomical accuracy, supporting the feasibility of using frozen specimens for preclinical modeling. Full article

This randomized controlled clinical trial compared a conventional combined screw- and cement-retained prosthesis (CSCRP) workflow (control group) with a fully digital cementless screw-retained prosthesis (CL-SRP) system (test group) for single posterior implant restorations. A total of 40 implants in 35 patients were allocated to either workflow. Clinical procedure times, prosthetic accuracy, peri-implant soft tissue changes, and marginal bone loss (MBL) were assessed. The test group demonstrated significantly shorter total prosthetic time (p < 0.001) and impression-taking time (p < 0.001) compared with the control group. Prosthetic adjustment time (p = 0.211) and adjustment volume (p = 0.474) did not differ significantly. Gingival shape changes were likewise not statistically significant (p = 0.966). MBL was significantly lower in the test group (p < 0.05). From a prosthetic standpoint, both workflows yielded clinically acceptable outcomes; however, the digital CL-SRP approach improved procedural efficiency and early peri-implant bone preservation without compromising prosthetic quality. This trial had inherent limitations, including a short follow-up duration, a relatively small sample size, combined test conditions, and restriction to single posterior implants. Therefore, further long-term studies are warranted to confirm durability and broader clinical applicability. Full article

Background: The use of tapered fluted revision stems has been shown to be reliable and safe. Primary stability is mandatory for a long-lasting fixation between bone and a prosthesis. Nevertheless, aseptic loosening due to insufficient primary stability occurs and may be related to technically improper preparation of the femoral canal. Instructions of manufacturers are heterogeneous regarding preparation of implant beds. Questions/Purposes: Does speed or the design of the reamer influence the accuracy of the implant bed and, consecutively, primary stability? Materials and Methods: A test foam with an elastic moduli and pressure resistance similar to that of cancellous bone was used. The medullary canal was prepared with the use of reamers of two different straight and tapered femoral revision devices. Three different rotational speeds were used for preparation. After preparation, primary stability was measured and fixating characteristics were derived. Results: Sufficient primary stability was achievable by all three preparation methods but fixating characteristics were different. Significantly higher micro-motions were detected near the tip of the prosthesis compared to those at all more proximal measuring points. Reaming with high velocity resulted in significantly higher micro-motions compared to that with mid- or low-speed burring. Conclusions: Different preparation methods may be one explanation for the range of reported survivorship data of the two devices with aseptic loosening as the end point. The precision of the implant bed and fixating characteristics were best after reaming with lower velocity. Superior but not significantly better fixation characteristics were achieved with the monobloc stem compared to those with the modular device. Full article