Search Results (72)

Background: Rehabilitation of the severely atrophic posterior mandible remains surgically challenging, and inferior alveolar nerve (IAN) repositioning is a well-established technique that enables implant placement in anatomically compromised cases. Although neurosensory outcomes following nerve relocation have been extensively investigated, the regenerative capacity of the mandibular canal itself has not been previously evaluated. This study presents the first computer-assisted, cone-beam computed tomography (CBCT)-based assessment of bony canal regeneration after IAN transposition. Methods: Twenty-two patients who underwent unilateral IAN transposition were evaluated using standardized CBCT one year postoperatively. A semi-manual segmentation workflow was performed using Mimics Core Medical software version 27.0 (Materialise), and regenerated canal walls were identified according to four strict criteria: (1) canal continuity across sequential CBCT sections, (2) defined canal walls demonstrating high-density bone (>800 HU, or >400 HU), (3) ≥270° circumferential bony enclosure, and (4) morphology consistent with the native mandibular canal. Regeneration was quantified as the proportion of the surgically disrupted canal segment exhibiting a fully, or near fully, reconstructed canal. Results: Mandibular canal regeneration was observed in all patients. The mean regeneration at one year was 72.7% ± 13% when applying strict >800 HU criteria, with 20 patients demonstrating substantial (>70%) reformation and 2 patients showing partial regeneration (<40%). When a lower density threshold (>400 HU) was applied to include early or less mineralized bone, the mean regeneration increased to 78.1% ± 11%, indicating the presence of maturing bone structures that did not yet meet full-density criteria. Conclusions: Computer-assisted CBCT analysis demonstrates that partial to extensive regeneration of the mandibular canal occurs within one year following IAN transposition. This study provides the first quantitative evidence of this phenomenon, highlighting the intrinsic regenerative potential of the mandibular canal and suggesting a possible association with postoperative neurosensory recovery. Full article

Purpose: The objective of this study was to evaluate and compare the precision of dental implant placements using augmented reality (AR)-iPhone (Apple, Cupertino, CA, USA) navigation technology versus conventional 3D-printed surgical guides. The accuracy was assessed by comparing the actual implant positions to their predefined three-dimensional (3D) locations in surgical plans using the Exocad software (Exocad, Dormstadt, Germany). Materials and Methods: Fourteen standardized mandibular models were divided into two groups: AR-guided (AR1-AR7) and 3D-printed surgical guide-assisted (Group 1–7). Each model received four implants in positions 35, 32, 42, and 45. Postoperative CBCT scans were aligned with the preoperative plans in the Exocad software to measure three-dimensional deviations, including total entry error, total apex error, and angular error. Statistical analysis was performed using the Statistica 12 software (StatSoft, Tulsa, OK, USA), incorporating Shapiro–Wilk normality tests, ANOVA, and post hoc LSD tests (where applicable). Results: The in vitro comparative experiment demonstrated AR group superior accuracy with mean deviations of 0.42 ± 0.12 mm at the entry point and 0.51 ± 0.18 mm at the apex, compared to 0.48 ± 0.15 mm and 0.58 ± 0.22 mm, respectively, in the 3D-printed guide group (p < 0.05). Angular deviation was significantly lower in the AR group (1.8° ± 0.6°) versus the guide group (2.1° ± 0.7°, p = 0.009). Descriptive statistics revealed the median apex error was 0.49 mm (IQR: 0.38–0.61) for AR versus 0.56 mm (IQR: 0.45–0.72) for guides. Conclusions: AR iPhone navigation technology achieved clinically acceptable accuracy compared to static 3D-printed guides, particularly in controlling angular deviations. While both methods produced clinically acceptable results, AR technology represents a significant advancement for precision-sensitive cases. Full article

Emerging artificial intelligence (AI) and robotic surgical technologies have the potential to influence digital implant dentistry substantially. As a narrative review, and building on the foundations outlined in Part I, which described current digital tools and workflows alongside their persistent interface-related limitations, this second part examines how AI and robotics may overcome these barriers. This synthesis is based on peer-reviewed literature published between 2020 and 2025, identified through searches in PubMed, Scopus, and Web of Science. Current evidence suggests that AI-based approaches, including rule-based systems, traditional machine learning, and deep learning, may achieve expert-level performance in diagnostic imaging, multimodal data registration, virtual patient model generation, implant planning, prosthetic design, and digital smile design. These methods offer substantial improvements in efficiency, reproducibility, and accuracy while reducing reliance on manual data handling across software, datasets, and workflow interfaces. In parallel, robotic-assisted implant surgery has advanced from surgeon-guided systems to semi-autonomous and fully autonomous platforms, with the potential to provide enhanced surgical precision and reduce operator dependency compared with conventional static or dynamic navigation. Several of these technologies have already reached early stages of clinical deployment, although important challenges remain regarding interoperability, standardization, validation, and the continuing need for human oversight. Together, these innovations may enable the gradual convergence of digital technologies, real-time-assisted, unified, end-to-end implant prosthodontic workflows, and gradual automation, while acknowledging that full automation remains a longer-term prospect. By synthesizing current evidence and proof-of-concept applications, this review aims to provide clinicians with a comprehensive overview of the AI and robotics toolkit relevant to implant dentistry and to outline both the opportunities and remaining limitations of these disruptive technologies as the field progresses towards seamless, fully integrated treatment pathways. Full article

Background: This study aimed to explore the application value of magnetic resonance imaging (MRI)-based three-dimensional segmentation and reconstruction technology for spatial structural identification and volumetric quantification of glandular and adipose tissues in bilateral gynecomastia (GM) patients undergoing surgical treatment, hoping to provide precise imaging data to support clinical surgical decision-making. Methods: A retrospective analysis was performed on preoperative MRI images and general clinical data of 52 patients with bilateral gynecomastia at the patient level (bilateral totals, N = 52) who underwent surgical treatment in the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, from March 2023 to September 2024. All images were acquired using a SIEMENS Aera 1.5 T MRI scanner with T1-weighted three-dimensional fat-suppressed sequence (t1_fl3d_tra_spair). Semi-automatic segmentation and active contour modeling (Snake model) using ITK-SNAP 4.0 software were employed to independently identify glandular and adipose tissues, reconstruct accurate three-dimensional anatomical models, and quantitatively analyze tissue volumes. Results: The MRI-based three-dimensional segmentation and reconstruction method accurately distinguished glandular and adipose tissues in male breasts, establishing precise three-dimensional anatomical models with excellent reproducibility and operational consistency. Among the 52 patients with bilateral gynecomastia, glandular tissue volume exhibited a markedly non-normal distribution, with a median of 6.11 cm³ (IQR, 3.03–12.98 cm³). Adipose tissue volume followed a normal distribution with a mean of 1348.84 ± 494.97 cm³. The total breast tissue volume also showed a normal distribution, with a mean of 1361.97 ± 496.83 cm³. The proportion of glandular tissue in total breast volume was non-normally distributed with a median of 0.50% (IQR, 0.27–1.21%), while the proportion of adipose tissue was also non-normally distributed with a median of 99.50% (IQR, 98.79–99.73%). Conclusions: MRI combined with computer-assisted three-dimensional segmentation and reconstruction technology efficiently and accurately achieves spatial identification, three-dimensional modeling, and volumetric quantification of glandular and adipose tissues in patients with bilateral gynecomastia. It objectively reveals the spatial compositional characteristics of male breast tissues. This approach provides precise, quantitative data for clinical decision-making regarding surgical treatment of gynecomastia, featuring robust standardization and strong clinical applicability. Full article

The advancement of science and technology has elevated the practice of surgery where computer systems now perform the majority of calculations required for successful interventions. This technological progress can be leveraged to foster surgical improvements by developing and implementing novel computer models for the preoperative planning of surgical treatments. Such systems enable surgeons to select optimal treatment tactics and dosages of operative interventions tailored to individual patients. Currently, there is no consensus on the use of expectant management for hemangiomas, as the most effective therapeutic strategy often depends on the tumor’s type and location, with early treatment being critical in some cases. Accurate diagnosis and effective treatment necessitate precise determination of the tumor’s type, growth characteristics, structure, and location. The use of a surgical method for hemangiomas removal is better for the removal of small formations in places that are not critical from a cosmetic prospective (for example, for males this might be the back and legs). This paper presents a method for creating a three-dimensional (3D) model of hemangioma using polynomial approximation and spline modeling to assist surgeons. The development of the mathematical model, the software implementation, and a comprehensive error analysis are explained in this work. The resulting model demonstrated an average approximation error of 5.6%, and a discriminant analysis confirmed the significance of five key parameters for successful resection. The proposed system offers a robust and economically viable tool for improving the accuracy and outcomes of hemangioma surgery. Full article

Background/Objective: This study investigates the implementation and evolution of intelligent medical question-answering (QA) systems in healthcare to enhance service efficiency and quality. Methods: Through an integrated literature review and bibliometric analysis using CiteSpace 6.3.R1(64-bit) Basic software, we systematically evaluated core concepts, frameworks, and applications within medical QA systems, analyzing literature from 2018 to 2025 to identify research trends. Results: Significant applications were revealed across clinical decision support, medical knowledge retrieval, traditional Chinese medicine (TCM) formulation development, medical imaging report analysis, medical record quality control, mental health monitoring, and emotion recognition, demonstrating optimized resource allocation and service efficiency. Persistent challenges include system accuracy limitations, multimodal interaction capabilities, user trust barriers, and privacy protection concerns. Conclusion: Future research should prioritize multimodal diagnostic imaging, TCM-specific AI agents, and virtual-reality-assisted surgical exploration. Contributions: This work consolidates current achievements while establishing theoretical–practical foundations for innovation and large-scale implementation, advancing intelligent healthcare transformation. Full article

Orthognathic surgery, particularly maxillomandibular advancement (MMA), has emerged as an effective therapeutic option for patients with moderate to severe OSA who are refractory to conventional treatments. The wedge osteotomy of the maxilla, often performed in combination with mandibular surgery, can be a surgical treatment for obstructive sleep apnea (OSA). This case series report describes 6 OSA patients without anteroposterior maxillary deficiency who were treated with wedge osteotomy of the maxilla. Material and Methods: We conducted a retrospective analysis of 6 patients who underwent maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA), all operated on consecutively by the same surgeon between 2018 and 2024 at the Maxillofacial Surgery of San Camillo-Forlanini Hospital, in Rome, Italy. Patients were evaluated using a CAD/CAM-assisted approach. A pre- and postoperative comparative analysis was conducted to assess the effectiveness of the surgical treatment in improving OSA-related parameters. Maxillary wedge osteotomy and bilateral sagittal split osteotomies (BSSO) of the mandibular ramus were digitally planned. Results: The comparison between preoperative and postoperative CT scans, along with 3D reconstructions generated using dedicated software, revealed a counterclockwise rotation of the occlusal plane, resulting in a mandibular advancement of approximately 13 mm. The CT shows a significant increase in airway volume following the skeletal repositioning. The airway volume increased from 20.665 ± 546 mm³ to 27.177 ± 446 mm³. Conclusions: Counterclockwise rotational orthognathic surgery without maxillary advancement has been shown to effectively enlarge the posterior pharyngeal space while also delivering excellent esthetic outcomes. Full article

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by a reduction or complete interruption of airflow during sleep, with episodes lasting at least 10 s. In severe cases, blood oxygen saturation can drop significantly, reaching levels as low as 40%. The aim of this study was to compare CAD/CAM-assisted maxillomandibular advancement (MMA) with traditional surgical techniques in the treatment of obstructive sleep apnea (OSA). We conducted a retrospective analysis of patients who underwent maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA), all operated on consecutively by the same surgeon between 2022 and 2024 at the Maxillofacial Surgery of Policlinico Hospital San Camillo-Forlanini, Rome, Italy. This study included 18 patients with severe obstructive sleep apnea syndrome (OSAS) who underwent maxillomandibular advancement (MMA) surgery. The patients had a mean age of 38 years; 11 were male and 7 were female. Patients were divided into two groups: Group A, treated using a CAD/CAM-assisted surgical approach (five male and four female), and Group B, treated with conventional surgical techniques (six male and three female). Results: The comparison between preoperative and postoperative CT scans, along with 3D reconstructions using dedicated software, demonstrated a significant increase in airway volume following the skeletal repositioning. Notably, airway volume increased from 19.25 ± 0.5 mm³ to 26.14 ± 1.264 mm³ in group A and 20.564 ± 0.71 mm³ to 25.425 ±1.103 mm³ in group B. Conclusion: No significant differences were observed between the CAD/CAM-assisted and conventional surgical techniques for maxillomandibular advancement (MMA) in the treatment of severe obstructive sleep apnea (OSA). Both approaches led to a reduction in the apnea–hypopnea index (AHI) and an increase in posterior airway space (PAS). However, the use of software and digital planning through CAD/CAM technology allows for greater precision and shorter operative times, making the procedure more efficient overall. Full article

The aim of this work is to analyse the effectiveness of the medical use of the Cavitron Ultrasonic Surgical Aspirator (CUSA) in microsurgical treatment of Intramedullary Spinal Cord Tumors (IMSCTs), with a focus on the thermo-mechanical effects on neighbouring tissues to assess any potential damage. Indeed, CUSA emerges as an innovative solution, minimally invasive tumor excision technique, enabling controlled and focused operations. This study employs a Finite Element Analysis (FEA) to simulate the vibratory and thermal interactions occurring during CUSA application. A computational model of a vertebral column segment affected by an IMSCT was developed and analysed using ANSYS 2024 software. The simulations examined strain distribution, heat generation, and temperature propagation within the biological tissues. The FEA results demonstrate that the vibratory-induced strain remains highly localised to the application site, and thermal effects, though measurable, do not exceed the critical safety threshold of 46 °C established in the literature. These findings suggest that CUSA can be safely used within defined operational parameters, provided that energy settings and exposure times are carefully managed to mitigate excessive thermal accumulation. These conclusions contribute to the understanding of the thermo-mechanical interactions in ultrasonic tumour resection and aim to assist medical professionals in optimising surgical protocols. Full article

Objectives: Pelvic tumor resections demand high surgical precision to ensure clear margins while preserving function. Although patient-specific instruments (PSIs) improve osteotomy accuracy, positioning errors remain a limitation. This study evaluates the feasibility, accuracy, and usability of a novel dual-function augmented reality (AR) system for intraoperative guidance in PSI positioning and osteotomy execution using a head-mounted display (HMD). The system provides dual-function support by assisting both PSI placement and osteotomy execution. Methods: Ten fresh-frozen cadaveric hemipelves underwent AR-assisted internal hemipelvectomy, using customized 3D-printed PSIs and a new in-house AR software integrated into an HMD. Angular and translational deviations between planned and executed osteotomies were measured using postoperative CT analysis. Absolute angular errors were computed from plane normals; translational deviation was assessed as maximum error at the osteotomy corner point in both sagittal (pitch) and coronal (roll) planes. A Wilcoxon signed-rank test and Bland–Altman plots were used to assess intra-workflow cumulative error. Results: The mean absolute angular deviation was 5.11 ± 1.43°, with 86.66% of osteotomies within acceptable thresholds. Maximum pitch and roll deviations were 4.53 ± 1.32 mm and 2.79 ± 0.72 mm, respectively, with 93.33% and 100% of osteotomies meeting translational accuracy criteria. Wilcoxon analysis showed significantly lower angular error when comparing final executed planes to intermediate AR-displayed planes (p < 0.05), supporting improved PSI positioning accuracy with AR guidance. Surgeons rated the system highly (mean satisfaction ≥ 4.0) for usability and clinical utility. Conclusions: This cadaveric study confirms the feasibility and precision of an HMD-based AR system for PSI-guided pelvic osteotomies. The system demonstrated strong accuracy and high surgeon acceptance, highlighting its potential for clinical adoption in complex oncologic procedures. Full article

Objectives: to evaluate the feasibility and utility of intraoperative optical coherence tomography (iOCT) utilizing an immersive augmented reality surgical headset (Beyeonics iOCT, Beyeonics Vision Ltd., Haifa, Israel) digital visualization platform with swept-source integrated OCT in ophthalmic surgery. Methods: As part of the Institutional Review Board-approved prospective DISCOVER study, the Beyeonics iOCT was utilized in multiple ophthalmic surgical procedures to evaluate the feasibility and utility of iOCT with this platform. The Beyeonics iOCT is a three-dimensional surgical visualization system that utilizes a swept-source integrated OCT within the digital microscope system. Surgeon feedback on system performance and integration into the surgical workflow was gathered via a prespecified survey. Results: Thirteen eyes of thirteen patients were included in this study. The surgical procedures consisted of four cataract surgeries, two lamellar corneal transplants, one pterygium removal, and six vitreoretinal surgeries. Surgeons were able to successfully view and review the iOCT images within the surgical Head-Mounted Display, eliminating the need for an external display. Utility feedback from surgeons included iOCT assisting with confirming wound architecture, corneal graft orientation, and retinal structure. All surgeries were completed without reverting to a conventional microscope, and no intraoperative adverse events occurred. Conclusions: The new visualization platform with integrated swept-source iOCT demonstrated feasibility and potential utility in multiple ophthalmic surgical platforms. Additional research related to outcomes, ergonomics, and enhanced software analysis is needed in the future. Full article

Background/Objectives: This study aimed to evaluate the results of continuous intracranial pressure (ICP) monitoring in children with macrocephaly or rapidly increasing head circumference (HC) diagnosed as benign external hydrocephalus (BEH). Here, we report the absolute ICP measurements, ICP pulsatility, and slow ICP waves after at least 48 h of continuous monitoring in a cohort of 36 children diagnosed with BEH. Methods: A prospective study of continuous ICP monitoring was performed in 36 consecutive children with macrocephaly (HC above the 97.5th percentile) or rapidly increasing HC (at least crossing two percentile curves), diagnosed with BEH (22 boys and 14 girls with a mean age of 23.6 ± 13.3 months, minimum: 6, maximum 65), using an epidural sensor. For the first four children in the study, hard copies of the ICP values were obtained using an analog recorder. Starting from the fifth patient, the ICP signal was sampled at 200 Hz and stored on a computer using a computer-based data acquisition and analysis system (LabChart v8.1 software). Results: Clinical signs or symptoms were identified in 20 patients (55.6%). Delayed motor or language development was noted in 18 (50%) and 20 (55.6%) patients, respectively. In 13 patients, the enlargement of the subarachnoid spaces was found to be associated with an additional condition. The median of mean ICP values for the entire cohort was 17 mmHg, with a minimum of 6.7 mmHg and a maximum of 29 mmHg. All patients exhibited a percentage of B waves exceeding 20% during the night, with a median value of 47.4% (min: 23.2, max: 75). Three children had nocturnal plateau waves. At night, regular ICP recordings alternated with periods of significant increases in ICP, often exceeding 10 mmHg above baseline values. High-amplitude B waves were noted during these episodes, and the amplitude of the cardiac waveform at the peak of the B waves was consistently greater than 5 mmHg, displaying an abnormal morphology (P2 > P1). A ventriculoperitoneal shunt was implanted in 30 of the 36 patients. Conclusions: Patients with BEH may present significant abnormalities in ICP. Monitoring this variable in certain cases can assist in determining the necessity for surgical treatment. Full article

For over two decades, robotic-assisted thoracic surgery (RATS) has revolutionized thoracic oncology. With enhanced visualization, dexterity, and precision, RATS has reduced blood loss, shortened hospital stays, and sped up recovery compared to traditional surgery or video-assisted thoracoscopic surgery (VATS). The use of 3D high-definition imaging and articulated instruments allows for complex resections and advanced lymph node assessment. RATS delivers oncological outcomes similar to open surgery and VATS, with high rates of complete (R0) resections and acceptable complication rates. Its minimally invasive nature promotes quicker recovery. Advances in imaging software and augmented reality further enhance surgical accuracy and reduce intraoperative risks. However, RATS has some limitations, including high costs and a lack of tactile feedback, and certain complex procedures, such as extended resections and intrapericardial interventions, remain challenging. With growing experience and technological advances, RATS shows promise in reducing morbidity, improving quality of life, and expanding access to advanced oncologic care. This article reviews the evolution, benefits, and limitations of RATS in NSCLC treatment, highlighting its emerging role in managing complex cases. Full article

Background and Objectives: Robotic-assisted surgery (RS) has progressively emerged as a promising technology in modern thoracolumbar spinal surgery, offering the potential to enhance accuracy and improve clinical outcomes. To date, the benefits of robot-assisted techniques in thoracolumbar spinal surgery remain controversial. The objective of this study was to assess the efficacy and safety of RS compared to fluoroscopy-assisted surgery (FS) in spinal fusion procedures. Materials and Methods: In accordance with the PRISMA guidelines, a systematic review and meta-analysis was conducted, using REVMAN V5.3 software. The review protocol was registered in the Prospective Register of Systematic Reviews (PROSPERO) website with the following registration number: CRD42024567193. Results: Eighteen studies were included in the meta-analysis with a total of 1566 patients examined. The results demonstrated a worse accuracy in FS in cases with major violations of the peduncular cortex (D–E grades, according to Gertzbein’s classification) [(odds ratio (OR) 0.47, 95%-CI 0.28 to 0.80, I² 0%]. In addition, a lower complication rate was shown in the RS group compared to the FS group, specifically regarding the need for surgical revision due to screw mispositioning (OR 0.28-CI 0.17 to 0.48, I² 98%). Conclusions: Advantages of robot-assisted techniques were demonstrated in terms of postoperative complications, revision surgery rates, and the accuracy of screw placement. While RS represents a valuable and promising technological advancement in thoracolumbar spinal surgery, future studies are needed to further explore its advantages in thoracolumbar spinal surgery and to identify which spinal surgical approach has greater advantages when using the robot. Full article

Background and Objectives: Realistic surgical simulation models are essential for neurosurgical training, particularly in glioma resection. We developed a patient-specific simulation model designed for fluorescence-guided glioma resection, providing an anatomically accurate and reusable platform for surgical education. While insular gliomas were used as an example, the model can be adapted to simulate gliomas in other brain regions, making it a versatile training tool. Methods: Using open-source 3D software, we created a digitally reconstructed skull, brain, and cerebral vessels, including a fluorescent insular glioma. The model was produced through additive manufacturing and designed with input from neurosurgeons to ensure a realistic and reusable representation of the Sylvian fissure and bone structures. The simulator’s educational effectiveness and usability were evaluated by two senior physicians, four assistant physicians, and six medical students using actual microsurgical instruments. Assessments were based on subjective and objective criteria. Results: Subjective evaluations, using a 5-point Likert scale, showed high face and content validity. Objective measures demonstrated strong construct validity, accurately reflecting the participant’s skills. Medical students and resident neurosurgeons showed marked improvement in their learning curve over three attempts, with progressive improvement in performance. Conclusions: This simulation model addresses advanced neurosurgical training needs by providing a highly realistic, cost- effective, and adaptable platform for fluorescence-guided glioma resection. Its effectiveness in enhancing surgical skills suggests significant potential for broader integration into neurosurgical training programs. Further studies are warranted to explore its applications in different glioma localizations and training settings. Full article