Fogorvosi szemle, 2021 (114. évfolyam, 1-4. szám)
2021-09-01 / 3. szám
FOGORVOSI SZEMLE 114. évf. 3. sz. 2021. n 130 treatment. J Clin Periodontol 2015 Jun; 42 (6): 557–566. Epub 2015 May 29. PMID: 25924545. https://doi.org/10.1111/jcpe.12409 25. SCULEAN A, CHIANTELLA GC, WINDISCH P, ARWEILER NB, BRECX M, GERA I: Healing of intra-bony defects following treatment with a composite bovine-derived xenograft (Bio-Oss Collagen) in combination with a collagen membrane (Bio-Gide PERIO). J Clin Periodontol 2005 Jul; 32 (7): 720–724. PMID: 15966877. https://doi.org/10.1111/j.1600-051X.2005.00758.x 26. TROMBELLI L, FARINA R, FRANCESCHETTI G, CALURA G: Single-flap approach with buccal access in periodontal reconstructive procedures. J Periodontol 2009 Feb; 80 (2): 353–360. PMID: 19186978. https://doi.org/10.1902/jop.2009.080420 27 VANDENBERGHE B, JACOBS R, YANG J: Diagnostic validity (or acuity) of 2D CCD versus 3D CBCT-images for assessing periodontal breakdown. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007 Sep; 104 (3): 395–401. Epub 2007 Jul 5. PMID: 17613257. https://doi.org/10.1016/j.tripleo.2007.03.012 28. WALTER C, KANER D, BERNDT DC, WEIGER R, ZITZMANN NU: Three-dimensional imaging as a pre-operative tool in decision making for furcation surgery. J Clin Periodontol 2009 Mar; 36 (3): 250–257. PMID: 19236537. https://doi.org/10.1111/j.1600-051X.2008.01367.x SOLYOM E, PALKOVICS D, PINTER CS, FRANCESCO GM, WINDISCH P Virtual planning and volumetric evaluation in the regenerative-reconstructive surgical treatment of a complex periodontal defect Case presentation Aim: Our aim was to present the regenerative-reconstructive surgical treatment of a complex periodontal defect. Surgical treatment planning was carried out on realistic virtual hybrid models, containing all relevant anatomical structures (teeth, alveolar bone and gingiva). Additional aim was to evaluate the outcome of the surgical treatment, by the superimposition of pre- and postoperative cone-beam computed tomography (CBCT) scans. Materials and methods: Utilizing a semi-automatic segmentation method, the 3D model of teeth and alveolar bone was generated from the CBCT scan using the open source radiographic image processing software, 3D Slicer. Spatial registration of the hard tissue model acquired from the CBCT scan and the digital model acquired with an intraoral scanner was performed based on anatomical landmarks. First step of the planned stepwise surgical treatment was the extraction and simultaneous alveolar ridge preservation of tooth 26. Surgery was carried out according to the extraction site development (XSD) technique. Second step was the regenerative treatment of the horizonto-vertical periodontal defect involving tooth 24 and 25. Superimposition of the pre- and postoperative CBCT scans allowed to validate the volumetric and linear changes. Results: In the surgical area the cumulative hard tissue gain was 0.44 cm3. Crestal bone resorption of 0.11 cm 3 oc curred at the palatal and buccal aspects. Linear measurements were performed to evaluate the hard tissue fill of the periodontal defect around tooth 24 and 26. On average the intrabony component showed a 53.88 ± 36.84% of hard tissue fill, with minor crestal bone resorption. On average a 1.22 ± 0.87 mm of gingival recession occurred around the teeth. Conclusion: It can be concluded that hybrid models acquired with the aforementioned technique allowed detailed planning of the surgical procedures. With the application of the postoperative volumetric and linear evaluation, the healing dynamics of the complex defect could be demonstrated thoroughly. Keywords: virtual surgical planning, regenerative-reconstructive periodontal surgery, alveolar ridge preservation, volumetric evaluation CBCT, segmentation, 3D radiographic image reconstruction Case report
