Reflected Vision in Surgical Practice and Implants

Everybody sit down. If you go to this little program, this little website, this little app called YouTube, and you do a search for "In your face oral surgeries" you'll find some pretty fun oral surgery procedures. There will be things like ginormous cyst  removals from maxilus. There will be lip wedge resections for squamous cell carcinoma. There will be jaw surgery procedures, chin surgery procedures, genioplasties, lefort 1's, bilateral sagittal split osteotomies, wisdom teeth, dental implants.

You go there, there's lots of fun stuff that's in your face oral surgery. Now, when you go there, I want you to subscribe and I want you to give it a thumbs up. This will help increase our rankings on YouTube and make this more visible. Please go ahead and do so and forward these videos onto anybody that you think may be interested.

The first article that I want to talk about is titled Reflected Vision in Surgical Practice: A novel method to circumvent posture related musculoskeletal disorders. This is by Krishnakumar. These guys, I'm gonna start off by noting that the prevalence of neck and back pain has been reported to be as high as 81% in practicing dentists. The literature shows that lower back pain in the most common presentation in surgeons who operate in the standing posture.

Remarkably, the current trend of sitting surgical or dental practices shift to the side of clinical pain from the lower back to the neck, upper back, and the TMJ in addition to associated neurological defects of the hand and wrist. The common methods for preventing posture related musculoskeletal problem are, number one, changing the patients table and chair height. Number two, using ergonomically designed operating chairs. Number three, frequently stretching the postural neck and back muscles between procedures. Four, using magnification in surgical practice.

Frequent breaks from work and muscle stretching might not be viable options for the oral maxillofacial surgeon because of the nature of the work and the prolonged duration of surgical procedures. There is something called the CPEX, that's CPEX lazy reader glasses out of Beijing, China with prism incorporated lenses developed an excellent field of vision through the reflective visual, maintaining an ergonomic neck posture.

Essentially, what these are, are some glasses that have prisms in them that allow you to keep your head and neck looking straight forward while your vision and what you're seeing is down in a normal position for where we need to see to do surgery. I thought this was kind of an ingenious way of trying to help posture and try to minimize head and neck pain for dentists. I may actually give these a shot and see what this is like.

It does state in the article that although a clinical use of prism glasses requires an adaptation period, it is shorter and the use of prism glasses is relatively easy to master compared with other optical aids such as surgical lips.

The next article I'd like to review is entitled Dental Implants: The last hundred years by Michael Black. He starts of by noting that this yeah is the 100 year anniversary of the American Association of Oral maxillofacial surgery and is the 75th anniversary of the journal of oral maxillofacial surgery.

It first talks about ancient implants and how the ancient Egyptians and south American civilizations used animal teeth or carved ivory. It's pretty doubtful that these implants functioned without early failure. In the 17th century, using a variety of materials in animals, replacement of tooth roots was performed in Europe. In the 18th century, teeth were transplanted from donors who sold their teeth to individuals desiring replacements.

Greenfield, in 1913, developed the basket style endosteal implant composed or iridium with a gold solder. Adams, in 1938, developed and patented a submergible threaded cylindrical implant with a smooth ball and hitch type connection. Metal devices were being implanted elsewhere in the bodies in cobalt chromium molybdenum, which is called Vitalium by Helmetica in 1938, was used and had a threaded design. Apparently this implant stayed in position after being placed in a fresh extraction site until the patient died in 1955. In this article, they actually have a picture of this implant.

A separiostal implant was developed by Dahl, and it was used to restore the maxilla in the mandible. There were problems with late failure and resorption of the basal bone with these, and jaw fracture and infection. The end implants currently used with an increase in predictability have replaces a separiostal implant. Most of the implant designs in the early 60's were a one piece implant, either solid screws or hollow basket design. In implants did not form an intimate connection between bone and implant. They developed a fibrous implant interface.

Blade implants, as reported in 1987, have some success, however, the predictability of the blade implant did not reach that of endosseous integrated implants. In the mid 1970's, another type of implant was introduced. The transosteal implant was placed in the interior mandible for an overdenture. The use of endosseous osteo-integrated implants was introduced to North America in 1982. At that conference, Branna Mark, at all, presented data from 15 years of work, which was highly evidence based with long-term clinical follow up findings.

Success was evaluated by measuring bone loss using standardized radiographs, gingival health function, and patient comfort. Cylindrical implants without threads were designed and placed in the 80's and 90's. These relied on titanium plasma sprayed surface coatings or hydroxyapatite coatings. However, crystal bone loss did occur with the result in implant failures in a group of patients. Currently, most implants placed have a threaded design rather than cylindrical or a press fit design.

There have also been advances in diagnostic methods, including CBCT scan, which provides cross sectional three dimensional images using a standard file format called the dicom file. There's also intraoral digital scanners, which have STL files, which allows superimposition of the patient's' teeth or a model setup onto the CBCT scan for further virtual planning.

The article goes along to discuss all sorts of different things. Probably one of the most pertinent would be the use of navigation to guide implant placement. Navigation includes surgical guides and the use of a static CT generated guide stint with a coordinated system, a specific drilling. It results in a less than 2mm crescent apical deviation from the plan and an angulation error of less than 5%.

There's also dynamic navigation. The advantages of dynamic navigation are improved accuracy, less invasive flap reflection as compared to freehand approaches unless trauma to surgeons because their posture's improved with less back and neck bending. The navigation, whether static or dynamic, provides a clinician with statistically significant improvements in implant placement accuracy compared with freehand methods.

In conclusion, the following summarized the past 100 years concerning implants. First of all, planning is the same over time. We must examine our patients and discuss their needs and desires with them. Technological advances just have been significant and we now have the ability to use digital optical and CT scanning to virtually plant the patients' reconstruction.                         

Number three, materials and methods for hard and soft tissue grafting are similar to those used for dental patients, but modified and improved. Number four, immediate treatment of the extraction site has moved from no intervention to immediate implant and prosthetic placement. Finally number five, we no longer need to rely on freehand methods to place an implant. We can now use navigation methods.

There is no guarantee as to the accuracy of this information. No treatment decision should be based on this information presented. Although every attempt is made to be accurate and factual, some items discussed are the opinion of the author and no liability will be assumed for the content presented.