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Article ; Online: Virtual planning for mandible resection and reconstruction.

Probst, Florian Andreas / Liokatis, Paris / Mast, Gerson / Ehrenfeld, Michael

Innovative surgical sciences

2023 Volume 8, Issue 3, Page(s) 137–148

Abstract: In mandibular reconstruction, computer-assisted procedures, including virtual surgical planning (VSP) and additive manufacturing (AM), have become an integral part of routine clinical practice. Especially complex cases with extensive defects after ... ...

Abstract	In mandibular reconstruction, computer-assisted procedures, including virtual surgical planning (VSP) and additive manufacturing (AM), have become an integral part of routine clinical practice. Especially complex cases with extensive defects after ablative tumor surgery benefit from a computer-assisted approach. Various CAD/CAM-manufactured tools such as surgical guides (guides for osteotomy, resection and predrilling) support the transition from virtual planning to surgery. Patient-specific implants (PSIs) are of particular value as they facilitate both osteosynthesis and the positioning of bone elements. Computer-based approaches may be associated with higher accuracy, efficiency, and superior patient outcomes. However, certain limitations should be considered, such as additional costs or restricted availability. In the future, automation of the planning process and augmented reality techniques, as well as MRI as a non-ionizing imaging modality, have the potential to further improve the digital workflow.
Language	English
Publishing date	2023-12-06
Publishing country	Germany
Document type	Journal Article ; Review
ISSN	2364-7485
ISSN (online)	2364-7485
DOI	10.1515/iss-2021-0045
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Nodal Disease and Survival in Oral Cancer: Is Occult Metastasis a Burden Factor Compared to Preoperatively Nodal Positive Neck?

Haidari, Selgai / Obermeier, Katharina Theresa / Kraus, Moritz / Otto, Sven / Probst, Florian Andreas / Liokatis, Paris

Cancers

2022 Volume 14, Issue 17

Abstract: The impact of neck involvement and occult metastasis (OM) in patients with oral squamous cell carcinoma (OSCC) favors an elective neck dissection. However, there are barely any existing data on survival for patients with OM compared with patients with ... ...

Abstract	The impact of neck involvement and occult metastasis (OM) in patients with oral squamous cell carcinoma (OSCC) favors an elective neck dissection. However, there are barely any existing data on survival for patients with OM compared with patients with positive lymph nodes detected preoperatively. This study aims to compare survival curves of patients suffering from lymph nodal metastases in a preoperatively N+ neck with those suffering from OM. In addition, clinical characteristics of the primary tumor were analyzed to predict occult nodal disease. This retrospective cohort study includes patients with an OSCC treated surgically with R0 resection with or without adjuvant chemoradiotherapy between 2010 and 2016. Minimum follow-up was 60 months. Kaplan-Meier analysis was used to compare the survival between patients with and without occult metastases and patients with N+ neck to those with occult metastases. Logistic regression was used to detect potential risk factors for occult metastases. The patient cohort consisted of 226 patients. Occult metastases occurred in 16 of 226 patients. In 53 of 226 patients, neck lymph nodes were described as suspect on CT imaging but had a pN0 neck. Higher tumor grading increased the chance of occurrence of occult metastasis 2.7-fold (OR = 2.68, 95% CI: 1.07-6.7). After 12, 24, 48 and 60 months, 82.3%, 73.8%, 69% and 67% of the N0 patients, respectively, were progression free. In the group with OM occurrence, for the same periods 66.6%, 50%, 33.3% and 33.3% of the patients, respectively, were free of disease. For the same periods, respectively, 81%, 63%, 47% and 43% of the patients in the N+ group but without OM remained disease free. The predictors for progression-free survival were a positive N status (HR = 1.44, 95% CI: 1.08-1.93) and the occurrence of OM (HR = 2.33, 95% CI: 1.17-4.64). The presence of occult metastasis could lead to decreased survival and could be a burdening factor requiring treatment escalation and a more aggressive follow-up than nodal disease detected in the preoperative diagnostic imaging.
Language	English
Publishing date	2022-08-31
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers14174241
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Book ; Online ; Thesis: Spezielle Aspekte der Bildgebung und bildgebungsbasierter computergestützter Verfahren in der Mund-, Kiefer- und Gesichtschirurgie

Probst, Florian Andreas [Verfasser]

2017

Author's details	Florian Andreas Probst
Keywords	Medizin, Gesundheit ; Medicine, Health
Subject code	sg610
Language	German
Publisher	Universitätsbibliothek der Ludwig-Maximilians-Universität
Publishing place	München
Document type	Book ; Online ; Thesis
Database	Digital theses on the web

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Article: Zukünftige Optionen zur Rekonstruktion bei ausgedehnten knöchernen Defekten im Kiefer-, Gesichts- und Schädelbereich mittels CAD/CAM-gefertigter bioaktiver Leitschienen

Probst, Florian Andreas

OP-Journal : wissenschaftliche, klinische und technische Informationen

2013 Volume 29, Issue 2, Page(s) 200–204

Abstract: Großdimensionierte knöcherne Defektsituationen stellen eine beträchtliche Herausforderung für die Mund-, Kiefer- und Gesichtschirurgie dar. Tissue-Engineering-(TE-)Anwendungen haben das Potenzial, in Zukunft eine vielversprechende Alternative zu ... ...

Abstract	Großdimensionierte knöcherne Defektsituationen stellen eine beträchtliche Herausforderung für die Mund-, Kiefer- und Gesichtschirurgie dar. Tissue-Engineering-(TE-)Anwendungen haben das Potenzial, in Zukunft eine vielversprechende Alternative zu autologen Regenerationstechniken zu sein. Derzeit gilt bspw. die Verwendung von Kompositscaffolds aus Tricalciumphosphat (TCP) und Polymeren sowie deren Besiedelung mit mesenchymalen Stammzellen oder Fettstammzellen als aussichtsreiche Tissue-Engineering-Strategie. CAD-CAM-Verfahren könnten dabei wesentlich dazu beitragen, die komplexe Morphologie des Gesichtsschädels zu rekonstruieren. Denkbare Indikationen zu Tissue-Engineering-Applikationen bestehen z. B. bei Kontinuitätsdefekten des Unterkiefers, Mittelgesichts- und Kalottendefekten sowie knöchernen Defekten des Kieferspaltbereichs.
Keywords	Computertassistierte Rekonstruktion ; Kieferchirurgie ; Gesichtschirurgie
Language	German
Document type	Article
ZDB-ID	1016068-1
ISSN	0178-1715
ISSN	0178-1715
Database	bibnet.org

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Article: Fixateur externe zur temporären Überbrückung von Defektzonen im Unterkiefer

Probst, Florian Andreas

OP-Journal : wissenschaftliche, klinische und technische Informationen

2013 Volume 29, Issue 2, Page(s) 147–155

Abstract: Die Verwendung des Fixateur externe stellt grundsätzlich eine temporäre Alternative zur internen lasttragenden Plattenosteosynthese bei Defektzonen im Unterkiefer dar. Er setzt sich aus 3 Hauptkomponenten zusammen, die allesamt aus Titan bestehen: 1) ... ...

Abstract	Die Verwendung des Fixateur externe stellt grundsätzlich eine temporäre Alternative zur internen lasttragenden Plattenosteosynthese bei Defektzonen im Unterkiefer dar. Er setzt sich aus 3 Hauptkomponenten zusammen, die allesamt aus Titan bestehen: 1) Pins oder Schanz-Schrauben, 2) vorgeformten Verbindungsstäben, 3) verstellbaren, kombinierten Klemmbacken mit Schnappmechanismus. Das Gesamtkonstrukt kann sowohl in „Visor-style“-Technik als auch in Modulartechnik zusammengesetzt werden. Der Gebrauch ist speziellen Indikationen vorbehalten: a) pathologische Frakturen, meist im Rahmen von infizierten Osteoradionekrosen, b) weitspännige Defekte nach ablativer Tumorchirurgie, c) Notfallmanagement beispielsweise bei Polytraumapatienten mit Unterkiefertrümmerfrakturen. Unserer Erfahrung nach ist die Technik komplikationsarm und verlässlich anwendbar. Sie genügt den Anforderungen einer lasttragenden Osteosynthese. Der Mandible External Fixator ist nicht zuletzt aufgrund der geringen Weichgewebstraumatisierung eine interessante Option bei multifragmentären Frakturen oder Defektzonen, die mit einer reduzierten Knochenqualität und/oder Weichgewebsdefiziten einhergehen.
Keywords	Kieferchirurgie ; Fixierung ; externe Fixation
Language	German
Document type	Article
ZDB-ID	1016068-1
ISSN	0178-1715
ISSN	0178-1715
Database	bibnet.org

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Article: Digital planning and individual implants for secondary reconstruction of midfacial deformities: A pilot study.

Liokatis, Paris / Malenova, Yoana / Fegg, Florian-Nepomuk / Haidari, Selgai / Probst, Monika / Boskov, Marko / Cornelius, Carl-Peter / Troeltzsch, Matthias / Probst, Florian-Andreas

Laryngoscope investigative otolaryngology

2022 Volume 7, Issue 2, Page(s) 369–379

Abstract: Objective: To evaluate the feasibility and accuracy of implementing three-dimensional virtual surgical planning (VSP) and subsequent transfer by additive manufactured tools in the secondary reconstruction of residual post-traumatic deformities in the ... ...

Abstract	Objective: To evaluate the feasibility and accuracy of implementing three-dimensional virtual surgical planning (VSP) and subsequent transfer by additive manufactured tools in the secondary reconstruction of residual post-traumatic deformities in the midface. Methods: Patients after secondary reconstruction of post-traumatic midfacial deformities were included in this case series. The metrical deviation between the virtually planned and postoperative position of patient-specific implants (PSI) and bone segments was measured at corresponding reference points. Further information collected included demographic data, post-traumatic symptoms, and type of transfer tools. Results: Eight consecutive patients were enrolled in the study. In five patients, VSP with subsequent manufacturing of combined predrilling/osteotomy guides and PSI was performed. In three patients, osteotomy guides, repositioning guides, and individually prebent plates were used following VSP. The median distances between the virtually planned and the postoperative position of the PSI were 2.01 mm ( Conclusion: This study demonstrated the feasibility of VSP and transfer by additive manufactured tools for the secondary reconstruction of complex residual post-traumatic deformities in the midface. However, the median deviations observed in this case series were unexpectedly high. The use of navigational systems may further improve the level of accuracy.
Language	English
Publishing date	2022-02-04
Publishing country	United States
Document type	Journal Article
ISSN	2378-8038
ISSN	2378-8038
DOI	10.1002/lio2.753
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Magnetic resonance imaging based computer-guided dental implant surgery-A clinical pilot study.

Probst, Florian Andreas / Schweiger, Josef / Stumbaum, Maria Juliane / Karampinos, Dimitrios / Burian, Egon / Probst, Monika

Clinical implant dentistry and related research

2020 Volume 22, Issue 5, Page(s) 612–621

Abstract: Background: Computer-guided implant surgery is currently based on radiographic techniques exposing patients to ionizing radiation.: Purpose: To assess, whether computer-assisted 3D implant planning with template-guided placement of dental implants ... ...

Abstract	Background: Computer-guided implant surgery is currently based on radiographic techniques exposing patients to ionizing radiation. Purpose: To assess, whether computer-assisted 3D implant planning with template-guided placement of dental implants based on magnetic resonance imaging (MRI) is feasible. Materials and methods: 3-Tesla MRI was performed in 12 subjects as a basis for prosthetically driven virtual planning and subsequent guided implant surgery. To evaluate the transferability of the virtually planned implant position, deviations between virtually planned and resulting implant position were studied. Matching of occlusal surfaces was assessed by comparing surface scans with MRI-derived images. In addition, the overall image quality and the ability of depicting anatomically important structures were rated. Results: MRI-based guided implant surgery with subsequent prosthetic treatment was successfully performed in nine patients. Mean deviations between virtually planned and resulting implant position (error at entry point 0.8 ± 0.3 mm, error at apex 1.2 ± 0.6 mm, angular deviation 4.9 ± 3.6°), mean deviation of occlusal surfaces between surface scans and MRI-based tooth reconstructions (mean 0.254 ± 0.026 mm) as well as visualization of important anatomical structures were acceptable for clinical application. Conclusion: Magnetic resonance imaging (MRI) based computer-assisted implant surgery is a feasible and accurate procedure that avoids exposure to ionizing radiation.
MeSH term(s)	Computer-Aided Design ; Computers ; Cone-Beam Computed Tomography ; Dental Implantation, Endosseous ; Dental Implants ; Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; Patient Care Planning ; Pilot Projects ; Surgery, Computer-Assisted
Chemical Substances	Dental Implants
Language	English
Publishing date	2020-09-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2094300-3
ISSN	1708-8208 ; 1523-0899
ISSN (online)	1708-8208
ISSN	1523-0899
DOI	10.1111/cid.12939
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Article ; Online: MRI-detected intraosseous bone marrow edema recedes after effective therapy of periodontitis.

Schwarting, Julian / Probst, Florian Andreas / Griesbauer, Magdalena / Robl, Teresa / Burian, Egon / Wiestler, Benedikt / Brunner, Teresa / Malenova, Yoana / Bumm, Caspar / Folwaczny, Matthias / Probst, Monika

European radiology

2023

Abstract: Objectives: T2 STIR MRI sequences can detect preclinical changes associated with periodontal inflammation, i.e. intraosseous edema in the tooth-supporting bone. In this study, we assessed whether MRI can be used for monitoring periodontal disease.: ... ...

Abstract	Objectives: T2 STIR MRI sequences can detect preclinical changes associated with periodontal inflammation, i.e. intraosseous edema in the tooth-supporting bone. In this study, we assessed whether MRI can be used for monitoring periodontal disease. Material and methods: In a prospective cohort study, we examined 35 patients with periodontitis between 10/2018 and 04/2019 by using 3D isotropic T2-weighted short tau inversion recovery (STIR) and Fast Field Echo T1-weighted Black bone sequences. All patients received standardized clinical exams before and three months after non-surgical periodontal therapy. Bone marrow edema extent was quantified in the STIR sequence at 922 sites before and after treatment. Results were compared with standard clinical findings. Non-parametric statistical analysis was performed. Results: Non-surgical periodontal treatment caused significant improvement in mean probing depth (p < 0.001) and frequency of bleeding on probing (p < 0.001). The mean depth of osseous edema per site was reduced from a median [IQR] of 2 [1, 3] mm at baseline to 1 [0, 3] mm, (p < 0.001). Periodontal treatment reduced the frequency of sites with edema from 35 to 24% (p < 0.01). Conclusion: The decrease of periodontal bone marrow edema, as observed with T2 STIR MR imaging, is indicative of successful periodontal healing. Clinical relevance statement: T2 STIR hyperintense bone marrow edema in the periodontal bone decreases after treatment and can therefore be used to evaluate treatment success. Furthermore, MRI reveals new options to depict hidden aspects of periodontitis. Key points: • T2 STIR hyperintense periodontal intraosseous edema was prospectively investigated in 35 patients with periodontitis before and after treatment and compared to clinical outcomes. • The frequency of affected sites was reduced from 35 to 24% (p < 0.001), and mean edema depth was reduced from a median [IQR] of 2 [1, 3] mm at baseline to 1 [0, 3] mm 3 months after treatment. (p < 0.001). • T2 STIR sequences can be used to monitor the posttreatment course of periodontitis.
Language	English
Publishing date	2023-10-19
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-023-10327-6
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Article ; Online: Accuracy of free-hand positioned patient specific implants (PSI) in primary reconstruction after inferior and/or medial orbital wall fractures.

Probst, Florian Andreas / Cornelius, Carl-Peter / Otto, Sven / Malenova, Yoana / Probst, Monika / Liokatis, Paris / Haidari, Selgai

Computers in biology and medicine

2021 Volume 137, Page(s) 104791

Abstract: Background: To assess the accuracy with which CAD/CAM-fabricated patient-specific titanium implants (PSI) are positioned for inferior and/or medial orbital wall reconstruction without the use of intraoperative navigation.: Methods: Patients who ... ...

Abstract	Background: To assess the accuracy with which CAD/CAM-fabricated patient-specific titanium implants (PSI) are positioned for inferior and/or medial orbital wall reconstruction without the use of intraoperative navigation. Methods: Patients who underwent a primary reconstruction of the orbital walls with PSI due to fractures were enrolled in this retrospective cohort analysis. The primary outcome variables were the mean surface distances (MSD) between virtually planned and postoperative PSI position and single linear deviations in the x-, y- and z-axis at corresponding reference points. Secondary outcome variables included demographic data, classification of orbital wall defects and clinical outcomes. Results: A total of 33 PSI (orbital floor n = 22; medial wall, n = 11) were examined in 27 patients. MSD was on a comparable level for the orbital floor and medial wall (median 0.39 mm, range 0.22-1.53 mm vs. median 0.42 mm, range 0.21-0.98 mm; p = 0.56). Single linear deviations were lower for reconstructions of the orbital floor compared to the medial wall (median 0.45 vs. 0.79 mm; p < 0.05). There was no association between the occurrence of diplopia and the accuracy level (p = 0.418). Conclusions: Free-hand positioning of PSI reaches a clinically appropriate level of accuracy, limiting the necessity of navigational systems to selected cases.
MeSH term(s)	Humans ; Orbit/surgery ; Orbital Fractures/diagnostic imaging ; Orbital Fractures/surgery ; Prostheses and Implants ; Reconstructive Surgical Procedures ; Retrospective Studies
Language	English
Publishing date	2021-08-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	127557-4
ISSN	1879-0534 ; 0010-4825
ISSN (online)	1879-0534
ISSN	0010-4825
DOI	10.1016/j.compbiomed.2021.104791
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Article ; Online: Geometric accuracy of magnetic resonance imaging-derived virtual 3-dimensional bone surface models of the mandible in comparison to computed tomography and cone beam computed tomography: A porcine cadaver study.

Probst, Florian Andreas / Burian, Egon / Malenova, Yoana / Lyutskanova, Plamena / Stumbaum, Maria Juliane / Ritschl, Lucas Maximilian / Kronthaler, Sophia / Karampinos, Dimitrios / Probst, Monika

Clinical implant dentistry and related research

2021 Volume 23, Issue 5, Page(s) 779–788

Abstract: Background: Providing accurate 3-dimensional virtual bone surface models is a prerequisite for virtual surgical planning and additive manufacturing in craniomaxillofacial surgery. For this purpose, magnetic resonance imaging (MRI) may be a radiation- ... ...

Abstract	Background: Providing accurate 3-dimensional virtual bone surface models is a prerequisite for virtual surgical planning and additive manufacturing in craniomaxillofacial surgery. For this purpose, magnetic resonance imaging (MRI) may be a radiation-free alternative to computed tomography (CT) and cone beam computed tomography (CBCT). Purpose: The aim of this study was to assess the geometric accuracy of 3-dimensional T1-weighted MRI-derived virtual bone surface models of the mandible in comparison to CT and CBCT. Materials and methods: Specimens of the mandible from porcine cadavers were scanned with (1) a 3-dimensional T1-weighted MRI sequence (0.6 mm isotropic voxel) optimized for bone imaging, (2) CT, and (3) CBCT. Cortical mandibular structures (n = 10) were segmented using semiautomated and manual techniques. Imaging-based virtual 3-dimensional models were aligned with a high-resolution optical 3-dimensional surface scan of the dissected bone (=ground truth) and global geometric deviations were calculated (mean surface distance [MSD]/root-mean-square distance [RMSD]). Agreement between the imaging modalities was assessed by equivalence testing and Bland-Altman analysis. Results: Intra- and inter-rater agreement was on a high level for all modalities. Global geometric deviations (MSD/RMSD) between optical scans and imaging modalities were 0.225 ± 0.020 mm/0.345 ± 0.074 mm for CT, 0.280 ± 0.067 mm/0.371 ± 0.074 mm for MRI, and 0.352 ± 0.076 mm/0.454 ± 0.071 mm for CBCT. All imaging modalities were statistically equivalent within an equivalence margin of ±0.3 mm, and Bland-Altman analysis indicated high agreement as well. Conclusions: The results of this study indicate that the accuracy and reliability of MRI-derived virtual 3-dimensional bone surface models is equal to CT and CBCT. MRI may be considered as a reliable alternative to CT and CBCT in computer-assisted craniomaxillofacial surgery.
MeSH term(s)	Animals ; Cadaver ; Cone-Beam Computed Tomography ; Magnetic Resonance Imaging ; Mandible/diagnostic imaging ; Reproducibility of Results ; Swine
Language	English
Publishing date	2021-07-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2094300-3
ISSN	1708-8208 ; 1523-0899
ISSN (online)	1708-8208
ISSN	1523-0899
DOI	10.1111/cid.13033
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