Positioning accuracy assessment of minimally invasive percutaneous injection techniques for the treatment of temporomandibular disorders

Antônio Luís Neto Custódio, Andrew Cameron, Mahmoud Bakr, Chris Little, Bruno Ramos Chrcanovic, Peter Reher, Antônio Luís Neto Custódio, Andrew Cameron, Mahmoud Bakr, Chris Little, Bruno Ramos Chrcanovic, Peter Reher

Abstract

Objective: The aim of the present study was to evaluate the accuracy of an extraoral CBCT-planned 3D-printed surgical guide aimed to percutaneous injection of substances into the temporomandibular joint (TMJ) and the lateral pterygoid muscle (LPM).

Methods: Nine human cadaver heads were used. Pre-planning CBCT and facial scans were obtained and three percutaneous injection sites were planned: one for the lower compartment of the TMJ and two for the LPM. A digital surgical guide was then designed with small titanium sleeves and printed by a 3D printer. After the injections, new CBCT scans with the needles in place were obtained in order to assess the accuracy of the procedure in relation to the virtual planning.

Results: The mean values for angle deviation were very low (range 1.13o-4.08o), the same happening for the mean difference in the length reached (range 1.82-2.64 mm), as well as for the mean difference in the needle tip dislocation (range 0.94-2.03 mm).

Conclusion: The guide seems to be a reliable tool for accurate percutaneous injection of drugs into the inferior compartment of the TMJ and the LPM. Further studies are necessary to test the efficacy and validate the method in an in vivo study.

Keywords: 3D printing; Temporomandibular joint; lateral pterygoid muscle; percutaneous injection; surgical guide.

Figures

Figure 1.
Figure 1.
Scan of cadaver head obtained with Bellus 3D Dental Pro.
Figure 2.
Figure 2.
Alignment of the facial scan with the CBCT using the custom alignment tool in Implant Studio 3Shape A/S.
Figure 3.
Figure 3.
Surgical guide testing of adaption to cadaver head.
Figure 4.
Figure 4.
Cadaver in CBCT machine with guides in place prior to needle insertion and scanning.
Figure 5.
Figure 5.
Needles in situ showing premeasured depth stoppers for needles.
Figure 6.
Figure 6.
Extraction of needle positioned in relation to original planned guide position using Intellispace Portal software.
Figure 7.
Figure 7.
Deviation of planned vs actual position of needles measurements using Rhinoceros 3D software.

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Source: PubMed

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