A Reasoning Method for Determining the Suitable …...information analysis as in the case of the dental implant process [3]. The dental implant process is complex and multi-variable,

A Reasoning Method for Determining the Suitable

Dental Implant

Anderson L. Szejka, Marcelo Rudek, Osiris Canciglieri Jnr.

Department of Manufacturing Engineering of Pontifical Catholic University of Paraná

Industrial and Systems Engineering Post-Graduate Program

Rua Imaculada Conceição, 1155 - Curitiba – PR - Brazil

CEP 80215-901 – [email protected], [email protected]

Abstract— The technological evolution over the last decades

brought the necessity of integration between different areas of

knowledge and an example is the integration between the

Odontology and Engineering in order to find new solutions to

improve the surgical process of dental implants. This work

proposes a conceptual reasoning model for determining the

dental implant based on tomographic image. This system

analyses the bone and mucosa structures from the tomographic

images and then creates a three-dimensional model of the dental

arch and will support the dentist during the pre-operative in the

selection of the most suitable implant according to the

characteristics of each bone and the necessary tools for its

insertion. It, also, will help the dentist in the surgical procedure

because it allows the design of a guide mask which will assist the

dentist during the drill and internal tread process for the implant

fixation. Therefore the method allows the virtual visualization

and simulation the whole dental implant process. The article’s

main contributions are: i) conception and development of a

computational reasoning tool that supports the process of dental

implantation; ii) the interactivity in the development of surgical

planning through a three-dimensional geometric model of the

dental arch; iii) the reduction of surgical and the patient’s

recovery time.

Keywords: Dental Implant Imaging Process; Strategic

Planning; Product Development; Reasoning Systems.

I. INTRODUCTION

The advances of the computer modelling techniques

combined with design techniques have been changing the

computer systems into more robust and autonomous systems

that are able to present, under certain definitions, a reasoning

that can solve or assist in the solution of determined problems.

These systems have been used in different areas with the

intention to offer support to the decision making through the

information analysis as in the case of the dental implant process

[3].

The dental implant process is complex and multi-variable,

that is, n variables must be considered to define the implant and

the tools for its insertion and it is the dentist competency their

identification and analysis [7]. However, for this process

analysis, generally, the dentist has only 2D images obtained by

computer tomography (CT) and magnetic resonance imaging

(MRI) what can raise the level of implants that fail prematurely

due to the lack of understanding of the interface between the

bone and implant [8]. In traditional computer tomography

imaging it is not possible to measure the bone density, the

precise location of the nerves or measure the thickness of them

leaving to the discretion of the dentist the decision about the

best implant [4].

This article proposes a reasoning method to determine the

most suitable implant that will help the dentist to plan the

whole implant process from the dental implant definition until

the selection of the tools for its insertion. The system will

support the dentist decision making through the three-

dimensional reconstruction of the dental arc bone and the gum

mucosa based on DICOM files obtained from computer

tomography. This reasoning method has the purpose of making

the dental implant procedure more precise and safer since in the

traditional methods could occur premature failures, besides that

an implant positioning error can cause the interception of a

nerve what would cause the patient‟s partial or total facial

paralysis and loss of consciousness. Therefore, this method

reduces the time of the implant procedure as well as the time of

patient‟s recovery and its quality is higher than the traditional

dental implant methods.

II. RESEARCH METHODOLOGY

This research has a practical approach because the

knowledge study was applied in the solution of a specific problem and also it has a qualitative approach as it searches a deep comprehension of a specific phenomenon through descriptions, comparisons and exploratory interpretations providing a closer familiarity with the problem to make it explicit. Relating to the technical proceedings it is considered literature review and experimental research. It is a literature review because it was elaborated based on books, articles and works already published and works available in the internet; and it is experimental research in the definition of the object of study, as much in the selection of the variables that will affect the surgical planning as in the definition of the way of control of the object of study.

The figure 1 illustrates the research process stages. The principal objective of the research is to purpose a conceptual

Proceedings of the 41st International Conference on Computers & Industrial Engineering

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method to determine the most suitable implant using a reasoning system that helps the dentist in the planning of the dental implant process. The detail “A” represents the necessary knowledge about implant traditional techniques and the new technologies that can be approached to assist in this process. The “B” detail proposes a conceptual reasoning method which questions the system and the dentist in order to orientate the dentist in his decision making converging to the best solution. In the “C” detail is presented the implementation process through the case study. The model is being implemented using the Matlab® platform which is already in a toolbox of imaging processing helping in the development of the 3D image reconstruction algorithms and in the spectral analysis of the tomographic cuts to define bone density; and in the detail “D” there is a preliminary analysis of the results obtained with the conceptual model and the expected results.

Figure 1. Research methodological sequence

III. BACKGROUND TECHNOLOGIES

The continuous technology development has been offering an increase in the technological equipment reliability mostly with the increase in the processing velocity where the same algorithm can be executed several times in a very short time in order to verify the integrity of the obtained solution [2]. This advance made possible, for several areas, the use of more and more autonomous equipment that are able of understand the problems and solve them[10]. Nowadays the industry uses a lot these autonomous systems in their productive environments due to their agility and reliability [5] but it has been observed a growth in the use of these tools in areas such as medicine and odontology.

In the case of dental implant process it was verified an increment in the use of these tools predominantly in the area of 3D image reconstruction through computer tomography "fig. 2" providing to the dentist a better visualization of the patient‟s bone structure [11]. This overstepped some limitations that exist in the planning of the conventional dental implant treatments mainly in the pre-implant phase that is based on the

2D image obtained by the magnetic resonance [3].

Figure 2. 3D reconstruction

In this manner, in this graphical multi-visualization environment proportionated by the image reconstruction there is an increase in the dentist interactivity with surgical planning [13]. The use of these imaging reconstruction techniques have transformed the dental implant procedures safer as occurs in other areas that already use these obtained images for three- dimensional modeling (3D), for example, the skull reconstruction [14, 15, 16], where it is realized all the bone reconstruction and correct in virtual way all the missing parts that exists in the bone, exporting these information in CAD file, making possible the manufacture of the part and after that its insertion. These technologies of virtual reality have been widely spread and they are making better the interpretation of the patient‟s tomographic images in order to improve the performance of the planned treatment and to reduce the patient‟s recovery time.

There are commercial systems that allow the virtual insertion of the implant [17], however it is the dentist responsibility the whole process of insertion, simulation and analysis and in most of the time the nerve location must be realized manually, reducing a lot the obtained precision and increasing the risks as some of the nerves can be ruptured causing since a partial paralysation of the mouth until total loss of consciousness [1]. Other existing limitation is that the majority of the systems reconstruct only the bone arc ignoring the gum mucosa that covers the dental arc which is a risk since the implant bolt will not be only in the bone but it must be aligned with the mucosa and if this reference is ignored the implant will be disproportionate in relation to the others teeth and will compromise the aesthetic and functionality of it [12].


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IV. CONCEPTUAL REASONING METHOD FOR DETERMINING

THE SUITABLE DENTAL IMPLANT

In the traditional dental implant proceedings initially is realized an analysis of the patient‟s dental arc and gum mucosa through computer tomography and magnetic resonance where it is evaluated the bone characteristics and the possible nerves locations. These information added to the dental implant region of interest make possible the identification of the best implant model to suit the found characteristics as well as the identification of the all necessary tools for its insertion during the surgical procedure [6, 9].

However this analysis is not determinist, that is, the whole analysis is visual and only a few tools give support to the dentist, principally in the dental implant measurement. In this way, the dentist sometimes during the surgical procedures changes completely the surgical plan using other implant model and consequently another tools which aggravates a lot the surgery final quality as in most of the time the perforation of the bone had already began and the new implant is smaller. Based on that, this research proposes a conceptual reasoning method as illustrated in the “fig.3” that has the aim of giving support to the dentist in the dental implant process since the determination of the implant until the guide mask design which will assist the dentist during the implant insertion procedure. Thus, the method provides a strategic planning to the dental implant.

Figure 3. Conceptual reasoning method for determining the suitable dental

implant

This model aims to assist the dentist as much in the surgical planning as in the surgical proceedings with accurate information in order to reduce the surgical and post-surgical

time, with a faster patient‟s recovery and reduction in the implant rejection. The method was divided into 5 phases:

Missing teeth (Detail A – ―Fig. 3‖). With the growth in the population life time sometimes the loss of the teeth occur by the weakness of the dental structure or by the lack of preventive care, however there are cases that occur by accidents and can be partial or total;

Dental Implant Determining (Detail B – ―Fig. 3‖). , In order to determine the kind of the dental implant some questions must be considered such as: Which is the model of the dental implant?; What are the Dental Implant dimension?; Which are the masticatory load (force) that the implant will suffer?; and when these questions are answered there are the initiation of the analysis and determination of the most suitable implant;

Determination of the Tools (Detail C – ―Fig. 3‖). After the determination of the implant it is initiated the process of planning of the tools that will be use during the surgical procedures, from the drill diameter until the torque wrench and the necessary torque force for the implant fixation accordingly with the load that the bone will suffer;

Mask guide Design (Detail D – ―Fig. 3‖). The guide mask will help the dentist during the whole surgical process and in case of occurs some fails in this mask it would cause very severe problems;

Dental Insertion (Detail E – ―Fig. 3‖). At the end of the process the dental implant is inserted and it will be necessary to follow the patient until the bone reintegrates the implant as one single body becoming the implant as the root of the original tooth.

A. Dental Implant Determining

The first reasoning of the method must be how to determine

the type of implant most suitable and for this it must analyse the patient‟s dental structure through computer tomography and 3D scans where files in DICOM format are obtained containing digital imaging information in axial, traversal and panoramic cut that allow the 3D reconstruction. With these models it is possible to extract key characteristics such as bone density, nerves locations which will guide to the determination, among a set of implants, the most suitable to the patient, as illustrated in “fig.4”. Nevertheless, how this is not a determinist science [6] is the dentist responsibility to identify among the selected implants the one that will better adapt to the patient.

After the implant selection the dentist can realize the virtual insertion of the selected one, simulating the final result. Therefore it is possible to visualize how the implant will fit in the patient‟s mouth and in case of any nerve be disrupted by the procedure the system will automatically alert.


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Figure 4. Reasoning model to dental implant determining

B. Determination of the Tools

The method's second reasoning is to plan strategically the

logical order of the execution of the activities of the dental

implant process, that is, based on the information of the dental

implant determination it is defined the phases of pre-drill, drill

and internal tread to insert the implant since according to the

bone characteristics different procedures must be taken, for

example, the physiological saline irrigation in order to reduce

the temperature during the drill process. This step helps in the

planning of the surgical process presented in the “fig. 5”,

anticipating possible problems that could occur during the

surgery.

Figure 5. Tools Determining Reasoning

C. Mask guide design

The last reasoning of the method is the guide mask design

which will assist the dentist during the drill and internal tread

process for the implant fixation. This mask demonstrated in

the “fig. 6” must be designed according to the mould obtained

from the gum mucosa of the patient since any variation would

make impossible or incorrect the implant fixation damaging

the procedure. This guide mask is useful because without it

there is no reference for orientation and positioning in the

patient‟s mouth leaving all the procedures to the dentist

ability, in the other hand, the mask increases the reliability and

reduces the risks of nerve interception and loss of holes

because of the positioning error.

Rapid prototyping mask

Guide bushing for implant fixing

Guide bushing for fixing mask

at the surgical process

Figure 6. Mask guide

V. DISCUSION OF EXPECTED RESULTS

The expected results of the proposed conceptual method are

the evolution of the dental implant process, awaking in the

dentist the sense of analysis and strategic planning. This

reasoning method is a tool that follows the dentist in the

decision making as it allows the virtual view since the

definition of the implant until the selection of the tools

necessary during the surgery procedure with the planning of

every and each phase that will occur until the final insertion.

Therefore, with this planning is expected to reduce the total

time of surgery increasing the patient‟s recovery and the

procedure‟s quality besides the trying to reduce the dental

implant rejection by the patient‟s body due to error in the

implant selection.

Moreover the planning, with the data obtained by the

computer tomography it is possible to re-create in a virtual

environment the patient‟s mouth structure allowing the virtual

design of the guide mask that will help the dentist during the

surgery procedure and after the virtual design export this

model to the numerical files that will be read by numerical

control centre in order to re-create this mask reducing the

accuracy failures found in the plasters moulds.

VI. CONCLUSION

The article discussed about the dental implant process and

its limitations and proposed a reasoning method that supports

the dentist in the strategic planning of the whole process, since


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the implant definition until the tools used in the implant

insertion together with the development of a guide mask

which will help the dentist during the surgery procedure. The

aim of this method is to analyse the dental structure of each

patient from the computer tomography, that is, it is analysed

the bone structure, the mouth mucosa, nerves location among

others factors determining accurately the implant more

suitable for each case. In this way the surgical procedure

becomes faster, more reliable and the time of the post-surgery

is reduced. Despite the results are yet preliminary it is already

possible see the method potential due to the autonomy that the

systems showed in the decision making of the surgical

planning. Therefore several themes for future researches can

be proposed, for example:

The use of artificial intelligence for the reconstruction of the bone area of the dental arc for the implant insertion;

Development of the new tools and accessories;

Development of real time monitoring systems for the implant insertion.

ACKNOWLEDGMENT

The authors would like to thank the Pontifical Catholic University of Paraná (PUC-PR), for financial support of this research.

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A Reasoning Method for Determining the Suitable …...information analysis as in the case of the dental implant process [3]. The dental implant process is complex and multi-variable,