Introduction
Maxillofacial prosthetics is a specialized prosthodontics field that replaces part
or all of the stomatognathic and craniofacial structures.[1] It intends to restore form and function, enhance aesthetics, and improve the overall
quality of life. Patients experience maxillofacial deformities because of trauma,
cancer, or congenital disabilities.[2]
Maxillofacial prostheses have a long history, dating back to ancient civilizations,
with documented records of their use. Mummified Egyptians were found buried with enamel-covered
silver eyes with bronze lids as well as nasal and auricular structures. Evidence from
ancient Greek, Chinese, and Indian civilizations was also documented. In the 16th
century, French surgeons were pioneers in the use of artificial eyes, ears, noses,
and obturators, laying the groundwork for the field.[3]
Over the years, materials such as paper-mâché, leather, ivory, gold, and silver were
used to create these prostheses, while later glass and wood became common materials.
In the 17th century, Pierre Fauchaud described a palatal obturator with foldable wings
for insertion. In the 19th century, William Morton used gold obturators and porcelain
artificial noses. By the end of the 19th century, vulcanite had been introduced, along
with other materials such as celluloid, gelatin, glycerin-based materials, and resins.[2]
The 20th century witnessed maxillofacial prostheses primarily focusing on restoring
cleft palate, apart from during the First and Second World Wars, when a high demand
for facial prostheses was reported, leading to the development of specialized maxillofacial
units in the United Kingdom.[4]
The development of maxillofacial prosthetics continued to evolve and involve diverse
prosthetic devices functioning intra- and extraorally, including obturators, orbital,
nasal, auricular, and facial prostheses. Because of the associated aesthetic and psychological
issues, such prostheses commonly require high-quality precision, efficiency, and personalization,
thus improving patient outcomes and boosting quality of life.[5]
Over the years, maxillofacial prosthetic rehabilitation has undergone significant
transformation due to advancements in digital technologies, materials, and communication.
Modern prosthodontists now have access to advanced tools and techniques. Currently,
maxillofacial prostheses are fabricated using acrylic resins, silicones, and advanced
biomimetic materials. They are retained and supported by teeth, osseointegrated implants,
remaining skin with or without adhesive, and body cavities.[2]
[6]
Maxillofacial prosthetics were typically fabricated using conventional impressions
and hand-sculpted wax patterns, followed by flasking and packing silicone or polymethyl
methacrylate, and a trial-and-error fitting process. In contrast, intraoral and extraoral
scanners enable precise three-dimensional (3D) imaging of defect areas. The cone-beam
computed tomography (CBCT) machine is a well-established adjunctive diagnostic, virtual
simulation, and treatment planning tool, integrating CBCT scans with surface scans
enables more accurate surgical and prosthetic planning.[2]
[7]
Digital approaches widened the range of materials used, including medical-grade silicones
printed with specialized 3D printers, resins for molds or prototypes, and titanium
or polyetheretherketone frameworks printed via selective laser melting (SLM) or other
metal 3D printing (3DP) techniques. These digital materials and technologies typically
offer improved biocompatibility, color matching, and mechanical properties compared
to traditional options, leading to a more precise fit.[8]
However, these digital advancements also come with limitations. The initial cost of
equipment and training can be high, and access to these technologies may be limited
in certain regions. Additionally, some digital materials may not be as aesthetically
pleasing or durable as conventional silicones, and there can be challenges in color-matching
complex facial features with specific digital systems. Finally, there is a need for
technician expertise in both digital and artistic domains.[9]
This review aimed to summarize the latest innovations in maxillofacial prosthetics,
focusing on emerging digital technologies. It provides an overview of recent rehabilitation
techniques in this field, presenting their applications, benefits, barriers, and associated
incentives. Part II will discuss the pioneering innovations in materials, biomaterials,
and regenerative therapies.
Discussion
Maxillofacial prosthetics has witnessed significant technological advancements in
recent years, particularly integrating digital tools and AI into clinical and laboratory
workflows. This research reviewed the key innovations in maxillofacial prosthetic
technology, which have transformed the design, fabrication, and delivery of prostheses.
The following subsections explore developments in digital imaging and modeling, computer-aided
design and manufacturing (CAD/CAM) applications, 3DP technologies, and the role of
AI-assisted planning.
Digital Imaging
Recent advances in medical imaging scanning technologies, including CBCT, digital
CT, and magnetic resonance imaging (MRI), produce files in the Digital Imaging and
Communication in Medicine format. These files must be converted and saved as STL (Standard
Tessellation Language) files and then used to construct adaptable 3D models of the
patient's unique anatomical features for maxillofacial rehabilitation.[10] The STL model of the prosthesis can be modified using CAD software. Then, it can
be printed using 3DP techniques such as selective laser sintering (SLS) and fused
deposition modeling (FDM).[11] These technologies are particularly effective for complex cases, such as auricular
and orbital defects.[12]
Intra- and extraoral scanning enhanced prosthetic design and fit accuracy by capturing
the defect's topography and superficial structures of the teeth and soft tissues and
transferring them directly into 3D STL files.[13] These imaging modalities allowed for precise 3D representations of complex anatomical
structures, which have been utilized to determine the optimal location for implant
placement, particularly in patients with uncertain bone quality or quantity. Thus,
they facilitate the planning and execution of prosthetic devices.[14]
Wang et al[11] employed a digital approach to rehabilitate facial deformities resulting from maxillofacial
trauma. The process involved gathering data through CBCT imaging and 3D facial scans.
ProPlan CMF software generated a virtual model representing the patient's craniofacial
hard tissues, realistic facial soft tissues, and existing dentition. This digital
workflow successfully predicted aesthetic outcomes for patients with maxillofacial
trauma, enhanced communication with patients, decreased clinical time, and informed
the collective design of implant placement and prosthetic restoration fabrication.
Vosselman et al[15] presented a digitized surgical planning workflow for single-stage maxillectomy procedures
and zygomatic implant placement, utilizing 3D-printed cutting and drilling guides.
This approach enabled the immediate insertion of zygomatic implants and the simultaneous
fabrication of an implant-supported obturator prosthesis, demonstrating high positional
precision and prosthetic fit.
Data Acquisition
Data acquisition is the initial and most crucial step, as it determines the outcome
of the prostheses. Various surface scanners, such as intraoral, structured light,
laser, and facial scanners, are reliable methods for defect data acquisition.[16]
Corsalini et al[17] conducted a randomized controlled trial and demonstrated that digital impressions
in implant prosthetic rehabilitation showed significantly better interproximal and
occlusal contact, less impression time, and enhanced patient satisfaction. In contrast,
no significant differences were reported for the abutment-implant fit.
Digital scanners capture highly detailed 3D representations of the patient's anatomy,
reducing the discomfort and distortion risks associated with conventional impression-taking.
They also capture precise topographical data without direct tissue contact, thus eliminating
the risk of interoperator variability. The acquired digital data can then be seamlessly
integrated into CAD/CAM software, streamlining prosthetic rehabilitation's design
and manufacturing phases through various rapid prototyping (RP) techniques.[16]
The clinical outcomes of laser scanners and digital imaging have influenced the preferred
digital techniques in various clinical applications. According to Suresh et al,[12] laser scanning systems are extensively utilized in fabricating nasal prostheses,
while combining CT scans and digital photography is preferred for auricular prostheses.
Additionally, digital photography and stereophotogrammetry are the preferred methods
for large facial defects, and the combination of MRI and CT scans appears to be a
superior approach for data acquisition for obturators.
Aponte-Wesson et al[18] utilized digital impressions to rehabilitate a patient with bilateral maxillectomy
and extensive tissue loss for retention and support. The digital impressions enabled
capturing three opposing sinus undercuts to retain, support, and stabilize a hollow
one-piece obturator prosthesis.
A facial scanner is a noncontact optical tool that can capture 3D facial models with
skin texture and color in an open data format. Face scanners allow facial recognition,
emotion capturing, aesthetic planning, and maxillofacial rehabilitation. The accuracy
of facial scanners is crucial, and studies have found differences between stated and
actual accuracy, especially for patients with midfacial deformities.[19]
Stereophotogrammetry, the extraction of 3D features from two-dimensional images of
anatomical defects taken from different viewpoints, is a reported alternative to producing
3D surface models of patients' faces. However, the images' resolution is low, and
finer skin details are not recorded.[20]
The primary beneficial outcomes of digital data acquisition technologies in the treatment
planning of prosthetic rehabilitation for maxillofacial defects included reduced fabrication
time, as well as improved dimensional accuracy. Aesthetics, dimensional accuracy,
and patient satisfaction were highly recognized outcomes in facial prostheses.[12]
Baghani et al[21] conducted a study to evaluate the accuracy of digital impression techniques based
on trueness and precision in capturing implant-level impressions for maxillofacial
prostheses. Two intraoral scanners (TRIOS 3 and CS 3700) and one desktop extraoral
scanner (Open Technology) were compared using a reference model simulating an auricular
defect. The results revealed statistically significant differences in accuracy among
the scanners. In some measurements, the TRIOS 3 scanner showed superior performance
compared to the Open Technology and CS 3700 scanners. However, in other measurements,
the Open Technology scanner outperformed the intraoral options. The CS 3700 scanner
consistently showed higher deviation in several comparisons. Despite variability in
scanner performance, the authors concluded that digital impression techniques, both
intraoral and extraoral, can serve as viable alternatives to conventional methods
for maxillofacial prosthesis fabrication.
Hatamleh et al[22] conducted a cross-sectional study to evaluate the impact of digital technologies
on the provision of maxillofacial prosthetic services and to assess patient attitudes
and perceptions. The study included 37 patients with facial defects who received prosthetic
rehabilitation at an ear, nose, and throat clinic. The patients reported that their
prostheses were comfortable, easy to handle, and confidence-enhancing, with most wearing
them for over 12 hours daily. So, digital technologies significantly enhance the fabrication
process and patient experience, supporting improved satisfaction, functionality, and
acceptance of maxillofacial prostheses.
Computer-Aided Design and Manufacturing
Digital imaging techniques provide detailed anatomical information, which forms the
foundation for CAD/CAM processes. These processes utilize software to design and manufacture
products. This allows for precise and customized prosthetic solutions. Furthermore,
virtual simulations of prosthetic rehabilitation enable clinicians to assess and refine
treatment plans before physical fabrication, thereby optimizing outcomes and reducing
the need for iterative adjustments.[14]
Digitally designed prosthetics significantly reduce production time and improve the
final product's quality. This efficiently produces high-quality, patient-specific
prostheses, reduces the time required for fabrication, and minimizes human error.[23]
[24]
[25]
CAD/CAM produces various surgical assistant tools, such as stereolithography (SLA)
models, surgical guides, and patient-specific implants (PSIs), which can facilitate
the transition from virtual to real. SLA models are CAD/CAM-generated replicas of
the craniomaxillofacial bone and planned bone transplants, which serve as templates
for preoperative planning, intraoperative checks, patient education, and training.
Surgical guides such as repositioning guides, occlusal splints, osteotomy (cutting)
guides, and combined predrilling/osteotomy transmit the virtually planned operation
to the surgical site in computer-aided surgeries.[26]
[27]
Costa-Palau et al[28] used the digital workflow to restore a large midfacial defect in the right cheek
and lip, applying the virtual planning, designing, and manufacturing of the prostheses
through 3D silicone printing. The digital prosthesis had acceptable esthetics and
fit with enhanced patient satisfaction, especially regarding efficiency, comfort,
and delivery time.
Ali et al[29] combined the digital workflow with the conventional to produce the definitive obturator
in an anterior maxillectomy patient. Digital scanning was performed for the oral condition
and the available interim obturator. Then, CAD/CAM technology was used to fabricate
a definitive metal framework obturator. The technique enhanced patient adaptation
and ensured more comfortable and reliable clinical procedures.
3D Printing and Rapid Prototyping
3DP is an additive manufacturing (AM) process that creates 3D objects by organizing
layers of the used materials on top of each other. It encompasses various technologies,
including FDM, SLS, and SLA, silicone 3DP, and powder printing/ binder jetting.[16]
The field has witnessed remarkable advancements since Charles Hull's pioneering work
in SLA-based 3DP in 1986. AM, also known as 3DP, creates physical objects from 3D
digital models by depositing or solidifying materials layer by layer.[30]
RP is an application used in manufacturing to create a model faster than the normal
process. RP is mainly completed using 3DP or AM technology.[31]
Reconstructing the facial skeleton, addressing asymmetry, restoring orbital volume,
reducing displaced fractures, and enhancing aesthetics and functionality can be complex.
The precise transfer of surgical planning from the virtual environment to the actual
surgical setting is critical in computer-assisted surgery and is essential for achieving
clinically satisfactory accuracy.[32]
AM technologies, such as extrusion and photopolymerization, enable the fabrication
of customized designs with intricate structural complexity and rapid and cost-effective
delivery. 3DP also allows the production of biocompatible materials that can enhance
the durability and functionality of prosthetic devices. Common materials utilized
in SLA models include polyamide, silicone, and acrylics, with the latter offering
the ability to be transparent or dyed to highlight specific structures.[33]
Four-, Five-, and Six-Dimensional Printing
The integration of four-dimensional (4D) printing involves materials that can change
shape or properties over time, and this field is also being explored as a future advancement.[34]
4D printing is based on adding a fourth dimension to standard 3DP by adding the element
of time or self-transformation. The printed object changes shape or function in response
to external stimuli such as heat, moisture, light, or magnetic fields.[35]
[36]
Thermoresponsive materials [e.g., poly (N-isopropyl acrylamide), gelatin, collagen, poly(ether urethane)] are frequently employed
materials in 4D printing platforms. pH-sensitive materials swell or collapse depending
on the surrounding pH due to the presence of functional groups such as hydroxyl (−OH)
group in the polymer chain. Moisture-sensitive materials (e.g., hydrogels) have a
similar hydrophilic functional group as the pH-responsive systems. Their hydrophilicity
causes the systems to swell to a volume greater than the original volume.[37]
[38]
The ability of 4D-printed prosthetics to adapt to a patient's changing anatomy can
significantly enhance comfort and reduce the need for frequent adjustments or replacements.[39]
[40]
The dynamic nature of 4D-printed materials allows for better aesthetic integration
with the patient's natural features, improving the prosthetic's visual and functional
aspects. Integrating AI and 4D printing in maxillofacial applications can aid in the
early detection of medical conditions. This allows for timely intervention and improved
patient care. Technology can help identify potential problems before they become more
serious.[41]
Using 4D printing has enhanced the efficiency of prosthetic production and application.
This emerging technology simplifies the manufacturing process by reducing the need
for multiple fittings and adjustments. As a result, health care providers can save
valuable time and resources. Additionally, this technology allows for faster turnaround
times, ultimately enhancing patient satisfaction.[42]
The five-dimensional (5D) printing refers to a process where the material is deposited
along curved axes (instead of the traditional flat layers in 3DP). This adds more
freedom in how the material is arranged, leading to stronger and more complex structure.
The material is deposited in five dimensions: X, Y, Z, and two rotational axes (A and B). This results in stronger, lighter facial prosthetic structures with improved integration
capabilities.[43]
The six-dimensional printing is a conceptual expansion of 5D printing, integrating
additional real-time sensory feedback and self-healing capabilities during or after
fabrication. It Incorporates six dimensions: X, Y, Z, two rotational axes (A and B), plus functional interactivity (real-time feedback). Smart prosthetics with built-in
sensors could be used to monitor fit, functionality, and tissue interaction in maxillofacial
prosthetics.[44]
Digital Twin Technology
Digital twin (DT) refers to the creation of a virtual representation of a physical
object, system, or process that mirrors its real-world counterpart. This digital replica
is connected to the physical entity via sensors and data streams, allowing for real-time
monitoring, analysis, and simulation.[45]
DT optimizes treatments by simulating their effects on virtual patient models, reducing
trial-and-error and adverse outcomes. Surgeons benefit from enhanced surgical planning
and training through detailed visualizations of anatomical structures. In drug discovery,
DT predicts drug efficacy, safety, and potential side effects based on genetic profiles.
Remote patient monitoring becomes feasible as models can be accessed anywhere. Overall,
DT significantly enhances patient outcomes, care quality, and operational efficiency.[46]
[47]
Seth et al[48] conducted a systematic review to evaluate the current applications, effectiveness,
and limitations of DT technology in plastic surgery. The authors screened 110 studies
that specifically focused on DT use in various domains of plastic surgery, including
breast reconstruction, craniofacial surgery, and microsurgery. Across these studies,
DTs were primarily employed for preoperative planning and intraoperative guidance,
with reported benefits including improved surgical accuracy, reduced complications,
and enhanced patient satisfaction. Despite promising outcomes, the review identified
significant challenges impeding widespread adoption. These include high costs, technical
complexity, reliance on advanced imaging and computational technologies, and limited
integration in postoperative care or real-time monitoring.
Virtual Reality and Augmented Reality
The integration of VR and AR into maxillofacial prosthetics offers numerous benefits,
from enhanced precision in surgical planning to improved patient engagement and advanced
medical training. VR offers a fully immersive digital environment, enabling the replication
of surgical and anatomical scenarios for purposes such as education, treatment planning,
and patient involvement. In contrast, AR integrates digital information with the physical
world, allowing clinicians to visualize 3D models of prostheses and anatomical structures
directly within the surgical setting. Together, these technologies provide dynamic
tools for real-time simulation and visualization, enhancing surgical precision and
improving patient outcomes.[49]
In other words, VR transmits the user to a virtual environment, whereas AR overlays
digital information on real objects or places in real time. Precise image segmentation
is a critical step in digital image processing for VR and AR applications. This process
delineates detailed anatomical data and pathological features, such as the extent
of tumor infiltration, which is especially important for virtual surgical planning
(VSP).[50]
These technologies are being explored for patient education and presurgical planning.
VR and AR can provide immersive experiences that help patients visualize expected
outcomes, leading to better patient engagement and understanding of the treatment
process.[51]
[52]
Shepherd et al[53] conducted a scoping review to evaluate the current literature on the use of immersive
VR for enhancing patient understanding in perioperative settings. The review focused
on studies involving adult patients (≥ 18 years) where VR was employed to support
education about their medical condition or upcoming surgical procedure. A total of
12 studies were included, most of which were unpowered and nonrandomized experimental
trials. In these studies, VR was primarily utilized during the informed consent process,
allowing patients to visualize 3D anatomical models relevant to their surgery. The
results consistently indicated improvements in both subjective and objective measures
of patient understanding following VR exposure. However, the authors emphasize the
need for future research employing rigorous, statistically powered study designs to
validate these early findings and support broader clinical integration.
Virtual Surgical Planning
This technique employs VR and AR technologies to simulate surgical procedures and
implant placement. By creating a virtual environment, practitioners can visualize
the treatment plan, assess the fit of prosthetic devices, and make necessary adjustments
before the actual surgical process as an alternative to conventional navigational
systems.[16]
[54]
[55]
In VSP, VR facilitates the visualization of digital information in three dimensions.
The surgeon uses handheld regulators and devices with haptic feedback to interact
with the virtual surgical environment and the physical spatial position. VR is extensively
used for preoperative anatomical assessment, VSP, and intraoperative navigation.[56]
On the other hand, AR enables the operator to overlap digital models and data directly
onto the surgical bed. This projection into the real world improves the surgical experience
while excluding the need to look away from the patient.[57] AR utilizes several technologies to overlay the physical world viewed by the operator.
An optical see-through display uses devices like Google Glass or HoloLens to project
the digital-to-real anatomy. The degree of accuracy and precision in genioplasty and
orthognathic surgeries planned by HoloLens was acceptable but not satisfactory for
mandibular angle osteotomy.[58]
[59]
Integrated planning is another concept that combines surgical planning with prosthodontic
rehabilitation, enabling precise prosthesis design. Various CAD/CAM-manufactured tools,
such as the surgical guides, support the transition from virtual planning to surgery.[60] Additional tools for dental rehabilitation, such as optical scans of the occlusion
or virtual dental setups, may be integrated into the planning process. Superimposing
these supplementary elements with virtual 3D models results in highly detailed hybrid
models.[50]
VSP has proven particularly beneficial for patients with head and neck cancer, improving
the accuracy of zygomatic implant positioning and the fit of obturator prostheses.
These innovative techniques have also been beneficial in mandibular resection and
reconstruction, the restoration of intermaxillary relationships, and dental rehabilitation.[50]
[52]
[55]
A systematic review by Tel et al,[61] analyzed the software utilized for VSP in craniomaxillofacial surgery over the past
decade. The study identified 77 different software programs, with the Materialise
suite being the most prevalent, accounting for 36.3% of cases. The review highlighted
that certain software packages are associated with specific surgical procedures, underscoring
the tailored application of VSP tools in clinical practice.
A systematic review and meta-analysis examined the comparative advantages of VSP over
traditional surgical planning. The findings indicated that VSP offers improved accuracy
in achieving planned surgical outcomes, particularly in complex bimaxillary osteotomies.
However, the evidence regarding reductions in operative time remains inconclusive,
suggesting the need for further high-quality studies to substantiate these benefits.[62]
Nevertheless, ongoing research is necessary to address existing challenges in VSP,
such as standardization of software applications, cost considerations, and the need
for comprehensive clinical validation across various surgical disciplines.
Patient-Specific Implants
Conventional treatments for bone defects, such as standard-sized implants and autogenous
bone grafts, are considered the gold standard. However, these methods require customization
to fit the shape of the defects, which can be labor-intensive and time-consuming.
This challenge is particularly pronounced in the oral and maxillofacial regions, where
complex anatomical structures like the orbital floor pose difficulties in obtaining
an exact 3D shape. Even minor discrepancies between the implant and the bone defect
can lead to implant instability or failure.[33]
PSIs that precisely match the original structures in a shorter timeframe have emerged
to address these challenges. Notably, 3D-printed titanium implants have gained significant
attention, particularly for reconstructing large-sized, load-bearing areas. Titanium
implants offer exceptional strength-to-weight ratio, rigidity, biocompatibility, anti-infection,
corrosion resistance, and nonmagnetic properties. However, they are often costly and
heavier than the original anatomy, leading to subsidence resulting from stress shielding
effects and disparities in elasticity modulus.[63]
[64]
Alternatively, researchers have explored using biocompatible polymer materials with
reduced weight. Bioresorbable patient-specific 3D-printed bone grafts, meshes, and
plates are a promising alternative to conventional implants. 3DP of medical-grade
polymer with β-tricalcium phosphate has been used to create degradable polymeric PSIs
that were integrated into VSP. It reported desirable surface characteristics and achievable
wall thicknesses, enabling the successful fabrication of plates, orbital implants,
bone regeneration meshes, and scaffolds.[65]
[66]
Others have focused on optimizing the internal configuration of titanium implants
using 3DP methods such as SLM and electron beam melting. These methods allow for designing
desired internal configurations and maintaining porosity and pore continuity to reduce
implant weight and enhance osteointegration.[67]
[68]
[69]
These customized implants have demonstrated potential clinical applications in cranioplasty
and mandibular reconstruction, providing stability and contributing to the correct
implementation of the reconstruction by enabling a completely digital workflow. Compared
to conventional reconstruction plates, these PSIs offer further benefits, including
high flexibility in plate design and screw placement, reduced operating times, and
potential biomechanical improvements, as they may be less prone to plate fatigue fractures.[70]
Korn et al[71] evaluated the clinical outcomes of using PSIs for dental rehabilitation in patients
who had undergone maxillary resection due to squamous cell carcinoma. All implants
demonstrated primary and long-term clinical stability over a mean follow-up period
of 26 months. Definitive prosthodontic restorations were completed in every case,
with no instances of implant loosening. Major complications such as abscess formation
or fistulas were exclusively reported in irradiated patients with poor soft tissue
conditions. Minor complications, including mucositis and exposure of the implant framework,
were observed but did not affect the functionality or survival of the prostheses.
Short-term results of PSI are promising, but there is a paucity of long-term data
and well-conducted randomized clinical trials assessing the durability and overall
efficacy of PSIs. Further research is needed to substantiate their long-term benefits
and identify potential risks.
Artificial Intelligence and Machine Learning Algorithms
AI is anticipated to play a significant role in the future of maxillofacial prosthodontics,
offering potential enhancements in treatment planning and patient care. AI facilitates
automated processing and decision-making, while AR enhances real-world experiences
by superimposing digital data, providing new possibilities for patient care.[72]
[73]
Introducing AI with appropriate algorithms to provide suggestions on the crucial parameters
such as the most suitable transplant for a specific defect has great potential to
automate VSP, significantly reduce the time and effort required, and improve outcomes.[74]
[75]
[76]
Modabber et al[77] evaluated an algorithm for automating the VSP of fibula transfer, demonstrating
that this technology is applicable and can simplify the procedure. Automating digital
planning will likely further decrease the costs of VSP. Furthermore, it will simplify
the technology, and through this, the surgical procedure of microvascular reconstruction
of the mandible may become part of the daily routine of centers and surgeons that
do not yet perform it.
Pathak et al[78] employed a combination of AI and traditional methods to fabricate an implant-supported
prosthetic ear. The researchers employed AI-generated software to create a symmetrical,
natural-looking appearance for the prosthesis. Furthermore, AI techniques facilitated
the replication of the human ear's intricate, convoluted, and undulating anatomy.
The AI algorithms ensured precise replication through detailed scanning and analysis,
restoring symmetry and individuality to the patients' features.
Ali et al[79] evaluated the performance of four pretrained convolutional neural networks in recognizing
seven distinct maxillary prosthodontic scenarios, a preliminary step toward developing
an AI-powered prosthesis design system. All models consistently achieved diagnostic
accuracies exceeding 90%, demonstrating their potential utility in dental image analysis.
This AI application could aid in task allocation based on difficulty levels and enable
the development of an automated diagnosis system upon patient admission. Furthermore,
it facilitates prosthesis design by integrating the necessary morphology, oral function,
and treatment complexity.
Robotics in Maxillofacial Prosthetics
Systems like Yomi, the first Food and Drug Administration-approved robot-assisted
dental surgery system, uses real-time navigation and robotic arms to ensure accurate
implant placement, minimizing risks like nerve damage and bleeding. Autonomous systems,
such as those developed in China, perform minimally invasive surgeries with high precision,
reducing recovery times and improving patient safety. These systems integrate features
like preoperative planning, real-time navigation, and adaptive force feedback, ensuring
accurate and efficient procedures. Additionally, collaborative human-robot systems
combine the surgeon's expertise with robotic stability, enabling safer and more flexible
operations even in complex cases.[80]
[81]
[82]
Although direct studies on robotics in maxillofacial prosthetics are scarce, robotic
systems have been utilized in related maxillofacial procedures. Jain et al[83] assessed the accuracy of robot-assisted implant placement compared to dynamic and
static computer-assisted implant surgeries. The findings indicated that robotic systems
achieved significantly lower angular deviations and slightly reduced coronal and apical
deviations, suggesting enhanced precision over traditional methods.
A multicenter randomized controlled trial evaluated a semiactive robotic system for
dental implants. Results demonstrated superior accuracy compared to freehand surgery.[84]
While robotics have demonstrated enhanced precision in dental implantology and certain
maxillofacial surgeries, their direct application in maxillofacial prosthetics is
still emerging. Further research is needed to evaluate the effectiveness and practicality
of integrating robotic systems into the design and fabrication of maxillofacial prostheses.
Teleprosthetics and Remote Consultations
These technologies facilitate remote consultations and virtual simulations, improving
accessibility and patient engagement in treatment planning.[85]
The digital approach allowing clinicians to refine treatment plans before physical
fabrication, optimize outcomes and minimize the need for adjustments.[13]
[15]
The coronavirus disease 2019 pandemic has accelerated the adoption of telemedicine
in maxillofacial rehabilitation. Remote consultations allow for ongoing patient management
and follow-up, thereby improving access to care for patients in remote locations.[86]
Despite the potential benefits, there is a notable scarcity of researches specifically
addressing teleprosthetics in maxillofacial prosthetics. Mariño and Ghanim[87] highlighted that teledentistry applications, such as remote consultations and diagnoses,
have been successfully implemented across multiple countries, primarily focusing on
education and diagnostic services. These findings suggest a foundational framework
that could be adapted for maxillofacial prosthetics.
Moosa et al[87] conducted a cross-sectional study to evaluate the perceptions and attitudes of dental
professionals in Pakistan toward teledentistry, focusing on four domains: data security
and consent, practice enhancement, usefulness in clinical settings, and patient benefits.
The study revealed notable concerns regarding data security (59.8%) and patient consent
(52%), yet a majority (61.8%) acknowledged teledentistry's potential to reduce waiting
times and enhance clinical efficiency.
Further research is necessary to assess the feasibility, efficacy, and patient outcomes
of teleprosthetics interventions in maxillofacial care.
