Computer-Guided Bone Biopsy of Radiopaque Jaw Lesions Using Patient-Specific 3D-Printed Surgical Guides

Introduction
Bone biopsy is the gold standard for the diagnosis of intraosseous jaw lesions. However, conventional freehand biopsy can be technically demanding when lesions are located near critical anatomical structures or in difficult-to-access areas, increasing the risk of inadequate tissue sampling and surgical complications. The integration of CBCT, intraoral digital scanning, and CAD/CAM technology enables the fabrication of patient-specific surgical guides, potentially improving biopsy precision, enhancing procedural predictability, and reducing surgical invasiveness compared with the conventional freehand approach. The aim of this prospective study was to evaluate implant planning software used for designing patient-specific surgical guides for computer-guided bone biopsy.

Materials and Methods
This prospective study was conducted at the University of Bari Aldo Moro, Faculty of Dentistry. Radiopaque lesions detected within edentulous areas during routine preoperative CBCT examinations required histopathological assessment. CBCT-derived DICOM datasets were matched with STL files obtained from intraoral digital scans to virtually plan the biopsy trajectory. Patient-specific surgical guides were designed using implant planning CAD/CAM software and fabricated by 3D printing to accurately guide the trephine bur during bone core biopsy.

Results
Four patients were prospectively enrolled. The fully digital workflow enabled reliable positioning of the trephine bur and accurate targeting of the planned biopsy site in all cases. Adequate bone specimens were successfully harvested from every patient, allowing definitive histopathological diagnosis of cemento-osseous dysplasia. No intraoperative or postoperative complications, including damage to adjacent anatomical structures, were observed.

Conclusions
Computer-guided bone biopsy using patient-specific 3D-printed surgical guides was safe and accurate for the histological evaluation of radiopaque jaw lesions in the patients treated in our study. The digital workflow allows precise tissue sampling, reduces surgical morbidity, and improves diagnostic reliability. However, its implementation requires dedicated digital planning, CAD/CAM design, and guide fabrication, resulting in higher costs and longer preoperative preparation compared with conventional biopsy procedures.