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Farrell BB, Franco PB, Tucker MR. Virtual Surgical Planning in Orthognathic Surgery. Oral Maxillofac Surg Clin North Am 2014; 26:459-73. [DOI: 10.1016/j.coms.2014.08.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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102
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Nabha W, Hong YM, Cho JH, Hwang HS. Assessment of metal artifacts in three-dimensional dental surface models derived by cone-beam computed tomography. Korean J Orthod 2014; 44:229-35. [PMID: 25309862 PMCID: PMC4192524 DOI: 10.4041/kjod.2014.44.5.229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 03/17/2014] [Accepted: 03/18/2014] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of this study was to assess artifacts induced by metallic restorations in three-dimensional (3D) dental surface models derived by cone-beam computed tomography (CBCT). Methods Fifteen specimens, each with four extracted human premolars and molars embedded in a plaster block, were scanned by CBCT before and after the cavitated second premolars were restored with dental amalgam. Five consecutive surface models of each specimen were created according to increasing restoration size: no restoration (control) and small occlusal, large occlusal, disto-occlusal, and mesio-occluso-distal restorations. After registering each restored model with the control model, maximum linear discrepancy, area, and intensity of the artifacts were measured and compared. Results Artifacts developed mostly on the buccal and lingual surfaces. They occurred not only on the second premolar but also on the first premolar and first molar. The parametric values increased significantly with increasing restoration size. Conclusions Metallic restorations induce considerable artifacts in 3D dental surface models. Artifact reduction should be taken into consideration for a proper diagnosis and treatment planning when using 3D surface model derived by CBCT in dentofacial deformity patients.
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Affiliation(s)
- Wael Nabha
- Department of Orthodontics, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Young-Min Hong
- Department of Orthodontics, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Jin-Hyoung Cho
- Department of Orthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Hyeon-Shik Hwang
- Department of Orthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
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103
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Affiliation(s)
- David Alfi
- Department of Oral & Maxillofacial Surgery, Houston Methodist Specialty Physician Group, Weill Medical College Cornell University, New York, 6560 Fannin Suite 1280, Houston, TX 77030, USA.
| | - Din Lam
- Oral and Maxillofacial Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Jaime Gateno
- Department of Oral & Maxillofacial Surgery, Houston Methodist Specialty Physician Group, Weill Medical College Cornell University, New York, 6560 Fannin Suite 1280, Houston, TX 77030, USA
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van Nunen D, Janssen L, Stubenitsky B, Han K, Muradin M. Stereolithographic skull models in the surgical planning of fronto-supraorbital bar advancement for non-syndromic trigonocephaly. J Craniomaxillofac Surg 2014; 42:959-65. [DOI: 10.1016/j.jcms.2014.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 10/08/2013] [Accepted: 01/03/2014] [Indexed: 12/12/2022] Open
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Digital Occlusal Splint for Condylar Reconstruction in Children With Temporomandibular Joint Ankylosis. J Oral Maxillofac Surg 2014; 72:1585-93. [DOI: 10.1016/j.joms.2013.12.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/25/2013] [Accepted: 12/27/2013] [Indexed: 11/21/2022]
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106
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Ye N, Long H, Xue J, Wang S, Yang X, Lai W. Integration accuracy of laser-scanned dental models into maxillofacial cone beam computed tomography images of different voxel sizes with different segmentation threshold settings. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:780-6. [DOI: 10.1016/j.oooo.2014.02.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/05/2014] [Accepted: 02/19/2014] [Indexed: 11/25/2022]
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107
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Germec-Cakan D, Canter HI, Cakan U, Demir B. Interdisciplinary treatment of a patient with bilateral cleft lip and palate and congenitally missing and transposed teeth. Am J Orthod Dentofacial Orthop 2014; 145:381-92. [PMID: 24582029 DOI: 10.1016/j.ajodo.2013.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/01/2013] [Accepted: 06/01/2013] [Indexed: 11/19/2022]
Abstract
The comprehensive treatment of a patient with cleft lip and palate requires an interdisciplinary approach for functional and esthetic outcomes. A 20-year-old woman with bilateral cleft lip and palate had a chief complaint of unesthetic appearance of her teeth and the presence of oronasal fistulae. Her clinical and radiographic evaluation showed a dolichofacial growth pattern, a Class II skeletal relationship with retroclined maxillary central incisors, 5 mm of negative overjet, maxillary constriction, maxillary and mandibular crowding, congenitally missing maxillary right incisors and left lateral incisor, and a transposed maxillary left canine. Her treatment plan included the extraction of 3 premolars, maxillary expansion, segmental maxillary osteotomy, repair of the oronasal fistulae, rhinoplasty, periodontal surgery, and prosthodontic rehabilitation. To obtain a better occlusion and reduce the dimensions of the fistulae, orthognathic surgery comprising linear and rotational movements of the maxillary segments (premaxilla, right and left maxillary alveolar segments) in all 3 axes was planned by performing 3-dimensional virtual surgery on 3-dimensional computerized tomography. At the end of the interdisciplinary treatment, a functional occlusion, a harmonious profile, and patient satisfaction were achieved. Posttreatment records after 1 year showed stable results.
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Affiliation(s)
- Derya Germec-Cakan
- Associate professor, Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey.
| | - Halil Ibrahim Canter
- Associate professor, Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Acibadem University, Istanbul, Turkey
| | - Umut Cakan
- Assistant professor, Department of Prosthodontics, Faculty of Dentistry, Istanbul Medipol University, Istanbul, Turkey
| | - Becen Demir
- Periodontist in private practice, Istanbul, Turkey
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108
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Ayoub N, Ghassemi A, Rana M, Gerressen M, Riediger D, Hölzle F, Modabber A. Evaluation of computer-assisted mandibular reconstruction with vascularized iliac crest bone graft compared to conventional surgery: a randomized prospective clinical trial. Trials 2014; 15:114. [PMID: 24716651 PMCID: PMC3998950 DOI: 10.1186/1745-6215-15-114] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 03/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Computer-assisted surgery plays an increasingly important role in mandibular reconstruction, ensuring the best possible masticatory function and aesthetic outcome. METHODS Twenty patients were randomly assigned to computer-assisted or conventional mandibular reconstruction with vascularized iliac crest bone graft in a prospective study design.Virtual surgical planning was based on preoperative CT-data using specific surgical planning software. A rapid prototyping guide transferred the virtual surgery plan to the operation site. During surgery the transplant ischemic time, reconstruction time, time for shaping the transplant and amount of bone removed were measured. Additionally, the difference in the intercondylar distance before and after surgery was calculated. RESULTS Computer-assisted surgery shortened the time of transplant ischemia (P < 0.005) and defect reconstruction (P < 0.001) compared to conventional surgery. The time to saw and shape the transplant at the donor site was shorter using conventional surgery (P < 0.005); therefore, the overall time for surgery didn't change (P = 0.527). In the computer-assisted group, the amount of bone harvested equaled the defect size, whereas the transplant size in the conventional group exceeded the defect site by 16.8 ± 5.6 mm (P < 0.001) on average. The intercondylar distance before compared to after surgery was less affected in the computer-assisted than in the conventional group (P < 0.001). CONCLUSIONS The presented study shows that computer-assisted surgery can help reduce the time for mandibular defect reconstruction and consequently the transplant ischemic time. In the computer-assisted group, the iliac crest donor site defect was downsized and the postoperative condyle position was less altered, reducing possible risks of postoperative complications and donor site morbidity. TRIAL REGISTRATION DRKS00005181.
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Affiliation(s)
| | | | | | | | | | | | - Ali Modabber
- Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
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109
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Movahed R, Teschke M, Wolford LM. Protocol for Concomitant Temporomandibular Joint Custom-Fitted Total Joint Reconstruction and Orthognathic Surgery Utilizing Computer-Assisted Surgical Simulation. J Oral Maxillofac Surg 2013; 71:2123-9. [DOI: 10.1016/j.joms.2013.07.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/18/2013] [Indexed: 11/25/2022]
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Adolphs N, Haberl EJ, Liu W, Keeve E, Menneking H, Hoffmeister B. Virtual planning for craniomaxillofacial surgery--7 years of experience. J Craniomaxillofac Surg 2013; 42:e289-95. [PMID: 24286863 DOI: 10.1016/j.jcms.2013.10.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/25/2013] [Accepted: 10/08/2013] [Indexed: 11/29/2022] Open
Abstract
Contemporary computer-assisted surgery systems more and more allow for virtual simulation of even complex surgical procedures with increasingly realistic predictions. Preoperative workflows are established and different commercially software solutions are available. Potential and feasibility of virtual craniomaxillofacial surgery as an additional planning tool was assessed retrospectively by comparing predictions and surgical results. Since 2006 virtual simulation has been performed in selected patient cases affected by complex craniomaxillofacial disorders (n = 8) in addition to standard surgical planning based on patient specific 3d-models. Virtual planning could be performed for all levels of the craniomaxillofacial framework within a reasonable preoperative workflow. Simulation of even complex skeletal displacements corresponded well with the real surgical result and soft tissue simulation proved to be helpful. In combination with classic 3d-models showing the underlying skeletal pathology virtual simulation improved planning and transfer of craniomaxillofacial corrections. Additional work and expenses may be justified by increased possibilities of visualisation, information, instruction and documentation in selected craniomaxillofacial procedures.
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Affiliation(s)
- Nicolai Adolphs
- Dept. of Oral and Maxillofacial Surgery, Clinical Navigation, Surgical Robotics, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Ernst-Johannes Haberl
- Pediatric Neurosurgery, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Weichen Liu
- Clinical Navigation, Surgical Robotics, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Erwin Keeve
- Clinical Navigation, Surgical Robotics, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Horst Menneking
- Dept. of Oral and Maxillofacial Surgery, Clinical Navigation, Surgical Robotics, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Bodo Hoffmeister
- Dept. of Oral and Maxillofacial Surgery, Clinical Navigation, Surgical Robotics, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
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111
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Digital replacement of the distorted dentition acquired by cone beam computed tomography (CBCT): a pilot study. Int J Oral Maxillofac Surg 2013; 42:1488-93. [DOI: 10.1016/j.ijom.2013.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 12/07/2012] [Accepted: 01/10/2013] [Indexed: 11/20/2022]
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112
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Planning Surgical Reconstruction in Treacher-Collins Syndrome Using Virtual Simulation. Plast Reconstr Surg 2013; 132:790e-805e. [DOI: 10.1097/prs.0b013e3182a48d33] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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113
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Huotilainen E, Jaanimets R, Valášek J, Marcián P, Salmi M, Tuomi J, Mäkitie A, Wolff J. Inaccuracies in additive manufactured medical skull models caused by the DICOM to STL conversion process. J Craniomaxillofac Surg 2013; 42:e259-65. [PMID: 24268714 DOI: 10.1016/j.jcms.2013.10.001] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/08/2013] [Accepted: 10/08/2013] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The process of fabricating physical medical skull models requires many steps, each of which is a potential source of geometric error. The aim of this study was to demonstrate inaccuracies and differences caused by DICOM to STL conversion in additively manufactured medical skull models. MATERIAL AND METHODS Three different institutes were requested to perform an automatic reconstruction from an identical DICOM data set of a patients undergoing tumour surgery into an STL file format using their software of preference. The acquired digitized STL data sets were assessed and compared and subsequently used to fabricate physical medical skull models. The three fabricated skull models were then scanned, and differences in the model geometries were assessed using established CAD inspection software methods. RESULTS A large variation was noted in size and anatomical geometries of the three physical skull models fabricated from an identical (or "a single") DICOM data set. CONCLUSIONS A medical skull model of the same individual can vary markedly depending on the DICOM to STL conversion software and the technical parameters used. Clinicians should be aware of this inaccuracy in certain applications.
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Affiliation(s)
- Eero Huotilainen
- BIT Research Centre, Department of Industrial Engineering and Management, School of Science and Technology, Aalto University, P.O. Box 15500, FI-00076 Helsinki, Finland
| | - Risto Jaanimets
- Oral and Maxillofacial Unit, Department of Otorhinolaryngology, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland; Medical Imaging Center, Department of Radiology, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland.
| | - Jiří Valášek
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, Brno University of Technology, Technická 2896/2, 616 69 Brno, Czech Republic
| | - Petr Marcián
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, Brno University of Technology, Technická 2896/2, 616 69 Brno, Czech Republic
| | - Mika Salmi
- BIT Research Centre, Department of Industrial Engineering and Management, School of Science and Technology, Aalto University, P.O. Box 15500, FI-00076 Helsinki, Finland
| | - Jukka Tuomi
- BIT Research Centre, Department of Industrial Engineering and Management, School of Science and Technology, Aalto University, P.O. Box 15500, FI-00076 Helsinki, Finland
| | - Antti Mäkitie
- BIT Research Centre, Department of Industrial Engineering and Management, School of Science and Technology, Aalto University, P.O. Box 15500, FI-00076 Helsinki, Finland; Dept. of Otolaryngology - Head & Neck Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 220, FI-00029 Helsinki, Finland
| | - Jan Wolff
- Oral and Maxillofacial Unit, Department of Otorhinolaryngology, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland; Medical Imaging Center, Department of Radiology, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
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114
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Kim SH, Kim DS, Huh KH, Lee SS, Heo MS, Choi SC, Hwang SJ, Yi WJ. Direct and continuous localization of anatomical landmarks for image-guided orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:402-10. [DOI: 10.1016/j.oooo.2013.06.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/23/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
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115
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Rangel FA, Maal TJJ, Bronkhorst EM, Breuning KH, Schols JGJH, Bergé SJ, Kuijpers-Jagtman AM. Accuracy and reliability of a novel method for fusion of digital dental casts and Cone Beam Computed Tomography scans. PLoS One 2013; 8:e59130. [PMID: 23527111 PMCID: PMC3604103 DOI: 10.1371/journal.pone.0059130] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 02/11/2013] [Indexed: 11/18/2022] Open
Abstract
Several methods have been proposed to integrate digital models into Cone Beam Computed Tomography scans. Since all these methods have some drawbacks such as radiation exposure, soft tissue deformation and time-consuming digital handling processes, we propose a new method to integrate digital dental casts into Cone Beam Computed Tomography scans. Plaster casts of 10 patients were randomly selected and 5 titanium markers were glued to the upper and lower plaster cast. The plaster models were scanned, impressions were taken from the plaster models and the impressions were also scanned. Linear measurements were performed on all three models, to assess accuracy and reproducibility. Besides that, matching of the scanned plaster models and scanned impressions was done, to assess the accuracy of the matching procedure. Results show that all measurement errors are smaller than 0.2 mm, and that 81% is smaller than 0.1 mm. Matching of the scanned plaster casts and scanned impressions show a mean error between the two surfaces of the upper arch of 0.14 mm and for the lower arch of 0.18 mm. The time needed for reconstructing the CBCT scans to a digital patient, where the impressions are integrated into the CBCT scan of the patient takes about 15 minutes, with little variance between patients. In conclusion, we can state that this new method is a reliable method to integrate digital dental casts into CBCT scans. As far as radiation exposure, soft tissue deformation and digital handling processes are concerned, it is a significant improvement compared to the previously published methods.
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Affiliation(s)
- Frits A. Rangel
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- 3D Facial Imaging Research Group Nijmegen–Bruges, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Thomas J. J. Maal
- 3D Facial Imaging Research Group Nijmegen–Bruges, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Oral and Craniomaxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Ewald M. Bronkhorst
- Department of Preventive and Restorative Dentistry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - K. Hero Breuning
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- 3D Facial Imaging Research Group Nijmegen–Bruges, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jan G. J. H. Schols
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- 3D Facial Imaging Research Group Nijmegen–Bruges, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Stefaan J. Bergé
- 3D Facial Imaging Research Group Nijmegen–Bruges, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Oral and Craniomaxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- 3D Facial Imaging Research Group Nijmegen–Bruges, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- * E-mail:
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116
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Foley BD, Thayer WP, Honeybrook A, McKenna S, Press S. Mandibular Reconstruction Using Computer-Aided Design and Computer-Aided Manufacturing: An Analysis of Surgical Results. J Oral Maxillofac Surg 2013; 71:e111-9. [DOI: 10.1016/j.joms.2012.08.022] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 08/24/2012] [Accepted: 08/24/2012] [Indexed: 11/30/2022]
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117
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Orthognathic positioning system: intraoperative system to transfer virtual surgical plan to operating field during orthognathic surgery. J Oral Maxillofac Surg 2013; 71:911-20. [PMID: 23312847 DOI: 10.1016/j.joms.2012.11.004] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 10/27/2012] [Accepted: 11/07/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To introduce the concept and use of an occlusal-based "orthognathic positioning system" (OPS) to be used during orthognathic surgery. MATERIALS AND METHODS The OPS consists of intraoperative occlusal-based devices that transfer virtual surgical planning to the operating field for repositioning of the osteotomized dentoskeletal segments. The system uses detachable guides connected to an occlusal splint. An initial drilling guide is used to establish stable references or landmarks. These are drilled on the bone that will not be repositioned adjacent to the osteotomy line. After mobilization of the skeletal segment, a final positioning guide, referenced to the drilled landmarks, is used to transfer the skeletal segment according to the virtual surgical planning. The OPS is digitally designed using 3-dimensional computer-aided design/computer-aided manufacturing technology and manufactured with stereolithographic techniques. CONCLUSIONS Virtual surgical planning has improved the preoperative assessment and, in conjunction with the OPS, the execution of orthognathic surgery. The OPS has the possibility to eliminate the inaccuracies commonly associated with traditional orthognathic surgery planning and to simplify the execution by eliminating surgical steps such as intraoperative measuring, determining the condylar position, the use of bulky intermediate splints, and the use of intermaxillary wire fixation. The OPS attempts precise translation of the virtual plan to the operating field, bridging the gap between virtual and actual surgery.
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He D, Huang D, Yang C, Gou H. Application of computer-assisted design and manufacture technique in the treatment of condylar osteochondroma combined with jaw bone deformities: Report of a case. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2013. [DOI: 10.1016/j.ajoms.2012.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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119
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Rangel FA, Maal TJJ, Bergé SJ, Kuijpers-Jagtman AM. Integration of digital dental casts in cone-beam computed tomography scans. ISRN DENTISTRY 2012; 2012:949086. [PMID: 23050159 PMCID: PMC3461639 DOI: 10.5402/2012/949086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 08/30/2012] [Indexed: 12/03/2022]
Abstract
Cone-beam computed tomography (CBCT) is widely used in maxillofacial surgery. The CBCT image of the dental arches, however, is of insufficient quality to use in digital planning of orthognathic surgery. Several authors have described methods to integrate digital dental casts into CBCT scans, but all reported methods have drawbacks. The aim of this feasibility study is to present a new simplified method to integrate digital dental casts into CBCT scans. In a patient scheduled for orthognathic surgery, titanium markers were glued to the gingiva. Next, a CBCT scan and dental impressions were made. During the impression-taking procedure, the titanium markers were transferred to the impression. The impressions were scanned, and all CBCT datasets were exported in DICOM format. The two datasets were matched, and the dentition derived from the scanned impressions was transferred to the CBCT of the patient. After matching the two datasets, the average distance between the corresponding markers was 0.1 mm. This novel method allows for the integration of digital dental casts into CBCT scans, overcoming problems such as unwanted extra radiation exposure, distortion of soft tissues due to the use of bite jigs, and time-consuming digital data handling.
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Affiliation(s)
- Frits A Rangel
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, 309 Dentistry, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Kim SG, Yi WJ, Hwang SJ, Choi SC, Lee SS, Heo MS, Huh KH, Kim TI, Hong H, Yoo JH. Development of 3D statistical mandible models for cephalometric measurements. Imaging Sci Dent 2012; 42:175-82. [PMID: 23071968 PMCID: PMC3465760 DOI: 10.5624/isd.2012.42.3.175] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 06/11/2012] [Accepted: 06/23/2012] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to provide sex-matched three-dimensional (3D) statistical shape models of the mandible, which would provide cephalometric parameters for 3D treatment planning and cephalometric measurements in orthognathic surgery. Materials and Methods The subjects used to create the 3D shape models of the mandible included 23 males and 23 females. The mandibles were segmented semi-automatically from 3D facial CT images. Each individual mandible shape was reconstructed as a 3D surface model, which was parameterized to establish correspondence between different individual surfaces. The principal component analysis (PCA) applied to all mandible shapes produced a mean model and characteristic models of variation. The cephalometric parameters were measured directly from the mean models to evaluate the 3D shape models. The means of the measured parameters were compared with those from other conventional studies. The male and female 3D statistical mean models were developed from 23 individual mandibles, respectively. Results The male and female characteristic shapes of variation produced by PCA showed a large variability included in the individual mandibles. The cephalometric measurements from the developed models were very close to those from some conventional studies. Conclusion We described the construction of 3D mandibular shape models and presented the application of the 3D mandibular template in cephalometric measurements. Optimal reference models determined from variations produced by PCA could be used for craniofacial patients with various types of skeletal shape.
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Affiliation(s)
- Sung-Goo Kim
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
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121
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Accuracy of a computer-aided surgical simulation protocol for orthognathic surgery: a prospective multicenter study. J Oral Maxillofac Surg 2012; 71:128-42. [PMID: 22695016 DOI: 10.1016/j.joms.2012.03.027] [Citation(s) in RCA: 272] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 03/06/2012] [Accepted: 03/07/2012] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this prospective multicenter study was to assess the accuracy of a computer-aided surgical simulation (CASS) protocol for orthognathic surgery. MATERIALS AND METHODS The accuracy of the CASS protocol was assessed by comparing planned outcomes with postoperative outcomes of 65 consecutive patients enrolled from 3 centers. Computer-generated surgical splints were used for all patients. For the genioplasty, 1 center used computer-generated chin templates to reposition the chin segment only for patients with asymmetry. Standard intraoperative measurements were used without the chin templates for the remaining patients. The primary outcome measurements were the linear and angular differences for the maxilla, mandible, and chin when the planned and postoperative models were registered at the cranium. The secondary outcome measurements were the maxillary dental midline difference between the planned and postoperative positions and the linear and angular differences of the chin segment between the groups with and without the use of the template. The latter were measured when the planned and postoperative models were registered at the mandibular body. Statistical analyses were performed, and the accuracy was reported using root mean square deviation (RMSD) and the Bland-Altman method for assessing measurement agreement. RESULTS In the primary outcome measurements, there was no statistically significant difference among the 3 centers for the maxilla and mandible. The largest RMSDs were 1.0 mm and 1.5° for the maxilla and 1.1 mm and 1.8° for the mandible. For the chin, there was a statistically significant difference between the groups with and without the use of the chin template. The chin template group showed excellent accuracy, with the largest positional RMSD of 1.0 mm and the largest orientation RMSD of 2.2°. However, larger variances were observed in the group not using the chin template. This was significant in the anteroposterior and superoinferior directions and the in pitch and yaw orientations. In the secondary outcome measurements, the RMSD of the maxillary dental midline positions was 0.9 mm. When registered at the body of the mandible, the linear and angular differences of the chin segment between the groups with and without the use of the chin template were consistent with the results found in the primary outcome measurements. CONCLUSIONS Using this computer-aided surgical simulation protocol, the computerized plan can be transferred accurately and consistently to the patient to position the maxilla and mandible at the time of surgery. The computer-generated chin template provides greater accuracy in repositioning the chin segment than the intraoperative measurements.
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Olszewski R. Surgical Engineering in Cranio-Maxillofacial Surgery: A Literature Review. JOURNAL OF HEALTHCARE ENGINEERING 2012. [DOI: 10.1260/2040-2295.3.1.53] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Gelesko S, Markiewicz MR, Weimer K, Bell RB. Computer-aided orthognathic surgery. Atlas Oral Maxillofac Surg Clin North Am 2012; 20:107-118. [PMID: 22365433 DOI: 10.1016/j.cxom.2012.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Savannah Gelesko
- Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR 97239, USA
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Orthognathic treatment of asymmetry: two cases of “waferless” stereotactic maxillary positioning. Br J Oral Maxillofac Surg 2012; 50:e27-9. [DOI: 10.1016/j.bjoms.2011.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 07/21/2011] [Indexed: 11/19/2022]
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125
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Kau CH. Creation of the virtual patient for the study of facial morphology. Facial Plast Surg Clin North Am 2012; 19:615-22, viii. [PMID: 22004856 DOI: 10.1016/j.fsc.2011.07.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The author provides an overview of the new imaging technologies that allow the practitioner to accurately capture the patient's soft tissue facial morphology and underlying bones and teeth, including details of dental model integration. This article describes how a virtual patient is created and manipulated and the practical use of this technology. It takes the quantification of the 3D surface further by proposing a reference framework of landmarks of craniofacial structure that can be used for comparison of surgical change, growth, gender, and phenotype.
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Affiliation(s)
- Chung How Kau
- Department of Orthodontics, University of Alabama at Birmingham, School of Dentistry, 1919 7th Avenue South, Birmingham, AL 35294, USA.
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126
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Laine AF. In the spotlight: biomedical imaging. IEEE Rev Biomed Eng 2012; 4:9-11. [PMID: 22273784 DOI: 10.1109/rbme.2011.2173617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Andrew F Laine
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
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Alhadidi A, Cevidanes LH, Paniagua B, Cook R, Festy F, Tyndall D. 3D quantification of mandibular asymmetry using the SPHARM-PDM tool box. Int J Comput Assist Radiol Surg 2011; 7:265-71. [PMID: 22089896 DOI: 10.1007/s11548-011-0665-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 10/25/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE Pretreatment diagnosis of mandibular asymmetry in orthognathic surgery patients can be improved by quantitative shape modeling and analysis. The UNC SPHARM-PDM (University of North Carolina Spherical Harmonics-Point Distribution Model) toolbox was applied to a cohort of patients and the results were evaluated. METHODS Three-dimensional (3D) virtual surface models are constructed from CBCT scans of each patient in the cohort by segmentation. Mirroring on a sagittal arbitrary plane is used to flip the left and right sides of each image. An automatic voxel-based registration on the cranial base is used to align the volume and its mirror for comparison. SPHARM-PDM is used to compute correspondent models for each hemimandible and the mirror of the contralateral side. Procrustes analysis was used to evaluate discrepancies between each pair of models to assess asymmetry. Mandibular asymmetry was also located and quantified by computing corresponding surface distances between each hemimandible (left and right sides) and the mirror of the contralateral side. RESULTS There were no statistically significant differences in surrogates for mandibular asymmetry assessment based on right or the left side mirroring. Those surrogates are the rotational and translational differences between each hemimandible and the mirror of the contralateral side in 3 planes of space (the absolute values of Procrustes registration output in 6 degrees of freedom). Absolute and signed distance maps between each hemimandible and the mirror of the contralateral side located and quantified areas of asymmetry diagnosis for each patient. Even though mandibular condyle asymmetry was observed in 8% of the cases and mandibular asymmetry along areas of the ramus and mandibular corpus was noted in 17.8% of the cases, the remaining 74.2% showed generalized morphological and positional asymmetry at the condyle, the ramus and mandibular corpus. CONCLUSION Three-dimensional diagnosis of mandibular asymmetry revealed the complex involvement of morphological components of the mandible and the heterogeneous nature of this clinical condition. SPHARM-PDM has a promising role in the individual diagnosis and quantification of mandibular asymmetry.
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Taub PJ, Lampert JA. Pediatric Craniofacial Surgery: A Review for the Multidisciplinary Team. Cleft Palate Craniofac J 2011; 48:670-83. [DOI: 10.1597/08-051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Pediatric craniofacial surgery is a specialty that grew dramatically in the 20th century and continues to evolve today. Out of the efforts to correct facial deformities encountered during World War II, the techniques of modern craniofacial surgery developed. An analysis of the relevant literature allowed the authors to explore this historical progression. Current advances in technology, tissue engineering, and molecular biology have further refined pediatric craniofacial surgery. The development of distraction osteogenesis and the progressive study of craniosynostosis provide remarkable examples of this momentum. The growing study of genetics, biotechnology, the influence of growth factors, and stem cell research provide additional avenues of innovation for the future. The following article is intended to reveal a greater understanding of pediatric craniofacial surgery by examining the past, present, and possible future direction. It is intended both for the surgeon, as well as for the nonsurgical individual specialists vital to the multidisciplinary craniofacial team.
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Affiliation(s)
- Peter J. Taub
- Division of Plastic Surgery, Mount Sinai Medical Center, New York, New York
| | - Joshua A. Lampert
- Division of Plastic Surgery, Mount Sinai Medical Center, New York, New York
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Markiewicz MR, Bell RB. The Use of 3D Imaging Tools in Facial Plastic Surgery. Facial Plast Surg Clin North Am 2011; 19:655-82, ix. [DOI: 10.1016/j.fsc.2011.07.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND AND OBJECTIVE Virtual surgical simulation and training system offers a cost-effective and efficient alternative to traditional training and surgical planning. However, the algorithm for surgical simulation is sophisticated, and the requirement of computer software and hardware is high. The objective of this study was to explore the feasibility of tree-structure architectonic model in simplifying and realizing virtual orthognathic surgical simulation. METHODS Four patients with skeletal malocclusions were enrolled in this study. Craniomaxillofacial computed tomography scan was obtained, and three-dimensional model was reconstructed using Simplant software. Maxillary Le Fort I osteotomy, bilateral sagittal split ramus osteotomy, vertical ramus osteotomy, and genioplasty were carried out on the three-dimensional model in advance. Tree-structure architectonic model was established in the sterolithography format. With stereoscopic glasses, using digital gloves, operators immersed in virtual environment and operated on "real" patients performing surgical simulation. RESULTS Through establishing tree-structure architectonic model in advance, the complex algorithm for virtual osteotomy was simplified, and computational complexity was reduced. Three-dimensional model can be visualized from any viewing point. Operators were immersed in the virtual environment with a conspicuous sense of immersion. An obvious image and tactile feedback was perceived when touching and moving the bony segments. Virtual orthognathic surgical simulation and training were realized with real-time image and tactile perception feedback. CONCLUSIONS Establishing tree-structure architectonic model in advance is an ideal alternative in implementing virtual orthognathic surgical simulation. Virtual surgical simulation and training were realized with a strong sense of immersion. Craniomaxillofacial three-dimensional virtual surgical simulation system can be used in orthognathic surgical planning, simulation, and operation training.
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Gateno J, Xia JJ, Teichgraeber JF. New Methods to Evaluate Craniofacial Deformity and to Plan Surgical Correction. Semin Orthod 2011; 17:225-234. [PMID: 21927548 DOI: 10.1053/j.sodo.2011.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The success of cranio-maxillofacial (CMF) surgery depends not only on surgical techniques, but also upon an accurate surgical plan. Unfortunately, traditional planning methods are often inadequate for planning complex cranio-maxillofacial deformities. To this end, we developed 3D computer-aided surgical simulation (CASS) technique. Using our CASS method, we are able to treat patients with significant asymmetries in a single operation which in the past was usually completed in two stages. The purpose of this article is to introduce our CASS method in evaluating craniofacial deformities and planning surgical correction. In addition, we discuss the problems associated with the traditional surgical planning methods. Finally, we discuss the strength and pitfalls of using three-dimensional measurements to evaluate craniofacial deformity.
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Affiliation(s)
- Jaime Gateno
- Chairman, Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute, Houston, TX; Professor of Clinical Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY; and Associate Professor, Department of Pediatric Plastic Surgery, The University of Texas Health Science Center at Houston, TX
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Modern concepts in computer-assisted craniomaxillofacial reconstruction. Curr Opin Otolaryngol Head Neck Surg 2011; 19:295-301. [DOI: 10.1097/moo.0b013e328348a924] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Chang YB, Xia JJ, Gateno J, Xiong Z, Teichgraeber JF, Lasky RE, Zhou X. In vitro evaluation of new approach to digital dental model articulation. J Oral Maxillofac Surg 2011; 70:952-62. [PMID: 21764490 DOI: 10.1016/j.joms.2011.02.109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 02/14/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of the present study was to evaluate the accuracy of our newly developed approach to digital dental model articulation. MATERIALS AND METHODS Twelve sets of stone dental models from patients with craniomaxillofacial deformities were used for validation. All the models had stable occlusion and no evidence of early contact. The stone models were hand articulated to the maximal intercuspation (MI) position and scanned using a 3-dimensional surface laser scanner. These digital dental models at the MI position served as the control group. To establish an experimental group, each mandibular dental model was disarticulated from its original MI position to 80 initial positions. Using a regular office personal computer, they were digitally articulated to the MI position using our newly developed approach. These rearticulated mandibular models served as the experimental group. Finally, the translational, rotational, and surface deviations in the mandibular position were calculated between the experimental and control groups, and statistical analyses were performed. RESULTS All the digital dental models were successfully articulated. Between the control and experimental groups, the largest translational difference in mandibular position was within 0.2 mm ± 0.6 mm. The largest rotational difference was within 0.1° ± 1.1°. The averaged surface deviation was 0.08 ± 0.07. The results of the Bland and Altman method of assessing measurement agreement showed tight limits for the translational, rotational, and surface deviations. In addition, the final positions of the mandibular articulated from the 80 initial positions were absolutely agreed on. CONCLUSION The results of our study have demonstrated that using our approach, the digital dental models can be accurately and effectively articulated to the MI position. In addition, the 3-dimensional surface geometry of the mandibular teeth played a more important role in digital dental articulation than the initial position of the mandibular teeth.
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Affiliation(s)
- Yu-Bing Chang
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Methodist Hospital Research Institute, Houston, TX, USA
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Xia JJ, Shevchenko L, Gateno J, Teichgraeber JF, Taylor TD, Lasky RE, English JD, Kau CH, McGrory KR. Outcome study of computer-aided surgical simulation in the treatment of patients with craniomaxillofacial deformities. J Oral Maxillofac Surg 2011; 69:2014-24. [PMID: 21684451 PMCID: PMC3119456 DOI: 10.1016/j.joms.2011.02.018] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 02/09/2011] [Accepted: 02/09/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to determine whether the surgical outcomes achieved with computer-aided surgical simulation (CASS) are better than those achieved with traditional methods. MATERIALS AND METHODS Twelve consecutive patients with craniomaxillofacial (CMF) deformities were enrolled. According to the CASS clinical protocol, a 3-dimensional computer composite skull model for each patient was generated and reoriented to the neutral head posture. These models underwent 2 virtual surgeries: 1 was based on CASS (experimental group) and the other was based on traditional methods 1 year later (control group). Once the 2 virtual surgeries were completed, 2 experienced oral and maxillofacial surgeons at 2 different settings evaluated the 2 surgical outcomes. They were blinded to the planning method used on the virtual models and each other's evaluation results. The primary outcome was overall CMF skeletal harmony. The secondary outcomes were individual maxillary, mandibular, and chin harmonies. Statistical analyses were performed. RESULTS Overall CMF skeletal harmony achieved with CASS was statistically significantly better than that achieved with traditional methods. In addition, the maxillary and mandibular surgical outcomes achieved with CASS were significantly better. Furthermore, although not included in the statistical model, the chin symmetry achieved by CASS tended to be better. A regression model was established between mandibular symmetry and overall CMF skeletal harmony. CONCLUSION The surgical outcomes achieved with CASS are significantly better than those achieved with traditional planning methods. In addition, CASS enables the surgeon to better correct maxillary yaw deformity, better place proximal/distal segments, and better restore mandibular symmetry. The critical step in achieving better overall CMF skeletal harmony is to restore mandibular symmetry.
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Affiliation(s)
- James J Xia
- Department of Oral and Maxillofacial Surgery, Methodist Hospital Research Institute, Houston, TX 77030, USA.
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Long-term treatment outcome of presurgical nasoalveolar molding in patients with unilateral cleft lip and palate. J Craniofac Surg 2011; 22:333-6. [PMID: 21239929 DOI: 10.1097/scs.0b013e318200d874] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the long-term effectiveness of presurgical nasoalveolar molding (PNAM) in patients with unilateral cleft lip and palate (UCLP). METHODS Twenty-five patients with UCLP treated by either PNAM or non-PNAM therapy between 1998 and 2003 were recruited in the study. During the clinical examination and data analysis, the evaluators were blinded to which patients received PNAM. The patients were reviewed clinically, and their facial morphology was captured with a three-dimensional scanner. Their dental arch configuration and occlusion were recorded by plaster dental models. After the patient evaluations and measurements were completed, the patient list was unblinded. There were 20 patients in the PNAM group and 5 patients in the non-PNAM group. Fisher exact tests and Wilcoxon rank sum tests were used to compare the outcomes. RESULTS Clinically, the improvement in the PNAM group was most evident in nasal and lip anatomy. However, there were no statistically significant differences between the 2 groups on each of the measurements on three-dimensional facial images and dental models. CONCLUSIONS Our study suggests a trend toward a long-term clinical improvement in nasal and lip anatomy of UCLP patients treated with PNAM. However, these improved results were not confirmed by three-dimensional stereophotography. There was no statistically significant difference in the long-term three-dimensional anthropometric measurements and dental model analysis between the PNAM group and the non-PNAM group.
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Bell RB. Computer planning and intraoperative navigation in orthognathic surgery. J Oral Maxillofac Surg 2011; 69:592-605. [PMID: 21353924 DOI: 10.1016/j.joms.2009.06.030] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 06/26/2009] [Indexed: 10/18/2022]
Affiliation(s)
- R Bryan Bell
- Oral and Maxillofacial Surgery Service, Legacy Emanuel Hospital, 1849 Northwest Kearney, Suite 300, Portland, OR 97209, USA.
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Three-dimensional quantification of mandibular asymmetry through cone-beam computerized tomography. ACTA ACUST UNITED AC 2011; 111:757-70. [PMID: 21497527 DOI: 10.1016/j.tripleo.2011.02.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 11/09/2010] [Accepted: 02/01/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to determine if 3-dimensional (3D) shape analysis precisely diagnoses right and left differences in asymmetry patients. STUDY DESIGN Cone-beam computerized tomography (CT) data were acquired before treatment from 20 patients with mandibular asymmetry. 3D shape analysis was used to localize and quantify the extent of virtually simulated asymmetry. Two approaches were used: 1) mirroring on the midsagittal plane determined from landmarks; and 2) mirroring on an arbitrary plane and then registering on the cranial base of the original image. The validation presented in this study used simulated data and was applied to 3 clinical cases. RESULTS For mirroring on the midsagittal plane, there was a >99% probability that the difference between measured and simulated asymmetry was <0.5 mm. For mirroring with cranial base registration, there was a >84% probability of differences <0.5 mm. CONCLUSIONS Mandibular asymmetry can be precisely quantified with both mirroring methods. Cranial base registration has the potential to be used for patients with trauma situations or when key landmarks are unreliable or absent.
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Comparing 3-Dimensional Virtual Methods for Reconstruction in Craniomaxillofacial Surgery. J Oral Maxillofac Surg 2011; 69:1184-94. [DOI: 10.1016/j.joms.2010.02.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 11/03/2009] [Accepted: 02/16/2010] [Indexed: 11/22/2022]
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Aboul-Hosn Centenero S, Hernández-Alfaro F. 3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results - our experience in 16 cases. J Craniomaxillofac Surg 2011; 40:162-8. [PMID: 21458285 DOI: 10.1016/j.jcms.2011.03.014] [Citation(s) in RCA: 192] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 12/23/2010] [Accepted: 03/01/2011] [Indexed: 11/29/2022] Open
Abstract
The aim of this article is to determine the advantages of 3D planning in predicting postoperative results and manufacturing surgical splints using CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) technology in orthognathic surgery when the software program Simplant OMS 10.1 (Materialise(®), Leuven, Belgium) was used for the purpose of this study which was carried out on 16 patients. A conventional preoperative treatment plan was devised for each patient following our Centre's standard protocol, and surgical splints were manufactured. These splints were used as study controls. The preoperative treatment plans devised were then transferred to a 3D-virtual environment on a personal computer (PC). Surgery was simulated, the prediction of results on soft and hard tissue produced, and surgical splints manufactured using CAD/CAM technology. In the operating room, both types of surgical splints were compared and the degree of similitude in results obtained in three planes was calculated. The maxillary osteotomy line was taken as the point of reference. The level of concordance was used to compare the surgical splints. Three months after surgery a second set of 3D images were obtained and used to obtain linear and angular measurements on screen. Using the Intraclass Correlation Coefficient these postoperative measurements were compared with the measurements obtained when predicting postoperative results. Results showed that a high degree of correlation in 15 of the 16 cases. A high coefficient of correlation was obtained in the majority of predictions of results in hard tissue, although less precise results were obtained in measurements in soft tissue in the labial area. The study shows that the software program used in the study is reliable for 3D planning and for the manufacture of surgical splints using CAD/CAM technology. Nevertheless, further progress in the development of technologies for the acquisition of 3D images, new versions of software programs, and further studies of objective data are necessary to increase precision in computerised 3D planning.
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Affiliation(s)
- Samir Aboul-Hosn Centenero
- Instituto de Cirugía Maxilofacial e Implantología, Clínica Teknon, C/Vilana, 12, Office 185, 08022 Barcelona, Spain.
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Gateno J, Xia JJ, Teichgraeber JF. New 3-dimensional cephalometric analysis for orthognathic surgery. J Oral Maxillofac Surg 2011; 69:606-22. [PMID: 21257250 PMCID: PMC3059215 DOI: 10.1016/j.joms.2010.09.010] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 09/22/2010] [Indexed: 11/23/2022]
Abstract
Two basic problems have been associated with traditional 2-dimensional cephalometry. First, many important parameters cannot be measured on plain cephalograms; and second, most 2-dimensional cephalometric measurements are distorted in the presence of facial asymmetry. Three-dimensional cephalometry, which has been facilitated by the introduction of cone-beam computed tomography, can solve these problems. However, before this can be realized, fundamental problems must be solved. These include the unreliability of internal reference systems and some 3-dimensional measurements, and the lack of tools to assess and measure the symmetry. In the present report, we present a new 3-dimensional cephalometric analysis that uses different geometric approaches to solve these fundamental problems. The present analysis allows the accurate measurement of the size, shape, position, and orientation of the different facial units and incorporates a novel method to measure asymmetry.
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Affiliation(s)
- Jaime Gateno
- Chairman, Department of Oral and Maxillofacial Surgery, The Methodist Hospital, Houston, TX; Professor of Clinical Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY; and Associate Professor, Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, TX
| | - James J. Xia
- Director of Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute, Houston, TX; Associate Professor of Surgery (Oral and Maxillofacial Surgery), Weill Medicine College, Cornell University, New York, NY; Associate Professor, Departments of Pediatric Surgery and Orthodontics, The University of Texas Health Science Center at Houston, TX
| | - John F. Teichgraeber
- Professor and Chief, Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, TX
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Using a Clinical Protocol for Orthognathic Surgery and Assessing a 3-Dimensional Virtual Approach: Current Therapy. J Oral Maxillofac Surg 2011; 69:623-37. [DOI: 10.1016/j.joms.2010.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 09/02/2010] [Accepted: 11/01/2010] [Indexed: 11/17/2022]
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McCormick SU, Drew SJ. Virtual Model Surgery for Efficient Planning and Surgical Performance. J Oral Maxillofac Surg 2011; 69:638-44. [DOI: 10.1016/j.joms.2010.10.047] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 10/14/2010] [Indexed: 10/18/2022]
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Xia JJ, McGrory JK, Gateno J, Teichgraeber JF, Dawson BC, Kennedy KA, Lasky RE, English JD, Kau CH, McGrory KR. A new method to orient 3-dimensional computed tomography models to the natural head position: a clinical feasibility study. J Oral Maxillofac Surg 2011; 69:584-91. [PMID: 21353923 PMCID: PMC3053123 DOI: 10.1016/j.joms.2010.10.034] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 10/14/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical feasibility of a new method to orient 3-dimensional (3D) computed tomography models to the natural head position (NHP). This method uses a small and inexpensive digital orientation device to record NHP in 3 dimensions. This device consists of a digital orientation sensor attached to the patient via a facebow and an individualized bite jig. The study was designed to answer 2 questions: 1) whether the weight of the new device can negatively influence the NHP and 2) whether the new method is as accurate as the gold standard. PATIENTS AND METHODS Fifteen patients with craniomaxillofacial deformities were included in the study. Each patient's NHP is recorded 3 times. The first NHP was recorded with a laser scanning method without the presence of the digital orientation device. The second NHP was recorded with the digital orientation device. Simultaneously, the third NHP was also recorded with the laser scanning method. Each recorded NHP measurement was then transferred to the patient's 3D computed tomography facial model, resulting in 3 different orientations for each patient: the orientation generated via the laser scanning method without the presence of the digital orientation sensor and facebow (orientation 1), the orientation generated by use of the laser scanning method with the presence of the digital orientation sensor and facebow (orientation 2), and the orientation generated with the digital orientation device (orientation 3). Comparisons are then made between orientations 1 and 2 and between orientations 2 and 3, respectively. Statistical analyses are performed. RESULTS The results show that in each pair, the difference (Δ) between the 2 measurements is not statistically significantly different from 0°. In addition, in the first pair, the Bland-Altman lower and upper limits of the Δ between the 2 measurements are within 1.5° in pitch and within a subdegree in roll and yaw. In the second pair, the limits of the Δ in all 3 dimensions are within 0.5°. CONCLUSION Our technique can accurately record NHP in 3 dimensions and precisely transfer it to a 3D model. In addition, the extra weight of the digital orientation sensor and facebow has minimal influence on the self-balanced NHP establishment.
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Affiliation(s)
- James J Xia
- Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute, Houston, TX, USA.
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Chandran R, Keeler GD, Christensen AM, Weimer KA, Caloss R. Application of Virtual Surgical Planning for Total Joint Reconstruction With a Stock Alloplast System. J Oral Maxillofac Surg 2011; 69:285-94. [DOI: 10.1016/j.joms.2010.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 02/03/2010] [Accepted: 03/04/2010] [Indexed: 11/15/2022]
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145
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Plooij JM, Maal TJJ, Haers P, Borstlap WA, Kuijpers-Jagtman AM, Bergé SJ. Digital three-dimensional image fusion processes for planning and evaluating orthodontics and orthognathic surgery. A systematic review. Int J Oral Maxillofac Surg 2010; 40:341-52. [PMID: 21095103 DOI: 10.1016/j.ijom.2010.10.013] [Citation(s) in RCA: 178] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 05/30/2010] [Accepted: 10/13/2010] [Indexed: 10/18/2022]
Abstract
The three important tissue groups in orthognathic surgery (facial soft tissues, facial skeleton and dentition) can be referred to as a triad. This triad plays a decisive role in planning orthognathic surgery. Technological developments have led to the development of different three-dimensional (3D) technologies such as multiplanar CT and MRI scanning, 3D photography modalities and surface scanning. An objective method to predict surgical and orthodontic outcome should be established based on the integration of structural (soft tissue envelope, facial skeleton and dentition) and photographic 3D images. None of the craniofacial imaging techniques can capture the complete triad with optimal quality. This can only be achieved by 'image fusion' of different imaging techniques to create a 3D virtual head that can display all triad elements. A systematic search of current literature on image fusion in the craniofacial area was performed. 15 articles were found describing 3D digital image fusion models of two or more different imaging techniques for orthodontics and orthognathic surgery. From these articles it is concluded, that image fusion and especially the 3D virtual head are accurate and realistic tools for documentation, analysis, treatment planning and long term follow up. This may provide an accurate and realistic prediction model.
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146
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Virtual restoration of anatomic jaw relationship to obtain a precise 3D model for total joint prosthesis construction for treatment of TMJ ankylosis with open bite. Int J Oral Maxillofac Surg 2010; 39:1012-5. [DOI: 10.1016/j.ijom.2010.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 04/21/2010] [Accepted: 06/02/2010] [Indexed: 11/22/2022]
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147
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Velangi A. Is Computer-Assisted Orthognathic Surgery Effective in Establishing Normal Dental Relationships? J Oral Maxillofac Surg 2010. [DOI: 10.1016/j.joms.2010.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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148
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Chang YB, Xia JJ, Gateno J, Xiong Z, Zhou X, Wong STC. An automatic and robust algorithm of reestablishment of digital dental occlusion. IEEE TRANSACTIONS ON MEDICAL IMAGING 2010; 29:1652-1663. [PMID: 20529735 PMCID: PMC5668907 DOI: 10.1109/tmi.2010.2049526] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In the field of craniomaxillofacial (CMF) surgery, surgical planning can be performed on composite 3-D models that are generated by merging a computerized tomography scan with digital dental models. Digital dental models can be generated by scanning the surfaces of plaster dental models or dental impressions with a high-resolution laser scanner. During the planning process, one of the essential steps is to reestablish the dental occlusion. Unfortunately, this task is time-consuming and often inaccurate. This paper presents a new approach to automatically and efficiently reestablish dental occlusion. It includes two steps. The first step is to initially position the models based on dental curves and a point matching technique. The second step is to reposition the models to the final desired occlusion based on iterative surface-based minimum distance mapping with collision constraints. With linearization of rotation matrix, the alignment is modeled by solving quadratic programming. The simulation was completed on 12 sets of digital dental models. Two sets of dental models were partially edentulous, and another two sets have first premolar extractions for orthodontic treatment. Two validation methods were applied to the articulated models. The results show that using our method, the dental models can be successfully articulated with a small degree of deviations from the occlusion achieved with the gold-standard method.
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Affiliation(s)
- Yu-Bing Chang
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77841 USA
| | - James J. Xia
- Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute, and Department of Surgery (Oral and Maxillofacial Surgery), Weil Medical College of Cornell University, Houston, TX 77030 USA and also with Departments of Pediatric Surgery and Orthodontics, University of Texas Health Science Center, Houston, TX 77030 USA
| | - Jaime Gateno
- Department of Oral and Maxillofacial Surgery, the Methodist Hospital Research Institute, and Department of Surgery (Oral and Maxillofacial Surgery), Weil Medical College of Cornell University, Houston, TX 77030 USA
| | - Zixiang Xiong
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77841 USA
| | | | - Stephen T. C. Wong
- Center for Biotechnology and Informatics, The Methodist Hospital Research Institute and Department of Radiology, The Methodist Hospital, Weill Medical College of Cornell University, Houston, TX 77030 USA
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Tucker S, Cevidanes LHS, Styner M, Kim H, Reyes M, Proffit W, Turvey T. Comparison of actual surgical outcomes and 3-dimensional surgical simulations. J Oral Maxillofac Surg 2010; 68:2412-21. [PMID: 20591553 DOI: 10.1016/j.joms.2009.09.058] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 09/14/2009] [Indexed: 11/18/2022]
Abstract
PURPOSE The advent of imaging software programs has proved to be useful for diagnosis, treatment planning, and outcome measurement, but precision of 3-dimensional (3D) surgical simulation still needs to be tested. This study was conducted to determine whether the virtual surgery performed on 3D models constructed from cone-beam computed tomography (CBCT) can correctly simulate the actual surgical outcome and to validate the ability of this emerging technology to recreate the orthognathic surgery hard tissue movements in 3 translational and 3 rotational planes of space. MATERIALS AND METHODS Construction of pre- and postsurgery 3D models from CBCTs of 14 patients who had combined maxillary advancement and mandibular setback surgery and 6 patients who had 1-piece maxillary advancement surgery was performed. The postsurgery and virtually simulated surgery 3D models were registered at the cranial base to quantify differences between simulated and actual surgery models. Hotelling t tests were used to assess the differences between simulated and actual surgical outcomes. RESULTS For all anatomic regions of interest, there was no statistically significant difference between the simulated and the actual surgical models. The right lateral ramus was the only region that showed a statistically significant, but small difference when comparing 2- and 1-jaw surgeries. CONCLUSIONS Virtual surgical methods were reliably reproduced. Oral surgery residents could benefit from virtual surgical training. Computer simulation has the potential to increase predictability in the operating room.
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Affiliation(s)
- Scott Tucker
- Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC, USA
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150
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Bell RB. Computer planning and intraoperative navigation in cranio-maxillofacial surgery. Oral Maxillofac Surg Clin North Am 2010; 22:135-56. [PMID: 20159483 DOI: 10.1016/j.coms.2009.10.010] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Preoperative computer design and stereolithographic modeling combined with intraoperative navigation provide a useful guide for and possibly more accurate reconstruction of a variety of complex cranio-maxillofacial deformities. Although probably not necessary for routine use, the author's early experience confirms that of other surgeons with more than a decade of experience: computer-assisted surgery is indicated for complex posttraumatic or postablative reconstruction of the orbits, cranium, maxilla, and mandible; total temporomandibular joint replacement; orthognathic surgery; and complex dental/craniofacial implantology. Further study is needed to provide outcomes data and cost-benefit analyses for each of these indications.
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Affiliation(s)
- R Bryan Bell
- Oral and Maxillofacial Surgery Service, Legacy Emanuel Hospital and Health Center, Head and Neck Surgical Associates, Oregon Health & Science University, 1849 NW Kearney, Suite 300, Portland, OR 97209, USA.
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