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Kim J, Jeung D, Cho R, Yang B, Hong J. A Proof of Concept: Optimized Jawbone-Reduction Model for Mandibular Fracture Surgery. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:1151-1159. [PMID: 38332406 DOI: 10.1007/s10278-024-01014-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/19/2023] [Accepted: 12/26/2023] [Indexed: 02/10/2024]
Abstract
Previous research on computer-assisted jawbone reduction for mandibular fracture surgery has only focused on the relationship between fractured sections disregarding proper dental occlusion with the maxilla. To overcome malocclusion caused by overlooking dental articulation, this study aims to provide a model for jawbone reduction based on dental occlusion. After dental landmarks and fracture sectional features are extracted, the maxilla and two mandible segments are aligned first using the extracted dental landmarks. A swarm-based optimization is subsequently performed by simultaneously observing the fracture section fitting and the dental occlusion condition. The proposed method was evaluated using jawbone data of 12 subjects with simulated and real mandibular fractures. Results showed that the optimized model achieved both accurate jawbone reduction and desired dental occlusion, which may not be possible by existing methods.
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Affiliation(s)
- Jinmin Kim
- DIGITRACK. Inc., Daegu, Republic of Korea
| | - Deokgi Jeung
- Department of Robotics and Mechatronics Engineering, DGIST, 333 Techno Jungang-Daero, Daegu, 42988, Republic of Korea
- Department of Medical Robotics, Korea Institute of Machinery and Materials, Daegu, Republic of Korea
| | - Ranyeong Cho
- Division of Oral & Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-Ro 170Beon-Gil, Gyeonggi-Do, 14068, Republic of Korea
| | - Byoungeun Yang
- Division of Oral & Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-Ro 170Beon-Gil, Gyeonggi-Do, 14068, Republic of Korea.
| | - Jaesung Hong
- Department of Robotics and Mechatronics Engineering, DGIST, 333 Techno Jungang-Daero, Daegu, 42988, Republic of Korea.
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Wilkat M, Liu S, Schwerter M, Schrader F, Saigo L, Karnatz N, Kübler NR, Rana M. A New Approach to Virtual Occlusion in Orthognathic Surgery Planning Using Mixed Reality-A Technical Note and Review of the Literature. J Pers Med 2023; 13:1709. [PMID: 38138936 PMCID: PMC10744857 DOI: 10.3390/jpm13121709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Orthognathic surgery plays a vital role in correcting various skeletal discrepancies of the maxillofacial region. Achieving optimal occlusion is a fundamental aspect of orthognathic surgery planning, as it directly influences postoperative outcomes and patient satisfaction. Traditional methods for setting final occlusion involve the use of dental casts which are time-consuming, prone to errors and cannot be easily shared among collaborating specialties. In recent years, advancements in digital technology have introduced innovative approaches, such as virtual occlusion, which may offer enhanced accuracy and efficiency in orthognathic surgery planning. Furthermore, the emergence of mixed reality devices and their 3D visualization capabilities have brought about novel benefits in the medical field, particularly in computer-assisted planning. This paper presents for the first time a prototype tool for setting virtual occlusion during orthognathic surgery planning using mixed reality technology. A complete walkthrough of the workflow is presented including an explanation of the implicit advantages of this novel tool. The new approach to defining virtual occlusion is set into context with other published methods of virtual occlusion setting, discussing advantages and limitations as well as concepts of surgical occlusion for orthognathic surgery.
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Affiliation(s)
- Max Wilkat
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Shufang Liu
- Brainlab AG, Olof-Palme-Str. 9, 81829 München, Germany
| | | | - Felix Schrader
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Leonardo Saigo
- Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, 5 Second Hospital Ave., Singapore 168938, Singapore
| | - Nadia Karnatz
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Norbert R. Kübler
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Majeed Rana
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
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Almadi D, Benington P, Ju X, Ayoub A. Reproducibility and reliability of digital occlusal planning for orthognathic surgery. Int J Oral Maxillofac Surg 2023; 52:1074-1080. [PMID: 36941160 DOI: 10.1016/j.ijom.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023]
Abstract
The digital articulation of dental models is gradually replacing the conventional physical approach for occlusal prediction planning. This study was performed to compare the accuracy and reproducibility of free-hand articulation of two groups of digital and physical dental models, 12 Class I (group 1) and 12 Class III (group 2). The models were scanned using an intraoral scanner. The physical and digital models were independently articulated 2 weeks apart by three orthodontists to achieve the maximum inter-digitation, with coincident midlines and a positive overjet and overbite. The occlusal contacts provided by the software color-coded maps were assessed and the differences in the pitch, roll, and yaw were measured. The reproducibility of the achieved occlusion of both the physical and digital articulation was excellent. The z-axis displayed the smallest absolute mean differences of 0.10 ± 0.08 mm and 0.27 ± 0.24 mm in the repeated physical and repeated digital articulations, respectively, both in group 2. The largest discrepancies between the two methods of articulation were in the y-axis (0.76 ± 0.60 mm, P = 0.010) and in roll (1.83° ± 1.72°, P = 0.005). The overall measured differences were< 0.8 mm and< 2°. Despite the steep learning curve, digital occlusal planning is accurate enough for clinical applications.
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Affiliation(s)
- D Almadi
- Oral and Maxillofacial Surgery Service, Glasgow University Dental Hospital and School, Glasgow, UK
| | - P Benington
- Orthodontic Service, Glasgow University Dental Hospital and School, Glasgow, UK
| | - X Ju
- Medical Device Unit, Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Hospital, Glasgow, UK
| | - A Ayoub
- Oral and Maxillofacial Surgery Service, Glasgow University Dental Hospital and School, Glasgow, UK.
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Plaster Casts vs. Intraoral Scans: Do Different Methods of Determining the Final Occlusion Affect the Simulated Outcome in Orthognathic Surgery? J Pers Med 2022; 12:jpm12081288. [PMID: 36013237 PMCID: PMC9409745 DOI: 10.3390/jpm12081288] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
A virtual occlusal adjustment in orthognathic surgery has many advantages; however, the haptic information offered by plaster casts is missing when using intraoral scans. Feeling the interferences may be helpful in defining the best possible occlusion. Whether the use of a virtual occlusal adjustment instead of the conventional approach has a significant effect on the postsurgical position of the jaws is a question that remains unanswered. This study compares a virtual method to the conventional method of defining the final occlusion. Twenty-five orthognathic patients were included. Bimaxillary and single-jaw orthognathic surgery (mandible only) was simulated. The two methods were compared regarding discrepancies in the simulated postsurgical position of the mandible, measured three-dimensionally using MeshLab (MeshLab 2020.12 3D). An analysis using SPSS revealed no significant differences between the tested methods (p-values: 0.580 to 0.713). The mean absolute discrepancies ranged from 0.14 mm to 0.72 mm, laying within the scope of the clinically acceptable inaccuracies of an osteosynthesis in orthognathic surgery. The lack of haptic information in virtual planning had no relevant influence on the definition of the final occlusion and the simulated postsurgical outcome. However, in individual cases, plaster models might still be helpful in finding the adequate occlusion, especially in the sagittal dimension and in cases of patients with an anterior open bite, but this remains to be tested.
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Clinical feasibility evaluation of digital dental articulation for three-piece maxillary orthognathic surgery: a proof-of-concept study. Int J Oral Maxillofac Surg 2022; 51:1043-1049. [PMID: 35183403 PMCID: PMC9253058 DOI: 10.1016/j.ijom.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/23/2021] [Accepted: 02/01/2022] [Indexed: 11/22/2022]
Abstract
Digital dental articulation for three-piece maxillary orthognathic surgery is challenging. The purpose of this proof-of-concept study was to evaluate the clinical feasibility of a newly developed mathematical algorithm to digitally establish the final occlusion for three-piece maxillary surgery. Five patients with jaw deformities who had undergone a three-piece double-jaw surgery that was planned virtually were randomly selected for this study. The final occlusion had been hand-articulated using stone casts, scanned into the computer and used in the surgery. These hand-articulated occlusions served as the control group. To form the experimental group, the three-piece maxillary dental arch was articulated again automatically from the patient's original occlusion using the mathematical algorithm. The hand- and algorithm-articulated occlusions were then evaluated qualitatively by two experienced orthodontists. A quantitative evaluation was also performed. The results of the qualitative evaluation showed that all of the three-piece occlusions, hand- and algorithm-articulated, were clinically acceptable based on the American Board of Orthodontics grading system. When compared, two of the algorithm-articulated occlusions were clearly better (40%), one was the same (20%), and two were slightly worse (40%) than the hand-articulated occlusions. All of the quantitative measurements were comparable between the two articulation methods. In conclusion, the results of this study demonstrate that it is clinically feasible to digitally articulate the three-piece maxillary arch to the intact mandibular dental arch.
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Apostolakis D, Michelinakis G, Kamposiora P, Papavasiliou G. The current state of Computer Assisted Orthognathic Surgery: A narrative review. J Dent 2022; 119:104052. [DOI: 10.1016/j.jdent.2022.104052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 12/23/2022] Open
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Tooth Defect Segmentation in 3D Mesh Scans Using Deep Learning. ARTIF INTELL 2022. [DOI: 10.1007/978-3-031-20503-3_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Moore BK, Deane S, Huang W, Kim J, Parthasarathi K. Occlusal comparison of hand-articulation versus digital articulation in orthognathic surgery. Br J Oral Maxillofac Surg 2021; 60:443-447. [DOI: 10.1016/j.bjoms.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022]
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Baan F, van Meggelen EM, Verhulst AC, Bruggink R, Xi T, Maal TJJ. Virtual occlusion in orthognathic surgery. Int J Oral Maxillofac Surg 2020; 50:1219-1225. [PMID: 33358521 DOI: 10.1016/j.ijom.2020.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/08/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022]
Abstract
The aim of this retrospective study was to determine whether a virtually created occlusion is as accurate as a conventionally created occlusion. Seventeen orthognathic patients were included in the study, which was conducted in a university clinic. Plaster cast models were obtained and digitized. Two experienced observers created the conventional (gold standard) and virtual occlusion to assess inter-observer variability. One observer created the conventional and virtual occlusion a second time to assess the intra-observer variability. The criterion for accepting the virtual occlusion was that the difference between the gold standard and the virtual occlusion was not larger than the intra-observer variability for the gold standard. A non-parametric Kruskal-Wallis H test was performed to detect statistically significant differences between the intra- and inter-observer groups for both the conventional and virtual occlusion. No statistically significant differences were found between the different groups. The difference between the conventional and virtual occlusion group was 0.20mm larger than the intra-observer variability of the gold standard. The virtual occlusion tool presented here can be utilized in daily clinical practice and makes the use of physical dental models redundant.
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Affiliation(s)
- F Baan
- Radboudumc 3DLab The Netherlands, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - E M van Meggelen
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A C Verhulst
- Radboudumc 3DLab The Netherlands, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R Bruggink
- Radboudumc 3DLab The Netherlands, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - T Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - T J J Maal
- Radboudumc 3DLab The Netherlands, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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Wong S, Deng H, Gateno J, Yuan P, Garrett FA, Ellis RK, English JD, Jacob HB, Kim D, Xia JJ. Clinical Evaluation of Digital Dental Articulation for One-Piece Maxillary Surgery. J Oral Maxillofac Surg 2020; 78:799-805. [PMID: 32006486 PMCID: PMC7265171 DOI: 10.1016/j.joms.2019.12.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/25/2019] [Accepted: 12/14/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Methods for digital dental alignment are not readily available to automatically articulate the upper and lower jaw models. The purpose of the present study was to assess the accuracy of our newly developed 3-stage automatic digital articulation approach by comparing it with the reference standard of orthodontist-articulated occlusion. MATERIALS AND METHODS Thirty pairs of stone dental models from double-jaw orthognathic surgery patients who had undergone 1-piece Le Fort I osteotomy were used. Two experienced orthodontists manually articulated the models to their perceived final occlusion for surgery. Each pair of models was then scanned twice-while in the orthodontist-determined occlusion and again with the upper and lower models separated and positioned randomly. The separately scanned models were automatically articulated to the final occlusion using our 3-stage algorithm, resulting in an algorithm-articulated occlusion (experimental group). The models scanned together represented the manually articulated occlusion (control group). A qualitative evaluation was completed using a 3-point categorical scale by the same orthodontists, who were unaware of the methods used to articulate the models. A quantitative evaluation was also completed to determine whether any differences were present in the midline, canine, and molar relationships between the algorithm-determined and manually articulated occlusions using repeated measures analysis of variance (ANOVA). Finally, the mean ± standard deviation values were computed to determine the differences between the 2 methods. RESULTS The results of the qualitative evaluation revealed that all the algorithm-articulated occlusions were as good as the manually articulated ones. The results of the repeated measures ANOVA found no statistically significant differences between the 2 methods [F(1,28) = 0.03; P = .87]. The mean differences between the 2 methods were all within 0.2 mm. CONCLUSIONS The results of our study have demonstrated that dental models can be accurately, reliably, and automatically articulated using our 3-stage algorithm approach, meeting the reference standard of orthodontist-articulated occlusion.
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Affiliation(s)
- Sonny Wong
- Resident, Department of Orthodontics, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX
| | - Han Deng
- Postdoctoral Fellow, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX
| | - Jaime Gateno
- Chairman and Professor, Department of Oral and Maxillofacial Surgery, Houston Methodist, Houston, TX; Professor of Clinical Surgery (Oral and Maxillofacial Surgery), Joan & Sanford I. Weill Medical College of Cornell University, New York, NY
| | - Peng Yuan
- Research Associate, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX
| | - Fred A Garrett
- Clinical Professor, Department of Orthodontics, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX
| | - Randy K Ellis
- Clinical Associate Professor, Department of Orthodontics, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX
| | - Jeryl D English
- Chairman and Professor, Department of Orthodontics, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX
| | - Helder B Jacob
- Assistant Professor, Department of Orthodontics, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX
| | - Daeseung Kim
- Postdoctoral Fellow, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX
| | - James J Xia
- Professor, Department of Oral and Maxillofacial Surgery, and Director, Surgical Planning Laboratory, Houston Methodist, Houston, TX; and Professor of Surgery (Oral and Maxillofacial Surgery) Department of Surgery, Joan & Sanford I. Weill Medical College of Cornell University, New York, NY.
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