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On SW, Cho SW, Park SY, Yi SM, Park IY, Byun SH, Kim JC, Yang BE. Advancements in computer-assisted orthognathic surgery: A comprehensive review and clinical application in South Korea. J Dent 2024; 146:105061. [PMID: 38729289 DOI: 10.1016/j.jdent.2024.105061] [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: 01/22/2024] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES Orthognathic surgery (OS) has evolved with technological advancements, notably through the implementation of computer-assisted orthognathic surgery (CAOS). This article aims to elucidate various types of CAOS and their efficiency and accuracy, supplemented by a thorough literature review focusing on their clinical applications in South Korea. STUDY SELECTION, DATA, AND SOURCES A comprehensive search strategy was employed, including systematic reviews, meta-analyses, randomized controlled trials, and observational studies published until December 2023 in the PubMed, MEDLINE, and Google Scholar databases. The literature search was limited to articles written in English. RESULTS Static CAOS demonstrated high precision, reduced operative time, and high accuracy, suggesting its potential reliability in orthognathic procedures. Dynamic CAOS presented a promising avenue for exploration, showing an accuracy comparable to that of traditional methods. The critical considerations for CAOS include accuracy, time efficiency, and cost-effectiveness. Recent studies have indicated advancements in the time efficiency of static CAOS. Static CAOS requires less equipment and is more cost-effective than dynamic CAOS. CONCLUSIONS CAOS offers clear advantages over conventional OS in terms of surgical convenience and accuracy in implementing the surgical plan. To achieve recognition as the gold standard method for maxillofacial deformity treatment, CAOS must overcome its limitations and undergo continuous verification via well-designed studies. CLINICAL SIGNIFICANCE The introduction of CAOS, mainly static CAOS with high precision and reduced surgical time, signifies a notable advancement in OS. However, rigorous studies are warranted to validate CAOS as the gold standard for treating maxillofacial deformities.
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Affiliation(s)
- Sung-Woon On
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, South Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea
| | - Seoung-Won Cho
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea
| | - Sang-Yoon Park
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea; Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang 14066, South Korea
| | - Sang-Min Yi
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea; Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang 14066, South Korea
| | - In-Young Park
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang 14066, South Korea; Department of Orthodontics, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea
| | - Soo-Hwan Byun
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea; Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang 14066, South Korea
| | - Jong-Cheol Kim
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea; Daegu Mir Dental Hospital, Daegu 41940, South Korea
| | - Byoung-Eun Yang
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea; Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang 14066, South Korea.
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Karwowska NN, Baron M, Stern-Buchbinder Z, Buchbinder D. Computer-assisted planning and patient-specific plates in orthognathic surgery: a global study. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:673-680. [PMID: 37612163 DOI: 10.1016/j.oooo.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Using computer-assisted surgery (CAS) and patient-specific plates (PSP) in orthognathic surgery has shown improved accuracy and efficiency compared with traditional techniques. This study analyzed current global trends in planning and investigated the reasons for CAS and PSP use. STUDY DESIGN A survey of 29 multiple choice questions was distributed to AO Foundation Craniomaxillofacial e-mail subscribers biweekly between July 14, 2021 and September 2, 2021. Questions focused on specifics of respondents' preoperative workup, methods of data collection, and the use of cutting guides and patient-specific plates. Objective clinical outcomes and subjective surgeon reasons for use were also investigated. RESULTS Of the 557 responses, 420 (75.4%) participant responses were eligible for analyses. Most (302/420, 71.9%) respondents used CAS when performing orthognathic surgery, although regional differences were observed. Almost all respondents in North America implemented CAS in their surgery plan (44/46, 95.7%) compared with only 47.4% (18/38) in the Middle East/North Africa. Surgeons with 10 to 15 years of experience were far more likely to incorporate CAS. More than half (175/301, 58.1%) of CAS users also used PSP, of which 43% (68/158) did so for maxillary-only cases, 3.2% (5/158) used PSP for mandible-only surgeries, and 42.4% (67/158) used PSP for both. Surgeons' primary reasons for using CAS and PSP were accuracy (200/253, 79.1%), efficiency (196/253, 77.5%), and ease of preoperative planning (150/253, 59.3%). Most (77.9%) surgeons perceived that CAS was equal to or faster than traditional surgery. CONCLUSIONS Our study shows differences in use regionally and with surgeon experience. Surgeons primarily use CAS and PSP in orthognathic surgery to increase accuracy and efficiency, minimize intraoperative deviations from the surgical plan, and reduce total surgical time.
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Affiliation(s)
- N Nina Karwowska
- Division of Oral and Maxillofacial Surgery, Mount Sinai Health System, New York, NY, USA
| | - Michael Baron
- Division of Oral and Maxillofacial Surgery, Mount Sinai Health System, New York, NY, USA.
| | | | - Daniel Buchbinder
- Division of Maxillofacial Surgery, Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai-Mount Sinai Health System, New York, NY, USA
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Bueno S, Hammad Y, Schlieve T. Does the type of planning in orthognathic surgery influence patient satisfaction? Oral Maxillofac Surg 2023; 27:685-692. [PMID: 36121522 DOI: 10.1007/s10006-022-01114-6] [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: 12/21/2021] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To determine if the method of orthognathic surgery planning used-computer aided surgical simulation (CASS) versus analog model surgery-influenced patients' post-operative satisfaction. The authors hypothesized that there was no difference in patient satisfaction based on the type of planning in orthognathic surgery. METHODS This was a single-site, observational, retrospective cohort study consisting of a standardized survey aimed to be given to all patients who had orthognathic surgery at the authors' institution over a 6-year period. Patients were asked to complete a survey questionnaire that consisted of eight questions, each utilizing a five-point Likert scale. RESULTS There were 643 patients initially identified with 401 potential subjects meeting the inclusion criteria. Of these 401 patients, the survey was successfully administered to 161. Patients whose orthognathic surgery was planned virtually were not only significantly more likely to be satisfied with their appearance post-operatively, but also more likely to go through with surgery again if they could choose to (p < 0.05). CASS patients were also more likely to identify that their surgery was planned virtually. When stratified by age, younger patients were more likely to have read about CASS. When each survey question was stratified based on the type of surgery that was performed, there were no significant differences. CONCLUSION Patients whose surgeries were virtually planes were significantly more likely than model surgery patients to be satisfied with their post-operative appearance as well as with their decision to have orthognathic surgery. CASS has proven to be an accurate, time-saving, and potentially cost-saving tool for surgeons. Based on the results of this study, the type of surgical planning method matters for post-operative patient satisfaction with their appearance.
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Affiliation(s)
- Scott Bueno
- University of Texas Southwestern/ Parkland Memorial Hospital Oral & Maxillofacial Surgery, 5323 Harry Hines Blvd, CS3.104, Dallas, TX, 75390, USA.
| | - Yousef Hammad
- University of Texas Southwestern/ Parkland Memorial Hospital Oral & Maxillofacial Surgery, 5323 Harry Hines Blvd, CS3.104, Dallas, TX, 75390, USA
| | - Thomas Schlieve
- University of Texas Southwestern/ Parkland Memorial Hospital Oral & Maxillofacial Surgery, 5323 Harry Hines Blvd, CS3.104, Dallas, TX, 75390, USA
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Imai H, Yamashita Y, Takasu H, Fujita K, Ono T, Hirota M, Mitsudo K. Accuracy and influencing factors of maxillary and mandibular repositioning using pre-bent locking plates: a prospective study. Br J Oral Maxillofac Surg 2023; 61:659-665. [PMID: 37863724 DOI: 10.1016/j.bjoms.2023.07.008] [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: 04/05/2023] [Revised: 07/12/2023] [Accepted: 07/31/2023] [Indexed: 10/22/2023]
Abstract
In-house repositioning methods based on three-dimensional (3D)-printing technology and the use of pre-bent plates has been gaining popularity in orthognathic surgery. However, there remains room for further improvement in methods and investigations on clinical factors that affect accuracy. This single-centre, prospective study included 34 patients and aimed to evaluate the accuracy and factors influencing maxillary and mandibular repositioning using pre-bent locking plates. The plates were manually pre-bent on the 3D-printed models of the planned position, and their hole positions were scanned and reproduced intraoperatively with osteotomy guides. The accuracy of repositioning and plate-hole positioning was calculated in three axes with the set landmarks. The following clinical factors that affect repositioning accuracy were also verified: deviation of the plate-hole positioning, amount of planned movement, and amount of simulated bony interference. The median deviations of the repositioning and hole positioning between the preoperative plan and postoperative results were 0.26 mm and 0.23 mm, respectively, in the maxilla, and 0.69 mm and 0.36 mm, respectively, in the mandible, suggesting that the method was highly accurate, and the repositioning concept based on the plate hole and form matching was more effective in the maxilla. Results of the correlation test suggest that large amounts of bony interference and plate-hole positioning errors in the up/down direction could reduce mandibular repositioning accuracy.
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Affiliation(s)
- Haruki Imai
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Centre, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan; Department of Orthodontic Sciences, Tokyo Medical and Dental University (TMDU) Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan.
| | - Yosuke Yamashita
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Centre, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan
| | - Hikaru Takasu
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Centre, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan
| | - Koichi Fujita
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Centre, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan; Department of Orthodontic Sciences, Tokyo Medical and Dental University (TMDU) Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Takashi Ono
- Department of Orthodontic Sciences, Tokyo Medical and Dental University (TMDU) Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Makoto Hirota
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Centre, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
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Malenova Y, Ortner F, Liokatis P, Haidari S, Tröltzsch M, Fegg F, Obermeier KT, Hartung JT, Kakoschke TK, Burian E, Otto S, Sabbagh H, Probst FA. Accuracy of maxillary positioning using computer-designed and manufactured occlusal splints or patient-specific implants in orthognathic surgery. Clin Oral Investig 2023; 27:5063-5072. [PMID: 37382718 PMCID: PMC10492762 DOI: 10.1007/s00784-023-05125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To determine the accuracy of maxillary positioning using computer-designed and manufactured occlusal splints or patient-specific implants in orthognathic surgery. MATERIAL AND METHODS A retrospective analysis of 28 patients that underwent virtually planned orthognathic surgery with maxillary Le Fort I osteotomy either using VSP-generated splints (n = 13) or patient-specific implants (PSI) (n = 15) was conducted. The accuracy and surgical outcome of both techniques were compared by superimposing preoperative surgical planning with postoperative CT scans and measurement of translational and rotational deviation for each patient. RESULTS The 3D global geometric deviation between the planned position and the postoperative outcome was 0.60 mm (95%-CI 0.46-0.74, range 0.32-1.11 mm) for patients with PSI and 0.86 mm (95%-CI 0.44-1.28, range 0.09-2.60 mm) for patients with surgical splints. Postoperative differences for absolute and signed single linear deviations between planned and postoperative position were a little higher regarding the x-axis and pitch but lower regarding the y- and z-axis as well as yaw and roll for PSI compared to surgical splints. There were no significant differences regarding global geometric deviation, absolute and signed linear deviations in the x-, y-, and z-axis, and rotations (yaw, pitch, and roll) between both groups. CONCLUSIONS Regarding accuracy for positioning of maxillary segments after Le Fort I osteotomy in orthognathic surgery patient-specific implants and surgical splints provide equivalent high accuracy. CLINICAL RELEVANCE Patient-specific implants for maxillary positioning and fixation facilitate the concept of splintless orthognathic surgery and can be reliably used in clinical routines.
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Affiliation(s)
- Yoana Malenova
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany.
| | - Florian Ortner
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Selgai Haidari
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Matthias Tröltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
- Center for Oral, Maxillofacial, and Facial Reconstructive Surgery, Ansbach, Germany
| | - Florian Fegg
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Katharina T Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Jens T Hartung
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Tamara K Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Egon Burian
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Hisham Sabbagh
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital LMU Munich, Munich, Germany
| | - Florian A Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
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Trevisiol L, Bersani M, Martinez Garza A, Alvarado E, Arnett GW, D'Agostino A. Accuracy of virtual surgical planning in bimaxillary orthognathic surgery with mandible first sequence: A retrospective study. J Craniomaxillofac Surg 2023:S1010-5182(23)00093-8. [PMID: 37355372 DOI: 10.1016/j.jcms.2023.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/27/2023] [Accepted: 05/23/2023] [Indexed: 06/26/2023] Open
Abstract
The aim of this study was to verify treatment accuracy using virtual surgical planning (VSP) with a mandible-first sequence and strict surgical protocol to determine what surgical and methodological factors might influence outcomes. VSP transfer accuracy was evaluated retrospectively through a modified method involving voxel-based superimposition in patients who had undergone bimaxillary surgery with a mandible-first sequence to correct dentoskeletal deformities. Data analysis showed that the movements planned and those executed were substantially equivalent (p < 0.01), with the exception of mandibular and maxillary sagittal movements that were 0.72 ± 0.90 mm and 1.41 ± 1.04 mm smaller, respectively, than planned. This study showed that a mandible-first sequence is accurate for transferring virtual surgical planning intraoperatively. There are several factors involved in the proper transfer of virtual planning beyond the software, such as surgical technique and sequencing. Inaccurate sagittal movements and maxillary repositioning seem to depend mainly on surgical factors.
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Affiliation(s)
- Lorenzo Trevisiol
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Massimo Bersani
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy.
| | | | | | | | - Antonio D'Agostino
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
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Stamm T, Kanemeier M, Dirksen D, Middelberg C, Hohoff A, Kleinheinz J, Schmid JQ. The Position of the Virtual Hinge Axis in Relation to the Maxilla in Digital Orthognathic Surgery Planning-A k-Means Cluster Analysis. J Clin Med 2023; 12:jcm12103582. [PMID: 37240688 DOI: 10.3390/jcm12103582] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of this study was to investigate a possible relation between skeletal phenotypes and virtual mounting data in orthognathic surgery patients. A retrospective cohort study including 323 female (26.1 ± 8.7 years) and 191 male (27.9 ± 8.3 years) orthognathic surgery patients was conducted. A k-means cluster analysis was performed on the mounting parameters: the angle α between the upper occlusal plane (uOP) and the axis orbital plane (AOP); the perpendicular distance (AxV) from the uOP to the hinge axis; and the horizontal length (AxH) of the uOP from upper incisor edge to AxV, with subsequent statistical analysis of related cepalometric values. Three clusters of mounting data were identified, representing three skeletal phenotypes: (1) balanced face with marginal skeletal class II or III and α=8∘, AxV = 36 mm and AxH = 99 mm; (2) vertical face with skeletal class II and α=11∘, AxV = 27 mm and AxH = 88 mm; (3) horizontal face with class III and α=2∘, AxV = 36 mm and AxH = 86 mm. The obtained data on the position of the hinge axis can be applied to any digital planning in orthognathic surgery using CBCT or a virtual articulator, provided that the case can be clearly assigned to one of the calculated clusters.
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Affiliation(s)
- Thomas Stamm
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
| | - Moritz Kanemeier
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
| | - Dieter Dirksen
- Department of Prosthetic Dentistry and Biomaterials, University of Münster, 48149 Münster, Germany
| | | | - Ariane Hohoff
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, University of Münster, 48149 Münster, Germany
| | - Jonas Q Schmid
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
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Ahmed M, Ali S, Soliman S. Computer Guided Generated Dual-Purpose Splint for Bilateral Sagittal Split Osteotomy. J Maxillofac Oral Surg 2023; 22:239-244. [PMID: 36703665 PMCID: PMC9871130 DOI: 10.1007/s12663-022-01734-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/08/2022] [Indexed: 01/29/2023] Open
Abstract
Purpose to evaluate the efficacy of dual-purpose computer-generated splint in guiding the proximal and the distal segment in bilateral sagittal split osteotomy. Patients and Method It was a prospective case series study directed on 8 class III patients indicating the need of maxillary advancement and mandibular set back by bilateral sagittal split osteotomy. A CAD/CAM splint is generated to guide the distal segment to the stable maxilla and at the same time a grooved extension to engage the proximal segment ensuring the condyle in its planned position during fixation. The primary outcome was measured by calculating the difference between the pre- and post-operative condylar segment position. Results The present study included five female patient and three male patient with mean age of 28.4 ± 5.1 years. The accuracy of the splint in positioning the mandibular proximal segment showed promising results ranging from 2.59 to 0.49. Conclusion The dual-purpose splint introduced in this study showed satisfied results in maintaining the pre-operative condylar position while securing the distal segment in the desired plan.
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Affiliation(s)
- Mamdouh Ahmed
- Oral and Maxillofacial Surgery, Cairo University, Cairo, Egypt
| | - Sherif Ali
- Oral and Maxillofacial Surgery, Cairo University, Cairo, Egypt
| | - Sara Soliman
- Oral and Maxillofacial Surgery, Pharos University in Alexandria (PUA), Alexandria, Egypt
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Surgical Accuracy of 3D Virtual Surgery and CAD/CAM-Assisted Orthognathic Surgery for Skeletal Class III Patients. J Craniofac Surg 2023; 34:96-102. [PMID: 36044286 DOI: 10.1097/scs.0000000000008980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/30/2022] [Indexed: 01/11/2023] Open
Abstract
Orthognathic surgery is an effective surgical method to achieve functionality and facial esthetics for mandibular prognathism. If surgery is performed with a conventional method, errors may occur in the surgical preparation process and the surgical procedures, and there is a limitation in that the accuracy of surgery is determined according to the surgeon's experience and tactual sense. However, with the recent development of three-dimensional (3D) virtual planning and CAD/CAM technology, more 3D and predictable surgical planning and more accurate and time-saving surgery have become possible. The purpose of this study is to evaluate the surgical accuracy of 3D Virtual Surgery, CAD/CAM-Assisted Orthognathic surgery for Skeletal Class III Patients. The study included 18 patients who had undergone orthognathic surgery for skeletal class III malocclusion from January 2020 to December 2021. To evaluate the accuracy of the virtual planning, 3D facial cone-beam computed tomography taken immediately after surgery (T1) and virtual surgery data (Tv) were superimposed in each patient. Landmarks were set on each of the maxillary segment, mandibular distal segment, and left and right mandibular proximal segment, and the difference between T1 and Tv was compared 3D on the x , y , and z -axis. (ΔT: T1-Tv). As a result, the average distance between Tv and T1 at each landmark, all landmarks except for the posterior nasal spine of the maxillary segment showed <1 mm. In particular, the differences across the x and z -axis were very small, while the difference across the y -axis tend to be large. The comparison of the position of each segment in virtual surgery and actual surgery was as follows. It can be seen that all segments were located slightly downward, and the medial pole of the mandibular proximal segment was located posterolateral and the lateral pole was located anteromedial after the actual surgery compared with the virtual planning. It means that the proximal segment was slightly rotated, but the difference was within 1 mm, so it can be considered that the surgery was accurate. Base on this study, orthognathic surgery using 3D virtual surgery planning and CAD/CAM technologies was very accurate. By applying these cutting-edge technologies to clinical practice, it was possible not only to increase the predictability of surgery but also to improve the convenience of surgery. Therefore, it is thought that it will be important for clinicians to make continuous efforts to applicate cutting-edge technologies to be developed in the future to patient diagnosis and surgery.
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Starch-Jensen T, Hernández-Alfaro F, Kesmez Ö, Gorgis R, Valls-Ontañón A. Accuracy of Orthognathic Surgical Planning using Three-dimensional Virtual Techniques compared with Conventional Two-dimensional Techniques: a Systematic Review. J Oral Maxillofac Res 2023; 14:e1. [PMID: 37180406 PMCID: PMC10170664 DOI: 10.5037/jomr.2023.14101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/24/2023] [Indexed: 05/16/2023]
Abstract
Objectives The objective was to assess the accuracy of orthognathic surgical planning using three-dimensional virtual planning compared with conventional two-dimensional planning. Material and Methods MEDLINE (PubMed), Embase and Cochrane Library search combined with hand-search of relevant journals was conducted to identify randomized controlled trials (RCTs) published in English through August 2nd, 2022. Primary outcomes included postsurgical accuracy of hard and soft tissue. Secondary outcomes included treatment planning time, intraoperative time, intraoperative blood loss, complications, financial expenses, and patient-reported outcome measures (PROMs). Quality and risk-of-bias assessment were evaluated by Cochrane risk of bias tool and GRADE system. Results Seven RCTs characterised by low, high, and unclear risk of bias fulfilled inclusion criteria. Included studies disclosed conflicting results regarding accuracy of hard and soft tissue as well as treatment planning time. The intraoperative time was shortened, and financial expenses were increased with three-dimensional virtual surgical planning (TVSP), while no planning-related complications were revealed. Comparable improvement in PROMs were reported with TVSP and two-dimensional planning. Conclusions Future orthognathic surgical planning will indisputable be performed by three-dimensional virtual planning. The financial expenses, treatment planning time, and intraoperative time will therefore probably decrease due to further development of three-dimensional virtual planning techniques. The hard and soft tissue accuracy between planned position and achieved surgical outcome seems to be improved by three-dimensional virtual planning compared with two-dimensional planning, although results are inconsistent. Further development of three-dimensional virtual planning involving cutting guides and patient-specific osteosynthesis plates are therefore needed to improve the accuracy of orthognathic surgical planning.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
| | - Federico Hernández-Alfaro
- Institute of Maxillofacial Surgery, Teknon Medical Centre Barcelona, BarcelonaSpain
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, BarcelonaSpain
| | - Özlem Kesmez
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
| | - Romario Gorgis
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, AarhusDenmark
| | - Adaia Valls-Ontañón
- Institute of Maxillofacial Surgery, Teknon Medical Centre Barcelona, BarcelonaSpain
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, BarcelonaSpain
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Computer-aided Surgical Planning and Osteosynthesis Plates for Bimaxillary Orthognathic Surgery: A Study of 14 Consecutive Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4609. [DOI: 10.1097/gox.0000000000004609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 08/17/2022] [Indexed: 11/19/2022]
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12
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Seo HJ, Choi YK. Current trends in orthognathic surgery. Arch Craniofac Surg 2022; 22:287-295. [PMID: 34974683 PMCID: PMC8721433 DOI: 10.7181/acfs.2021.00598] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/20/2022] Open
Abstract
Orthognathic surgery has steadily evolved, gradually expanding its scope of application beyond its original purpose of simply correcting malocclusion and the facial profile. For instance, it is now used to treat obstructive sleep apnea and to achieve purely cosmetic outcomes. Recent developments in three-dimensional digital technology are being utilized throughout the entire process of orthognathic surgery, from establishing a surgical plan to printing the surgical splint. These processes have made it possible to perform more sophisticated surgery. The goal of this review article is to introduce current trends in the field of orthognathic surgery and controversies that are under active discussion. The role of a plastic surgeon is not limited to performing orthognathic surgery itself, but also encompasses deep involvement throughout the entire process, including the set-up of surgical occlusion and overall surgical planning. The authors summarize various aspects in the field of orthognathic surgery with the hope of providing helpful information both for plastic surgeons and orthodontists who are interested in orthognathic surgery.
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Affiliation(s)
- Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Youn-Kyung Choi
- Department of Orthodontics, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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13
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Jones JP, Amarista FJ, Jeske NA, Szalay D, Ellis E. Comparison of the Accuracy of Maxillary Positioning with Interim Splints versus Patient Specific Guides and Plates in Executing a Virtual Bimaxillary Surgical Plan. J Oral Maxillofac Surg 2022; 80:827-837. [DOI: 10.1016/j.joms.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 11/25/2022]
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Surgical Accuracy of Positioning the Maxilla in Patients With Skeletal Class II Malocclusion Using Computer-Aided Design and Computer-Aided Manufacturing-Assisted Orthognathic Surgery. J Craniofac Surg 2021; 33:1479-1483. [PMID: 34907951 DOI: 10.1097/scs.0000000000008407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the surgical accuracy of positioning the maxilla in patients with skeletal class II malocclusion using computer-aided design and computer-aided manufacturing (CAD/CAM)-assisted orthognathic surgery. MATERIALS AND METHODS The samples consisted of 10 patients with skeletal class II malocclusion, whose cone-beam computed tomographys taken before and immediately after surgery were available and who underwent bimaxillary orthognathic surgery by a single surgeon using Le Fort I osteotomy and bilateral sagittal split ramus osteotomy at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, South Korea between January 2018 and December 2019. After virtual surgical planning was performed using the FACEGIDE system (Korea), surgical cutting guides, intermediate splints, and custom-made titanium mini-plates were fabricated using CAD/CAM technique. Using 8 landmarks (anterior nasal spine, point A, #16, #13, contact point between #11 and #21, #23, #26, posterior nasal spine), the mean differences between the virtually planned (Virtual) and actual postsurgical position of the maxilla (Actual) in the three-dimensional coordinates (ΔActual-Virtual) and their mean absolute deviations were investigated. RESULTS The mean differences of 8 landmarks were 0.42 mm left side movement in the transverse coordinate, 0.15 mm forward movement in the sagittal coordinate and 0.10 mm downward movement in the vertical coordinate. Their mean absolute deviations were 0.98, 0.67, and 0.62 mm in the sagittal, vertical, and transverse coordinates, respectively. CONCLUSIONS Since the mean difference was less than 0.5 mm and the range of error was less than 1.0 mm, CAD/CAM-assisted orthognathic surgery might have a high degree of surgical accuracy and clinical relevance in the positioning of the maxilla.
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Chen C, Sun N, Jiang C, Liu Y, Sun J. Accurate transfer of bimaxillary orthognathic surgical plans using computer-aided intraoperative navigation. Korean J Orthod 2021; 51:321-328. [PMID: 34556586 PMCID: PMC8461385 DOI: 10.4041/kjod.2021.51.5.321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
Objective To examine the accuracy of computer-aided intraoperative navigation (Ci-Navi) in bimaxillary orthognathic surgery by comparing preoperative planning and postoperative outcome. Methods The study comprised 45 patients with congenital dentomaxillofacial deformities who were scheduled to undergo bimaxillary orthognathic surgery. Virtual bimaxillary orthognathic surgery was simulated using Mimics software. Intraoperatively, a Le Fort I osteotomy of the maxilla was performed using osteotomy guide plates. After the Le Fort I osteotomy and bilateral sagittal split ramus osteotomy of the mandible, the mobilized maxilla and the distal mandibular segment were fixed using an occlusal splint, forming the maxillomandibular complex (MMC). Realtime Ci-Navi was used to lead the MMC in the designated direction. Osteoplasty of the inferior border of the mandible was performed using Ci-Navi when facial symmetry and skeletal harmony were of concern. Linear and angular distinctions between preoperative planning and postoperative outcomes were calculated. Results The mean linear difference was 0.79 mm (maxilla: 0.62 mm, mandible: 0.88 mm) and the overall mean angular difference was 1.20°. The observed difference in the upper incisor point to the Frankfort horizontal plane, midfacial sagittal plane, and coronal plane was < 1 mm in 40 cases. Conclusions This study demonstrates the role of Ci-Navi in the accurate positioning of bone segments during bimaxillary orthognathic surgery. Ci-Navi was found to be a reliable method for the accurate transfer of the surgical plan during an operation.
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Affiliation(s)
- Chen Chen
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ningning Sun
- Department of Emergency Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chunmiao Jiang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yanshan Liu
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jian Sun
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Department of Emergency Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Randomized Controlled Clinical Trial to Assess the Utility of Computer-Aided Intraoperative Navigation in Bimaxillary Orthognathic Surgery. J Craniofac Surg 2021; 32:2205-2209. [PMID: 33538444 DOI: 10.1097/scs.0000000000007512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Accurate application of the preoperative surgical plan in actual surgical settings is of paramount importance in orthognathic surgery. This randomized controlled clinical trial aimed to evaluate the accuracy of computer-aided intraoperative navigation (Ci-Navi) compared with that of conventional navigation methods in bimaxillary orthognathic surgery. Fifty-two patients were randomly divided into 2 groups. Group A (n = 26) patients underwent surgery assisted with Ci-Navi and group B (n = 26) patients underwent surgery assisted with conventional intraoperative navigation methods. During the operation, after LeFort I osteotomy, the mobile maxilla was repositioned to the designated position either using assistance from real-time Ci-Navi (group A) or using an intermediate splint (group B). Intra- and intergroup linear and angular differences between preoperative planning and postoperative outcomes were calculated. In group A, the overall mean linear difference was 0.79 mm (0.62 mm for the maxilla and 0.88 mm for the mandible) and the overall mean angular difference was 1.20°. In 23 cases, the difference from the upper incisor point to the Frankfort horizontal plane, midfacial sagittal plane, and coronal plane was less than 1 mm. In group B, the overall mean linear difference was 1.98 mm (1.76 mm for the maxilla and 2.02 mm for the mandible) and the overall mean angular difference was 2.08°. The difference from the upper incisor point to the Frankfort horizontal plane, midfacial sagittal plane, and coronal plane was less than 1 mm in 15 cases. This study demonstrates the utility of Ci-Navi is superior to the conventional methods in aiding the accurate repositioning of bony segments in bimaxillary orthognathic surgery.
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Kim CS, Lee H. Comparison of actual amount of movement with surgical treatment objective in the orthognathic maxillary repositioning. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:e85-e89. [PMID: 34507005 DOI: 10.1016/j.jormas.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the postoperative position of the maxilla with the surgical treatment objectives (STO) in bimaxillary orthognathic surgery for evaluating the surgical accuracy and investigating the pattern and cause of the discrepancy. METHODS Patients undergoing conventional bimaxillary orthognathic surgery by a single oral and maxillofacial surgeon were enrolled. Utilizing the superimposition of preoperative and postoperative computed tomography images, the actual amounts of positional change of both the maxillary central incisor and first molars were compared with those of STO. All the patients were divided into two groups according to the actual discrepancy between STO and the postoperative position and factors that may affect surgical accuracy were analyzed. RESULTS In 62 cases, the absolute mean value of the positional difference between STO and the actual outcome was 2.20 mm (X-axis, 0.93 mm; Y-axis, 1.31 mm; and Z-axis, 1.09 mm) in the maxillary central incisor. The signed mean value of the central incisor was -0.07 mm, 0.79 mm, and -0.57 mm in the X-, Y-, and Z-axes, respectively, and the value in the Y- and Z-axes showed a statistically significant difference in comparison with STO (P<0.01). Age, sex, skeletal Angle classification, maxillary and mandibular profile, use of 3D virtual surgery, facial asymmetry, and yawing correction did not show a statistically significant correlation with surgical accuracy at the central incisor. CONCLUSION There was an acceptable range of discrepancy between postoperative maxillary position and STO after orthognathic surgery; however, there was a tendency for posterior and downward movement in the maxillary anterior teeth.
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Affiliation(s)
- Chang-Su Kim
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul Metropolitan government - Seoul National University Boramae Medical Center
| | - Ho Lee
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul Metropolitan government - Seoul National University Boramae Medical Center.
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Quantitative Asymmetry Assessment between Virtual and Mixed Reality Planning for Orthognathic Surgery—A Retrospective Study. Symmetry (Basel) 2021. [DOI: 10.3390/sym13091614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Orthognathic surgical planning compromises three clinical needs: occlusal balancing, symmetry, and harmony, which may result in multiple outcomes. Facial symmetry is the ultimate goal for patients and practitioners. Pure virtual planning and mixed reality planning were two innovative technologies in clinical practices compared to conventional model surgery used for decades. We proposed quantitative asymmetry assessment methods in both mandibular contour (in 2D) and a midface and mandible relationship in 3D. A computerized optimal symmetry plane, being the median plane, was applied in both planning methods. In the 3D asymmetry assessment between two planning methods, the deviation angle and deviation distance between midface and mandible were within 2° and 1.5 mm, respectively. There was no significant difference, except the symmetry index of the anterior deviation angle between the virtual and mixed reality planning in the 3D asymmetry assessment. In the mandible contour assessment, there was no significant difference between the virtual and mixed reality planning in asymmetry assessment in the frontal and frontal downward inclined views. Quantitative outcomes in 3D asymmetry indices showed that mixed reality planning was slightly more symmetric than virtual planning, with the opposite in 2D contouring.
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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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Heifetz-Li JJ, Mechas N, Deitrick P. How accurate are patient-specific osteotomy guides and fixation plates in orthognathic surgery? ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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21
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Grillo R. Orthognathic Surgery: A Bibliometric Analysis of the Top 100 Cited Articles. J Oral Maxillofac Surg 2021; 79:2339-2349. [PMID: 34245705 DOI: 10.1016/j.joms.2021.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/19/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE An increasing number of articles on orthognathic surgery are published every year. This paper aims to provide a list of the top 100 cited articles on orthognathic surgery to help any professional level with interest in this topic and to map the trends of orthognathic surgery publications over time. METHODS A bibliographic search (retrospective study) following STROBE guidelines was performed on Google Scholar (GS) and Dimensions with the term "orthognathic surgery" in the title, abstract, and keywords. The number of citations, citations per year, authors, and publication year were evaluated. A ranking was created in GS citations order with the top 100 cited articles and variables discussed individually. A graphical illustration of keywords was created using VOSviewer. These steps are fundamental in creating this list and relating it to all published articles on the topic. RESULTS A helpful list of the top 100 articles was developed to help professionals in entirely different manners. Virtual planning and complications in orthognathic surgery were the most cited topics, with a 95% confidence interval (P < .05). Some curiosities are discussed, such as increasing interest in surgery first and the relation between airway/obstructive sleep apnea and orthognathic surgery. CONCLUSIONS Bibliometric and altmetric analysis for free using Google Scholar and Dimensions is laborious but possible. Bibliometrics is a powerful tool to become actualized at any health professional level, from students to academics; and could save considerable effort and time for parties interested in the topic. Appropriate keywords are a crucial step to wider article dissemination.
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Affiliation(s)
- Ricardo Grillo
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Faculdade São Leopoldo Mandic, Campinas, Brazil.
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22
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Mascarenhas W, Makhoul N. Efficient in-house 3D printing of an orthognathic splint for single-jaw cases. Int J Oral Maxillofac Surg 2021; 50:1075-1077. [PMID: 33446444 DOI: 10.1016/j.ijom.2020.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/18/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
The purpose of this paper is to outline a simple and effective digital protocol for in-house 3D-printing of orthognathic splints for use during single-jaw orthognathic surgery. Using this protocol, an intraoral scanner, and virtual planning software, computer-designed splints were fabricated by a rapid prototyping machine in-house. The protocol was utilized for 35 consecutive patients requiring single-jaw orthognathic surgery between January 2019 and March 2020. The total time from initial scan to splint fabrication for each case was between 5 and 9hours, including 3minutes for scanning of models, 4.5minutes for development of the splint, and 4-8hours for rapid prototyping and post-processing. This time varied based on the complexity of the design and the number of splints printed simultaneously. The average cost of raw materials for each splint was $0.73 Canadian dollars.
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Affiliation(s)
- W Mascarenhas
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, McGill University, Montreal, Québec, Canada.
| | - N Makhoul
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, McGill University, Montreal, Québec, Canada; Department of Dentistry and Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Québec, Canada
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23
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New protocol for in-house management of computer assisted orthognathic surgery. Br J Oral Maxillofac Surg 2020; 58:e265-e271. [DOI: 10.1016/j.bjoms.2020.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 07/16/2020] [Indexed: 11/17/2022]
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Monteiro Carneiro NC, Oliveira DV, Real FH, Karla da Silva Tabosa A, Carneiro Júnior JT. A new model of customized maxillary guide for orthognathic surgery: Precision analysis. J Craniomaxillofac Surg 2020; 48:1119-1125. [PMID: 33288374 DOI: 10.1016/j.jcms.2020.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 08/17/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the surgical accuracy of a new Maxillary Bone-Dental-Supported guide (MBDS) for osteotomy and maxillary positioning in orthognathic surgeries. MATERIALS AND METHODS The customized MBDS were prototyped through CAD-CAM technology (computer-aided design and manufacturing). The planning image (CT0) was superimposed on the computed tomography scan post-treatment (CT1) and the mean of positional differences between them were obtained tridimensionally at the axes: mediolateral (X), anteroposterior (Y) and vertical (Z). RESULTS Eleven patients were selected according to the inclusion and exclusion criteria. The mediolateral movement showed the best precision, with a greater mean difference of 0.34 mm at the CI point (central incisor) and less than 0.02 mm at the RM point (right molar). In the vertical direction, the largest mean discrepancy found was 0.50 mm and on the y-axis, anteroposterior, was 0.74 mm, as well as two at the CI point. The skeletal SNA point, on the other hand, showed the smallest average discrepancies: 0.10 mm (x-axis), 0.03 mm (y-axis) and 0 mm (z-axis). Overall, 99.24% of the discrepancies found were less than 2 mm. CONCLUSION Our results suggests that the double support, osseous and dental, present in that new guide, favored the positional stability of the maxilla and promoted better control of its vertical axis. Furthermore, the function of an osteotomy guide increases the predictability and security of the surgical procedure.
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Affiliation(s)
- Nayara Cristina Monteiro Carneiro
- Oral and Maxillofacial Surgery - João de Barros Barreto University Hospital, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil; Msc and PhD Student in Oral and Maxillofacial Surgery - Federal University of Pará, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil.
| | - Douglas Voss Oliveira
- Oral and Maxillofacial Surgery - Brazilian Dental Association, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil; Msc and PhD Student in Oral and Maxillofacial Surgery - Federal University of Pará, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil.
| | - Flávio Henrique Real
- Oral and Maxillofacial Surgery - Getúlio Vargas Hospital, Recife, Brazil; Msc in Oral and Maxillofacial Surgery - Federal University of Pará, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil.
| | - Ana Karla da Silva Tabosa
- Oral and Maxillofacial Surgery - Brazilian Dental Association, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil; Master Student in Oral and Maxillofacial Surgery - Federal University of Pará, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil.
| | - José Thiers Carneiro Júnior
- PhD in Neurosciences and Cell Biology - Federal University of Pará, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil; Oral and Maxillofacial Surgery, Irmandade da Santa Casa de Misericórdia Hospital, São Paulo, Brazil.
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Chen H, Bi R, Hu Z, Chen J, Jiang N, Wu G, Li Y, Luo E, Zhu S. Comparison of three different types of splints and templates for maxilla repositioning in bimaxillary orthognathic surgery: a randomized controlled trial. Int J Oral Maxillofac Surg 2020; 50:635-642. [PMID: 33131986 DOI: 10.1016/j.ijom.2020.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/02/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023]
Abstract
The selection and implementation of a plan for maxillary surgery is of the utmost importance in achieving the desired outcome for the patient undergoing two-jaw orthognathic surgery. Some splint-based and splintless methods, accompanied by computer-assisted techniques, are helpful in improving surgical plan implementation. However, randomized controlled trials focused on this procedure are lacking. This study included 61 patients who underwent bimaxillary surgeries. The patients were randomly assigned to a conventional resin occlusal splint (CROS) group, a digital occlusal splint (DOS) group, or a digital templates (DT) group, in a 1:1:1 ratio. The mean linear distance between the planned and actual postoperative positions of eight selected points on the surfaces of the maxillary teeth was selected as the outcome measure. The distance was significantly smaller in the DT group (1.17±0.66mm) when compared to both the CROS group (2.55±0.95mm, P<0.05) and DOS group (2.15±1.12mm, P<0.05). However, the difference between the CROS group and DOS group was not statistically significant. These findings indicate that using digital templates results in the best performance in transferring the surgical plan to the operation environment as compared to the other two types of splints. This suggests that the application of digital templates could provide a reliable treatment option.
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Affiliation(s)
- H Chen
- Department of Orthognathic and TMJ Surgery, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - R Bi
- Department of Orthognathic and TMJ Surgery, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Z Hu
- Orthodontic Department, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - J Chen
- Orthodontic Department, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - N Jiang
- Department of Orthognathic and TMJ Surgery, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - G Wu
- Department of Plastic and Aesthetic Surgery, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Y Li
- Department of Orthognathic and TMJ Surgery, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - E Luo
- Department of Orthognathic and TMJ Surgery, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - S Zhu
- Department of Orthognathic and TMJ Surgery, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Computer-Aided Design and Manufacturing Cutting and Drilling Guides with Prebent Titanium Plates Improve Surgical Accuracy of Skeletal Class III Malocclusion. Plast Reconstr Surg 2020; 145:963e-974e. [PMID: 32332545 DOI: 10.1097/prs.0000000000006794] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the effects of the use of computer-aided design and manufacturing cutting and drilling guides with prebent titanium plates for the correction of skeletal class III malocclusion. METHODS In this prospective, randomized, controlled clinical trial, 46 patients with skeletal class III malocclusion were randomly assigned into two groups. The patients underwent bimaxillary surgery with computer-aided design and manufacturing cutting and drilling guides with prebent titanium plates (experimental group) or computer-aided design and manufacturing splints (control group). Preoperative and postoperative imaging data were collected and then analyzed using Mimics Research 19.0, Geomagic Studio, and IBM SPSS Version 21.0. RESULTS Deformity evaluation and posttreatment assessment were performed for all patients. The experimental group had fewer postoperative complications. Comparison of the linear and angular differences to facial reference planes revealed more accurate repositioning of the mandible and condyles in the experimental group, although the position of several landmarks still requires small adjustments. CONCLUSION Computer-aided design and manufacturing cutting and drilling guides with prebent titanium plates effectively corrected skeletal class III malocclusion, providing positional control of segments with reasonable surgical accuracy. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Does a learning curve exist for accuracy in three-dimensional planning for maxillary positioning in bimaxillary orthognathic surgery? Int J Oral Maxillofac Surg 2020; 49:787-793. [DOI: 10.1016/j.ijom.2019.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/26/2019] [Accepted: 10/04/2019] [Indexed: 11/24/2022]
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28
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Xu R, Ye N, Zhu S, Shi B, Li J, Lai W. Comparison of the postoperative and follow-up accuracy of articulator model surgery and virtual surgical planning in skeletal class III patients. Br J Oral Maxillofac Surg 2020; 58:933-939. [PMID: 32446591 DOI: 10.1016/j.bjoms.2020.04.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 04/23/2020] [Indexed: 02/08/2023]
Abstract
The aim of this study was to evaluate the postoperative and follow-up accuracy of using an intermediate occlusal splint between articulator model surgery (AMS) and virtual surgical planning (VSP) in double-jaw operations. Thirty skeletal class III patients were randomly allocated to have AMS or VSP. In the AMS group surgical planning was done through conventional articulator model surgery, and an intermediate occlusal splint made of acrylic resin was used. In the VSP group the surgical simulation was done virtually, and the same intermediate splint was used in the software and then fabricated using rapid prototyping technology. Preoperatively, one week postoperatively, and 1∼2-years later we obtained follow-up cone-beam computed tomographic (CT) images of each patient. Absolute linear differences between planned and actual outcomes, as well as planned and follow-up outcomes, were evaluated. There was no significant difference in either postoperative accuracy or follow-up accuracy between the methods, and there was no significant difference in the rate of skeletal relapse. Planning transfer by intermediate splint might therefore be the dominant factor in the final inaccuracies. The potentially greater accuracy of VSP may be realised with the help of new positioning devices instead of an intermediate splint.
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Affiliation(s)
- R Xu
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, 14 Ren Min Nan Road, Chengdu, 610041, PR China; State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, 14 Ren Min Nan Road, Chengdu, 610041, PR China
| | - N Ye
- Department of Orthodontics, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Road, Shanghai, PR China
| | - S Zhu
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, 14 Ren Min Nan Road, Chengdu, 610041, PR China
| | - B Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, 14 Ren Min Nan Road, Chengdu, 610041, PR China
| | - J Li
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, 14 Ren Min Nan Road, Chengdu, 610041, PR China.
| | - W Lai
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, 14 Ren Min Nan Road, Chengdu, 610041, PR China.
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Liu K, Sun H, Zhang L, Li B, Chakraborty S, Wang X. Do patient-specific cutting guides and plates improve the accuracy of maxillary repositioning in hemifacial microsomia? Br J Oral Maxillofac Surg 2020; 58:590-596. [PMID: 32156446 DOI: 10.1016/j.bjoms.2020.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 02/25/2020] [Indexed: 11/25/2022]
Abstract
The aim of this retrospective study was to use computer-aided design and manufacturing (CAD/CAM) patient-specific plates and cutting guides for the waferless positioning and fixation of the maxilla after bimaxillary osteotomies in cases of hemifacial microsomia with condylar dysplasia or absence of the temporomandibular joint (TMJ), and to compare the results with the CAD/CAM fabricated surgical wafer by 3-dimensional analysis. Eighteen patients were selected from the hospital database, preoperative surgical planning and simulation were done on 3-dimensional computed tomographic models for all patients, and they were divided into Group I - in which CAD/CAM patient-specific cutting guides and plates were used; and Group II - in which CAD/CAM fabricated surgical wafers were used. Finally, the outcome was evaluated by comparing planned with postoperative outcomes. The largest discrepancies of the Le Fort I segment were 0.50 (0.18) mm in the anteroposterior direction and 0.82 (0.60)° in the yaw orientation with Group I. The largest discrepancies of the Le Fort I segment were 1.32 (1.40) mm in superioinferior direction and 8.48 (7.73)° in the yaw orientation with Group II. The CAD/CAM patient-specific cutting guides and plates proved to be reliable and have great value in improving the accuracy in repositioning the Le Fort I segment and in the efficacy of orthognathic treatment of hemifacial microsomia with condylar dysplasia or no TMJ. The CAD/CAM patient-specific cutting guides and plates are therefore a useful alternative to the wafer technique.
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Affiliation(s)
- K Liu
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology,National Clinical Research Center for Oral Diseases, Shanghai, China
| | - H Sun
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology,National Clinical Research Center for Oral Diseases, Shanghai, China
| | - L Zhang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology,National Clinical Research Center for Oral Diseases, Shanghai, China
| | - B Li
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology,National Clinical Research Center for Oral Diseases, Shanghai, China
| | | | - X Wang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology,National Clinical Research Center for Oral Diseases, Shanghai, China.
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Accuracy of mandible-independent maxillary repositioning using pre-bent locking plates: a pilot study. Int J Oral Maxillofac Surg 2019; 49:901-907. [PMID: 31889580 DOI: 10.1016/j.ijom.2019.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/29/2019] [Accepted: 11/29/2019] [Indexed: 11/21/2022]
Abstract
The double splint method is considered the gold standard for maxillary repositioning, but the procedure is lengthy and prone to error. Recent splintless methods have shown high repositioning accuracy; however, high costs and technical demands make them inaccessible to many patients. Therefore, a new cost-effective method of mandible-independent maxillary repositioning using pre-bent locking plates is proposed. Plates are bent on maxillary models in the planned position prior to surgery. The locations of the plate holes are replicated during surgery using osteotomy guides made from thermoplastic resin sheets. Pre-bent plates are subsequently fitted onto the maxilla, and plate holes are properly set to reposition the maxilla. The purpose of this study was to evaluate the accuracy of this method for maxillary repositioning and the reproducibility of the plate holes. Fifteen orthognathic surgery patients were evaluated retrospectively by superimposing preoperative simulations over their postoperative computed tomography models. The median deviations in maxillary repositioning and plate hole positioning between the preoperative plan and postoperative results were 0.43mm (range 0-1.55mm) and 0.33mm (range 0-1.86mm), respectively. There was no significant correlation between these deviations, suggesting that the method presented here allows highly accurate and reliable mandible-independent maxillary repositioning.
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Almeida MDG, Nassar MSP, Bataglion CAN, De Mello Filho FV, Terreri AL, Bataglion C. Comparison reproducibility between the facebow and a new technique based on a spirit level device. Cranio 2019; 39:344-350. [PMID: 31433268 DOI: 10.1080/08869634.2019.1650214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: This study aimed to introduce a spirit level device for mounting maxillary casts to compare the reproducibility between the facebow and this new technique.Methods: The maxillary casts of 10 participants were mounted in three different situations: 1) with the facebow; 2) with the spirit level device, the participant in seated position; and 3) with the spirit level device with participant in standing position. Each procedure was performed by three different evaluators. The values obtained were calculated using the Technical Error of Measurement (TEM) and the inter-evaluator Coefficient of Variation (CV).Results: The mean values obtained were 4.3 mm, 2.2 mm, and 2.6 mm for absolute TEM; 8.7%, 5.4%, and 6.4% for relative TEM; and 7.3%, 4.5%, and 5.6% for CV.Conclusion: These results show that the facebow is less reproducible compared to the new device, demonstrating that the new technique can be satisfactorily used in clinical practice.
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Affiliation(s)
- Marina De Godoy Almeida
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | | | - Francisco Veríssimo De Mello Filho
- Department of Ophthalmology, Otolaryngology-Head and Neck Surgery, Clinical Hospital of Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Alexandre Laguna Terreri
- Department of Ophthalmology, Otolaryngology-Head and Neck Surgery, Clinical Hospital of Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - César Bataglion
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
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Lartizien R, Zaccaria I, Noyelles L, Bettega G. Quantification of the inaccuracy of conventional articulator model surgery in Le Fort 1 osteotomy: evaluation of 30 patients controlled by the Orthopilot ® navigation system. Br J Oral Maxillofac Surg 2019; 57:672-677. [PMID: 31256987 DOI: 10.1016/j.bjoms.2019.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
Occlusal splints are commonly used to position the maxilla during traditional orthognathic surgery. We aimed to quantify the inaccuracy of the maxillary positioning (in three dimensions) in traditional model surgery with the Orthopilot® navigation system. Thirty Le Fort I osteotomies were made using a standard technique. The position of the maxilla was recorded by the navigation system and defined by three values of translation and three of rotation. The recorded data were compared with the planned data. The accuracy of positioning was classified in distinct classes with three major criteria (conformity, non-conformity, and failure) according to the discrepancy. The positioning of the maxilla was in conformity with operative planning in 3/30 of our Le Fort I osteotomies (95% CI 2% to 27%) and in failure in 22/30 (95% CI 54% to 88%). The dispersion of the discrepancy was more important in the sagittal plane, particularly for the sagittal rotation and for the back-front translation, which reflected greater inaccuracy in this plan. The frontal orientation of the maxilla was better controlled. The risk of maxillary malposition was proportional to the planned maxillary advancement.
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Affiliation(s)
- R Lartizien
- Maxillofacial surgery department, Annecy Genevois Hospital, 1 avenue de l'hôpital, 74370, Epagny Metz-Tessy, France; Université Grenoble Alpes, Medicine Faculty, 23 Avenue Maquis du Grésivaudan, 38700, La Tronche, France.
| | - I Zaccaria
- Clinical research department, Annecy Genevois Hospital, 1 avenue de l'hôpital, 74370, Epagny Metz-Tessy, France
| | - L Noyelles
- Maxillofacial surgery department, Annecy Genevois Hospital, 1 avenue de l'hôpital, 74370, Epagny Metz-Tessy, France
| | - G Bettega
- Maxillofacial surgery department, Annecy Genevois Hospital, 1 avenue de l'hôpital, 74370, Epagny Metz-Tessy, France
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Mulier D, Shaheen E, Shujaat S, Fieuws S, Jacobs R, Politis C. How accurate is digital-assisted Le Fort I maxillary osteotomy? A three-dimensional perspective. Int J Oral Maxillofac Surg 2019; 49:69-74. [PMID: 31266680 DOI: 10.1016/j.ijom.2019.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/28/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study was to evaluate the surgical accuracy of Le Fort I surgery compared to the three-dimensional (3D) virtual planning. Fifty-five patients (29 males, 26 females; age range 15-58 years) with skeletal class III malocclusion, who underwent bimaxillary surgery were included. A validated 3D accuracy assessment tool was utilized to assess the surgical accuracy of the maxillary positioning. For translational movements, the least amount of error was associated with mediolateral translation, whereas the surgical accuracy for anteroposterior and superoinferior translation showed a tendency towards a more posterior and inferior positioning of the maxilla compared to the planning. For rotational movements, the highest discrepancy was observed for pitch. Linear regression showed increased inaccuracy with increasing advancement for anteroposterior, superoinferior and pitch movements. To conclude, 3D virtual planning of maxilla was generally accurate when compared to achieved outcome for skeletal class III patients undergoing bimaxillary surgery.
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Affiliation(s)
- D Mulier
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - E Shaheen
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - S Shujaat
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - S Fieuws
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven-University of Leuven, Leuven, Belgium
| | - R Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - C Politis
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Rückschloß T, Ristow O, Müller M, Kühle R, Zingler S, Engel M, Hoffmann J, Freudlsperger C. Accuracy of patient-specific implants and additive-manufactured surgical splints in orthognathic surgery — A three-dimensional retrospective study. J Craniomaxillofac Surg 2019; 47:847-853. [DOI: 10.1016/j.jcms.2019.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/22/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022] Open
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Ho CT, Lin HH, Lo LJ. Intraoral Scanning and Setting Up the Digital Final Occlusion in Three-Dimensional Planning of Orthognathic Surgery. Plast Reconstr Surg 2019; 143:1027e-1036e. [DOI: 10.1097/prs.0000000000005556] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Parente EV, Antonini F, Zanardi G, Pagnoncelli RM. Tridimensional virtual planning protocol for double-jaw orthognathic surgery with mandible first surgical sequence. Oral Maxillofac Surg 2019; 23:253-262. [PMID: 30874939 DOI: 10.1007/s10006-019-00751-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Affiliation(s)
| | - Fernando Antonini
- UNESC School of Dentistry, Criciúma, Brazil. .,PhD Student, OMFS Department, PUCRS School of Dentistry, Porto Alegre, Brazil.
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Traditional face-bow transfer versus three-dimensional virtual reconstruction in orthognathic surgery. Int J Oral Maxillofac Surg 2019; 48:347-354. [DOI: 10.1016/j.ijom.2018.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/30/2018] [Accepted: 09/03/2018] [Indexed: 11/17/2022]
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Ji H, Du W, Xu C, Zhao Q, Ye B, Luo E. Computer-assisted osteotomy guides and pre-bent titanium plates improve the planning for correction of facial asymmetry. Int J Oral Maxillofac Surg 2019; 48:1043-1050. [PMID: 30773336 DOI: 10.1016/j.ijom.2019.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/05/2018] [Accepted: 01/26/2019] [Indexed: 02/05/2023]
Abstract
This study investigated the surgical outcomes and accuracy of computer-assisted osteotomy guides and pre-bent titanium plates in the treatment of patients with facial asymmetry. Thirteen patients with facial asymmetry undergoing bimaxillary orthognathic surgery were included. Virtual simulation of Le Fort I osteotomy, sagittal split ramus osteotomy, and genioplasty, if needed, was conducted on the preoperative three-dimensional model. Computer-assisted osteotomy guides and pre-bent titanium plates were produced and used in the actual operation. The postoperative outcome was assessed for facial symmetry and surgical accuracy. All patients were followed up for at least 18 months and their level of satisfaction was investigated. Use of the computer-assisted osteotomy guides and pre-bent titanium plates was successful in all patients. Maxillary canting, mandibular ramus inclination, and mandibular length were corrected on both sides postoperatively. Superimposition of the surgical simulation and postoperative images demonstrated favourable accuracy. Quantitative analysis revealed a mean linear difference of <0.60mm in the maxilla and 1.57mm in the mandible. All patients were satisfied with the surgical outcome; there were no complications or cases of relapse during follow-up. The application of computer-assisted osteotomy guides and pre-bent titanium plates achieved favourable outcomes and accuracy, improving planning for the correction of facial asymmetry.
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Affiliation(s)
- H Ji
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - W Du
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - C Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Q Zhao
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - B Ye
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - E Luo
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Tomomatsu N, Kurohara K, Nakakuki K, Yoshitake H, Kanemaru T, Yamaguchi S, Yoda T. Influence of the anatomical form of the posterior maxilla on the reliability of superior maxillary repositioning by Le Fort I osteotomy. Int J Oral Maxillofac Surg 2018; 48:612-619. [PMID: 30503635 DOI: 10.1016/j.ijom.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/03/2018] [Accepted: 11/13/2018] [Indexed: 11/18/2022]
Abstract
Certain patients with facial deformities require superior repositioning of the maxilla via Le Fort I osteotomy; however, the magnitude of superior repositioning of the maxilla is often less than expected. In this study, the correlation between the accuracy of superior repositioning of the maxilla and the anatomical form of the maxillary posterior region was examined. Seventy-five patients who underwent Le Fort I osteotomy without forward movement of the maxilla but with superior repositioning of the maxilla were included in this study. The bone volume around the descending palatine artery (DPA), the angle of the junction between the pterygoid process and the tuberosity, and the distance between the upper second molar and the pterygoid process were measured via three-dimensional analysis. A significant negative correlation (r=-0.566) was found between the bone volume around the DPA and the ratio of repositioning (actual movement divided by expected movement). It is possible that the superior repositioning of the maxilla expected prior to surgery was not sufficiently attained because of the large volume of bone around the DPA. The results of this study show that in some patients, superior repositioning was not achieved at the expected level because of bone interference attributable to the anatomical form of the maxillary posterior region.
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Affiliation(s)
- N Tomomatsu
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Kurohara
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan; Department of Oral and Maxillofacial Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
| | - K Nakakuki
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - H Yoshitake
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Kanemaru
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - S Yamaguchi
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Yoda
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Sánta Z, Kato Z. Elastic Alignment of Triangular Surface Meshes. Int J Comput Vis 2018. [DOI: 10.1007/s11263-018-1084-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Govaerts D, Shaheen E, Coopman R, De Mol A, Sun Y, Politis C. Accuracy of Le Fort I osteotomy in bimaxillary splint-based orthognathic surgery: focus on posterior maxillary movements. Int J Oral Maxillofac Surg 2018; 47:1398-1404. [DOI: 10.1016/j.ijom.2018.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/27/2018] [Accepted: 05/04/2018] [Indexed: 11/28/2022]
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Accuracy in orthognathic surgery─comparison of preoperative plan and postoperative outcome using computer-assisted two-dimensional cephalometry by the Onyx Ceph ® system. J Craniomaxillofac Surg 2018; 46:1793-1799. [PMID: 30174205 DOI: 10.1016/j.jcms.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 06/11/2018] [Accepted: 07/13/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This retrospective study analyzes deviations between preoperative planning and postoperative outcome in orthognathic surgery using 2D Onyx Ceph®-cephalometric analyzing and planning system. MATERIALS AND METHODS A total of 100 patients with a mean age 25.1 of years were included in this study. In 33 patients a bilateral sagittal split osteotomy and in seven patients a Le Fort I osteotomy was performed. A total of 60 patients were treated by a bimaxillary approach. Onyx Ceph® was used as cephalometric planning software (Onyx Ceph®), followed by mock operations. Postoperative cephalograms were obtained after 3.3 days and compared to preoperative planning cephalograms for sagittal (SNA, SNB, ANB) and vertical (ArGoMe, ML-NSL, NL-NSL) angle measurements. Real and absolute mean deviation were documented. RESULTS Absolute mean deviation (degrees) between postoperative and planned jaw movement was lower for the sagittal parameters SNA (0.58), SNB (1.15) and ANB (1.05) compared to the vertical parameters NL-NSL (1.47), ML-NSL (1.96) and ArGoMe (3.20). SNA, SNB and ANB showed constant deviations independent from the extent of jaw movement. With regard to the vertical parameters ML-NSL, ArGoMe and NL-NSL the extent of the postoperative rotational jaw movement was not as much as planned, particularly for vertical shifts of more than 4°. CONCLUSION By using the 2D Onyx Ceph® cephalometric software for orthognathic surgery, the deviations between planned and actual movements are within an acceptable and predictable range. Planning of extensive vertical alterations may result in greater deviations after surgery.
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Reaching the vertical versus horizontal target position in multi-segmental Le Fort I osteotomy is more difficult, but yields comparably stable results to one-segment osteotomy. Int J Oral Maxillofac Surg 2018; 47:456-464. [DOI: 10.1016/j.ijom.2017.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/09/2017] [Accepted: 10/09/2017] [Indexed: 11/24/2022]
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Tran NH, Tantidhnazet S, Raocharernporn S, Kiattavornchareon S, Pairuchvej V, Wongsirichat N. Accuracy of Three-Dimensional Planning in Surgery-First Orthognathic Surgery: Planning Versus Outcome. J Clin Med Res 2018; 10:429-436. [PMID: 29581806 PMCID: PMC5862091 DOI: 10.14740/jocmr3372w] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 02/20/2018] [Indexed: 11/11/2022] Open
Abstract
Background The benefit of computer-assisted planning in orthognathic surgery (OGS) has been extensively documented over the last decade. This study aimed to evaluate the accuracy of three-dimensional (3D) virtual planning in surgery-first OGS. Methods Fifteen patients with skeletal class III malocclusion who underwent bimaxillary OGS with surgery-first approach were included. A composite skull model was reconstructed using data from cone-beam computed tomography and stereolithography from a scanned dental cast. Surgical procedures were simulated using Simplant O&O software, and the virtual plan was transferred to the operation room using 3D-printed splints. Differences of the 3D measurements between the virtual plan and postoperative results were evaluated, and the accuracy was reported using root mean square deviation (RMSD) and the Bland-Altman method. Results The virtual planning was successfully transferred to surgery. The overall mean linear difference was 0.88 mm (0.79 mm for the maxilla and 1 mm for the mandible), and the overall mean angular difference was 1.16°. The RMSD ranged from 0.86 to 1.46 mm and 1.27° to 1.45°, within the acceptable clinical criteria. Conclusion In this study, virtual surgical planning and 3D-printed surgical splints facilitated the diagnosis and treatment planning, and offered an accurate outcome in surgery-first OGS.
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Affiliation(s)
- Ngoc Hieu Tran
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, 6 Yothi Street Rachathewee District, Bangkok 10400, Thailand
| | - Syrina Tantidhnazet
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, 6 Yothi Street Rachathewee District, Bangkok 10400, Thailand; Natthamet Wongsirichat, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, 6 Yothi Street Rachathewee District, Bangkok 10400, Thailand.
| | - Somchart Raocharernporn
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, 6 Yothi Street Rachathewee District, Bangkok 10400, Thailand
| | - Sirichai Kiattavornchareon
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, 6 Yothi Street Rachathewee District, Bangkok 10400, Thailand
| | - Verasak Pairuchvej
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, 6 Yothi Street Rachathewee District, Bangkok 10400, Thailand
| | - Natthamet Wongsirichat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, 6 Yothi Street Rachathewee District, Bangkok 10400, Thailand
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Accuracy of computer-assisted orthognathic surgery. J Craniomaxillofac Surg 2018; 46:293-298. [DOI: 10.1016/j.jcms.2017.11.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/25/2017] [Accepted: 11/24/2017] [Indexed: 11/22/2022] Open
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Cousley RRJ, Bainbridge M, Rossouw PE. The accuracy of maxillary positioning using digital model planning and 3D printed wafers in bimaxillary orthognathic surgery. J Orthod 2017; 44:256-267. [PMID: 28980512 DOI: 10.1080/14653125.2017.1383708] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Orthognathic wafers may be made using digital model movements and CAD-CAM technology. This paper analysed the accuracy of maxillary movements using this new process. DESIGN Retrospective study of pre and post-operative cephalograms. PARTICIPANTS Thirty consecutive orthognathic patients undergoing bimaxillary osteotomies in a UK hospital. METHODS Jaw movements were planned using cephalometric and Orthoanalyzer™ software. The resultant intermediate and final wafer occlusal relationships were used for wafer fabrication by 3D printing of the inter-occlusal space. Pre- and post-operative lateral cephalograms were compared in terms of maxillary antero-posterior and vertical movements. Statistical analyses including the paired t-test, two-sample t-test and Fisher's exact test. RESULTS Wide individual variation was observed between the planned and actual movements. Thirteen cases (43%) had a 2 mm discrepancy in at least one variable. Statistically significant differences between the planned and actual maxillary vertical movements were observed for the molar (U6y: p < 0.0001) and anterior maxillary (Ay: p < 0.01) differences. Analysis of a subgroup with primarily impaction movements demonstrated a statistically significant bias towards excessive maxillary advancement (U1x: p < 0.01) and incisor impaction (U1y: p < 0.01) in this group. CONCLUSIONS This new digital surgical wafer technique achieves a similar level of accuracy to the conventional facebow and model surgery process.
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Affiliation(s)
- Richard R J Cousley
- a Orthodontic Department , Peterborough and Stamford Hospitals NHS Foundation Trust , Peterborough , UK
| | - Mark Bainbridge
- a Orthodontic Department , Peterborough and Stamford Hospitals NHS Foundation Trust , Peterborough , UK
| | - P Emile Rossouw
- b Division of Orthodontics and Dentofacial Orthopedics , University of Rochester, Eastman Institute of Oral Health , Rochester , NY , USA
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Heufelder M, Wilde F, Pietzka S, Mascha F, Winter K, Schramm A, Rana M. Clinical accuracy of waferless maxillary positioning using customized surgical guides and patient specific osteosynthesis in bimaxillary orthognathic surgery. J Craniomaxillofac Surg 2017; 45:1578-1585. [DOI: 10.1016/j.jcms.2017.06.027] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/27/2017] [Accepted: 06/30/2017] [Indexed: 11/25/2022] Open
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Chin SJ, Wilde F, Neuhaus M, Schramm A, Gellrich NC, Rana M. Accuracy of virtual surgical planning of orthognathic surgery with aid of CAD/CAM fabricated surgical splint-A novel 3D analyzing algorithm. J Craniomaxillofac Surg 2017; 45:1962-1970. [PMID: 29066041 DOI: 10.1016/j.jcms.2017.07.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 05/31/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022] Open
Abstract
The benefit of computer-assisted planning in orthognathic surgery has been extensively documented over the last decade. This study aims to evaluate the accuracy of a virtual orthognathic surgical plan by a novel three dimensional (3D) analysis method. Ten patients who required orthognathic surgery were included in this study. A virtual surgical plan was achieved by the combination of a 3D skull model acquired from computed tomography (CT) and surface scanning of the upper and lower dental arch respectively and final occlusal position. Osteotomies and movement of maxilla and mandible were simulated by Dolphin Imaging 11.8 Premium® (Dolphin Imaging and Management Solutions, Chatsworth, CA). The surgical plan was transferred to surgical splints fabricated by means of Computer Aided Design/Computer Aided Manufacturing (CAD/CAM). Differences of three dimensional measurements between the virtual surgical plan and postoperative results were evaluated. The results from all parameters showed that the virtual surgical plans were successfully transferred by the assistance of CAD/CAM fabricated surgical splint. Wilcoxon's signed rank test showed that no statistically significant deviation between surgical plan and post-operational result could be detected. However, deviation of angle U1 axis-HP and distance of A-CP could not fulfill the clinical success criteria. Virtual surgical planning and CAD/CAM fabricated surgical splint are proven to facilitate treatment planning and offer an accurate surgical result in orthognathic surgery.
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Affiliation(s)
- Shih-Jan Chin
- Department of Craniomaxillofacial Surgery, Hannover Medical School, Germany
| | - Frank Wilde
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Military Hospital Ulm and Academic Hospital University, Ulm, Germany
| | - Michael Neuhaus
- Department of Craniomaxillofacial Surgery, Hannover Medical School, Germany
| | - Alexander Schramm
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Military Hospital Ulm and Academic Hospital University, Ulm, Germany
| | | | - Majeed Rana
- Department of Craniomaxillofacial Surgery, Hannover Medical School, Germany.
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49
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Azarmehr I, Stokbro K, Bell RB, Thygesen T. Surgical Navigation: A Systematic Review of Indications, Treatments, and Outcomes in Oral and Maxillofacial Surgery. J Oral Maxillofac Surg 2017; 75:1987-2005. [PMID: 28193444 DOI: 10.1016/j.joms.2017.01.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/26/2016] [Accepted: 01/09/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE This systematic review investigates the most common indications, treatments, and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years, and therapeutic indications are discussed. MATERIALS AND METHODS A systematic search in relevant electronic databases, journals, and bibliographies of the included articles was carried out. Clinical studies with 5 or more patients published between 2010 and 2015 were included. Traumatology, orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign body removal were the areas of interests. RESULTS The search generated 13 articles dealing with traumatology; 5, 6, 2, and 0 studies were found that dealt with the topics of orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign body removal, respectively. The average technical system accuracy and intraoperative precision reported were less than 1 mm and 1 to 2 mm, respectively. In general, SN is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients were identified in the field of traumatology. Treatment of complex orbital fractures was considerably improved by the use of SN compared with traditionally treated control groups. CONCLUSIONS SN seems to be a very promising addition to the surgical toolkit. Planning details of the surgical procedure in a 3-dimensional virtual environment and execution with real-time guidance can significantly improve precision. Among factors to be considered are the financial investments necessary and the learning curve.
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Affiliation(s)
- Iman Azarmehr
- Resident, Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark.
| | - Kasper Stokbro
- Resident, Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark
| | - R Bryan Bell
- Director, Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center; Attending Surgeon, Trauma Service, Legacy Emanuel Medical Center; and Consultant, Head and Neck Institute, Portland, OR
| | - Torben Thygesen
- Head of Department, Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark
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50
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Berger M, Nova I, Kallus S, Ristow O, Eisenmann U, Freudlsperger C, Seeberger R, Hoffmann J, Dickhaus H. Electromagnetic navigated positioning of the maxilla after Le Fort I osteotomy in preclinical orthognathic surgery cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:298-304. [PMID: 28049608 DOI: 10.1016/j.oooo.2016.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 09/19/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Inaccuracies in orthognathic surgery can be caused during face-bow registration, model surgery on plaster models, and intermaxillary splint manufacturing. Electromagnetic (EM) navigation is a promising method for splintless digitized maxillary positioning. STUDY DESIGN After performing Le Fort I osteotomy on 10 plastic skulls, the target position of the maxilla was guided by an EM navigation system. Specially implemented software illustrated the target position by real-time multistage colored three-dimensional imaging. Accuracy was determined by using pre- and postoperative cone beam computed tomography. RESULTS The high accuracy of the EM system was underlined by the fact that it had a navigated maxilla position discrepancy of only 0.4 mm, which was verified by postoperative cone beam computed tomography. CONCLUSIONS This preclinical study demonstrates a precise digitized approach for splintless maxillary repositioning after Le Fort I osteotomy. The accuracy and intuitive illustration of the introduced EM navigation system is promising for potential daily use in orthognathic surgery.
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Affiliation(s)
- Moritz Berger
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.
| | - Igor Nova
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Kallus
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Urs Eisenmann
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Robin Seeberger
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Hartmut Dickhaus
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
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