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Holte MB, Nielsen TW, Cattaneo PM, Pinholt EM. Stability of proximal mandibular anatomical structures following bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00100-0. [PMID: 38702201 DOI: 10.1016/j.ijom.2024.04.006] [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: 09/05/2023] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
The aim of this study was to investigate the stability of the proximal mandibular reference structures that have been proposed in the literature for superimposition. Forty proximal mandibular segments of 20 patients who underwent bilateral sagittal split osteotomy (BSSO) for advancement were reconstructed from a pair of pre- and postoperative (2 years) cone beam computed tomography scans, and spatially divided into the mandibular condyle, the coronoid process, and 20 mandibular ramus regions. To assess the stability of the anatomical regions, the volumetric and surface discrepancy between the superimposed pre- and postoperative regions were calculated. One-sample t-tests were applied to analyse the statistical stability of the individual regions. Two statistically stable (P < 0.05) structures in the proximal segment of the mandible following BSSO were identified: (1) the posterior part of the mandibular ramus above the gonial angle and below the condylar neck, and (2) the sub-coronoid area below the coronoid process/mandibular notch. Using these stable structures for superimposition resulted in an assessment discrepancy in the condylar displacement of up to 1.1 mm and in the volumetric change of up to 2.8%. Hence, it is suggested that these two identified stable structures are used as reference areas when assessing condylar displacement and change using superimposition.
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Affiliation(s)
- M B Holte
- 3D Lab Denmark, Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Esbjerg, Denmark
| | - T W Nielsen
- 3D Lab Denmark, Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Esbjerg, Denmark
| | - P M Cattaneo
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia
| | - E M Pinholt
- 3D Lab Denmark, Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Esbjerg, Denmark.
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Peng SP, Lin CH, Chen YA, Ko EWC. Three-dimensional facial soft-tissue changes after surgical orthodontics in different vertical facial types of skeletal Class III malocclusion: A retrospective study. J Craniomaxillofac Surg 2024; 52:522-531. [PMID: 38378366 DOI: 10.1016/j.jcms.2024.02.008] [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: 07/06/2023] [Revised: 11/17/2023] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Abstract
The study compared the soft-tissue response to hard-tissue movement among different Class III vertical facial types after orthognathic surgery (OGS). The study included 90 consecutive adult patients with skeletal Class III malocclusion who underwent two-jaw OGS. Patients were divided into three groups (high, medium, and low angle) based on the presurgical Frankfort-mandibular plane angle. Cone-beam computerized tomographs were taken before surgery and after debonding. Soft- and hard-tissue linear and angular measurements were performed using three-dimensional reconstruction images. One-way analysis of variance was used for intergroup comparisons. Soft tissue tended to respond more to hard-tissue movement in the lower lip area in patients with low angle (mean = 0.089, SD = 0.047, p = 0.023), whereas no significant difference was observed for other sites. Consistently, L1/Li thickness increased most significantly in the high-angle group (mean = 1.98, SD = 2.14, p = 0.0001), and B/Si thickness decreased most significantly after surgery (mean = 2.16, SD = 2.68, p = 0.016). The findings suggest that the high-angle group had a higher chance of undergoing genioplasty to enhance chin contour. Different OGS plans should be considered for different Class III vertical facial types.
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Affiliation(s)
- Shin-Pey Peng
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Craniofacial and Dental Science, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hui Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ying-An Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ellen Wen-Ching Ko
- Graduate Institute of Craniofacial and Dental Science, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan.
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Barone S, Cevidanes L, Miranda F, Gurgel ML, Anchling L, Hutin N, Bianchi J, Goncalves JR, Giudice A. Enhancing skeletal stability and Class III correction through active orthodontist engagement in virtual surgical planning: A voxel-based 3-dimensional analysis. Am J Orthod Dentofacial Orthop 2024; 165:321-331. [PMID: 38010236 PMCID: PMC10923113 DOI: 10.1016/j.ajodo.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Skeletal stability after bimaxillary surgical correction of Class III malocclusion was investigated through a qualitative and quantitative analysis of the maxilla and the distal and proximal mandibular segments using a 3-dimensional voxel-based superimposition among virtual surgical predictions performed by the orthodontist in close communication with the maxillofacial surgeon and 12-18 months postoperative outcomes. METHODS A comprehensive secondary data analysis was conducted on deidentified preoperative (1 month before surgery [T1]) and 12-18 months postoperative (midterm [T2]) cone-beam computed tomography scans, along with virtual surgical planning (VSP) data obtained by Dolphin Imaging software. The sample for the study consisted of 17 patients (mean age, 24.8 ± 3.5 years). Using 3D Slicer software, automated tools based on deep-learning approaches were used for cone-beam computed tomography orientation, registration, bone segmentation, and landmark identification. Colormaps were generated for qualitative analysis, whereas linear and angular differences between the planned (T1-VSP) and observed (T1-T2) outcomes were calculated for quantitative assessments. Statistical analysis was conducted with a significance level of α = 0.05. RESULTS The midterm surgical outcomes revealed a slight but significantly less maxillary advancement compared with the planned position (mean difference, 1.84 ± 1.50 mm; P = 0.004). The repositioning of the mandibular distal segment was stable, with insignificant differences in linear (T1-VSP, 1.01 ± 3.66 mm; T1-T2, 0.32 ± 4.17 mm) and angular (T1-VSP, 1.53° ± 1.60°; T1-T2, 1.54° ± 1.50°) displacements (P >0.05). The proximal segments exhibited lateral displacement within 1.5° for both the mandibular right and left ramus at T1-VSP and T1-T2 (P >0.05). CONCLUSIONS The analysis of fully digital planned and surgically repositioned maxilla and mandible revealed excellent precision. In the midterm surgical outcomes of maxillary advancement, a minor deviation from the planned anterior movement was observed.
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Affiliation(s)
- Selene Barone
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy.
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Felicia Miranda
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Marcela Lima Gurgel
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Luc Anchling
- Chemistry and Chemical Engineering School - Digital Sciences School Lyon, Lyon, France
| | - Nathan Hutin
- Chemistry and Chemical Engineering School - Digital Sciences School Lyon, Lyon, France
| | - Jonas Bianchi
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, Calif
| | - Joao Roberto Goncalves
- Department of Pediatric Dentistry, School of Dentist, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Amerigo Giudice
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Holte MB, Sæderup H, Pinholt EM. Comparison of surface- and voxel-based registration on the mandibular ramus for long-term three-dimensional assessment of condylar remodelling following orthognathic surgery. Dentomaxillofac Radiol 2022; 51:20210499. [PMID: 35143288 PMCID: PMC9499205 DOI: 10.1259/dmfr.20210499] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of the present study was to validate and compare the accuracy and reliability of surface- and voxel-based registration on the mandibular rami for long-term three-dimensional (3D) evaluation of condylar remodelling following Orthognathic Surgery. METHODS The mandible was 3D reconstructed from a pair of superimposed pre- and postoperative (two years) cone-beam computerized tomography scans and divided into the condyle, and 21 ramal regions. The accuracy of surface- and voxel-based registration was measured by the absolute mean surface distance of each region after alignment of the pre- and postoperative rami. To evaluate the reliability, mean absolute differences and intra class correlation coefficients (ICC) were calculated at a 95% confidence interval on volumetric and surface distance measurements of two observers. Paired t-tests were applied to statistically evaluate whether the accuracy and reliability of surface- and voxel-based registration were significantly different (p < 0.05). RESULTS A total of twenty subjects (sixteen female; four male; mean age 27.6 years) with class II malocclusion and maxillomandibular retrognathia, who underwent bimaxillary surgery, were included. Surface-based registration was more accurate and reliable than voxel-based registration on the mandibular ramus two years post-surgery (p < 0.05). The inter observer reliability of using surface-based registration was excellent, ICC range [0.82-1.00]. For voxel-based registration, the inter observer reliability ranged from poor to excellent [0.00-0.98]. The measurement error introduced by applying surface-based registration for assessment of condylar remodelling was considered clinical irrelevant (1.83% and 0.18 mm), while the measurement error introduced by voxel-based registration was considered clinical relevant (5.44% and 0.52 mm). CONCLUSIONS Surface-based registration was proven more accurate and reliable compared to voxel-based registration on the mandibular ramus for long-term 3D assessment of condylar remodelling following Orthognathic Surgery. However, importantly, the performance difference may be caused by an inappropriate reference structure, proposed in the literature, and applied in this study.
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Affiliation(s)
- Michael Boelstoft Holte
- Department of Oral and Maxillofacial Surgery & University of Southern Denmark, Faculty of Health Sciences, Department of Regional Health Research, University Hospital of Southern Denmark, Odense, Denmark
| | - Henrik Sæderup
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Odense, Denmark
| | - Else Marie Pinholt
- Department of Regional Health Research & University Hospital of Southern Denmark, Department of Oral and Maxillofacial Surgery, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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An assessment of surgical and 10-year follow-up vertical changes after contemporary Class II and III orthognathic surgery. Am J Orthod Dentofacial Orthop 2021; 161:e380-e389. [DOI: 10.1016/j.ajodo.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022]
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Guo ML, Huang Z, Wang C, Wang YJ. [Effect of bilateral sagittal split ramus osteotomy on temporomandibular joint symptom and condylar position in patients with skeletal class Ⅲ malocclusion by cone beam computed tomography]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:519-524. [PMID: 33085235 PMCID: PMC7573783 DOI: 10.7518/hxkq.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 07/16/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the effect of bilateral sagittal split ramus osteotomy (BSSRO) on temporomandibular joint (TMJ) symptom and condylar position in patients with skeletal class Ⅲ malocclusion treated with orthodontic-orthognathic surgical treatment. METHODS Twenty-four patients with skeletal class Ⅲ malocclusion who underwent orthodontic-orthognathic surgical treatment were included in the study. Their cone-beam computed tomography scans and TMJ symptom were evaluated, and their Helkimo index before BSSRO, 1 month after BSSRO, and 12 months after BSSRO was recorded. The maximum diameter of the horizontal and coronal sections, short axis diameters, neck width, height, joint space widths at different angles (45°, 90°, and 135°) of the condylar joint, bilateral condylar spacing, and different condylar angles (horizontal angle, vertical angle, and stress angle) in three dimensions were measured. Then, the changes in TMJ symptom and bone structure at different periods were analyzed. RESULTS The Helkimo index was anamnestic (Ai) or dysfunctional (Di) levels 0 or 1 before and after BSSRO, and no difference in Helkimo index was observed. The horizontal angle and joint space widths at 45° and 90° increased whereas the joint space width at 135° decreased at 1 month after BSSRO compared with before BSSRO (P<0.05). Except for the increase in condylar horizontal angle (P<0.05), no significant difference in other measurement items was noted (P>0.05) 12 month after BSSRO. CONCLUSIONS BSSRO would not have a remarkable effect on the TMJ symptom and condylar position of patients with skeletal class Ⅲ malocclusion who underwent orthodontic-orthognathic surgical treatment procedure and whose Helkimo index ranked Ai0, Ai1, Di0, and Di1.
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Affiliation(s)
- Mei-Ling Guo
- Dept. of General Dentistry, The Affiliated Stomatological Hospital of Nanchang University, The Key Laboratory of Oral Biomedicine of Jiangxi Province, Nanchang 330006, China
| | - Zhen Huang
- Dept. of Orthodontics, The Affiliated Stomatological Hospital of Nanchang University, The Key Laboratory of Oral Biomedicine of Jiangxi Province, Nanchang 330006, China
| | - Chong Wang
- Danshui Branch in Huizhou Stomatological Hospital, Huizhou 516001, China
| | - Yu-Jiang Wang
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Nanchang University, The Key Laboratory of Oral Biomedicine of Jiangxi Province, Nanchang 330006, China
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Verhelst P, Verstraete L, Shaheen E, Shujaat S, Darche V, Jacobs R, Swennen G, Politis C. Three-dimensional cone beam computed tomography analysis protocols for condylar remodelling following orthognathic surgery: a systematic review. Int J Oral Maxillofac Surg 2020; 49:207-217. [DOI: 10.1016/j.ijom.2019.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/13/2019] [Accepted: 05/10/2019] [Indexed: 11/25/2022]
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8
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Verhelst PJ, Shaheen E, de Faria Vasconcelos K, Van der Cruyssen F, Shujaat S, Coudyzer W, Salmon B, Swennen G, Politis C, Jacobs R. Validation of a 3D CBCT-based protocol for the follow-up of mandibular condyle remodeling. Dentomaxillofac Radiol 2019; 49:20190364. [PMID: 31674794 PMCID: PMC7068073 DOI: 10.1259/dmfr.20190364] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Three-dimensional models of mandibular condyles provide a way for condylar remodeling follow-up. The overall aim was to develop and validate a user-friendly workflow for cone beam CT (CBCT)-based semi-automatic condylar registration and segmentation. METHODS A rigid voxel-based registration (VBR) technique for registration of two post-operative CBCT-scans was tested. Two modified mandibular rami, with or without gonial angle, were investigated as the volume of interest for registration. Inter- and intraoperator reproducibility of this technique was tested on 10 mandibular rami of orthognathic patients by means of intraclass correlation coefficients (ICC's) and descriptive statistics of the transformation values from the VBR. The difference in reproducibility between the two modified rami was evaluated using a paired t-test (p < 0.05). For the segmentation, eight fresh frozen cadaver heads were scanned with CBCT and micro-CT. These data were used to test the inter- and intraoperator reproducibility (ICC's) and accuracy (Bland-Altman plot) of a newly designed workflow based on semi-automated contour enhancement. RESULTS Excellent ICC's (0.94-0.99) were obtained for the voxel-based registration technique using both modified rami. If the gonial angle was not included in the volume of interest, there was a trend of increased operator error suggested by significant higher interoperator differences in translation values (p = 0,0036). The segmentation workflow proved to be highly reproducible with excellent ICC's (0.99), low absolute mean volume differences between operators (23.19 mm3), within operators (28.93 mm3) and low surface distances between models of different operators (<0.20 mm). Regarding the accuracy, CBCT-models slightly overestimate the condylar volume compared to micro-CT. CONCLUSIONS This study provides a validated user-friendly and reproducible method of creating three-dimensional-surface models of mandibular condyles out of longitudinal CBCT-scans.
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Affiliation(s)
- Pieter-Jan Verhelst
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Karla de Faria Vasconcelos
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Fréderic Van der Cruyssen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Walter Coudyzer
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Benjamin Salmon
- Orofacial Pathologies, Imaging and Biotherapies EA2496 Lab, University of Paris, Montrouge, France.,Dental Medicine Department, AP-HP, Bretonneau Hospital, Paris, France
| | - Gwen Swennen
- Division of Maxillofacial Surgery, Department of Surgery, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and 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
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Assessment of condylar changes after orthognathic surgery using computed tomography regional superimposition. Int J Oral Maxillofac Surg 2019; 48:1201-1208. [DOI: 10.1016/j.ijom.2019.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/29/2018] [Accepted: 02/21/2019] [Indexed: 11/19/2022]
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10
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Weiss R, Read-Fuller A. Cone Beam Computed Tomography in Oral and Maxillofacial Surgery: An Evidence-Based Review. Dent J (Basel) 2019; 7:dj7020052. [PMID: 31052495 PMCID: PMC6631689 DOI: 10.3390/dj7020052] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 12/24/2022] Open
Abstract
Cone Beam Computed Tomography (CBCT) is a valuable imaging technique in oral and maxillofacial surgery (OMS) that can help direct a surgeon’s approach to a variety of conditions. A 3-dimensional analysis of head and neck anatomy allows practitioners to plan appropriately, operate with confidence, and assess results post-operatively. CBCT imaging has clear indications and limitations. CBCT offers the clinician 3-dimensional and multi-planar views for a more accurate diagnosis and treatment without the financial burden and radiation exposure of conventional computed tomography (CT) scans. Furthermore, CBCT overcomes certain limitations of 2-dimensional imaging, such as distortion, magnification, and superimposition. However, CBCT lacks the detailed depiction of soft tissue conditions for evaluation of pathologic conditions, head and neck infections, and temporomandibular joint (TMJ) disc evaluation. This review evaluates the evidence-based research supporting the application of CBCT in the various fields of oral and maxillofacial surgery, including dentoalveolar surgery, dental implants, TMJ, orthognathic surgery, trauma, and pathology, and will assess the value of CBCT in pre-operative assessment, surgical planning, and post-operative analysis when applicable. Additionally, the significant limitations of CBCT and potential areas for future research will be discussed.
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Affiliation(s)
- Robert Weiss
- Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry, Dallas, TX 75246, USA.
- Baylor Scott and White Health, Baylor University Medical Center-Dallas, Dallas, TX 75246, USA.
| | - Andrew Read-Fuller
- Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry, Dallas, TX 75246, USA.
- Attending Physician, Baylor Scott and White Health, Baylor University Medical Center-Dallas, Dallas, TX 75246, USA.
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Bianchi J, Porciúncula GM, Koerich L, Ignácio J, Wolford LM, Gonçalves JR. Three-dimensional stability analysis of maxillomandibular advancement surgery with and without articular disc repositioning. J Craniomaxillofac Surg 2018; 46:1348-1354. [DOI: 10.1016/j.jcms.2018.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/06/2018] [Accepted: 05/11/2018] [Indexed: 11/25/2022] Open
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Lo LJ, Weng JL, Ho CT, Lin HH. Three-dimensional region-based study on the relationship between soft and hard tissue changes after orthognathic surgery in patients with prognathism. PLoS One 2018; 13:e0200589. [PMID: 30067766 PMCID: PMC6070212 DOI: 10.1371/journal.pone.0200589] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/01/2018] [Indexed: 01/27/2023] Open
Abstract
Both deep understanding and reliable prediction of postoperative soft tissue changes are crucial for planning orthognathic surgery. Instead of estimating soft tissue responses by measuring individual landmark changes, this study aimed to investigate the relationship (ratio) between soft and hard tissue movements in different facial regions through three-dimensional cone-beam computed tomography (CBCT). Preoperative and postoperative CBCT images were superimposed using the surface registration method on the basis of the cranial base, and 10 facial regions of interest were defined. Region-based volumetric subtractions between the preoperative and postoperative segments were performed. The volumetric differences and surface of each region were used to estimate the average movement. Correlation and regression analyses were performed to examine the relationships between the corresponding soft and hard tissue movements. An overall pattern of facial soft tissue movement was observed in patients with prognathism who underwent orthognathic surgery. The experiment results have shown that mean ratios for the average soft-to-hard tissue movements in the facial regions varied, which may not exactly be similar to the published reports because of the population biocharacteristics and study methods, but the trend is in agreement with the previous studies. Additionally, the prediction capability of the regression model was significantly high, ranging from 0.786 to 0.857, in upper lip, upper vermilion, and chin regions, thus demonstrating that the skin outline changes in these critical regions could be reliably predicted from the underlying bone movements. These results could likely be applied in future soft tissue simulation in orthognathic surgery.
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Affiliation(s)
- Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Jing-Ling Weng
- Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Ting Ho
- Department of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsiu-Hsia Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
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Gaber RM, Shaheen E, Falter B, Araya S, Politis C, Swennen GRJ, Jacobs R. A Systematic Review to Uncover a Universal Protocol for Accuracy Assessment of 3-Dimensional Virtually Planned Orthognathic Surgery. J Oral Maxillofac Surg 2017. [PMID: 28646644 DOI: 10.1016/j.joms.2017.05.025] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to systematically review methods used for assessing the accuracy of 3-dimensional virtually planned orthognathic surgery in an attempt to reach an objective assessment protocol that could be universally used. MATERIALS AND METHODS A systematic review of the currently available literature, published until September 12, 2016, was conducted using PubMed as the primary search engine. We performed secondary searches using the Cochrane Database, clinical trial registries, Google Scholar, and Embase, as well as a bibliography search. Included articles were required to have stated clearly that 3-dimensional virtual planning was used and accuracy assessment performed, along with validation of the planning and/or assessment method. Descriptive statistics and quality assessment of included articles were performed. RESULTS The initial search yielded 1,461 studies. Only 7 studies were included in our review. An important variability was found regarding methods used for 1) accuracy assessment of virtually planned orthognathic surgery or 2) validation of the tools used. Included studies were of moderate quality; reviewers' agreement regarding quality was calculated to be 0.5 using the Cohen κ test. CONCLUSIONS On the basis of the findings of this review, it is evident that the literature lacks consensus regarding accuracy assessment. Hence, a protocol is suggested for accuracy assessment of virtually planned orthognathic surgery with the lowest margin of error.
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Affiliation(s)
- Ramy M Gaber
- Assistant Lecturer and Doctoral Student, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt, and Research Fellow, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium.
| | - Eman Shaheen
- Clinical engineer, OMFS-IMPATH research group, Department of Imaging and Pathology, Catholic University of Leuven & Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Leuven, Belgium
| | - Bart Falter
- Consultant, Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Leuven, Belgium
| | | | - Constantinus Politis
- Professor and Head, Department of Oral and Maxillofacial Surgery, Catholic University of Leuven, Leuven, Belgium
| | - Gwen R J Swennen
- Professor, Maxillofacial and Facial Plastic Surgery, Department of Surgery, Cleft and Craniofacial Centre, Bruges, Belgium, and Three-Dimensional Facial Imaging Research Group, General Hospital St Jan, Bruges, Belgium
| | - Reinhilde Jacobs
- Professor, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium
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Te Veldhuis EC, Te Veldhuis AH, Bramer WM, Wolvius EB, Koudstaal MJ. The effect of orthognathic surgery on the temporomandibular joint and oral function: a systematic review. Int J Oral Maxillofac Surg 2017; 46:554-563. [PMID: 28174061 DOI: 10.1016/j.ijom.2017.01.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 12/12/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
The objective of this systematic review was to examine the effect of orthognathic surgery (OS) on the temporomandibular joint and oral function. Electronic databases were systematically searched for studies published until October 2015. Articles were assessed against predefined inclusion criteria. The included papers were divided into four groups based on the type of OS performed. The following items were recorded: quality of evidence using the Oxford Centre for Evidence-Based medicine (CEBM) criteria, number of patients, presence/absence of controls, mean age at treatment, follow-up time, clinical examination findings, bite force, use of the Helkimo Index and Research Diagnostic Criteria for Temporomandibular Disorders, imaging findings, and patient questionnaire results. A total of 4669 articles were identified; 76 relevant articles were included in the review. These studies assessed a total 3399 patients and 380 controls, with a mean age of 25.4 years. The great variety of OS techniques, examination techniques, diagnostic criteria, and imaging techniques used in the articles studied, as well as the quality of the study designs, made it difficult to compare studies and to draw conclusions. However, looking at the different aspects studied in general, it can be stated that OS seems to have little or no harmful effect on the TMJ and oral function (level of evidence: levels II, III, and IV).
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Affiliation(s)
- E C Te Veldhuis
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands.
| | - A H Te Veldhuis
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
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Three-dimensional maxillary and mandibular regional superimposition using cone beam computed tomography: a validation study. Int J Oral Maxillofac Surg 2016; 45:662-9. [DOI: 10.1016/j.ijom.2015.12.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 10/27/2015] [Accepted: 12/08/2015] [Indexed: 11/21/2022]
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Koerich L, Ruellas ACO, Paniagua B, Styner M, Turvey T, Cevidanes LHS. Three-dimensional regional displacement after surgical-orthodontic correction of Class III malocclusion. Orthod Craniofac Res 2015; 19:65-73. [PMID: 26521755 DOI: 10.1111/ocr.12114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate how displacements of maxillo-mandibular structures are associated with each other at splint removal and 1 year post-surgery following 1-jaw and 2-jaw surgeries for correction of Class III malocclusion. SETTING AND SAMPLE POPULATION Fifty patients who underwent surgical correction with maxillary advancement only (n = 25) or combined with mandibular setback (n = 25) were prospectively enrolled in this study. METHODS Cone-beam computed tomographies were taken pre-surgery, at splint removal and at 1 year post-surgery. Three-dimensional cranial base superimpositions and shape correspondence were used to measure the outcomes from pre-surgery to splint removal (surgical changes) and splint removal to 1 year post-surgery (post-surgical adaptations). Pearson's correlation coefficients were used to evaluate the association between the regional displacements. RESULTS Both surgery groups presented mandibular clockwise rotation with surgery and post-surgical adaptive counterclockwise rotation. In patients treated with maxillary advancement only, the surgical changes of the maxilla were significantly correlated with chin changes. The amount and direction of chin autorotation were significantly correlated with right and left ramus autorotation. Right and left condylar displacements were significantly correlated. One year post-surgery, adaptive displacements and bone remodeling of both rami were correlated with the chin and condylar changes. For the 2-jaw group, the few correlations between the positional and remodeling changes in the anatomic regions of interest observed due to the surgery were different than those observed after post-surgical adaptations, suggesting that these changes occurred independently. CONCLUSION Our results indicate that surgical displacements and post-surgical adaptations are often correlated in one-jaw surgery and are, in general, independent in two-jaw surgery.
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Affiliation(s)
- L Koerich
- International Dental Program, Virginia Commonwealth University, Richmond, VA, USA
| | - A C O Ruellas
- Department of Orthodontics, University Federal of Rio de Janeiro, Rio de Janeiro, Brazil
| | - B Paniagua
- Departments of Psychiatry and Computer Science, University of North Carolina, Chapel Hill, NC, USA
| | - M Styner
- Departments of Psychiatry and Computer Science, University of North Carolina, Chapel Hill, NC, USA
| | - T Turvey
- Department of Oral and Maxillofacial Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - L H S Cevidanes
- Department of Orthodontics, University of Michigan, Ann Arbor, MI, USA
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Cevidanes LHS, Ruellas ACO, Jomier J, Nguyen T, Pieper S, Budin F, Styner M, Paniagua B. Incorporating 3-dimensional models in online articles. Am J Orthod Dentofacial Orthop 2015; 147:S195-204. [PMID: 25925649 PMCID: PMC4418234 DOI: 10.1016/j.ajodo.2015.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 02/01/2015] [Accepted: 02/01/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aims of this article are to introduce the capability to view and interact with 3-dimensional (3D) surface models in online publications, and to describe how to prepare surface models for such online 3D visualizations. METHODS Three-dimensional image analysis methods include image acquisition, construction of surface models, registration in a common coordinate system, visualization of overlays, and quantification of changes. Cone-beam computed tomography scans were acquired as volumetric images that can be visualized as 3D projected images or used to construct polygonal meshes or surfaces of specific anatomic structures of interest. The anatomic structures of interest in the scans can be labeled with color (3D volumetric label maps), and then the scans are registered in a common coordinate system using a target region as the reference. The registered 3D volumetric label maps can be saved in .obj, .ply, .stl, or .vtk file formats and used for overlays, quantification of differences in each of the 3 planes of space, or color-coded graphic displays of 3D surface distances. RESULTS All registered 3D surface models in this study were saved in .vtk file format and loaded in the Elsevier 3D viewer. In this study, we describe possible ways to visualize the surface models constructed from cone-beam computed tomography images using 2D and 3D figures. The 3D surface models are available in the article's online version for viewing and downloading using the reader's software of choice. These 3D graphic displays are represented in the print version as 2D snapshots. Overlays and color-coded distance maps can be displayed using the reader's software of choice, allowing graphic assessment of the location and direction of changes or morphologic differences relative to the structure of reference. The interpretation of 3D overlays and quantitative color-coded maps requires basic knowledge of 3D image analysis. CONCLUSIONS When submitting manuscripts, authors can now upload 3D models that will allow readers to interact with or download them. Such interaction with 3D models in online articles now will give readers and authors better understanding and visualization of the results.
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Affiliation(s)
- Lucia H S Cevidanes
- Assistant professor, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich.
| | - Antonio C O Ruellas
- Associate professor, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; CNPq Researcher and postdoctoral fellow, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | | | - Tung Nguyen
- Assistant professor, Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC
| | | | - Francois Budin
- Software engineer, Neuro Image Research and Analysis Laboratory, Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Martin Styner
- Associate professor, Neuro Image Research and Analysis Laboratory, Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Beatriz Paniagua
- Assistant professor, Neuro Image Research and Analysis Laboratory, Department of Psychiatry, University of North Carolina, Chapel Hill, NC
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Can cone-beam computed tomography superimposition help orthodontists better understand relapse in surgical patients? Am J Orthod Dentofacial Orthop 2014; 146:641-54. [DOI: 10.1016/j.ajodo.2013.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 11/17/2022]
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Nguyen T, Cevidanes L, Paniagua B, Zhu H, Koerich L, De Clerck H. Use of shape correspondence analysis to quantify skeletal changes associated with bone-anchored Class III correction. Angle Orthod 2013; 84:329-36. [PMID: 23886012 DOI: 10.2319/041513-288.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the three-dimensional (3D) skeletal changes in the mandibles of Class III patients treated with bone-anchored maxillary protraction using shape correspondence analysis. MATERIAL AND METHOD Twenty-five consecutive patients with skeletal Class III who were between the ages of 9 and 13 years (mean age, 11.10 ± 1.1 years) were treated using Class III intermaxillary elastics and bilateral miniplates (two in the infrazygomatic crests of the maxilla and two in the anterior mandible). Cone-beam computed tomography (CBCT) was performed for each patient before initial loading (T1) and at 1 year out (T2). From the CBCT scans, 3D models were generated, registered on the anterior cranial base, and analyzed using 3D linear distances and vectors between corresponding point-based surfaces. RESULTS Bone-anchored traction produced anteroposterior and vertical skeletal changes in the mandible. The novel application of Shape correspondence analysis showed vectors of mean (± standard deviation) distal displacement of the posterior ramus of 3.6 ± 1.4 mm, while the chin displaced backward by 0.5 ± 3.92 mm. The lower border of the mandible at the menton region was displaced downward by 2.6 ± 1.2 mm, and the lower border at the gonial region moved downward by 3.6 ± 1.4 mm. There was a downward and backward displacement around the gonial region with a mean closure of the gonial angle by 2.1°. The condyles were displaced distally by a mean of 2.6 ± 1.5 mm, and there were three distinct patterns for displacement: 44% backward, 40% backward and downward, and 16% backward and upward. CONCLUSION This treatment approach induces favorable control of the mandibular growth pattern and can be used to treat patients with components of mandibular prognathism.
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Affiliation(s)
- Tung Nguyen
- a Assistant Professor, Department of Orthodontics, University of North Carolina, Chapel Hill, NC
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