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Cho JY, Ryu J, Jung S, Kook MS, Park HJ, Oh HK. In-house CAD/CAM fabricated repositioning guide in maxillary repositioning after Le Fort I osteotomy. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:102102. [PMID: 39362633 DOI: 10.1016/j.jormas.2024.102102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Accepted: 09/30/2024] [Indexed: 10/05/2024]
Abstract
OBJECTIVE This study aimed to compare the accuracy of two transferring methods, which are the intermediate splint made by computer-aided design (CAD)/computer-aided manufacturing (CAM) and the customized maxillary repositioning guide for orthognathic surgery. MATERIALS AND METHODS Patient data regarding virtual surgical simulations were collected. For analyzing the accuracy, the postoperative cone-beam computed tomography and preoperative simulation data were superimposed. The x, y, and z coordinates were obtained at three landmarks in the maxillary dentition, and the linear and angular differences between the surgical simulation and the actual surgery were evaluated. RESULTS Thirty-three patients were included in this study, 16 in the splint group and 17 in the guide group. One coordinate in the guide group and nine in the splint group showed errors of >2 mm, with a statistically significant difference. There was no significant difference between the two groups in the three-dimensional error distance at each reference point. In most measurements, the interquartile range of the guide group showed a narrower distribution than that of the splint group. CONCLUSION It is more advantageous to use a customized maxillary repositioning guide than an intermediate splint made via CAD/CAM to obtain an accuracy within the 2 mm discrepancy range.
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Affiliation(s)
- Jin-Yong Cho
- Department of Oral & Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea; Department of Dentistry, School of Medicine, Gachon University, Incheon, Republic of Korea
| | - Jaeyoung Ryu
- Department of Oral & Maxillofacial Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea.
| | - Seunggon Jung
- Department of Oral & Maxillofacial Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea
| | - Min-Suk Kook
- Department of Oral & Maxillofacial Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea
| | - Hong-Ju Park
- Department of Oral & Maxillofacial Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea
| | - Hee-Kyun Oh
- Department of Oral & Maxillofacial Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea
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Gagnier D, Gregoire C, Brady J, Sterea A, Chaput T. Evaluation of a Fully Digital, In-House Virtual Surgical Planning Workflow for Bimaxillary Orthognathic Surgery. J Oral Maxillofac Surg 2024; 82:1038-1051.e1. [PMID: 38825321 DOI: 10.1016/j.joms.2024.05.002] [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: 11/01/2023] [Revised: 05/04/2024] [Accepted: 05/05/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND The advantages of virtual surgical planning (VSP) for orthognathic surgery are clear. Previous studies have evaluated in-house VSP; however, few fully digital, in-house protocols for orthognathic surgery have been studied. PURPOSE The purpose of this study was to evaluate the difference between the virtual surgical plan and actual surgical outcome for orthognathic surgery using a fully digital, in-house VSP workflow. STUDY DESIGN, SETTING, SAMPLE This is a prospective cohort study from September 2020 to November 2022 of patients at the Victoria General Hospital in Halifax, NS, Canada who underwent bimaxillary orthognathic surgery. Patients were excluded if they had previously undergone orthognathic surgery or were diagnosed with a craniofacial syndrome. MAIN OUTCOME VARIABLES The primary outcome variables were the mean 3-dimensional (3D) (Euclidean) distance error, as well as mean error and mean absolute error in the transverse (x axis), vertical (y axis), and anterior-posterior (z axis) dimensions. COVARIATES Covariates included age, sex, and surgical sequence (mandible-first or maxilla-first). ANALYSES The primary outcome was tested using Z and t critical value confidence intervals. The P value was set at .05. The 3D distance error for mandible-first and maxilla-first groups was compared using a 2-sample t-test as well as analysis of variance. RESULTS The study sample included 52 subjects (24 males and 28 females) with a mean age of 27.7 (± 12.1) years. Forty three subjects underwent mandible-first surgery and 9 maxilla-first surgery. The mean absolute distance error was largest in the anterior-posterior dimension for all landmarks (except posterior nasal spine, left condyle, and gonion) and exceeded the threshold for clinical acceptability (2 mm) in 16 of 23 landmarks. Additionally, mean distance error in the anterior-posterior dimension was negative for all landmarks, indicating deficient movement in that direction. The effect of surgical sequence on 3D distance error was not statistically significant (P = .37). CONCLUSION AND RELEVANCE In general, the largest contributor to mean 3D distance error was deficient movement in the anterior-posterior direction. Otherwise, mean absolute distance error in the vertical and transverse dimensions was clinically acceptable (< 2 mm). These findings were felt to be valuable for treatment planning purposes when using a fully digital, in-house VSP workflow.
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Affiliation(s)
- David Gagnier
- OMS Resident, Department of Oral and Maxillofacial Surgery, Halifax, Nova Scotia, Canada.
| | - Curtis Gregoire
- OMS Residency Program Director, Department of Oral and Maxillofacial Surgery, Halifax, Nova Scotia, Canada
| | - James Brady
- OMS Faculty, Department of Oral and Maxillofacial Surgery, Halifax, Nova Scotia, Canada
| | - Andra Sterea
- Dentistry Student, Department of Oral and Maxillofacial Surgery, Halifax, Nova Scotia, Canada
| | - Taylor Chaput
- Dentistry Student, Department of Oral and Maxillofacial Surgery, Halifax, Nova Scotia, Canada
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Roy ID, Desai AP, Ramyasri M, Mukesh K. The role of patient specific implants in the oral and maxillofacial region. Med J Armed Forces India 2024; 80:387-391. [PMID: 39071763 PMCID: PMC11280128 DOI: 10.1016/j.mjafi.2024.04.022] [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: 03/11/2024] [Accepted: 04/29/2024] [Indexed: 07/30/2024] Open
Abstract
Reconstructing maxillofacial defects is quiet challenging due to the region's complex anatomy, and cosmetic and functional effects on patients. With the help of developing technologies, patient-specific implants (PSIs) using virtual surgical planning based on a Computer aided designing (CAD)/Computer aided manufacturing (CAM) platform is an evolving treatment option. PSIs can be used in patients with maxillofacial defects and reconstruction. PSIs are also being used in the form of preformed plates for virtually planned orthognathic surgeries. Customized temporomandibular joint (TMJ) prosthesis is being routinely used in the debilitating/degenerative joint disease as a part of alloplastic joint replacement. The reconstruction of the maxillofacial region using autogenous tissue will always be gold standard due to near match of the recipient site. However, autogenous bone grafts positioned using PSIs or in certain areas such as the TMJ complex and the orbital region the PSIs are being offered with advantage of reduced donor-site morbidity. The future research is focussed towards the development of PSIs being used as a scaffold for engineering of the recipient tissue to restore the lost anatomy of specific region. This article reviews the varied aspects of this new technology of PSI for correction of various deformities/defects during the maxillofacial reconstruction.
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Affiliation(s)
- Indranil Deb Roy
- Professor & Head, Department of Dental Surgery & Oral Health Sciences, Armed Forces Medical College, Pune, India
| | - Ajay Premanand Desai
- Associate Professor, Department of Dental Surgery & Oral Health Sciences, Armed Forces Medical College, Pune, India
| | - M. Ramyasri
- Resident, Department of Dental Surgery & Oral Health Sciences, Armed Forces Medical College, Pune, India
| | - K. Mukesh
- Resident, Department of Dental Surgery & Oral Health Sciences, Armed Forces Medical College, Pune, India
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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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Manninen AA, Heliövaara A, Horelli J, Mesimäki K, Wilkman T, Lindford AJ, Lassus P. Long-term skeletal, cephalometric, and volumetric changes in two Helsinki bimaxillary face transplant patients. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00065-1. [PMID: 38906770 DOI: 10.1016/j.ijom.2024.03.009] [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: 05/15/2023] [Revised: 03/01/2024] [Accepted: 03/19/2024] [Indexed: 06/23/2024]
Abstract
Analysis of skeletal, cephalometric, and volumetric changes and occlusion during long-term follow-up was performed for two patients who underwent bimaxillary facial transplantation (FT). The study material consisted of the follow-up data of two bimaxillary composite FT performed in Helsinki University Hospital, one in 2016 and the other in 2018. Serial three-dimensional computed tomography scans obtained during follow-up (6 years for patient 1, 4 years for patient 2) were analyzed. The position of the maxilla remained stable in both patients. At 4 and 6 years, the changes in the anterior maxilla were ≤1 mm, while the anterior mandible had moved 2.6-4 mm anteriorly and the mandibular midline 0.4-3.7 mm to the left side. Patient 1 underwent re-osteosynthesis 4 months after transplantation due to mandibular non-union. Patient 2 had a sagittal mandibular osteotomy at 15 months after FT due to lateral crossbite and tension created by temporomandibular joint rotation. Thereafter both patients had a stable occlusion. A continuous bone volume reduction in the mandible was noticed in both patients (6% and 9% reduction of the transplanted volume). The volume of the transplanted maxilla decreased during the early postoperative period but increased back to the original transplanted volume during the follow-up.
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Affiliation(s)
- A A Manninen
- Department of Plastic Surgery, Park Hospital, Helsinki University Hospital (HUS), University of Helsinki, Helsinki, Finland.
| | - A Heliövaara
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | | | - K Mesimäki
- Department of Oral and Maxillofacial Diseases, Meilahti Hospital, Helsinki University Hospital (HUS), Helsinki, Finland
| | - T Wilkman
- Department of Oral and Maxillofacial Diseases, Meilahti Hospital, Helsinki University Hospital (HUS), Helsinki, Finland
| | - A J Lindford
- Department of Plastic Surgery, Park Hospital, Helsinki University Hospital (HUS), University of Helsinki, Helsinki, Finland
| | - P Lassus
- Department of Plastic Surgery, Park Hospital, Helsinki University Hospital (HUS), University of Helsinki, Helsinki, Finland
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Yari A, Hasheminasab M, Badri A, Tanbakuchi B, Fasih P. Accuracy of maxillary repositioning surgery in teaching hospitals using conventional model surgery. Oral Maxillofac Surg 2024; 28:935-943. [PMID: 37486423 DOI: 10.1007/s10006-023-01174-2] [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: 06/08/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE The aim of this study was to assess the accuracy of maxillary repositioning surgery in teaching hospitals using conventional model surgery. MATERIALS AND METHODS A total of 73 patients undergoing single-piece LeFort I osteotomies in the maxilla and bilateral sagittal split osteotomies in the mandible were included in the study. Preoperative and immediate postoperative cone-beam CT were compared in computer software (Dolphin3D©). Maxillary landmarks relative to the vertical and horizontal reference lines were evaluated. The difference between the planned and achieved maxillary positions was measured. Distance error in millimeters and achievement ratio (achieved displacement/planned displacement*100) were calculated for different maxillary movements. RESULTS Midline correction and advancement were the most accurate movements with an overall mean distance error of 0.53 mm and 0.63 mm respectively while posterior impaction and setback were the least accurate movements with 1.38 mm and 1.76 mm mean discrepancies, respectively. A significant difference was observed only in setback movement regarding the discrepancy value (P < .05). Although setback and down-graft movements tended to under-correction, all other movements were overcorrected. As the magnitude of maxillary movements increases, the accuracy decreases. In severe displacements (≥ 8 mm), the accuracy declines significantly (P < .05). CONCLUSION Classic cast surgery and manually fabricated intermediate splints in teaching hospitals yield accurate and acceptable results in the majority of cases (84.6%). The accuracy of maxillary repositioning decreases as the magnitude of displacement increases.
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Affiliation(s)
- Amir Yari
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahboube Hasheminasab
- Department of Orthodontics, Arthur Dugoni School of Dentistry, University of the Pacific, San Francisco, CA, USA
| | - Amirali Badri
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrad Tanbakuchi
- Department of Orthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Paniz Fasih
- Department of Prosthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Parente EV, Silvares MG, Zerbinatti DCZ, da Silva Pinto S. Minimally invasive sagittal osteotomy-technical note. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00112-7. [PMID: 38734489 DOI: 10.1016/j.ijom.2024.04.007] [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: 10/07/2023] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024]
Abstract
This article describes a novel minimally invasive technique for bilateral sagittal split osteotomy (BSSO) that aims to reduce surgical trauma while maintaining bone overlap and rigid internal fixation for proper consolidation of the bone segments. The technique involves a small vestibular mucoperiosteal incision made on the lateral aspect of the mandible between the first and second molars, enabling a standard ramus split, surgical segment movement, and miniplate fixation. A retrospective evaluation of 67 consecutive patients who underwent BSSO using this protocol showed favorable split of the mandible with no unfavorable splits or non-union. Patients were discharged from hospital within an average of 17 h with minimal postoperative complications. This technique provides good surgical visualization with a very small incision and allows standard BSSO surgery without difficulty.
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Affiliation(s)
- E V Parente
- Private Practice, Florianópolis, Santa Catarina, Brazil
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Bevini M, Gulotta C, Lunari O, Cercenelli L, Marcelli E, Felice P, Tarsitano A, Badiali G. Morpho-functional analysis of the temporomandibular joint following mandible-first bimaxillary surgery with mandible-only patient-specific implants. J Craniomaxillofac Surg 2024; 52:570-577. [PMID: 38485626 DOI: 10.1016/j.jcms.2024.02.009] [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: 04/27/2023] [Revised: 10/25/2023] [Accepted: 02/02/2024] [Indexed: 05/18/2024] Open
Abstract
The aim of this study was to evaluate condylar and glenoid fossa remodeling after bimaxillary orthognathic surgery guided by patient-specific mandibular implants. In total, 18 patients suffering from dentofacial dysmorphism underwent a virtually planned bimaxillary mandibular PSI-guided orthognathic procedure. One month prior to surgery, patients underwent a CBCT scan and optical scans of the dental arches; these datasets were re-acquired 1 month and at least 9 months postsurgery. Three-dimensional models of the condyles, glenoid fossae, and interarticular surface space (IASS) were obtained and compared to evaluate the roto-translational positional discrepancy and surface variation of each condyle and glenoid fossa, and the IASS variation. The condylar position varied by an average of 4.31° and 2.18 mm, mainly due to surgically unavoidable ramus position correction. Condylar resorption remodeling was minimal (average ≤ 0.1 mm), and affected skeletal class III patients the most. Later condylar remodeling was positively correlated with patient age. No significant glenoid fossa remodeling was observed. No postoperative orofacial pain was recorded at clinical follow-up. The procedure was accurate in minimizing the shift in relationship between the bony components of the TMJ and their remodeling, and was effective in avoiding postoperative onset of orofacial pain. An increase in sample size, however, would be useful to confirm our findings.
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Affiliation(s)
- Mirko Bevini
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.
| | - Chiara Gulotta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Italy.
| | - Ottavia Lunari
- School of Medecine, Alma Mater Studiorum, University of Bologna, Italy.
| | - Laura Cercenelli
- Laboratory of Bioengineering-eDIMES Lab, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
| | - Emanuela Marcelli
- Laboratory of Bioengineering-eDIMES Lab, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
| | - Pietro Felice
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Italy.
| | - Achille Tarsitano
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Italy.
| | - Giovanni Badiali
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Italy.
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Ho JPTF, Zhou N, van Riet TCT, Schreurs R, Becking AG, de Lange J. Assessment of Surgical Accuracy in Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea: A Preliminary Analysis. J Pers Med 2023; 13:1517. [PMID: 37888128 PMCID: PMC10608325 DOI: 10.3390/jpm13101517] [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: 09/18/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
This retrospective study aimed to: (1) investigate the surgical accuracy of maxillomandibular advancement (MMA) in obstructive sleep apnea (OSA) patients, with a specific focus on maxillary and mandibular advancement and counter-clockwise rotation and (2) investigate the correlation between the amount of achieved advancement and the reduction in the relative apnea hypopnea index (AHI). Sixteen patients, for whom a three-dimensional virtual surgical plan was generated preoperatively and a computed tomography scan (CT) or cone-beam computer tomography (CBCT) was acquired postoperatively, were included. The postoperative CT or CBCT was compared to the virtual surgical plan, and differences in the mandibular and maxillary advancement and counter-clockwise rotation were assessed. Maxillary and mandibular advancement (median 3.1 mm, p = 0.002 and 2.3 mm, p = 0.03, respectively) and counter-clockwise rotation (median 3.7°, p = 0.006 and 4.7°, p = 0.001, respectively) were notably less than intended. A significant correlation was found between the planned maxillary advancement and the difference between the planned and actual maxillary advancement (p = 0.048; adjusted R2 = 0.1979) and also between the planned counter-clockwise rotation and the difference between the planned and actual counter-clockwise rotation for the mandible (p = 0.012; adjusted R2 = 0.3261). Neither the maxilla-first nor the mandible-first surgical sequence proved to be superior in terms of the ability to achieve the intended movements (p > 0.45). Despite a significant reduction (p = 0.001) in the apnea hypopnea index (AHI) from a median of 62.6 events/h to 19.4 events/h following MMA, no relationship was found between the extent of maxillary or mandibular advancement and AHI improvement in this small cohort (p = 0.389 and p = 0.387, respectively). This study underlines the necessity for surgeons and future research projects to be aware of surgical inaccuracies in MMA procedures for OSA patients. Additionally, further research is required to investigate if sufficient advancement is an important factor associated with MMA treatment outcome.
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Affiliation(s)
- Jean-Pierre T. F. Ho
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
- Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Northwest Clinics, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
| | - Ning Zhou
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
| | - Tom C. T. van Riet
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
- Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
| | - Alfred G. Becking
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
- Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
- Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
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Wang X, Wei H, Li B. From "Empirical Surgery" to "Precision Surgery": establishment and clinical application of precision orthognathic surgery system. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2023; 41:491-501. [PMID: 37805673 PMCID: PMC10580229 DOI: 10.7518/hxkq.2023.2023152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/08/2023] [Indexed: 10/09/2023]
Abstract
Orthognathic surgery, which involve osteotomy and repositioning of the maxillomandibular complex, has recently emerged as a crucial method of correcting dentofacial deformities. The optimal placement of the maxillomandibular complex holds utmost significance during orthognathic surgery because it directly affects the surgical outcome. To accurately achieve the ideal position of the maxillomandibular complex, with the rapid advancements in digital surgery and 3D-printing technology, orthognathic surgery has entered an era of "Precision Surgery" from the pervious "Empirical Surgery." This article provides comprehensive insights into our extensive research and exploration of the treatment modality known as "precision orthognathic surgery" over the years. We also present the technical system and application in"Ortho+X" treatment modality to offer valuable references and assistance to our colleagues in the field.
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Affiliation(s)
- Xudong Wang
- Dept. of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & College of Stomatology, Shanghai Jiao Tong University & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Hongpu Wei
- Dept. of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & College of Stomatology, Shanghai Jiao Tong University & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Biao Li
- Dept. of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & College of Stomatology, Shanghai Jiao Tong University & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
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Cho RY, Byun SH, Park SY, On SW, Kim JC, Yang BE. Patient-specific plates for facial fracture surgery: A retrospective case series. J Dent 2023; 137:104650. [PMID: 37544353 DOI: 10.1016/j.jdent.2023.104650] [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: 10/18/2022] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVES Surgeons often encounter challenges when treating maxillofacial fractures using conventional methods that involve trimming or bending ready-made titanium plates for open reduction and internal fixation (ORIF) since it can be time-consuming, imprecise, and inconvenient. This retrospective case series aimed to introduce a novel bone reduction method that utilizes virtual planning, patient-specific surgical guides, and titanium plates. METHODS Seven patients with mandibular symphysis or subcondylar fractures resulting from facial trauma underwent cone-beam computed tomography (CBCT) or facial CT scans, and their medical histories were documented. Virtual surgery was conducted based on three-dimensional (3D) stereolithography images derived from CT scans using the FaceGide software (MegaGen, Daegu, Korea). ORIF was performed using patient-specific surgical guides and plates that were designed, printed, and milled. Radiographic, clinical, and occlusal evaluations were conducted at two weeks and six weeks postoperatively. Subsequently, 3D images from virtual surgery and postoperative CT scans were compared. RESULTS The comparison of 3D virtual surgery and postoperative images revealed minimal surface differences of less than 1 mm. T-scan evaluations indicated that there were no statistically significant differences between the two- and six-week postoperative assessments. Favorable clinical outcomes were observed. CONCLUSION This novel method demonstrated stable outcomes in terms of occlusion and healing, with no notable complications. Consequently, this approach may serve as a viable alternative to conventional methods. CLINICAL SIGNIFICANCE Facial fracture surgery that utilizes patient-specific surgical guides and plates within a digital workflow can facilitate meticulous surgical planning, reducing the risk of complications and minimizing operation time.
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Affiliation(s)
- Ran-Yeong Cho
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Soo-Hwan Byun
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sang-Yoon Park
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sung-Woon On
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Jong-Cheol Kim
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Mir Dental Hospital, Daegu 41940, Republic of Korea
| | - Byoung-Eun Yang
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea.
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Yoo HJ, Hartsfield JK, Mian AS, Allan BP, Naoum S, Lee RJH, Goonewardene MS. Accuracy of mandibular repositioning surgery using new technology: Computer-aided design and manufacturing customized surgical cutting guides and fixation plates. Am J Orthod Dentofacial Orthop 2023; 163:357-367.e3. [PMID: 36503861 DOI: 10.1016/j.ajodo.2021.12.021] [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: 10/01/2020] [Revised: 11/01/2021] [Accepted: 12/01/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Recent 3-dimensional technology advancements have resulted in new techniques to improve the accuracy of intraoperative transfer. This study aimed to validate the accuracy of computer-aided design and manufacturing (CAD-CAM) customized surgical cutting guides and fixation plates on mandibular repositioning surgery performed in isolation or combined with simultaneous maxillary repositioning surgery. METHODS Sixty patients who underwent mandibular advancement surgery by the same surgeon were retrospectively evaluated by 3-dimensional surface-based superimposition. A 3-point coordinate system (x, y, z) was used to identify the linear and angular discrepancies between the planned movements and actual outcomes. Wilcoxon rank sum test was used to compare the outcomes between the mandible-only and the bimaxillary surgery groups with significance at P <0.05. Pearson correlation coefficient compared planned mandible advancement to the outcome from advancement planned. The centroid, which represents the mandible as a single unit, was computed from 3 landmarks, and the discrepancies were evaluated by the root mean square error (RMSE) for clinical significance set at 2 mm for linear discrepancies and 4° for angular discrepancies. RESULTS There was no statistically significant difference between the planned and actual position of the mandible in either group when considering absolute values of the differences. When considering raw directional data, a statistically significant difference was identified in the y-axis suggesting a tendency for under-advancement of the mandible in the bimaxillary group. The largest translational RMSE for the centroid was 0.77 mm in the sagittal dimension for the bimaxillary surgery group. The largest rotational RMSE for the centroid was 1.25° in the transverse dimension for the bimaxillary surgery group. Our results show that the precision and clinical feasibility of CAD-CAM customized surgical cutting guides and fixation plates on mandibular repositioning surgery is well within clinically acceptable parameters. CONCLUSION Mandibular repositioning surgery can be performed predictably and accurately with the aid of CAD-CAM customized surgical cutting guides and fixation plates with or without maxillary surgery.
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Affiliation(s)
- Ho Jin Yoo
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - James K Hartsfield
- Division of Orthodontics, Department of Oral Health Science, College of Dentistry, and Department of Microbiology, Immunology and Molecular Genetics, College of Medicine, University of Kentucky, Lexington, KY; Division of Oral Development and Behavioural Sciences, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - Ajmal S Mian
- School of Computer Science and Software Engineering, the University of Western Australia, Crawley, Western Australia, Australia
| | - Brent P Allan
- Private practice, Perth, Western Australia, Australia; Department of Orthodontics, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Steven Naoum
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - Richard J H Lee
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - Mithran S Goonewardene
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia.
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Kim MK, Ham MJ, Kim WR, Kim HG, Kwon KJ, Kim SG, Park YW. Investigating the accuracy of mandibulectomy and reconstructive surgery using 3D customized implants and surgical guides in a rabbit model. Maxillofac Plast Reconstr Surg 2023; 45:8. [PMID: 36701071 PMCID: PMC9880108 DOI: 10.1186/s40902-023-00375-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study aimed to analyze the accuracy of the output of three-dimensional (3D) customized surgical guides and titanium implants in a rabbit model, and of mandibulectomy, reconstructive surgery, and surgical outcome; additionally, the correlation between surgical accuracy and surgical outcomes, including the differences in surgical outcome according to surgical accuracy, was analyzed. RESULTS The output of implants was accurately implemented within the error range (- 0.03-0.03 mm), and the surgical accuracy varied depending on the measured area (range - 0.4-1.1 mm). Regarding surgical outcomes, angle between the mandibular lower borders showed the most sensitive results and distance between the lingual cusps of the first molars represented the most accurate outcomes. A significant correlation was noted between surgical accuracy in the anteroposterior length of the upper borders pre- and postoperatively and the angle between the mandibular lower borders (regression coefficient = 0.491, p = 0.028). In the group wherein surgery was performed more accurately, the angle between the mandibular lower borders was reproduced more accurately (p = 0.021). A selective laser melting machine accurately printed the implants as designed. Considering the positive correlation among surgical accuracy in the mandibular upper borders, angle between the mandibular lower borders, and more accurately reproduced angle between the mandibular lower borders, the angle between the mandibular lower borders is considered a good indicator for evaluating the outcomes of reconstructive surgery. CONCLUSION To reduce errors in surgical outcomes, it is necessary to devise a positioner for the surgical guide and design a 3D surgical guide to constantly maintain the direction of bone resection. A fixed area considering the concept of three-point fixation should be selected for stable positioning of the implant; in some cases, bilateral cortical bone fixation should be considered. The angle between the mandibular lower borders is a sensitive indicator for evaluating the outcomes of reconstructive surgery.
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Affiliation(s)
- Min Keun Kim
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
| | - Min Ji Ham
- grid.454135.20000 0000 9353 1134Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Gangneung, 25440 Republic of Korea
| | - Won Rae Kim
- grid.454135.20000 0000 9353 1134Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Gangneung, 25440 Republic of Korea
| | - Hyung Giun Kim
- grid.454135.20000 0000 9353 1134Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Gangneung, 25440 Republic of Korea
| | - Kwang Jun Kwon
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
| | - Seong Gon Kim
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
| | - Young Wook Park
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
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Three-Dimensional Accuracy and Stability of Personalized Implants in Orthognathic Surgery: A Systematic Review and a Meta-Analysis. J Pers Med 2023; 13:jpm13010125. [PMID: 36675786 PMCID: PMC9867342 DOI: 10.3390/jpm13010125] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
This systematic review aimed to determine the accuracy/stability of patient-specific osteosynthesis (PSI) in orthognathic surgery according to three-dimensional (3D) outcome analysis and in comparison to conventional osteosynthesis and computer-aided designed and manufactured (CAD/CAM) splints or wafers. The PRISMA guidelines were followed and six academic databases and Google Scholar were searched. Records reporting 3D accuracy/stability measurements of bony segments fixated with PSI were included. Of 485 initial records, 21 met the eligibility (566 subjects), nine of which also qualified for a meta-analysis (164 subjects). Six studies had a high risk of bias (29%), and the rest were of low or moderate risk. Procedures comprised either single-piece or segmental Le Fort I and/or mandibular osteotomy and/or genioplasty. A stratified meta-analysis including 115 subjects with single-piece Le Fort I PSI showed that the largest absolute mean deviations were 0.5 mm antero-posteriorly and 0.65° in pitch. PSIs were up to 0.85 mm and 2.35° more accurate than conventional osteosynthesis with CAD/CAM splint or wafer (p < 0.0001). However, the clinical relevance of the improved accuracy has not been shown. The literature on PSI for multi-piece Le Fort I, mandibular osteotomies and genioplasty procedure is characterized by high methodological heterogeneity and a lack of randomized controlled trials. The literature is lacking on the 3D stability of bony segments fixated with PSI.
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Barone S, Muraca D, Averta F, Diodati F, Giudice A. Qualitative and quantitative assessment of condylar displacement after orthognathic surgery: A voxel-based three-dimensional analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:685-690. [PMID: 34763135 DOI: 10.1016/j.jormas.2021.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/17/2021] [Accepted: 11/04/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aimed to evaluate the morphometric changes in the position of the mandibular condyles before and after orthognathic surgery. METHODS A retrospective single-center cohort study was conducted and included patients with a presurgical (T1) and postsurgical (T2) Cone Beam computed tomography (CBCT). The primary predictor variable was the orthognathic surgical treatment. Pre-operative and post-operative CBCT scans were superimposed using voxel-based registration. Semitransparent overlays of the models of condylar regions at T1 and T2 were created for the qualitative analysis. The primary outcome variable was the quantitative displacement of condyles (CoR; CoL) analyzed in X, Y, Z axis and the 3D distances. Descriptive and bivariate statistical analysis was performed, setting α=0.05. RESULTS The study sample included 33 patients (mean age: 25.33±2.49 years) affected by skeletal class III malocclusion with or without skeletal asymmetry. The X-axis showed a mean movement of 0.25 ± 0.17 mm for CoR, and 0.52 ± 0.51 mm for CoL. The Y-axis showed a mean movement of 0.29 ± 0.2 mm for CoR, and 0.51 ± 0.8 mm for CoL. The Z-axis was 0.33 ± 0.2 mm for CoR, and 0.5 ± 0.49 mm for CoL. No statistically significant difference was calculated comparing the movement of condylar surface between asymmetric and not asymmetric patients (p = 0.26 for CoR; p = 0.13 for CoL). No statistically significant difference was found in intercondylar distance between T1 and T2 (p = 0.39). CONCLUSION No statistically nor clinically significant condylar displacement are recorded in orthognathic surgery patients at 12 to 18 months of follow-up.
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Affiliation(s)
- Selene Barone
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Danila Muraca
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Fiorella Averta
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Federica Diodati
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Amerigo Giudice
- Oral and Maxillofacial Surgeon, Professor, School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa 88100 Catanzaro, Italy.
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Hoque ME, Showva NN, Ahmed M, Rashid AB, Sadique SE, El-Bialy T, Xu H. Titanium and titanium alloys in dentistry: current trends, recent developments, and future prospects. Heliyon 2022; 8:e11300. [PMID: 36387463 PMCID: PMC9640965 DOI: 10.1016/j.heliyon.2022.e11300] [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: 06/22/2022] [Revised: 09/26/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Many implant materials have been used in various dental applications depending on their efficacy and availability. A dental implant must possess the required characteristics, such as biocompatibility, corrosion & wear resistance, adequate mechanical properties, osseointegration, etc., to ensure its safe and optimum use. This review analyzes various aspects of titanium (Ti) and Ti alloys, including properties, manufacturing processes, surface modifications, applications as dental implants, and limitations. In addition, it also presents a perception of recent advances in Ti-based implant materials and the futuristic development of innovative dental implants.
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Affiliation(s)
- Md Enamul Hoque
- Department of Biomedical Engineering, Military Institute of Science and Technology, Dhaka, Bangladesh
| | - Nazmir-Nur Showva
- Department of Biomedical Engineering, Military Institute of Science and Technology, Dhaka, Bangladesh
| | - Mansura Ahmed
- Department of Biomedical Engineering, Military Institute of Science and Technology, Dhaka, Bangladesh
| | - Adib Bin Rashid
- Department of Industrial and Production Engineering, Military Institute of Science and Technology, Dhaka, Bangladesh
| | - Sarder Elius Sadique
- College of Information Technology and Engineering, Marshall University, West Virginia, USA
| | - Tarek El-Bialy
- Department of Dentistry & Dental Hygiene, University of Alberta, Alberta, Canada
| | - Huaizhong Xu
- Department of Biobased Materials Science, Kyoto Institute of Technology (KIT), Sakyoku, Kyoto City, Japan
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Zotti R, Oliva G, Tian C, Isola G, Dalessandri D, Zanetti U, Bianchi I, Bonetti S. Clinical Accuracy of Splintless Maxillary Positioning with Aid of CAD/CAM Fabricated Surgical Cutting Guides and Titanium Plates. COATINGS 2022; 12:1463. [DOI: 10.3390/coatings12101463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
New digital technologies are improving the accuracy of orthognathic surgery. One of the new approaches transfers the surgical plan into real surgery without using an occlusal splint. This pilot study aims to validate the splintless approach to orthognathic surgery on a series of cases. Five patients were enrolled. Surgeries were planned using a digital surgical simulation method thanks to three-dimensional images. The splintless surgical approach was planned for maxillary reposition. This consisted of cutting guides and three-dimensionally (3D) printed custom titanium plates. These two were created using the computer-aided design and computer-aided manufacturing (CAD-CAM) technique and were used intraoperatively to guide the osteotomy and repositioning of the bony segments without the use of the surgical splint. The difference between the planned surgery and the real final position was analyzed thanks to superimposition techniques and landmark analysis. Statistical tests were performed to detect significant differences. No difference was found in any of the landmarks. Midline landmarks differed from the planned position by 0.34 mm. Higher variability was found in the posterior landmark. These findings suggest that a splintless approach is useful in transferring the surgical plan without using an occlusal splint.
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Affiliation(s)
- Rinaldo Zotti
- School of Dentistry, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Giorgio Oliva
- School of Dentistry, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Carlo Tian
- School of Dentistry, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Gaetano Isola
- School of Dentistry, Department of General Surgery and Medical and Surgical Specialties, University of Catania, Via S. Sofia 78, 95124 Catania, Italy
| | - Domenico Dalessandri
- School of Dentistry, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Umberto Zanetti
- School of Dentistry, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Ilenia Bianchi
- Section of Forensic Medical Sciences, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Stefano Bonetti
- School of Dentistry, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
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Advantages of using custom guides and plates in mandibular chin wing osteotomies: A 3-case series. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wang H, Chi Y, Huang H, Su S, Xue H, Hou J. Combined use of 3D printing and computer-assisted navigation in the clinical treatment of multiple maxillofacial fractures. Asian J Surg 2022:S1015-9584(22)01374-4. [DOI: 10.1016/j.asjsur.2022.09.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022] Open
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Dadhich A, Nilesh K, Shah S, Saluja H. Three-dimensional printing in maxillofacial surgery: A quantum leap in future. Natl J Maxillofac Surg 2022; 13:S203-S211. [PMID: 36393959 PMCID: PMC9651252 DOI: 10.4103/njms.njms_65_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/02/2020] [Accepted: 10/05/2020] [Indexed: 12/02/2022] Open
Abstract
Although application of three-dimensional (3D) printing in oral and maxillofacial surgery (OMFS) was first reported almost 30 years back, reduction in its manufacturing cost and availability of affordable 3D printing devices have popularized its use over the past few years. The 3D-printed objects include anatomical models, occlusal splints, drilling, or cutting guides and patient-specific implants (custom made plates and reconstruction devices). The anatomical model not only assists the surgeon in better understanding of the deformity or pathology but also aids in explaining the same to the patient and relatives. Mock surgery carried out on these models improve precision and thereby reduce the operating time. The guiding splints provide an exact design and fit for the graft, thus replicating form and function of the jawbone. The patient specific implants manufactured through computer-assisted designing help in superior replication of original anatomical form. This paper intends to highlight the current applications of 3D printing in field of maxillofacial surgery in the management of facial deformity, esthetic disturbances, and jaw pathologies. Cases of condylar hyperplasia, jaw tumor, facial asymmetry secondary to joint deformity, apertognathia, and chin augmentation managed with the application of 3D printing have been described in this paper. It also discusses the history, techniques, advantages, limitations, and future scope of 3D printing technology in OMFS.
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Affiliation(s)
- Anuj Dadhich
- Department of Oral and Maxillofacial Surgery, Rural Dental College, Loni, Maharashtra, India
| | - Kumar Nilesh
- Department of Oral and Maxillofacial Surgery, SDS, Krishna Institute of Medical Sciences Deemed to be University, Karad, Maharashtra, India,Address for correspondence: Dr. Kumar Nilesh, Department of Oral and Maxillofacial Surgery, SDS, Krishna Institute of Medical Sciences Deemed to be University, Karad, Maharashtra, India. E-mail:
| | - Seemit Shah
- Department of Oral and Maxillofacial Surgery, Rural Dental College, Loni, Maharashtra, India
| | - Harish Saluja
- Department of Oral and Maxillofacial Surgery, Rural Dental College, Loni, Maharashtra, India
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Personal guide assisted orthognathic surgery: application of a T-shaped tooth bone combined supporting osteotomy guide plate and positioning guide plate. J Craniofac Surg 2022; 33:e736-e738. [PMID: 35776922 DOI: 10.1097/scs.0000000000008661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/28/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The precise movement of the maxilla is particularly important for orthognathic surgery, especially for patients with maxillary segmentation. In this preliminary study, the authors present a new tooth bone combined with a supporting osteotomy guide and positioning guide to guide the osteotomy and reduction of the maxilla. Through our preoperative simulation and postoperative image fusion, the authors found that the overlapping area is more than 90%. According to compare of the virtual plans and the postoperative results based on distances from the maxillary land- marks to the horizontal plane, sagittal plane, and coronal plane, the surgical error was about 2mm. Our T-shaped guide provides a reliable method for patients with maxillary segmental osteotomy, which may be a useful alternative to the intermediate.
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Sánchez-Jáuregui E, Baranda-Manterola E, Ranz-Colio Á, Bueno de Vicente Á, Acero-Sanz J. Custom made cutting guides and osteosynthesis plates versus CAD/CAM occlusal splints in positioning and fixation of the maxilla in orthognathic surgery: A prospective randomized study. J Craniomaxillofac Surg 2022; 50:609-614. [PMID: 35760659 DOI: 10.1016/j.jcms.2022.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/22/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022] Open
Abstract
The aim of this study is to compare the accuracy of maxilla positioning in orthognathic surgery with the use of custom-made devices (cutting guides and patient-fitted osteosynthesis plates) comparing to CAD/CAM splints. A prospective randomized study was performed. Patients with dentofacial deformities undergoing orthognathic surgery were compared, using customized guides (experimental group) vs. CAD/CAM surgical splints (control group) for the repositioning of the upper maxilla. Preoperative and postoperative CT scans were used to compare positioning and fixation of the maxilla in the three planes of space. A total of 30 patients were included in the study (15 patients in each study group). The mean error obtained with customized guides was 0.8 mm (range 0.1-1.9) in the anterior-posterior axis, 0.4 mm (range 0-1.4) in the vertical axis and 0.2 mm (range 0-1.1) in the horizontal axis. There were statistically significant differences in the anterior-posterior and vertical axes in favour of the customized implants, whereas there were no differences in the horizontal plane. Furthermore, there was a mean reduction of the operative time of 36.5 min in the experimental group. Within the limitations of the study it seems that patient specific surgical guides should be preferred when accuracy of repositioning of the maxilla and saving operative time are the priority.
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Affiliation(s)
- Eduardo Sánchez-Jáuregui
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal (University of Alcalá de Henares), Madrid, Spain.
| | - Elena Baranda-Manterola
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal (University of Alcalá de Henares), Madrid, Spain.
| | - Álvaro Ranz-Colio
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal (University of Alcalá de Henares), Madrid, Spain.
| | - Ángela Bueno de Vicente
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal (University of Alcalá de Henares), Madrid, Spain.
| | - Julio Acero-Sanz
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal (University of Alcalá de Henares), Madrid, Spain.
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Chen H, Jiang N, Bi R, Liu Y, Li Y, Zhao W, Zhu S. Comparison of the accuracy of maxillary repositioning between using splints and templates in two-jaw orthognathic surgery. J Oral Maxillofac Surg 2022; 80:1331-1339. [DOI: 10.1016/j.joms.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
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Computer Aided Orthognathic Surgery: A General Method for Designing and Manufacturing Personalized Cutting/Repositioning Templates. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Orthognathic surgery allows broad-spectrum deformity correction involving both aesthetic and functional aspects on the TMJ (temporo-mandibular joint) and on the facial skull district. The combination of Reverse Engineering (RE), Virtual Surgery Planning (VSP), Computer Aided Design (CAD), Additive Manufacturing (AM), and 3D visualization allows surgeons to plan, virtually, manipulations and the translation of the human parts in the operating room. This work’s aim was to define a methodology, in the form of a workflow, for surgery planning and for designing and manufacturing templates for orthognathic surgery. Along the workflow, the error chain was checked and the maximum error in virtual planning was evaluated. The three-dimensional reconstruction of the mandibular shape and bone fragment movements after segmentation allow complete planning of the surgery and, following the proposed method, the introduction of both the innovative evaluation of the transversal intercondylar distance variation after mandibular arch advancement/set and the possibility of use of standard plates to plan and realize a customized surgery. The procedure was adopted in one clinical case on a patient affected by a class III malocclusion with an associated open bite and right deviation of the mandible with expected good results. Compared with the methods from most recent literature, the presented method introduces two elements of novelty and improves surgery results by optimizing costs and operating time. A new era of collaboration among surgeons and engineer has begun and is now bringing several benefits in personalized surgery.
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Main Applications and Recent Research Progresses of Additive Manufacturing in Dentistry. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5530188. [PMID: 35252451 PMCID: PMC8894006 DOI: 10.1155/2022/5530188] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 12/16/2021] [Accepted: 01/28/2022] [Indexed: 12/13/2022]
Abstract
In recent ten years, with the fast development of digital and engineering manufacturing technology, additive manufacturing has already been more and more widely used in the field of dentistry, from the first personalized surgical guides to the latest personalized restoration crowns and root implants. In particular, the bioprinting of teeth and tissue is of great potential to realize organ regeneration and finally improve the life quality. In this review paper, we firstly presented the workflow of additive manufacturing technology. Then, we summarized the main applications and recent research progresses of additive manufacturing in dentistry. Lastly, we sketched out some challenges and future directions of additive manufacturing technology in dentistry.
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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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PSI-Guided Mandible-First Orthognathic Surgery: Maxillo-Mandibular Position Accuracy and Vertical Dimension Adjustability. J Pers Med 2021; 11:jpm11111237. [PMID: 34834588 PMCID: PMC8622626 DOI: 10.3390/jpm11111237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/06/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
In orthognathic surgery, patient-specific osteosynthesis implants (PSIs) represent a novel approach for the reproduction of the virtual surgical planning on the patient. The aim of this study is to analyse the quality of maxillo-mandibular positioning using a hybrid mandible-first mandibular-PSI-guided procedure on twenty-two patients while the upper maxilla was fixed using manually bent stock titanium miniplates. The virtual surgical plan was used to design PSIs and positioning guides, which were then 3D printed using biocompatible materials. A Cone Beam Computed Tomography (CBCT) scan was performed one month after surgery and postoperative facial skeletal models were segmented for comparison against the surgical plan. A three-dimensional cephalometric analysis was carried out on both planned and obtained anatomies. A Spearman correlation matrix was computed on the calculated discrepancies in order to achieve a more comprehensive description of maxillo-mandibular displacement. Intraoperatively, all PSIs were successfully applied. The procedure was found to be accurate in planned maxillo-mandibular positioning reproduction, while maintaining a degree of flexibility to allow for aesthetics-based verticality correction in a pitch range between −5.31 and +1.79 mm. Such a correction did not significantly affect the achievement of planned frontal symmetry.
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Randomized Clinical Trial of the Accuracy of Patient-Specific Implants versus CAD/CAM Splints in Orthognathic Surgery. Plast Reconstr Surg 2021; 148:1101-1110. [PMID: 34705785 PMCID: PMC8542074 DOI: 10.1097/prs.0000000000008427] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background: The maxilla position is essential for the aesthetic and functional outcomes of orthognathic surgery. Previous studies demonstrated the advantages of patient-specific implants in orthognathic surgery. However, more data are needed to confirm the superiority of patient-specific implants over surgical splints created with computer-aided design/computer-aided manufacturing (CAD/CAM). This randomized controlled trial aimed to compare the accuracy of patient-specific implants and CAD/CAM splints for maxilla repositioning in orthognathic surgery. Methods: Patients (n = 64) who required orthognathic surgery were randomly assigned to use either patient-specific implants (patient-specific implant group) or CAD/CAM surgical splints (splint group) to reposition the maxilla. The outcome evaluation was completed by comparing virtual plans with actual results. The primary outcome was the discrepancies of the centroid position of the maxilla. Other translation and orientation discrepancies of the maxilla were also assessed. Results: The authors analyzed 27 patients in the patient-specific implant group and 31 in the splint group. The maxilla position discrepancy was 1.41 ± 0.58 mm in the patient-specific implant group and 2.20 ± 0.94 mm in the splint group; the between-group difference was significant (p < 0.001). For the patient-specific implant group, the largest translation discrepancy was 1.02 ± 0.66 mm in the anteroposterior direction, and the largest orientation discrepancy was 1.85 ± 1.42 degrees in pitch. For the splint group, the largest translation discrepancy was 1.23 ± 0.93 mm in the mediolateral direction, and the largest orientation discrepancy was 1.72 ± 1.56 degrees in pitch. Conclusion: The result showed that using patient-specific implants in orthognathic surgery resulted in a more accurate maxilla position than CAD/CAM surgical splints. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
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Yusa K, Ishikawa S, Takagi A, Kunii S, Iino M. Bone marrow space volume of the mandible influencing intraoperative blood loss in bilateral sagittal split osteotomy: A pilot Study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:429-433. [PMID: 34715408 DOI: 10.1016/j.jormas.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate whether the bone marrow space volume of the mandible affects blood loss during bilateral sagittal split osteotomy (BSSO). Sixteen patients who underwent BSSO in our hospital were included in this study. Bone marrow space volume of the mandible was measured by analyzing images from computed tomography. Blood loss during BSSO was measured by weighing gauze, measuring suctioned blood, and adjusting for the volume of irrigation solution used during BSSO. Mean blood loss during BSSO for the 16 patients was 200.5 ml, and patients were divided into: Group I, with less than mean blood loss; and Group II, with greater than mean blood loss. Total bone marrow space volume was significantly greater in Group II (12,450.7 ± 2644.3 mm3) than in Group I (9130.3 ± 3005.8 mm3; P<0.05). A correlation between bone marrow space volume and blood loss during BSSO was suggested, and these results are beneficial for surgeons planning and preparing the orthognathic surgery.
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Affiliation(s)
- Kazuyuki Yusa
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan.
| | - Shigeo Ishikawa
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Akira Takagi
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Shunsuke Kunii
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Mitsuyoshi Iino
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
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Manninen AA, Törnwall J, Horelli JC, Heliövaara AK, Mesimäki KV, Lindford AJ, Wilkman TSE, Lassus P. Virtual 3D planning and prediction accuracy in two bimaxillary face transplantations in Helsinki. J Plast Reconstr Aesthet Surg 2021; 75:605-612. [PMID: 34794919 DOI: 10.1016/j.bjps.2021.09.061] [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: 08/31/2019] [Revised: 04/19/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to describe the 3D planning process used in our two composite face transplantations and to analyze the accuracy of a virtual transplantation in predicting the end-result of face transplantation. METHODS The study material consists of two bimaxillary composite face transplantations performed in the Helsinki University Hospital in 2016 and 2018. Computed tomography (CT) scans of the recipient and donor were used to define the osteotomy lines and perform the virtual face transplantation and to 3D print customized osteotomy guides for recipient and donor. Differences between cephalometric linear and angular measurements of the virtually simulated and the actual postoperative face transplantation were calculated. RESULTS No changes to the planned osteotomy lines were needed during surgery. The differences in skeletal linear and angular measurements of the virtually simulated predictions and the actual postoperative face transplantations of the two patients varied between 0.1-5.6 mm and 0.7°-4°. The postoperative skeletal relationship between maxilla and mandible in both patients were almost identical in comparison to the predictions. CONCLUSIONS 3D planning is feasible and provides close to accurate bone reconstruction in face transplantation. Preoperative virtual transplantation assists planning and improves the outcome in bimaxillary face transplantation.
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Affiliation(s)
- Atte A Manninen
- Department of Plastic Surgery, Helsinki University Hospital (HUS), University of Helsinki, Finland.
| | - Jyrki Törnwall
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital (HUS), Finland
| | | | - Arja K Heliövaara
- Cleft palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital, Finland
| | - Karri V Mesimäki
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital (HUS), Finland
| | - Andrew J Lindford
- Department of Plastic Surgery, Helsinki University Hospital (HUS), University of Helsinki, Finland
| | - Tommy S E Wilkman
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital (HUS), Finland
| | - Patrik Lassus
- Department of Plastic Surgery, Helsinki University Hospital (HUS), University of Helsinki, Finland
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Quast A, Santander P, Kahlmeier T, Moser N, Schliephake H, Meyer-Marcotty P. Predictability of maxillary positioning: a 3D comparison of virtual and conventional orthognathic surgery planning. Head Face Med 2021; 17:27. [PMID: 34256775 PMCID: PMC8276391 DOI: 10.1186/s13005-021-00279-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background Virtual surgery planning (VSP) is believed to reduce inaccuracies in maxillary positioning compared to conventional surgery planning (CSP) due to the elimination of face-bow transfer and laboratory steps. However, there is still a lack of comparative studies for the accuracy of splint-based maxillary positioning in CSP versus VSP. Therefore, the objective of this retrospective, observational study was to compare if splints produced by VSP and CSP reach postoperative outcomes within clinically acceptable limits. Methods The planned and actual postoperative results of 52 patients (VSP: n = 26; CSP: n = 26) with a mean age of 24.4 ± 6.2 years were investigated by three-dimensional (3D) alignment with planning software. The conventional treatment plan was digitized, so that the evaluation of both methods was performed in the same manner using the same coordinate system. Inaccuracies were measured by sagittal, vertical and transversal deviations of the upper central incisors and the inclination of the maxillary occlusal plane between the planned and achieved maxillary positions. Results Both methods demonstrated significant differences between the planned and actual outcome. The highest inaccuracies were observed in vertical impaction and midline correction. No significant differences between CSP and VSP were observed in any dimension. Errors in vertical and sagittal dimension intensified each other. Conclusions In conclusion, splint-based surgeries reached similar results regardless of the applied planning method and splint production.
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Affiliation(s)
- Anja Quast
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Petra Santander
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Timon Kahlmeier
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Norman Moser
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Philipp Meyer-Marcotty
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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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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Accuracy and cost effectiveness of a waferless osteotomy approach, using patient specific guides and plates in orthognathic surgery: a systematic review. Br J Oral Maxillofac Surg 2021; 60:537-546. [PMID: 35305840 DOI: 10.1016/j.bjoms.2021.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/03/2021] [Indexed: 11/21/2022]
Abstract
The aim of this systematic review is to evaluate the accuracy of waferless osteotomy procedures in orthognathic surgery with a secondary aim to determine the cost-effectiveness of the procedure. A literature search was conducted on the databases PubMed and Scopus, with PRISMA guidelines followed. An initial yield of 4149 articles were identified, ten of which met the desired inclusion criteria. The total sample of patients undergoing waferless osteotomies included in this review was 142 patients. Nine of the studies used surgical cutting guides along with customised surgical plates to eliminate the surgical wafer and one study used pre-bent locking plates instead of customised plates. The eligible articles determined their surgical accuracy by comparing the positions of bony or dental landmarks on the pre-operative and post-operative images. The articles all reported acceptable accuracy within previously established clinical parameters. The majority of authors concluded that it is an accurate surgical approach and can be cost effective which is often a barrier to novel techniques however there were studies that contrasted the view of the cost efficacy. Due to the lack of published randomised controlled trials, current evidence is not strong enough to recommend the use of surgical cutting guides and customised/pre-bent plates for orthognathic surgery.
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Harding J, Hartsfield JK, Mian AS, Allan BP, Naoum S, Lee RJH, Goonewardene MS. Accuracy of mandibular proximal segment position using virtual surgical planning and custom osteosynthesis plates. Int J Oral Maxillofac Surg 2021; 51:219-225. [PMID: 33941394 DOI: 10.1016/j.ijom.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/23/2021] [Accepted: 04/07/2021] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to determine whether the use of custom osteosynthesis plates increased the accuracy of proximal segment position following bilateral sagittal split osteotomy in a cohort of 30 patients when compared to a control group of 25 patients who had surgery with conventional plates. Surgery was performed by a single surgeon between October 2015 and December 2017. Post-surgical cone beam computed tomography scans were segmented using Mimics Innovation Suite (Materialise NV), and surface-based superimposition was achieved using ProPlan CMF (Materialise NV). However, there was a tendency for the rotational error to be smaller in the custom group than in the control group. The root mean square error in both groups and for all variables fell within clinical parameters of 2 mm and 4°. In conclusion, the results of this study indicate that customized mandibular fixation plates do not necessarily improve the accuracy of the proximal segments post-surgically; however they may be of benefit in individual patients.
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Affiliation(s)
- J Harding
- Orthodontic Department, UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - J K Hartsfield
- Orthodontics and Oral Health Research, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA; Division of Oral Development and Behavioural Sciences, UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - A S Mian
- School of Computer Science and Software Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - B P Allan
- Private Maxillofacial Surgery Practice, Perth, Australia
| | - S Naoum
- Orthodontic Department, UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - R J H Lee
- Orthodontic Department, UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - M S Goonewardene
- Orthodontic Department, UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia.
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Abstract
OBJECTIVE Orthognathic surgery is an effective method to correct the dentomaxillofacial deformities. The aim of the study is to introduce the robot-assisted orthognathic surgery and demonstrate the accuracy and feasibility of robot-assisted osteotomy in transferring the preoperative virtual surgical planning (VSP) into the intraoperative phase. METHODS The CMF robot system, a craniomaxillofacial surgical robot system was developed, consisted of a robotic arm with 6 degrees of freedom, a self-developed end-effector, and an optical localizer. The individualized end-effector was installed with reciprocating saw so that it could perform osteotomy. The study included control and experimental groups. In control group, under the guidance of navigation system, surgeon performed the osteotomies on 3 skull models. In experimental group, according to the preoperative VSP, the robot completed the osteotomies on 3 skull models automatically with assistance of navigation. Statistical analysis was carried out to evaluate the accuracy and feasibility of robot-assisted orthognathic surgery and compare the errors between robot-assisted automatic osteotomy and navigation-assisted manual osteotomy. RESULTS All the osteotomies were successfully completed. The overall osteotomy error was 1.07 ± 0.19 mm in the control group, and 1.12 ± 0.20 mm in the experimental group. No significant difference in osteotomy errors was found in the robot-assisted osteotomy groups (P = 0.353). There was consistence of errors between robot-assisted automatic osteotomy and navigation-assisted manual osteotomy. CONCLUSION In robot-assisted orthognathic surgery, the robot can complete an osteotomy according to the preoperative VSP and transfer a preoperative VSP into the actual surgical operation with good accuracy and feasibility.
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Pillai S, Upadhyay A, Khayambashi P, Farooq I, Sabri H, Tarar M, Lee KT, Harb I, Zhou S, Wang Y, Tran SD. Dental 3D-Printing: Transferring Art from the Laboratories to the Clinics. Polymers (Basel) 2021; 13:polym13010157. [PMID: 33406617 PMCID: PMC7795531 DOI: 10.3390/polym13010157] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/14/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022] Open
Abstract
The rise of three-dimensional (3D) printing technology has changed the face of dentistry over the past decade. 3D printing is a versatile technique that allows the fabrication of fully automated, tailor-made treatment plans, thereby delivering personalized dental devices and aids to the patients. It is highly efficient, reproducible, and provides fast and accurate results in an affordable manner. With persistent efforts among dentists for refining their practice, dental clinics are now acclimatizing from conventional treatment methods to a fully digital workflow to treat their patients. Apart from its clinical success, 3D printing techniques are now employed in developing haptic simulators, precise models for dental education, including patient awareness. In this narrative review, we discuss the evolution and current trends in 3D printing applications among various areas of dentistry. We aim to focus on the process of the digital workflow used in the clinical diagnosis of different dental conditions and how they are transferred from laboratories to clinics. A brief outlook on the most recent manufacturing methods of 3D printed objects and their current and future implications are also discussed.
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Affiliation(s)
- Sangeeth Pillai
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (S.P.); (A.U.); (P.K.); (H.S.); (M.T.); (K.T.L.); (I.H.); (S.Z.); (Y.W.)
| | - Akshaya Upadhyay
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (S.P.); (A.U.); (P.K.); (H.S.); (M.T.); (K.T.L.); (I.H.); (S.Z.); (Y.W.)
| | - Parisa Khayambashi
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (S.P.); (A.U.); (P.K.); (H.S.); (M.T.); (K.T.L.); (I.H.); (S.Z.); (Y.W.)
| | - Imran Farooq
- Faculty of Dentistry, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - Hisham Sabri
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (S.P.); (A.U.); (P.K.); (H.S.); (M.T.); (K.T.L.); (I.H.); (S.Z.); (Y.W.)
| | - Maryam Tarar
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (S.P.); (A.U.); (P.K.); (H.S.); (M.T.); (K.T.L.); (I.H.); (S.Z.); (Y.W.)
| | - Kyungjun T. Lee
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (S.P.); (A.U.); (P.K.); (H.S.); (M.T.); (K.T.L.); (I.H.); (S.Z.); (Y.W.)
| | - Ingrid Harb
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (S.P.); (A.U.); (P.K.); (H.S.); (M.T.); (K.T.L.); (I.H.); (S.Z.); (Y.W.)
| | - Stephanie Zhou
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (S.P.); (A.U.); (P.K.); (H.S.); (M.T.); (K.T.L.); (I.H.); (S.Z.); (Y.W.)
| | - Yifei Wang
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (S.P.); (A.U.); (P.K.); (H.S.); (M.T.); (K.T.L.); (I.H.); (S.Z.); (Y.W.)
| | - Simon D. Tran
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (S.P.); (A.U.); (P.K.); (H.S.); (M.T.); (K.T.L.); (I.H.); (S.Z.); (Y.W.)
- Correspondence: ; Tel.: +1-514-398-7203
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Zigterman BGR, Huys SEF, Mommaerts MY. Third-generation slotplates for orthognathic and facial corrective surgery. J Craniomaxillofac Surg 2020; 49:17-23. [PMID: 33229067 DOI: 10.1016/j.jcms.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 07/02/2020] [Accepted: 11/02/2020] [Indexed: 02/03/2023] Open
Abstract
The aim of this study was to retrospectively assess the osteosynthesis material-related morbidity rates of third-generation (3.0) slotplates, and to compare those with the previously researched second-generation (2.0) slotplates. In the 2.0 slotplate design, there were additional tabs in line with the vertical slotted screw hole; in between these tabs, the additional locking screw was placed. In the 3.0 slotplates, these tabs were replaced by a full screw hole for the locking screw, and the 3.0 slotplates are slightly broader than the 2.0 slotplates. Osteosynthesis material-related morbidity rates after Le Fort I-type, zygoma-valgisation, and chin osteotomies were assessed in a cohort receiving 3.0 slotplates in a tertiary care centre and compared to a previously analysed cohort receiving 2.0 slotplates in the same tertiary care centre. Medical records of 77 patients (101 surgeries) receiving 3.0 slotplates were reviewed. Plate infection and plate removal rates were low in the 3.0 slotplate group (2.6% (p = 0.123) and 3.9% (p = 0.103), respectively). No delayed union or non-union occurred in the 3.0 slotplate group. Comparing the morbidity rates with the 2.0 slotplate cohort did not yield any significant differences. Although there was a tendency towards better outcomes with 3.0 slotplates compared to the 2.0 slotplates, the outcome differences did not reach statistical significance.
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Affiliation(s)
- Brandaan G R Zigterman
- European Face Centre (Chair: Prof. Maurice Y. Mommaerts), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium.
| | - Stijn E F Huys
- Department of Mechanical Engineering, Biomechanics Section, KU Leuven, Leuven, Belgium; R&D Officer, CADskills BVBA, Gent, Belgium
| | - Maurice Y Mommaerts
- European Face Centre (Chair: Prof. Maurice Y. Mommaerts), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
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Karanxha L, Rossi D, Hamanaka R, Giannì AB, Baj A, Moon W, Del Fabbro M, Romano M. Accuracy of splint vs splintless technique for virtually planned orthognathic surgery: A voxel-based three-dimensional analysis. J Craniomaxillofac Surg 2020; 49:1-8. [PMID: 33277160 DOI: 10.1016/j.jcms.2020.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/20/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE This study compared two transferring methods for virtually planned orthognathic surgery - the CAD/CAM intermediate splint and the customized surgical guide with fixation plates. METHODS This was a prospective clinical study in which participants were consecutively recruited and underwent bimaxillary orthognathic surgery. They were divided into two groups based on the transferring method used. The pre- and postoperative CBCTs were aligned using voxel-based landmark-free registration, and the discrepancies for selected points were compared with the planned displacement of the virtually planned surgery. The maxilla and mandible were analyzed separately, and translation and rotation movements were considered. RESULTS A total of 16 patients, divided into two groups of eight patients each, were included in this study. The splintless group was significantly more accurate for the translation movement along the x-axes for points A (p = 0.008; mean absolute error 0.527 ± 0.387 for the splint group and 0.137 ± 0.067 for the splintless group) and Ans (p = 0.045; mean absolute error 0.535 ± 0.446 for the splint group and 0.156 ± 0.002 for the splintless group). For the mandible there was a significant difference in accuracy along the x-axes for points B (p = 0.049; mean absolute errors 1.728 ± 1.181 and 0.697 ± 0.519 for the splint and splintless groups, respectively), LL3 (p = 0.049; mean absolute error 1.629 ± 0.912 and 0.851 ± 0.797 for the splint and splintless groups, respectively), LR3 (p = 0.049; mean absolute error 1.711 ± 0.906 and 0.844 ± 0.780 for the splint and splintless groups, respectively), with the splintless group being more accurate. For the rotation the splintless group was significantly more accurate along the y-axes (p = 0.04; mean absolute error 1.62 ± 0.78 and 0.49 ± 0.31 for the splint and splintless groups, respectively) and z-axes (p = 0.04; mean absolute error 0.63 ± 0.45 and 0.17 ± 0.05 for the splint and splintless groups, respectively) for the maxilla, while no significant difference was found for the mandible. CONCLUSIONS Overall, the customized fixation plate system is more accurate than the intermediate CAD/CAM splint for transferring the virtual plan into the operation room.
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Affiliation(s)
- Lorena Karanxha
- Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi di Milano, Milan, Italy.
| | - Diego Rossi
- Maxillo-Facial and Dental Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Ryo Hamanaka
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Biomedical Sciences, Nagasaki University, Japan; Section of Orthodontics, School of Dentistry, University of California, Los Angeles, USA
| | - Aldo Bruno Giannì
- Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi di Milano, Milan, Italy; Maxillo-Facial and Dental Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Baj
- Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi di Milano, Milan, Italy; Maxillo-Facial and Dental Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Won Moon
- Section of Orthodontics, School of Dentistry, University of California, Los Angeles, USA
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Michele Romano
- Maxillo-Facial and Dental Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Milan, Italy
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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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Deformation Assessment of the Manually Pre-bent Titanium Miniplates in Orthognathic Surgery With Finite Element Analysis. J Craniofac Surg 2020; 32:883-887. [PMID: 33038180 DOI: 10.1097/scs.0000000000007125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study summarized the literature regarding the application of pre-bent titanium miniplates in orthognathic surgery and evaluated the extra deformation of the manually pre-bent titanium miniplates via finite element analysis for acquiring higher surgical accuracy. The literature was reviewed with a chart. Three models of titanium miniplates with different thicknesses (1.0 mm, 0.8 mm, 0.6 mm) were created using COMSOL Multiphysics software for biomechanical behavior analysis. The 3 models were virtually bent into 5 angles (15 degree, 30 degree, 45 degree, 60 degree, 80 degree). respectively to simulate the preoperative virtual bending, then to simulate the practical manual bending via finite element analysis. The stresses and displacements of these models were recorded. The models from virtual bending simulation and manual bending simulation were registered to analyze the deviations. The results showed that the maximum stress and the displacement deviations between the virtual bending models and the manual bending models increased with the thickness and bending angle of the pre-bent miniplate models. To improve the surgical accuracy, measures should be applied to the manually pre-bent titanium miniplates to reduce the extra deformation when the plate being thicker and the bending angle being larger.
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Qaisi M, Boukheir MA, Shah B, Murphy J. The Predictive Hole Technique: A Technical Note. J Oral Maxillofac Surg 2020; 79:722-727. [PMID: 33010217 DOI: 10.1016/j.joms.2020.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/09/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
We describe a novel technique in which predictive holes, normally unique to patient-specific plates, may be utilized with off the shelf stock plates. This allows for the numerous benefits of predictive holes in mandibular reconstruction while negating the added cost of a custom milled plate. Three case examples are presented for technique illustration.
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Affiliation(s)
- Mohammed Qaisi
- Professor of Oral & Maxillofacial Surgery, Midwestern University, Program Director, Division of Oral & Maxillofacial Surgery, Adjunct Attending Physician, Division of Otolaryngology, Cook County Health, Chicago, IL.
| | - Mohamed Ali Boukheir
- Chief Resident, Division of Oral & Maxillofacial Surgery, Cook County Health, Chicago, IL
| | - Biraj Shah
- Assistant Professor of Oral & Maxillofacial Surgery, Midwestern University, Attending Physician, Division of Oral & Maxillofacial Surgery, Cook County Health, Chicago, IL
| | - James Murphy
- Associate Professor of Oral & Maxillofacial Surgery, Midwestern University, Attending Physician, Division of Oral & Maxillofacial Surgery, Adjunct Attending Physician, Division of Otolaryngology, Cook County Health, Chicago, IL
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Accuracy and reliability of voxel-based dentoalveolar registration (VDAR) in orthognathic surgical patients: a pilot study with two years' follow-up. Br J Oral Maxillofac Surg 2020; 59:413-418. [PMID: 33714624 DOI: 10.1016/j.bjoms.2020.08.033] [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: 03/02/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to validate the applicability of using maxillary voxel-based dentoalveolar registration (VDAR) at long-term follow up in orthognathic surgical patients. A retrospective sample of 25 patients (skeletal class II or III) who underwent bimaxillary orthognathic surgery was recruited and divided into two groups. Group A included 15 patients (seven females, eight males, mean (SD) age 25.8 (14.4) years) with unrestored dentition and group B involved 10 patients (five females, five males, mean (SD) age: 26.2 (11.9) years) with dental restorative treatment. Postoperative cone-beam computed tomography (CBCT) scans were acquired at four time-points, one to six weeks (T1), six months (T2), one year (T3) and two years (T4). Voxel- based registration was applied using the cranial base and then complete dental segment with part of the alveolar bone at T1-T2, T1-T3 and T1-T4 time-intervals. The translational and rotational accuracy and reproducibility of the registered maxillary segment was evaluated at these three intervals by analysing the transformation matrix using singular value decomposition. All translational and rotational measurements showed excellent reliability in both groups without any significant difference. The combined translational and rotational difference was found to be within the clinically acceptable range of 2mm and 4°. The VDAR was found to be accurate and reliable to be utilised for a long-term skeletal follow-up in orthognathic surgical patients.
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Validation of a patient-specific system for mandible-first bimaxillary surgery: ramus and implant positioning precision assessment and guide design comparison. Sci Rep 2020; 10:13317. [PMID: 32770002 PMCID: PMC7415134 DOI: 10.1038/s41598-020-70107-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/25/2020] [Indexed: 11/09/2022] Open
Abstract
In orthognathic surgery, the use of patient-specific osteosynthesis devices is a novel approach used to transfer the virtual surgical plan to the patient. The aim of this study is to analyse the quality of mandibular anatomy reproduction using a mandible-first mandibular-PSI guided procedure on 22 patients. Three different positioning guide designs were compared in terms of osteosynthesis plate positioning and mandibular anatomical outcome. PSIs and positioning guides were designed according to virtual surgical plan and 3D printed using biocompatible materials. A CBCT scan was performed 1 month after surgery and postoperative mandibular models were segmented for comparison against the surgical plan. A precision comparison was carried out among the three groups. Correlations between obtained rami and plates discrepancies and between planned rami displacements and obtained rami discrepancies were calculated. Intraoperatively, all PSIs were successfully applied. The procedure was found to be accurate in planned mandibular anatomy reproduction. Different guide designs did not differ in mandibular outcome precision. Plate positional discrepancies influenced the corresponding ramus position, mainly in roll angle and vertical translation. Ramus planned displacement was found to be a further potential source of inaccuracy, possibly due to osteosynthesis surface interference.
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Dodier P, Winter F, Auzinger T, Mistelbauer G, Frischer JM, Wang WT, Mallouhi A, Marik W, Wolfsberger S, Reissig L, Hammadi F, Matula C, Baumann A, Bavinzski G. Single-stage bone resection and cranioplastic reconstruction: comparison of a novel software-derived PEEK workflow with the standard reconstructive method. Int J Oral Maxillofac Surg 2020; 49:1007-1015. [DOI: 10.1016/j.ijom.2019.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/07/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
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47
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Figueiredo CE, Paranhos LR, da Silva RP, Herval ÁM, Blumenberg C, Zanetta-Barbosa D. Accuracy of orthognathic surgery with customized titanium plates-Systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:88-97. [PMID: 32622000 DOI: 10.1016/j.jormas.2020.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/24/2020] [Indexed: 10/23/2022]
Abstract
This systematic review aimed to evaluate the accuracy of customized titanium plates in orthognathic surgery compared to standard outcome in virtual surgical planning. PRISMA and JBI guidelines were followed. Research protocol was registered in PROSPERO. Six databases and two gray literature repositories were used as sources of research articles. Descriptive clinical studies, that performed orthognathic surgery using custom titanium plates, were included. Risk of bias was assessed by "The Joanna-Briggs Institute Critical Appraisal tools for use in Systematic Reviews Checklist for Case Series". Of the 11,916 studies initially identified, seven met the eligibility criteria and were included. The studies were published between 2015 and 2019. Most of the studies (57%) had a low risk of bias, while one had a high risk of bias. Total sample included 74 patients with 63 bimaxillary surgeries and 11 unimaxillary surgeries. All studies showed acceptable accuracy within previously established clinical parameters. Although the eligible articles assessed the accuracy of the orthognathic surgery with respect to virtual planning, the wide variability of evaluation methodologies made it impossible to calculate a combined accuracy measure. It was not possible to perform a meta-analysis, so a pragmatic recommendation on the use of these plates is not possible.
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Affiliation(s)
- C E Figueiredo
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - L R Paranhos
- Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil.
| | - R P da Silva
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Á M Herval
- Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - C Blumenberg
- Centre for Epidemiological Research, International Centre for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - D Zanetta-Barbosa
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
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Philippe B. Accuracy of position of cutting and drilling guide for sagittal split guided surgery: a proof of concept study. Br J Oral Maxillofac Surg 2020; 58:940-946. [PMID: 32448723 DOI: 10.1016/j.bjoms.2020.04.034] [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: 09/21/2019] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
The benefits of three-dimensional planning and guided surgery have been realised over the last few years in maxillofacial surgery. Reproducing the exact positioning of the cutting and drilling guides on the flat mandibular angles defined by the engineer is a challenge for the surgeon and for the reliability of guided bilateral sagittal split osteotomy. Reference screws positioned on the skeleton before the acquisition of medical computed tomographic data can provide a fixed landmark that can be used during surgery and by the engineer during the design phase. The objective of this proof of concept in vitro study is to calculate the accuracy obtained for guides positioned by inserting a reference screw. The precision obtained for 30 guides following the insertion of 30 reference screws on 15 mandibular models was analysed. The models were scanned using an optical scanner and compared to CAD-CAM projects. The mean (SD) absolute position (in)-inaccuracy is 0.1616 (0.1141) mm for the entire guide surface and 0.13143 (0.0835) mm for the rim surface. The results indicate that the use of reference screws is efficient, and so they can be used to position guides accurately during guided bilateral sagittal split osteotomy.
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Affiliation(s)
- B Philippe
- Private Practice, 19, rue de Téhéran, 75008 Paris, France; Consultant, DRA Villa 747 Jumeirah Beach Road, Dubai, United Arab Emirates.
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49
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Tonin RH, Iwaki Filho L, Yamashita AL, Ferraz FWDS, Tolentino EDS, Previdelli ITDS, Brum B, Iwaki LCV. Accuracy of 3D virtual surgical planning for maxillary positioning and orientation in orthognathic surgery. Orthod Craniofac Res 2020; 23:229-236. [PMID: 31925879 DOI: 10.1111/ocr.12363] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/15/2019] [Accepted: 12/31/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This retrospective and observational study evaluated the accuracy of a 3D virtual surgical planning (VSP) for the maxillary positioning and orientation in patients undergoing bimaxillary orthognathic surgery, comparing the planned and postoperative outcomes. SETTING AND SAMPLE POPULATION Seventy consecutive patients of both sexes, who were submitted to bimaxillary orthognathic surgery between 2015 and 2019 were included in our study. MATERIAL AND METHODS The patients were evaluated by fusing preoperative planning and postoperative outcome using cone-beam computed tomography scan evaluation. Three-dimensional VSP and postoperative outcomes were compared by using three linear and three angular measurements. The main outcome interest was the difference between the VSP movement, and the surgical movement obtained. The success criterion adopted was a mean linear difference of <2 mm and a mean angular difference of <4°. RESULTS Results were analysed using a linear mixed model with fixed and random effects, at α = .05. No significant statistical differences were found for linear and angular measurements between the planned and postsurgical outcomes (P > .05). All overlapping points presented values within the range considered clinically irrelevant (<2 mm; <1°). CONCLUSIONS Three-dimensional VSP was executed with a high degree of accuracy. When comparing the planned and postsurgical outcomes, all overlapping points presented values within the range considered clinically irrelevant.
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Affiliation(s)
| | | | | | - Flávio Wellington da Silva Ferraz
- Oral and Maxillofacial Surgery Department, Clinics Hospital of Medicine School and University Hospital of the University of São Paulo, São Paulo, Brazil
| | | | | | - Beatriz Brum
- Statistic Department, State University of Maringá, Maringá, Brazil
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Mathew S, Antony P, Nandagopal N, Sebastian A. New, easier, effective, and stable splinting technique for maxillofacial osteotomy. Br J Oral Maxillofac Surg 2019; 57:948-949. [DOI: 10.1016/j.bjoms.2019.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
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