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Habib AA, Sharara AA, Yousry TN, Swidan AO. Accuracy of computer-assisted design and manufactured three-dimensional device for condylar positioning in mandibular bilateral sagittal split osteotomy (clinical trial). Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:331-337. [PMID: 38155012 DOI: 10.1016/j.oooo.2023.11.001] [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: 09/21/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Aligning dental arches in orthognathic treatment after undergoing LeFort I osteotomy or bilateral sagittal split osteotomy (BSSO) relies on occlusal splints, which do not provide precise control over the condylar head. AIM OF THE STUDY To clinically and radiographically assess the accuracy of computer-assisted design and manufactured (CAD/CAM) surgical guide for condylar positioning in a BSSO. MATERIALS AND METHODS The study recruited 8 patients with a non-syndromic dentofacial deformity who underwent a BSSO. Surgery was planned according to CAD/CAM technology. After osteotomy, a pre-operative guide was used, followed by a repositioning guide. Computed tomography scans were conducted on all patients 1 week pre-operatively, immediately, and 3 months postoperatively. RESULTS The data are presented as median values with the 25th and 75th percentiles. Eight patients (37.50% females and 62.50% males) between the ages of 19 and 24 underwent BSSOs. The surgical procedure successfully corrected their skeletal deformities. The absolute change between immediate postoperative and pre-operative condylar angle was 0.15 (0.00-0.3). The absolute change between 3 months postoperative and pre-operative condylar angle was 0.20 (0.00-0.30). CONCLUSION The stability of the condylar head in position is well assessed by 3-dimensional condylar positioning devices designed and manufactured by CAD/CAM technology in the mandibular BSSO.
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Affiliation(s)
- Aliaa A Habib
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Ahmed A Sharara
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Tarek N Yousry
- Orthodontics Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Ahmed O Swidan
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Mancino AV, Milano FE, Risk MR, Ritacco LE. Open-source navigation system for tracking dissociated parts with multi-registration. Int J Comput Assist Radiol Surg 2023; 18:2167-2177. [PMID: 36881354 DOI: 10.1007/s11548-023-02853-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 02/08/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE During reconstructive surgery, knee and hip replacements, and orthognathic surgery, small misalignments in the pose of prosthesis and bones can lead to severe complications. Hence, the translational and angular accuracies are critical. However, traditional image-based surgical navigation lacks orientation data between structures, and imageless systems are unsuitable for cases of deformed anatomy. We introduce an open-source navigation system using a multiple registration approach that can track instruments, implants, and bones to precisely guide the surgeon in emulating a preoperative plan. METHODS We derived the analytical error of our method and designed a set of phantom experiments to measure its precision and accuracy. Additionally, we trained two classification models to predict the system reliability from fiducial points and surface matching registration data. Finally, to demonstrate the procedure feasibility, we conducted a complete workflow for a real clinical case of a patient with fibrous dysplasia and anatomical misalignment of the right femur using plastic bones. RESULTS The system is able to track the dissociated fragments of the clinical case and average alignment errors in the anatomical phantoms of [Formula: see text] mm and [Formula: see text]. While the fiducial-points registration showed satisfactory results given enough points and covered volume, we acknowledge that the surface refinement step is mandatory when attempting surface matching registrations. CONCLUSION We believe that our device could bring significant advantages for the personalized treatment of complex surgical cases and that its multi-registration attribute is convenient for intraoperative registration loosening cases.
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Affiliation(s)
- A V Mancino
- Instituto Tecnológico de Buenos Aires, Buenos Aires, Argentina.
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.
- Instituto de Medicina Traslacional e Ingeniería Biomédica, Buenos Aires, Argentina.
- Computer Assisted Surgery Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - F E Milano
- Instituto Tecnológico de Buenos Aires, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - M R Risk
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
- Instituto de Medicina Traslacional e Ingeniería Biomédica, Buenos Aires, Argentina
| | - L E Ritacco
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
- Instituto de Medicina Traslacional e Ingeniería Biomédica, Buenos Aires, Argentina
- Computer Assisted Surgery Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Beek DM, Baan F, Liebregts J, Nienhuijs M, Bergé S, Maal T, Xi T. A learning curve in 3D virtual surgical planned orthognathic surgery. Clin Oral Investig 2023:10.1007/s00784-023-05013-2. [PMID: 37083986 DOI: 10.1007/s00784-023-05013-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/29/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES To assess the surgical accuracy of 3D virtual surgical planned orthognathic surgery and the influence of posterior impaction and magnitude of the planned movements on a possible learning curve. MATERIALS AND METHODS This prospective cohort study included subjects who underwent bimaxillary surgery between 2016 and 2020 at the Department of Oral and Maxillofacial Surgery of the Radboud University Medical Center, Nijmegen. 3D virtual surgical planning (VSP) was performed with CBCT data and digitalized dentition data. By using voxel-based matching with pre- and postoperative CBCT data the maxillary movements were quantified in six degrees of freedom. The primary outcome variable, surgical accuracy, was defined as the difference between the planned and achieved maxillary movement. RESULTS Based on 124 subjects, the surgical accuracy increased annually from 2016 to 2020 in terms of vertical translations (0.82 ± 0.28 mm; p = 0.038) and yaw rotations (0.68 ± 0.22°; p = 0.028). An increase in surgical accuracy was observed when combining all six degrees of freedom (p = 0.021) and specifically between 2016 and 2020 (p = 0.004). An unfavorable learning curve was seen with posterior impaction and with a greater magnitude of movements. CONCLUSION The present study demonstrated a significant increase in surgical accuracy annually and therefore supports the presence of a learning curve. CLINICAL RELEVANCE Cases with planned maxillary posterior impaction and/or a great magnitude of jaw movements should be transferred from the 3D VSP with extra care to obtain a satisfactory surgical accuracy.
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Affiliation(s)
- Dirk-Melle Beek
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Frank Baan
- Radboudumc 3D Lab, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Jeroen Liebregts
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Marloes Nienhuijs
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Stefaan Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Thomas Maal
- Radboudumc 3D Lab, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands.
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Xia L, Jiang W, Yao K, Wei S, Yu W, Lu X. Evaluation of treatment with unilateral mandibular sagittal split ramus osteotomy and maxillary osteotomy in patients with condylar osteochondroma and mandibular asymmetry: A retrospective case series. J Craniomaxillofac Surg 2023; 51:123-129. [PMID: 36803856 DOI: 10.1016/j.jcms.2023.01.007] [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: 09/06/2022] [Revised: 10/14/2022] [Accepted: 01/20/2023] [Indexed: 01/22/2023] Open
Abstract
The aim of the study was to describe an approach where condylar resection with condylar neck preservation was combined with Le Fort I osteotomy and unilateral mandibular sagittal split ramus osteotomy (SSRO). Patients with a unilateral condylar osteochondroma combined with dentofacial deformity and facial asymmetry who underwent surgery between January 2020 and December 2020 were enrolled. The operation included condylar resection, Le Fort I osteotomy and contralateral mandibular sagittal split ramus osteotomy (SSRO). Simplant Pro 11.04 software was used to reconstruct and measure the preoperative and postoperative craniomaxillofacial CT images. The deviation and rotation of the mandible, change in the occlusal plane, position of the "new condyle" and facial symmetry were compared and evaluated during follow-up. Three patients were included in the present study. The patients were followed up for 9.6 months on average (range, 8-12). Immediate postoperative CT images showed that the mandible deviation and rotation and occlusion plane canting decreased significantly postoperatively; facial symmetry was improved but still compromised. During the follow-up, the mandible gradually rotated to the affected side, the position of the "new condyle" moved further inside toward the fossa, and both the mandible rotation and facial symmetry were more significantly improved. Within the limitations of the study it seems that for some patients a combination of condylectomy with condylar neck preservation and unilateral mandibular SSRO can be effective in achieving facial symmetry.
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Affiliation(s)
- Liang Xia
- Department of Oral and Cranio-maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, PR China.
| | - Wenxin Jiang
- Department of Stomatology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
| | - Kan Yao
- Department of Oral and Cranio-maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, PR China.
| | - Silong Wei
- Department of Oral and Cranio-maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, PR China.
| | - Wenwen Yu
- Department of Oral and Cranio-maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, PR China.
| | - Xiaofeng Lu
- Department of ENT and Oral Maxillofacial Surgery, Shanghai Children Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
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Computer guided maxillo-malar piezoelectric osteotomies for midface augmentation. J Plast Reconstr Aesthet Surg 2023; 76:34-43. [PMID: 36513002 DOI: 10.1016/j.bjps.2022.10.040] [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: 04/14/2021] [Revised: 07/13/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Despite maxillo-malar osteotomies having been discarded in the most recent literature, in the setting of orthognathic surgery they provide several advantages for middle third augmentation. This paper reintroduces maxillo-malar osteotomies as an effective method to increase volume of midfacial region in combination with contemporary technology, including piezosurgery, virtual surgical planning, and navigation. MATERIAL AND METHODS Eighteen patients with midface hypoplasia were included in this study and underwent orthognathic surgery with maxillo-malar osteotomies. All patients underwent the same workflow: virtual design of maxillo-malar osteotomies, surgery with navigation-assisted piezoelectric osteotomies, and computerized morphometric analysis. RESULTS Simulated maxillo-malar osteotomies were successfully replicated in the operating room, as shown by accuracy evaluation performed using three-dimensional analysis. In long-term follow-up period, no permanent complications were assessed. Superimposition between postoperative and preoperative CBCTs revealed that the soft tissue area influenced by the underlying skeletal movement was comparable for all cases. CONCLUSIONS Virtual surgical planning, navigation, and piezosurgery are today indispensable tools to perform maxillo-malar osteotomies safely and accurately. We suggest incorporating such osteotomies in the surgeon's armamentarium for patients with severe midfacial hypoplasia as they offer an integrated solution to restore functionality and aesthetics.
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Clinical Application of Digital Joint Guide in the Fracture of the Condyle Neck. J Craniofac Surg 2022; 33:e636-e641. [PMID: 35882243 DOI: 10.1097/scs.0000000000008717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study is to use a digital guide plate for joint positioning to assist the reduction of condylar neck fractures and evaluate the accuracy of the reduction after surgery. MATERIALS AND METHODS In this study, 20 patients were selected from January 2016 to October 2020, and the reduction of the mandibular condyle neck fracture was designed virtual and digital based on the computed tomography data of the patients, based on the position of the condyle in the articular socket, the height of the ascending mandibular ramus, and the joints. The average value of the anterior space and the posterior space of the joint is these indicators, the position of the condyle is reconstructed, and the fracture reduction finger guide plate is designed. During the operation, the digital guide plate is used to assist the reduction of the condyle neck fracture. The postoperative follow-up was 4 to 12 months to check the accuracy of the reduction. RESULTS A total of 20 patients, all fractures achieved complete bone healing, the patients' mouth opening was normal, no obvious complications were found, and none of the patients had facial paralysis. In the postoperative evaluation and preoperative virtual design plan, the chromatographic error was within 2 mm, and the magnetic resonance of the temporomandibular joint showed no displacement of the articular disc. CONCLUSION The digital joint guide can reduce the fracture of the condyle neck while ensuring the position of the condyle in the joint socket, which is beneficial to reduce the occurrence of subsequent temporomandibular joint complications.
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The Predictability of the Surgical Outcomes of Class III Patients in the Transverse Dimension—A Study of Three-Dimensional Assessment. J Pers Med 2022; 12:jpm12071147. [PMID: 35887645 PMCID: PMC9316286 DOI: 10.3390/jpm12071147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to assess the outcomes of planned maxillary surgical movements in the transverse direction in patients possessing a Class III skeletal pattern. The available consecutive patients’ records were retrospectively reviewed. Only those possessing a Class III skeletal pattern, and for whom the same virtual planning system was used, were enrolled. The waferless technique was used to guide the jawbone repositioning. A representative triangle in the virtual maxilla of each stage was used to validate the planned surgical movements (PSMs) and the outcome discrepancy (OD). The linear and angular measurements were retrieved for the assessments of the correlation between PSM and OD. In total, 44 adult patients who met the inclusion criteria were studied. The average linear OD of the A-point in the transverse direction was 0.66 ± 0.54 mm, and the yaw correction showed 1.02 ± 0.84 degrees in difference. There was no specific correlation between the linear PSMs and ODs; however, the angular ones were positively correlated. With the help of the waferless technique to transfer the virtual planning results, the practitioners could confidently predict the postsurgical maxillary position in the transverse direction in the orthognathic surgery of Class III patients. However, the yaw correction should be carefully planned to avoid postsurgical instabilities.
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Shen CH, Hung TY, Wang M, Chang YC, Fang CY. Utilizing virtual surgical planning and orthognathic surgery to correct severe facial asymmetry without orthodontic treatment. J Dent Sci 2022; 17:647-651. [PMID: 35028112 PMCID: PMC8740078 DOI: 10.1016/j.jds.2021.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 07/20/2021] [Indexed: 11/25/2022] Open
Abstract
Combining double-jaw surgery and orthodontic treatment to correct dentofacial asymmetry is a standard procedure but time consuming and costly. In order to provide alternative solutions, previewing the possible results with precise virtual surgical planning (VSP) system can help clinicians select patients suited for correcting facial asymmetry surgically without orthodontic treatment. In our experiences, after rigid or semirigid fixation of the maxilla, using intermaxillary fixation (IMF) without mandibular bony fixation is another key. This kind of fixation can minimize the chances of changing the condylar position and occlusion after the rotation of the maxillomandibular complex. If the original occlusion can be maintained, then orthodontic treatment can be avoided. Here we presented two facial asymmetry cases who requested surgical correction and refused orthodontic treatment. With careful preoperative planning using VSP, double-jaw surgery with maxillary bony fixation and IMF was conducted and both patients were satisfied by their aesthetic outcomes. With minimal dental compensation, the long-term results were relatively stable.
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Affiliation(s)
- Chih-Hui Shen
- Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tz-Ya Hung
- Department of Dentistry, Songshan Branch, Tri-Service General Hospital, Taipei, Taiwan.,Division of Orthodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Monica Wang
- Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chao Chang
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan.,Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chih-Yuan Fang
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
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Tondin GM, Leal MDOCD, Costa ST, Grillo R, Jodas CRP, Teixeira RG. Evaluation of the accuracy of virtual planning in bimaxillary orthognathic surgery: Systematic review. Br J Oral Maxillofac Surg 2021; 60:412-421. [PMID: 35120785 DOI: 10.1016/j.bjoms.2021.09.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/05/2021] [Indexed: 11/27/2022]
Abstract
The purpose of this research was to evaluate the accuracy of virtual planning in bimaxillary orthognathic surgery in bone by comparing the mean linear and angular measurements of the surgical plan with the actual surgical result. Electronic databases, MEDLINE via PubMed, Web of Science, SCOPUS, the Cochrane Library, grey literature, and the American clinical trials registry (www.ClinicalTrials.gov), were accessed as search engines. The studies consisted of publications on the assessment of accuracy in virtual planning in bimaxillary orthognathic surgery between 2010 and 2020. After application of the eligibility criteria, 26 articles were included, and their quality was evaluated using the methodological index for non-randomised studies (MINORS) tool and Cohen's kappa statistic in the MedCalc program (MedCalc Software Ltd). Evidence obtained by comparing the planning and surgical results, both in the maxilla and mandible, showed that there is great accuracy in virtual planning in bimaxillary orthognathic surgery.
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Affiliation(s)
- Gustavo Marques Tondin
- São Leopoldo Mandic College, Buccomaxillofacial Surgery and Traumatology Department, Campinas, São Paulo, Brazil
| | - Marilia de Oliveira Coelho Dutra Leal
- Institute of Legal Medicine - RR, Brazil/Pos PhD Pathology - Histology Department, Dentistry School, Campinas State University, Piracicaba, São Paulo, Brazil
| | - Sarah Teixeira Costa
- Institute of Criminalistics- SP, Brazil/Dentistry School, Presidente Tancredo Neves University Center, São João del Rei, Minas Gerais, Brazil.
| | - Ricardo Grillo
- São Leopoldo Mandic College, Buccomaxillofacial Surgery and Traumatology Department, Campinas, São Paulo, Brazil
| | | | - Rubens Gonçalves Teixeira
- São Leopoldo Mandic College, Buccomaxillofacial Surgery and Traumatology Department, Campinas, São Paulo, Brazil
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Postsurgical Stability of Temporomandibular Joint of Skeletal Class III Patients Treated with 2-Jaw Orthognathic Surgery via Computer-Aided Three-Dimensional Simulation and Navigation in Orthognathic Surgery (CASNOS). BIOMED RESEARCH INTERNATIONAL 2021; 2021:1563551. [PMID: 34409098 PMCID: PMC8367535 DOI: 10.1155/2021/1563551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/30/2021] [Accepted: 07/20/2021] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study is to clarify the postsurgical stability of temporomandibular joints in skeletal class III patients treated with 2-jaw orthognathic surgery which was performed utilizing computer-aided three-dimensional simulation and navigation in orthognathic surgery (CASNOS) protocol. Materials and Methods 23 consecutive nongrowing skeletal class III patients with mandibular prognathism associated with maxillary retrognathism treated with 2-jaw orthognathic surgery between 2018 and 2019 were enrolled in this study. The surgery was planned according to the standardized protocol of CASNOS (computer-aided three-dimensional simulation and navigation in orthognathic surgery). Computed tomography (CT) scans were performed in all patients 3 weeks presurgically and 6 months postsurgically. ITKSNAP and 3D Slicer software were used to reconstruct three-dimensional facial skeletal images, to carry out image segmentation, and to superimpose and quantify the TMJ position changes before and after surgery. Amount of displacement of the most medial and lateral points of the condyles and the change of intercondylar angles were measured to evaluate the postsurgical stability of TMJ. Results A total amount of 23 skeletal class III patients (female : male = 12 : 11) with age ranged from 20.3 to 33.5 years (mean: 24.39 ± 4.8 years old) underwent Le Fort I maxillary advancement and BSSO setback of the mandible. The surgical outcome revealed the satisfactory correction of their skeletal deformities. The mean displacement of the right most lateral condylar point (RL-RL′) was 1.04 ± 0.42 mm and the mean displacement of the left most lateral condylar point (LL-LL′) was 1.19 ± 0.41 mm. The mean displacement of the right most medial condylar point (RM-RM′) was 1.03 ± 0.39 mm and the left most medial condylar point (LM-LM′) was 0.96 ± 0.39 mm. The mean intercondylar angle was 161.61 ± 5.08° presurgically and 159.28 ± 4.92° postsurgically. Conclusion The postsurgical position of TM joint condyles in our study only presented a mild change with all the landmark displacement within a range of 1.2 mm. This indicates the bimaxillary orthognathic surgery via 3D CASNOS protocol can achieve a desired and stable result of TMJ position in treating skeletal class III adult patients with retrognathic maxilla and prognathic mandible.
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Ho CT, Lai HC, Lin HH, Denadai R, Lo LJ. Outcome of full digital workflow for orthognathic surgery planning in the treatment of asymmetric skeletal class III deformity. J Formos Med Assoc 2021; 120:2100-2112. [PMID: 34092467 DOI: 10.1016/j.jfma.2021.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 03/25/2021] [Accepted: 05/03/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/PURPOSE Studies have reported the advantages of digital imaging-assisted orthognathic surgery planning, but there is scarce information about a full digital planning modality. This study evaluated the 3D cephalometric-based and patient-reported outcomes of a full digital workflow for orthognathic surgery planning in the treatment of asymmetric maxillomandibular disharmony. METHODS A postoperative 3D image dataset of 30 Taiwanese Chinese patients with asymmetric skeletal Class III deformities who underwent full digital planning for two-jaw surgery were retrieved from the authors' database. The 3D cephalometric data (dental, skeletal, and soft tissue evaluations) were compared to the ethnicity-matched 3D cephalometric normative values. Patient-reported outcome measure tools regarding postoperative overall appearance and satisfaction with facial areas (ranging from 0 to 100 and 0 to 10, respectively) were administered. The number of needed or requested revisionary surgery was collected. RESULTS No difference (all p > 0.05) was observed between the orthognathic-surgery-treated patients and the normative value for most of the tested 3D cephalometric parameters, with the exception (p < 0.05) of three mandible and occlusal-plane-related parameters. Both patient-reported outcome measure tools showed that patients' satisfaction with their postoperative appearance was high for overall face (89.7 ± 4.5) and specific facial regions (nose, 7.1 ± 1.3; lip, 8.3 ± 1.6; upper gum, 8.5 ± 1.2; cheek, 8.8 ± 1.1; chin, 9.2 ± 1.2; and teeth, 9.3 ± 0.8), with no need for revisionary surgery. CONCLUSION The patients treated with a full 3D digital planning-assisted two-jaw surgery had a similar 3D dental relation, facial convexity, and symmetry compared to healthy ethnicity-matched individuals, and they reported higher satisfaction levels with their postoperative facial appearance results.
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Affiliation(s)
- Cheng-Ting Ho
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Chih Lai
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Hsia Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Rafael Denadai
- Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Lun-Jou Lo
- Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Gao WL, Lee YH, Tsai CY, Wu TJ, Lai JP, Lin SS, Chang YJ. One-Year Treatment Outcome of Profile Changes After Transcutaneous Maxillary Distraction Osteogenesis in Growing Children With Cleft Lip and Palate. Cleft Palate Craniofac J 2021; 59:299-306. [PMID: 33813912 DOI: 10.1177/10556656211005638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the long-term stability of LeFort I osteotomy followed by distraction osteogenesis with a transcutaneous rigid external device for the treatment of severe maxillary hypoplasia in patients with cleft lip and palate. PATIENTS AND METHODS Nine patients with cleft lip and palate underwent rigid external distraction after a LeFort I osteotomy for maxillary advancement. Lateral cephalometric films were analyzed for assessment of treatment outcome and stability in 1 month, 6 months, and 1 year after distraction. RESULTS Significant maxillary advancement was observed in the horizontal direction, with the anterior nasal spine (ANS) distance of the maxilla increasing by an average of 20.5 ± 5.1 mm after distraction. The ANS relapse rates in 6 months and 1 year were 8.7% and 12.8%, respectively. The mean inclination of upper incisors to the palatal plane was almost unchanged (before: 109.8° ± 6.6°; after: 108.9° ± 7.5°). The movement ratios at the nasal tip/ANS, soft tissue A point/A point, and the upper vermilion border/upper incisor edge were 0.36:1, 0.72:1, and 0.83:1, respectively. CONCLUSION Considerable maxillary advancement was achieved with less change of incisors inclination after distraction. Moreover, the relapse rate after 1 year was minimal. The concave facial profile was improved as well as the facial balance and aesthetics.
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Affiliation(s)
- Wei-Ling Gao
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Yi-Hao Lee
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Chi-Yu Tsai
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Te-Ju Wu
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Jui-Pin Lai
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Shiu-Shiung Lin
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Yu-Jen Chang
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
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Vamvanij N, Chinpaisarn C, Denadai R, Seo HJ, Pai BCJ, Lin HH, Lo LJ. Maintaining the space between the mandibular ramus segments during bilateral sagittal split osteotomy does not influence the stability. J Formos Med Assoc 2021; 120:1768-1776. [PMID: 33775535 DOI: 10.1016/j.jfma.2021.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/PURPOSE Three-dimensional computer-assisted orthognathic surgery allows to simulate the space between the mandibular ramus segments, i.e. intersegmental gap, for the correction of facial asymmetry. The purposes of the study were to estimate the screws- and mandible bone-related changes from the early postoperative period to the period after the debonding and to measure the association between the intersegmental gap volume and the screws- and mandible bone-related changes. METHODS This cone-beam computed tomography (CBCT)-assisted retrospective study assessed the stability of the bicortical positional screw fixations in maintaining the space between the mandibular ramus segments after bilateral sagittal split osteotomy in correction of 31 patients with malocclusion and facial asymmetry. The primary predictor variable was the CBCT-based intersegmental gap volume at early postoperative period (T1). The primary outcome variables were CBCT-based screws- and bone-related measurement changes between the T1 and T2 (at debonding) periods. RESULTS No significant differences were observed in screws-related linear and angular measurements between T1 and T2 virtual models. Some of mandible bone-related linear and angular measurements had significant differences (P < 0.05) between the T1 and T2 images, but with no clinical repercussion such as need of revisionary surgery. The gap volume and the screws- and bone-related changes had no significant correlations. CONCLUSION This study contributes to the multidisciplinary-related literature by demonstrating that the bicortical positional screws-based fixation technique in maintaining the three-dimensional-simulated space between the mandibular ramus segments is a stable and clinically acceptable option for correction of facial asymmetry associated with malocclusion, regardless of intersegmental gap size.
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Affiliation(s)
- Natthacha Vamvanij
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chatchawarn Chinpaisarn
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Rafael Denadai
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Betty C J Pai
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiu-Hsia Lin
- Image Lab and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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Liu S, Li J, Xu C, Zhou H, Liao C, Fei W, Luo E. Effect of computer-assisted design and manufacturing cutting and drilling guides accompanied with pre-bent titanium plates on the correction of skeletal class II malocclusion: a randomized controlled trial. Int J Oral Maxillofac Surg 2021; 50:1320-1328. [PMID: 33685740 DOI: 10.1016/j.ijom.2021.01.023] [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: 07/24/2020] [Revised: 10/27/2020] [Accepted: 01/06/2021] [Indexed: 02/08/2023]
Abstract
This study was performed to assess the effect of correcting skeletal class II malocclusion based on the application of computer-assisted design and manufacturing (CAD/CAM) cutting and drilling guides accompanied with pre-bent titanium plates. Fifty patients with skeletal class II malocclusion were recruited into this prospective randomized controlled clinical trial and assigned to two groups. Patients underwent bilateral sagittal split ramus osteotomy directed by CAD/CAM cutting and drilling guides accompanied with pre-bent titanium plates (group A) or CAD/CAM splints (group B). Postoperative assessments were performed. Differences between the virtually simulated and postoperative models were measured. Patients in both groups had a satisfactory occlusion and appearance. More accurate repositioning of the proximal segment was found in group A than in group B when comparing linear and angular differences to reference planes; however, no significant difference was revealed for the distal segment. In conclusion, CAD/CAM cutting and drilling guides with pre-bent titanium plates can provide considerable surgical accuracy for the positional control of the proximal segments in bilateral sagittal split ramus osteotomy for the correction of skeletal class II deformities.
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Affiliation(s)
- S Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - J Li
- Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - C Xu
- Department of Stomatology, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Chengdu, China
| | - H Zhou
- Department of Stomatology, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Chengdu, China
| | - C Liao
- Department of Stomatology, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Chengdu, China
| | - W Fei
- Department of Stomatology, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Chengdu, China
| | - E Luo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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15
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Kao JH. Highlights. J Formos Med Assoc 2020. [PMCID: PMC7270216 DOI: 10.1016/j.jfma.2020.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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