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Chen PRF, Chuang KT, Hsu SSP, Chen YR, Chen CT. Modification of Sagittal Split Osteotomy in Class II Asymmetry: Optimizing Bone Contact between Proximal and Distal Segments. Plast Reconstr Surg 2024; 153:1142e-1151e. [PMID: 37257138 DOI: 10.1097/prs.0000000000010784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Computer-assisted surgical simulation (CASS) allows more precise orthognathic surgery. However, few studies have evaluated associations between CASS-designed bilateral sagittal split osteotomy (SSO) and bone contact surface in class II mandibular asymmetry. This study aims to evaluate the effects of using computer-assisted simulation and design modification of SSO to improve bony contact in skeletal class II asymmetry. METHODS This retrospective analysis reviewed 28 patients with class II asymmetry who underwent orthognathic surgery, including 15 with modified SSO (group CS) and 13 with conventional SSO (group C). Modified SSO was designed under CASS. Operative characteristics, postoperative outcomes, and complications were collected and compared between the two groups. RESULTS Bony contact was found at the distal end of the proximal segment in all group CS patients, while bone gap was noted in all group C patients ( P < 0.05). Moreover, bone graft was used in four group C patients but was not used in all cases in group CS patients ( P < 0.05). A trend toward lower operative time or perioperative bleeding was noted in group CS, but without statistical significance. After 1-year follow-up, inferior alveolar nerve disturbances were noted in two group CS patients and one group C patient. Palpable bone gap with uneven jaw line was noted in two group C patients 1 year after surgery and one patient received fat graft treatment. CONCLUSION The simulation-based SSO modification provides appropriate contact surface and eliminates the bone gap between proximal and distal segments in class II asymmetry. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | - Kai-Ti Chuang
- Department of Plastic and Reconstructive Surgery, New Taipei Municipal TuCheng Hospital
| | | | - Yu-Ray Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Chien-Tzung Chen
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital at Linkou
- Craniofacial Research Center at Taoyuan, Chang Gung University, College of Medicine
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Kouhi M, de Souza Araújo IJ, Asa'ad F, Zeenat L, Bojedla SSR, Pati F, Zolfagharian A, Watts DC, Bottino MC, Bodaghi M. Recent advances in additive manufacturing of patient-specific devices for dental and maxillofacial rehabilitation. Dent Mater 2024; 40:700-715. [PMID: 38401992 DOI: 10.1016/j.dental.2024.02.006] [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: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Customization and the production of patient-specific devices, tailoring the unique anatomy of each patient's jaw and facial structures, are the new frontiers in dentistry and maxillofacial surgery. As a technological advancement, additive manufacturing has been applied to produce customized objects based on 3D computerized models. Therefore, this paper presents advances in additive manufacturing strategies for patient-specific devices in diverse dental specialties. METHODS This paper overviews current 3D printing techniques to fabricate dental and maxillofacial devices. Then, the most recent literature (2018-2023) available in scientific databases reporting advances in 3D-printed patient-specific devices for dental and maxillofacial applications is critically discussed, focusing on the major outcomes, material-related details, and potential clinical advantages. RESULTS The recent application of 3D-printed customized devices in oral prosthodontics, implantology and maxillofacial surgery, periodontics, orthodontics, and endodontics are presented. Moreover, the potential application of 4D printing as an advanced manufacturing technology and the challenges and future perspectives for additive manufacturing in the dental and maxillofacial area are reported. SIGNIFICANCE Additive manufacturing techniques have been designed to benefit several areas of dentistry, and the technologies, materials, and devices continue to be optimized. Image-based and accurately printed patient-specific devices to replace, repair, and regenerate dental and maxillofacial structures hold significant potential to maximize the standard of care in dentistry.
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Affiliation(s)
- Monireh Kouhi
- Dental Materials Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Isaac J de Souza Araújo
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan, School of Dentistry, Ann Arbor, MI, United States
| | - Farah Asa'ad
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Oral Biochemistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lubna Zeenat
- School of Engineering, Deakin University, Geelong 3216, Australia; Department of Biomedical Engineering, IIT Hyderabad, Kandi, Sangareddy, Telangana 502285, India
| | - Sri Sai Ramya Bojedla
- Department of Biomedical Engineering, IIT Hyderabad, Kandi, Sangareddy, Telangana 502285, India
| | - Falguni Pati
- Department of Biomedical Engineering, IIT Hyderabad, Kandi, Sangareddy, Telangana 502285, India
| | - Ali Zolfagharian
- School of Engineering, Deakin University, Geelong 3216, Australia
| | - David C Watts
- School of Medical Sciences, University of Manchester, Manchester, UK
| | - Marco C Bottino
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan, School of Dentistry, Ann Arbor, MI, United States; Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Mahdi Bodaghi
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK.
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Liu K, Luo S, Wang X, Cao J, Guo Y, Zhang Y, Li B, Zhang L, Wang X. Objective assessment of visual attention in orthognathic surgery training based on eye tracking. J Craniomaxillofac Surg 2024; 52:65-70. [PMID: 37884435 DOI: 10.1016/j.jcms.2023.08.017] [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: 10/28/2022] [Revised: 01/13/2023] [Accepted: 08/23/2023] [Indexed: 10/28/2023] Open
Abstract
The aim of this study was to investigate the differences in visual attention between novices and orthognathic experts, as well as to provide evidence for use in developing and optimizing training strategies for orthognathic surgery. Novice and orthognathic experts were recruited, and their distributions of visual attention were monitored via an eye-tracking device while they watched orthognathic surgery videos. The percentages of visual fixation duration devoted to the areas of interest - surgical objects, instruments controlled by the main surgeon, and instruments controlled by the assistants - in each orthognathic surgery section were analyzed and compared between the two groups using repeated-measures factorial analysis of variance (ANOVA). In total, there were 18 participants, comprising both novices (n = 9) and experts (n = 9). For all sections of orthognathic surgery, the percentage of fixation duration on surgical objects was significantly higher for the novices than for the experts (p = 0.031, p = 0.005, p = 0.026, p = 0.047, p = 0.047, p = 0.031, p = 0.027, p = 0.034, p = 0.008, and p = 0.016). During the maxillary segment separation as part of Le Fort I osteotomy and the splitting of the mandible as part of bilateral sagittal split osteotomy, the novices also had a higher percentage of fixation duration on the instruments controlled by the main surgeon, as compared with the experts (p = 0.007 and p = 0.048, respectively). Novices invested great cognitive effort into the surgical objects in each section of orthognathic surgery, including the instruments controlled by the main surgeon in the maxillary segment separation and the splitting of the mandible. Strengthening this aspect of instruction could help novices reduce their cognitive load and achieve mastery more efficiently.
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Affiliation(s)
- Kai Liu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Songyuan Luo
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xinxi Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jian Cao
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yuxiang Guo
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yujie Zhang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Biao Li
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China.
| | - Lei Zhang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China.
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 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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Peng MJ, Lin Z, Tan Z, Hu Y, Chen P, To MKT. Virtual operation for hip joint replacement implemented by Sensable_FreeForm_Modelling: A surgical drill. Int J Med Robot 2023; 19:e2552. [PMID: 37489032 DOI: 10.1002/rcs.2552] [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: 01/19/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE To design a virtual operation of joint replacement for surgical drills using a haptic device, SenSable_FreeForm_Modelling (SFM), to enhance surgeons' efficiency and enable "Virtual tutorial without reality" for interns. METHOD A patient with hip joint osteoarthritis is randomly selected to perform Total Hip Replacement (THR). The hip images were input into Mimics in the format of *.dicom after CT scan and then exported to SFM using the stereolithographic (*.stl) format. A surgical toolkit can be created virtually with Computer Aided Design software such as Pro-E or Ghost SDK and a visual drill scenario of THR directed by a force-respondent stick, namely Phantom. RESULT 3D models of the hip joint were rebuilt illustrating clearly that the geometrical shapes of the surgical equipment created are similar to real instruments, and the THR operation is emulated distinctly in novelty. CONCLUSION In obedience to an ancient maxim, so called 'genuine knowledge originated from practice', this simulative operation offers hands-on experience for students in the orthopaedics field with remarkable effects, contributing not only teaching cases for medical courses but also a planning basis for physical surgery.
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Affiliation(s)
- Matthew JianQiao Peng
- Department of Spinal Surgery, Affiliated JiangMen Hospital of TCM @ Ji'Nan University, JiangMen, China
| | - Ze Lin
- Department of Orthopedics, PuNing People's Hospital, GuangDong, China
| | - ZhiJia Tan
- Department of Orthopedics & Traumatology, University of HongKong - Shenzhen Hospital, Shenzhen, GuangDong, China
| | - Yong Hu
- Department of Orthopedics & Traumatology, University of HongKong - Shenzhen Hospital, Shenzhen, GuangDong, China
| | - Peikai Chen
- Department of Orthopedics & Traumatology, University of HongKong - Shenzhen Hospital, Shenzhen, GuangDong, China
| | - Michael Kai-Tsun To
- Department of Orthopedics & Traumatology, University of HongKong - Shenzhen Hospital, Shenzhen, GuangDong, China
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Sharma N, Zubizarreta-Oteiza J, Tourbier C, Thieringer FM. Can Steam Sterilization Affect the Accuracy of Point-of-Care 3D Printed Polyetheretherketone (PEEK) Customized Cranial Implants? An Investigative Analysis. J Clin Med 2023; 12:jcm12072495. [PMID: 37048579 PMCID: PMC10094830 DOI: 10.3390/jcm12072495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Polyetheretherketone (PEEK) has become the biomaterial of choice for repairing craniofacial defects over time. Prospects for the point-of-care (POC) fabrication of PEEK customized implants have surfaced thanks to the developments in three-dimensional (3D) printing systems. Consequently, it has become essential to investigate the characteristics of these in-house fabricated implants so that they meet the necessary standards and eventually provide the intended clinical benefits. This study aimed to investigate the effects of the steam sterilization method on the dimensional accuracy of POC 3D-printed PEEK customized cranial implants. The objective was to assess the influence of standard sterilization procedures on material extrusion-based 3D-printed PEEK customized implants with non-destructive material testing. Fifteen PEEK customized cranial implants were fabricated using an in-house material extrusion-based 3D printer. After fabrication, the cranial implants were digitalized with a professional-grade optical scanner before and after sterilization. The dimensional changes for the 3D-printed PEEK cranial implants were analyzed using medically certified 3D image-based engineering software. The material extrusion 3D-printed PEEK customized cranial implants displayed no statistically significant dimensional difference with steam sterilization (p > 0.05). Evaluation of the cranial implants’ accuracy revealed that the dimensions were within the clinically acceptable accuracy level with deviations under 1.00 mm. Steam sterilization does not significantly alter the dimensional accuracy of the in-house 3D-printed PEEK customized cranial implants.
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Affiliation(s)
- Neha Sharma
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167C, 4123 Allschwil, Switzerland
- Correspondence:
| | - Jokin Zubizarreta-Oteiza
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167C, 4123 Allschwil, Switzerland
| | - Céline Tourbier
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167C, 4123 Allschwil, Switzerland
| | - Florian M. Thieringer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167C, 4123 Allschwil, Switzerland
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Extended Maxillary Osteotomy Guide: A Design That Allows Manipulation of the Osteotomy Direction on the Posterior and Inner Walls of the Maxilla. J Craniofac Surg 2022; 33:2146-2153. [DOI: 10.1097/scs.0000000000008740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/30/2022] [Indexed: 11/27/2022] Open
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Barretto MDA, Melhem-Elias F, Deboni MCZ. The untold history of planning in orthognathic surgery: a narrative review from the beginning to virtual surgical simulation. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e251-e259. [PMID: 35413462 DOI: 10.1016/j.jormas.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
We aimed to produce a narrative review of planning orthognathic surgery, chronologically. Also, to present flaws of methods and the future of orthognathic surgery planning. The search was carried out mainly in PubMed, SCOPUS, Embase, and Cochrane databases. Also was complemented by manual search in reference lists from identified studies and in grey literature. The first orthognathic surgery was reported in 1849, and it took more than a century for the development of the traditional orthognathic 2D planning. Besides the advances, surgeons observed failures and lacks on 2D method in representing with reliability the facial and maxillary tridimensional structure (3D). With technological developments in 90s and 2000s, methodological improvements were granted, and the 3D protocol was created. The CASS and Charlotte protocols were the earliest 3D planning protocols conceived. Since then, some steps were simplified, and new technologies are being developed and added to create a more reliable and precise way of planning orthognathic surgery.
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Affiliation(s)
- M D A Barretto
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, Sao Paulo, SP 05088-000, Brazil.
| | - F Melhem-Elias
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, Sao Paulo, SP 05088-000, Brazil
| | - M C Z Deboni
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, Sao Paulo, SP 05088-000, Brazil
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Accuracy of Segmented Le Fort I Osteotomy with Virtual Planning in Orthognathic Surgery Using Patient-Specific Implants: A Case Series. J Clin Med 2022; 11:jcm11195495. [PMID: 36233363 PMCID: PMC9572233 DOI: 10.3390/jcm11195495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background: When maxillary transversal expansion is needed, two protocols of treatment can be used: a maxillary orthodontic expansion followed by a classical bimaxillary osteotomy or a bimaxillary osteotomy with maxillary segmentation. The aim of this study was to assess the accuracy of segmented Le Fort I osteotomy using computer-aided orthognathic surgery and patient-specific titanium plates in patients who underwent a bimaxillary osteotomy for occlusal trouble with maxillary transversal insufficiencies. Methods: A virtual simulation of a Le Fort I osteotomy with maxillary segmentation, a sagittal split ramus osteotomy, and genioplasty (if needed) was conducted on a preoperative three-dimensional (3D) model of each patient’s skull using ProPlan CMF 3.0 software (Materialise, Leuven, Belgium). Computer-assisted osteotomy saw-and-drill guides and patient-specific implants (PSIs, titanium plates) were produced and used during the surgery. We chose to focus on the maxillary repositioning accuracy by comparing the preoperative virtual surgical planning and the postoperative 3D outcome skulls using surface superimpositions and 13 standard dental and bone landmarks. Errors between these preoperative and postoperative landmarks were calculated and compared to discover if segmental maxillary repositioning using PSIs was accurate enough to be safely used to treat transversal insufficiencies. Results: A total of 22 consecutive patients—15 females and 7 males, with a mean age of 27.4 years—who underwent bimaxillary computer-assisted orthognathic surgery with maxillary segmentation were enrolled in the study. All patients presented with occlusion trouble, 13 with Class III malocclusions (59%) and 9 (41%) with Class II malocclusions. A quantitative analysis revealed that, overall, the mean absolute discrepancies for the x-axis (transversal dimension), y-axis (anterior−posterior dimensions), and z-axis (vertical dimension) were 0.59 mm, 0.74 mm, and 0.56 mm, respectively. The total error rate of maxillary repositioning was 0.62 mm between the postoperative cone-beam computed tomography (CBCT) and the preoperatively planned 3D skull. According to the literature, precision in maxilla repositioning is defined by an error rate (clinically relevant) at each landmark of <2 mm and a total error of <2 mm for each patient. Conclusions: A high degree of accuracy between the virtual plan and the postoperative result was observed.
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Hyun CM, Bayaraa T, Yun HS, Jang TJ, Park HS, Seo JK. Deep learning method for reducing metal artifacts in dental cone-beam CT using supplementary information from intra-oral scan. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac8852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/09/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Objective. Recently, dental cone-beam computed tomography (CBCT) methods have been improved to significantly reduce radiation dose while maintaining image resolution with minimal equipment cost. In low-dose CBCT environments, metallic inserts such as implants, crowns, and dental fillings cause severe artifacts, which result in a significant loss of morphological structures of teeth in reconstructed images. Such metal artifacts prevent accurate 3D bone-teeth-jaw modeling for diagnosis and treatment planning. However, the performance of existing metal artifact reduction (MAR) methods in handling the loss of the morphological structures of teeth in reconstructed CT images remains relatively limited. In this study, we developed an innovative MAR method to achieve optimal restoration of anatomical details. Approach. The proposed MAR approach is based on a two-stage deep learning-based method. In the first stage, we employ a deep learning network that utilizes intra-oral scan data as side-inputs and performs multi-task learning of auxiliary tooth segmentation. The network is designed to improve the learning ability of capturing teeth-related features effectively while mitigating metal artifacts. In the second stage, a 3D bone-teeth-jaw model is constructed with weighted thresholding, where the weighting region is determined depending on the geometry of the intra-oral scan data. Main results. The results of numerical simulations and clinical experiments are presented to demonstrate the feasibility of the proposed approach. Significance. We propose for the first time a MAR method using radiation-free intra-oral scan data as supplemental information on the tooth morphological structures of teeth, which is designed to perform accurate 3D bone-teeth-jaw modeling in low-dose CBCT environments.
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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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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: 14] [Impact Index Per Article: 4.7] [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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Lobo F, Filho LI, Sigua-Rodriguez EA, da Silva BG, Tolentino EDS, Borges YM, da Silva MC, Tonin RH, Iwaki LCV. Evaluation of ortogonblender software bone movement tools in bimaxillary orthognatic surgeries performed in dolphin software. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:417-421. [PMID: 34628097 DOI: 10.1016/j.jormas.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022]
Abstract
The aim of this observational, longitudinal and retrospective study was to evaluate the fidelity of virtual surgical planning (VSP) performed on Dolphin Imaging & Management Solutions® 11.95 software on hard tissues, using the tools of the open-source software OrtogOnBlender - Blender3D. For this, linear, angular and 7-point anatomical measurements of the skeletal profile were used, and the discrepancies between the VSP and the result after bimaxillary orthognathic surgery were calculated. Pre- and postoperative cone beam CT (CBCT) scans of 43 consecutive patients with class II and III skeletal deformities were evaluated and the results of the VSP were compared to the 1-month postoperative results. All overlapping points presented values within the range considered clinically irrelevant (< 2 mm and < 4°) and differences were not significant (p > 0.05). The comparison of anatomical points showed lower values (≤ 2.11 mm) in point A of class II. For hard tissues, the comparison between VSP and 1-month postoperative tomography demonstrated the faithful results of virtual planning using this software.
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Affiliation(s)
- Fernanda Lobo
- Department of Dentistry, State University of Maringá (UEM), Maringá PR, Brazil.
| | - Liogi Iwaki Filho
- Department of Dentistry, State University of Maringá (UEM), Maringá PR, Brazil
| | | | - Breno Gabriel da Silva
- Department of Exact Sciences, "Luiz de Queiroz" College of Agriculture, University of São Paulo (ESALQ/USP), Piracicaba, Brazil
| | | | - Yana Miranda Borges
- Science and Technology of Amazonas (IFAM), Federal Institute of Education, Manaus, Brazil
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Total Temporomandibular Joint Replacement and Simultaneous Orthognathic Surgery Using Computer-Assisted Surgery. J Maxillofac Oral Surg 2021; 20:394-403. [PMID: 34408366 DOI: 10.1007/s12663-020-01422-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022] Open
Abstract
Background Disorders of the temporomandibular joint (TMJ) are frequent and are usually associated with other disorders of the facial skeleton. Surgery might be needed to correct TMJ anatomy and function and, in cases where pathologies coexist, a two-stage corrective surgery might be needed. However, the current fashion of single-stage procedures is feasible with the aid of new technologies such as computer-assisted surgery (CAS). This is a step forward toward performing complex procedures such as a TMJ replacement with simultaneous orthognathic surgery. CAS allows designing patient-fitted prosthesis and more predictable and accurate surgeries. Moreover, intraoperative development can be controlled in real time with intraoperative navigation, and postoperative results can be measured and compared afterwards. Aims The primary purpose of this article is to present the protocol used in our institution for orthognathic surgery associated with unilateral and bilateral TMJ replacement with patient-fitted prostheses guided with CAS. Materials and methods We present two cases to illustrate our protocol and its results. Results In the first case, the difference in millimeters between planning and surgical outcomes was 1.72 mm for the glenoid component and 2.16 mm for the condylar prosthesis; for the second case, differences in the right side were 2.59 mm for the glenoid component and 2.06 mm for the ramus, and in the left side, due to the anatomy the difference was a little greater, without clinical significance. Conclusion Combined surgery of the midface and mandible with total TMJ replacement is feasible and beneficial for the patient. CAS facilitates the planning and design of custom-fit prosthesis and execution of these procedures.
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A Digital Approach to Evaluating Tooth Root Position Without Repeated Cone-beam Computed Tomography Scans. J Craniofac Surg 2021; 33:e347-e349. [PMID: 34347718 DOI: 10.1097/scs.0000000000008058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The purpose of this report is to introduce a digital approach to evaluating three-dimensional root position without radiation using virtual tooth model which is composed of intraoral-scanned crown and cone-beam computed tomography (CBCT)-scanned root. Successful treatment depends not only on the formulation of a proper initial diagnosis, but also on an accurate assessment of treatment progress, which should include the monitoring and evaluation of tooth and root movements. Although CBCT allows the visualization of the true root position and angulation in three-dimensions, the obtaining of serial CBCT scans for this purpose is associated with concerns regarding radiation exposure. This report introduces a method for monitoring three-dimensional root position following tooth movement during treatment that does not require repeated CBCT scans. This method uses an individual virtual tooth model composed of intraoral-scanned crowns and CBCT-scanned roots. When an evaluation of root positions is needed during treatment, only additional intraoral scan is needed and is integrated into the tooth model; this allows root positions to be estimated without the need for another CBCT scan. The use of a virtual tooth model can potentially allow clinicians to accurately monitor tooth position in routine clinical practice, without the hazards of increased radiation exposure.
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Noh HK, Park HS. Does maxillary yaw exist in patients with skeletal Class III facial asymmetry? Am J Orthod Dentofacial Orthop 2021; 160:573-587. [PMID: 34332794 DOI: 10.1016/j.ajodo.2020.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/01/2020] [Accepted: 05/01/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This study aimed to evaluate maxillary skeletal and dental yaw in patients with skeletal Class III facial asymmetry and investigate its correlation with menton deviation. METHODS Initial cone-beam computed tomography data from 60 patients with skeletal Class III malocclusion were used. There were 30 patients in both the symmetrical group (menton deviation <2 mm) and the asymmetrical group (menton deviation >4 mm). After reconstruction of 3-dimensional (3D) cone-beam computed tomography data, maxillary yaw and 3D positions of skeletal and dental landmarks were measured and compared between the groups. After that, correlations between menton deviation and the other variables were assessed. RESULTS No significant difference was noted in maxillary skeletal and dental yaw between the 2 groups. In the assessment of 3D positions, translation of the maxillary bone and maxillary dentition toward the menton deviation was observed (P <0.01). Maxillary skeletal and dental yaw was not significantly correlated with menton deviation in the asymmetrical group. CONCLUSIONS Maxillary skeletal and dental yaw was not evident in either group. Therefore, when planning maxillary surgery for patients with skeletal Class III facial asymmetry malocclusion, it may be appropriate to shift the focus of decompensation from maxillary yaw to maxillary translation.
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Affiliation(s)
- Hyung-Kyu Noh
- Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - Hyo-Sang Park
- Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, South Korea.
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Yamashita AL, Iwaki Filho L, Ferraz FWDS, Ramos AL, Previdelli ITDS, Pereira OCN, Tolentino EDS, Chicarelli M, Iwaki LCV. Accuracy of three-dimensional soft tissue profile prediction in orthognathic surgery. Oral Maxillofac Surg 2021; 26:271-279. [PMID: 34302576 DOI: 10.1007/s10006-021-00988-2] [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: 01/04/2021] [Accepted: 07/11/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the accuracy of three-dimensional (3D) soft tissue prediction in bimaxillary orthognathic surgery. METHODS Cone-beam computed tomographs of 88 patients with class II (n = 46) and class III (n = 42) malocclusions, who underwent bimaxillary orthognathic surgery, were included in this retrospective study. 3D soft tissue prediction and postoperative outcome were compared by using ten landmarks of facial soft tissues. Patients' sex and age were also assessed. Results were analyzed using a mixed model methodology (p < 0.05). RESULTS The success criterion adopted was a mean discrepancy of < 2 mm. Most mandibular landmarks indicated a tendency for underprediction with a downward direction in class II patients, with some values > 2 mm. In class III, there was overprediction with a downward direction for the mandibular landmarks, with values < 2 mm. More accurate results were found in female and older patients. CONCLUSIONS 3D surgical planning showed clinically acceptable results for predicting soft tissues in patients undergoing bimaxillary orthognathic surgery, with more accurate results for class III patients. Although some differences were found when age and sex were interacted, a consistent association between these variables could not be stated. These results support the clinician, as accuracy can provide a strong guide to the surgeon when planning surgical orthodontic treatment.
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Affiliation(s)
- Amanda Lury Yamashita
- Department of Dentistry, State University of Maringá, Avenida Mandacaru n° 1550, bloco S-08, Maringá, Paraná, CEP: 87080-000, Brazil.
| | - Liogi Iwaki Filho
- Department of Dentistry, State University of Maringá, Avenida Mandacaru n° 1550, bloco S-08, Maringá, Paraná, CEP: 87080-000, Brazil
| | - Flávio Wellington da Silva Ferraz
- Department of Oral and Maxillofacial Surgery, Clinics Hospital of Medicine School and University Hospital of University of São Paulo, São Paulo, São Paulo, Brazil
| | - Adilson Luiz Ramos
- Department of Dentistry, State University of Maringá, Avenida Mandacaru n° 1550, bloco S-08, Maringá, Paraná, CEP: 87080-000, Brazil
| | | | | | - Elen de Souza Tolentino
- Department of Dentistry, State University of Maringá, Avenida Mandacaru n° 1550, bloco S-08, Maringá, Paraná, CEP: 87080-000, Brazil
| | - Mariliani Chicarelli
- Department of Dentistry, State University of Maringá, Avenida Mandacaru n° 1550, bloco S-08, Maringá, Paraná, CEP: 87080-000, Brazil
| | - Lilian Cristina Vessoni Iwaki
- Department of Dentistry, State University of Maringá, Avenida Mandacaru n° 1550, bloco S-08, Maringá, Paraná, CEP: 87080-000, Brazil
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Methods of mandibular condyle position and rotation center used for orthognathic surgery planning: a systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:345-352. [PMID: 34237437 DOI: 10.1016/j.jormas.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022]
Abstract
We aimed to evaluate whether there is a consensus among bi- (2D) and three-dimensional (3D) evaluations of mandible condyle position and its rotation center. Also, if this data can be replicated in orthognathic surgery planning. The survey was carried out on the major databases (PubMed, SCOPUS, Embase, Cochrane). Human or human bio models evaluations in 2D or 3D of mandibular condylar position concerning its fossa and rotational axis for orthognathic surgery planning were eligible. The heterogeneity of the studies and uncertainties in methodological biases did not allow us to identify the superiority of 2D or 3D methodology in determination of the condylar rotational axis. There is a lot of divergences in the definition of occlusal relationships among dental specialties. Although there was no consensus regarding condylar position in relation to the fossa, the most reported axis of rotation was positioned posterior-inferior. Weak scientific evidence and divergences in dental vocabulary shows the need for clinical studies with more accurate and transparent methodological design to standardize concepts. Despite we cannot affirm, we can suggest that the centric relation (CR) is not the condylar position when clinically manipulated in the posterior superior direction. This condylar position is the retruded contact position (RCt) while CR is the functional position of the condyle. In this way, the orthognathic surgery has two occlusal relationships during planning and execution. The ideal axis of rotation for orthognathic surgery planning must be fixed, permit individualization for each condyle and be reproducible. The 2D planning is obsolete as cannot provide all the necessary tools for an accurate planning.
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da Costa Senior O, Vaes L, Mulier D, Jacobs R, Politis C, Shaheen E. Three dimensional assessment of segmented Le Fort I osteotomy planning and follow-up: A validation study. J Dent 2021; 111:103707. [PMID: 34077799 DOI: 10.1016/j.jdent.2021.103707] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/14/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES The planning accuracy and stability during follow-up of segmented Le Fort I osteotomy, often evaluated using 2D cephalometry and dental cast analysis, is controversial. The aim of this study is to develop and validate a 3D semi-automatic, voxel-based registration assessment protocol to evaluate planning accuracy and stability of segmented Le Fort I osteotomy with individualization of the maxillary segments. METHODS Preoperative, immediate postoperative and six months postoperative CBCT images were used to evaluate accuracy and stability of the individual segments in 20 patients (13 female; 7 male) who underwent segmented Le Fort I osteotomy. Three translational (left/right, intrusion/extrusion, anterior/posterior) and three rotational (pitch, roll, yaw) dimensions were calculated for each maxillary segment by means of a user-friendly module. Inter- and intra-observer Inter Class Coefficient (ICC) and mean absolute difference (MAD) were calculated. RESULTS The inter- and intra-observer reliability ICC varied between 0.93 and 0.99 for the translational and rotational accuracy and stability assessments, indicating excellent reliability. The MAD ranged between 0.21 mm and 0.32 mm for the translational error and between 0.6° and 0.9° for the rotational dimension. CONCLUSIONS The 3D assessment protocol for accuracy of segmented Le Fort I planning and short-term follow-up, proved to have high reliability with only a small margin of error. CLINICAL SIGNIFICANCE The proposed 3D assessment protocol allows future in-depth analysis of segmented Le Fort I osteotomy and might implicate future improvement where necessary.
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Affiliation(s)
- Oliver da Costa Senior
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium.
| | - Lukas Vaes
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium
| | - Delphine Mulier
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium
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Frizziero L, Santi GM, Leon-Cardenas C, Donnici G, Liverani A, Papaleo P, Napolitano F, Pagliari C, Di Gennaro GL, Stallone S, Stilli S, Trisolino G, Zarantonello P. In-House, Fast FDM Prototyping of a Custom Cutting Guide for a Lower-Risk Pediatric Femoral Osteotomy. Bioengineering (Basel) 2021; 8:bioengineering8060071. [PMID: 34073324 PMCID: PMC8230284 DOI: 10.3390/bioengineering8060071] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/11/2021] [Accepted: 05/20/2021] [Indexed: 12/01/2022] Open
Abstract
Three-dimensional printed custom cutting guides (CCGs) are becoming more and more investigated in medical literature, as a patient-specific approach is often desired and very much needed in today’s surgical practice. Three-dimensional printing applications and computer-aided surgical simulations (CASS) allow for meticulous preoperatory planning and substantial reductions of operating time and risk of human error. However, several limitations seem to slow the large-scale adoption of 3D printed CCGs. CAD designing and 3D printing skills are inevitably needed to develop workflow and address the study; therefore, hospitals are pushed to include third-party collaboration, from highly specialized medical centers to industrial engineering companies, thus increasing the time and cost of labor. The aim of this study was to move towards the feasibility of an in-house, low-cost CCG 3D printing methodology for pediatric orthopedic (PO) surgery. The prototype of a femoral cutting guide was developed for its application at the IOR—Rizzoli Orthopedic Institute of Bologna. The element was printed with an entry-level 3D printer with a high-temperature PLA fiber, whose thermomechanical properties can withstand common steam heat sterilization without bending or losing the original geometry. This methodology allowed for extensive preoperatory planning that would likewise reduce the overall surgery time, whilst reducing the risks related to the intervention.
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Affiliation(s)
- Leonardo Frizziero
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
- Correspondence:
| | - Gian Maria Santi
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
| | - Christian Leon-Cardenas
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
| | - Giampiero Donnici
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
| | - Alfredo Liverani
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
| | - Paola Papaleo
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
| | - Francesca Napolitano
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
| | - Curzio Pagliari
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
| | - Giovanni Luigi Di Gennaro
- IRCCS—Istituto Ortopedico Rizzoli (Rizzoli Orthopaedic Institute), Paediatric Orthopaedics and Traumatology, 40136 Bologna, Italy; (G.L.D.G.); (S.S.); (S.S.); (G.T.); (P.Z.)
| | - Stefano Stallone
- IRCCS—Istituto Ortopedico Rizzoli (Rizzoli Orthopaedic Institute), Paediatric Orthopaedics and Traumatology, 40136 Bologna, Italy; (G.L.D.G.); (S.S.); (S.S.); (G.T.); (P.Z.)
| | - Stefano Stilli
- IRCCS—Istituto Ortopedico Rizzoli (Rizzoli Orthopaedic Institute), Paediatric Orthopaedics and Traumatology, 40136 Bologna, Italy; (G.L.D.G.); (S.S.); (S.S.); (G.T.); (P.Z.)
| | - Giovanni Trisolino
- IRCCS—Istituto Ortopedico Rizzoli (Rizzoli Orthopaedic Institute), Paediatric Orthopaedics and Traumatology, 40136 Bologna, Italy; (G.L.D.G.); (S.S.); (S.S.); (G.T.); (P.Z.)
| | - Paola Zarantonello
- IRCCS—Istituto Ortopedico Rizzoli (Rizzoli Orthopaedic Institute), Paediatric Orthopaedics and Traumatology, 40136 Bologna, Italy; (G.L.D.G.); (S.S.); (S.S.); (G.T.); (P.Z.)
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Effectiveness Assessment of CAD Simulation in Complex Orthopedic Surgery Practices. Symmetry (Basel) 2021. [DOI: 10.3390/sym13050850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This experimental study defines the usage of a computer-aided surgical simulation process that is effective, safe, user-friendly, and low-cost, that achieves a detailed and realistic representation of the anatomical region of interest. The chosen tools for this purpose are state-of-the-art Computer Aided Design (CAD) software for mechanical design, and are the fundamental application dedicated to parametric modeling. These tools support different work environments, each one is for a specific type of modeling, and they allow the simulation of surgery. The result will be a faithful representation of the anatomical part both before and after the surgical procedure, screening all the intermediate phases. The doctor will assess different lines of action according to the results, then he will communicate them to the engineer who, consequently, will correct the antisymmetric issue and regenerate the model. Exact measurements of the mutual positions of the various components, skeletal and synthetic, can be achieved; all the osteosynthesis tools, necessary for the surgeon, can be included in the project according to different types of fracture to perfectly match the morphology of the bone to be treated. The method has been tested on seven clinical cases of different complexity and nature and the results of the simulations have been found to be of great effectiveness in the phase of diagnosis and of preoperative planning for the doctors and surgeons; therefore, allowing a lower risk medical operation with a better outcome. This work delivers experimental results in line with theoretical research findings in detail; moreover, full experimental and/or methodical details are provided, so that outcomes could be obtained.
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Hernández-Alfaro F, Rosemberg V, Masià-Gridilla J, Valls-Ontañón A. Improving accuracy of the intermediate splint in substantial intermaxillary sagittal discrepancies using an extra anterior anchorage point: technical note. Med Oral Patol Oral Cir Bucal 2021; 26:e151-e155. [PMID: 32851985 PMCID: PMC7980301 DOI: 10.4317/medoral.24089] [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: 06/15/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022] Open
Abstract
Background To describe a technical feature that increases the stability of the intermediate splint in patients where bimaxillary surgery with great maxillary/mandibular advancements are planned.
Material and Methods Prospective evaluation of the intermediate splint dental vertical penetration in patients undergoing bimaxillary surgery where great sagittal discrepancy occur in the anterior sector between the upper and lower jaws when the intermediate splint is placed by adding an extra intermaxillary fixation (IMF) screw (2x9 mm) placed between the central incisors of the maxilla and fixed to the most anterior aspect of the intermediate splint following the direction of the sagittal maxillo-mandibular discrepancy from January to September 2018.
Results The postoperative evaluation comparing the accuracy of conventional fixation versus fixation with an extra anterior anchorage point through photographic assessment and intraoral digital scanner demonstrated better dental penetration, and therefore improved intermediate splint precision with the latter in all cases
Conclusions Our results suggest that this is a simple and safe technique that can be easily reproduced and optimizes the outcomes by increasing the accuracy of translation of the planned surgical movements to the operating room. Key words:Orthognathic surgery, intermediate splint, accuracy, intermaxillary fixation, bone screw.
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Affiliation(s)
- F Hernández-Alfaro
- Maxillofacial Institute, Teknon Medical Center Carrer de Vilana, 12 (desp 185) 08022 - Barcelona, Spain
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Neo B, Lim L, Mohammed-Ali R. Time benefits of 3D planning in orthognathic surgery: a systematic review. Br J Oral Maxillofac Surg 2021; 60:120-127. [DOI: 10.1016/j.bjoms.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
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Application of Virtual Planning for Three-Dimensional Guided Maxillofacial Reconstruction of Pruzansky-Kaban III Hemifacial Microsomia Using Custom Made Fixation Plate. J Craniofac Surg 2021; 32:896-901. [PMID: 33405441 DOI: 10.1097/scs.0000000000007258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Pruzansky-Kaban III hemifacial microsomia (HFM) is a rare congenital facial deformity, and it is challenging to reconstruct the facial appearance. The aim of the present study was to describe a technique of application of virtual planning for three-dimensional (3D) guided maxillofacial reconstruction of Pruzansky-Kaban III HFM using custom made fixation plate. METHODS With the help of 3D models, a preoperative virtual planning and surgical simulation were performed. Computer-aided design/computer-aided manufacture (CAD/CAM) patient customized guides and custom fixation plates were designed to reconstruct the maxillofacial skull intraoperatively. Assessment was achieved through evaluation of the postoperative effects, such as imaging, facial appearance recovery and operation time. RESULTS Five patients with Pruzansky-Kaban III HFM were enrolled into this study. The results showed an exceptional accuracy between the preoperative virtual planning and the outcomes actually achieved postoperatively. Intraoperative measurements were no longer needed and the different surgical steps became more simple and easier. The total time was distributed as: 160 minutes for the surgical time, 40 minutes for preoperative virtual plan, and 80 minutes for designing the patient specific cutting guides and custom fixation plates. The operating time and tissue damage were reduced. All cases underwent uneventful healing without any complications. CONCLUSION The technique of patient specific guides and custom fixation plates is a reliable method of conveying the virtual plan to the operative field with higher efficiency in patients with Pruzansky-Kaban III HFM.
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Baan F, Bruggink R, Nijsink J, Maal TJJ, Ongkosuwito EM. Fusion of intra-oral scans in cone-beam computed tomography scans. Clin Oral Investig 2021; 25:77-85. [PMID: 32495223 PMCID: PMC7785548 DOI: 10.1007/s00784-020-03336-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical accuracy of the fusion of intra-oral scans in cone-beam computed tomography (CBCT) scans using two commercially available software packages. MATERIALS AND METHODS Ten dry human skulls were subjected to structured light scanning, CBCT scanning, and intra-oral scanning. Two commercially available software packages were used to perform fusion of the intra-oral scans in the CBCT scan to create an accurate virtual head model: IPS CaseDesigner® and OrthoAnalyzer™. The structured light scanner was used as a gold standard and was superimposed on the virtual head models, created by IPS CaseDesigner® and OrthoAnalyzer™, using an Iterative Closest Point algorithm. Differences between the positions of the intra-oral scans obtained with the software packages were recorded and expressed in six degrees of freedom as well as the inter- and intra-observer intra-class correlation coefficient. RESULTS The tested software packages, IPS CaseDesigner® and OrthoAnalyzer™, showed a high level of accuracy compared to the gold standard. The accuracy was calculated for all six degrees of freedom. It was noticeable that the accuracy in the cranial/caudal direction was the lowest for IPS CaseDesigner® and OrthoAnalyzer™ in both the maxilla and mandible. The inter- and intra-observer intra-class correlation coefficient showed a high level of agreement between the observers. CLINICAL RELEVANCE IPS CaseDesigner® and OrthoAnalyzer™ are reliable software packages providing an accurate fusion of the intra-oral scan in the CBCT. Both software packages can be used as an accurate fusion tool of the intra-oral scan in the CBCT which provides an accurate basis for 3D virtual planning.
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Affiliation(s)
- F Baan
- Radboudumc 3DLab The Netherlands, Radboud university medical center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands.
- Department of Dentistry, section of Orthodontics and Craniofacial Biology, Radboud university medical center, Philips van Leydenlaan 25, 6525, EX, Nijmegen, The Netherlands.
| | - R Bruggink
- Radboudumc 3DLab The Netherlands, Radboud university medical center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
- Department of Dentistry, section of Orthodontics and Craniofacial Biology, Radboud university medical center, Philips van Leydenlaan 25, 6525, EX, Nijmegen, The Netherlands
| | - J Nijsink
- Radboudumc 3DLab The Netherlands, Radboud university medical center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - T J J Maal
- Radboudumc 3DLab The Netherlands, Radboud university medical center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
- Department of Oral and Maxillofacial Surgery, Radboud university medical center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - E M Ongkosuwito
- Department of Dentistry, section of Orthodontics and Craniofacial Biology, Radboud university medical center, Philips van Leydenlaan 25, 6525, EX, Nijmegen, The Netherlands
- Amalia Cleft and Craniofacial Centre, Radboud university medical centre, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
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Palone M, Falce GL, Albertini P, Giudice AD, Baciliero U, Cremonini F. Accuracy Assessment of Virtual Surgical Planning Comparing 3D Virtual Surgical Planning and Post-Operative CBCTs in Surgical Skeletal Class III Cases: A Retrospective Study. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Impellizzeri A, Horodynski M, De Stefano A, Palaia G, Polimeni A, Romeo U, Guercio-Monaco E, Galluccio G. CBCT and Intra-Oral Scanner: The Advantages of 3D Technologies in Orthodontic Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249428. [PMID: 33339197 PMCID: PMC7765620 DOI: 10.3390/ijerph17249428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 05/28/2023]
Abstract
BACKGROUND The aim is to demonstrate the validity of the monitoring through intraoral scanner of the dental movements and the real impact, advantages, and convenience, in terms of treatment time and efficiency gain, to frequently monitor a patient with the scanner application. METHODS A movement control of palatally impacted canines was performed, surgically treated with laser opercolectomy. Three-dimensional models of the patient's dental arch were obtained with intraoral scanner during a monitoring time of 4 months. The STL (Standard Triangle Language) files were superimposed with the 3D models extrapolated from the pre-operative CT (Computerized Tomography). The measurements of eruption, exposed palatal and vestibular areas, and distances between the canines and the incisors were performed, using digital technologies and with a digital caliber. RESULTS Descriptive and inferential statistical analysis of the data obtained from both conventional and digital monitoring has been realized and performing the T Student Test for paired data. CONCLUSION The advantages of digital monitoring are numerous, like the possibility to reduce the error of method caused by manual measurement on plaster casts and the possibility to compare the pattern and amount of eruption of the canine in the same patient overtime.
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Ferraz FWDS, Iwaki-Filho L, Souza-Pinto GND, Iwaki LCV, Li AT, Cardoso MDA. A comparative study of the accuracy between two computer-aided surgical simulation methods in virtual surgical planning. J Craniomaxillofac Surg 2020; 49:84-92. [PMID: 33376041 DOI: 10.1016/j.jcms.2020.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/22/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The aim of this retrospective and observational study was to compare the accuracy of two different virtual surgical planning (VSP) protocols, namely, the CASS method and the modified CASS method. MATERIALS AND METHODS The patients underwent bimaxillary orthognathic surgery, planned using either the CASS method or the modified CASS method. Linear and angular discrepancies between the VSP outcome and postoperative outcome for both groups were compared for maxilla, mandible, and chin segments. Aside from the comparison between both groups, additional criteria were used to determine the accuracy of the protocol based on a linear and angular difference between planned and actual outcomes of less than 2 mm and 4°, respectively. The intergroup comparisons were performed by one-way ANOVA, with the level of significance set at 5%. RESULTS A total of 21 patients, of both genders, were assigned into group I (n = 11), planned with the CASS method, and group II (n = 10), planned with the modified CASS method. Both the CASS and modified CASS methods presented similar accuracy with regard to linear differences for the maxilla, mandible, and chin segments, except for ΔX for the mandibular segment, where the modified CASS method showed slightly better accuracy. However, there was a statistically significant difference with regard to angular differences in the chin segment, with the CASS method shown to be the more accurate. Aside from Δpitch for the chin segment, no linear or angular differences exceeded 2 mm or 4°. CONCLUSION Although statistically significant differences were found with regard to angular measurements in the chin segment, the accuracy of the modified CASS method for virtual planning can be considered as clinically equivalent, with a performance comparable to that of the CASS method.
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Affiliation(s)
- Flavio Wellington da Silva Ferraz
- Oral and Maxillofacial Surgery, Hospital Das Clínicas, University of São Paulo (USP), Rua Dr Eneas de Carvalho, 255, 05403-010, São Paulo, São Paulo, Brazil.
| | - Liogi Iwaki-Filho
- Oral and Maxillofacial Surgery, State University of Maringá (UEM), Avenida Mandacaru, 1550, 87080-000, Maringá, Paraná, Brazil.
| | - Gustavo Nascimento de Souza-Pinto
- Oral Radiology and Stomatology, Department of Dentistry, State University of Maringá (UEM), Avenida Mandacaru, 1550, 87080-000, Maringá, Paraná, Brazil.
| | - Lilian Cristina Vessoni Iwaki
- Oral Radiology and Stomatology, Department of Dentistry, State University of Maringá (UEM), Avenida Mandacaru, 1550, 87080-000, Maringá, Paraná, Brazil.
| | - An Tien Li
- Department of Dentistry, School of Health Sciences, University of Brasilia (UNB), Campus Universitário Darcy Ribeiro, Brasília, 70910-900, Distrito Federal, Brazil.
| | - Mauricio de Almeida Cardoso
- Department of Dentistry, São Leopoldo Mandic, Rua Dr José Rocha Junqueira, 13, 13045-755, Campinas, São Paulo, Brazil.
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Palazzo G, Ronsivalle V, Oteri G, Lo Giudice A, Toro C, Campagna P, Patini R, Bocchieri S, Bianchi A, Isola G. Comparison between Additive and Subtractive CAD-CAM Technique to Produce Orthognathic Surgical Splints: A Personalized Approach. J Pers Med 2020; 10:jpm10040273. [PMID: 33322616 PMCID: PMC7768501 DOI: 10.3390/jpm10040273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023] Open
Abstract
The present study aimed to evaluate the accuracy of digitally designed surgical splints generated with milling technology (material subtractive procedure) and with 3D printing technology (material additive procedure) through a customized approach in the planning of surgical orthognathic splints. Cone beam computed tomography (CBCT) examinations and scanned dental models of 10 subjects who had required surgical treatment of skeletal malocclusion were included. Simulation of the orthognathic surgery was performed according to dento-skeletal and aesthetic characteristics of the subjects and the visual treatment objective (VTO), using Dolphin3D software (Dolphin Imaging, version 11.0, Chatsworth, CA, USA). Afterward, the Appliance Designer software (3Shape A/S, Copenhagen, Denmark) was used to digitally design the surgical splints that were generated twice using laser stereolithography technology (DWS 0.29D, DWS, Vicenza, Italy) and milling technology (Sirona inLab MC X5). Finally, each physical splint was digitalized using a desktop scanner (D500 3D, 3Shape A/S, Copenhagen, Denmark) in order to perform deviation analysis using the original project as a reference. The relative percentage of matching (trueness) was calculated (Geomagic Control X software (3D Systems, version 2018.1.1, 3D Systems, Rock Hill, SC, USA). An Independent Student's t-test was used to statistically analyze the data. The milled splints showed a lower value of root to mean square (RMS) relative to the original project (0.20 mm ± 0.018) compared to the prototyped splints (0.31 ± 0.021) (p < 0.001). According to the present findings, surgical splints generated with milling technology present higher trueness compared with 3D printing technology.
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Affiliation(s)
- Giuseppe Palazzo
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
| | - Vincenzo Ronsivalle
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
| | - Giacomo Oteri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, School of Dentistry, University of Messina, Via Consolare Valeria 1, 98123 Messina, Italy;
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
| | - Corrado Toro
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
| | - Paola Campagna
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
| | - Romeo Patini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Dentistry and Maxillofacial Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: (R.P.); (G.I.); Tel.: +39-06-3015-4286 (R.P.); +39-09-5743-5359 (G.I.)
| | - Salvatore Bocchieri
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
| | - Alberto Bianchi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
- Correspondence: (R.P.); (G.I.); Tel.: +39-06-3015-4286 (R.P.); +39-09-5743-5359 (G.I.)
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Chung M, Lee J, Song W, Song Y, Yang IH, Lee J, Shin YG. Automatic Registration Between Dental Cone-Beam CT and Scanned Surface via Deep Pose Regression Neural Networks and Clustered Similarities. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:3900-3909. [PMID: 32746134 DOI: 10.1109/tmi.2020.3007520] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Computerized registration between maxillofacial cone-beam computed tomography (CT) images and a scanned dental model is an essential prerequisite for surgical planning for dental implants or orthognathic surgery. We propose a novel method that performs fully automatic registration between a cone-beam CT image and an optically scanned model. To build a robust and automatic initial registration method, deep pose regression neural networks are applied in a reduced domain (i.e., two-dimensional image). Subsequently, fine registration is performed using optimal clusters. A majority voting system achieves globally optimal transformations while each cluster attempts to optimize local transformation parameters. The coherency of clusters determines their candidacy for the optimal cluster set. The outlying regions in the iso-surface are effectively removed based on the consensus among the optimal clusters. The accuracy of registration is evaluated based on the Euclidean distance of 10 landmarks on a scanned model, which have been annotated by experts in the field. The experiments show that the registration accuracy of the proposed method, measured based on the landmark distance, outperforms the best performing existing method by 33.09%. In addition to achieving high accuracy, our proposed method neither requires human interactions nor priors (e.g., iso-surface extraction). The primary significance of our study is twofold: 1) the employment of lightweight neural networks, which indicates the applicability of neural networks in extracting pose cues that can be easily obtained and 2) the introduction of an optimal cluster-based registration method that can avoid metal artifacts during the matching procedures.
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Boccalatte LA, Nassif MG, Figari MF, Gómez NL, Argibay MC, Mancino AV, Ritacco LE. Computer-assisted surgery for replacement of the temporomandibular joint with customized prostheses: can we validate the results? Oral Maxillofac Surg 2020; 24:317-325. [PMID: 32518971 DOI: 10.1007/s10006-020-00858-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Replacing the temporomandibular joint poses an important challenge to maxillofacial surgeons, and for certain disorders, it represents the treatment's gold standard. Computer-assisted surgery (comprising preoperative virtual planning, virtual intraoperative navigation and 3D printing) is a useful tool for this type of surgery. However, we do not know if and how much the final position of the prosthesis differs, in absolute values, from what was planned virtually in the preoperative phase. We propose a comparative result validation system for temporomandibular joint replacement METHODS: In the present study, we propose a comparative validation system using overlapping images, between the model obtained with preoperative virtual planning and the postoperative result. RESULTS The mean difference for all screws of the glenoid prosthesis was 2.08 mm (range, 1.20-3.03) and for all screws of the condylar prosthesis it was 2.33 mm (range, 1.16-3.56). Mean overall difference between both prostheses in all patients was 2.21 mm (range, 1.16-3.56). CONCLUSIONS The validation system proposed by overlapping pre- and postoperative images in temporomandibular joint replacement allowed us to establish differences in absolute values between the virtual preoperative model and the actual postoperative result expressed in millimeters.
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Affiliation(s)
- L A Boccalatte
- Head and Neck - Craniomaxillofacial Surgery Section, General Surgery Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190 C1181ACH, Buenos Aires, Argentina.
- Academic Department of Morphological Sciences, Instituto Universitario, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
- Academic Department of Surgery, Instituto Universitario, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - M G Nassif
- Head and Neck - Craniomaxillofacial Surgery Section, General Surgery Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190 C1181ACH, Buenos Aires, Argentina
| | - M F Figari
- Head and Neck - Craniomaxillofacial Surgery Section, General Surgery Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190 C1181ACH, Buenos Aires, Argentina
- Academic Department of Surgery, Instituto Universitario, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - N L Gómez
- Head and Neck - Craniomaxillofacial Surgery Section, General Surgery Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190 C1181ACH, Buenos Aires, Argentina
| | - M C Argibay
- Computer Assisted Surgery (CAS Unit), Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A V Mancino
- Computer Assisted Surgery (CAS Unit), Hospital Italiano de Buenos Aires, Argentina - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), Buenos Aires, Argentina
| | - L E Ritacco
- Academic Department of Morphological Sciences, Instituto Universitario, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Computer Assisted Surgery (CAS Unit), Hospital Italiano de Buenos Aires, Argentina - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), Buenos Aires, Argentina
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Park JH, Hwang CJ, Choi YJ, Houschyar KS, Yu JH, Bae SY, Cha JY. Registration of digital dental models and cone-beam computed tomography images using 3-dimensional planning software: Comparison of the accuracy according to scanning methods and software. Am J Orthod Dentofacial Orthop 2020; 157:843-851. [PMID: 32487314 DOI: 10.1016/j.ajodo.2019.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/01/2019] [Accepted: 12/01/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The registration of cone-beam computed tomography (CBCT) images and digital dental models is required for the design and manufacturing of dental devices such as implant guides and surgical wafers. This study aims to register intraoral scan (IS) models and cast scan (CS) models onto CBCT images using 3-dimensional (3D) planning software and evaluate the registration accuracy according to scanning methods and 3D planning software. METHODS The CBCT image of an artificial skull model with reference markers was taken. The CS model and the IS model were obtained from the same skull model, registered onto the CBCT image using 3D planning software packages providing manual registration (MR) function and point-based registration (PR) functions, and set as the experimental groups. After registration, shell to shell deviations and positional differences between the reference model and the experimental models were evaluated. RESULTS The shell to shell deviations ranged from 0.03 to 0.18 mm. Deviations in both the maxilla and mandible were significantly different according to scanning methods and software packages. In the anteroposterior direction, the IS-MR and CS-MR groups showed significantly different positions. In the superoinferior direction, the MR and PR groups showed significantly different positions. CONCLUSIONS The registration using the PR function of the 3D planning software packages was significantly more accurate than the registration using the MR function. There was no significant difference between the registrations using the IS model and the CS model when using the PR functions.
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Affiliation(s)
- Jin-Ho Park
- Department of Orthodontics, Institute of Craniofacial Deformities, Yonsei University College of Dentistry, Seoul, South Korea
| | - Chung-Ju Hwang
- Department of Orthodontics, Institute of Craniofacial Deformities, Yonsei University College of Dentistry, Seoul, South Korea
| | - Yoon-Jeong Choi
- Department of Orthodontics, Institute of Craniofacial Deformities, Yonsei University College of Dentistry, Seoul, South Korea
| | - Khosrow Siamak Houschyar
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Jae-Hun Yu
- Department of Orthodontics, Institute of Craniofacial Deformities, Yonsei University College of Dentistry, Seoul, South Korea; BK PLUS project, Yonsei University College of Dentistry, Seoul, South Korea
| | - So-Yeon Bae
- Department of Dental Laboratory Science and Engineering, College of Health Science, Korea University, Seoul, South Korea
| | - Jung-Yul Cha
- Department of Orthodontics, Institute of Craniofacial Deformities, Yonsei University College of Dentistry, Seoul, South Korea; BK PLUS project, Yonsei University College of Dentistry, Seoul, South Korea.
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Farrell BB. Evolving Management of Dentofacial Deformities with Digital Planning and Patient-Specific Fixation. Atlas Oral Maxillofac Surg Clin North Am 2020; 28:59-71. [PMID: 32741515 DOI: 10.1016/j.cxom.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Brian B Farrell
- Carolinas Center for Oral and Facial Surgery, 411 Billingsley Road, Suite 105, Charlotte, NC 28211, USA; Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
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Computer-Aided Surgical Simulation for Correcting Complex Limb Deformities in Children. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10155181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This work aims to present an in-house low-cost computer-aided simulation (CASS) process that was recently implemented in the preoperative planning of complex osteotomies for limb deformities in children. Five patients admitted to the Unit of Paediatric Orthopaedics and Traumatology from April 2018 to December 2019, for correcting congenital or post-traumatic limb deformities were included in the study. Three-dimensional (3D) digital models were generated from Computed Tomography (CT) scans, using free open-source software, and the surgery was planned and simulated starting from the 3D digital model. 3D printed sterilizable models were fabricated using a low-cost 3D printer, and animations of the operation were generated with the aim to accurately explain the operation to parents. All procedures were successfully planned using our CASS method and the 3D printed models were used during the operation, improving the understanding of the severely abnormal bony anatomy. The surgery was precisely reproduced according to CASS and the deformities were successfully corrected in four cases, while in one case, the intraoperative intentional undersizing of the bone osteotomy produced an incomplete correction of a congenital forearm deformity. Our study describes the application of a safe, effective, user-friendly, and low-cost CASS process in paediatric orthopaedics (PO) surgery. We are convinced that our study will stimulate the widespread adoption of this technological innovation in routine clinical practice for the treatment of rare congenital and post-traumatic limb deformities during childhood.
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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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Jamali S, Pourarz S, Nasrabadi N, Ahmadizadeh H, Khorram M, Darvish M. The Using Virtual Computer-Assisted Planning in Orthognathic Surgery: A Systematic Review and Meta-Analysis. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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37
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Ho CT, Denadai R, Lai HC, Lo LJ, Lin HH. Computer-Aided Planning in Orthognathic Surgery: A Comparative Study with the Establishment of Burstone Analysis-Derived 3D Norms. J Clin Med 2019; 8:E2106. [PMID: 31810228 PMCID: PMC6947285 DOI: 10.3390/jcm8122106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/16/2019] [Accepted: 11/26/2019] [Indexed: 02/05/2023] Open
Abstract
Three-dimensional (3D) computer-aided simulation has revolutionized orthognathic surgery treatment, but scarce 3D cephalometric norms have been defined to date. The purposes of this study were to (1) establish a normative database of 3D Burstone cephalometric measurements for adult male and female Chinese in Taiwan, (2) compare this 3D norm dataset with the two-dimensional (2D) Burstone norms from Caucasian and Singaporean Chinese populations, and (3) apply these 3D norms to assess the outcome of a computer-aided simulation of orthognathic surgery. Three-dimensional Burstone cephalometric analysis was performed on 3D digital craniofacial image models generated from cone-beam computed tomography datasets of 60 adult Taiwanese Chinese individuals with normal occlusion and balanced facial profile. Three-dimensional Burstone analysis was performed on 3D image datasets from patients with skeletal Class III pattern (n = 30) with prior computer-aided simulation. Three-dimensional Burstone cephalometric measurements showed that Taiwanese Chinese males had significantly (p < 0.05) larger anterior and posterior facial heights, maxillary length, and mandibular ramus height than females, with no significant (p > 0.05) difference for facial soft-tissue parameters. The 3D norm dataset revealed Taiwanese Chinese-specific facial characteristics, with Taiwanese presenting (p < 0.05) a more convex profile, protrusive maxillary apical bases, protruding mandible, protruding upper and lower lips, and a shorter maxillary length and lower facial height than Caucasians. Taiwanese had significantly (p < 0.05) larger maxillary projection, vertical height ratio, lower face throat angle, nasolabial angle, and upper lip protrusion than Singaporean Chinese. No significant (p > 0.05) difference was observed between 3D norms and computer-aided simulation-derived 3D patient images for horizontal skeletal, vertical skeletal, and dental measurements, with the exception of two dental parameters (p < 0.05). This study contributes to literature by providing gender- and ethnic-specific 3D Burstone cephalometric norms, which can assist in the multidisciplinary-based delivery of orthodontic surgical care for Taiwanese Chinese individuals worldwide, including orthodontic management, computer-assisted simulation, and outcome assessment.
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Affiliation(s)
- Cheng-Ting Ho
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (C.-T.H.); (H.-C.L.)
| | - Rafael Denadai
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 333, Taiwan; (R.D.); (L.-J.L.)
| | - Hsin-Chih Lai
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (C.-T.H.); (H.-C.L.)
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 333, Taiwan; (R.D.); (L.-J.L.)
| | - Hsiu-Hsia Lin
- Image Lab and Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
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38
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Bell RB. A History of Orthognathic Surgery in North America. J Oral Maxillofac Surg 2019; 76:2466-2481. [PMID: 30502870 DOI: 10.1016/j.joms.2018.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 10/27/2022]
Abstract
This review highlights the contributions of American oral and maxillofacial surgeons to the field of orthognathic surgery. The present state of the art and science of orthognathic surgery is the harvest of yesterday's innovation and research. An improved understanding of the biological and surgical principles and the routine involvement of orthodontics have fueled widespread adoption of a coordinated approach to the treatment of dentofacial problems. Technologic advances in rigid internal fixation, virtual surgical planning with computer-aided manufacturing of occlusal splints and cutting guides, custom implants, and worldwide interest in the correction of dentofacial and craniofacial deformities have resulted in highly predictable, efficient, and safe treatment, which scarcely resembles the situation 70 years ago.
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Affiliation(s)
- R Bryan Bell
- Medical Director, Providence Head and Neck Cancer Program, and Associate Member, Earle A. Chiles Research Institute, Robert W. Franz Cancer Center, Providence Cancer Institute Head and Neck Institute, Portland, OR.
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39
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Gao JY, Yu XQ. Efficacy of orthodontic and orthognathic treatment for oral and maxillofacial deformities. Medicine (Baltimore) 2019; 98:e17324. [PMID: 31574866 PMCID: PMC6775369 DOI: 10.1097/md.0000000000017324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aims to assess the efficacy and safety of orthodontic and orthognathic treatment (OOT) for patients with oral and maxillofacial deformities (OMDF) systematically. METHODS This study will comprehensively search Cochrane Library, PubMed, EMBASE, Scopus, Web of Science, PsycINFO, Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from their inceptions to the July 1, 2019. Grey literature will be explored via searching dissertations, Google scholar and conference abstracts. Two team members will independently perform all citations, data extraction, and methodological quality. We will also utilize RevMan 5.3 Software for statistical analysis. RESULTS This study will provide high quality evidence of OOT for OMDF. The primary outcomes consist of number of patients cured; proportion of patients healed; and time to complete healing within trial period. Secondary outcomes include quality of life (often assessed as any relevant scales, such as 36-Item Short Form Survey), costs, and complications. CONCLUSION This study will provide evidence for judging whether OOT is effective treatment for OMDF. SYSTEMATIC REVIEW REGISTRATION CRD42019144610.
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Affiliation(s)
- Jin-Yu Gao
- Department of Orthodontics, Yan’an University Affiliated Stomatological Hospital, Yan’an
| | - Xiao-Qin Yu
- Department of Stomatology, Ankang People's Hospital, Ankang, China
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Comparison of the Planned Versus Actual Jaw Movement Using Splint-Based Virtual Surgical Planning: How Close Are We at Achieving the Planned Outcomes? J Oral Maxillofac Surg 2019; 77:1675-1680. [DOI: 10.1016/j.joms.2019.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 11/23/2022]
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Li B, Wang S, Wei H, Zeng F, Wang X. The use of patient-specific implants in genioplasty and its clinical accuracy: a preliminary study. Int J Oral Maxillofac Surg 2019; 49:461-465. [PMID: 31353173 DOI: 10.1016/j.ijom.2019.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 03/23/2019] [Accepted: 06/04/2019] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to assess the accuracy and clinical validation of patient-specific implants (PSI) in genioplasty. Fifteen patients with chin deformities were enrolled. Virtual planning was performed with the computer-aided surgical simulation method. The three-dimensional-printed titanium cutting guide and patient-specific plate were designed to guide the osteotomy and allow repositioning and fixation of the chin. The outcome was evaluated by comparing the plan with actual outcomes. All operations were successfully completed with PSIs. There was no difficulty in using patient-specific plates. The largest root-mean-square difference of the chin position was 0.69 mm in mediolateral translation and 2.01° in the yaw orientation. The results of the study indicated that the PSI technique was an accurate method of transferring the virtual plan to the operation field with great efficiency in genioplasty. A significant advantage of the PSI technique is that the patient-specific plate could simultaneously complete the repositioning and fixation of the chin. Intraoperative measurements and reposition guides were no longer required. Operative procedures were greatly simplified.
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Affiliation(s)
- B Li
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - S Wang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - H Wei
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - F Zeng
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - X Wang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
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42
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Yiasemidou M, Glassman D, Jayne D, Miskovic D. Is patient-specific pre-operative preparation feasible in a clinical environment? A systematic review and meta-analysis. Comput Assist Surg (Abingdon) 2019; 23:57-68. [PMID: 30497290 DOI: 10.1080/24699322.2018.1495266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Technical difficulty of an operation is associated with patient and disease characteristics, indicating the necessity for surgeons to exercise patient-specific preparation. Such methods have been shown to be effective in the simulation suite, however, application in a real clinical environment has been sporadic. This systematic review attempts to answer if patient-specific preparation in challenging surgical procedures is feasible. A systematic review of OvidMedline, Embase and all Evidence Based Medicine review databases, was conducted in search of studies who described surgical rehearsals in all specialties. Following the application of defined inclusion and exclusion criteria relevant data were extracted and summarised. Descriptive synthesis was performed for all included studies and meta-analysis of data was applied when possible. Of fourty-nine studies included, thirty-seven were case-series, ten were non-randomised comparative trials and two randomised controlled trials. Accuracy of applied methods ranged from 66.7 to 100% and a good outcome was seen in 60-100% of operations. Meta-analysis of studies comparing rehearsals to real procedures (same patients) showed that simulated procedures were significantly faster than real ones (SMD = -1.56 [-2.19, -0.93] p < 0.00001) but were similar in other outcomes (fluoroscopy time: SMD = -0.1 [-0.63, 0.42] p = 0.7, fluoroscopy volume: SMD = -0.43[-0.97, 0.11], p = 0.12). Meta-analysis of studies comparing pre-operative rehearsals to standard treatment (two distinct groups of patients), demonstrated that real procedures were performed quicker if pre-operative rehearsal took place (SMD = -0.47 [-0.79, -0.16], P = 0.003) but the immediate clinical outcome was similar for practiced and not practiced operations (SMD =0.03[-0.23, 0.29], p = 0.82). Current evidence suggests that patient-specific pre-operative preparation is feasible and safe and decreases operational time.
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Affiliation(s)
- Marina Yiasemidou
- a Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , Leeds , UK
| | | | - David Jayne
- a Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , Leeds , UK
| | - Danilo Miskovic
- a Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , Leeds , UK
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Shen S, Jiang T, Shen SG, Wang X. A reversed approach for simultaneous mandibular symphyseal split osteotomy and genioplasty. Int J Oral Maxillofac Surg 2019; 48:1209-1212. [PMID: 30799056 DOI: 10.1016/j.ijom.2019.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/15/2018] [Accepted: 01/21/2019] [Indexed: 11/28/2022]
Abstract
Performing a mandibular symphyseal split and genioplasty simultaneously and accurately is a technical challenge for the surgeon. The aim of this study was to validate a reversed approach for simultaneous symphyseal split and genioplasty. A cutting guide and a repositioning guide were designed and printed three-dimensionally in titanium. The symphyseal split and genioplasty were performed successfully. The accuracy of the technique appears to be appropriate for clinical application.
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Affiliation(s)
- S Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th Peoples Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Centre for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - T Jiang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th Peoples Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - S G Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th Peoples Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Centre for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - X Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th Peoples Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Centre for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China.
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44
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Surgery-First Orthognathic Surgery for Severe Facial Asymmetry Combined With Mandibular Distraction Osteogenesis Using a Three-Dimensional Internal Distractor. J Craniofac Surg 2019; 30:39-46. [DOI: 10.1097/scs.0000000000004929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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45
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Kim JE, Park JH, Kim JH, Shim JS. Computer-based implant planning involving a prefabricated custom tray with alumina landmark structures. J Prosthet Dent 2018; 121:373-377. [PMID: 30409722 DOI: 10.1016/j.prosdent.2018.06.002] [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: 04/03/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 11/17/2022]
Abstract
The purpose of this technical report was to describe a method for the fabrication of a custom tray with landmark structures to coordinate cone beam computed tomography and scan data for use in guided implant surgery in patients with numerous artifact-causing metal prostheses. The fabricated custom tray can be used to coordinate cone beam computed tomography data and scan data from the dentition, as well as to fabricate the prostheses.
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Affiliation(s)
- Jong-Eun Kim
- Clinical Assistant Professor, Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Ji-Hyun Park
- Graduate student, Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Jee-Hwan Kim
- Associate Professor, Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - June-Sung Shim
- Professor, Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Republic of Korea.
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46
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Li B, Sun H, Zeng F, Zhang T, Wang X. Accuracy of a CAD/CAM surgical template for mandibular distraction: a preliminary study. Br J Oral Maxillofac Surg 2018; 56:814-819. [DOI: 10.1016/j.bjoms.2018.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 09/03/2018] [Indexed: 11/28/2022]
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47
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Shaheen E, Coopman R, Jacobs R, Politis C. Optimized 3D virtually planned intermediate splints for bimaxillary orthognathic surgery: A clinical validation study in 20 patients. J Craniomaxillofac Surg 2018; 46:1441-1447. [DOI: 10.1016/j.jcms.2018.05.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/01/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022] Open
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48
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Yang HJ, Han JJ, Hwang SJ. Accuracy of 3D reproduction of natural head position using three different manual reorientation methods compared to 3D software. J Craniomaxillofac Surg 2018; 46:1625-1630. [DOI: 10.1016/j.jcms.2018.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/26/2018] [Accepted: 06/07/2018] [Indexed: 11/27/2022] Open
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49
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Aristizábal JF, Martínez-Smit R, Díaz C, Pereira Filho VA. Surgery-first approach with 3D customized passive self-ligating brackets and 3D surgical planning: Case report. Dental Press J Orthod 2018; 23:47-57. [PMID: 30088565 PMCID: PMC6072454 DOI: 10.1590/2177-6709.23.3.047-057.oar] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/02/2017] [Indexed: 11/22/2022] Open
Abstract
It is possible to unify three-dimensional customized orthodontic techniques and three-dimensional surgical technology. In this case report, it is introduced a treatment scheme consisting of passive self-ligation customized brackets and virtual surgical planning combined with the orthognathic surgery-first approach in a Class III malocclusion patient. Excellent facial and occlusal outcomes were obtained in a reduced treatment time of five months.
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Affiliation(s)
| | - Rosana Martínez-Smit
- CES University, Departamento de Ortodoncia (Medellín, Colombia).,Universidade Estadual Paulista, Departamento de Ortodontia e Pediatria, Faculdade de Odontologia de Araraquara (Araraquara/SP, Brazil)
| | - Cristian Díaz
- Universidad del Valle, Departamento de Ortodoncia (Cali, Colombia)
| | - Valfrido Antonio Pereira Filho
- Universidade Estadual Paulista, Departamento de Diagnóstico e Cirurgia Bucomaxilofacial, Faculdade de Odontologia de Araraquara (Araraquara/SP, Brazil)
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50
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Stokbro K, Thygesen T. A 3-Dimensional Approach for Analysis in Orthognathic Surgery—Using Free Software for Voxel-Based Alignment and Semiautomatic Measurement. J Oral Maxillofac Surg 2018; 76:1316-1326. [DOI: 10.1016/j.joms.2017.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 10/04/2017] [Accepted: 11/04/2017] [Indexed: 10/18/2022]
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