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Bueno S, Hammad Y, Schlieve T. Does the type of planning in orthognathic surgery influence patient satisfaction? Oral Maxillofac Surg 2023; 27:685-692. [PMID: 36121522 DOI: 10.1007/s10006-022-01114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To determine if the method of orthognathic surgery planning used-computer aided surgical simulation (CASS) versus analog model surgery-influenced patients' post-operative satisfaction. The authors hypothesized that there was no difference in patient satisfaction based on the type of planning in orthognathic surgery. METHODS This was a single-site, observational, retrospective cohort study consisting of a standardized survey aimed to be given to all patients who had orthognathic surgery at the authors' institution over a 6-year period. Patients were asked to complete a survey questionnaire that consisted of eight questions, each utilizing a five-point Likert scale. RESULTS There were 643 patients initially identified with 401 potential subjects meeting the inclusion criteria. Of these 401 patients, the survey was successfully administered to 161. Patients whose orthognathic surgery was planned virtually were not only significantly more likely to be satisfied with their appearance post-operatively, but also more likely to go through with surgery again if they could choose to (p < 0.05). CASS patients were also more likely to identify that their surgery was planned virtually. When stratified by age, younger patients were more likely to have read about CASS. When each survey question was stratified based on the type of surgery that was performed, there were no significant differences. CONCLUSION Patients whose surgeries were virtually planes were significantly more likely than model surgery patients to be satisfied with their post-operative appearance as well as with their decision to have orthognathic surgery. CASS has proven to be an accurate, time-saving, and potentially cost-saving tool for surgeons. Based on the results of this study, the type of surgical planning method matters for post-operative patient satisfaction with their appearance.
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Affiliation(s)
- Scott Bueno
- University of Texas Southwestern/ Parkland Memorial Hospital Oral & Maxillofacial Surgery, 5323 Harry Hines Blvd, CS3.104, Dallas, TX, 75390, USA.
| | - Yousef Hammad
- University of Texas Southwestern/ Parkland Memorial Hospital Oral & Maxillofacial Surgery, 5323 Harry Hines Blvd, CS3.104, Dallas, TX, 75390, USA
| | - Thomas Schlieve
- University of Texas Southwestern/ Parkland Memorial Hospital Oral & Maxillofacial Surgery, 5323 Harry Hines Blvd, CS3.104, Dallas, TX, 75390, USA
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2
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Ruggiero F, Borghi A, Bevini M, Badiali G, Lunari O, Dunaway D, Marchetti C. Soft tissue prediction in orthognathic surgery: Improving accuracy by means of anatomical details. PLoS One 2023; 18:e0294640. [PMID: 38011187 PMCID: PMC10681161 DOI: 10.1371/journal.pone.0294640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
Three-dimensional virtual simulation of orthognathic surgery is now a well-established method in maxillo-facial surgery. The commercial software packages are still burdened by a consistent imprecision on soft tissue predictions. In this study, the authors produced an anatomically detailed patient specific numerical model for simulation of soft tissue changes in orthognathic surgery. Eight patients were prospectively enrolled. Each patient underwent CBCT and planar x-rays prior to surgery and in addition received an MRI scan. Postoperative soft-tissue change was simulated using Finite Element Modeling (FEM) relying on a patient-specific 3D models generated combining data from preoperative CBCT (hard tissue) scans and MRI scans (muscles and skin). An initial simulation was performed assuming that all the muscles and the other soft tissue had the same material properties (Homogeneous Model). This model was compared with the postoperative CBCT 3D simulation for validation purpose. Design of experiments (DoE) was used to assess the effect of the presence of the muscles considered and of their variation in stiffness. The effect of single muscles was evaluated in specific areas of the midface. The quantitative distance error between the homogeneous model and actual patient surfaces for the midface area was 0.55 mm, standard deviation 2.9 mm. In our experience, including muscles in the numerical simulation of orthognathic surgery, brought an improvement in the quality of the simulation obtained.
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Affiliation(s)
| | - Alessandro Borghi
- Department of Engineering, Durham University, Durham, United Kingdom
| | - Mirko Bevini
- Oral and Maxillofacial Surgery Unit, IRCCS AOU di Bologna, Bologna, Italy
| | - Giovanni Badiali
- DIBINEM, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Oral and Maxillofacial Surgery Unit, IRCCS AOU di Bologna, Bologna, Italy
| | - Ottavia Lunari
- Oral and Maxillofacial Surgery Unit, IRCCS AOU di Bologna, Bologna, Italy
| | - David Dunaway
- Craniofacial Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Claudio Marchetti
- DIBINEM, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Oral and Maxillofacial Surgery Unit, IRCCS AOU di Bologna, Bologna, Italy
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Jaiswal MS, Hwang DS. Clinical Analysis of Patients who Underwent Reoperation After Orthognathic Surgery: A 14-Year Retrospective Study. J Craniofac Surg 2023; 34:e781-e785. [PMID: 37643112 DOI: 10.1097/scs.0000000000009655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/20/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE The purpose of this study was to analyze the patients clinically who underwent reoperation after certain Orthognathic procedures, and to assess the reoperation rate. Furthermore, the authors also evaluated the incidence of intraoperative and postoperative complications that led to the need for reoperation. METHODS Total 526 patients were selected who underwent Orthognathic surgery between July 2008 and February 2022 at the Department of Oral and Maxillofacial Surgery in Pusan National University Dental Hospital by single surgeon. All the patients information were extracted from electronic database of our university. Demographic, radiologic, intraoperative, and postoperative data were recorded and compiled. RESULTS Out of 526 patients, 265 (50.3%) were males and 261 (49.6%) were females. The total number of patients who showed complication is 89 (16.9%) and the patients who underwent reoperation are 17 (3.2%). The common complications that occurred were postoperative sensory disturbance (31; 5.8%), unwanted fractures (17; 3.2%), intraoperative nerve injury (11; 2%), wound dehiscence (11; 2%), infection (10; 1.9%), tooth injury (2; 0.3%), and others (18; 3.4%). The serious complications that led to reoperation include severe bleeding (6; 1.1%), unesthetic results (5; 0.9%), non-union of maxilla (4; 0.7%), and failed osteosynthesis (2; 0.3%). After 2018, all the orthognathic surgeries were performed with the help of virtual surgical planning. After application of virtual surgical planning, the number of patients with complications statistically decreased. CONCLUSION The present study showed that the reoperation rate after orthognathic surgery was low, this rate was more decreased after applying 3-dimensional virtual surgery and 3-dimensional printed plate, especially in unesthetic cases.
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Affiliation(s)
- M Shriya Jaiswal
- Department of Oral and Maxillofacial Surgery, Dental and Life Science Institute, Dental School, Pusan National University
| | - Dae-Seok Hwang
- Department of Oral and Maxillofacial Surgery, Dental and Life Science Institute, Dental School, Pusan National University
- Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Republic of Korea
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Dental and Craniomaxillofacial Implant Surgery. J Oral Maxillofac Surg 2023; 81:E75-E94. [PMID: 37833030 DOI: 10.1016/j.joms.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Deng HH, Liu Q, Chen A, Kuang T, Yuan P, Gateno J, Kim D, Barber JC, Xiong KG, Yu P, Gu KJ, Xu X, Yan P, Shen D, Xia JJ. Clinical feasibility of deep learning-based automatic head CBCT image segmentation and landmark detection in computer-aided surgical simulation for orthognathic surgery. Int J Oral Maxillofac Surg 2023; 52:793-800. [PMID: 36372697 PMCID: PMC10169531 DOI: 10.1016/j.ijom.2022.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/14/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
The purpose of this ambispective study was to investigate whether deep learning-based automatic segmentation and landmark detection, the SkullEngine, could be used for orthognathic surgical planning. Sixty-one sets of cone beam computed tomography (CBCT) images were automatically inferred for midface, mandible, upper and lower teeth, and 68 landmarks. The experimental group included automatic segmentation and landmarks, while the control group included manual ones that were previously used to plan orthognathic surgery. The qualitative analysis of segmentation showed that all of the automatic results could be used for computer-aided surgical simulation. Among these, 98.4% of midface, 70.5% of mandible, 98.4% of upper teeth, and 93.4% of lower teeth could be directly used without manual revision. The Dice similarity coefficient was 96% and the average symmetric surface distance was 0.1 mm for all four structures. With SkullEngine, it took 4 minutes to complete the automatic segmentation and an additional 10 minutes for a manual touchup. The results also showed the overall mean difference between the two groups was 2.3 mm for the midface and 2.4 mm for the mandible. In summary, the authors believe that automatic segmentation using SkullEngine is ready for daily practice. However, the accuracy of automatic landmark digitization needs to be improved.
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Affiliation(s)
- H H Deng
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas, USA.
| | - Q Liu
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - A Chen
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas, USA
| | - T Kuang
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas, USA
| | - P Yuan
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas, USA
| | - J Gateno
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas, USA; Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, New York, USA
| | - D Kim
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas, USA
| | - J C Barber
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas, USA
| | - K G Xiong
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas, USA
| | - P Yu
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas, USA
| | - K J Gu
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas, USA
| | - X Xu
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - P Yan
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - D Shen
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - J J Xia
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas, USA; Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, New York, USA.
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Leung YY, Leung JKC, Li ATC, Teo NEZ, Leung KPY, Au SW, Li DTS, Su YX. Accuracy and safety of in-house surgeon-designed three-dimensional-printed patient-specific implants for wafer-less Le Fort I osteotomy. Clin Oral Investig 2023; 27:705-713. [PMID: 36401069 DOI: 10.1007/s00784-022-04798-y] [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: 03/06/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The design and fabrication of three-dimensional (3D)-printed patient-specific implants (PSIs) for orthognathic surgery are customarily outsourced to commercial companies. We propose a protocol of designing PSIs and surgical guides by orthognathic surgeons-in-charge instead for wafer-less Le Fort I osteotomy. The aim of this prospective study was to evaluate the accuracy and post-operative complications of PSIs that are designed in-house for Le Fort I osteotomy. MATERIALS AND METHODS The post-operative cone beam computer tomography (CBCT) model of the maxilla was superimposed to the virtual surgical planning to compare the discrepancies of pre-determined landmarks, lines, and principal axes between the two models. Twenty-five patients (12 males, 13 females) were included. RESULTS The median linear deviations of the post-operative maxilla of the x, y, and z axes were 0.74 mm, 0.75 mm, and 0.72 mm, respectively. The deviations in the principal axes for pitch, yaw, and roll were 1.40°, 0.90°, and 0.60°, respectively. There were no post-operative complications related to the PSIs in the follow-up period. CONCLUSIONS The 3D-printed PSIs designed in-house for wafer-less Le Fort I osteotomy are accurate and safe. CLINICAL RELEVANCE Its clinical outcomes and accuracy are comparable to commercial PSIs for orthognathic surgery. TRIAL REGISTRATION Clinical trial registration number: HKUCTR-2113. Date of registration: 29 July 2016.
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Affiliation(s)
- Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong.
| | - Jasper Ka Chai Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Alvin Tsz Choi Li
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Nathan En Zuo Teo
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Karen Pui Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Shun Wai Au
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Dion Tik Shun Li
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yu-Xiong Su
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
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Sánchez-Jáuregui E, Baranda-Manterola E, Ranz-Colio Á, Bueno de Vicente Á, Acero-Sanz J. Custom made cutting guides and osteosynthesis plates versus CAD/CAM occlusal splints in positioning and fixation of the maxilla in orthognathic surgery: A prospective randomized study. J Craniomaxillofac Surg 2022; 50:609-614. [PMID: 35760659 DOI: 10.1016/j.jcms.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/22/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022] Open
Abstract
The aim of this study is to compare the accuracy of maxilla positioning in orthognathic surgery with the use of custom-made devices (cutting guides and patient-fitted osteosynthesis plates) comparing to CAD/CAM splints. A prospective randomized study was performed. Patients with dentofacial deformities undergoing orthognathic surgery were compared, using customized guides (experimental group) vs. CAD/CAM surgical splints (control group) for the repositioning of the upper maxilla. Preoperative and postoperative CT scans were used to compare positioning and fixation of the maxilla in the three planes of space. A total of 30 patients were included in the study (15 patients in each study group). The mean error obtained with customized guides was 0.8 mm (range 0.1-1.9) in the anterior-posterior axis, 0.4 mm (range 0-1.4) in the vertical axis and 0.2 mm (range 0-1.1) in the horizontal axis. There were statistically significant differences in the anterior-posterior and vertical axes in favour of the customized implants, whereas there were no differences in the horizontal plane. Furthermore, there was a mean reduction of the operative time of 36.5 min in the experimental group. Within the limitations of the study it seems that patient specific surgical guides should be preferred when accuracy of repositioning of the maxilla and saving operative time are the priority.
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Affiliation(s)
- Eduardo Sánchez-Jáuregui
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal (University of Alcalá de Henares), Madrid, Spain.
| | - Elena Baranda-Manterola
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal (University of Alcalá de Henares), Madrid, Spain.
| | - Álvaro Ranz-Colio
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal (University of Alcalá de Henares), Madrid, Spain.
| | - Ángela Bueno de Vicente
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal (University of Alcalá de Henares), Madrid, Spain.
| | - Julio Acero-Sanz
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal (University of Alcalá de Henares), Madrid, Spain.
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Computer Aided Orthognathic Surgery: A General Method for Designing and Manufacturing Personalized Cutting/Repositioning Templates. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Orthognathic surgery allows broad-spectrum deformity correction involving both aesthetic and functional aspects on the TMJ (temporo-mandibular joint) and on the facial skull district. The combination of Reverse Engineering (RE), Virtual Surgery Planning (VSP), Computer Aided Design (CAD), Additive Manufacturing (AM), and 3D visualization allows surgeons to plan, virtually, manipulations and the translation of the human parts in the operating room. This work’s aim was to define a methodology, in the form of a workflow, for surgery planning and for designing and manufacturing templates for orthognathic surgery. Along the workflow, the error chain was checked and the maximum error in virtual planning was evaluated. The three-dimensional reconstruction of the mandibular shape and bone fragment movements after segmentation allow complete planning of the surgery and, following the proposed method, the introduction of both the innovative evaluation of the transversal intercondylar distance variation after mandibular arch advancement/set and the possibility of use of standard plates to plan and realize a customized surgery. The procedure was adopted in one clinical case on a patient affected by a class III malocclusion with an associated open bite and right deviation of the mandible with expected good results. Compared with the methods from most recent literature, the presented method introduces two elements of novelty and improves surgery results by optimizing costs and operating time. A new era of collaboration among surgeons and engineer has begun and is now bringing several benefits in personalized surgery.
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Clinical feasibility evaluation of digital dental articulation for three-piece maxillary orthognathic surgery: a proof-of-concept study. Int J Oral Maxillofac Surg 2022; 51:1043-1049. [PMID: 35183403 PMCID: PMC9253058 DOI: 10.1016/j.ijom.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/23/2021] [Accepted: 02/01/2022] [Indexed: 11/22/2022]
Abstract
Digital dental articulation for three-piece maxillary orthognathic surgery is challenging. The purpose of this proof-of-concept study was to evaluate the clinical feasibility of a newly developed mathematical algorithm to digitally establish the final occlusion for three-piece maxillary surgery. Five patients with jaw deformities who had undergone a three-piece double-jaw surgery that was planned virtually were randomly selected for this study. The final occlusion had been hand-articulated using stone casts, scanned into the computer and used in the surgery. These hand-articulated occlusions served as the control group. To form the experimental group, the three-piece maxillary dental arch was articulated again automatically from the patient's original occlusion using the mathematical algorithm. The hand- and algorithm-articulated occlusions were then evaluated qualitatively by two experienced orthodontists. A quantitative evaluation was also performed. The results of the qualitative evaluation showed that all of the three-piece occlusions, hand- and algorithm-articulated, were clinically acceptable based on the American Board of Orthodontics grading system. When compared, two of the algorithm-articulated occlusions were clearly better (40%), one was the same (20%), and two were slightly worse (40%) than the hand-articulated occlusions. All of the quantitative measurements were comparable between the two articulation methods. In conclusion, the results of this study demonstrate that it is clinically feasible to digitally articulate the three-piece maxillary arch to the intact mandibular dental arch.
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Midsagittal Plane First: Building a Strong Facial Reference Frame for Computer-Aided Surgical Simulation. J Oral Maxillofac Surg 2021; 80:641-650. [PMID: 34942153 DOI: 10.1016/j.joms.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE A facial reference frame is a 3-dimensional Cartesian coordinate system that includes 3 perpendicular planes: midsagittal, axial, and coronal. The order in which one defines the planes matters. The purposes of this study are to determine the following: 1) what sequence (axial-midsagittal-coronal vs midsagittal-axial-coronal) produced more appropriate reference frames and 2) whether orbital or auricular dystopia influenced the outcomes. METHODS This study is an ambispective cross-sectional study. Fifty-four subjects with facial asymmetry were included. The facial reference frames of each subject (outcome variable) were constructed using 2 methods (independent variable): axial plane first and midsagittal plane first. Two board-certified orthodontists together blindly evaluated the results using a 3-point categorical scale based on their careful inspection and expert intuition. The covariant for stratification was the existence of orbital or auricular dystopia. Finally, Wilcoxon signed rank tests were performed. RESULTS The facial reference frames defined by the midsagittal plane first method was statistically significantly different from ones defined by the axial plane first method (P = .001). Using the midsagittal plane first method, the reference frames were more appropriately defined in 22 (40.7%) subjects, equivalent in 26 (48.1%) and less appropriately defined in 6 (11.1%). After stratified by orbital or auricular dystopia, the results also showed that the reference frame computed using midsagittal plane first method was statistically significantly more appropriate in both subject groups regardless of the existence of orbital or auricular dystopia (27 with orbital or auricular dystopia and 27 without, both P < .05). CONCLUSIONS The midsagittal plane first sequence improves the facial reference frames compared with the traditional axial plane first approach. However, regardless of the sequence used, clinicians need to judge the correctness of the reference frame before diagnosis or surgical planning.
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Lee SJ, Yoo JY, Woo SY, Yang HJ, Kim JE, Huh KH, Lee SS, Heo MS, Hwang SJ, Yi WJ. A Complete Digital Workflow for Planning, Simulation, and Evaluation in Orthognathic Surgery. J Clin Med 2021; 10:jcm10174000. [PMID: 34501449 PMCID: PMC8432567 DOI: 10.3390/jcm10174000] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study was to develop a complete digital workflow for planning, simulation, and evaluation for orthognathic surgery based on 3D digital natural head position reproduction, a cloud-based collaboration platform, and 3D landmark-based evaluation. We included 24 patients who underwent bimaxillary orthognathic surgery. Surgeons and engineers could share the massive image data immediately and conveniently and collaborate closely in surgical planning and simulation using a cloud-based platform. The digital surgical splint could be optimized for a specific patient before or after the physical fabrication of 3D printing splints through close collaboration. The surgical accuracy was evaluated comprehensively via the translational (linear) and rotational (angular) discrepancies between identical 3D landmarks on the simulation and postoperative computed tomography (CT) models. The means of the absolute linear discrepancy at eight tooth landmarks were 0.61 ± 0.55, 0.86 ± 0.68, and 1.00 ± 0.79 mm in left–right, advance–setback, and impaction–elongation directions, respectively, and 1.67 mm in the root mean square direction. The linear discrepancy in the left–right direction was significantly different from the other two directions as shown by analysis of variance (ANOVA, p < 0.05). The means of the absolute angular discrepancies were 1.43 ± 1.06°, 0.50 ± 0.31°, and 0.58 ± 0.41° in the pitch, roll, and yaw orientations, respectively. The angular discrepancy in the pitch orientation was significantly different from the other two orientations (ANOVA, p < 0.05). The complete digital workflow that we developed for orthognathic patients provides efficient and streamlined procedures for orthognathic surgery and shows high surgical accuracy with efficient image data sharing and close collaboration.
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Affiliation(s)
- Sang-Jeong Lee
- Dental Research Institute, Seoul National University, Seoul 03080, Korea;
| | - Ji-Yong Yoo
- Department of Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 08826, Korea; (J.-Y.Y.); (S.-Y.W.)
| | - Sang-Yoon Woo
- Department of Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 08826, Korea; (J.-Y.Y.); (S.-Y.W.)
| | - Hoon Joo Yang
- Department of Oral and Maxillofacial Surgery and Dental Research Institute, School of Dentistry, Seoul National University, Seoul 03080, Korea
- Correspondence: (H.J.Y.); (W.-J.Y.)
| | - Jo-eun Kim
- Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital, Seoul 03080, Korea;
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul 03080, Korea; (K.-H.H.); (S.-S.L.); (M.-S.H.)
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul 03080, Korea; (K.-H.H.); (S.-S.L.); (M.-S.H.)
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul 03080, Korea; (K.-H.H.); (S.-S.L.); (M.-S.H.)
| | - Soon Jung Hwang
- Hwang Soon Jung’s Dental Clinic for Oral and Maxillofacial Surgery, Seoul 06626, Korea;
| | - Won-Jin Yi
- Department of Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 08826, Korea; (J.-Y.Y.); (S.-Y.W.)
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul 03080, Korea; (K.-H.H.); (S.-S.L.); (M.-S.H.)
- Correspondence: (H.J.Y.); (W.-J.Y.)
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12
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Kim D, Kuang T, Rodrigues YL, Gateno J, Shen SGF, Wang X, Stein K, Deng HH, Liebschner MAK, Xia JJ. A novel incremental simulation of facial changes following orthognathic surgery using FEM with realistic lip sliding effect. Med Image Anal 2021; 72:102095. [PMID: 34090256 DOI: 10.1016/j.media.2021.102095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Abstract
Accurate prediction of facial soft-tissue changes following orthognathic surgery is crucial for surgical outcome improvement. We developed a novel incremental simulation approach using finite element method (FEM) with a realistic lip sliding effect to improve the prediction accuracy in the lip region. First, a lip-detailed mesh is generated based on accurately digitized lip surface points. Second, an improved facial soft-tissue change simulation method is developed by applying a lip sliding effect along with the mucosa sliding effect. Finally, the orthognathic surgery initiated soft-tissue change is simulated incrementally to facilitate a natural transition of the facial change and improve the effectiveness of the sliding effects. Our method was quantitatively validated using 35 retrospective clinical data sets by comparing it to the traditional FEM simulation method and the FEM simulation method with mucosa sliding effect only. The surface deviation error of our method showed significant improvement in the upper and lower lips over the other two prior methods. In addition, the evaluation results using our lip-shape analysis, which reflects clinician's qualitative evaluation, also proved significant improvement of the lip prediction accuracy of our method for the lower lip and both upper and lower lips as a whole compared to the other two methods. In conclusion, the prediction accuracy in the clinically critical region, i.e., the lips, significantly improved after applying incremental simulation with realistic lip sliding effect compared with the FEM simulation methods without the lip sliding effect.
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Affiliation(s)
- Daeseung Kim
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, 6560 Fannin St, Houston, TX 77030, USA
| | - Tianshu Kuang
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, 6560 Fannin St, Houston, TX 77030, USA
| | - Yriu L Rodrigues
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, 6560 Fannin St, Houston, TX 77030, USA
| | - Jaime Gateno
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, 6560 Fannin St, Houston, TX 77030, USA; Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, 407 E 61st St, New York, NY 10065, USA
| | - Steve G F Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University College of Medicine, 639 Zhi-Zao-Ju Road, Shanghai 200011, China
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University College of Medicine, 639 Zhi-Zao-Ju Road, Shanghai 200011, China
| | - Kirhyn Stein
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, 6560 Fannin St, Houston, TX 77030, USA
| | - Hannah H Deng
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, 6560 Fannin St, Houston, TX 77030, USA
| | - Michael A K Liebschner
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
| | - James J Xia
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, 6560 Fannin St, Houston, TX 77030, USA; Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, 407 E 61st St, New York, NY 10065, USA.
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13
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Mascarenhas W, Makhoul N. Efficient in-house 3D printing of an orthognathic splint for single-jaw cases. Int J Oral Maxillofac Surg 2021; 50:1075-1077. [PMID: 33446444 DOI: 10.1016/j.ijom.2020.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/18/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
The purpose of this paper is to outline a simple and effective digital protocol for in-house 3D-printing of orthognathic splints for use during single-jaw orthognathic surgery. Using this protocol, an intraoral scanner, and virtual planning software, computer-designed splints were fabricated by a rapid prototyping machine in-house. The protocol was utilized for 35 consecutive patients requiring single-jaw orthognathic surgery between January 2019 and March 2020. The total time from initial scan to splint fabrication for each case was between 5 and 9hours, including 3minutes for scanning of models, 4.5minutes for development of the splint, and 4-8hours for rapid prototyping and post-processing. This time varied based on the complexity of the design and the number of splints printed simultaneously. The average cost of raw materials for each splint was $0.73 Canadian dollars.
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Affiliation(s)
- W Mascarenhas
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, McGill University, Montreal, Québec, Canada.
| | - N Makhoul
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, McGill University, Montreal, Québec, Canada; Department of Dentistry and Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Québec, Canada
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14
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Kwon TG, Miloro M, Han MD. How Accurate Is 3-Dimensional Computer-Assisted Planning for Segmental Maxillary Surgery? J Oral Maxillofac Surg 2020; 78:1597-1608. [DOI: 10.1016/j.joms.2020.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
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15
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Valls-Ontañón A, Ascencio-Padilla RDJ, Vela-Lasagabaster A, Sada-Malumbres A, Haas-Junior OL, Masià-Gridilla J, Hernández-Alfaro F. Relevance of 3D virtual planning in predicting bony interferences between distal and proximal fragments after sagittal split osteotomy. Int J Oral Maxillofac Surg 2020; 49:1020-1028. [PMID: 31918988 DOI: 10.1016/j.ijom.2019.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/29/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
After sagittal split osteotomy, the mandibular distal and proximal fragments do not always align themselves passively to one another, resulting in bony interferences and subsequent anomalous settlement of the condyles. Predicting these interferences could be an important ancillary procedure for avoiding intra- and postoperative surgical complications, rendering orthognathic surgery more effective and safer. This study evaluated the relevance of virtual surgical planning in assessing the displacement of the proximal segments after virtual distal segment repositioning, for predicting bony interferences between the segments and thus avoiding related intra- and postoperative surgical complications. The presence of interferences between the distal and proximal segments was compared between virtually predicted (computer-assisted simulation surgery, Dolphin software) and real cases in 100 consecutive patients diagnosed with dentofacial deformities who underwent orthognathic surgery with mandibular repositioning (using a short lingual osteotomy (SLO)). The results indicated that clockwise rotation of the mandible was the mandibular movement most prone to segment interference. Furthermore, virtual planning was sensitive (100%) but had low specificity (51.6%) in predicting proximal and distal segment interferences. This low specificity was due to the software-based automated design of the mandibular osteotomy, where the length of the distal segment was longer than the real SLO, and the mandibular ramus sagittal split was located just behind Spix's spine. Thus, more precise simulated osteotomies are needed to further validate the accuracy of virtual planning for this purpose.
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Affiliation(s)
- A Valls-Ontañón
- Institute of Maxillofacial Surgery, Teknon Medical Centre Barcelona, Barcelona, Spain; Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.
| | | | - A Vela-Lasagabaster
- Institute of Maxillofacial Surgery, Teknon Medical Centre Barcelona, Barcelona, Spain
| | - A Sada-Malumbres
- Institute of Maxillofacial Surgery, Teknon Medical Centre Barcelona, Barcelona, Spain
| | - O L Haas-Junior
- Institute of Maxillofacial Surgery, Teknon Medical Centre Barcelona, Barcelona, Spain
| | - J Masià-Gridilla
- Institute of Maxillofacial Surgery, Teknon Medical Centre Barcelona, Barcelona, Spain; Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - F Hernández-Alfaro
- Institute of Maxillofacial Surgery, Teknon Medical Centre Barcelona, Barcelona, Spain; Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
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Zaragoza-Siqueiros J, Medellin-Castillo HI, de la Garza-Camargo H, Lim T, Ritchie JM. An integrated haptic-enabled virtual reality system for orthognathic surgery planning. Comput Methods Biomech Biomed Engin 2019; 22:499-517. [PMID: 30714408 DOI: 10.1080/10255842.2019.1566817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Conventional Orthognathic surgery (OGS) planning involves cephalometric analyses and dental casts to be mounted on an articulator. Dental segments are subsequently identified, cut and repositioned to allow the fabrication of intraoral wafers that guide the positioning of the osteotomy bone segments. This conventional planning introduces many inaccuracies that affect the post-surgery outcomes. Although computer technologies have advanced computational tools for OGS planning, they have failed in providing a practical solution. Many focuses only on some specific stages of the planning process, and their ability to transfer preoperative planning data to the operating room is limited. This paper proposes a new integrated haptic-enabled virtual reality (VR) system for OGS planning. The system incorporates CAD tools and haptics to facilitate a complete planning process and is able to automatically generate preoperative plans. A clinical pre-diagnosis is also provided automatically by the system based on the patient's digital data. A functional evaluation based on a real patient case study demonstrates that the proposed virtual OGS planning method is feasible and more effective than the traditional approach at increasing the intuitiveness and reducing errors and planning times.
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Affiliation(s)
| | | | | | - Theodore Lim
- c Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences , Heriot-Watt University , Riccarton , Edinburgh , UK
| | - James M Ritchie
- c Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences , Heriot-Watt University , Riccarton , Edinburgh , UK
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Brito HHDA, Mordente CM. Facial asymmetry: virtual planning to optimize treatment predictability and aesthetic results. Dental Press J Orthod 2018; 23:80-89. [PMID: 30672989 PMCID: PMC6340196 DOI: 10.1590/2177-6709.23.6.080-089.bbo] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/05/2018] [Indexed: 02/03/2023] Open
Abstract
Facial asymmetry is a condition that compromises function and social interactions and, consequently, the quality of life. Orthodontic-surgical treatment may be indicated to achieve a stable occlusion and significant improvement in facial aesthetics. The virtual planning of the maxillary, mandibular and chin movements can be done prior to surgery. These movements can be successfully performed with the use of prototyped guides obtained from virtual planning. The aim of this article is to show the state of the art of treatments of facial asymmetries, and emphasize how important is the multi-disciplinary approach to achieve predictable aesthetic and functionally stable results in a patient with facial asymmetry and chin protrusion.
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Affiliation(s)
- Hélio Henrique de Araújo Brito
- Pontifícia Universidade Católica de Minas Gerais, Programa de Pós-graduação em Odontologia, Departamento de Ortodontia (Belo Horizonte/MG, Brazil)
| | - Carolina Morsani Mordente
- Pontifícia Universidade Católica de Minas Gerais, Programa de Pós-graduação em Odontologia, Departamento de Ortodontia (Belo Horizonte/MG, Brazil)
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Chen K, Xiao D, Abotaleb B, Chen H, Li Y, Zhu S. Accuracy of Virtual Surgical Planning in Treatment of Temporomandibular Joint Ankylosis Using Distraction Osteogenesis: Comparison of Planned and Actual Results. J Oral Maxillofac Surg 2018; 76:2422.e1-2422.e20. [DOI: 10.1016/j.joms.2018.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Unilateral sagittal split ramus osteotomy: an alternative for some cases of asymmetric mandibular prognathism. Int J Oral Maxillofac Surg 2017; 47:630-637. [PMID: 29223700 DOI: 10.1016/j.ijom.2017.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/19/2017] [Accepted: 11/21/2017] [Indexed: 11/23/2022]
Abstract
The objective of this study was to propose a treatment protocol for patients with lateral prognathism based on the unilateral sagittal split ramus osteotomy (USSRO). This was a prospective study involving 31 patients with lateral prognathism, who required a bilateral sagittal split ramus osteotomy (BSSRO). Two groups were formed using the proposed protocol, with specific inclusion criteria for each group: BSSRO (n=17) and USSRO (n=14). Occlusal parameters (dental midline deviation, overbite, and overjet) were measured preoperatively (T0), at model surgery (T1), 1 month postoperative (T2), and 1year after surgery (T3) and compared. P-values of <0.05 were considered significant. No significant difference was found between the USSRO and BSSRO groups for all occlusal parameters (T0, T1, T2, and T3). In both groups, there was a significant difference between T0 and T1 and no significant difference between T1 and T2 or T1 and T3 in all of the occlusal parameters; the exception was overbite between T1 and T2 in the BSSRO group, which showed a significant difference. No patient in either group showed signs or symptoms of temporomandibular joint dysfunction at T0 or T3. USSRO was found to be a stable alternative in patients with asymmetric mandibular prognathism. At the same time, it reduced the operating time and morbidity when compared to BSSRO.
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Zhang X, Kim D, Shen S, Yuan P, Liu S, Tang Z, Zhang G, Zhou X, Gateno J, Liebschner MAK, Xia JJ. An eFTD-VP framework for efficiently generating patient-specific anatomically detailed facial soft tissue FE mesh for craniomaxillofacial surgery simulation. Biomech Model Mechanobiol 2017; 17:387-402. [PMID: 29027022 DOI: 10.1007/s10237-017-0967-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 09/25/2017] [Indexed: 11/26/2022]
Abstract
Accurate surgical planning and prediction of craniomaxillofacial surgery outcome requires simulation of soft tissue changes following osteotomy. This can only be achieved by using an anatomically detailed facial soft tissue model. The current state-of-the-art of model generation is not appropriate to clinical applications due to the time-intensive nature of manual segmentation and volumetric mesh generation. The conventional patient-specific finite element (FE) mesh generation methods are to deform a template FE mesh to match the shape of a patient based on registration. However, these methods commonly produce element distortion. Additionally, the mesh density for patients depends on that of the template model. It could not be adjusted to conduct mesh density sensitivity analysis. In this study, we propose a new framework of patient-specific facial soft tissue FE mesh generation. The goal of the developed method is to efficiently generate a high-quality patient-specific hexahedral FE mesh with adjustable mesh density while preserving the accuracy in anatomical structure correspondence. Our FE mesh is generated by eFace template deformation followed by volumetric parametrization. First, the patient-specific anatomically detailed facial soft tissue model (including skin, mucosa, and muscles) is generated by deforming an eFace template model. The adaptation of the eFace template model is achieved by using a hybrid landmark-based morphing and dense surface fitting approach followed by a thin-plate spline interpolation. Then, high-quality hexahedral mesh is constructed by using volumetric parameterization. The user can control the resolution of hexahedron mesh to best reflect clinicians' need. Our approach was validated using 30 patient models and 4 visible human datasets. The generated patient-specific FE mesh showed high surface matching accuracy, element quality, and internal structure matching accuracy. They can be directly and effectively used for clinical simulation of facial soft tissue change.
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Affiliation(s)
- Xiaoyan Zhang
- College of Computer Science and Software Engineering, Shenzhen University, Shenzhen, China
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Daeseung Kim
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Shunyao Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th Peoples Hospital, Shanghai Jiaotong University School of Medicine and Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Peng Yuan
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Siting Liu
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Zhen Tang
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Guangming Zhang
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Xiaobo Zhou
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jaime Gateno
- Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College of Cornell University, New York, NY, USA
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Michael A K Liebschner
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA.
| | - James J Xia
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th Peoples Hospital, Shanghai Jiaotong University School of Medicine and Shanghai Key Laboratory of Stomatology, Shanghai, China.
- Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College of Cornell University, New York, NY, USA.
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA.
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21
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Hwang HS, Oh MH, Oh HK, Oh H. Surgery-first approach in correcting skeletal Class III malocclusion with mandibular asymmetry. Am J Orthod Dentofacial Orthop 2017; 152:255-267. [DOI: 10.1016/j.ajodo.2014.10.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/01/2014] [Accepted: 10/01/2014] [Indexed: 11/28/2022]
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22
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Triplett RG, Berger J, Jensen O, Louis P. Dental and Craniomaxillofacial Implant Surgery. J Oral Maxillofac Surg 2017; 75:e74-e93. [PMID: 28728740 DOI: 10.1016/j.joms.2017.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Kim D, Ho DCY, Mai H, Zhang X, Shen SGF, Shen S, Yuan P, Liu S, Zhang G, Zhou X, Gateno J, Liebschner MAK, Xia JJ. A clinically validated prediction method for facial soft-tissue changes following double-jaw surgery. Med Phys 2017; 44:4252-4261. [PMID: 28570001 DOI: 10.1002/mp.12391] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE It is clinically important to accurately predict facial soft-tissue changes prior to orthognathic surgery. However, the current simulation methods are problematic, especially in anatomic regions of clinical significance, e.g., the nose, lips, and chin. We developed a new 3-stage finite element method (FEM) approach that incorporates realistic tissue sliding to improve such prediction. METHODS In Stage One, soft-tissue change was simulated, using FEM with patient-specific mesh models generated from our previously developed eFace template. Postoperative bone movement was applied on the patient mesh model with standard FEM boundary conditions. In Stage Two, the simulation was improved by implementing sliding effects between gum tissue and teeth using a nodal force constraint scheme. In Stage Three, the result of the tissue sliding effect was further enhanced by reassigning the soft-tissue-bone mapping and boundary conditions using nodal spatial constraint. Finally, our methods have been quantitatively and qualitatively validated using 40 retrospectively evaluated patient cases by comparing it to the traditional FEM method and the FEM with sliding effect, using a nodal force constraint method. RESULTS The results showed that our method was better than the other two methods. Using our method, the quantitative distance errors between predicted and actual patient surfaces for the entire face and any subregions thereof were below 1.5 mm. The overall soft-tissue change prediction was accurate to within 1.1 ± 0.3 mm, with the accuracy around the upper and lower lip regions of 1.2 ± 0.7 mm and 1.5 ± 0.7 mm, respectively. The results of qualitative evaluation completed by clinical experts showed an improvement of 46% in acceptance rate compared to the traditional FEM simulation. More than 80% of the result of our approach was considered acceptable in comparison with 55% and 50% following the other two methods. CONCLUSION The FEM simulation method with improved sliding effect showed significant accuracy improvement in the whole face and the clinically significant regions (i.e., nose and lips) in comparison with the other published FEM methods, with or without sliding effect using a nodal force constraint. The qualitative validation also proved the clinical feasibility of the developed approach.
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Affiliation(s)
- Daeseung Kim
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Dennis Chun-Yu Ho
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Huaming Mai
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Xiaoyan Zhang
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Steve G F Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, 200011, China
| | - Shunyao Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, 200011, China
| | - Peng Yuan
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Siting Liu
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Guangming Zhang
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA
| | - Xiaobo Zhou
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA
| | - Jaime Gateno
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA.,Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY, 10065, USA
| | | | - James J Xia
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA.,Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, 200011, China.,Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY, 10065, USA
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24
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Gaber RM, Shaheen E, Falter B, Araya S, Politis C, Swennen GRJ, Jacobs R. A Systematic Review to Uncover a Universal Protocol for Accuracy Assessment of 3-Dimensional Virtually Planned Orthognathic Surgery. J Oral Maxillofac Surg 2017. [PMID: 28646644 DOI: 10.1016/j.joms.2017.05.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to systematically review methods used for assessing the accuracy of 3-dimensional virtually planned orthognathic surgery in an attempt to reach an objective assessment protocol that could be universally used. MATERIALS AND METHODS A systematic review of the currently available literature, published until September 12, 2016, was conducted using PubMed as the primary search engine. We performed secondary searches using the Cochrane Database, clinical trial registries, Google Scholar, and Embase, as well as a bibliography search. Included articles were required to have stated clearly that 3-dimensional virtual planning was used and accuracy assessment performed, along with validation of the planning and/or assessment method. Descriptive statistics and quality assessment of included articles were performed. RESULTS The initial search yielded 1,461 studies. Only 7 studies were included in our review. An important variability was found regarding methods used for 1) accuracy assessment of virtually planned orthognathic surgery or 2) validation of the tools used. Included studies were of moderate quality; reviewers' agreement regarding quality was calculated to be 0.5 using the Cohen κ test. CONCLUSIONS On the basis of the findings of this review, it is evident that the literature lacks consensus regarding accuracy assessment. Hence, a protocol is suggested for accuracy assessment of virtually planned orthognathic surgery with the lowest margin of error.
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Affiliation(s)
- Ramy M Gaber
- Assistant Lecturer and Doctoral Student, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt, and Research Fellow, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium.
| | - Eman Shaheen
- Clinical engineer, OMFS-IMPATH research group, Department of Imaging and Pathology, Catholic University of Leuven & Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Leuven, Belgium
| | - Bart Falter
- Consultant, Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Leuven, Belgium
| | | | - Constantinus Politis
- Professor and Head, Department of Oral and Maxillofacial Surgery, Catholic University of Leuven, Leuven, Belgium
| | - Gwen R J Swennen
- Professor, Maxillofacial and Facial Plastic Surgery, Department of Surgery, Cleft and Craniofacial Centre, Bruges, Belgium, and Three-Dimensional Facial Imaging Research Group, General Hospital St Jan, Bruges, Belgium
| | - Reinhilde Jacobs
- Professor, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium
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Li B, Shen S, Jiang W, Li J, Jiang T, Xia JJ, Shen SG, Wang X. A new approach of splint-less orthognathic surgery using a personalized orthognathic surgical guide system: A preliminary study. Int J Oral Maxillofac Surg 2017; 46:1298-1305. [PMID: 28552440 DOI: 10.1016/j.ijom.2017.03.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 10/15/2016] [Accepted: 03/20/2017] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to evaluate a personalized orthognathic surgical guide (POSG) system for bimaxillary surgery without the use of surgical splint. Ten patients with dentofacial deformities were enrolled. Surgeries were planned with the computer-aided surgical simulation method. The POSG system was designed for both maxillary and mandibular surgery. Each consisted of cutting guides and three-dimensionally (3D) printed custom titanium plates to guide the osteotomy and repositioning the bony segments without the use of the surgical splints. Finally, the outcome evaluation was completed by comparing planned outcomes with postoperative outcomes. All operations were successfully completed using the POSG system. The largest root-mean-square deviations were 0.74mm and 1.93° for the maxillary dental arch, 1.10mm and 2.82° for the mandibular arch, 0.83mm and 2.59° for the mandibular body, and 0.98mm and 2.45° for the proximal segments. The results of the study indicated that our POSG system is capable of accurately and effectively transferring the surgical plan without the use of surgical splint. A significant advantage is that the repositioning of the bony segments is independent to the mandibular autorotation, thus eliminates the potential problems associated with the surgical splint.
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Affiliation(s)
- B Li
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - S Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - W Jiang
- Clinical Translation R&D Center of 3D Printing Technology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J Li
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - T Jiang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J J Xia
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute for Academic Medicine, Houston Methodist Hospital, Texas, USA; Weill Medical College, Cornell University, New York, NY, USA
| | - S G Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - X Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China.
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Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 1: planning sequence. Int J Oral Maxillofac Surg 2016; 44:1431-40. [PMID: 26573562 DOI: 10.1016/j.ijom.2015.06.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/29/2015] [Accepted: 06/08/2015] [Indexed: 11/21/2022]
Abstract
The success of craniomaxillofacial (CMF) surgery depends not only on the surgical techniques, but also on an accurate surgical plan. The adoption of computer-aided surgical simulation (CASS) has created a paradigm shift in surgical planning. However, planning an orthognathic operation using CASS differs fundamentally from planning using traditional methods. With this in mind, the Surgical Planning Laboratory of Houston Methodist Research Institute has developed a CASS protocol designed specifically for orthognathic surgery. The purpose of this article is to present an algorithm using virtual tools for planning a double-jaw orthognathic operation. This paper will serve as an operation manual for surgeons wanting to incorporate CASS into their clinical practice.
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Xia JJ, Gateno J, Teichgraeber JF, Yuan P, Li J, Chen KC, Jajoo A, Nicol M, Alfi DM. Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 2: three-dimensional cephalometry. Int J Oral Maxillofac Surg 2016; 44:1441-50. [PMID: 26573563 DOI: 10.1016/j.ijom.2015.06.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/27/2015] [Accepted: 06/08/2015] [Indexed: 11/25/2022]
Abstract
Three-dimensional (3D) cephalometry is not as simple as just adding a 'third' dimension to a traditional two-dimensional cephalometric analysis. There are more complex issues in 3D analysis. These include how reference frames are created, how size, position, orientation and shape are measured, and how symmetry is assessed. The main purpose of this article is to present the geometric principles of 3D cephalometry. In addition, the Gateno-Xia cephalometric analysis is presented; this is the first 3D cephalometric analysis to observe these principles.
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Affiliation(s)
- J J Xia
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Oral and Maxillofacial Surgery, Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, NY, USA.
| | - J Gateno
- Oral and Maxillofacial Surgery, Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, NY, USA; Department of Oral and Maxillofacial Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - J F Teichgraeber
- Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, TX, USA
| | - P Yuan
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - J Li
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - K-C Chen
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Department of Oral and Maxillofacial Surgery, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan
| | - A Jajoo
- Department of Mathematics, University of Houston, TX, USA
| | - M Nicol
- Department of Mathematics, University of Houston, TX, USA
| | - D M Alfi
- Oral and Maxillofacial Surgery, Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, NY, USA; Department of Oral and Maxillofacial Surgery, Houston Methodist Hospital, Houston, TX, USA
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An integrated orthognathic surgery system for virtual planning and image-guided transfer without intermediate splint. J Craniomaxillofac Surg 2014; 42:2010-7. [DOI: 10.1016/j.jcms.2014.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 08/22/2014] [Accepted: 09/25/2014] [Indexed: 11/22/2022] Open
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Haas OL, Becker OE, de Oliveira RB. Computer-aided planning in orthognathic surgery-systematic review. Int J Oral Maxillofac Surg 2014; 44:S0901-5027(14)00430-5. [PMID: 25432508 DOI: 10.1016/j.ijom.2014.10.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 08/15/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Abstract
The aim of this study was to conduct a systematic review to evaluate the accuracy and benefits of computer-aided planning in orthognathic surgery. The search was performed in PubMed, EMBASE, Cochrane Library, LILACS, and SciELO. The articles identified were assessed independently and in a blinded manner by two authors using selection criteria and eligibility criteria. The database search yielded 375 studies. Following the application of search and eligibility criteria, a final nine studies were included in the systematic review. The level of agreement between the authors in the study selection process was substantial (κ=0.767) and study eligibility was considered excellent (κ=0.863). The accuracy of translation was <1.2mm in the maxilla (vertical) and <1.1mm in the mandible (sagittal), and for rotation was <1.5° in the maxilla (pitch) and <1.8° in the mandible (pitch). Two studies showed a medium potential risk of bias and six studies showed a high potential risk of bias. Computer-aided planning in orthognathic surgery was considered accurate for the studies included in this systematic review. However, the low quality of these studies means that randomized clinical trials are needed to compare computer-aided planning to conventional planning in orthognathic surgery.
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Affiliation(s)
- O L Haas
- Department of Oral and Maxillofacial Surgery, Pontificial Catholic University of Rio Grande do Sul - PUC/RS, Rio Grande do Sul, Brazil.
| | - O E Becker
- Department of Oral and Maxillofacial Surgery, Pontificial Catholic University of Rio Grande do Sul - PUC/RS, Rio Grande do Sul, Brazil
| | - R B de Oliveira
- Department of Oral and Maxillofacial Surgery, Pontificial Catholic University of Rio Grande do Sul - PUC/RS, Rio Grande do Sul, Brazil
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Farrell BB, Franco PB, Tucker MR. Virtual Surgical Planning in Orthognathic Surgery. Oral Maxillofac Surg Clin North Am 2014; 26:459-73. [DOI: 10.1016/j.coms.2014.08.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pachêco-Pereira C, De Luca Canto G, Major PW, Flores-Mir C. Variation of orthodontic treatment decision-making based on dental model type: A systematic review. Angle Orthod 2014; 85:501-9. [DOI: 10.2319/051214-343.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACTObjective: To determine in which clinical scenarios digital models are valid as replacements for plaster models during orthodontic treatment decision-making process and treatment planning.Materials and Methods: An attempt to identify all pertinent published information was made. Retained articles were those where a decision-making process leading to differential orthodontic treatment plans based on either method were compared. The search was tailored for PubMed and adapted for EMBASE, MEDLINE, the Cochrane Library, LILACS, and Web of Science. A partial grey literature search was conducted through Google Scholar. References lists of the included articles were screened for potential relevant studies. The methodology of selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS).Results: Only two studies were finally selected for the qualitative and quantitative synthesis. QUADAS results scores from selected studies ranged from 61% to 83% of 11 items evaluated. In one, the overall treatment plan regarding orthognathic surgery for Class II malocclusion changed in 13% to 22% of the cases. In the other one, 6% of the orthodontic treatment plans changed.Conclusion: Digital models could be used to replace plaster models in Class II malocclusion treatment planning.
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Affiliation(s)
- Camila Pachêco-Pereira
- Master in Dentistry student and Clinical Instructor, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Graziela De Luca Canto
- Adjunct Professor, Department of Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil, and Postdoctoral Fellow, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Paul W. Major
- Professor and Chair, School of Dentistry, and Senior Associate Dean, Dental Affairs, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Carlos Flores-Mir
- Associate Professor, Division Head of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Accuracy of maxillary repositioning in two-jaw surgery with conventional articulator model surgery versus virtual model surgery. Int J Oral Maxillofac Surg 2014; 43:732-8. [DOI: 10.1016/j.ijom.2013.11.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 10/01/2013] [Accepted: 11/12/2013] [Indexed: 11/21/2022]
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Haq J, Patel N, Weimer K, Matthews NS. Single stage treatment of ankylosis of the temporomandibular joint using patient-specific total joint replacement and virtual surgical planning. Br J Oral Maxillofac Surg 2014; 52:350-5. [PMID: 24480620 DOI: 10.1016/j.bjoms.2014.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Abstract
Ankylosis of the temporomandibular joint (TMJ) is a debilitating condition that can result in pain, trismus, and a poor quality of life. It can be caused by injury, infection, and rheumatoid disease. Current management includes gap arthroplasty, interpositional arthroplasty, and reconstruction. Traditionally, joints are reconstructed using stock implants, or the procedure is done in two stages with an additional computed tomography (CT) scan between the resective and reconstructive procedures and use of stereolithographic models to aid the design of the definitive prostheses. We describe a technique for the resection of ankylosis and reconstruction of the joint in a single operation using virtually designed custom-made implants. Five patients with ankylosis of the TMJ had a single stage operation with reconstruction between 2010 and 2012. All had preoperative high-resolution CT with contrast angiography. During an international web-based teleconference between the surgeon and the engineer a virtual resection of the ankylosis was done using the reconstructed CT images. The bespoke cutting guides and implants were designed virtually at the same time and were then manufactured precisely using computer-aided design and manufacture (CAD-CAM) over 6 weeks. After release of the ankylosis and reconstruction, the patients underwent an exercise regimen to improve mouth opening. Follow-up was for a minimum of 6 months. Four patients had one operation, and one patient had two. Median/Mean maximum incisal opening increased from 0.6mm before operation to 25 mm afterwards (range 23-27), and there was minimal surgical morbidity. This new method effectively treats ankylosis of the TMJ in a single stage procedure. Fewer operations and hospital stays, and the maintenance of overall clinical outcome are obvious advantages.
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Affiliation(s)
- Jahrad Haq
- Dept. of Oral & Maxillofacial Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Nishma Patel
- Dept. of Oral & Maxillofacial Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Katherine Weimer
- Medical Modeling Inc., 17301 West Colfax Avenue, Suite 300 Golden, CO, USA
| | - N Shaun Matthews
- Dept. of Oral & Maxillofacial Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
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Scolozzi P, Herzog G. Total mandibular subapical osteotomy and Le Fort I osteotomy using piezosurgery and computer-aided designed and manufactured surgical splints: a favorable combination of three techniques in the management of severe mouth asymmetry in Parry-Romberg syndrome. J Oral Maxillofac Surg 2013; 72:991-9. [PMID: 24280170 DOI: 10.1016/j.joms.2013.09.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 09/30/2013] [Accepted: 09/30/2013] [Indexed: 11/30/2022]
Abstract
Although its pathogenesis remains obscure, Parry-Romberg syndrome (PRS) has been associated with the linear scleroderma en coup de sabre. PRS is characterized by unilateral facial atrophy of the skin, subcutaneous tissue, muscles, and bones with at least 1 dermatome supplied by the trigeminal nerve. Facial asymmetry represents the most common sequela and can involve the soft tissues, craniomaxillofacial skeleton, dentoalveolar area, and temporomandibular joint. Although orthognathic procedures have been reported for skeletal reconstruction, treatment of facial asymmetry has been directed to augmentation of the soft tissue volume on the atrophic side using different recontouring or volumetric augmentation techniques. Total mandibular subapical osteotomy has been used in the management of dentofacial deformities, such as open bite and mandibular dentoalveolar retrusion or protrusion associated with an imbalance between the lower lip and the chin. Management of orthognathic procedures has been improved by the recent introduction of stereolithographic surgical splints using computer-aided design (CAD) and computer-aided manufacturing (CAM) technology and piezosurgery. Piezosurgery has increased security during surgery, especially for delicate procedures associated with a high risk of nerve injury. The present report describes a combined total mandibular subapical osteotomy and Le Fort I osteotomy using piezosurgery and surgical splints fabricated using CAD and CAM for the correction of severe mouth asymmetry related to vertical dentoalveolar disharmony in a patient with PRS.
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Affiliation(s)
- Paolo Scolozzi
- Head, Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, Hôpitaux Universitaire de Genève, Geneva, Switzerland.
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Philippe B. Chirurgie maxillofaciale guidée : simulation et chirurgie assistée par guides stéréolithographiques et miniplaques titane préfabriquées. ACTA ACUST UNITED AC 2013; 114:228-246. [PMID: 23928253 DOI: 10.1016/j.revsto.2013.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 06/27/2013] [Indexed: 11/18/2022]
Affiliation(s)
- B Philippe
- 19, rue de Téhéran, 75008 Paris, France; Clinique Sainte-Isabelle, 92200 Neuilly-sur-Seine, France.
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Dhima M, Salinas TJ, Rieck KL. Virtual surgical planning for treatment of severe mandibular retrognathia with collapsed occlusion using contemporary surgical and prosthodontic protocols. J Oral Maxillofac Surg 2013; 71:1923-32. [PMID: 23988145 DOI: 10.1016/j.joms.2013.06.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/13/2013] [Accepted: 06/13/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE To meet functional and esthetic needs in an older adult for treatment of complex skeletal and dentoalveolar deformities using contemporary surgical and prosthodontic protocols. METHODS An older adult with dentoalveolar complex and skeletal deformity (mandibular retrognathia) was treated by a combination of virtual planning and current surgical and prosthodontic protocols. Treatment planning steps and sequencing are presented. RESULTS Skeletal, soft tissue, and dental harmonies were attained without biological or mechanical complications. Definitive oral rehabilitation was completed with a maxillary complete denture and a mandibular metal ceramic fixed implant-retained prosthesis. CONCLUSIONS A surgical and prosthodontic team approach in combination with technologic advances can predictably optimize esthetic and functional outcomes for patients with complex skeletal and dentoalveolar deformities.
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Affiliation(s)
- Matilda Dhima
- Assistant Professor, Mayo Clinic College of Medicine; Resident, Division of Prosthetic and Esthetic Dentistry, Department of Dental Specialties, Mayo Clinic, Rochester, MN.
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Orthognathic positioning system: intraoperative system to transfer virtual surgical plan to operating field during orthognathic surgery. J Oral Maxillofac Surg 2013; 71:911-20. [PMID: 23312847 DOI: 10.1016/j.joms.2012.11.004] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 10/27/2012] [Accepted: 11/07/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To introduce the concept and use of an occlusal-based "orthognathic positioning system" (OPS) to be used during orthognathic surgery. MATERIALS AND METHODS The OPS consists of intraoperative occlusal-based devices that transfer virtual surgical planning to the operating field for repositioning of the osteotomized dentoskeletal segments. The system uses detachable guides connected to an occlusal splint. An initial drilling guide is used to establish stable references or landmarks. These are drilled on the bone that will not be repositioned adjacent to the osteotomy line. After mobilization of the skeletal segment, a final positioning guide, referenced to the drilled landmarks, is used to transfer the skeletal segment according to the virtual surgical planning. The OPS is digitally designed using 3-dimensional computer-aided design/computer-aided manufacturing technology and manufactured with stereolithographic techniques. CONCLUSIONS Virtual surgical planning has improved the preoperative assessment and, in conjunction with the OPS, the execution of orthognathic surgery. The OPS has the possibility to eliminate the inaccuracies commonly associated with traditional orthognathic surgery planning and to simplify the execution by eliminating surgical steps such as intraoperative measuring, determining the condylar position, the use of bulky intermediate splints, and the use of intermaxillary wire fixation. The OPS attempts precise translation of the virtual plan to the operating field, bridging the gap between virtual and actual surgery.
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He D, Huang D, Yang C, Gou H. Application of computer-assisted design and manufacture technique in the treatment of condylar osteochondroma combined with jaw bone deformities: Report of a case. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2013. [DOI: 10.1016/j.ajoms.2012.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bouchard C, Landry PÉ. Precision of maxillary repositioning during orthognathic surgery: a prospective study. Int J Oral Maxillofac Surg 2012. [PMID: 23200425 DOI: 10.1016/j.ijom.2012.10.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to evaluate the accuracy of surgical splints and an external reference point to reposition the maxilla during orthognathic surgery. Before surgery, a radiological marker was inserted inside the orthodontic bracket of the first right maxillary molar. A surgical splint was utilized to reposition the maxilla in the sagittal and coronal planes after the osteotomy. The vertical position was established by measuring the distance between a Kirschner wire inserted at bony nasion and the orthodontic wire. Preoperative and postoperative cephalometric radiographs were obtained and manually traced. The radiological marker and the tip of the right maxillary incisor were used as specific landmarks. Their displacement on the pre- and postoperative radiographs was measured. The actual surgical movement of the maxilla was compared to the initial surgical planning. 23 patients met the inclusion criteria to participate in the study. The mean difference between the planned and executed movements of the maxilla was 0.1mm (p=0.71). The difference was not statistically significant for any given movements of the maxilla. The use of surgical splints made from model surgery combined with an external reference point at bony nasion is accurate methods for repositioning the maxilla during orthognathic surgery.
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Affiliation(s)
- Carl Bouchard
- Department of Oral and Maxillofacial surgery, Centre Hospitalier Universitaire (CHU) de Québec, Pavillon Hôpital de l'Enfant-Jésus, Université Laval, Québec (Québec), Canada.
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Smith RA, Block MS, Sclar AG. Dental and craniomaxillofacial implant surgery. J Oral Maxillofac Surg 2012; 70:e72-106. [PMID: 23128008 DOI: 10.1016/j.joms.2012.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Gelesko S, Markiewicz MR, Weimer K, Bell RB. Computer-aided orthognathic surgery. Atlas Oral Maxillofac Surg Clin North Am 2012; 20:107-118. [PMID: 22365433 DOI: 10.1016/j.cxom.2012.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Savannah Gelesko
- Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR 97239, USA
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