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Grillo R, Quinta Reis BA, Ali K, Melhem-Elias F. Emerging Trends in Virtual Surgical Planning for Orthognathic Surgery: A Global Overview of Research and Publication Patterns. J Oral Maxillofac Surg 2024; 82:922-930. [PMID: 38677326 DOI: 10.1016/j.joms.2024.04.003] [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: 01/31/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Anticipating trends and pursuing innovative ideas are imperative for the advancement of science. The objective of this study was to conduct a bibliometric analysis of 3-dimensional virtual simulation in orthognathic surgery, explore its implications for clinical practice, and identify future publication trends through digital tools. METHODS This study employed a retrospective bibliometric analysis using data obtained from the Web of Science database. The search strategy focused on articles related to orthognathic surgery and virtual simulation techniques. RStudio and bibliometrix tools were used to data mining. The independent variables retrieved from digital analysis were the emerging themes related to virtual planning in orthognathic surgery. The trends that we identified were facial esthetics, digital workflow, personalized treatments, and complex cases. The primary outcome variable was the number of publications dedicated to virtual simulation in orthognathic surgery, along with secondary outcomes such as citation rates, language of publication, country of origin, institutional affiliations, and emerging research themes. Covariates included variables related to publication characteristics, author affiliations, and geographic distribution of publications. Publication analyses over time involved descriptive statistics, regression analysis, Pearson correlation tests, and graphical representation techniques. Statistical significance was set at a 95% confidence interval (P value < .05). RESULTS A comprehensive analysis of 987 articles reveals the impact of included authors, with a mean h-index of 62 (SD = 18.4). The analysis further illuminates a discernible upward trend in publications on this subject, showcasing a linear pattern with a notable R2 value of 0.88 (P = .021). English remains the predominant language of publication, accounting for 97.97% of articles, while contributions hailed from a diverse spectrum of 56 countries. Interestingly, a moderate correlation emerges between publication numbers and gross domestic product per capita (r = 0.30, P = .044) and total area (r = 0.30, P = .032), whereas a more substantial correlation is evident with total population (r = 0.61, P = .034). Notably, the most cited article amassed 254 citations. Furthermore, a Pearson correlation coefficient of 0.97 underscores the correlation between citation density and the year of publication. CONCLUSION The bibliometric indicators provided insights for evaluating research productivity and the quality of research output. Emerging themes included facial esthetics, 3-dimensional printing, and the utilization of custom-made templates and implants. This study holds relevance for maxillofacial surgeons, academics, and researchers alike.
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Affiliation(s)
- Ricardo Grillo
- Postgradution Program, Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil; Head, Department of Oral and Maxillofacial Surgery, Faculdade Patos de Minas, Brasília-DF, Brazil.
| | | | - Kamran Ali
- Full Professor, Department of Oral Surgery, College of Dental Medicine, Qatar University, Doha, Qatar
| | - Fernando Melhem-Elias
- Oral and Maxillofacial Surgeon, Department of Oral Surgery, Private Practice, São Paulo-SP, Brazil; Associate Professor, Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil
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Chen YJ, Tsai CY, Chang ZC, Yao CC, Kok SH. Differential outcomes of jaw bone position after surgical-orthodontic treatment in three types of skeletal Class III asymmetry patients. J Formos Med Assoc 2024:S0929-6646(24)00305-X. [PMID: 38987030 DOI: 10.1016/j.jfma.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/22/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND/PURPOSE Facial asymmetry is common in Class III patients requiring orthognathic surgery. This study aimed to analyze jaw bone position after surgical-orthodontic treatment in three types of skeletal Class III asymmetry patients. METHODS The retrospective study included 30 Class III patients who underwent surgical-orthodontic treatment comprising LeFort I osteotomy and bilateral sagittal split osteotomy (BSSO) without genioplasty. Cone-beam computed tomography (CBCT) images obtained before surgery (T1) and after post-surgical orthodontic treatment (T2) were superimposed with voxel-based registration. Patients were classified into three groups based on T1 CBCT scans. Groups 1 and 2 exhibited menton and ramus deviated to the same side. Menton deviation was larger than ramus width asymmetry in group 1, while the reverse was true for group 2. Group 3 had menton deviation contralateral to the side with greater ramus width. RESULTS Menton deviation after treatment was improved in all groups. Ramus width asymmetry and coronal ramus angle difference decreased in groups 1 and 2. Neither improvement nor deterioration of ramus width asymmetry was noted for group 3. Comparing to groups 1 and 2, group 3 had greater roll and yaw rotations of distal segment, more upward pitch of proximal segment on chin deviation side, and largest inward yaw as well as backward translation of proximal segment on non-deviation side. CONCLUSION The positional changes of osteotomy segments differed among three types of mandibular asymmetry. Special attention should be given to the atypical mandibular asymmetry with mandibular body and ramus deviating to opposite directions during surgical correction of jaw deflection.
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Affiliation(s)
- Yi-Jane Chen
- Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Yen Tsai
- Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Zwei-Chieng Chang
- Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Chen Yao
- Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Sang-Heng Kok
- Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
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Gorla LFDO, Gabrielli MAC, Dos Santos JC, Nusrath M, Lee NJ. Guided versus non-guided chin repositioning: a retrospective study on accuracy. Br J Oral Maxillofac Surg 2024:S0266-4356(24)00175-X. [PMID: 39127558 DOI: 10.1016/j.bjoms.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/29/2024] [Accepted: 06/29/2024] [Indexed: 08/12/2024]
Abstract
Genioplasty is a widely used surgical approach to address chin deformities by performing an osteotomy on the inferior border of the mandible to allow for comprehensive repositioning of the chin. This study aimed to compare the accuracy of freehand chin repositioning with a guided technique that employed specialised surgical guides. For this retrospective study, data from 30 adult patients who underwent orthognathic surgery to correct dentofacial deformities were analysed. All patients underwent virtual planning before surgery, with half of them treated using freehand chin repositioning and the other half using the guided technique. The surgical outcomes were measured and compared with the virtual plan to assess the positional and rotational accuracy of the techniques. In terms of translational assessment, noteworthy values that exceeded clinically acceptable limits were observed only in sagittal movement in the freehand group (0.97 mm, interquartile range (IQR) 0.73-2.29 mm). Regarding rotational accuracy, both groups exhibited an IQR that surpassed acceptable limits for pitch (3.26°, IQR 2.06-5.20 for the guided group and 2.57°, IQR 1.63-4.24° for the freehand group). The Mann-Whitney test indicated no statistical differences between the groups in any translational or rotational assessment. In conclusion, although there was no statistical difference, the guided technique proved effective in achieving clinically acceptable accuracy in all positions and almost all rotations, displaying superior results in sagittal positioning compared with the freehand technique. To fully harness the advantages of guides and to guarantee accuracy in all rotations, we recommend further research involving guides made of more rigid materials, and customised implants.
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Affiliation(s)
| | | | - José Cleveilton Dos Santos
- Department of Diagnostic and Surgery, São Paulo State University (Unesp), School of Dentistry, Araraquara, Brazil.
| | - Muzzammil Nusrath
- Department of Oral and Maxillofacial Surgery, Royal Hallamshire Hospital, Sheffield, UK.
| | - Nicholas J Lee
- Department of Oral and Maxillofacial Surgery, Royal Hallamshire Hospital, Sheffield, UK
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On SW, Cho SW, Park SY, Yi SM, Park IY, Byun SH, Kim JC, Yang BE. Advancements in computer-assisted orthognathic surgery: A comprehensive review and clinical application in South Korea. J Dent 2024; 146:105061. [PMID: 38729289 DOI: 10.1016/j.jdent.2024.105061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES Orthognathic surgery (OS) has evolved with technological advancements, notably through the implementation of computer-assisted orthognathic surgery (CAOS). This article aims to elucidate various types of CAOS and their efficiency and accuracy, supplemented by a thorough literature review focusing on their clinical applications in South Korea. STUDY SELECTION, DATA, AND SOURCES A comprehensive search strategy was employed, including systematic reviews, meta-analyses, randomized controlled trials, and observational studies published until December 2023 in the PubMed, MEDLINE, and Google Scholar databases. The literature search was limited to articles written in English. RESULTS Static CAOS demonstrated high precision, reduced operative time, and high accuracy, suggesting its potential reliability in orthognathic procedures. Dynamic CAOS presented a promising avenue for exploration, showing an accuracy comparable to that of traditional methods. The critical considerations for CAOS include accuracy, time efficiency, and cost-effectiveness. Recent studies have indicated advancements in the time efficiency of static CAOS. Static CAOS requires less equipment and is more cost-effective than dynamic CAOS. CONCLUSIONS CAOS offers clear advantages over conventional OS in terms of surgical convenience and accuracy in implementing the surgical plan. To achieve recognition as the gold standard method for maxillofacial deformity treatment, CAOS must overcome its limitations and undergo continuous verification via well-designed studies. CLINICAL SIGNIFICANCE The introduction of CAOS, mainly static CAOS with high precision and reduced surgical time, signifies a notable advancement in OS. However, rigorous studies are warranted to validate CAOS as the gold standard for treating maxillofacial deformities.
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Affiliation(s)
- Sung-Woon On
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, South Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea
| | - Seoung-Won Cho
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea
| | - Sang-Yoon Park
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea; Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang 14066, South Korea
| | - Sang-Min Yi
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea; Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang 14066, South Korea
| | - In-Young Park
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang 14066, South Korea; Department of Orthodontics, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea
| | - Soo-Hwan Byun
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea; Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang 14066, South Korea
| | - Jong-Cheol Kim
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea; Daegu Mir Dental Hospital, Daegu 41940, South Korea
| | - Byoung-Eun Yang
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea; Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang 14066, South Korea.
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Manninen AA, Heliövaara A, Horelli J, Mesimäki K, Wilkman T, Lindford AJ, Lassus P. Long-term skeletal, cephalometric, and volumetric changes in two Helsinki bimaxillary face transplant patients. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00065-1. [PMID: 38906770 DOI: 10.1016/j.ijom.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 03/01/2024] [Accepted: 03/19/2024] [Indexed: 06/23/2024]
Abstract
Analysis of skeletal, cephalometric, and volumetric changes and occlusion during long-term follow-up was performed for two patients who underwent bimaxillary facial transplantation (FT). The study material consisted of the follow-up data of two bimaxillary composite FT performed in Helsinki University Hospital, one in 2016 and the other in 2018. Serial three-dimensional computed tomography scans obtained during follow-up (6 years for patient 1, 4 years for patient 2) were analyzed. The position of the maxilla remained stable in both patients. At 4 and 6 years, the changes in the anterior maxilla were ≤1 mm, while the anterior mandible had moved 2.6-4 mm anteriorly and the mandibular midline 0.4-3.7 mm to the left side. Patient 1 underwent re-osteosynthesis 4 months after transplantation due to mandibular non-union. Patient 2 had a sagittal mandibular osteotomy at 15 months after FT due to lateral crossbite and tension created by temporomandibular joint rotation. Thereafter both patients had a stable occlusion. A continuous bone volume reduction in the mandible was noticed in both patients (6% and 9% reduction of the transplanted volume). The volume of the transplanted maxilla decreased during the early postoperative period but increased back to the original transplanted volume during the follow-up.
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Affiliation(s)
- A A Manninen
- Department of Plastic Surgery, Park Hospital, Helsinki University Hospital (HUS), University of Helsinki, Helsinki, Finland.
| | - A Heliövaara
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | | | - K Mesimäki
- Department of Oral and Maxillofacial Diseases, Meilahti Hospital, Helsinki University Hospital (HUS), Helsinki, Finland
| | - T Wilkman
- Department of Oral and Maxillofacial Diseases, Meilahti Hospital, Helsinki University Hospital (HUS), Helsinki, Finland
| | - A J Lindford
- Department of Plastic Surgery, Park Hospital, Helsinki University Hospital (HUS), University of Helsinki, Helsinki, Finland
| | - P Lassus
- Department of Plastic Surgery, Park Hospital, Helsinki University Hospital (HUS), University of Helsinki, Helsinki, Finland
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Kim J, Jeung D, Cho R, Yang B, Hong J. A Proof of Concept: Optimized Jawbone-Reduction Model for Mandibular Fracture Surgery. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:1151-1159. [PMID: 38332406 DOI: 10.1007/s10278-024-01014-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/19/2023] [Accepted: 12/26/2023] [Indexed: 02/10/2024]
Abstract
Previous research on computer-assisted jawbone reduction for mandibular fracture surgery has only focused on the relationship between fractured sections disregarding proper dental occlusion with the maxilla. To overcome malocclusion caused by overlooking dental articulation, this study aims to provide a model for jawbone reduction based on dental occlusion. After dental landmarks and fracture sectional features are extracted, the maxilla and two mandible segments are aligned first using the extracted dental landmarks. A swarm-based optimization is subsequently performed by simultaneously observing the fracture section fitting and the dental occlusion condition. The proposed method was evaluated using jawbone data of 12 subjects with simulated and real mandibular fractures. Results showed that the optimized model achieved both accurate jawbone reduction and desired dental occlusion, which may not be possible by existing methods.
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Affiliation(s)
- Jinmin Kim
- DIGITRACK. Inc., Daegu, Republic of Korea
| | - Deokgi Jeung
- Department of Robotics and Mechatronics Engineering, DGIST, 333 Techno Jungang-Daero, Daegu, 42988, Republic of Korea
- Department of Medical Robotics, Korea Institute of Machinery and Materials, Daegu, Republic of Korea
| | - Ranyeong Cho
- Division of Oral & Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-Ro 170Beon-Gil, Gyeonggi-Do, 14068, Republic of Korea
| | - Byoungeun Yang
- Division of Oral & Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-Ro 170Beon-Gil, Gyeonggi-Do, 14068, Republic of Korea.
| | - Jaesung Hong
- Department of Robotics and Mechatronics Engineering, DGIST, 333 Techno Jungang-Daero, Daegu, 42988, Republic of Korea.
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Gagnier D, Gregoire C, Brady J, Sterea A, Chaput T. Evaluation of a Fully Digital, In-House Virtual Surgical Planning Workflow for Bimaxillary Orthognathic Surgery. J Oral Maxillofac Surg 2024:S0278-2391(24)00294-5. [PMID: 38825321 DOI: 10.1016/j.joms.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 05/04/2024] [Accepted: 05/05/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND The advantages of virtual surgical planning (VSP) for orthognathic surgery are clear. Previous studies have evaluated in-house VSP; however, few fully digital, in-house protocols for orthognathic surgery have been studied. PURPOSE The purpose of this study was to evaluate the difference between the virtual surgical plan and actual surgical outcome for orthognathic surgery using a fully digital, in-house VSP workflow. STUDY DESIGN, SETTING, SAMPLE This is a prospective cohort study from September 2020 to November 2022 of patients at the Victoria General Hospital in Halifax, NS, Canada who underwent bimaxillary orthognathic surgery. Patients were excluded if they had previously undergone orthognathic surgery or were diagnosed with a craniofacial syndrome. MAIN OUTCOME VARIABLES The primary outcome variables were the mean 3-dimensional (3D) (Euclidean) distance error, as well as mean error and mean absolute error in the transverse (x axis), vertical (y axis), and anterior-posterior (z axis) dimensions. COVARIATES Covariates included age, sex, and surgical sequence (mandible-first or maxilla-first). ANALYSES The primary outcome was tested using Z and t critical value confidence intervals. The P value was set at .05. The 3D distance error for mandible-first and maxilla-first groups was compared using a 2-sample t-test as well as analysis of variance. RESULTS The study sample included 52 subjects (24 males and 28 females) with a mean age of 27.7 (± 12.1) years. Forty three subjects underwent mandible-first surgery and 9 maxilla-first surgery. The mean absolute distance error was largest in the anterior-posterior dimension for all landmarks (except posterior nasal spine, left condyle, and gonion) and exceeded the threshold for clinical acceptability (2 mm) in 16 of 23 landmarks. Additionally, mean distance error in the anterior-posterior dimension was negative for all landmarks, indicating deficient movement in that direction. The effect of surgical sequence on 3D distance error was not statistically significant (P = .37). CONCLUSION AND RELEVANCE In general, the largest contributor to mean 3D distance error was deficient movement in the anterior-posterior direction. Otherwise, mean absolute distance error in the vertical and transverse dimensions was clinically acceptable (< 2 mm). These findings were felt to be valuable for treatment planning purposes when using a fully digital, in-house VSP workflow.
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Affiliation(s)
- David Gagnier
- OMS Resident, Department of Oral and Maxillofacial Surgery, Halifax, Nova Scotia, Canada.
| | - Curtis Gregoire
- OMS Residency Program Director, Department of Oral and Maxillofacial Surgery, Halifax, Nova Scotia, Canada
| | - James Brady
- OMS Faculty, Department of Oral and Maxillofacial Surgery, Halifax, Nova Scotia, Canada
| | - Andra Sterea
- Dentistry Student, Department of Oral and Maxillofacial Surgery, Halifax, Nova Scotia, Canada
| | - Taylor Chaput
- Dentistry Student, Department of Oral and Maxillofacial Surgery, Halifax, Nova Scotia, Canada
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Parente EV, Silvares MG, Zerbinatti DCZ, da Silva Pinto S. Minimally invasive sagittal osteotomy-technical note. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00112-7. [PMID: 38734489 DOI: 10.1016/j.ijom.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024]
Abstract
This article describes a novel minimally invasive technique for bilateral sagittal split osteotomy (BSSO) that aims to reduce surgical trauma while maintaining bone overlap and rigid internal fixation for proper consolidation of the bone segments. The technique involves a small vestibular mucoperiosteal incision made on the lateral aspect of the mandible between the first and second molars, enabling a standard ramus split, surgical segment movement, and miniplate fixation. A retrospective evaluation of 67 consecutive patients who underwent BSSO using this protocol showed favorable split of the mandible with no unfavorable splits or non-union. Patients were discharged from hospital within an average of 17 h with minimal postoperative complications. This technique provides good surgical visualization with a very small incision and allows standard BSSO surgery without difficulty.
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Affiliation(s)
- E V Parente
- Private Practice, Florianópolis, Santa Catarina, Brazil
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Liu Z, Zhong Y, Lyu X, Zhang J, Huang M, Liu S, Zheng L. Accuracy of the modified tooth-supported 3D printing surgical guides based on CT, CBCT, and intraoral scanning in maxillofacial region: A comparison study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101853. [PMID: 38555078 DOI: 10.1016/j.jormas.2024.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Tooth-supported surgical guides have demonstrated superior accuracy compared with bone-supported guides. This study aimed to modify the fabrication of tooth-supported guides for compatibility with tumor resection procedures and investigate their accuracy. METHODS Patients with tumors who underwent osteotomy with the assistance of modified tooth- or bone-supported surgical guides were included. Virtual surgical planning (VSP) was employed to align three dimensional (3D) models extracted from intraoperative computed tomography (CT) images. The distances and angular deviations between the actual osteotomy plane and preoperative plane were recorded. A comparative analysis of osteotomy discrepancies between tooth-supported and bone-supported guides, as well as among tooth-supported guides based on CT, cone-beam CT (CBCT), or intraoral scanner (IOS) was conducted. The factors influencing the precision of the guides were analyzed. RESULTS Sixty patients with 81 resection planes were included in this study. In the tooth-supported group, the mean deviations in the osteotomy plane and angle were 1.39 mm and 4.30°, respectively, whereas those of the bone-supported group were 2.16 mm and 4.95°. In the tooth-supported isotype guide groups, the mean deviations of the osteotomy plane were 1.39 mm, 1.47 mm, 1.23 mm across CT, CBCT, and IOS, respectively. The accuracy of the modified tooth-supported guides remained consistent regardless of number and position of the teeth supporting the guide and location of the osteotomy lines. CONCLUSIONS The findings indicate that the modified tooth-supported surgical guides demonstrated high accuracy in the maxillofacial region, contributing to a reduction in the amount of surgically detached soft tissue.
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Affiliation(s)
- Zezhao Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Yiwei Zhong
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Xiaoming Lyu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Jie Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Mingwei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Shuming Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Lei Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China.
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10
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Berends B, Bielevelt F, Schreurs R, Vinayahalingam S, Maal T, de Jong G. Fully automated landmarking and facial segmentation on 3D photographs. Sci Rep 2024; 14:6463. [PMID: 38499700 PMCID: PMC10948387 DOI: 10.1038/s41598-024-56956-9] [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: 11/17/2023] [Accepted: 03/13/2024] [Indexed: 03/20/2024] Open
Abstract
Three-dimensional facial stereophotogrammetry provides a detailed representation of craniofacial soft tissue without the use of ionizing radiation. While manual annotation of landmarks serves as the current gold standard for cephalometric analysis, it is a time-consuming process and is prone to human error. The aim in this study was to develop and evaluate an automated cephalometric annotation method using a deep learning-based approach. Ten landmarks were manually annotated on 2897 3D facial photographs. The automated landmarking workflow involved two successive DiffusionNet models. The dataset was randomly divided into a training and test dataset. The precision of the workflow was evaluated by calculating the Euclidean distances between the automated and manual landmarks and compared to the intra-observer and inter-observer variability of manual annotation and a semi-automated landmarking method. The workflow was successful in 98.6% of all test cases. The deep learning-based landmarking method achieved precise and consistent landmark annotation. The mean precision of 1.69 ± 1.15 mm was comparable to the inter-observer variability (1.31 ± 0.91 mm) of manual annotation. Automated landmark annotation on 3D photographs was achieved with the DiffusionNet-based approach. The proposed method allows quantitative analysis of large datasets and may be used in diagnosis, follow-up, and virtual surgical planning.
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Affiliation(s)
- Bo Berends
- 3D Lab Radboudumc, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Freek Bielevelt
- 3D Lab Radboudumc, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Ruud Schreurs
- 3D Lab Radboudumc, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (UMC), AMC, Academic Center for Dentistry Amsterdam (ACTA), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Shankeeth Vinayahalingam
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Thomas Maal
- 3D Lab Radboudumc, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Guido de Jong
- 3D Lab Radboudumc, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Garzia S, Capellini K, Gasparotti E, Pizzuto D, Spinelli G, Berti S, Positano V, Celi S. Three-Dimensional Multi-Modality Registration for Orthopaedics and Cardiovascular Settings: State-of-the-Art and Clinical Applications. SENSORS (BASEL, SWITZERLAND) 2024; 24:1072. [PMID: 38400229 PMCID: PMC10891817 DOI: 10.3390/s24041072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
The multimodal and multidomain registration of medical images have gained increasing recognition in clinical practice as a powerful tool for fusing and leveraging useful information from different imaging techniques and in different medical fields such as cardiology and orthopedics. Image registration could be a challenging process, and it strongly depends on the correct tuning of registration parameters. In this paper, the robustness and accuracy of a landmarks-based approach have been presented for five cardiac multimodal image datasets. The study is based on 3D Slicer software and it is focused on the registration of a computed tomography (CT) and 3D ultrasound time-series of post-operative mitral valve repair. The accuracy of the method, as a function of the number of landmarks used, was performed by analysing root mean square error (RMSE) and fiducial registration error (FRE) metrics. The validation of the number of landmarks resulted in an optimal number of 10 landmarks. The mean RMSE and FRE values were 5.26 ± 3.17 and 2.98 ± 1.68 mm, respectively, showing comparable performances with respect to the literature. The developed registration process was also tested on a CT orthopaedic dataset to assess the possibility of reconstructing the damaged jaw portion for a pre-operative planning setting. Overall, the proposed work shows how 3D Slicer and registration by landmarks can provide a useful environment for multimodal/unimodal registration.
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Affiliation(s)
- Simone Garzia
- BioCardioLab, Bioengineering Unit, Fondazione Toscana G. Monasterio, 54100 Massa, Italy; (S.G.); (K.C.); (E.G.); (V.P.)
- Department of Information Engineering, University of Pisa, 56122 Pisa, Italy;
| | - Katia Capellini
- BioCardioLab, Bioengineering Unit, Fondazione Toscana G. Monasterio, 54100 Massa, Italy; (S.G.); (K.C.); (E.G.); (V.P.)
| | - Emanuele Gasparotti
- BioCardioLab, Bioengineering Unit, Fondazione Toscana G. Monasterio, 54100 Massa, Italy; (S.G.); (K.C.); (E.G.); (V.P.)
| | - Domenico Pizzuto
- Department of Information Engineering, University of Pisa, 56122 Pisa, Italy;
| | - Giuseppe Spinelli
- Maxillofacial Surgery Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Firenze, Italy;
| | - Sergio Berti
- Diagnostic and Interventional Cardiology Department, Fondazione Toscana G. Monasterio, 54100 Massa, Italy;
| | - Vincenzo Positano
- BioCardioLab, Bioengineering Unit, Fondazione Toscana G. Monasterio, 54100 Massa, Italy; (S.G.); (K.C.); (E.G.); (V.P.)
| | - Simona Celi
- BioCardioLab, Bioengineering Unit, Fondazione Toscana G. Monasterio, 54100 Massa, Italy; (S.G.); (K.C.); (E.G.); (V.P.)
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Buch FO, Stokbro K. Accuracy and stability of the condyle position after orthognathic surgery: A retrospective study. J Craniomaxillofac Surg 2024; 52:240-245. [PMID: 38172014 DOI: 10.1016/j.jcms.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/21/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
The purpose of this study was to evaluate the accuracy and stability of condylar positioning in patients treated with bimaxillary procedures compared with patients treated with maxillary procedures alone. All patients had undergone treatment at Odense University Hospital and were treated with inferior maxillary procedures. The primary outcome was changes in condyle position and the primary predictor variable was time: pre-operative (T0) measurements to 1-week post-operative (T1) and 1-year post-operative (T2) measurements. Condyle movement was measured using dual voxel-based alignment. Sixteen patients were included. Seven patients underwent solitary maxillary procedure and 9 patients bimaxillary procedure. Bimaxillary procedures overall showed a condyle positional change in pitch from T0 to T1 and T1 to T2 compared to maxillary procedures alone. Condylar translation was stable despite large differences in positioning. Compared to solitary maxillary procedures, bimaxillary procedures showed a statistically significant anterocranial rotation at 1-week follow-up movement (3.95° vs. -0.95°; SD 3,74 vs 1,05; P value = 0.000) and an additional statistically significant anterocranial movement at 1 year after surgery (4.89° vs 0.60°; SD 3,82 vs 0,92; P value = 0.000). In conclusion a need for greater anterocranial stability of the sagittal split osteotomy than that provided by 3 bicortically fixated screws alone might be indicated.
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Affiliation(s)
- Frederik Ohm Buch
- Department of Oral and Maxillofacial Surgery, Odense University Hospital, Denmark
| | - Kasper Stokbro
- Consultant Surgeon & Head of Research, Department of Oral and Maxillofacial Surgery, Odense University Hospital, Oral and Maxillofacial Research Department, Clinical Institute, University of Southern Denmark, Denmark.
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Yang X, Huang K, Yang D, Zhao W, Zhou X. Biomedical Big Data Technologies, Applications, and Challenges for Precision Medicine: A Review. GLOBAL CHALLENGES (HOBOKEN, NJ) 2024; 8:2300163. [PMID: 38223896 PMCID: PMC10784210 DOI: 10.1002/gch2.202300163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/20/2023] [Indexed: 01/16/2024]
Abstract
The explosive growth of biomedical Big Data presents both significant opportunities and challenges in the realm of knowledge discovery and translational applications within precision medicine. Efficient management, analysis, and interpretation of big data can pave the way for groundbreaking advancements in precision medicine. However, the unprecedented strides in the automated collection of large-scale molecular and clinical data have also introduced formidable challenges in terms of data analysis and interpretation, necessitating the development of novel computational approaches. Some potential challenges include the curse of dimensionality, data heterogeneity, missing data, class imbalance, and scalability issues. This overview article focuses on the recent progress and breakthroughs in the application of big data within precision medicine. Key aspects are summarized, including content, data sources, technologies, tools, challenges, and existing gaps. Nine fields-Datawarehouse and data management, electronic medical record, biomedical imaging informatics, Artificial intelligence-aided surgical design and surgery optimization, omics data, health monitoring data, knowledge graph, public health informatics, and security and privacy-are discussed.
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Affiliation(s)
- Xue Yang
- Department of Pancreatic Surgery and West China Biomedical Big Data CenterWest China HospitalSichuan UniversityChengdu610041China
| | - Kexin Huang
- Department of Pancreatic Surgery and West China Biomedical Big Data CenterWest China HospitalSichuan UniversityChengdu610041China
| | - Dewei Yang
- College of Advanced Manufacturing EngineeringChongqing University of Posts and TelecommunicationsChongqingChongqing400000China
| | - Weiling Zhao
- Center for Systems MedicineSchool of Biomedical InformaticsUTHealth at HoustonHoustonTX77030USA
| | - Xiaobo Zhou
- Center for Systems MedicineSchool of Biomedical InformaticsUTHealth at HoustonHoustonTX77030USA
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Pellby D, Bengtsson M. Do Patients Detect Changes in Breathing After Orthognathic Surgery? J Oral Maxillofac Surg 2024; 82:36-46. [PMID: 37858599 DOI: 10.1016/j.joms.2023.09.017] [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: 04/22/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Orthognathic surgery addresses facial aesthetics and function in patients with dentofacial deformities. It is associated with changes in upper airway volume (UAV). If changes in UAV are perceived by asymptomatic patients is unclear. PURPOSE The purpose was to measure associations between changes in UAV and patient-reported benefits using patient-reported outcome measures. STUDY DESIGN A sample presenting dentofacial deformities without reported breathing problems undergoing orthognathic surgery was retrospectively studied. Patients aged 18-30 years with 12-month follow-up were included. Patients with systemic disease, drug abuse, mental health disorder, or temporomandibular joint dysfunction were excluded. PREDICTOR The predictor variable was changes in UAV measured in 3-dimensional computed tomography. Subjects were grouped into increased or decreased UAV. MAIN OUTCOME VARIABLE The primary outcome variable was changes in health-related quality of life measured with Oral Health Impact Profile 49 (OHIP-49). COVARIATES Weight, height, age, sex, and sub-scaled OHIP-49 were registered. Cephalometric measurements of hard tissue movements were recorded. ANALYSES Mean, standard deviation, and a level of statistical significance at P < .05 were used. Differences in OHIP-49 were compared using unpaired t-test. The correlation between covariates and outcomes was analyzed using the Spearman's rank test. Analysis of covariance between the predictor and outcome, adjusted for covariates (body mass index), was performed. RESULTS Fifty-four subjects with a mean age of 20.89 years and 52% males were enrolled. The mean change in UAV was 0.12 cm3 (standard deviation [SD] 9.21, P = .93) with a mean absolute deviation of 7.28 cm3 (SD 5.54). The mean change in OHIP-49 score was 20.93 (SD 28.90). Twenty-seven (50%) subjects had increased UAV (7.4 cm3, SD 6.13) and the other had decreased (-7.17 cm3, SD 5.01) (P = .01). At follow-up, equal levels of mean OHIP-49 score were found, but because of a baseline difference (15.74, P = .048), the subjects with and without increased UAV improved in OHIP-49 score 13.04 (SD 30.53) and 28.81 (SD 25.33), respectively (P = .04). CONCLUSIONS Because equal levels of OHIP-49 score at follow-up, changes in UAV could not be associated with patient-reported health-related quality of life. Patient-reported outcome measure evaluations of orthognathic surgical treatment for airway obstruction should be performed in patients with a perceived impairment.
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Affiliation(s)
- David Pellby
- Consultant Dentomaxillofacial Radiology, Department of Imaging and Function, Skåne University Hospital, Lund, Sweden
| | - Martin Bengtsson
- Consultant Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
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Recker MJ, Barber JC, Xia JJ, Markiewicz MR, Kuang T, Deng HH, Singh T, Reynolds RM. Accuracy of Surgical Outcome Using Computer-Aided Surgical Simulation in Fronto-Orbital Advancement for Craniosynostosis: A Pilot Study. Oper Neurosurg (Hagerstown) 2024; 26:46-53. [PMID: 37811925 DOI: 10.1227/ons.0000000000000925] [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: 05/08/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Computer-aided surgical simulation (CASS) can be used to virtually plan ideal outcomes of craniosynostosis surgery. Our purpose was to create a workflow analyzing the accuracy of surgical outcomes relative to virtually planned fronto-orbital advancement (FOA). METHODS Patients who underwent FOA using CASS between October 1, 2017, and February 28, 2022, at our center and had postoperative computed tomography within 6 months of surgery were included. Virtual 3-dimensional (3D) models were created and coregistered using each patient's preoperative and postoperative computed tomography data. Three points on each bony segment were used to define the object in 3D space. Each planned bony segment was manipulated to match the actual postoperative outcome. The change in position of the 3D object was measured in translational (X, Y, Z) and rotational (roll, pitch, yaw) aspects to represent differences between planned and actual postoperative positions. The difference in the translational position of several bony landmarks was also recorded. Wilcoxon signed-rank tests were performed to measure significance of these differences from the ideal value of 0, which would indicate no difference between preoperative plan and postoperative outcome. RESULTS Data for 63 bony segments were analyzed from 8 patients who met the inclusion criteria. Median differences between planned and actual outcomes of the segment groups ranged from -0.3 to -1.3 mm in the X plane; 1.4 to 5.6 mm in the Y plane; 0.9 to 2.7 mm in the Z plane; -1.2° to -4.5° in pitch; -0.1° to 1.0° in roll; and -2.8° to 1.0° in yaw. No significant difference from 0 was found in 21 of 24 segment region/side combinations. Translational differences of bony landmarks ranged from -2.7 to 3.6 mm. CONCLUSION A high degree of accuracy was observed relative to the CASS plan. Virtual analysis of surgical accuracy in FOA using CASS was feasible.
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Affiliation(s)
- Matthew J Recker
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo , New York , USA
| | - Joshua C Barber
- Department of Oral and Maxillofacial Surgery, Houston Methodist Academic Institute, Research Institute and Hospital, Houston , Texas , USA
| | - James J Xia
- Department of Oral and Maxillofacial Surgery, Houston Methodist Academic Institute, Research Institute and Hospital, Houston , Texas , USA
- Department of Surgery (Oral and Maxillofacial Surgery), Weill-Cornell Medical College, New York , New York , USA
| | - Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, Buffalo , New York , USA
| | - Tianshu Kuang
- Department of Oral and Maxillofacial Surgery, Houston Methodist Academic Institute, Research Institute and Hospital, Houston , Texas , USA
| | - Hannah H Deng
- Department of Oral and Maxillofacial Surgery, Houston Methodist Academic Institute, Research Institute and Hospital, Houston , Texas , USA
| | - Tanya Singh
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo , New York , USA
| | - Renée M Reynolds
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo , New York , USA
- Department of Pediatric Neurosurgery, John R. Oishei Children's Hospital, Buffalo , New York , USA
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16
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Lin HH, Kuo JC, Lo LJ, Ho CT. Optimizing Orthognathic Surgery: Leveraging the Average Skull as a Dynamic Template for Surgical Simulation and Planning in 30 Patient Cases. J Clin Med 2023; 12:7758. [PMID: 38137827 PMCID: PMC10743958 DOI: 10.3390/jcm12247758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Virtual planning has revolutionized orthognathic surgery (OGS), marking a significant advancement in the field. This study aims to showcase the practical application of our established 3D average skull template as a guiding framework for surgical planning, and to share valuable insights from our clinical experience. We enrolled 30 consecutive Taiwanese patients (18 females and 12 males) who underwent two-jaw orthognathic surgery with surgical simulation, utilizing the average skull template for planning. Results indicate the method's applicability and precision. By adhering to the surgical plan, post-operative outcomes closely aligned with the average skull template, showing negligible deviations of less than 2 mm. Moreover, patients expressed high satisfaction with post-surgery facial changes, with the chin appearance receiving the highest satisfaction scores, while the lowest scores were attributed to nose appearance. Notably, the substantial change in lower jaw position post-mandibular setback surgery contributed to increased satisfaction with the chin position. In conclusion, this study does not seek to replace established surgical planning methods, but underscores that utilizing an average skull as a surgical design template provides a viable, accurate, and efficient option for OGS patients.
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Affiliation(s)
- Hsiu-Hsia Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan;
| | - Jyun-Cheng Kuo
- Dental Department of TuCheng Hospital, New Taipei Municipal, New Taipei City 236, Taiwan;
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 333, Taiwan;
| | - Cheng-Ting Ho
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
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Wang S, Ge W, Qi L, Cao N, Meng J, Zhang L. Mandible-First Sequencing Increase Surgical Accuracy for Patients With Skeletal Class II Malocclusion Concomitant With Unstable Condyle-Fossa Relation. J Craniofac Surg 2023:00001665-990000000-01255. [PMID: 38055333 DOI: 10.1097/scs.0000000000009890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 10/16/2023] [Indexed: 12/08/2023] Open
Abstract
The aim of this study was to explore whether mandible-first sequencing increases the surgical accuracy in bimaxillary orthognathic surgery for patients with skeletal class II malocclusion concomitant with the unstable condyle-fossa relation. A retrospective evaluation of 19 patients who had undergone virtually planned double-splint orthognathic surgery with different operation sequences was performed: maxilla-first (n=9) or mandible-first (n=10) surgery. The centroid position, translational, and rotational differences in the maxilla were evaluated by comparing the virtual plans with actual results. The stability was assessed by comparing the actual results with the follow-up outcomes 6 months postoperatively. The accuracy of the maxilla centroid position was improved in mandible-first sequencing surgery: mandible-first 1.87±0.94 mm versus maxilla-first 2.70±0.75 mm (P<0.05). Moreover, no significant difference was detected in the translational and orientational discrepancies between the 2 groups. Neither sequencing procedure differed in the overall stability: maxilla-first (1.48±1.13 mm) versus mandible-first (1.57±0.90 mm). This study indicated that the mandible-first surgery leads to a more accurate maxilla position than the maxilla-first surgery for patients with skeletal class II malocclusion concomitant with the unstable condyle-fossa relation.
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Affiliation(s)
- Shoupeng Wang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai
- Department of Stomatology, Central Hospital of Xuzhou City, Xuzhou, Jiangsu Province, China
| | - Weiwen Ge
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai
| | - Lei Qi
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai
| | - Ningning Cao
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai
| | - Jian Meng
- Department of Stomatology, Central Hospital of Xuzhou City, Xuzhou, Jiangsu Province, China
| | - Lei Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai
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Sarkarat F, Tofighi O, Jamilian A, Fateh A, Abbaszadeh F. Are Virtually Designed 3D Printed Surgical Splints Accurate Enough for Maxillary Reposition as an Intermediate Orthognathic Surgical Guide. J Maxillofac Oral Surg 2023; 22:861-872. [PMID: 38105840 PMCID: PMC10719200 DOI: 10.1007/s12663-023-01942-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 05/20/2023] [Indexed: 12/19/2023] Open
Abstract
Background and Aim The accuracy of the virtually-designed 3D-printed surgical splints requires investigation for the practical use of surgical plan in the operating room. This study aimed to compare the validity of the 3D-printed and the conventional intermediate splints and evaluate the outcomes after the surgical application of the 3D-printed splint compared with the predicted values. Methods In this study, ten patients with dentofacial deformity were recruited. Participants were analyzed by the conventional surgical planning and virtual surgical planning. The intermediate surgical splints were created by the conventional and 3D-printing methods. Maxillary movements in 3 spatial directions were measured in an articulator after the application of both splints. Correlation and agreement between the two methods were tested by intraclass correlation coefficient (ICC). After the confirmation of 3D printed splint validity for each patient, the surgery was performed using 3D printed splints. It is assumed that ideally cephalometric prediction values are going to be obtained using conventional acrylic splints (gold standard). So, as a second objective, the outcome of the surgically-applied 3D-printed splint was evaluated and compared with the predicted values and finally analyzed by the paired t-test. Results Based on the observations, there was an excellent agreement between the virtually-designed 3D-printed and conventional intermediate surgical splints (ICC ranged between 0.83 and 0.99 for linear values). There was a good cumulative agreement of ICC greater than 0.80. Overall, the mean linear measurements were not different between conventional and 3D-printed splint on the articulator. Also, there were no significant differences between the linear and angular measurements of 2D-cephalometric prediction and postoperation values. Conclusion The results showed cautiously the acceptable accuracy of the 3D-printed splints for several parameters in three spatial dimensions within the laboratory and clinical settings.
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Affiliation(s)
- Farzin Sarkarat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Craniomaxillofacial Research Center, Tehran Islamic Azad University of Medical Sciences, Tehran, Iran
- Department of Oral and Maxillofacial Surgery, Gulf Medical University, Ajman, UAE
| | - Omid Tofighi
- Craniomaxillofacial Research Center, Tehran Azad University of Medical Sciences, Tehran, Iran
| | - Abdolreza Jamilian
- Department of Orthodontics, Faculty of Dentistry, Craniomaxillofacial Research Center, Tehran Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Ali Fateh
- Craniomaxillofacial Research Center, Tehran Azad University of Medical Sciences, Tehran, Iran
| | - Farid Abbaszadeh
- Faculty of Science and Medical Technologies, Tehran Islamic Azad University, Science and Research Branch, Tehran, Iran
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Tabchi Y, Zaoui F, Bahoum A. Accuracy of hard and soft tissue prediction using three-dimensional simulation software in bimaxillary osteotomies: A systematic review. Int Orthod 2023; 21:100802. [PMID: 37499444 DOI: 10.1016/j.ortho.2023.100802] [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: 05/28/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Orthognathic surgery is considered nowadays as a revolutionary treatment option for treating skeletal discrepancies and severe malocclusions in the sagittal, vertical and transverse dimensions. This surgery allows both the restoration of facial harmony and the achievement of satisfactory dental occlusion. The technology of computer-assisted surgeries including virtual surgical simulation programs and planning software greatly contributes to providing a three-dimensional simulation and precise mobilization of the maxilla and/or mandible, thus allowing the prediction of the final outcome in soft tissues. This study aims to systematically review the available scientific literature about the accuracy of the hard and soft tissue predictions delivered by the many promoted three-dimensional simulation software. MATERIAL AND METHODS An electronic search was conducted on various databases: Medline via PubMed, The Cochrane Library, EBSCO-host, and Web of Science. The search was established on a well-defined research question following PICO principle: population, intervention, comparator and outcome. Search evaluation and the assessment of risk of bias were undertaken in each study following its type and design. RESULTS Fifteen studies were included for qualitative analysis. Seven studies evaluated the accuracy of soft tissue prediction, seven focused more on the accuracy of hard tissue and one study assessed both hard and soft tissue prediction accuracy delivered by the simulation software. Moreover, three studies were judged to be low risk and four were classified as high risk. Included studies revealed that hard tissue prediction is highly accurate and reliable, leading to clinically acceptable results. Yet, soft tissue prediction is unclear due to various factors that bias its results. Caution should therefore be taken when providing information about the soft tissue planning to patients. CONCLUSIONS Computer assisted 3D simulation protocols allow for more precise repositioning of the maxilla and/or mandible compared to conventional 2D methods. However, 3D soft tissue prediction using simulation software remains less accurate, especially in the labial region.
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Affiliation(s)
- Yosra Tabchi
- Department of Orthodontics and dentofacial Orthopedics, Faculty of Dentistry, Mohammed V University in Rabat - Souissi, Rabat, Morocco.
| | - Fatima Zaoui
- Department of Orthodontics and dentofacial Orthopedics, Faculty of Dentistry, Mohammed V University in Rabat - Souissi, Rabat, Morocco.
| | - Asmae Bahoum
- Department of Orthodontics and dentofacial Orthopedics, Faculty of Dentistry, Mohammed V University in Rabat - Souissi, Rabat, Morocco.
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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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Sato N, Denadai R, Hung YT, Chung KH, Chou PY, Pai BCJ, Lo LJ, Lin HH. Single-Splint, 2-Jaw Orthognathic Surgery for Correction of Facial Asymmetry: 3-Dimensional Planning and Surgical Execution. J Craniofac Surg 2023:00001665-990000000-01254. [PMID: 38018966 DOI: 10.1097/scs.0000000000009912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/28/2023] [Indexed: 11/30/2023] Open
Abstract
Three-dimensional (3D) planning of orthognathic surgery (OGS) improves the treatment of facial asymmetry and malocclusion, but no consensus exists among clinicians regarding technical details. This study verified the consistency of authors' workflow and strategies between 3D planning and surgical execution for facial asymmetry. This retrospective study recruited consecutive patients (n=54) with nonsyndromic facial asymmetry associated with malocclusion. The stepwise workflow included orthodontic treatment, 3D imaging-based evaluation, planning, and transferring the virtual of single-splint 2-jaw OGS to actual surgery in all patients. Seven landmark-based measurements were selected for postoperative assessment of facial symmetry. Fifty patients had no anesthetic/surgical-related episode and procedure-related complications. Others experienced wound infection (n=1), transient TMJ discomfort (n=1), and facial numbness (n=3). Two cases had minor residual asymmetry (cheek and chin, respectively), but did not request revisionary bone or soft tissue surgery. Comparisons between the planned and postoperative 3D images with quantitative measurement revealed acceptable outcome data. The results showed a significant increase in facial symmetry at 7 landmark-based postoperative measurements for both male and female. This 3D-assisted pathway of OGS permitted achievement of consistent satisfactory results in managing facial asymmetry, with low rate of complications and secondary management.
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Affiliation(s)
- Nobuhiro Sato
- Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Sao Paulo, Brazil
| | - Yi-Tan Hung
- Image Lab and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | | | - Pang-Yun Chou
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Betty C J Pai
- Department of Craniofacial Orthodontics and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Hsia Lin
- Image Lab and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Surgical Correction of Maxillofacial Skeletal Deformities. J Oral Maxillofac Surg 2023; 81:E95-E119. [PMID: 37833031 DOI: 10.1016/j.joms.2023.06.026] [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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Shah B, Hallinan B, Kramer A, Caccamese JF. Predictability of the virtual surgical plan for orthognathic surgery with the mandible surgery first sequence. Int J Oral Maxillofac Surg 2023; 52:1179-1187. [PMID: 37087313 DOI: 10.1016/j.ijom.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/24/2023]
Abstract
The aim of this study was to compare the virtually planned position to the postoperative position of the maxilla, having performed the maxilla-first sequence or mandible-first sequence orthognathic surgery. An audit of 64 patients who underwent bimaxillary surgery between 2017 and 2020 was performed. Thirty patients had maxilla-first surgery and 34 had mandible-first surgery. The planned and post-surgical positions were analyzed using specific skeletal landmarks. Differences were calculated and the two-sample t-test was used to compare the groups. Measured differences between the planned and postoperative results differed significantly between the mandible-first and maxillary-first surgery groups (P < 0.001). The maxillary central incisors were under-advanced in the anterior-posterior direction in both groups. Most data points showed deviation from the surgical plan ≤ 2 mm and ≤ 4°. Secondarily, maxillary under-advancement in the mandible-first cohort was evaluated; these patients were subdivided into rigid and non-rigid fixation groups. The non-rigid fixation group showed less accuracy compared to the rigid fixation group, which was statistically significant (P = 0.014). The findings of this study demonstrate that virtual surgical planning can be less accurate in predicting the maxillary incisor position when performing mandible-first surgery, but this inaccuracy is within the acceptable range and can be mitigated by rigid fixation of the mandible.
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Affiliation(s)
- B Shah
- Clinic D, Oral and Maxillofacial Surgery, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA.
| | - B Hallinan
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Maryland, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - A Kramer
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Maryland, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - J F Caccamese
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Maryland, University of Maryland Medical Center, Baltimore, Maryland, USA
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Prevost A, Lauwers F, Varazzani A, Poulet V, Mure M, Lopez R, Cavallier Z. Outpatient orthognathic surgery: a prospective study of predictive factors for the length of hospital stays. Clin Oral Investig 2023; 27:6781-6788. [PMID: 37792221 DOI: 10.1007/s00784-023-05290-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/27/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Transitioning from non-outpatient orthognathic surgery to outpatient surgery is a new challenge, and it is essential to target the eligible population as precisely as possible. Several authors describe series of outpatient orthognathic surgery but do not include the reasons for their success or failure. The main aim of this study was to identify the factors significantly associated with "successful" outpatient orthognathic treatment. The secondary objective was to determine the factors significantly associated with prolonged hospital stays (≥ 2 nights). MATERIALS AND METHODS A prospective cohort study including patients undergoing orthognathic surgery was conducted over a period of 1 year. We recorded the prognostic factors that contributed to successful outpatient treatment and prolonged hospital stays. These factors were evaluated by bivariate and multivariate analysis. RESULTS A total of 102 patients were included, and the success rate of treatment was 65%. The variables that were isolated by multivariate analysis were: patients over the age of 22, procedures ending before 1 pm, brief operations, the absence of both postoperative vomiting and the administration of morphine. CONCLUSION Patient selection, organisation of outpatient facilities and anaesthetic protocols contribute to the development of outpatient orthognathic surgery. These initial considerations provide a framework for our practice, but the considerations that predict the failure of outpatient surgery will need to be clarified. CLINICAL RELEVANCE Orthognathic surgery can be performed on outpatient basis in selected cases. Age, the operative time, procedure end time, postoperative vomiting and the administration of morphine are associated with the success of outpatient care.
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Affiliation(s)
- Alice Prevost
- Plastic and Maxillo-Facial Surgery Department, CHU Purpan, University Hospital Center of Toulouse, Place du Docteur Baylac, 31059, Toulouse Cedex, France.
| | - Frédéric Lauwers
- Plastic and Maxillo-Facial Surgery Department, CHU Purpan, University Hospital Center of Toulouse, Place du Docteur Baylac, 31059, Toulouse Cedex, France
| | - Andréa Varazzani
- Plastic and Maxillo-Facial Surgery Department, Hospices Civils de Lyon, Lyon-Sud Hospital-Claude-Bernard Lyon 1 University, 165 Chemin du Grand-Revoyet, 69310, Pierre-Bénite, France
| | - Vinciane Poulet
- Plastic and Maxillo-Facial Surgery Department, CHU Purpan, University Hospital Center of Toulouse, Place du Docteur Baylac, 31059, Toulouse Cedex, France
| | - Marion Mure
- Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, Place du Docteur Baylac, 31059, Toulouse, France
| | - Raphael Lopez
- Plastic and Maxillo-Facial Surgery Department, CHU Purpan, University Hospital Center of Toulouse, Place du Docteur Baylac, 31059, Toulouse Cedex, France
| | - Zoé Cavallier
- Plastic and Maxillo-Facial Surgery Department, CHU Purpan, University Hospital Center of Toulouse, Place du Docteur Baylac, 31059, Toulouse Cedex, France
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Ho JPTF, Zhou N, van Riet TCT, Schreurs R, Becking AG, de Lange J. Assessment of Surgical Accuracy in Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea: A Preliminary Analysis. J Pers Med 2023; 13:1517. [PMID: 37888128 PMCID: PMC10608325 DOI: 10.3390/jpm13101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
This retrospective study aimed to: (1) investigate the surgical accuracy of maxillomandibular advancement (MMA) in obstructive sleep apnea (OSA) patients, with a specific focus on maxillary and mandibular advancement and counter-clockwise rotation and (2) investigate the correlation between the amount of achieved advancement and the reduction in the relative apnea hypopnea index (AHI). Sixteen patients, for whom a three-dimensional virtual surgical plan was generated preoperatively and a computed tomography scan (CT) or cone-beam computer tomography (CBCT) was acquired postoperatively, were included. The postoperative CT or CBCT was compared to the virtual surgical plan, and differences in the mandibular and maxillary advancement and counter-clockwise rotation were assessed. Maxillary and mandibular advancement (median 3.1 mm, p = 0.002 and 2.3 mm, p = 0.03, respectively) and counter-clockwise rotation (median 3.7°, p = 0.006 and 4.7°, p = 0.001, respectively) were notably less than intended. A significant correlation was found between the planned maxillary advancement and the difference between the planned and actual maxillary advancement (p = 0.048; adjusted R2 = 0.1979) and also between the planned counter-clockwise rotation and the difference between the planned and actual counter-clockwise rotation for the mandible (p = 0.012; adjusted R2 = 0.3261). Neither the maxilla-first nor the mandible-first surgical sequence proved to be superior in terms of the ability to achieve the intended movements (p > 0.45). Despite a significant reduction (p = 0.001) in the apnea hypopnea index (AHI) from a median of 62.6 events/h to 19.4 events/h following MMA, no relationship was found between the extent of maxillary or mandibular advancement and AHI improvement in this small cohort (p = 0.389 and p = 0.387, respectively). This study underlines the necessity for surgeons and future research projects to be aware of surgical inaccuracies in MMA procedures for OSA patients. Additionally, further research is required to investigate if sufficient advancement is an important factor associated with MMA treatment outcome.
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Affiliation(s)
- Jean-Pierre T. F. Ho
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
- Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Northwest Clinics, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
| | - Ning Zhou
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
| | - Tom C. T. van Riet
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
- Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
| | - Alfred G. Becking
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
- Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
- Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
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26
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Quast A, Sadlonova M, Asendorf T, Derad C, Mouchoux J, Horn J, Schliephake H, Kauffmann P, Meyer-Marcotty P. The impact of orthodontic-surgical treatment on facial expressions-a four-dimensional clinical trial. Clin Oral Investig 2023; 27:5841-5851. [PMID: 37561212 PMCID: PMC10560183 DOI: 10.1007/s00784-023-05195-9] [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: 03/21/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE The objective of this clinical trial was to compare facial expressions (magnitude, shape change, time, and symmetry) before (T0) and after (T1) orthognathic surgery by implementing a novel method of four-dimensional (4D) motion capture analysis, known as videostereophotogrammetry, in orthodontics. METHODS This prospective, single-centre, single-arm trial included a total of 26 adult patients (mean age 28.4 years; skeletal class II: n = 13, skeletal class III: n = 13) with indication for orthodontic-surgical treatment. Two reproducible facial expressions (maximum smile, lip purse) were captured at T0 and T1 by videostereophotogrammetry as 4D face scan. The magnitude, shape change, symmetry, and time of the facial movements were analysed. The motion changes were analysed in dependence of skeletal class and surgical movements. RESULTS 4D motion capture analysis was feasible in all cases. The magnitude of the expression maximum smile increased from 15.24 to 17.27 mm (p = 0.002), while that of the expression lip purse decreased from 9.34 to 8.31 mm (p = 0.01). Shape change, symmetry, and time of the facial movements did not differ significantly pre- and postsurgical. The changes in facial movements following orthodontic-surgical treatment were observed independently of skeletal class and surgical movements. CONCLUSIONS Orthodontic-surgical treatment not only affects static soft tissue but also soft tissue dynamics while smiling or lip pursing. CLINICAL RELEVANCE To achieve comprehensive orthodontic treatment plans, the integration of facial dynamics via videostereophotogrammetry provides a promising approach in diagnostics. TRIAL REGISTRATION NUMBER DRKS00017206.
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Affiliation(s)
- Anja Quast
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
| | - Monika Sadlonova
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychosomatic Medicine and Psychotherapy, University of Goettingen Medical Center, Goettingen, Germany
- Department of Cardiovascular and Thoracic Surgery, University of Goettingen Medical Center, Goettingen, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Carlotta Derad
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Jérémy Mouchoux
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Julia Horn
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Philipp Kauffmann
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Philipp Meyer-Marcotty
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
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Wang X, Wei H, Li B. From "Empirical Surgery" to "Precision Surgery": establishment and clinical application of precision orthognathic surgery system. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2023; 41:491-501. [PMID: 37805673 PMCID: PMC10580229 DOI: 10.7518/hxkq.2023.2023152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/08/2023] [Indexed: 10/09/2023]
Abstract
Orthognathic surgery, which involve osteotomy and repositioning of the maxillomandibular complex, has recently emerged as a crucial method of correcting dentofacial deformities. The optimal placement of the maxillomandibular complex holds utmost significance during orthognathic surgery because it directly affects the surgical outcome. To accurately achieve the ideal position of the maxillomandibular complex, with the rapid advancements in digital surgery and 3D-printing technology, orthognathic surgery has entered an era of "Precision Surgery" from the pervious "Empirical Surgery." This article provides comprehensive insights into our extensive research and exploration of the treatment modality known as "precision orthognathic surgery" over the years. We also present the technical system and application in"Ortho+X" treatment modality to offer valuable references and assistance to our colleagues in the field.
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Affiliation(s)
- Xudong Wang
- Dept. of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & College of Stomatology, Shanghai Jiao Tong University & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Hongpu Wei
- Dept. of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & College of Stomatology, Shanghai Jiao Tong University & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Biao Li
- Dept. of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & College of Stomatology, Shanghai Jiao Tong University & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
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Almadi D, Benington P, Ju X, Ayoub A. Reproducibility and reliability of digital occlusal planning for orthognathic surgery. Int J Oral Maxillofac Surg 2023; 52:1074-1080. [PMID: 36941160 DOI: 10.1016/j.ijom.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023]
Abstract
The digital articulation of dental models is gradually replacing the conventional physical approach for occlusal prediction planning. This study was performed to compare the accuracy and reproducibility of free-hand articulation of two groups of digital and physical dental models, 12 Class I (group 1) and 12 Class III (group 2). The models were scanned using an intraoral scanner. The physical and digital models were independently articulated 2 weeks apart by three orthodontists to achieve the maximum inter-digitation, with coincident midlines and a positive overjet and overbite. The occlusal contacts provided by the software color-coded maps were assessed and the differences in the pitch, roll, and yaw were measured. The reproducibility of the achieved occlusion of both the physical and digital articulation was excellent. The z-axis displayed the smallest absolute mean differences of 0.10 ± 0.08 mm and 0.27 ± 0.24 mm in the repeated physical and repeated digital articulations, respectively, both in group 2. The largest discrepancies between the two methods of articulation were in the y-axis (0.76 ± 0.60 mm, P = 0.010) and in roll (1.83° ± 1.72°, P = 0.005). The overall measured differences were< 0.8 mm and< 2°. Despite the steep learning curve, digital occlusal planning is accurate enough for clinical applications.
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Affiliation(s)
- D Almadi
- Oral and Maxillofacial Surgery Service, Glasgow University Dental Hospital and School, Glasgow, UK
| | - P Benington
- Orthodontic Service, Glasgow University Dental Hospital and School, Glasgow, UK
| | - X Ju
- Medical Device Unit, Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Hospital, Glasgow, UK
| | - A Ayoub
- Oral and Maxillofacial Surgery Service, Glasgow University Dental Hospital and School, Glasgow, UK.
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Du A, Ding N, Zhang J, Zhang J, Zhu J, Zhu L. Impact of Mandibular Angle Osteotomy Using a Geometric Mathematical Design on the Aesthetic Osteotomy Line: A Retrospective Observational Study. Aesthetic Plast Surg 2023; 47:1945-1956. [PMID: 36315263 DOI: 10.1007/s00266-022-03117-w] [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: 06/09/2022] [Accepted: 09/08/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mandibular angle osteotomy (MAO) is a frequently described technique in Eastern females. The success hinges on the precise positioning of the osteotomy line. The geometric mathematical method is viable. Therefore, we explored the impact of mandibular angle osteotomy using aesthetic standards and printed digital osteotomy templates (DOTs) on the aesthetic osteotomy line. METHODS This retrospective observational study included female patients with prominent mandibular angle (PMA) who underwent MAO at our hospital between January 2020 and March 2021. Thirty-three female patients were included, 22 in the DOTs group using new DOTs, and 11 in the traditional group using traditional free-hand techniques. RESULTS Regarding the width of the excised bone, the postoperative deviation from the preoperative plan was not significant in the DOTs group (0.5 ± 0.3 mm, P > 0.05), while the deviation was significant for the traditional group (2.5 ± 1.2 mm, P<0.05). The preparation time was longer in the DOTs group than in the traditional group (82 ± 11 vs. 53±4 min, P < 0.001). The osteotomy time and the operation time were shorter in the DOTs group than in the traditional group (osteotomy: 54 ± 5 vs. 73 ± 6 min; preparation: 124 ± 10 vs. 169 ± 13 min; both P < 0.001). The Likert (4.0 ± 0.5 vs. 1.0 ± 0.6, P = 0.006) and FACE-Q scores (17.5 ± 1.7 vs. 15.6 ± 1.3, P = 0.029) were higher in the DOTs group. CONCLUSIONS The new method of positioning the new aesthetic osteotomy line based on geometric analysis might provide a possible osteotomy method that strongly suggests effectiveness, safety, individualization, and accuracy, with a shorter operation and higher patient satisfaction. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Antong Du
- Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Ward Building 18th Floor, 415 Fengyang Road, Huangpu, Shanghai, 200003, China
| | - Neng Ding
- Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Ward Building 18th Floor, 415 Fengyang Road, Huangpu, Shanghai, 200003, China
| | - Jian Zhang
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai University, Shanghai, 200237, China
| | - Jianlin Zhang
- Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Ward Building 18th Floor, 415 Fengyang Road, Huangpu, Shanghai, 200003, China
| | - Jie Zhu
- Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Ward Building 18th Floor, 415 Fengyang Road, Huangpu, Shanghai, 200003, China
| | - Lie Zhu
- Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Ward Building 18th Floor, 415 Fengyang Road, Huangpu, Shanghai, 200003, 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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Wei X, Zheng J, Bu L, Luo Y, Qiu Y, Yang C. Digital template-guided genioplasty for patients with jaw deformity resulting from temporomandibular joint ankylosis: A comparison between single- and double-layer genioplasty. Int J Oral Maxillofac Surg 2023; 52:1057-1063. [PMID: 36990830 DOI: 10.1016/j.ijom.2023.03.003] [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: 04/21/2022] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
The aim of this study was to compare single- and double-layer digital template-assisted genioplasty for the correction of jaw deformity resulting from temporomandibular joint ankylosis (TMJA). Thirteen patients with jaw deformity resulting from TMJA who underwent lateral arthroplasty, costochondral graft, or total joint replacement combined with single- or double-layer digital template-assisted genioplasty were included. Computed tomography data were obtained for the preoperative design. Digital templates were designed and manufactured using three-dimensional printing to assist with the chin osteotomy and repositioning in single- or double-layer genioplasty. Of the 13 patients included, seven underwent single-layer genioplasty and six underwent double-layer genioplasty. The digital templates precisely reflected the osteotomy planes and repositioning of the chin segments intraoperatively. The radiographic evaluation showed that the patients who underwent double-layer genioplasty exhibited more chin advancement (11.95 ± 0.92 mm vs 7.50 ± 0.89 mm; P < 0.001) with a slightly larger mean surface error (1.19 ± 0.14 mm vs 0.75 ± 0.15 mm; P < 0.001) than those who underwent single-layer genioplasty. This indicates that double-layer genioplasty better promoted chin advancement and improved the facial shape, but was accompanied by more surgical error compared with the preoperative design. Furthermore, hardly any nerve damage was observed. Digital templates are useful for assisting in surgical procedures.
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Affiliation(s)
- X Wei
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, and National Clinical Research Center of Stomatology, Shanghai, China
| | - J Zheng
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, and National Clinical Research Center of Stomatology, Shanghai, China
| | - L Bu
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, and National Clinical Research Center of Stomatology, Shanghai, China
| | - Y Luo
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, and National Clinical Research Center of Stomatology, Shanghai, China
| | - Y Qiu
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, and National Clinical Research Center of Stomatology, Shanghai, China
| | - C Yang
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, and National Clinical Research Center of Stomatology, Shanghai, China.
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Alhabshi MO, Aldhohayan H, BaEissa OS, Al Shehri MS, Alotaibi NM, Almubarak SK, Al Ahmari AA, Khan HA, Alowaimer HA. Role of Three-Dimensional Printing in Treatment Planning for Orthognathic Surgery: A Systematic Review. Cureus 2023; 15:e47979. [PMID: 38034130 PMCID: PMC10686238 DOI: 10.7759/cureus.47979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Three-dimensional (3D) printing refers to a wide range of additive manufacturing processes that enable the construction of structures and models. It has been rapidly adopted for a variety of surgical applications, including the printing of patient-specific anatomical models, implants and prostheses, external fixators and splints, as well as surgical instrumentation and cutting guides. In comparison to traditional methods, 3D-printed models and surgical guides offer a deeper understanding of intricate maxillofacial structures and spatial relationships. This review article examines the utilization of 3D printing in orthognathic surgery, particularly in the context of treatment planning. It discusses how 3D printing has revolutionized this sector by providing enhanced visualization, precise surgical planning, reduction in operating time, and improved patient communication. Various databases, including PubMed, Google Scholar, ScienceDirect, and Medline, were searched with relevant keywords. A total of 410 articles were retrieved, of which 71 were included in this study. This article concludes that the utilization of 3D printing in the treatment planning of orthognathic surgery offers a wide range of advantages, such as increased patient satisfaction and improved functional and aesthetic outcomes.
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Affiliation(s)
- Manaf O Alhabshi
- Oral and Maxillofacial Surgery, King Abdullah Medical City, Jeddah, SAU
| | | | - Olla S BaEissa
- General Dentistry, North of Riyadh Dental Clinic, Second Health Cluster, Riyadh, SAU
- General Dentistry, Ibn Sina National College, Jeddah, SAU
| | | | | | | | | | - Hayithm A Khan
- Oral and Maxillofacial Surgery, Ministry of Health, Jeddah, SAU
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Malenova Y, Ortner F, Liokatis P, Haidari S, Tröltzsch M, Fegg F, Obermeier KT, Hartung JT, Kakoschke TK, Burian E, Otto S, Sabbagh H, Probst FA. Accuracy of maxillary positioning using computer-designed and manufactured occlusal splints or patient-specific implants in orthognathic surgery. Clin Oral Investig 2023; 27:5063-5072. [PMID: 37382718 PMCID: PMC10492762 DOI: 10.1007/s00784-023-05125-9] [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: 02/19/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To determine the accuracy of maxillary positioning using computer-designed and manufactured occlusal splints or patient-specific implants in orthognathic surgery. MATERIAL AND METHODS A retrospective analysis of 28 patients that underwent virtually planned orthognathic surgery with maxillary Le Fort I osteotomy either using VSP-generated splints (n = 13) or patient-specific implants (PSI) (n = 15) was conducted. The accuracy and surgical outcome of both techniques were compared by superimposing preoperative surgical planning with postoperative CT scans and measurement of translational and rotational deviation for each patient. RESULTS The 3D global geometric deviation between the planned position and the postoperative outcome was 0.60 mm (95%-CI 0.46-0.74, range 0.32-1.11 mm) for patients with PSI and 0.86 mm (95%-CI 0.44-1.28, range 0.09-2.60 mm) for patients with surgical splints. Postoperative differences for absolute and signed single linear deviations between planned and postoperative position were a little higher regarding the x-axis and pitch but lower regarding the y- and z-axis as well as yaw and roll for PSI compared to surgical splints. There were no significant differences regarding global geometric deviation, absolute and signed linear deviations in the x-, y-, and z-axis, and rotations (yaw, pitch, and roll) between both groups. CONCLUSIONS Regarding accuracy for positioning of maxillary segments after Le Fort I osteotomy in orthognathic surgery patient-specific implants and surgical splints provide equivalent high accuracy. CLINICAL RELEVANCE Patient-specific implants for maxillary positioning and fixation facilitate the concept of splintless orthognathic surgery and can be reliably used in clinical routines.
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Affiliation(s)
- Yoana Malenova
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany.
| | - Florian Ortner
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Selgai Haidari
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Matthias Tröltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
- Center for Oral, Maxillofacial, and Facial Reconstructive Surgery, Ansbach, Germany
| | - Florian Fegg
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Katharina T Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Jens T Hartung
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Tamara K Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Egon Burian
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Hisham Sabbagh
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital LMU Munich, Munich, Germany
| | - Florian A Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
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Byun SH, Park SY, Yi SM, Park IY, On SW, Jeong CK, Kim JC, Yang BE. Clinical Stability of Bespoke Snowman Plates for Fixation following Sagittal Split Ramus Osteotomy of the Mandible. Bioengineering (Basel) 2023; 10:914. [PMID: 37627799 PMCID: PMC10452001 DOI: 10.3390/bioengineering10080914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Maxillofacial skeletal surgery often involves the use of patient-specific implants. However, errors in obtaining patient data and designing and manufacturing patient-specific plates and guides can occur even with accurate virtual surgery. To address these errors, bespoke Snowman plates were designed to allow movement of the mandible. This study aimed to compare the stability of bespoke four-hole miniplates with that of a bespoke Snowman plate for bilateral sagittal split ramus osteotomy (SSRO), and to present a method to investigate joint cavity changes, as well as superimpose virtual and actual surgical images of the mandible. This retrospective study included 22 patients who met the inclusion criteria and underwent orthognathic surgery at a university hospital between 2015 and 2018. Two groups were formed on the basis of the plates used: a control group with four-hole bespoke plates and a study group with bespoke Snowman plates. Stability was assessed by measuring the condyle-fossa space and superimposing three-dimensional virtual surgery images on postoperative cone-beam computed tomography (CBCT) scans. No significant differences were observed in the condyle-fossa space preoperatively and 1 year postoperatively between the control and study groups. Superimposing virtual surgery and CBCT scans revealed minimal differences in the landmark points, with no variation between groups or timepoints. The use of bespoke Snowman plates for stabilizing the mandible following SSRO exhibited clinical stability and reliability similar to those with bespoke four-hole plates. Additionally, a novel method was introduced to evaluate skeletal stability by separately analyzing the condyle-fossa gap changes and assessing the mandibular position.
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Affiliation(s)
- Soo-Hwan Byun
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; (S.-H.B.); (S.-Y.P.); (S.-M.Y.); (J.-C.K.)
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- 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; (S.-H.B.); (S.-Y.P.); (S.-M.Y.); (J.-C.K.)
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sang-Min Yi
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; (S.-H.B.); (S.-Y.P.); (S.-M.Y.); (J.-C.K.)
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - In-Young Park
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
- Department of Orthodontics, Hallym University Sacred Heart Hospital, Anyang 14066, 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; (I.-Y.P.); (S.-W.O.)
- 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
| | - Chun-Ki Jeong
- Department of Dental Science & Technology, Shingu College, Seongnam 13174, Republic of Korea;
| | - Jong-Cheol Kim
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; (S.-H.B.); (S.-Y.P.); (S.-M.Y.); (J.-C.K.)
- 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; (S.-H.B.); (S.-Y.P.); (S.-M.Y.); (J.-C.K.)
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
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35
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Onică N, Onică CA, Budală DG, Gelețu GL, Balan M, Baciu ER, Murariu A, Pertea M. The Use of 3D Technology in the Management of Residual Asymmetry following Orthognathic Surgery: A Case Report. Healthcare (Basel) 2023; 11:2172. [PMID: 37570412 PMCID: PMC10418807 DOI: 10.3390/healthcare11152172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
The purpose of this case report was to present the aesthetic result of the reconstruction of facial residual asymmetry after orthognathic surgery using a patient-specific three-dimensional (3D) mold and a custom-made polymethyl methacrylate implant. Through computer-aided design (CAD), the healthy contralateral side of the mandible was superimposed onto the side with the defect. Exocad Gallway (exocad GmbH, Darmstadt, Germany) was used to design the patient-specific implants (PSIs) of the right mandibular angle. Next, the implant mold was created using the Meshmixer software (Version 3.5, Autodesk Inc., San Rafael, CA, USA) and fabricated using additive manufacturing. During the surgical procedure, the patient-specific implant (PSI) was cast inside the resin mold using Simplex P bone cement (Stryker, Mahwah, NJ, USA). The implant was fixed using three screws. Combining both indirect (involving the dental laboratory) and direct (with surgical intervention) approaches, this innovative hybrid method, which incorporates both computer-aided design and additive manufacturing (AM), not only enhanced facial aesthetics, functional rehabilitation, and patient quality of life but also mitigated the potential risks linked to conventional grafting methods.
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Affiliation(s)
- Neculai Onică
- Independent Researcher, 700612 Iasi, Romania; (N.O.); (C.A.O.)
| | | | - Dana Gabriela Budală
- Department of Implantology, Removable Dentures, Dental Technology, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Gabriela Luminița Gelețu
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (M.B.); (A.M.)
| | - Mihail Balan
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (M.B.); (A.M.)
| | - Elena-Raluca Baciu
- Department of Implantology, Removable Dentures, Dental Technology, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Alice Murariu
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (M.B.); (A.M.)
| | - Mihaela Pertea
- Department of Plastic Surgery, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
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36
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Lee JH, Lee HL, Park IY, On SW, Byun SH, Yang BE. Effectiveness of creating digital twins with different digital dentition models and cone-beam computed tomography. Sci Rep 2023; 13:10603. [PMID: 37391453 PMCID: PMC10313775 DOI: 10.1038/s41598-023-37774-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 06/27/2023] [Indexed: 07/02/2023] Open
Abstract
Distortion of dentition may occur in cone-beam computed tomography (CBCT) scans due to artifacts, and further imaging is frequently required to produce digital twins. The use of a plaster model is common; however, it has certain drawbacks. This study aimed to assess the feasibility of different digital dentition models over that of plaster casts. Plaster models, alginate impressions, intraoral scan (IOS) images, and CBCT images of 20 patients were obtained. The desktop model scanner was used to scan the alginate impression twice, five minutes and two hours after impression-making. Using an IOS, the full arch was scanned in segments using CS 3600 and simultaneously with i700 wireless. The digital twins obtained from the alginate impression and IOS were superimposed with those obtained from the plaster cast. The differences and distances at each reference point were measured. Scans of alginate impressions after two hours showed the greatest discrepancies, but these were all less than the CBCT voxel size of 0.39 mm. Alginate impression scans and IOS are suitable supplements to CBCT compared to the plaster model. Accuracy can be improved by scanning the alginate impression within five minutes or by intraoral scanning of the entire arch with segmentation.
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Affiliation(s)
- Joo-Hee Lee
- Division of Pediatric Dentistry, Hallym University Sacred Heart Hospital, Anyang, 14066, Korea
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon, 24252, Korea
- Institute of Clinical Dentistry, Hallym University, Chuncheon, 24252, Korea
| | - Hye-Lim Lee
- Division of Pediatric Dentistry, Hallym University Sacred Heart Hospital, Anyang, 14066, Korea
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon, 24252, Korea
- Institute of Clinical Dentistry, Hallym University, Chuncheon, 24252, Korea
| | - In-Young Park
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon, 24252, Korea
- Institute of Clinical Dentistry, Hallym University, Chuncheon, 24252, Korea
| | - Sung-Woon On
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon, 24252, Korea
- Institute of Clinical Dentistry, Hallym University, Chuncheon, 24252, Korea
| | - Soo-Hwan Byun
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang, 14066, Korea
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon, 24252, Korea
- Institute of Clinical Dentistry, Hallym University, Chuncheon, 24252, Korea
| | - Byoung-Eun Yang
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang, 14066, Korea.
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon, 24252, Korea.
- Institute of Clinical Dentistry, Hallym University, Chuncheon, 24252, Korea.
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37
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Oh HJ, Son IS, Lee SJ, Sohn HB, Seo BM. Effect of maxillary impaction on mandibular surgical accuracy in virtually-planned orthognathic surgery: A retrospective study. J Craniomaxillofac Surg 2023:S1010-5182(23)00096-3. [PMID: 37355370 DOI: 10.1016/j.jcms.2023.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/03/2023] [Accepted: 05/23/2023] [Indexed: 06/26/2023] Open
Abstract
Although surgical accuracy has been evaluated in bi-maxillary procedures, few studies have investigated the relationship between maxillary and mandibular accuracy. The present study evaluated the effect of maxillary impaction accuracy on mandibular surgical outcome. This cohort study analyzed skeletal class III patients who underwent planned maxillary impaction in bi-maxillary surgery. The primary predictor was the difference between the virtual plan and surgical outcome in the maxilla, as determined by three-dimensional (3D) and vertical differences. The secondary predictors were the planned 3D distances in the maxilla and mandible. The primary outcome was mandibular surgical accuracy, defined as the difference between the planned and actual outcomes, calculated as 3D Euclidean distance. The study included 73 patients. Increased differences between the planned and actual outcomes in the maxilla were associated with increased differences in the mandible. The post-operative position of the mandible was closer to the planned position when the position of the impacted maxilla was superior than when it was inferior to the planned position. Moving the maxilla closer to the planned position resulted in a more accurate mandibular position. These findings suggest that careful surgical procedures are needed to avoid inferior positioning of the maxilla during maxillary impaction surgery.
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Affiliation(s)
- Hyun Jun Oh
- Department of Oral and Maxillofacial Surgery, National Cancer Center, Goyang, South Korea; Dental Research Institute, Seoul National University, Seoul, South Korea
| | | | - Shin-Jae Lee
- Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Hong-Bum Sohn
- Department of Orthodontics, Eton Dental Clinic, South Korea
| | - Byoung-Moo Seo
- Department of Oral and Maxillofacial Surgery, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea.
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38
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Philip MR, AlFotawi R. The accuracy of soft tissue movement using virtual planning for non-syndromic facial asymmetry cases-a systematic review. Oral Maxillofac Surg 2023; 27:187-200. [PMID: 35434758 DOI: 10.1007/s10006-022-01059-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/06/2022] [Indexed: 06/02/2023]
Abstract
The 3D prediction of post-operative changes is an inevitable tool for the surgical correction of facial asymmetry. The objective is to execute an evidence-based review answering the following question. Does the 3D virtual prediction planning draw reliable and accurate results in the surgical outcome related to the soft tissues of the face in facial asymmetry? This systematic review of the literature is based on the 3D soft tissue prediction planning of facial asymmetry correction to draw conclusions on the reliability and accuracy of these methods in the surgical outcome related to the soft tissues of the face. PubMed, Web of Science, Cochrane, and Ovid databases were adopted for the literature search. Studies published between years 2000 and 2020, aimed at the assessment of soft tissue predictions using software prediction packages for facial asymmetry, were selected. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) was applied. Quadas-2 tool was used for the qualitative evaluation of selected studies. Initial search yielded 248 articles. Twenty articles fulfilled the inclusion and exclusion criteria and selected for qualitative analysis. Finally, 12 articles were selected for quantitative analysis. The results indicate 3D imaging prediction methods provided more accurate information with less distortion for soft tissue prediction regardless of various softwares currently available. The prediction of soft tissue accuracy in facial asymmetry was less accurate in lower face regardless of the type of surgery for facial asymmetry. The mean prediction error was less than 2 mm.
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Affiliation(s)
- Manju Roby Philip
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud Bin Abdul Aziz University for Health Sciences, NGHA, Riyadh, Kingdom of Saudi Arabia.
| | - Randa AlFotawi
- Department of Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia
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39
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Trevisiol L, Bersani M, Martinez Garza A, Alvarado E, Arnett GW, D'Agostino A. Accuracy of virtual surgical planning in bimaxillary orthognathic surgery with mandible first sequence: A retrospective study. J Craniomaxillofac Surg 2023:S1010-5182(23)00093-8. [PMID: 37355372 DOI: 10.1016/j.jcms.2023.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/27/2023] [Accepted: 05/23/2023] [Indexed: 06/26/2023] Open
Abstract
The aim of this study was to verify treatment accuracy using virtual surgical planning (VSP) with a mandible-first sequence and strict surgical protocol to determine what surgical and methodological factors might influence outcomes. VSP transfer accuracy was evaluated retrospectively through a modified method involving voxel-based superimposition in patients who had undergone bimaxillary surgery with a mandible-first sequence to correct dentoskeletal deformities. Data analysis showed that the movements planned and those executed were substantially equivalent (p < 0.01), with the exception of mandibular and maxillary sagittal movements that were 0.72 ± 0.90 mm and 1.41 ± 1.04 mm smaller, respectively, than planned. This study showed that a mandible-first sequence is accurate for transferring virtual surgical planning intraoperatively. There are several factors involved in the proper transfer of virtual planning beyond the software, such as surgical technique and sequencing. Inaccurate sagittal movements and maxillary repositioning seem to depend mainly on surgical factors.
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Affiliation(s)
- Lorenzo Trevisiol
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Massimo Bersani
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy.
| | | | | | | | - Antonio D'Agostino
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
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40
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Stamm T, Kanemeier M, Dirksen D, Middelberg C, Hohoff A, Kleinheinz J, Schmid JQ. The Position of the Virtual Hinge Axis in Relation to the Maxilla in Digital Orthognathic Surgery Planning-A k-Means Cluster Analysis. J Clin Med 2023; 12:jcm12103582. [PMID: 37240688 DOI: 10.3390/jcm12103582] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of this study was to investigate a possible relation between skeletal phenotypes and virtual mounting data in orthognathic surgery patients. A retrospective cohort study including 323 female (26.1 ± 8.7 years) and 191 male (27.9 ± 8.3 years) orthognathic surgery patients was conducted. A k-means cluster analysis was performed on the mounting parameters: the angle α between the upper occlusal plane (uOP) and the axis orbital plane (AOP); the perpendicular distance (AxV) from the uOP to the hinge axis; and the horizontal length (AxH) of the uOP from upper incisor edge to AxV, with subsequent statistical analysis of related cepalometric values. Three clusters of mounting data were identified, representing three skeletal phenotypes: (1) balanced face with marginal skeletal class II or III and α=8∘, AxV = 36 mm and AxH = 99 mm; (2) vertical face with skeletal class II and α=11∘, AxV = 27 mm and AxH = 88 mm; (3) horizontal face with class III and α=2∘, AxV = 36 mm and AxH = 86 mm. The obtained data on the position of the hinge axis can be applied to any digital planning in orthognathic surgery using CBCT or a virtual articulator, provided that the case can be clearly assigned to one of the calculated clusters.
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Affiliation(s)
- Thomas Stamm
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
| | - Moritz Kanemeier
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
| | - Dieter Dirksen
- Department of Prosthetic Dentistry and Biomaterials, University of Münster, 48149 Münster, Germany
| | | | - Ariane Hohoff
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, University of Münster, 48149 Münster, Germany
| | - Jonas Q Schmid
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
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Balel Y. The Last 40 Years of Orthognathic Surgery: A Bibliometric Analysis. J Oral Maxillofac Surg 2023:S0278-2391(23)00317-8. [PMID: 37075807 DOI: 10.1016/j.joms.2023.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Bibliometric analyses provide information on the effectiveness, performance, trends, and various other characteristics of research by using mathematical and statistical analysis methods for data related to scientific publications. This study aims to determine the focus of studies in the field of orthognathic surgery, map it, and present the results in a simplified manner through a comprehensive bibliometric analysis of the relevant literature. METHODS In this bibliometric analysis study, orthognathic surgery publications from 1980 to 2022 were retrieved from the Web of Science Core Collection database. The independent variables were co-citations, while the outcome variables included cross-country collaboration analysis, keyword analysis, co-citation analysis, and cluster analysis of the co-citation network. Covariates were the number of publications, number of citations, year range, centrality value, and silhouette value. The bibliometric analysis was conducted using CiteSpace, VOSviewer, and R-Studio software. RESULTS A total of 7,135 publications and 75,822 references were included in the analysis, and the annual growth rate of publications was 9.52%. The co-citation clustering analysis revealed that the orthognathic surgery literature was organized into 16 subject headings. Patient satisfaction was found to be the most widely published topic. The youngest clusters, representing new topics in the field, were virtual planning and examination of condylar changes after orthognathic surgery. CONCLUSION Bibliometric analysis methods were used to evaluate the 40-year history of the orthognathic surgery literature. The analysis identified the most influential publications, the topics in which the literature is divided, and hot spots in the field. By conducting similar bibliometric research studies in the future, the progress and future direction of the literature can be monitored based on evidence.
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Affiliation(s)
- Yunus Balel
- Consultant, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokat Gaziosmanpaşa University, Tokat, Turkey.
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Yoo HJ, Hartsfield JK, Mian AS, Allan BP, Naoum S, Lee RJH, Goonewardene MS. Accuracy of mandibular repositioning surgery using new technology: Computer-aided design and manufacturing customized surgical cutting guides and fixation plates. Am J Orthod Dentofacial Orthop 2023; 163:357-367.e3. [PMID: 36503861 DOI: 10.1016/j.ajodo.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/01/2021] [Accepted: 12/01/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Recent 3-dimensional technology advancements have resulted in new techniques to improve the accuracy of intraoperative transfer. This study aimed to validate the accuracy of computer-aided design and manufacturing (CAD-CAM) customized surgical cutting guides and fixation plates on mandibular repositioning surgery performed in isolation or combined with simultaneous maxillary repositioning surgery. METHODS Sixty patients who underwent mandibular advancement surgery by the same surgeon were retrospectively evaluated by 3-dimensional surface-based superimposition. A 3-point coordinate system (x, y, z) was used to identify the linear and angular discrepancies between the planned movements and actual outcomes. Wilcoxon rank sum test was used to compare the outcomes between the mandible-only and the bimaxillary surgery groups with significance at P <0.05. Pearson correlation coefficient compared planned mandible advancement to the outcome from advancement planned. The centroid, which represents the mandible as a single unit, was computed from 3 landmarks, and the discrepancies were evaluated by the root mean square error (RMSE) for clinical significance set at 2 mm for linear discrepancies and 4° for angular discrepancies. RESULTS There was no statistically significant difference between the planned and actual position of the mandible in either group when considering absolute values of the differences. When considering raw directional data, a statistically significant difference was identified in the y-axis suggesting a tendency for under-advancement of the mandible in the bimaxillary group. The largest translational RMSE for the centroid was 0.77 mm in the sagittal dimension for the bimaxillary surgery group. The largest rotational RMSE for the centroid was 1.25° in the transverse dimension for the bimaxillary surgery group. Our results show that the precision and clinical feasibility of CAD-CAM customized surgical cutting guides and fixation plates on mandibular repositioning surgery is well within clinically acceptable parameters. CONCLUSION Mandibular repositioning surgery can be performed predictably and accurately with the aid of CAD-CAM customized surgical cutting guides and fixation plates with or without maxillary surgery.
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Affiliation(s)
- Ho Jin Yoo
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - James K Hartsfield
- Division of Orthodontics, Department of Oral Health Science, College of Dentistry, and Department of Microbiology, Immunology and Molecular Genetics, College of Medicine, University of Kentucky, Lexington, KY; Division of Oral Development and Behavioural Sciences, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - Ajmal S Mian
- School of Computer Science and Software Engineering, the University of Western Australia, Crawley, Western Australia, Australia
| | - Brent P Allan
- Private practice, Perth, Western Australia, Australia; Department of Orthodontics, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Steven Naoum
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - Richard J H Lee
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - Mithran S Goonewardene
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia.
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Ahmed M, Ali S, Soliman S. Computer Guided Generated Dual-Purpose Splint for Bilateral Sagittal Split Osteotomy. J Maxillofac Oral Surg 2023; 22:239-244. [PMID: 36703665 PMCID: PMC9871130 DOI: 10.1007/s12663-022-01734-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/08/2022] [Indexed: 01/29/2023] Open
Abstract
Purpose to evaluate the efficacy of dual-purpose computer-generated splint in guiding the proximal and the distal segment in bilateral sagittal split osteotomy. Patients and Method It was a prospective case series study directed on 8 class III patients indicating the need of maxillary advancement and mandibular set back by bilateral sagittal split osteotomy. A CAD/CAM splint is generated to guide the distal segment to the stable maxilla and at the same time a grooved extension to engage the proximal segment ensuring the condyle in its planned position during fixation. The primary outcome was measured by calculating the difference between the pre- and post-operative condylar segment position. Results The present study included five female patient and three male patient with mean age of 28.4 ± 5.1 years. The accuracy of the splint in positioning the mandibular proximal segment showed promising results ranging from 2.59 to 0.49. Conclusion The dual-purpose splint introduced in this study showed satisfied results in maintaining the pre-operative condylar position while securing the distal segment in the desired plan.
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Affiliation(s)
- Mamdouh Ahmed
- Oral and Maxillofacial Surgery, Cairo University, Cairo, Egypt
| | - Sherif Ali
- Oral and Maxillofacial Surgery, Cairo University, Cairo, Egypt
| | - Sara Soliman
- Oral and Maxillofacial Surgery, Pharos University in Alexandria (PUA), Alexandria, Egypt
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El-Mahallawy Y, Abdelrahman HH, Al-Mahalawy H. Accuracy of virtual surgical planning in mandibular reconstruction: application of a standard and reliable postoperative evaluation methodology. BMC Oral Health 2023; 23:119. [PMID: 36814232 PMCID: PMC9945410 DOI: 10.1186/s12903-023-02811-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE The purpose of this study was to determine the accuracy of virtual surgical planning for mandibular reconstruction, along with the implementation of a postoperative evaluation methodology. MATERIALS AND METHODS The study is a prospective case series for computer-assisted mandibular reconstruction surgery. Analysis of the degree of agreement between virtual measurements and postoperative actual outcomes was performed. The reliability of the proposed evaluation methodology was assessed and analyzed using the Inter-Class Coefficient (ICC) test. Statistical significance was set at the 5% level. RESULTS Nine consecutive patients were selected. The analysis of all angular and linear parameters reported a highly statistically significant degree of agreement between the preoperative and postoperative measurements (P < 0.001). Furthermore, an extreme degree of reliability was reported when the evaluation methodology was scrutinized (ICC = 0.9). CONCLUSION The excellent degree of agreement between the virtual plan and the actual outcome reported in this study validated the surgical accuracy of virtually assisted mandibular reconstruction. This study pointed out the reliability and reproducibility of the standardized evaluation protocol in an attempt to obtain a tolerable value for the acceptable postoperative results regarding the accuracy of computer-assisted surgery.
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Affiliation(s)
- Yehia El-Mahallawy
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Champlion St, Azrite, Alexandria, Egypt.
| | - Hams H. Abdelrahman
- grid.7155.60000 0001 2260 6941Dental Public Health and Pediatric Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Haytham Al-Mahalawy
- grid.411170.20000 0004 0412 4537Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Fayoum University, Fayoum, Egypt
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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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Merta M, Heliövaara A, Leikola J, Suojanen J. Early experience of wafer-free Le Fort I osteotomy with patient-specific implants in cleft lip and palate patients. J Plast Reconstr Aesthet Surg 2023; 77:78-86. [PMID: 36563638 DOI: 10.1016/j.bjps.2022.10.051] [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: 09/15/2021] [Revised: 06/21/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The use of virtual surgical planning and patient-specific saw and drill guides combined with customized osteosynthesis is becoming a gold standard in orthognathic surgery. The aim of this study is to report preliminary results of the use of virtual surgical planning and the wafer-free PSI technique in cleft patients. MATERIALS AND METHODS Patient-specific saw and drill guides combined with milled patient-specific 3D titanium alloy implants were used in reposition and fixation in Le Fort I osteotomy of 12 cleft patients. Surgical information was retrieved from hospital records. Pre- and post-operative lateral cephalograms were analyzed. RESULTS In 10 of 12 cases, the implants fitted as planned to predesigned drill holes and bone contours with high precision. In one patient, the mobilization of the maxilla was too demanding for virtually planned advancement, and the implants could not be used. In another patient, PSI fitting was impaired due to an insufficient mobilization of maxilla and tension on PSI fixation with screws. After the surgery, the mean advancement of the anterior maxilla (point A) of all patients was 5.8 mm horizontally (range 2.7-10.1) and -3.1 mm vertically (range -9.2 to 3.4). Skeletal relationships of the maxilla and mandible could be corrected successfully in all patients except for the one whose PSI could not be used. CONCLUSIONS Virtual surgical planning combined with PSI is a possible useful clinical adjunct for the correction of maxillary hypoplasia in cleft patients. Large maxillary advancements and scarring may be cause problems for desired advancement and for the use of implants.
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Affiliation(s)
- Minna Merta
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillo-Facial Surgery, Lahti, Finland
| | - Arja Heliövaara
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Junnu Leikola
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Juho Suojanen
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillo-Facial Surgery, Lahti, Finland; Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
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Three-Dimensional Accuracy and Stability of Personalized Implants in Orthognathic Surgery: A Systematic Review and a Meta-Analysis. J Pers Med 2023; 13:jpm13010125. [PMID: 36675786 PMCID: PMC9867342 DOI: 10.3390/jpm13010125] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
This systematic review aimed to determine the accuracy/stability of patient-specific osteosynthesis (PSI) in orthognathic surgery according to three-dimensional (3D) outcome analysis and in comparison to conventional osteosynthesis and computer-aided designed and manufactured (CAD/CAM) splints or wafers. The PRISMA guidelines were followed and six academic databases and Google Scholar were searched. Records reporting 3D accuracy/stability measurements of bony segments fixated with PSI were included. Of 485 initial records, 21 met the eligibility (566 subjects), nine of which also qualified for a meta-analysis (164 subjects). Six studies had a high risk of bias (29%), and the rest were of low or moderate risk. Procedures comprised either single-piece or segmental Le Fort I and/or mandibular osteotomy and/or genioplasty. A stratified meta-analysis including 115 subjects with single-piece Le Fort I PSI showed that the largest absolute mean deviations were 0.5 mm antero-posteriorly and 0.65° in pitch. PSIs were up to 0.85 mm and 2.35° more accurate than conventional osteosynthesis with CAD/CAM splint or wafer (p < 0.0001). However, the clinical relevance of the improved accuracy has not been shown. The literature on PSI for multi-piece Le Fort I, mandibular osteotomies and genioplasty procedure is characterized by high methodological heterogeneity and a lack of randomized controlled trials. The literature is lacking on the 3D stability of bony segments fixated with PSI.
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CASAGRANDE CPM, CASAGRANDE MVS, TEIXEIRA AODB, ALENCAR DS, DIAS BSDB, ALMEIDA RCC, QUINTÃO CA, CARVALHO FAR. Cartesian three-dimensional method to quantify displacements between cone beam computed tomography models. Dental Press J Orthod 2023; 27:e222199. [PMID: 36629628 PMCID: PMC9829105 DOI: 10.1590/2177-6709.27.5.e222199.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/24/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Research in Orthodontics and Oral Surgery has been relying on three-dimensional (3D) models to evaluate treatment results with displacement color map techniques, even though it has important limitations. OBJECTIVES This study proposed a method of tracking translational movements of 3D objects to evaluate displacements in surfaces with no shape modification. METHODS Cone Beam Computed Tomography (CBCT) data of ten patients were imported to the Dolphin software. A hypothetical virtual surgical plan (randomly defined) was developed in the software and afterwards verified using the proposed method. All the procedures were carried out by two evaluators, in two different time-points, with a 15-day interval. ITK-Snap software was used to generate high quality STL models. Centroid points were automatically generated and their coordinates were compared to confirm if they represented the known displacements simulated. The paired t-test and the Bland-Altman plots were used, as well as the intraclass correlation coefficient. RESULTS Interexaminers and intra-examiner tests showed excellent reliability of the method, with mean displacement measurement error values under 0.1mm. The paired t-test did not show any statistically significant differences. CONCLUSION The method showed excellent reliability to track the simulated translational displacements of bone segments.
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Affiliation(s)
| | | | | | - David Silveira ALENCAR
- Universidade do Estado do Rio de Janeiro, Faculdade de Odontologia (Rio de Janeiro/RJ, Brazil).
| | | | | | - Cátia Abdo QUINTÃO
- Universidade do Estado do Rio de Janeiro, Faculdade de Odontologia (Rio de Janeiro/RJ, Brazil).
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The Accuracy of Computer-Assisted Surgical Planning in Predicting Soft Tissue Responses After Le Fort I Osteotomy: Retrospective Analysis. J Craniofac Surg 2023; 34:131-138. [PMID: 36104836 DOI: 10.1097/scs.0000000000008970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/25/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Mismatch between preoperative planning and surgical outcome in maxillofacial surgery relate to on-table replication of presurgical planning and predictive algorithm inaccuracy: software error was hereby decoupled from planning inaccuracy to assess a commercial software. The hypothesis was that soft tissue prediction error would be minimized if the surgical procedure was replicated precisely as planned and is independent of the extent of bone repositioning. MATERIALS AND METHODS Cone-beam computed tomography scans of 16 Le Fort I osteotomy patients were collected at Boston Children's Hospital. Preoperative and postoperative models of bone and soft tissue were constructed and the maxilla repositioning was replicated. Each model was subdivided into 6 regions: mouth, nose, eyes, and cheeks. Soft tissue prediction (performed using Proplan CMF-Materialise) for each patient was compared with the relative postoperative reconstruction and error was determined. P <0.05 was considered significant. RESULTS Le Fort I segment repositioning was replicated within 0.70±0.18 mm. The highest prediction error was found in the mouth (1.49±0.77 mm) followed by the cheeks (0.98±0.34 mm), nose (0.86±0.23 mm), and eyes (0.76±0.32). Prediction error on cheeks correlated significantly with mouth ( r =0.63, P < 0.01) and nose ( r =0.67, P < 0.01). Mouth prediction error correlated with total advancement ( r =0.52, P =0.04). CONCLUSIONS ProPlan CMF is a useful outcome prediction tool; however, accuracy decreases with the extent of maxillary advancement even when errors in surgical replication are minimized.
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Pellby D, Bengtsson M. Changes in the upper airway volume after orthognathic surgery: three-dimensional measurements in a supine body position. Int J Oral Maxillofac Surg 2022:S0901-5027(22)00462-3. [PMID: 36481123 DOI: 10.1016/j.ijom.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/19/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
The objectives of this study were to analyse the changes in airway cross-sectional areas and volumes due to surgical movements of the jaws and to identify any possible correlation with the direction of the movements. Fifty-seven participants, aged 18-28 years (mean 20.8 years) at surgery, were followed up for 12 months postoperatively. Pre- and postoperative measurements of the facial region obtained from computed tomography in a supine position were analysed according to the surgical movements and changes in the upper airways. Intra-rater reliability was assessed. Comparisons and correlations of jaw movements, changes in airway volume, and body mass index (BMI) were made. The cohort showed a significant change between the pre- and postoperative measurements for areas associated with the anterior nasal spine (P = 0.013), posterior nasal spine (P = 0.049), uvula (P = 0.006), and epiglottis (P = 0.046). Additionally, a correlation was found between the airway volume change and the change in mandible position (correlation coefficient 0.324, P = 0.014). All participants were non-smokers, and no correlation was observed between BMI and the upper airway volume. Changes in the upper airway can be expected following surgical movements of the jaws. A correlation was shown between a sagittal direction of the movements and the changes in the airways. Patients with obstructive sleep apnoea who are indicated for surgical movements of the jaws are expected to benefit from orthognathic surgery.
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