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Di Brigida L, Cortese A, Cataldo E, Naddeo A. A New Method to Design and Manufacture a Low-Cost Custom-Made Template for Mandible Cut and Repositioning Using Standard Plates in BSSO Surgery. Bioengineering (Basel) 2024; 11:668. [PMID: 39061750 PMCID: PMC11273722 DOI: 10.3390/bioengineering11070668] [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: 06/08/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
In this study, a new methodology for designing and creating a custom-made template for maxillofacial surgery has been developed. The custom-made template can be used both for cutting and repositioning of the mandible arches for executing a BSSO (bilateral sagittal split osteotomy) treatment. The idea was developed in order to give the possibility of using a custom-made template with standard plates, thus reducing long times, high costs and low availability of custom-made plates; this represents the proof of novelty of the proposed template, based on a well-established methodology. The methodology was completely developed in the CAD virtual environment and, after the surgeons' assessment, an in-vitro experiment by a maxillofacial surgeon was performed in order to check the usability and the versatility of the system, thanks to the use of additive manufacturing technologies. When computer-aided technologies are used for orthognathic surgery, there are significant time and cost savings that can be realised, as well as improved performance. The cost of the whole operation is lower than the standard one, thanks to the use of standard plates. To carry out the procedures, the proposed methodology allows for inexpensive physical mock-ups that enable the BSSO procedure to be performed.
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Affiliation(s)
- Liliana Di Brigida
- Department of Industrial Engineering, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, SA, Italy; (L.D.B.); (E.C.)
- Technogym Research and Development Department, Via Calcinaro 2861, 47521 Cesena, FC, Italy
| | - Antonio Cortese
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 84081 Baronissi, SA, Italy;
| | - Emilio Cataldo
- Department of Industrial Engineering, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, SA, Italy; (L.D.B.); (E.C.)
- Techno Design S.r.l., via Rosa Jemma, 2, 84091 Battipaglia, SA, Italy
| | - Alessandro Naddeo
- Department of Industrial Engineering, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, SA, Italy; (L.D.B.); (E.C.)
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Habib AA, Sharara AA, Yousry TN, Swidan AO. Accuracy of computer-assisted design and manufactured three-dimensional device for condylar positioning in mandibular bilateral sagittal split osteotomy (clinical trial). Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:331-337. [PMID: 38155012 DOI: 10.1016/j.oooo.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Aligning dental arches in orthognathic treatment after undergoing LeFort I osteotomy or bilateral sagittal split osteotomy (BSSO) relies on occlusal splints, which do not provide precise control over the condylar head. AIM OF THE STUDY To clinically and radiographically assess the accuracy of computer-assisted design and manufactured (CAD/CAM) surgical guide for condylar positioning in a BSSO. MATERIALS AND METHODS The study recruited 8 patients with a non-syndromic dentofacial deformity who underwent a BSSO. Surgery was planned according to CAD/CAM technology. After osteotomy, a pre-operative guide was used, followed by a repositioning guide. Computed tomography scans were conducted on all patients 1 week pre-operatively, immediately, and 3 months postoperatively. RESULTS The data are presented as median values with the 25th and 75th percentiles. Eight patients (37.50% females and 62.50% males) between the ages of 19 and 24 underwent BSSOs. The surgical procedure successfully corrected their skeletal deformities. The absolute change between immediate postoperative and pre-operative condylar angle was 0.15 (0.00-0.3). The absolute change between 3 months postoperative and pre-operative condylar angle was 0.20 (0.00-0.30). CONCLUSION The stability of the condylar head in position is well assessed by 3-dimensional condylar positioning devices designed and manufactured by CAD/CAM technology in the mandibular BSSO.
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Affiliation(s)
- Aliaa A Habib
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Ahmed A Sharara
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Tarek N Yousry
- Orthodontics Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Ahmed O Swidan
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Straub A, Gubik S, Kübler A, Breitenbuecher N, Vollmer A, Renner T, Müller-Richter U, Hartmann S, Brands R. Comparison of Patient-Specific Condylar Positioning Devices and Manual Methods in Orthognathic Surgery: A Prospective Randomized Trial. J Clin Med 2024; 13:737. [PMID: 38337431 PMCID: PMC10856595 DOI: 10.3390/jcm13030737] [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: 12/28/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND This study investigated whether patient-specific condylar positioning devices (CPDs) are beneficial compared to the conventional manual positioning of the condyles. METHODS In this prospective, randomized trial, patients undergoing orthognathic surgery with a bilateral sagittal split osteotomy of the mandible were included. The ascending ramus was positioned with computer-aided designed and computer-aided manufactured (CAD/CAM) patient-specific devices in the CPD group and manually in the control group. Postoperatively, cone-beam computed tomography (CBCT) was performed to align the virtually planned position with the postoperative result. RESULTS Thirty patients were enrolled in the study, with 14 randomized to the CPD group and 16 to the control group. In the CPD group, the ascending ramus differed in the postoperative CBCT scan from the virtually planned position by 0.8 mm in the left/right, 0.8 mm in the front/back, and 1.3 mm in the cranial/caudal direction. The corresponding control-group values were 1.1 mm, 1.3 mm, and 1.6 mm. CPD and controls differed significantly for the left/right movement of the rami (p = 0.04) but not for the other directions or rotations (p > 0.05). CONCLUSIONS The results demonstrate that both methods are accurate, and postoperative results matched the virtually planned position precisely. It can be assumed that the described CPDs are beneficial when a condylar position different from the preoperative is desired.
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Affiliation(s)
- Anton Straub
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
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Yazaki M, Aihara T, Okamoto D, Saito S, Suzuki H, Nogami S, Yamauchi K. Comparison of three-dimensional soft tissue changes according to the split pattern after sagittal split osteotomy in patients with skeletal class III malocclusion. Clin Oral Investig 2023; 28:34. [PMID: 38147171 PMCID: PMC10751263 DOI: 10.1007/s00784-023-05431-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES This study aimed to analyse the changes in soft tissue and hard tissue stability associated with the split pattern, i.e. long split (LS) or short split (SS), after sagittal split osteotomy. MATERIALS AND METHODS Patients who underwent sagittal split ramus osteotomy were classified into LS or SS groups according to postoperative computed tomography images. They were examined via lateral cephalography and three-dimensional (3D) optical scanning before surgery (T0) and 1 (T1), 3 (T2), and 12 (T3) months after surgery. Six standard angles (SNA, SNB, ANB, FMA, FMIA, and IMPA) were used as measures of hard tissue change. The two sets of 3D data were superimposed, and the volumetric differences were calculated as the soft tissue change. The areas evaluated were delimited by 10 × 20-mm rectangles in the frontal aspect and a 25 × 25-mm square in the lateral aspect. RESULTS A total of 42 sides (26 patients) were analysed, including 20 (16 patients) in the SS group and 22 (16 patients) in the LS group. We found no significant differences in cephalographic angle or soft tissue changes in the frontal aspect between the SS and LS groups. We found significant differences in the subauricular region from T0-T1 (p = 0.02), T0-T2 (p = 0.03), and T0-T3 (p = 0.037) in terms of soft tissue changes in the lateral aspect. The volume increase associated with posterior mandibular movement was greater in the LS group. CONCLUSIONS We found that LS patients with mandibular prognathism exhibited increased subauricular volumes following mandibular setback. CLINICAL RELEVANCE It is essential to predict the postoperative facial profile before surgery. The split pattern after sagittal split osteotomy affects the postoperative profile of patients with mandibular prognathism.
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Affiliation(s)
- Mai Yazaki
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Tomoki Aihara
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Daigo Okamoto
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Shizu Saito
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Hikari Suzuki
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Shinnosuke Nogami
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan.
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Jeong M, Radomski K, Lopez D, Liu JT, Lee JD, Lee SJ. Materials and Applications of 3D Printing Technology in Dentistry: An Overview. Dent J (Basel) 2023; 12:1. [PMID: 38275676 PMCID: PMC10814684 DOI: 10.3390/dj12010001] [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: 10/09/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE This narrative review aims to provide an overview of the mechanisms of 3D printing, the dental materials relevant to each mechanism, and the possible applications of these materials within different areas of dentistry. METHODS Subtopics within 3D printing technology in dentistry were identified and divided among five reviewers. Electronic searches of the Medline (PubMed) database were performed with the following search keywords: 3D printing, digital light processing, stereolithography, digital dentistry, dental materials, and a combination of the keywords. For this review, only studies or review papers investigating 3D printing technology for dental or medical applications were included. Due to the nature of this review, no formal evidence-based quality assessment was performed, and the search was limited to the English language without further restrictions. RESULTS A total of 64 articles were included. The significant applications, applied materials, limitations, and future directions of 3D printing technology were reviewed. Subtopics include the chronological evolution of 3D printing technology, the mechanisms of 3D printing technologies along with different printable materials with unique biomechanical properties, and the wide range of applications for 3D printing in dentistry. CONCLUSIONS This review article gives an overview of the history and evolution of 3D printing technology, as well as its associated advantages and disadvantages. Current 3D printing technologies include stereolithography, digital light processing, fused deposition modeling, selective laser sintering/melting, photopolymer jetting, powder binder, and 3D laser bioprinting. The main categories of 3D printing materials are polymers, metals, and ceramics. Despite limitations in printing accuracy and quality, 3D printing technology is now able to offer us a wide variety of potential applications in different fields of dentistry, including prosthodontics, implantology, oral and maxillofacial, orthodontics, endodontics, and periodontics. Understanding the existing spectrum of 3D printing applications in dentistry will serve to further expand its use in the dental field. Three-dimensional printing technology has brought about a paradigm shift in the delivery of clinical care in medicine and dentistry. The clinical use of 3D printing has created versatile applications which streamline our digital workflow. Technological advancements have also paved the way for the integration of new dental materials into dentistry.
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Affiliation(s)
- Min Jeong
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA 02115, USA; (M.J.); (K.R.); (D.L.); (J.D.L.)
| | - Kyle Radomski
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA 02115, USA; (M.J.); (K.R.); (D.L.); (J.D.L.)
| | - Diana Lopez
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA 02115, USA; (M.J.); (K.R.); (D.L.); (J.D.L.)
| | - Jack T. Liu
- Dexter Southfield, Brookline, MA 02445, USA;
| | - Jason D. Lee
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA 02115, USA; (M.J.); (K.R.); (D.L.); (J.D.L.)
| | - Sang J. Lee
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA 02115, USA; (M.J.); (K.R.); (D.L.); (J.D.L.)
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Liu J, Hao J, Lin H, Pan W, Yang J, Feng Y, Wang G, Li J, Jin Z, Zhao Z, Liu Z. Deep learning-enabled 3D multimodal fusion of cone-beam CT and intraoral mesh scans for clinically applicable tooth-bone reconstruction. PATTERNS (NEW YORK, N.Y.) 2023; 4:100825. [PMID: 37720330 PMCID: PMC10499902 DOI: 10.1016/j.patter.2023.100825] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/24/2023] [Accepted: 07/21/2023] [Indexed: 09/19/2023]
Abstract
High-fidelity three-dimensional (3D) models of tooth-bone structures are valuable for virtual dental treatment planning; however, they require integrating data from cone-beam computed tomography (CBCT) and intraoral scans (IOS) using methods that are either error-prone or time-consuming. Hence, this study presents Deep Dental Multimodal Fusion (DDMF), an automatic multimodal framework that reconstructs 3D tooth-bone structures using CBCT and IOS. Specifically, the DDMF framework comprises CBCT and IOS segmentation modules as well as a multimodal reconstruction module with novel pixel representation learning architectures, prior knowledge-guided losses, and geometry-based 3D fusion techniques. Experiments on real-world large-scale datasets revealed that DDMF achieved superior segmentation performance on CBCT and IOS, achieving a 0.17 mm average symmetric surface distance (ASSD) for 3D fusion with a substantial processing time reduction. Additionally, clinical applicability studies have demonstrated DDMF's potential for accurately simulating tooth-bone structures throughout the orthodontic treatment process.
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Affiliation(s)
- Jiaxiang Liu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Hangzhou 310000, China
- Zhejiang University-University of Illinois at Urbana-Champaign Institute, Zhejiang University, Haining 314400, China
- College of Computer Science and Technology, Zhejiang University, Hangzhou 310058, China
| | - Jin Hao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Harvard School of Dental Medicine, Harvard University, Boston, MA 02115, USA
| | - Hangzheng Lin
- Zhejiang University-University of Illinois at Urbana-Champaign Institute, Zhejiang University, Haining 314400, China
| | - Wei Pan
- OPT Machine Vision Tech Co., Ltd., Tokyo 135-0064, Japan
| | - Jianfei Yang
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Yang Feng
- Angelalign Inc., Shanghai 200433, China
| | - Gaoang Wang
- Zhejiang University-University of Illinois at Urbana-Champaign Institute, Zhejiang University, Haining 314400, China
| | - Jin Li
- Department of Stomatology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518025, China
| | - Zuolin Jin
- Department of Orthodontics, School of Stomatology, Air Force Medical University, Xi’an 710032, China
| | - Zhihe Zhao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Zuozhu Liu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Hangzhou 310000, China
- Zhejiang University-University of Illinois at Urbana-Champaign Institute, Zhejiang University, Haining 314400, China
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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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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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Sneha A, Krishnan M, Satheesh T, Dhasarathan P, Muralidoss H. Patient-Specific Plates for Genioplasty: A Case Report. Cureus 2023; 15:e38746. [PMID: 37303387 PMCID: PMC10248537 DOI: 10.7759/cureus.38746] [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: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
A 20-year-old male patient presented with a retruded chin and crowding of the upper front tooth region. The patient's problem list included skeletal class II malocclusion, retruded chin, and shallow mentolabial sulcus. A treatment plan was curated using clinical examination, cephalometric analysis, and 3D measurements, which included the advancement genioplasty of 5 mm. Osteotomy cut was planned digitally by computer-aided surgical simulation technology (Dolphin Software, Dolphin Imaging Systems, California, USA) and then transferred to Geomagic Software (3D Systems, North Carolina, USA) where patient-specific plates were designed. The patient-specific plates were 3D printed using selective laser melting. Intraoperatively, the osteotomy cut was given using a surgical guide, and an advancement of 5 mm was performed, fixing the segments using patient-specific plates. The outcome was compared with the curated treatment plan to assess accuracy. The primary objective of the case report is to provide a digital method of the treatment plan and surgical accuracy in genioplasty using patient-specific plates.
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Affiliation(s)
- Alladi Sneha
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Tharini Satheesh
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Pradeep Dhasarathan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Hemavathy Muralidoss
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
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Beek DM, Baan F, Liebregts J, Nienhuijs M, Bergé S, Maal T, Xi T. A learning curve in 3D virtual surgical planned orthognathic surgery. Clin Oral Investig 2023:10.1007/s00784-023-05013-2. [PMID: 37083986 DOI: 10.1007/s00784-023-05013-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/29/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES To assess the surgical accuracy of 3D virtual surgical planned orthognathic surgery and the influence of posterior impaction and magnitude of the planned movements on a possible learning curve. MATERIALS AND METHODS This prospective cohort study included subjects who underwent bimaxillary surgery between 2016 and 2020 at the Department of Oral and Maxillofacial Surgery of the Radboud University Medical Center, Nijmegen. 3D virtual surgical planning (VSP) was performed with CBCT data and digitalized dentition data. By using voxel-based matching with pre- and postoperative CBCT data the maxillary movements were quantified in six degrees of freedom. The primary outcome variable, surgical accuracy, was defined as the difference between the planned and achieved maxillary movement. RESULTS Based on 124 subjects, the surgical accuracy increased annually from 2016 to 2020 in terms of vertical translations (0.82 ± 0.28 mm; p = 0.038) and yaw rotations (0.68 ± 0.22°; p = 0.028). An increase in surgical accuracy was observed when combining all six degrees of freedom (p = 0.021) and specifically between 2016 and 2020 (p = 0.004). An unfavorable learning curve was seen with posterior impaction and with a greater magnitude of movements. CONCLUSION The present study demonstrated a significant increase in surgical accuracy annually and therefore supports the presence of a learning curve. CLINICAL RELEVANCE Cases with planned maxillary posterior impaction and/or a great magnitude of jaw movements should be transferred from the 3D VSP with extra care to obtain a satisfactory surgical accuracy.
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Affiliation(s)
- Dirk-Melle Beek
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Frank Baan
- Radboudumc 3D Lab, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Jeroen Liebregts
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Marloes Nienhuijs
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Stefaan Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Thomas Maal
- Radboudumc 3D Lab, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands.
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Kim MK, Ham MJ, Kim WR, Kim HG, Kwon KJ, Kim SG, Park YW. Investigating the accuracy of mandibulectomy and reconstructive surgery using 3D customized implants and surgical guides in a rabbit model. Maxillofac Plast Reconstr Surg 2023; 45:8. [PMID: 36701071 PMCID: PMC9880108 DOI: 10.1186/s40902-023-00375-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study aimed to analyze the accuracy of the output of three-dimensional (3D) customized surgical guides and titanium implants in a rabbit model, and of mandibulectomy, reconstructive surgery, and surgical outcome; additionally, the correlation between surgical accuracy and surgical outcomes, including the differences in surgical outcome according to surgical accuracy, was analyzed. RESULTS The output of implants was accurately implemented within the error range (- 0.03-0.03 mm), and the surgical accuracy varied depending on the measured area (range - 0.4-1.1 mm). Regarding surgical outcomes, angle between the mandibular lower borders showed the most sensitive results and distance between the lingual cusps of the first molars represented the most accurate outcomes. A significant correlation was noted between surgical accuracy in the anteroposterior length of the upper borders pre- and postoperatively and the angle between the mandibular lower borders (regression coefficient = 0.491, p = 0.028). In the group wherein surgery was performed more accurately, the angle between the mandibular lower borders was reproduced more accurately (p = 0.021). A selective laser melting machine accurately printed the implants as designed. Considering the positive correlation among surgical accuracy in the mandibular upper borders, angle between the mandibular lower borders, and more accurately reproduced angle between the mandibular lower borders, the angle between the mandibular lower borders is considered a good indicator for evaluating the outcomes of reconstructive surgery. CONCLUSION To reduce errors in surgical outcomes, it is necessary to devise a positioner for the surgical guide and design a 3D surgical guide to constantly maintain the direction of bone resection. A fixed area considering the concept of three-point fixation should be selected for stable positioning of the implant; in some cases, bilateral cortical bone fixation should be considered. The angle between the mandibular lower borders is a sensitive indicator for evaluating the outcomes of reconstructive surgery.
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Affiliation(s)
- Min Keun Kim
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
| | - Min Ji Ham
- grid.454135.20000 0000 9353 1134Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Gangneung, 25440 Republic of Korea
| | - Won Rae Kim
- grid.454135.20000 0000 9353 1134Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Gangneung, 25440 Republic of Korea
| | - Hyung Giun Kim
- grid.454135.20000 0000 9353 1134Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Gangneung, 25440 Republic of Korea
| | - Kwang Jun Kwon
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
| | - Seong Gon Kim
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
| | - Young Wook Park
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
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Usevitch DE, Bronheim RS, Reyes MC, Babilonia C, Margalit A, Jain A, Armand M. Review of Enhanced Handheld Surgical Drills. Crit Rev Biomed Eng 2023; 51:29-50. [PMID: 37824333 PMCID: PMC10874117 DOI: 10.1615/critrevbiomedeng.2023049106] [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] [Indexed: 10/14/2023]
Abstract
The handheld drill has been used as a conventional surgical tool for centuries. Alongside the recent successes of surgical robots, the development of new and enhanced medical drills has improved surgeon ability without requiring the high cost and consuming setup times that plague medical robot systems. This work provides an overview of enhanced handheld surgical drill research focusing on systems that include some form of image guidance and do not require additional hardware that physically supports or guides drilling. Drilling is reviewed by main contribution divided into audio-, visual-, or hardware-enhanced drills. A vision for future work to enhance handheld drilling systems is also discussed.
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Affiliation(s)
- David E. Usevitch
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, United States
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Rachel S. Bronheim
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Miguel C. Reyes
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Carlos Babilonia
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Adam Margalit
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Amit Jain
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Mehran Armand
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, United States
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, United States
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Accuracy of Three-Dimensional Soft-Tissue Prediction Considering the Facial Aesthetic Units Using a Virtual Planning System in Orthognathic Surgery. J Pers Med 2022; 12:jpm12091379. [PMID: 36143164 PMCID: PMC9503557 DOI: 10.3390/jpm12091379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Virtual surgical planning (VSP) is commonly used in orthognathic surgery. A precise soft-tissue predictability would be a helpful tool, for determining the correct displacement distances of the maxilla and mandible. This study aims to evaluate the soft-tissue predictability of the VSP software IPS CaseDesigner® (KLS Martin Group, Tuttlingen, Germany). Twenty patients were treated with bimaxillary surgery and were included in the study. The soft-tissue simulation, done by the VSP was exported as STL files in the engineering software Geomagic Control XTM (3D systems, RockHill, SC, USA). Four months after surgery, a 3D face scan of every patient was performed and compared to the preoperative simulation. The quality of the soft-tissue simulation was validated with the help of a distance map. This distance map was calculated using the inter-surface distance algorithm between the preoperative simulation of the soft-tissue and the actual scan of the postoperative soft-tissue surface. The prediction of the cranial parts of the face (upper cheek, nose, upper lip) was more precise than the prediction of the lower areas (lower cheek, lower lip, chin). The percentage of correctly predicted soft-tissue for the face in total reached values from 69.4% to 96.0%. The VSP system IPS CaseDesigner® (KLS Martin Group; Tuttlingen, Germany) predicts the patient’s post-surgical soft-tissue accurately. Still, this simulation has to be seen as an approximation, especially for the lower part of the face, and continuous improvement of the underlying algorithm is needed for further development.
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Plaster Casts vs. Intraoral Scans: Do Different Methods of Determining the Final Occlusion Affect the Simulated Outcome in Orthognathic Surgery? J Pers Med 2022; 12:jpm12081288. [PMID: 36013237 PMCID: PMC9409745 DOI: 10.3390/jpm12081288] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
A virtual occlusal adjustment in orthognathic surgery has many advantages; however, the haptic information offered by plaster casts is missing when using intraoral scans. Feeling the interferences may be helpful in defining the best possible occlusion. Whether the use of a virtual occlusal adjustment instead of the conventional approach has a significant effect on the postsurgical position of the jaws is a question that remains unanswered. This study compares a virtual method to the conventional method of defining the final occlusion. Twenty-five orthognathic patients were included. Bimaxillary and single-jaw orthognathic surgery (mandible only) was simulated. The two methods were compared regarding discrepancies in the simulated postsurgical position of the mandible, measured three-dimensionally using MeshLab (MeshLab 2020.12 3D). An analysis using SPSS revealed no significant differences between the tested methods (p-values: 0.580 to 0.713). The mean absolute discrepancies ranged from 0.14 mm to 0.72 mm, laying within the scope of the clinically acceptable inaccuracies of an osteosynthesis in orthognathic surgery. The lack of haptic information in virtual planning had no relevant influence on the definition of the final occlusion and the simulated postsurgical outcome. However, in individual cases, plaster models might still be helpful in finding the adequate occlusion, especially in the sagittal dimension and in cases of patients with an anterior open bite, but this remains to be tested.
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Computer Aided Orthognathic Surgery: A General Method for Designing and Manufacturing Personalized Cutting/Repositioning Templates. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Orthognathic surgery allows broad-spectrum deformity correction involving both aesthetic and functional aspects on the TMJ (temporo-mandibular joint) and on the facial skull district. The combination of Reverse Engineering (RE), Virtual Surgery Planning (VSP), Computer Aided Design (CAD), Additive Manufacturing (AM), and 3D visualization allows surgeons to plan, virtually, manipulations and the translation of the human parts in the operating room. This work’s aim was to define a methodology, in the form of a workflow, for surgery planning and for designing and manufacturing templates for orthognathic surgery. Along the workflow, the error chain was checked and the maximum error in virtual planning was evaluated. The three-dimensional reconstruction of the mandibular shape and bone fragment movements after segmentation allow complete planning of the surgery and, following the proposed method, the introduction of both the innovative evaluation of the transversal intercondylar distance variation after mandibular arch advancement/set and the possibility of use of standard plates to plan and realize a customized surgery. The procedure was adopted in one clinical case on a patient affected by a class III malocclusion with an associated open bite and right deviation of the mandible with expected good results. Compared with the methods from most recent literature, the presented method introduces two elements of novelty and improves surgery results by optimizing costs and operating time. A new era of collaboration among surgeons and engineer has begun and is now bringing several benefits in personalized surgery.
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16
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Kang SH, Tak HJ, Kim HJ, Lee SH. Reduction malarplasty using a simulated surgical guide for asymmetric/prominent zygoma. Head Face Med 2022; 18:11. [PMID: 35351162 PMCID: PMC8962158 DOI: 10.1186/s13005-022-00314-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/21/2022] [Indexed: 11/19/2022] Open
Abstract
Background The present study introduces a reduction malarplasty using a three-dimensional (3D)-printed surgical guide and evaluates the guide’s technical applicability. Methods Twenty malarplasties were performed for 12 subjects with zygomatic asymmetry/prominency using the current method. 3D reconstruction of the craniomaxillofacial region and fine dental occlusion was made with image data from computed tomograpy and dental scanning. A computer-assisted surgical simulation was performed for reduction malarplasty and a surgical guide was designed for later 3D printing. The manufactured surgical guide was introduced to the operation field to guide the surgery; its surgical accuracy was confirmed by comparing five corresponding points from preoperative simulation and postoperative data. Results We successfully performed the reduction malarplasty with the surgical guide. The accuracy level of surgery fell to 0.93 mm of total median difference for the corresponding zygoma points of preoperative simulations and postoperative zygoma. The anterior and upper points showed less error level (0.59 and 0.73 mm difference, respectively) than did other points. Conclusions We developed a computer-assisted surgical technique using a surgical guide for asymmetrical/prominent zygoma which proved to be simple, practical, and accurate; it is expected to help surgeons perform reduction malarplasty with ease and accuracy.
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Affiliation(s)
- Sang-Hoon Kang
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea.,Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Hye-Jin Tak
- Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | | | - Sang-Hwy Lee
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea. .,Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea. .,Department of Oral and Maxillofacial Surgery and Oral Science Research Center, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.
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The Impact of Virtual Surgical Planning on Orthognathic Surgery. J Craniofac Surg 2022; 33:1418-1423. [DOI: 10.1097/scs.0000000000008607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 02/09/2022] [Indexed: 11/26/2022] Open
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18
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Liokatis P, Malenova Y, Fegg F, Haidari S, Probst M, Boskov M, Cornelius C, Troeltzsch M, Probst F. Digital planning and individual implants for secondary reconstruction of midfacial deformities: A pilot study. Laryngoscope Investig Otolaryngol 2022; 7:369-379. [PMID: 35434332 PMCID: PMC9008187 DOI: 10.1002/lio2.753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/03/2022] [Accepted: 01/20/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the feasibility and accuracy of implementing three‐dimensional virtual surgical planning (VSP) and subsequent transfer by additive manufactured tools in the secondary reconstruction of residual post‐traumatic deformities in the midface. Methods Patients after secondary reconstruction of post‐traumatic midfacial deformities were included in this case series. The metrical deviation between the virtually planned and postoperative position of patient‐specific implants (PSI) and bone segments was measured at corresponding reference points. Further information collected included demographic data, post‐traumatic symptoms, and type of transfer tools. Results Eight consecutive patients were enrolled in the study. In five patients, VSP with subsequent manufacturing of combined predrilling/osteotomy guides and PSI was performed. In three patients, osteotomy guides, repositioning guides, and individually prebent plates were used following VSP. The median distances between the virtually planned and the postoperative position of the PSI were 2.01 mm (n = 18) compared to a median distance concerning the bone segments of 3.05 mm (n = 12). In patients where PSI were used, the median displacement of the bone segments was lower (n = 7, median 2.77 mm) than in the group with prebent plates (n = 5, 3.28 mm). Conclusion This study demonstrated the feasibility of VSP and transfer by additive manufactured tools for the secondary reconstruction of complex residual post‐traumatic deformities in the midface. However, the median deviations observed in this case series were unexpectedly high. The use of navigational systems may further improve the level of accuracy. To evaluate the feasibility and accuracy of implementing three‐dimensional virtual surgical planning (VSP) and subsequent transfer by additive manufactured tools in the secondary reconstruction of residual post‐traumatic deformities in the midface. This study demonstrated the feasibility of VSP and transfer by additive manufactured tools for the secondary reconstruction of complex residual post‐traumatic deformities in the midface. However, the median deviations observed in this case series were unexpectedly high. The use of navigational systems may further improve the level of accuracy.
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Affiliation(s)
- Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Yoana Malenova
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Florian‐Nepomuk Fegg
- 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
| | - Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine Klinikum rechts der Isar, Technical University of Munich Munich Germany
| | - Marko Boskov
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Carl‐Peter Cornelius
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Matthias Troeltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Florian‐Andreas Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
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19
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Chow W, He Z, Liu Y, Song J, Xu C, Luo E. Intraoperative condylar positioning techniques on mandible in orthognathic surgery. Orthod Craniofac Res 2022; 25:449-458. [PMID: 35108447 DOI: 10.1111/ocr.12568] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/29/2021] [Accepted: 01/22/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE The surgical condylar displacement often resulted in relapse and serious symptoms of temporomandibular joint disorders (TMD) after orthognathic surgery. To minimize the displacement, numerous techniques have been proposed. To verify their accuracy in positioning and effectiveness in preventing postoperative TMD and relapse, we reviewed the literature related to intraoperative condylar positioning techniques on the mandible in this study. METHODS The literature on condylar positioning techniques was reviewed with 2 charts, including the non-computer-assisted and the computer-assisted positioning methods. The pre- and postoperative alterations of condyles, the postoperative temporomandibular joint (TMJ) function, and surgical relapse were analyzed regarding the techniques. The clinical usage and characteristics were reviewed as well. RESULTS A total of 22 articles, including 907 patients, have been reported since 2001. Nearly all methods reach a considerable positioning accuracy within the range of 1-2 mm and 1-2° from the preoperative position. We ranked the accuracy of the methods from high to low: CAD/CAM CPDs>CAD/CAM titanium plate positioning>manual positioning>computer-assisted navigation systems>imaging positioning systems. Most skeletal class II and class III patients achieved great occlusion and had no TMJ dysfunction or relapse after condylar positioning. CONCLUSION Both the non-computer-assisted and computer-assisted condylar positioning techniques reach considerable accuracy in locating the preoperative condyle position and preventing TMJ dysfunction and surgical relapse. Different levels of surgeons and cases can benefit from multiple suggested positioning methods. Further research with large samples and long-term follow-up is worth looking forward to upgrading the current methods, improving the clinical utility, and developing new positioning techniques.
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Affiliation(s)
- WingYan Chow
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Diseases &, Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ze He
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Diseases &, Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yao Liu
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Diseases &, Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jian Song
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Diseases &, Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - ChunWei Xu
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Diseases &, Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - En Luo
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Diseases &, Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Beek DM, Baan F, Liebregts J, Bergé S, Maal T, Xi T. Surgical accuracy in 3D planned bimaxillary osteotomies: intraoral scans and plaster casts as digital dentition models. Int J Oral Maxillofac Surg 2021; 51:922-928. [PMID: 34952772 DOI: 10.1016/j.ijom.2021.11.016] [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: 01/22/2021] [Revised: 09/01/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
The aim of this study was to assess whether the use of intraoral scans (IOS) is an eligible alternative to conventional plaster casts in terms of surgical accuracy of three-dimensionally planned bimaxillary osteotomies. This retrospective cohort study included patients who underwent bimaxillary surgery between 2016 and 2020 in the Department of Oral and Maxillofacial Surgery at Radboud University Medical Center, Nijmegen. Three-dimensional virtual planning was performed with the use of plaster casts in one group and IOS in the other group. Cone beam computed tomography scans were acquired preoperatively and at 1 week following surgery. By using voxel-based matching, the maxillary movements were quantified in six degrees of freedom. The primary outcome variable, surgical accuracy, was defined as the difference between the planned maxillary movements and those achieved. Of 152 patients, 113 were documented with plaster casts and 39 with IOS. The surgical accuracy was comparable in terms of maxillary vertical, sagittal, and transverse translations, as well as roll and yaw. Maxillary pitch (difference 0.55 ± 0.26°; P = 0.001) was in favour of the IOS group. This study demonstrated that IOS can be used as an alternative to conventional plaster casts in the three-dimensional planning of bimaxillary osteotomies.
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Affiliation(s)
- D-M Beek
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - F Baan
- Radboudumc 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Liebregts
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T Maal
- Radboudumc 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
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Randomized Clinical Trial of the Accuracy of Patient-Specific Implants versus CAD/CAM Splints in Orthognathic Surgery. Plast Reconstr Surg 2021; 148:1101-1110. [PMID: 34705785 PMCID: PMC8542074 DOI: 10.1097/prs.0000000000008427] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background: The maxilla position is essential for the aesthetic and functional outcomes of orthognathic surgery. Previous studies demonstrated the advantages of patient-specific implants in orthognathic surgery. However, more data are needed to confirm the superiority of patient-specific implants over surgical splints created with computer-aided design/computer-aided manufacturing (CAD/CAM). This randomized controlled trial aimed to compare the accuracy of patient-specific implants and CAD/CAM splints for maxilla repositioning in orthognathic surgery. Methods: Patients (n = 64) who required orthognathic surgery were randomly assigned to use either patient-specific implants (patient-specific implant group) or CAD/CAM surgical splints (splint group) to reposition the maxilla. The outcome evaluation was completed by comparing virtual plans with actual results. The primary outcome was the discrepancies of the centroid position of the maxilla. Other translation and orientation discrepancies of the maxilla were also assessed. Results: The authors analyzed 27 patients in the patient-specific implant group and 31 in the splint group. The maxilla position discrepancy was 1.41 ± 0.58 mm in the patient-specific implant group and 2.20 ± 0.94 mm in the splint group; the between-group difference was significant (p < 0.001). For the patient-specific implant group, the largest translation discrepancy was 1.02 ± 0.66 mm in the anteroposterior direction, and the largest orientation discrepancy was 1.85 ± 1.42 degrees in pitch. For the splint group, the largest translation discrepancy was 1.23 ± 0.93 mm in the mediolateral direction, and the largest orientation discrepancy was 1.72 ± 1.56 degrees in pitch. Conclusion: The result showed that using patient-specific implants in orthognathic surgery resulted in a more accurate maxilla position than CAD/CAM surgical splints. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
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22
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Yusa K, Ishikawa S, Takagi A, Kunii S, Iino M. Bone marrow space volume of the mandible influencing intraoperative blood loss in bilateral sagittal split osteotomy: A pilot Study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:429-433. [PMID: 34715408 DOI: 10.1016/j.jormas.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate whether the bone marrow space volume of the mandible affects blood loss during bilateral sagittal split osteotomy (BSSO). Sixteen patients who underwent BSSO in our hospital were included in this study. Bone marrow space volume of the mandible was measured by analyzing images from computed tomography. Blood loss during BSSO was measured by weighing gauze, measuring suctioned blood, and adjusting for the volume of irrigation solution used during BSSO. Mean blood loss during BSSO for the 16 patients was 200.5 ml, and patients were divided into: Group I, with less than mean blood loss; and Group II, with greater than mean blood loss. Total bone marrow space volume was significantly greater in Group II (12,450.7 ± 2644.3 mm3) than in Group I (9130.3 ± 3005.8 mm3; P<0.05). A correlation between bone marrow space volume and blood loss during BSSO was suggested, and these results are beneficial for surgeons planning and preparing the orthognathic surgery.
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Affiliation(s)
- Kazuyuki Yusa
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan.
| | - Shigeo Ishikawa
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Akira Takagi
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Shunsuke Kunii
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Mitsuyoshi Iino
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
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23
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Chen C, Sun N, Jiang C, Liu Y, Sun J. Accurate transfer of bimaxillary orthognathic surgical plans using computer-aided intraoperative navigation. Korean J Orthod 2021; 51:321-328. [PMID: 34556586 PMCID: PMC8461385 DOI: 10.4041/kjod.2021.51.5.321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
Objective To examine the accuracy of computer-aided intraoperative navigation (Ci-Navi) in bimaxillary orthognathic surgery by comparing preoperative planning and postoperative outcome. Methods The study comprised 45 patients with congenital dentomaxillofacial deformities who were scheduled to undergo bimaxillary orthognathic surgery. Virtual bimaxillary orthognathic surgery was simulated using Mimics software. Intraoperatively, a Le Fort I osteotomy of the maxilla was performed using osteotomy guide plates. After the Le Fort I osteotomy and bilateral sagittal split ramus osteotomy of the mandible, the mobilized maxilla and the distal mandibular segment were fixed using an occlusal splint, forming the maxillomandibular complex (MMC). Realtime Ci-Navi was used to lead the MMC in the designated direction. Osteoplasty of the inferior border of the mandible was performed using Ci-Navi when facial symmetry and skeletal harmony were of concern. Linear and angular distinctions between preoperative planning and postoperative outcomes were calculated. Results The mean linear difference was 0.79 mm (maxilla: 0.62 mm, mandible: 0.88 mm) and the overall mean angular difference was 1.20°. The observed difference in the upper incisor point to the Frankfort horizontal plane, midfacial sagittal plane, and coronal plane was < 1 mm in 40 cases. Conclusions This study demonstrates the role of Ci-Navi in the accurate positioning of bone segments during bimaxillary orthognathic surgery. Ci-Navi was found to be a reliable method for the accurate transfer of the surgical plan during an operation.
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Affiliation(s)
- Chen Chen
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ningning Sun
- Department of Emergency Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chunmiao Jiang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yanshan Liu
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jian Sun
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Department of Emergency Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Rubio-Palau J, Ayats-Soler M, Albert-Cazalla A, Martìnez-Padilla I, Prieto-Gundin A, Prieto-Peronnet N, Ramìrez-Fernández MP, Mareque-Bueno J. Accuracy of Virtually Planned Maxillary Distraction in Cleft Patients - An Evaluative Study. Ann Maxillofac Surg 2021; 11:49-57. [PMID: 34522654 PMCID: PMC8407633 DOI: 10.4103/ams.ams_331_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/07/2020] [Accepted: 12/15/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Maxillary distraction may be used to treat severe maxillary hypoplasia in cleft lip and palate (CLP) patients. Three-dimensional (3D) planning has been shown to increase the accuracy of distraction and reduce operative time and complications. The aim of the study was to measure the accuracy of internal maxillary distraction after 3D planning in CLP patients, to add evidence to validate the virtual osteotomy and distraction procedure. Materials and Methods: Eleven CLP patients with severe maxillary hypoplasia underwent maxillary distraction using internal distractors. Virtual planning was used to design the osteotomies, the distractor position, and the distraction vector. Cutting and positioning guides transferred this information to the surgical procedure. Four to six month postoperative computed tomography-scan was done before distractor removal; anatomical reference points were compared to the virtual planning to determine accuracy. Results: A high accuracy (point dislocation <1.5 mm) was found in 90% of the points of the surface of the maxilla; the majority of the zygomatic screws were placed within a distance of 0.8–1 mm from their planned position. Discussion: The high accuracy achieved through virtual planning promotes optimal distractor placement; a customized distraction vector has a direct effect on the final position of the maxilla.
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Affiliation(s)
- Josep Rubio-Palau
- Department of Pediatric Surgery, Division of Maxillofacial Surgery, Hospital Sant Joan De Déu, Barcelona, Spain.,Department of Innovation (3D4H, 3D for Health), Hospital Sant Joan De Déu, Barcelona, Spain
| | - Marta Ayats-Soler
- Department of Innovation (3D4H, 3D for Health), Hospital Sant Joan De Déu, Barcelona, Spain
| | | | - Irene Martìnez-Padilla
- Department of Pediatric Surgery, Division of Maxillofacial Surgery, Hospital Sant Joan De Déu, Barcelona, Spain
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Randomized Controlled Clinical Trial to Assess the Utility of Computer-Aided Intraoperative Navigation in Bimaxillary Orthognathic Surgery. J Craniofac Surg 2021; 32:2205-2209. [PMID: 33538444 DOI: 10.1097/scs.0000000000007512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Accurate application of the preoperative surgical plan in actual surgical settings is of paramount importance in orthognathic surgery. This randomized controlled clinical trial aimed to evaluate the accuracy of computer-aided intraoperative navigation (Ci-Navi) compared with that of conventional navigation methods in bimaxillary orthognathic surgery. Fifty-two patients were randomly divided into 2 groups. Group A (n = 26) patients underwent surgery assisted with Ci-Navi and group B (n = 26) patients underwent surgery assisted with conventional intraoperative navigation methods. During the operation, after LeFort I osteotomy, the mobile maxilla was repositioned to the designated position either using assistance from real-time Ci-Navi (group A) or using an intermediate splint (group B). Intra- and intergroup linear and angular differences between preoperative planning and postoperative outcomes were calculated. In group A, the overall mean linear difference was 0.79 mm (0.62 mm for the maxilla and 0.88 mm for the mandible) and the overall mean angular difference was 1.20°. In 23 cases, the difference from the upper incisor point to the Frankfort horizontal plane, midfacial sagittal plane, and coronal plane was less than 1 mm. In group B, the overall mean linear difference was 1.98 mm (1.76 mm for the maxilla and 2.02 mm for the mandible) and the overall mean angular difference was 2.08°. The difference from the upper incisor point to the Frankfort horizontal plane, midfacial sagittal plane, and coronal plane was less than 1 mm in 15 cases. This study demonstrates the utility of Ci-Navi is superior to the conventional methods in aiding the accurate repositioning of bony segments in bimaxillary orthognathic surgery.
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Lo LJ, Niu LS, Liao CH, Lin HH. A novel CAD/CAM composite occlusal splint for intraoperative verification in single-splint two-jaw orthognathic surgery. Biomed J 2021; 44:353-362. [PMID: 34144940 PMCID: PMC8358214 DOI: 10.1016/j.bj.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 06/22/2019] [Accepted: 03/02/2020] [Indexed: 11/08/2022] Open
Abstract
Background Previous computer-generated splints were designed and produced without modification than the traditional occlusal splints, which did not facilitate surgeon's intraoperative judgment in the single-splint two-jaw orthognathic surgery. Modifications of the digital occlusal splint can be achieved using computer-aided design and computer-aided manufacturing (CAD/CAM) software. This study reported the design, clinical application and validation of a novel CAD/CAM occlusal splint. Methods The maxillary and mandibular segments were fixed into the final occlusal splint and moved to the planned position according to the 3-dimensional simulation. The composite occlusal splint has 4 orthogonal bars to facilitate intraoperative assessment of the dental and skeletal midline, facial soft tissue midline, occlusal plane, upper tooth show, facial symmetry and facial bone position. To validate the surgical outcome, 5 parameters including pitch, roll and yaw rotations, midline deviation and chin position were measured on the virtual plan and the postoperative cone-beam computed tomography images to quantify the difference. Results The results showed no significant differences in the 5 parameters between the simulation and postoperative images. The root-mean-square difference between the conventional splints and CAD/CAM surgical splint ranged from 0.18 to 0.31 mm by superimposition of the two image models. All patients were satisfied with the treatment outcomes. Overall, this novel occlusal splint is ideal for verification of the maxillomandibular position during surgery. Conclusion The novel composite occlusal splint provided useful and informative check to verify the maxillomandibular complex (MMC) position and facial appearance in single-splint two-jaw orthognathic surgery.
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Affiliation(s)
- Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, and Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lien-Shin Niu
- Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hao Liao
- Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Hsia Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Grillo R. Orthognathic Surgery: A Bibliometric Analysis of the Top 100 Cited Articles. J Oral Maxillofac Surg 2021; 79:2339-2349. [PMID: 34245705 DOI: 10.1016/j.joms.2021.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/19/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE An increasing number of articles on orthognathic surgery are published every year. This paper aims to provide a list of the top 100 cited articles on orthognathic surgery to help any professional level with interest in this topic and to map the trends of orthognathic surgery publications over time. METHODS A bibliographic search (retrospective study) following STROBE guidelines was performed on Google Scholar (GS) and Dimensions with the term "orthognathic surgery" in the title, abstract, and keywords. The number of citations, citations per year, authors, and publication year were evaluated. A ranking was created in GS citations order with the top 100 cited articles and variables discussed individually. A graphical illustration of keywords was created using VOSviewer. These steps are fundamental in creating this list and relating it to all published articles on the topic. RESULTS A helpful list of the top 100 articles was developed to help professionals in entirely different manners. Virtual planning and complications in orthognathic surgery were the most cited topics, with a 95% confidence interval (P < .05). Some curiosities are discussed, such as increasing interest in surgery first and the relation between airway/obstructive sleep apnea and orthognathic surgery. CONCLUSIONS Bibliometric and altmetric analysis for free using Google Scholar and Dimensions is laborious but possible. Bibliometrics is a powerful tool to become actualized at any health professional level, from students to academics; and could save considerable effort and time for parties interested in the topic. Appropriate keywords are a crucial step to wider article dissemination.
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Affiliation(s)
- Ricardo Grillo
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Faculdade São Leopoldo Mandic, Campinas, Brazil.
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Okamoto D, Yamauchi K, Yazaki M, Saito S, Suzuki H, Nogami S, Takahashi T. A comparison of postoperative, three-dimensional soft tissue changes in patients with skeletal class III malocclusions treated via orthodontics-first and surgery-first approaches. J Craniomaxillofac Surg 2021; 49:898-904. [PMID: 33994293 DOI: 10.1016/j.jcms.2021.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/18/2021] [Accepted: 04/20/2021] [Indexed: 11/15/2022] Open
Abstract
The aim of this retrospective study was to compare three-dimensional (3D) soft tissue and hard tissue changes between orthodontics-first approach (OFA) and surgery-first approach (SFA) after mandibular setback surgery. All patients underwent bilateral sagittal split osteotomy, and were examined by lateral cephalograms and 3D optical scanner before surgery (T0) and 1 (T1), 3 (T2), and 12 (T3) months after surgery. Three standard angles (FMA, U1 to FH, IMPA) were measured as hard tissue change and the 2 sets of 3D data were superimposed, and volumetric differences were calculated as soft tissue change. Statistical analyses were performed by using unpaired t-tests. Differences with P < 0.05 were considered significant. A total of 39 patients with mandibular prognathism were included in this study. The OFA group consisted of 24 patients and the SFA group of 15 patients. The SFA group exhibited more labial inclination from T1 to T2 (p = 0.008) and T2 to T3 (p = 0.003) than did the OFA group. There were no significant changes at maxilla and mandible at each term of T0, T1, T2 and T3 (p > 0.05), but compared to before surgery, mandibular volume in SFA group significant increased at 1year (p = 0.049) after surgery. We found that the soft tissue changes after the SFA differed significantly from those after the OFA; thus, soft tissue predictions require more care. An analysis of our data compared with OFA and SFA for the patient with mandibular prognathism confirm that the mandibular soft tissue changes by postoperative orthodontic treatment and occlusal relationship in SFA.
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Affiliation(s)
- Daigo Okamoto
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan.
| | - Mai Yazaki
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Shizu Saito
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Hikari Suzuki
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Shinnosuke Nogami
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
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Baan F, Bruggink R, Nijsink J, Maal TJJ, Ongkosuwito EM. Fusion of intra-oral scans in cone-beam computed tomography scans. Clin Oral Investig 2021; 25:77-85. [PMID: 32495223 PMCID: PMC7785548 DOI: 10.1007/s00784-020-03336-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical accuracy of the fusion of intra-oral scans in cone-beam computed tomography (CBCT) scans using two commercially available software packages. MATERIALS AND METHODS Ten dry human skulls were subjected to structured light scanning, CBCT scanning, and intra-oral scanning. Two commercially available software packages were used to perform fusion of the intra-oral scans in the CBCT scan to create an accurate virtual head model: IPS CaseDesigner® and OrthoAnalyzer™. The structured light scanner was used as a gold standard and was superimposed on the virtual head models, created by IPS CaseDesigner® and OrthoAnalyzer™, using an Iterative Closest Point algorithm. Differences between the positions of the intra-oral scans obtained with the software packages were recorded and expressed in six degrees of freedom as well as the inter- and intra-observer intra-class correlation coefficient. RESULTS The tested software packages, IPS CaseDesigner® and OrthoAnalyzer™, showed a high level of accuracy compared to the gold standard. The accuracy was calculated for all six degrees of freedom. It was noticeable that the accuracy in the cranial/caudal direction was the lowest for IPS CaseDesigner® and OrthoAnalyzer™ in both the maxilla and mandible. The inter- and intra-observer intra-class correlation coefficient showed a high level of agreement between the observers. CLINICAL RELEVANCE IPS CaseDesigner® and OrthoAnalyzer™ are reliable software packages providing an accurate fusion of the intra-oral scan in the CBCT. Both software packages can be used as an accurate fusion tool of the intra-oral scan in the CBCT which provides an accurate basis for 3D virtual planning.
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Affiliation(s)
- F Baan
- Radboudumc 3DLab The Netherlands, Radboud university medical center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands.
- Department of Dentistry, section of Orthodontics and Craniofacial Biology, Radboud university medical center, Philips van Leydenlaan 25, 6525, EX, Nijmegen, The Netherlands.
| | - R Bruggink
- Radboudumc 3DLab The Netherlands, Radboud university medical center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
- Department of Dentistry, section of Orthodontics and Craniofacial Biology, Radboud university medical center, Philips van Leydenlaan 25, 6525, EX, Nijmegen, The Netherlands
| | - J Nijsink
- Radboudumc 3DLab The Netherlands, Radboud university medical center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - T J J Maal
- Radboudumc 3DLab The Netherlands, Radboud university medical center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
- Department of Oral and Maxillofacial Surgery, Radboud university medical center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - E M Ongkosuwito
- Department of Dentistry, section of Orthodontics and Craniofacial Biology, Radboud university medical center, Philips van Leydenlaan 25, 6525, EX, Nijmegen, The Netherlands
- Amalia Cleft and Craniofacial Centre, Radboud university medical centre, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
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Alkhayer A, Piffkó J, Lippold C, Segatto E. Accuracy of virtual planning in orthognathic surgery: a systematic review. Head Face Med 2020; 16:34. [PMID: 33272289 PMCID: PMC7716456 DOI: 10.1186/s13005-020-00250-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/24/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The elaboration of a precise pre-surgical plan is essential during surgical treatment of dentofacial deformities. The aim of this study was to evaluate the accuracy of computer-aided simulation compared with the actual surgical outcome, following orthognathic surgery reported in clinical trials. METHODS Our search was performed in PubMed, EMBASE, Cochrane Library and SciELO for articles published in the last decade. A total of 392 articles identified were assessed independently and in a blinded manner using eligibility criteria, out of which only twelve articles were selected for inclusion in our research. Data were presented using intra-class correlation coefficient, and linear and angular differences in three planes. RESULTS The comparison of the accuracy analyses of the examined method has shown an average translation (< 2 mm) in the maxilla and also in the mandible (in three planes). The accuracy values for pitch, yaw, and roll (°) were (< 2.75, < 1.7 and < 1.1) for the maxilla, respectively, and (< 2.75, < 1.8, < 1.1) for the mandible. Cone-beam computed tomography (CBCT) with intra-oral scans of the dental casts is the most used imaging protocols for virtual orthognathic planning. Furthermore, calculation of the linear and angular differences between the virtual plan and postoperative outcomes was the most frequented method used for accuracy assessment (10 out of 12 studies) and a difference less than 2 mm/° was considered acceptable and accurate. When comparing this technique with the classical planning, virtual planning appears to be more accurate, especially in terms of frontal symmetry. CONCLUSION Virtual planning seems to be an accurate and reproducible method for orthognathic treatment planning. However, more clinical trials are needed to clearly determine the accuracy and validation of the virtual planning in orthognathic surgery.
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Affiliation(s)
- Ali Alkhayer
- Craniofacial Unit, Department of Oral & Maxillofacial Surgery, University of Szeged, Tisza Lajos krt. 97, Szeged, Hungary
| | - József Piffkó
- Department of Oral & Maxillofacial Surgery, Faculty of Medicine, University of Szeged, Kálvária sugárút. 57, Szeged, Hungary
| | - Carsten Lippold
- Department of Orthodontics, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W30, Waldeyerstraße 30, 48149, Münster, Germany.
| | - Emil Segatto
- Craniofacial Unit, Department of Oral & Maxillofacial Surgery, University of Szeged, Tisza Lajos krt. 97, Szeged, Hungary
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Monteiro Carneiro NC, Oliveira DV, Real FH, Karla da Silva Tabosa A, Carneiro Júnior JT. A new model of customized maxillary guide for orthognathic surgery: Precision analysis. J Craniomaxillofac Surg 2020; 48:1119-1125. [PMID: 33288374 DOI: 10.1016/j.jcms.2020.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 08/17/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the surgical accuracy of a new Maxillary Bone-Dental-Supported guide (MBDS) for osteotomy and maxillary positioning in orthognathic surgeries. MATERIALS AND METHODS The customized MBDS were prototyped through CAD-CAM technology (computer-aided design and manufacturing). The planning image (CT0) was superimposed on the computed tomography scan post-treatment (CT1) and the mean of positional differences between them were obtained tridimensionally at the axes: mediolateral (X), anteroposterior (Y) and vertical (Z). RESULTS Eleven patients were selected according to the inclusion and exclusion criteria. The mediolateral movement showed the best precision, with a greater mean difference of 0.34 mm at the CI point (central incisor) and less than 0.02 mm at the RM point (right molar). In the vertical direction, the largest mean discrepancy found was 0.50 mm and on the y-axis, anteroposterior, was 0.74 mm, as well as two at the CI point. The skeletal SNA point, on the other hand, showed the smallest average discrepancies: 0.10 mm (x-axis), 0.03 mm (y-axis) and 0 mm (z-axis). Overall, 99.24% of the discrepancies found were less than 2 mm. CONCLUSION Our results suggests that the double support, osseous and dental, present in that new guide, favored the positional stability of the maxilla and promoted better control of its vertical axis. Furthermore, the function of an osteotomy guide increases the predictability and security of the surgical procedure.
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Affiliation(s)
- Nayara Cristina Monteiro Carneiro
- Oral and Maxillofacial Surgery - João de Barros Barreto University Hospital, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil; Msc and PhD Student in Oral and Maxillofacial Surgery - Federal University of Pará, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil.
| | - Douglas Voss Oliveira
- Oral and Maxillofacial Surgery - Brazilian Dental Association, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil; Msc and PhD Student in Oral and Maxillofacial Surgery - Federal University of Pará, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil.
| | - Flávio Henrique Real
- Oral and Maxillofacial Surgery - Getúlio Vargas Hospital, Recife, Brazil; Msc in Oral and Maxillofacial Surgery - Federal University of Pará, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil.
| | - Ana Karla da Silva Tabosa
- Oral and Maxillofacial Surgery - Brazilian Dental Association, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil; Master Student in Oral and Maxillofacial Surgery - Federal University of Pará, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil.
| | - José Thiers Carneiro Júnior
- PhD in Neurosciences and Cell Biology - Federal University of Pará, Augusto Corrêa, 01, Guamá. CEP, 66075-110, Belém, PA, Brazil; Oral and Maxillofacial Surgery, Irmandade da Santa Casa de Misericórdia Hospital, São Paulo, Brazil.
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Wong A, Goonewardene MS, Allan BP, Mian AS, Rea A. Accuracy of maxillary repositioning surgery using CAD/CAM customized surgical guides and fixation plates. Int J Oral Maxillofac Surg 2020; 50:494-500. [PMID: 32919821 DOI: 10.1016/j.ijom.2020.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/23/2020] [Accepted: 08/20/2020] [Indexed: 11/16/2022]
Abstract
The advent of three-dimensional imaging and computer-aided surgical simulation (CASS) have brought about a paradigm shift in surgical planning. The aim of this study was to assess the accuracy of maxillary repositioning surgery using computer-aided design and manufacturing (CAD/CAM) customized titanium surgical guides and fixation plates. Thirty consecutive adult patients, 13 male and 17 female, with a mean age of 29.2 years and 25.5 years, respectively, requiring Le Fort I maxillary osteotomy, with or without simultaneous mandibular surgery, were evaluated retrospectively. All orthognathic surgeries were performed by one experienced surgeon. The pre-surgical and post-surgical volumetric imaging were superimposed to assess the linear and angular differences between the planned and actual positions of the maxilla following surgery. With the use of the CAD/CAM titanium surgical guides and fixation plates, all surgical movements were within 2mm and 4° of the planned movements, which is considered clinically insignificant. The overall root mean square error between the planned and actual surgical movements was 0.38mm in the transverse dimension, 0.64mm in the anteroposterior dimension, and 0.55mm in the vertical dimension. In regard to the centroid of the maxilla, the absolute angular difference of the maxillary centroid was 1.06° in pitch, 0.47° in roll, and 0.49° in yaw. Maxillary repositioning surgery can be performed with high accuracy using CAD/CAM titanium surgical guides and fixation plates.
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Affiliation(s)
- A Wong
- Orthodontic Department, School of Dentistry, The University of Western Australia, Nedlands, Western Australia, Australia.
| | - M S Goonewardene
- Orthodontic Department, School of Dentistry, The University of Western Australia, Nedlands, Western Australia, Australia.
| | - B P Allan
- Private Maxillofacial Surgical Practice, Perth, Australia.
| | - A S Mian
- School of Computer Science and Software Engineering, The University of Western Australia (M017), Crawley, Western Australia, Australia.
| | - A Rea
- UWA Centre for Applied Statistics, School of Mathematics and Statistics, The University of Western Australia, Nedlands, Western Australia, Australia.
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Pietzka S, Mascha F, Winter K, Kämmerer PW, Sakkas A, Schramm A, Wilde F. Clinical Accuracy of 3D-Planned Maxillary Positioning Using CAD/CAM-Generated Splints in Combination With Temporary Mandibular Fixation in Bimaxillary Orthognathic Surgery. Craniomaxillofac Trauma Reconstr 2020; 13:290-299. [PMID: 33456700 DOI: 10.1177/1943387520949348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Study Design The aim of this study was to evaluate the accuracy of 3-dimensional (3D)-planned maxillary positioning by using computer-assisted design (CAD)/computer-assisted manufacturing (CAM) splints combined with temporary mandibular fixation in bimaxillary orthognathic surgery. In orthognathic surgery, customized splints work sufficiently well to transfer preoperative planning into the operation site for transverse und sagittal positioning of the maxilla. The vertical positioning is more difficult due to the non-fixed mandibular reference. Therefore, the combined use of CAD/CAM splints and temporary mandibular fixation to the zygomatic region was applied for transferring the 3D-planned maxillary position into the operation site from 2012 until 2015 in our hospital. Objective In addition to the general accuracy, the precision should therefore be checked especially in the vertical plane compared to axial and sagittal plane. Methods In this retrospective study, we calculated the deviation of 5 occlusal landmarks of the maxilla in 35 consecutive patients by fusing preoperative 3D planning images and postoperative computed tomography scans after bimaxillary surgery. Results The overall median deviation of maxillary positioning between plan and surgical result was 0.99 mm. The accuracy of left-right positioning was median 0.96 mm. Anterior-posterior positioning of the maxilla showed a median accuracy of 0.94 mm. Just slightly higher values were determined for the upward-downward positioning (median 1.06 mm). Conclusions This demonstrates the predictability of maxillary positioning by using CAD/CAM splints in combination with temporary mandibular fixation in all 3 axes.
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Affiliation(s)
- S Pietzka
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, Ulm, Germany.,Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Ulm, Germany
| | - F Mascha
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, Ulm, Germany.,Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Ulm, Germany
| | - K Winter
- Institute of Anatomy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - P W Kämmerer
- Department of Cranio-Maxillofacial Surgery, University Medical Centre Mainz, Mainz, Germany
| | - A Sakkas
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Ulm, Germany
| | - A Schramm
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, Ulm, Germany.,Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Ulm, Germany
| | - F Wilde
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, Ulm, Germany.,Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Ulm, Germany
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Narita M, Takaki T, Shibahara T, Iwamoto M, Yakushiji T, Kamio T. Utilization of desktop 3D printer-fabricated "Cost-Effective" 3D models in orthognathic surgery. Maxillofac Plast Reconstr Surg 2020; 42:24. [PMID: 32821740 PMCID: PMC7395922 DOI: 10.1186/s40902-020-00269-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background In daily practice, three-dimensional patient-specific jawbone models (3D models) are a useful tool in surgical planning and simulation, resident training, patient education, and communication between the physicians in charge. The progressive improvements of the hardware and software have made it easy to obtain 3D models. Recently, in the field of oral and maxillofacial surgery, there are many reports on the benefits of 3D models. We introduced a desktop 3D printer in our department, and after a prolonged struggle, we successfully constructed an environment for the "in-house" fabrication of the previously outsourced 3D models that were initially outsourced. Through various efforts, it is now possible to supply inexpensive 3D models stably, and thus ensure safety and precision in surgeries. We report the cases in which inexpensive 3D models were used for orthodontic surgical simulation and discuss the surgical outcomes. Review We explained the specific CT scanning considerations for 3D printing, 3D printing failures, and how to deal with them. We also used 3D models fabricated in our system to determine the contribution to the surgery. Based on the surgical outcomes of the two operators, we compared the operating time and the amount of bleeding for 25 patients who underwent surgery using a 3D model in preoperative simulations and 20 patients without using a 3D model. There was a statistically significant difference in the operating time between the two groups. Conclusions In this article, we present, with surgical examples, our in-house practice of 3D simulation at low costs, the reality of 3D model fabrication, problems to be resolved, and some future prospects.
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Affiliation(s)
- Masato Narita
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 1-2-2 Masago, Mihama-ku, Chiba, 261-8502 Japan
| | - Takashi Takaki
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 1-2-2 Masago, Mihama-ku, Chiba, 261-8502 Japan
| | - Takahiko Shibahara
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 1-2-2 Masago, Mihama-ku, Chiba, 261-8502 Japan
| | - Masashi Iwamoto
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 1-2-2 Masago, Mihama-ku, Chiba, 261-8502 Japan
| | - Takashi Yakushiji
- Oral and Maxillofacial Surgery, National Hospital Organization Takasaki General Medical Center, 32 Takamatsu, Takasaki, Gunma 371-0829 Japan
| | - Takashi Kamio
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University, 1-9-20 Fujimi-cho, Chiyoda-ku, Tokyo, 102-8159 Japan
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Harrison P, Patel A, Cheng A, Bell RB. Three-Dimensional Computer-Assisted Surgical Planning, Manufacturing, and Intraoperative Navigation in Oncologic Surgery. Atlas Oral Maxillofac Surg Clin North Am 2020; 28:129-144. [PMID: 32741510 DOI: 10.1016/j.cxom.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Phillip Harrison
- Providence Cancer Institute, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA; The Head and Neck Institute, Head and Neck Surgical Associates, 1849 Northwest Kearney, Suite 300, Portland, OR 97209, USA; Legacy Cancer Institute, Legacy Good Samaritan Medical Center, 1015 Northwest 22nd Avenue, Portland, OR 97210, USA.
| | - Ashish Patel
- Providence Cancer Institute, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA; The Head and Neck Institute, Head and Neck Surgical Associates, 1849 Northwest Kearney, Suite 300, Portland, OR 97209, USA; Legacy Cancer Institute, Legacy Good Samaritan Medical Center, 1015 Northwest 22nd Avenue, Portland, OR 97210, USA. https://twitter.com/patelmddds
| | - Allen Cheng
- Providence Cancer Institute, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA; Legacy Cancer Institute, Legacy Good Samaritan Medical Center, 1015 Northwest 22nd Avenue, Portland, OR 97210, USA. https://twitter.com/allenchengddsmd
| | - R Bryan Bell
- Providence Cancer Institute, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA; Earle A. Chiles Research Institute in the Robert W. Franz Cancer Center, Providence Cancer Institute, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA. https://twitter.com/rbryanbell
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Cortese A, Chandran R, Borri A, Cataldo E. A Modified Novel Technique for Condylar Positioning in Mandibular Bilateral Sagittal Split Osteotomy Using Computer-Assisted Designed and Computer-Assisted Manufactured Surgical Guides. J Oral Maxillofac Surg 2020; 77:1069.e1-1069.e9. [PMID: 31046965 DOI: 10.1016/j.joms.2019.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 12/01/2022]
Abstract
Current techniques for orthognathic surgery after Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO) rely on intermediate and final occlusal splints for proper positioning of the dental arches without any control in positioning the condyle and ramus segments. Setting the 2 condyles in centric relation in the glenoid fossae at fixation is paramount for condylar function and the accuracy and stability of postoperative occlusion. Usually the 2 ramus segments are manually positioned and fixated in the final position according to the surgeon's experience. This report describes a novel technique to position the condyle and ramus segments in centric relation using skeletal guides designed by computer-assisted designed and computer-assisted manufactured (CAD-CAM) technology. The skeletal guides have a double-U shape designed to be tooth borne on the distal segment and bone borne on the proximal segment. The guides fit on the last molar crown and the anterior border of the ramus; using these reference points will position the mandibular arch and 2 ramus segments in ideal centric occlusion and centric relation. The condyle position in the sagittal, horizontal, and transverse planes was analyzed by computed tomography and differences in measurements were calculated. This technique confirms precise control of the condylar segment in centric relation with stable centric occlusion using CAD-CAM guides during BSSO.
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Affiliation(s)
- Antonio Cortese
- Aggregate Professor, Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Ravi Chandran
- Associate Professor and Chairman, Department of Oral-Maxillofacial Surgery and Pathology, University of Mississippi Medical Center, Jackson, MS.
| | - Antonio Borri
- Private Practice, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Emilio Cataldo
- PhD Student, Department of Industrial Engineering, University of Salerno, Salerno, Italy
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Rückschloß T, Ristow O, Kühle R, Weichel F, Roser C, Aurin K, Engel M, Hoffmann J, Freudlsperger C. Accuracy of laser-melted patient-specific implants in genioplasty - A three-dimensional retrospective study. J Craniomaxillofac Surg 2020; 48:653-660. [PMID: 32505528 DOI: 10.1016/j.jcms.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/10/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To assess the accuracy of laser-melted patient-specific implants (PSI) with regard to a preoperative virtual treatment plan for genioplasty based on a new analysis method without the use of landmarks. MATERIALS AND METHODS A retrospective evaluation of a cohort of Class II and Class III patients who had undergone virtually planned orthognathic surgery (including genioplasty) was carried out. The preoperative virtual treatment plan and the postoperative outcome were fused to calculate the translational and rotational discrepancies between the 3D planning and the actual surgical outcome. RESULTS The accuracy of left/right positioning was 0.25 ± 0.28 mm (p < 0.001), that of anterior/posterior positioning was 0.70 ± 0.64 mm (p < 0.001), and that of up/down-positioning was 0.45 ± 0.38 mm (p < 0.001). The rotational discrepancies were less than 2 deg. The virtually planned and postoperative positions of the chin differed significantly from each other (p < 0.001 for all rotational and translational discrepanices). CONCLUSION The findings demonstrate that PSIs can transfer the planned virtual genioplasty into the operation theatre with small but significant deviations. However, since no conclusions can be drawn from the results regarding surgical success in terms of shaping the soft tissue profile as well as the esthetic result, no superiority of PSI over traditional plate osteosynthesis can be demonstrated.
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Affiliation(s)
- Thomas Rückschloß
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
| | - Oliver Ristow
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Reinald Kühle
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Frederic Weichel
- University of Heidelberg, Institute of Medical Biometry and Informatics, Marsilius-Arkaden, Turm West, Im Neuenheimer Feld 130.3, D-69120, Heidelberg, Germany
| | - Christoph Roser
- University of Heidelberg, Department of Orthodontics, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Kerstin Aurin
- University of Heidelberg, Department of Conservative Dentistry, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Michael Engel
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Jürgen Hoffmann
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Christian Freudlsperger
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
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Kraeima J, Schepers R, Spijkervet F, Maal T, Baan F, Witjes M, Jansma J. Splintless surgery using patient-specific osteosynthesis in Le Fort I osteotomies: a randomized controlled multi-centre trial. Int J Oral Maxillofac Surg 2020; 49:454-460. [DOI: 10.1016/j.ijom.2019.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/30/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
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Mathew P, Mathai PC, David J, Shenoy U, Tiwari R. Current Orthognathic Practice in India: Do We Need to Change? J Maxillofac Oral Surg 2020; 19:1-11. [PMID: 31988555 PMCID: PMC6954926 DOI: 10.1007/s12663-019-01269-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The last decade or so has seen paradigm shifts in the various aspects of orthognathic surgery. A lot of these changes are to do with digitalization of the orthodontic-surgical workflow, optimization of surgery-first protocols, virtual surgical planning-based 3D printing solutions and changing patient-health-care dynamics. The aim of this article is to provide evidence-based recommendations that are both practical and economically viable for the current orthognathic practice in India.
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Affiliation(s)
- Philip Mathew
- Department of Maxillofacial Surgery, Jubilee Mission Medical College, Thrissur, India
| | - Paul C. Mathai
- Department of Maxillofacial Surgery, Jubilee Mission Medical College, Thrissur, India
| | - Jisha David
- Department of Maxillofacial Surgery, Jubilee Mission Medical College, Thrissur, India
| | - Usha Shenoy
- Department of Anesthesiology, Jubilee Mission Medical College, Thrissur, India
| | - Rahul Tiwari
- Department of Maxillofacial Surgery, Jubilee Mission Medical College, Thrissur, India
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Oth O, Durieux V, Orellana MF, Glineur R. Genioplasty with surgical guide using 3D-printing technology: A systematic review. J Clin Exp Dent 2020; 12:e85-e92. [PMID: 31976049 DOI: 10.4317/medoral.56145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/09/2019] [Indexed: 11/05/2022] Open
Abstract
Background The purpose of this systematic review is to evaluate the current state of the art of making genioplasties using 3D printing technology. Material and Methods A multi-database single-reviewer systematic review identified sixteen papers that fulfilled the selection criteria. There were mainly case series and case reports available (Level IV of the Oxford Evidence-based medicine scale); only two prospective study (Level III) evaluated this subject. These articles are analyzed in details and summarized in this review. Results The realization of genioplasties with surgical guide using 3D-printing technology could improve predictability and accuracy. It protects anatomical structures in the environment of the surgery, reducing by this way the morbidity and providing safer results. The type of printer and material used as well as the sterilization techniques should be further developed by the authors. The use of open-access software should also be further explored to allow the use of these new technologies by the largest number of surgeons. Conclusions Finally, prospective multi-center studies with larger samples should be performed to definitively conclude the benefits of this new technology and allow for its routine use. This article is the first systematic review on this topic. Key words:Genioplasty, printing, three-dimensional, surgery, computer-assisted.
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Affiliation(s)
- Olivier Oth
- Department of Oral and Maxillofacial Surgery, Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808 1070 Brussels, Belgium
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université Libre de Bruxelles (ULB), Route de Lennik 808 1070 Brussels, Belgium
| | - Maria-Fernanda Orellana
- Department of Oral and Maxillofacial Surgery, Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808 1070 Brussels, Belgium
| | - Régine Glineur
- Department of Oral and Maxillofacial Surgery, Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808 1070 Brussels, Belgium
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Oth O, Mestrallet P, Glineur R. Clinical Study on the Minimally Invasive-Guided Genioplasty Using Piezosurgery and 3D Printed Surgical Guide. Ann Maxillofac Surg 2020; 10:91-95. [PMID: 32855922 PMCID: PMC7433970 DOI: 10.4103/ams.ams_79_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 02/18/2020] [Accepted: 03/11/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A retrospective clinical study was performed regarding the minimally invasive-guided genioplasty technique (MIGG technique) described in a previous clinical note. The aims of this clinical study were to study the incidence of immediate complications with this technique compared with a control group using a nonminimally genioplasty technique, to validate the accuracy of the three-dimensional (3D) printed cutting guide, and to evaluate the duration of the surgery and the satisfaction of the surgeons with this technique. MATERIALS AND METHODS One controlled group, including 56 patients, operated with a classical genioplasty and one group, including 24 patients operated with the MIGG technique. The inclusion criteria were patients from 18 years old benefiting from orthognathic surgery for dysmorphic maxillofacial disorders, sleep apneas, or posttraumatic malocclusion; operated by the three same surgeons. A database was retrospectively made, including the demographics parameters, the indication, the type and the duration of surgery, the incidence of complication, and the type of complication. The accuracy of the cutting guide was also studied by the comparison of two distances in the MIGG group on the preoperative surgical simulation and on the postoperative cephalometric radiography. A satisfaction survey for the surgeons of the department regarding the MIGG technique was also analyzed. CONCLUSION No statistical difference was found in the incidence of complications between the MIGG group and the control group. Using a guide does not cause more surgical infection. The protection of the inferior alveolar nerve is obvious. The absence of statistical difference is due to the fact that the majority of patients also benefited from the bilateral sagittal split osteotomy during surgery. The 3D-cutting guide used is very accurate: There is indeed no significative difference in the measurements A and B before and after the genioplasty. The MIGG technique is thus a predictable, safe, and easy-to-use technique that should be used routinely by maxillofacial surgeons. It combines the latest technologies in piezosurgery and in 3D-guided surgery by the creation of a validated-accurate 3D-printed cutting guide. This technique is affordable by the use of open-source program and a desktop fused deposit Modeling 3D-printer. Finally, the comfort of the surgeon is improved, and the operating time is decreased.
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Affiliation(s)
- Olivier Oth
- Department of Oral and Maxillofacial Surgery, Erasme Hospital, Université Libre De Bruxelles, Brussels, Belgium
| | - Pierre Mestrallet
- Department of Oral and Maxillofacial Surgery, Erasme Hospital, Université Libre De Bruxelles, Brussels, Belgium
| | - Régine Glineur
- Department of Oral and Maxillofacial Surgery, Erasme Hospital, Université Libre De Bruxelles, Brussels, Belgium
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Hanafy M, Akoush Y, Abou-ElFetouh A, Mounir R. Precision of orthognathic digital plan transfer using patient-specific cutting guides and osteosynthesis versus mixed analogue–digitally planned surgery: a randomized controlled clinical trial. Int J Oral Maxillofac Surg 2020; 49:62-68. [DOI: 10.1016/j.ijom.2019.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/10/2019] [Accepted: 06/14/2019] [Indexed: 11/26/2022]
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Accuracy of mandible-independent maxillary repositioning using pre-bent locking plates: a pilot study. Int J Oral Maxillofac Surg 2019; 49:901-907. [PMID: 31889580 DOI: 10.1016/j.ijom.2019.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/29/2019] [Accepted: 11/29/2019] [Indexed: 11/21/2022]
Abstract
The double splint method is considered the gold standard for maxillary repositioning, but the procedure is lengthy and prone to error. Recent splintless methods have shown high repositioning accuracy; however, high costs and technical demands make them inaccessible to many patients. Therefore, a new cost-effective method of mandible-independent maxillary repositioning using pre-bent locking plates is proposed. Plates are bent on maxillary models in the planned position prior to surgery. The locations of the plate holes are replicated during surgery using osteotomy guides made from thermoplastic resin sheets. Pre-bent plates are subsequently fitted onto the maxilla, and plate holes are properly set to reposition the maxilla. The purpose of this study was to evaluate the accuracy of this method for maxillary repositioning and the reproducibility of the plate holes. Fifteen orthognathic surgery patients were evaluated retrospectively by superimposing preoperative simulations over their postoperative computed tomography models. The median deviations in maxillary repositioning and plate hole positioning between the preoperative plan and postoperative results were 0.43mm (range 0-1.55mm) and 0.33mm (range 0-1.86mm), respectively. There was no significant correlation between these deviations, suggesting that the method presented here allows highly accurate and reliable mandible-independent maxillary repositioning.
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Yan C, Jia HC, Xu JX, Xu T, Chen K, Sun JC, Shi JG. Computer-Based 3D Simulations to Formulate Preoperative Planning of Bridge Crane Technique for Thoracic Ossification of the Ligamentum Flavum. Med Sci Monit 2019; 25:9666-9678. [PMID: 31847005 PMCID: PMC6929566 DOI: 10.12659/msm.918387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The bridge crane technique is a novel surgical technique for the treatment of thoracic ossification of the ligamentum flavum (TOLF), but its preoperative planning has not been studied well, which limits the safety and efficacy of surgery to some extent. The purpose of this study was to investigate the method of application and effect of computer-aided preoperative planning (CAPP) on the bridge crane technique for TOLF. Material/Methods This retrospective multi-center included 40 patients with TOLF who underwent the bridge crane technique from 2016 to 2018. According to the utilization of CAPP, patients were divided into Group A (with CAPP, n=21) and Group B (without CAPP, n=19). Comparisons of clinical and radiological outcomes were carried out between the 2 groups. Results The patients in Group A had higher post-mJOA scores and IR of neurological function than those in Group B (p<0.05). Group A had shorter surgery time, fewer fluoroscopic images, and lower incidence of complications than Group B. In Group A, there was a high consistency of all the anatomical parameters between preoperative simulation and postoperative CT (p>0.05). In Group B, there were significant differences in 3 anatomical parameters between postoperative simulation and postoperative CT (p<0.05). In Group B, the patients with no complications had higher post-SVOR and lower SVRR and height of posterior suspension of LOC in postoperative CT than those in postoperative simulation (p<0.05). Conclusions CAPP can enable surgeons to control the decompression effect accurately and reduce the risk of related complications, which improves the safety and efficacy of surgery.
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Affiliation(s)
- Chen Yan
- Second Department of Spine Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China (mainland).,Undergraduate Incubation Center, Navy Medical University, Shanghai, China (mainland)
| | - Huai-Cheng Jia
- Second Department of Spine Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China (mainland).,Undergraduate Incubation Center, Navy Medical University, Shanghai, China (mainland)
| | - Jia-Xi Xu
- Second Department of Spine Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China (mainland).,Undergraduate Incubation Center, Navy Medical University, Shanghai, China (mainland)
| | - Tao Xu
- Department of Orthopedic Surgery, No. 906 Hospital of the People's Liberation Army (PLA), Ningbo, Zhejiang, China (mainland)
| | - Kun Chen
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China (mainland)
| | - Jing-Chuan Sun
- Second Department of Spine Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China (mainland)
| | - Jian-Gang Shi
- Second Department of Spine Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China (mainland)
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Qu M, Zhu S, Hu Z, Li Y, Abotaleb B, Bi R, Jiang N. The accuracy of three-dimensional rapid prototyped surgical template guided anterior segmental osteotomy. Med Oral Patol Oral Cir Bucal 2019; 24:e684-e690. [PMID: 31433393 PMCID: PMC6764704 DOI: 10.4317/medoral.23009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 05/27/2019] [Indexed: 11/16/2022] Open
Abstract
Background Surgical guiding templates provided a reliable way to transfer the simulation to the actual operation. However, there was no template designed for anterior segmental osteotomy so far. The study aimed to introduce and evaluate a set of 3D rapid prototyping surgical templates used in anterior segmental osteotomy. Material and Methods From August 2015 to August 2017, 17 patients with bimaxillary protrusions were recruited and occlusal-based multi-sectional templates were applied in the surgeries. The cephalometric analysis and 3D superimposition were performed to evaluate the differences between the simulations and actual post-operative outcomes. The patients were followed-up for 12 months to evaluate the incidence rate of complications and relapse. Results Bimaxillary protrusion was corrected in all patients with no complication. In radiographic evaluations, there was no statistically significant difference between the actual operations and the computer-aided 3D simulations (p >0.05, the mean linear and angular differences were less than 1.32mm and 1.72° consequently, and 3D superimposition difference was less than 1.4mm). The Pearson intraclass correlation coefficient reliabilities were high (0.897), and the correlations were highly significant (P< 0.001). Conclusions The 3D printed surgical template designed in this study can safely and accurately transfer the computer-aided 3D simulation into real practice. Key words:CAD/CAM; anterior segmental osteotomy; surgical guiding templates; bimaxillary protrusion; virtual surgery simulation.
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Affiliation(s)
- M Qu
- West China College of Stomatology, Sichuan University, Chengdu, Sichuan, 610041 China,
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Shirota T, Shiogama S, Asama Y, Tanaka M, Kurihara Y, Ogura H, Kamatani T. CAD/CAM splint and surgical navigation allows accurate maxillary segment positioning in Le Fort I osteotomy. Heliyon 2019; 5:e02123. [PMID: 31372564 PMCID: PMC6657307 DOI: 10.1016/j.heliyon.2019.e02123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/24/2019] [Accepted: 07/18/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate the accuracy of the maxillary segment positioning method using a splint fabricated by computer-aided design/computer-aided manufacturing (CAD/CAM) and surgical navigation in patients who required two-jaw surgery. Methods Subjects were 35 patients requiring two-jaw surgery. A 3-dimensional (3D) skull model was prepared using cone-beam computed tomography (CBCT) data and dentition model scan data. Two-jaw surgery was simulated using this model, and a splint for maxillary positioning was fabricated by CAD/CAM. Using coordinate transformation software, the coordinate axis of surgical simulation data was merged with the navigation system, and data were imported to the navigation system. The maxillary segment was placed using the CAD/CAM splint, and consistency of the maxillary segment position with that planned by simulation was confirmed using the navigation system. CBCT taken at 4 weeks postoperatively and the prediction image fabricated using surgical simulation were superimposed. Predicted movement distances (PMD) at 6 arbitrary measurement points and actual movement distance (AMD) in surgery were measured. Differences of 3D measurements between the surgical simulation and postoperative results were evaluated. Results No significant differences were seen between PMD and AMD at most measurement points on the X and Y axes. Although significant differences between PMD and AMD were seen on the Z axis, no difference was evident between linear distance on the estimated image and postoperative CBCT image at most measurement points in 3D space. Mean error at measurement points between the PMD and AMD ranged from 0.57 mm to 0.78 mm on the X axis, 0.64 mm–1.03 mm on the Y axis, and 0.84 mm–0.90 mm in the Z axis. Conclusion Position of the maxillary segment moved by the CAD/CAM splint in Le Fort I osteotomy was almost consistent with the position established by simulation using the navigation system, confirming clinical accuracy.
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Affiliation(s)
- Tatsuo Shirota
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University, Tokyo, Japan
| | - Sunao Shiogama
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University, Tokyo, Japan
| | - Yusuke Asama
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Motohiro Tanaka
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University, Tokyo, Japan
| | - Yuji Kurihara
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University, Tokyo, Japan
| | - Hiroshi Ogura
- Department of Information Science, Faculty of Arts and Sciences at Fujiyoshida, Showa University, Fujiyoshida, Japan
| | - Takaaki Kamatani
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University, Tokyo, Japan
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Li B, Wang S, Wei H, Zeng F, Wang X. The use of patient-specific implants in genioplasty and its clinical accuracy: a preliminary study. Int J Oral Maxillofac Surg 2019; 49:461-465. [PMID: 31353173 DOI: 10.1016/j.ijom.2019.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 03/23/2019] [Accepted: 06/04/2019] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to assess the accuracy and clinical validation of patient-specific implants (PSI) in genioplasty. Fifteen patients with chin deformities were enrolled. Virtual planning was performed with the computer-aided surgical simulation method. The three-dimensional-printed titanium cutting guide and patient-specific plate were designed to guide the osteotomy and allow repositioning and fixation of the chin. The outcome was evaluated by comparing the plan with actual outcomes. All operations were successfully completed with PSIs. There was no difficulty in using patient-specific plates. The largest root-mean-square difference of the chin position was 0.69 mm in mediolateral translation and 2.01° in the yaw orientation. The results of the study indicated that the PSI technique was an accurate method of transferring the virtual plan to the operation field with great efficiency in genioplasty. A significant advantage of the PSI technique is that the patient-specific plate could simultaneously complete the repositioning and fixation of the chin. Intraoperative measurements and reposition guides were no longer required. Operative procedures were greatly simplified.
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Affiliation(s)
- B Li
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - S Wang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - H Wei
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - F Zeng
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - X Wang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
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48
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Abstract
Clinicians use different diagnostic terms for patients with underdevelopment of facial features arising from the embryonic first and second pharyngeal arches, including first and second branchial arch syndrome, otomandibular dysostosis, oculoauriculovertebral syndrome, and hemifacial microsomia. Craniofacial microsomia has become the preferred term. Although no diagnostic criteria for craniofacial microsomia exist, most patients have a degree of underdevelopment of the mandible, maxilla, ear, orbit, facial soft tissue, and/or facial nerve. These anomalies can affect feeding, compromise the airway, alter facial movement, disrupt hearing, and alter facial appearance.
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Affiliation(s)
- Craig Birgfeld
- Pediatric Plastic and Craniofacial Surgery, Seattle Children's Hospital, 4800 Sand Point Way, M/S OB.9.520, PO Box 5371, Seattle, WA 98105, USA.
| | - Carrie Heike
- Craniofacial Pediatrics, Seattle Children's Hospital, 4800 Sand Point Way, M/S OB.9.528, PO Box 5371, Seattle, WA 98105, USA
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49
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Ho CT, Lin HH, Lo LJ. Intraoral Scanning and Setting Up the Digital Final Occlusion in Three-Dimensional Planning of Orthognathic Surgery. Plast Reconstr Surg 2019; 143:1027e-1036e. [DOI: 10.1097/prs.0000000000005556] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Kim JW, Kim JC, Jeong CG, Cheon KJ, Cho SW, Park IY, Yang BE. The accuracy and stability of the maxillary position after orthognathic surgery using a novel computer-aided surgical simulation system. BMC Oral Health 2019; 19:18. [PMID: 30646896 PMCID: PMC6334449 DOI: 10.1186/s12903-019-0711-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/04/2019] [Indexed: 01/28/2023] Open
Abstract
Background Many reports have been published on orthognathic surgery (OGS) using computer-aided surgical simulation (CASS). The purpose of this study was to evaluate the accuracy of the maxillary repositioning and the stability of the maxilla in patients who underwent OGS using a newly developed CASS program, a customized osteotomy guide, and a customized miniplate. Methods Thirteen patients who underwent OGS from 2015 to 2017 were included. All patients underwent a bimaxillary operation. First, a skull-dentition hybrid 3D image was rendered by merging the cone beam computed tomography (CBCT) images with the dentition scan file. After virtual surgery (VS) using the FaceGide® program, patient-customized osteotomy guides and miniplates were then fabricated and used in the actual operation. To compare the VS with the actual surgery and postoperative skeletal changes, each reference point marked on the image was compared before the operation (T0) and three days (T1), four months (T2), and a year (T3) after the operation, and with the VS (Tv). The differences between ΔTv (Tv-T0) and ΔT1 (T1-T0) were statistically compared using tooth-based reference points. The superimposed images of Tv and T1 were also investigated at eight bone-based reference points. The differences between the reference points of the bone surface were examined to evaluate the stability of the miniplate on the maxilla over time. Results None of the patients experienced complications. There were no significant differences between the reference points based on the cusp tip between ΔTv and ΔT1 (p > 0.01). Additionally, there were no significant differences between the Tv and T1 values of the bone surface (p > 0.01). The mean difference in the bone surface between Tv and T1 was 1.01 ± 0.3 mm. Regarding the stability of the miniplate, there were no significant differences between the groups. The difference in the bone surface between T1 and T3 was − 0.37 ± 0.29 mm. Conclusions VS was performed using the FaceGide® program, and customized materials produced based on the VS were applied in actual OGS. The maxilla was repositioned in almost the same manner as in the VSP plan, and the maxillary position remained stable for a year.
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Affiliation(s)
- Ju-Won Kim
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 11, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14066, Anyang, Republic of Korea.,Graduate School of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea.,Institute of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea
| | - Jong-Cheol Kim
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 11, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14066, Anyang, Republic of Korea.,Mir Dental Hospital, 12 Gongpyoungro Jung-gu Daegu, 41940, Daegu, Republic of Korea
| | - Chun-Gi Jeong
- Mir Dental Hospital, 12 Gongpyoungro Jung-gu Daegu, 41940, Daegu, Republic of Korea
| | - Kyeong-Jun Cheon
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 11, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14066, Anyang, Republic of Korea.,Graduate School of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea
| | - Seoung-Won Cho
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 11, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14066, Anyang, Republic of Korea.,Graduate School of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea
| | - In-Young Park
- Division of Orthodontics, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.,Graduate School of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea.,Institute of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea
| | - Byoung-Eun Yang
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 11, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14066, Anyang, Republic of Korea. .,Graduate School of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea. .,Institute of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea.
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