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Ajmera DH, Singh P, Leung YY, Khambay BS, Gu M. Establishment of the mid-sagittal reference plane for three-dimensional assessment of facial asymmetry: a systematic review : Establishment of the mid-sagittal reference plane: a systematic review. Clin Oral Investig 2024; 28:242. [PMID: 38575839 PMCID: PMC10995046 DOI: 10.1007/s00784-024-05620-7] [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: 05/09/2022] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To systematically review the literature for mid-sagittal plane establishment approaches to identify the most effective method for constructing the mid-sagittal plane for the evaluation of facial asymmetry. MATERIALS AND METHODS Six electronic databases (PubMed, Medline (via Ovid), EMBASE (via Ovid), Cochrane Library, Web of Science, and Scopus) and grey literature were searched for the studies that computed the mid-sagittal reference plane three-dimensionally, using a combination of MeSH terms and keywords. The methodological quality and the level of evidence for the included studies were analyzed using QUADAS-2 and GRADE, respectively. RESULTS The preliminary search yielded 6746 records, of which 42 articles that met the predefined inclusion criteria were included in the final analysis. All the included articles reported the construction of the mid-sagittal reference plane (MSP) using varied methods. The risk of bias and concerns regarding the applicability of the included studies were judged to be 'low'. The level of evidence was determined to be 'low' for the effectiveness of the technique and 'moderate' for the ease of clinical applicability. CONCLUSION Despite methodological heterogeneity, this review substantiates the comparable efficacy of cephalometric and morphometric MSP construction methods. A fully automated morphometric MSP holds promise as a viable option for routine clinical use. Nevertheless, future prospective studies with an emphasis on the impact, accuracy, and clinical applicability of MSP construction techniques in cases of facial asymmetry are required. CLINICAL RELEVANCE The present review will assist clinicians in selecting the most suitable method for MSP construction, leading to improved treatment planning and ultimately more favorable treatment outcomes.
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Affiliation(s)
- Deepal Haresh Ajmera
- Discipline of Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Pradeep Singh
- Discipline of Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Yiu Yan Leung
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Balvinder S Khambay
- Discipline of Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
- Orthodontics Department, School of Dentistry, University of Birmingham, Birmingham, UK.
- Discipline of Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong SAR, China.
| | - Min Gu
- Discipline of Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
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Riordan E, Yung A, Cheng K, Lim L, Clark J, Rtshiladze M, Ch'ng S. Modeling Methods in Craniofacial Virtual Surgical Planning. J Craniofac Surg 2023; 34:1191-1198. [PMID: 36806300 DOI: 10.1097/scs.0000000000009187] [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: 06/18/2022] [Accepted: 10/09/2022] [Indexed: 02/22/2023] Open
Abstract
Despite the widespread use of virtual surgical planning (VSP), few papers describe the modeling methods used to generate the digital simulations that underpin VSP. This paper aims to review the modeling methods that are currently available for use in VSP and the implications of their use in clinical practice. A literature review was undertaken of the two broad categories of modeling techniques; contour-based planning-namely mirroring from the contralateral side, templating from a normative database, and extrapolation from surrounding landmarks-and occlusal-based planning (OBP). The indications for each modeling method were discussed, including mandibular/maxillary reconstruction, pediatric craniofacial surgery, and orthognathic, as well as the limitations to the accuracy of modeling types. Unilateral defects of the upper/midface, wherein contour accuracy is paramount, are best reconstructed using mirroring methods, whereas bilateral defects-or cases with asymmetry due to craniofacial dysmorphology-are most suited to normative-data-based methods. Cases involving resection of the alveolar margin, in which functional occlusion is the primary outcome are best managed with OBP. Similarly, orthognathic surgery typically uses OBP, although complex cases involving asymmetry, such as clefts, may benefit from a combination of OBP and normative data methods. The choice of modeling methods is, therefore, largely driven by the defect type and the goals of reconstruction.
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Affiliation(s)
- Edward Riordan
- Department of Plastic Surgery, St George Hospital
- Melanoma Institute Australia, The University of Sydney
| | - Amanda Yung
- Melanoma Institute Australia, The University of Sydney
- Sydney Medical School, University of Sydney
| | - Kai Cheng
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District
| | - Lydia Lim
- Department of Maxillofacial Surgery, Westmead Hospital
| | - Jonathan Clark
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District
- Faculty of Medicine and Health, The University of Sydney
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre
| | - Michael Rtshiladze
- Melanoma Institute Australia, The University of Sydney
- Department of Plastic and Reconstructive Surgery, Sydney Children's Hospital Randwick
- Department of Plastic Surgery, Prince of Wales Hospital
| | - Sydney Ch'ng
- Melanoma Institute Australia, The University of Sydney
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District
- Faculty of Medicine and Health, The University of Sydney
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre
- Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Chen MY, Fang JJ, Lee JN, Periasamy S, Yen KC, Wang HC, Hsieh DJ. Supercritical Carbon Dioxide Decellularized Xenograft-3D CAD/CAM Carved Bone Matrix Personalized for Human Bone Defect Repair. Genes (Basel) 2022; 13:755. [PMID: 35627140 PMCID: PMC9141546 DOI: 10.3390/genes13050755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 12/04/2022] Open
Abstract
About 30-50% of oral cancer patients require mandibulectomy and autologous fibula reconstruction. Autograft is the gold standard choice because of its histocompatibility; however, it requires additional surgery from the patient and with possible complications such as loss of fibula leading to calf weakening in the future. Allograft and xenograft are alternatives but are susceptible to immune response. Currently, no personalized bone xenografts are available in the market for large fascial bone defects. In addition, a large-sized complex shape bone graft cannot be produced directly from the raw material. We propose the use of porcine bones with 3D CAD/CAM carving to reconstruct a personalized, wide range and complex-shaped bone. We anticipate that patients can restore their native facial appearance after reconstruction surgery. Supercritical CO2 (SCCO2) technology was employed to remove the cells, fat and non-collagenous materials while maintaining a native collagen scaffold as a biomedical device for bone defects. We successfully developed 3D CAD/CAM carved bone matrices, followed by SCCO2 decellularization of those large-sized bones. A lock-and-key puzzle design was employed to fulfil a wide range of large and complex-shaped maxillofacial defects. To conclude, the 3D CAD/CAM carved bone matrices with lock and key puzzle Lego design were completely decellularized by SCCO2 extraction technology with intact natural collagen scaffold. In addition, the processed bone matrices were tested to show excellent cytocompatibility and mechanical stiffness. Thus, we can overcome the limitation of large size and complex shapes of xenograft availability. In addition, the 3D CAD/CAM carving process can provide personalized tailor-designed decellularized bone grafts for the native appearance for maxillofacial reconstruction surgery for oral cancer patients and trauma patients.
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Affiliation(s)
- Meng-Yen Chen
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan;
| | - Jing-Jing Fang
- Department of Mechanical Engineering, College of Engineering, National Cheng Kung University, Tainan 701401, Taiwan;
| | - Jeng-Nan Lee
- Department of Mechanical Engineering, Cheng Shiu University, Kaohsiung 833301, Taiwan;
| | - Srinivasan Periasamy
- R & D Center, ACRO Biomedical Co., Ltd. 2nd. Floor, No.57, Luke 2nd. Rd., Luzhu District, Kaohsiung 821011, Taiwan; (S.P.); (K.-C.Y.); (H.-C.W.)
| | - Ko-Chung Yen
- R & D Center, ACRO Biomedical Co., Ltd. 2nd. Floor, No.57, Luke 2nd. Rd., Luzhu District, Kaohsiung 821011, Taiwan; (S.P.); (K.-C.Y.); (H.-C.W.)
| | - Hung-Chou Wang
- R & D Center, ACRO Biomedical Co., Ltd. 2nd. Floor, No.57, Luke 2nd. Rd., Luzhu District, Kaohsiung 821011, Taiwan; (S.P.); (K.-C.Y.); (H.-C.W.)
| | - Dar-Jen Hsieh
- R & D Center, ACRO Biomedical Co., Ltd. 2nd. Floor, No.57, Luke 2nd. Rd., Luzhu District, Kaohsiung 821011, Taiwan; (S.P.); (K.-C.Y.); (H.-C.W.)
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Pedersoli L, Dalessandri D, Tonni I, Bindi M, Isola G, Oliva B, Visconti L, Bonetti S. Facial Asymmetry Detected with 3D Methods in Orthodontics: A Systematic Review. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2111251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Historically, the development of two-dimensional (2D) imaging techniquesforerun that of three-dimensional (3D) ones. Some 2D methods are still considered valid and effective to diagnose facial asymmetry but 3D techniques may provide more precise and accurate measurements.
Objective:
The aim of this work is to analyze the accuracy and reliability of the imaging techniques available for the diagnosis of facial asymmetry in orthodontics and find the most reliable.
Methods:
A search strategy was implemented using PubMed (National Library of Medicine, NCBI).
Results:
A total of 3201 papers were identified in electronic searches. 90 articles, available in full text, were included in the qualitative synthesis consisting of 8 reviews on the diagnosis of facial asymmetry, 22 in vivo and in vitro studies on 2D methods and 60 in vivo and in vitro studies on 3D methods to quantify the asymmetry.
Conclusion:
2D techniques include X-ray techniques such as posterior-anterior cephalogram, which still represents the first level exam in the diagnosis of facial asymmetry. 3D techniques represent the second level exam in the diagnosis of facial asymmetry. The most current used techniques are CBCT, stereophotogrammetry, laser scanning, 3D optical sensors and contact digitization. The comparison between bilateral parameters (linear distances, angles, areas, volumes and contours) and the calculation of an asymmetry index represent the best choices for clinicians who use CBCT. The creation of a color-coded distance map seems to represent the most accurate, reliable and validated methods for clinicians who use stereophotogrammetry, laser scanning and 3D optical sensors.
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Shen CH, Hung TY, Wang M, Chang YC, Fang CY. Utilizing virtual surgical planning and orthognathic surgery to correct severe facial asymmetry without orthodontic treatment. J Dent Sci 2022; 17:647-651. [PMID: 35028112 PMCID: PMC8740078 DOI: 10.1016/j.jds.2021.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 07/20/2021] [Indexed: 11/25/2022] Open
Abstract
Combining double-jaw surgery and orthodontic treatment to correct dentofacial asymmetry is a standard procedure but time consuming and costly. In order to provide alternative solutions, previewing the possible results with precise virtual surgical planning (VSP) system can help clinicians select patients suited for correcting facial asymmetry surgically without orthodontic treatment. In our experiences, after rigid or semirigid fixation of the maxilla, using intermaxillary fixation (IMF) without mandibular bony fixation is another key. This kind of fixation can minimize the chances of changing the condylar position and occlusion after the rotation of the maxillomandibular complex. If the original occlusion can be maintained, then orthodontic treatment can be avoided. Here we presented two facial asymmetry cases who requested surgical correction and refused orthodontic treatment. With careful preoperative planning using VSP, double-jaw surgery with maxillary bony fixation and IMF was conducted and both patients were satisfied by their aesthetic outcomes. With minimal dental compensation, the long-term results were relatively stable.
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Affiliation(s)
- Chih-Hui Shen
- Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tz-Ya Hung
- Department of Dentistry, Songshan Branch, Tri-Service General Hospital, Taipei, Taiwan.,Division of Orthodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Monica Wang
- Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chao Chang
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan.,Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chih-Yuan Fang
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
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Quantitative Asymmetry Assessment between Virtual and Mixed Reality Planning for Orthognathic Surgery—A Retrospective Study. Symmetry (Basel) 2021. [DOI: 10.3390/sym13091614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Orthognathic surgical planning compromises three clinical needs: occlusal balancing, symmetry, and harmony, which may result in multiple outcomes. Facial symmetry is the ultimate goal for patients and practitioners. Pure virtual planning and mixed reality planning were two innovative technologies in clinical practices compared to conventional model surgery used for decades. We proposed quantitative asymmetry assessment methods in both mandibular contour (in 2D) and a midface and mandible relationship in 3D. A computerized optimal symmetry plane, being the median plane, was applied in both planning methods. In the 3D asymmetry assessment between two planning methods, the deviation angle and deviation distance between midface and mandible were within 2° and 1.5 mm, respectively. There was no significant difference, except the symmetry index of the anterior deviation angle between the virtual and mixed reality planning in the 3D asymmetry assessment. In the mandible contour assessment, there was no significant difference between the virtual and mixed reality planning in asymmetry assessment in the frontal and frontal downward inclined views. Quantitative outcomes in 3D asymmetry indices showed that mixed reality planning was slightly more symmetric than virtual planning, with the opposite in 2D contouring.
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A New Approach to Set the Absolute Midsagittal Plane of the Mandible Using a Similarity Index in Skeletal Class III Patients with Facial Asymmetry. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10238550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study sought to test the feasibility of a newly developed plane called computed modified absolute mandibular midsagittal plane (cmAMP) based on the similarity index (SI) for evaluating the stereoscopical symmetry of the mandible by comparison with other proposed midsagittal planes. This study involved 29 adult patients (15 men, 14 women; average age, 23.1 ± 6.9 years) with skeletal Class III facial asymmetry who underwent bimaxillary orthognathic surgery. Using cone-beam computed tomography images taken before and 1 year after surgery, cmAMP with the highest SI value between the two anterior segments of the hemi-mandible was set by a computer algorithm. Results show that the SI using cmAMP had the highest value (0.83 ± 0.04) before surgery compared to the other midsagittal planes, and was not significantly different from the SI (0.80 ± 0.05) using a facial midsagittal plane (MSP) after surgery. The distance (1.15 ± 0.74 mm) and angle (2.02 ± 0.82°) between MSP and cmAMP after surgery were significantly smaller than those between MSP and other midsagittal planes. In conclusion, the cmAMP plane best matches the two anterior segments of hemi-mandible symmetrically and is the closest to MSP after orthognathic surgery in skeletal Class III patients with facial asymmetry.
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8
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Chen Z, Mo S, Fan X, You Y, Ye G, Zhou N. A Meta-analysis and Systematic Review Comparing the Effectiveness of Traditional and Virtual Surgical Planning for Orthognathic Surgery: Based on Randomized Clinical Trials. J Oral Maxillofac Surg 2020; 79:471.e1-471.e19. [PMID: 33031773 DOI: 10.1016/j.joms.2020.09.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To explore the advantages of virtual surgical planning (VSP) and traditional surgical planning (TSP) to determine whether the current VSP technique is superior to the TSP technique for orthognathic surgery. METHODS An electronic search was carried out in the CENTRAL, PubMed, and Embase databases to identify randomized clinical trials (RCTs) that compared the VSP and TSP techniques regarding their surgical accuracy for hard tissue, prediction precision for soft tissue, required time for planning and surgery, cost and patient-reported outcomes. RESULTS Eight articles from 5 RCTs, involving 199 patients, were identified. The findings showed that the VSP and TSP techniques were similar in surgical accuracy for hard tissue in the sagittal plane, although the VSP technique was significantly more accurate in certain reference areas, especially in the anterior area of the maxilla. Both the VSP and TSP techniques had significantly better surgical accuracy for the maxilla than for the mandible. The VSP technique showed clinically significantly greater precision for soft tissue prediction in the sagittal plane. Patients who were treated via the VSP technique presented a more symmetrical frontal view, regardless of whether hard or soft tissue was involved. The VSP technique required more time for software planning, but it showed an advantage in time savings when considering the entire preoperative process. Accompanied by the use of an accurate computer-aided splint, the VSP technique could effectively reduce the operative time. Apart from the initial financial investment of software and hardware, the total cost of the VSP technique was similar to that of the TSP technique. Patients who were treated via the VSP or TSP technique showed similar improvements in quality-of-life. CONCLUSIONS Currently, the VSP technique has become a good alternative to the TSP technique for orthognathic surgery, especially regarding frontal-esthetic considerations. Studies reporting indicators with good representativeness and sensitivity using an identical comparative method are recommended.
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Affiliation(s)
- Zhixing Chen
- PhD Candidate, Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical University, Nanning, China; Guangxi Key Laboratory of the Rehabilitation and Reconstruction of Oral and Maxillofacial Research; Guangxi Colleges and Universities Key Laboratory of Treatment and Research for Oral and Maxillofacial Surgery Disease; Medical Scientific Research Center, Nanning, China
| | - Shuixue Mo
- Professor and Department Chair, Department of Orthodontics, College of Stomatology, Guangxi Medical University, Nanning, China
| | - Xuemin Fan
- Resident, Medicine Master, Department of Orthodontics, College of Stomatology, Guangxi Medical University, Nanning, China
| | - Yuting You
- Resident, Medicine Master, Department of Orthodontics, College of Stomatology, Guangxi Medical University, Nanning, China
| | - Guangrong Ye
- Resident, Medicine Master, Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical University, Nanning, China
| | - Nuo Zhou
- Professor and Vice President, Guangxi Medical University, Nanning, China.
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Ji H, Du W, Xu C, Zhao Q, Ye B, Luo E. Computer-assisted osteotomy guides and pre-bent titanium plates improve the planning for correction of facial asymmetry. Int J Oral Maxillofac Surg 2019; 48:1043-1050. [PMID: 30773336 DOI: 10.1016/j.ijom.2019.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/05/2018] [Accepted: 01/26/2019] [Indexed: 02/05/2023]
Abstract
This study investigated the surgical outcomes and accuracy of computer-assisted osteotomy guides and pre-bent titanium plates in the treatment of patients with facial asymmetry. Thirteen patients with facial asymmetry undergoing bimaxillary orthognathic surgery were included. Virtual simulation of Le Fort I osteotomy, sagittal split ramus osteotomy, and genioplasty, if needed, was conducted on the preoperative three-dimensional model. Computer-assisted osteotomy guides and pre-bent titanium plates were produced and used in the actual operation. The postoperative outcome was assessed for facial symmetry and surgical accuracy. All patients were followed up for at least 18 months and their level of satisfaction was investigated. Use of the computer-assisted osteotomy guides and pre-bent titanium plates was successful in all patients. Maxillary canting, mandibular ramus inclination, and mandibular length were corrected on both sides postoperatively. Superimposition of the surgical simulation and postoperative images demonstrated favourable accuracy. Quantitative analysis revealed a mean linear difference of <0.60mm in the maxilla and 1.57mm in the mandible. All patients were satisfied with the surgical outcome; there were no complications or cases of relapse during follow-up. The application of computer-assisted osteotomy guides and pre-bent titanium plates achieved favourable outcomes and accuracy, improving planning for the correction of facial asymmetry.
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Affiliation(s)
- H Ji
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - W Du
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - C Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Q Zhao
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - B Ye
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - E Luo
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Dobai A, Markella Z, Vízkelety T, Fouquet C, Rosta A, Barabás J. Landmark-based midsagittal plane analysis in patients with facial symmetry and asymmetry based on CBCT analysis tomography. J Orofac Orthop 2018; 79:371-379. [PMID: 30255320 DOI: 10.1007/s00056-018-0151-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/24/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Reconstruction of the facial midplane is relevant in anthropometry, orthodontics, maxillofacial surgery, and the accurate measurement of symmetry deviation is relevant in many fields of medicine especially when planning surgical treatment. In the literature, three different means of midplane generation have been published; however, there is currently no consensus regarding the approach to use. Morphometric methods are used to determine the true midsagittal plane (MSP), but its use in clinical practice is difficult. A regression plane based on N‑ANS-PNS landmarks reportedly approximates the morphometric MSP. As these points are vulnerable, we investigated which combination of landmarks can be substituted in symmetric and asymmetric faces. PATIENTS AND METHODS Thirty symmetric and 30 asymmetric faces were analyzed on cone-beam computed tomography scans. A total of 50 regression planes were generated based on three unpaired landmarks and 35 regression planes were generated based the midpoints of paired landmarks. The Na-ANS-PNS plane was used as reference plane, and the mean angle between it and each generated MSP was calculated. The differences from the reference plane were compared by t‑test between the groups. RESULTS In the symmetric group, 86% of angles deviated by <5° using unpaired points, whereby 74% of angles deviated by <5° for paired points. Between the two groups 50% of planes from midline points, and 77% of planes from paired points were significantly different. All planes deviated more in the asymmetric group. CONCLUSIONS The N‑ANS-PNS reference plane can be substituted with the following combinations: ANS-G-Ba, ANS-G-S, ANS-S-De, PNS-G-Ba, PNS-S-Ba, PNS-ANS-G, and PNS-N-Ba.
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Affiliation(s)
- Adrienn Dobai
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, 52 Maria Street, 1085, Budapest, Hungary.
| | - Zsolt Markella
- Kandó Kálmán Faculty of Electrical Engineering, Óbuda University, Budapest, Hungary
| | - Tamás Vízkelety
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, 52 Maria Street, 1085, Budapest, Hungary
| | | | | | - József Barabás
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, 52 Maria Street, 1085, Budapest, Hungary
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Plane-to-plane analysis of mandibular misalignment in patients with facial asymmetry. Am J Orthod Dentofacial Orthop 2018; 153:70-80. [DOI: 10.1016/j.ajodo.2017.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 11/19/2022]
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Martini M, Klausing A, Messing-Jünger M, Lüchters G. The self-defining axis of symmetry: A new method to determine optimal symmetry and its application and limitation in craniofacial surgery. J Craniomaxillofac Surg 2017; 45:1558-1565. [DOI: 10.1016/j.jcms.2017.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/01/2017] [Accepted: 06/27/2017] [Indexed: 11/17/2022] Open
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Authors’ response. Am J Orthod Dentofacial Orthop 2016; 150:909-910. [DOI: 10.1016/j.ajodo.2016.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 08/23/2016] [Accepted: 08/31/2016] [Indexed: 11/22/2022]
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Ozsoy U. Comparison of Different Calculation Methods Used to Analyze Facial Soft Tissue Asymmetry: Global and Partial 3-Dimensional Quantitative Evaluation of Healthy Subjects. J Oral Maxillofac Surg 2016; 74:1847.e1-9. [DOI: 10.1016/j.joms.2016.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
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Kim NR, Park SB, Shin SM, Choi YS, Kim SS, Son WS, Kim YI. Preliminary Study to Determine the Reference Plane of Patients With a Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2016; 54:707-714. [PMID: 27537492 DOI: 10.1597/16-026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine the three-dimensional midsagittal reference planes for unilateral cleft lip and palate (UCLP) patients that can be easily applied in a clinical setting. DESIGN This was a retrospective analysis. PATIENTS There were 35 UCLP patients (25 men, 10 women; 28.1 ± 6.9 years old) in this study. METHODS With landmark's three-dimensional coordinates obtained from cone-beam computed tomography, the symmetric midsagittal reference planes were calculated by applying the ordinary Procrustes superimposition method using the original and mirror images. Procrustes analysis was also used to find the closest landmarks to the calculated symmetric midsagittal reference plane and test its compatibility with the symmetrical midsagittal reference plane. MAIN OUTCOME MEASURE The three nearest landmarks to the symmetric midsagittal reference plane were Opisthion, Basion, and Nasion. RESULTS The averages of the sums of the squared Euclidean distance and squared Procrustes distance differences between the two configurations and shapes fabricated by the symmetrical and landmark-based midsagittal reference planes, respectively, were calculated as 1.836 ± 3.295 and 1.519 × 10-5 ± 2.351 × 10-5. CONCLUSION It was confirmed that the midsagittal reference planes from these selected landmarks for UCLP patients were compatible with symmetric midsagittal reference planes from the Procrustes analysis and the asymmetric measurements.
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Shin SM, Kim YM, Kim NR, Choi YS, Park SB, Kim YI. Statistical shape analysis-based determination of optimal midsagittal reference plane for evaluation of facial asymmetry. Am J Orthod Dentofacial Orthop 2016; 150:252-60. [DOI: 10.1016/j.ajodo.2016.01.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 01/01/2016] [Accepted: 01/01/2016] [Indexed: 10/21/2022]
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Fang JJ, Tu YH, Wong TY, Liu JK, Zhang YX, Leong IF, Chen KC. Evaluation of mandibular contour in patients with significant facial asymmetry. Int J Oral Maxillofac Surg 2016; 45:922-31. [DOI: 10.1016/j.ijom.2016.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 12/22/2015] [Accepted: 02/15/2016] [Indexed: 11/29/2022]
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Combined use of rapid-prototyping model and surgical guide in correction of mandibular asymmetry malformation patients with normal occlusal relationship. J Craniofac Surg 2015; 26:418-21. [PMID: 25759918 DOI: 10.1097/scs.0000000000001528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of this study is to discuss the application of rapid-prototyping model and surgical guide in the treatment of mandibular asymmetry malformation with normal occlusal relationship. STUDY DESIGN Twenty-four mandibular asymmetry malformation patients with relatively normal occlusal relationship were included in this study. Surgical 3-dimensional rapid-prototyping mandibular models were made for all patients from the computed tomography (CT) DICOM data. The presurgical plan was designed on the model, and the surgical guiders for the osteotomy lines were manufactured. Genioplasty and/or mandibular osteotomy based on the presurgical plan were performed on these patients with the combined use of the rapid-prototyping model and surgical guides. All patients underwent postoperative CT scan and had at least 3-month follow-up. RESULT All patients were satisfied with the final results. According to the postoperative CT images and 3-month follow-up, all patients' mandibular asymmetry malformation was significantly improved, and the operation time was distinctly shortened relative to the conventional method. CONCLUSION Rapid-prototyping model and surgical guide are viable auxiliary devices for the treatment of mandibular asymmetry malformation with relatively normal occlusal relationship. Combined use of them can make precise preoperative design, improve effects of operation, and shorten operating time.
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