1
|
Jiao Z, Liang Z, Liao Q, Chen S, Yang H, Hong G, Gui H. Deep learning for automatic detection of cephalometric landmarks on lateral cephalometric radiographs using the Mask Region-based Convolutional Neural Network: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:554-562. [PMID: 38480069 DOI: 10.1016/j.oooo.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/24/2024] [Accepted: 02/04/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE We examined the effectiveness and feasibility of the Mask Region-based Convolutional Neural Network (Mask R-CNN) for automatic detection of cephalometric landmarks on lateral cephalometric radiographs (LCRs). STUDY DESIGN In total, 400 LCRs, each with 19 manually identified landmarks, were collected. Of this total, 320 images were randomly selected as the training dataset for Mask R-CNN, and the remaining 80 images were used for testing the automatic detection of the 19 cephalometric landmarks, for a total of 1520 landmarks. Detection rate, average error, and detection accuracy rate were calculated to assess Mask R-CNN performance. RESULTS Of the 1520 landmarks, 1494 were detected, for a detection rate of 98.29%. The average error, or linear deviation distance between the detected points and the originally marked points of each detected landmark, ranged from 0.56 to 9.51 mm, with an average of 2.19 mm. For detection accuracy rate, 649 landmarks (43.44%) had a linear deviation distance less than 1 mm, 1020 (68.27%) less than 2 mm, and 1281 (85.74%) less than 4 mm in deviation from the manually marked point. The average detection time was 1.48 seconds per image. CONCLUSIONS Deep learning Mask R-CNN shows promise in enhancing cephalometric analysis by automating landmark detection on LCRs, addressing the limitations of manual analysis, and demonstrating effectiveness and feasibility.
Collapse
Affiliation(s)
- Zhentao Jiao
- Department of Oral and Maxillofacial Surgery, Dalian Stomatological Hospital, Dalian, China; Division for Globalization Initiative, Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Zhuangzhuang Liang
- School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Qian Liao
- Department of Oral and Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai, China
| | - Sheng Chen
- Department of Oral and Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai, China
| | - Hui Yang
- Department of Oral and Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai, China
| | - Guang Hong
- Division for Globalization Initiative, Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, Sendai, Japan.
| | - Haijun Gui
- Department of Oral and Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai, China.
| |
Collapse
|
2
|
Rosmaninho A, Zeitler JM, Vedovato E, Kois JC, Revilla-León M. Using an additively manufactured natural head position reference device to transfer the horizon orientation plane and integrate it with a 3-dimensional virtual patient: A dental technique. J Prosthet Dent 2024; 131:7-12. [PMID: 35382942 DOI: 10.1016/j.prosdent.2022.02.012] [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: 12/27/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 10/18/2022]
Abstract
A virtual patient is obtained by aligning a patient's digital information, including facial and intraoral digital scans with or without hard tissue information from a cone beam computed tomography scan. However, while computer-aided design programs facilitate virtual patient integration, they do not provide a way to relate the horizon orientation with the patient's horizontal and vertical facial references. The present technique describes a way of relating the horizon orientation plane to the natural head position of the patient. An additively manufactured natural head position reference device was used to transfer the horizon orientation plane to the 3-dimensional virtual patient.
Collapse
Affiliation(s)
| | | | | | - John C Kois
- Founder and Director Kois Center, Seattle, Wash; Affiliate Professor, Graduate Prosthodontics, Department of Restorative Dentistry, University of Washington, Seattle, Wash; Private Practice, Seattle, Wash
| | - Marta Revilla-León
- Affiliate Assistant Professor, Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash; Director of Research and Digital Dentistry, Kois Center, Seattle, Wash; Adjunct Professor, Department of Prosthodontics, Tufts University, Boston, Mass.
| |
Collapse
|
3
|
Ruggiero F, Borghi A, Bevini M, Badiali G, Lunari O, Dunaway D, Marchetti C. Soft tissue prediction in orthognathic surgery: Improving accuracy by means of anatomical details. PLoS One 2023; 18:e0294640. [PMID: 38011187 PMCID: PMC10681161 DOI: 10.1371/journal.pone.0294640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
Three-dimensional virtual simulation of orthognathic surgery is now a well-established method in maxillo-facial surgery. The commercial software packages are still burdened by a consistent imprecision on soft tissue predictions. In this study, the authors produced an anatomically detailed patient specific numerical model for simulation of soft tissue changes in orthognathic surgery. Eight patients were prospectively enrolled. Each patient underwent CBCT and planar x-rays prior to surgery and in addition received an MRI scan. Postoperative soft-tissue change was simulated using Finite Element Modeling (FEM) relying on a patient-specific 3D models generated combining data from preoperative CBCT (hard tissue) scans and MRI scans (muscles and skin). An initial simulation was performed assuming that all the muscles and the other soft tissue had the same material properties (Homogeneous Model). This model was compared with the postoperative CBCT 3D simulation for validation purpose. Design of experiments (DoE) was used to assess the effect of the presence of the muscles considered and of their variation in stiffness. The effect of single muscles was evaluated in specific areas of the midface. The quantitative distance error between the homogeneous model and actual patient surfaces for the midface area was 0.55 mm, standard deviation 2.9 mm. In our experience, including muscles in the numerical simulation of orthognathic surgery, brought an improvement in the quality of the simulation obtained.
Collapse
Affiliation(s)
| | - Alessandro Borghi
- Department of Engineering, Durham University, Durham, United Kingdom
| | - Mirko Bevini
- Oral and Maxillofacial Surgery Unit, IRCCS AOU di Bologna, Bologna, Italy
| | - Giovanni Badiali
- DIBINEM, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Oral and Maxillofacial Surgery Unit, IRCCS AOU di Bologna, Bologna, Italy
| | - Ottavia Lunari
- Oral and Maxillofacial Surgery Unit, IRCCS AOU di Bologna, Bologna, Italy
| | - David Dunaway
- Craniofacial Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Claudio Marchetti
- DIBINEM, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Oral and Maxillofacial Surgery Unit, IRCCS AOU di Bologna, Bologna, Italy
| |
Collapse
|
4
|
Surgical Correction of Maxillofacial Skeletal Deformities. J Oral Maxillofac Surg 2023; 81:E95-E119. [PMID: 37833031 DOI: 10.1016/j.joms.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
|
5
|
Trevisiol L, Bersani M, Martinez Garza A, Alvarado E, Arnett GW, D'Agostino A. Accuracy of virtual surgical planning in bimaxillary orthognathic surgery with mandible first sequence: A retrospective study. J Craniomaxillofac Surg 2023:S1010-5182(23)00093-8. [PMID: 37355372 DOI: 10.1016/j.jcms.2023.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/27/2023] [Accepted: 05/23/2023] [Indexed: 06/26/2023] Open
Abstract
The aim of this study was to verify treatment accuracy using virtual surgical planning (VSP) with a mandible-first sequence and strict surgical protocol to determine what surgical and methodological factors might influence outcomes. VSP transfer accuracy was evaluated retrospectively through a modified method involving voxel-based superimposition in patients who had undergone bimaxillary surgery with a mandible-first sequence to correct dentoskeletal deformities. Data analysis showed that the movements planned and those executed were substantially equivalent (p < 0.01), with the exception of mandibular and maxillary sagittal movements that were 0.72 ± 0.90 mm and 1.41 ± 1.04 mm smaller, respectively, than planned. This study showed that a mandible-first sequence is accurate for transferring virtual surgical planning intraoperatively. There are several factors involved in the proper transfer of virtual planning beyond the software, such as surgical technique and sequencing. Inaccurate sagittal movements and maxillary repositioning seem to depend mainly on surgical factors.
Collapse
Affiliation(s)
- Lorenzo Trevisiol
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Massimo Bersani
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy.
| | | | | | | | - Antonio D'Agostino
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| |
Collapse
|
6
|
Yoo HJ, Hartsfield JK, Mian AS, Allan BP, Naoum S, Lee RJH, Goonewardene MS. Accuracy of mandibular repositioning surgery using new technology: Computer-aided design and manufacturing customized surgical cutting guides and fixation plates. Am J Orthod Dentofacial Orthop 2023; 163:357-367.e3. [PMID: 36503861 DOI: 10.1016/j.ajodo.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/01/2021] [Accepted: 12/01/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Recent 3-dimensional technology advancements have resulted in new techniques to improve the accuracy of intraoperative transfer. This study aimed to validate the accuracy of computer-aided design and manufacturing (CAD-CAM) customized surgical cutting guides and fixation plates on mandibular repositioning surgery performed in isolation or combined with simultaneous maxillary repositioning surgery. METHODS Sixty patients who underwent mandibular advancement surgery by the same surgeon were retrospectively evaluated by 3-dimensional surface-based superimposition. A 3-point coordinate system (x, y, z) was used to identify the linear and angular discrepancies between the planned movements and actual outcomes. Wilcoxon rank sum test was used to compare the outcomes between the mandible-only and the bimaxillary surgery groups with significance at P <0.05. Pearson correlation coefficient compared planned mandible advancement to the outcome from advancement planned. The centroid, which represents the mandible as a single unit, was computed from 3 landmarks, and the discrepancies were evaluated by the root mean square error (RMSE) for clinical significance set at 2 mm for linear discrepancies and 4° for angular discrepancies. RESULTS There was no statistically significant difference between the planned and actual position of the mandible in either group when considering absolute values of the differences. When considering raw directional data, a statistically significant difference was identified in the y-axis suggesting a tendency for under-advancement of the mandible in the bimaxillary group. The largest translational RMSE for the centroid was 0.77 mm in the sagittal dimension for the bimaxillary surgery group. The largest rotational RMSE for the centroid was 1.25° in the transverse dimension for the bimaxillary surgery group. Our results show that the precision and clinical feasibility of CAD-CAM customized surgical cutting guides and fixation plates on mandibular repositioning surgery is well within clinically acceptable parameters. CONCLUSION Mandibular repositioning surgery can be performed predictably and accurately with the aid of CAD-CAM customized surgical cutting guides and fixation plates with or without maxillary surgery.
Collapse
Affiliation(s)
- Ho Jin Yoo
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - James K Hartsfield
- Division of Orthodontics, Department of Oral Health Science, College of Dentistry, and Department of Microbiology, Immunology and Molecular Genetics, College of Medicine, University of Kentucky, Lexington, KY; Division of Oral Development and Behavioural Sciences, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - Ajmal S Mian
- School of Computer Science and Software Engineering, the University of Western Australia, Crawley, Western Australia, Australia
| | - Brent P Allan
- Private practice, Perth, Western Australia, Australia; Department of Orthodontics, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Steven Naoum
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - Richard J H Lee
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - Mithran S Goonewardene
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia.
| |
Collapse
|
7
|
CASAGRANDE CPM, CASAGRANDE MVS, TEIXEIRA AODB, ALENCAR DS, DIAS BSDB, ALMEIDA RCC, QUINTÃO CA, CARVALHO FAR. Cartesian three-dimensional method to quantify displacements between cone beam computed tomography models. Dental Press J Orthod 2023; 27:e222199. [PMID: 36629628 PMCID: PMC9829105 DOI: 10.1590/2177-6709.27.5.e222199.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/24/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Research in Orthodontics and Oral Surgery has been relying on three-dimensional (3D) models to evaluate treatment results with displacement color map techniques, even though it has important limitations. OBJECTIVES This study proposed a method of tracking translational movements of 3D objects to evaluate displacements in surfaces with no shape modification. METHODS Cone Beam Computed Tomography (CBCT) data of ten patients were imported to the Dolphin software. A hypothetical virtual surgical plan (randomly defined) was developed in the software and afterwards verified using the proposed method. All the procedures were carried out by two evaluators, in two different time-points, with a 15-day interval. ITK-Snap software was used to generate high quality STL models. Centroid points were automatically generated and their coordinates were compared to confirm if they represented the known displacements simulated. The paired t-test and the Bland-Altman plots were used, as well as the intraclass correlation coefficient. RESULTS Interexaminers and intra-examiner tests showed excellent reliability of the method, with mean displacement measurement error values under 0.1mm. The paired t-test did not show any statistically significant differences. CONCLUSION The method showed excellent reliability to track the simulated translational displacements of bone segments.
Collapse
Affiliation(s)
| | | | | | - David Silveira ALENCAR
- Universidade do Estado do Rio de Janeiro, Faculdade de Odontologia (Rio de Janeiro/RJ, Brazil).
| | | | | | - Cátia Abdo QUINTÃO
- Universidade do Estado do Rio de Janeiro, Faculdade de Odontologia (Rio de Janeiro/RJ, Brazil).
| | | |
Collapse
|
8
|
A method based on 3D affine alignment for the quantification of palatal expansion. PLoS One 2022; 17:e0278301. [PMID: 36584107 PMCID: PMC9803133 DOI: 10.1371/journal.pone.0278301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 11/14/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The current methodologies to quantify the palatal expansion are based on a preliminary rigid superimposition of 3D digital models representing the status of a given patient at different times. A new method based on affine alignment is proposed and compared to the gold standard, leading to the automatic analysis of 3-dimensional structural changes and to a simple numeric quantification of overall expansion vector and a better alignment of the digital models. MATERIALS AND METHODS 40 digital models (timing span delta 25.8 ± 12.5 months) from young patients (mean age 10.7 ± 2.6) treated with two different palatal expansion techniques (20 subjects with RME-Rapid Maxillary Expander, and 20 subjects with NiTiSE, NiTi self-expander) were superimposed with the new affine alignment technique implemented as an extension package of the open-source MeshLab, from a golden standard starting point of rigid alignment. The results were then compared. RESULTS The new measurement function indicates a mean expansion expressed in a single numeric value of 9.3%, 10.3% for the RME group and 8.4% for the NiTiSE group respectively. The comparison with the golden standard showed a decrease to the average error from 0.91 mm to 0.58 mm. CONCLUSIONS Affine alignment improves the current perspective of structural change quantification in the specific group of growing patients treated with palatal expanders giving the clinician useful information on the 3-dimensional morphological changes.
Collapse
|
9
|
Barretto MDA, Melhem-Elias F, Deboni MCZ. The untold history of planning in orthognathic surgery: a narrative review from the beginning to virtual surgical simulation. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e251-e259. [PMID: 35413462 DOI: 10.1016/j.jormas.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
We aimed to produce a narrative review of planning orthognathic surgery, chronologically. Also, to present flaws of methods and the future of orthognathic surgery planning. The search was carried out mainly in PubMed, SCOPUS, Embase, and Cochrane databases. Also was complemented by manual search in reference lists from identified studies and in grey literature. The first orthognathic surgery was reported in 1849, and it took more than a century for the development of the traditional orthognathic 2D planning. Besides the advances, surgeons observed failures and lacks on 2D method in representing with reliability the facial and maxillary tridimensional structure (3D). With technological developments in 90s and 2000s, methodological improvements were granted, and the 3D protocol was created. The CASS and Charlotte protocols were the earliest 3D planning protocols conceived. Since then, some steps were simplified, and new technologies are being developed and added to create a more reliable and precise way of planning orthognathic surgery.
Collapse
Affiliation(s)
- M D A Barretto
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, Sao Paulo, SP 05088-000, Brazil.
| | - F Melhem-Elias
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, Sao Paulo, SP 05088-000, Brazil
| | - M C Z Deboni
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, Sao Paulo, SP 05088-000, Brazil
| |
Collapse
|
10
|
Melhem-Elias F, Reis BAQ, Afonso FAC, Barretto MDA, Deboni MCZ. An innovative universal protocol for orthognathic surgery three-dimensional virtual simulation. Int J Oral Maxillofac Surg 2022; 52:691-695. [PMID: 36115779 DOI: 10.1016/j.ijom.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/11/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
The aim of this technical note is to describe a protocol for three-dimensional virtual simulation of orthognathic surgery that has been designed to be easily implemented, without the need for any special clinical apparatus, software brand, or computed tomography sequence. The protocol comprises innovative concepts and simplified steps for image segmentation, creation of a composite skull, control of the condylar position, and sequencing of bimaxillary surgery. This protocol was applied by the developers in about 2000 cases performed between 2015 and 2022, and has become quite popular among local surgeons. Previous preliminary studies have shown that it meets the accuracy standards for clinical use, although further studies with larger numbers of patients are desirable for additional validation.
Collapse
Affiliation(s)
- F Melhem-Elias
- Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil; Private Practice in Oral and Maxillofacial Surgery, São Paulo-SP, Brazil.
| | - B A Q Reis
- Private Practice in Oral and Maxillofacial Surgery, São Paulo-SP, Brazil
| | - F A C Afonso
- Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil
| | - M D A Barretto
- Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil
| | - M C Z Deboni
- Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil
| |
Collapse
|
11
|
Chin Wing Osteotomy for Improving Mandible Projection and Contour in Patients with Normal Occlusion: Case Reports. J Maxillofac Oral Surg 2022; 21:521-529. [DOI: 10.1007/s12663-022-01708-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 03/08/2022] [Indexed: 10/18/2022] Open
|
12
|
Lobo F, Filho LI, Sigua-Rodriguez EA, da Silva BG, Tolentino EDS, Borges YM, da Silva MC, Tonin RH, Iwaki LCV. Evaluation of ortogonblender software bone movement tools in bimaxillary orthognatic surgeries performed in dolphin software. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:417-421. [PMID: 34628097 DOI: 10.1016/j.jormas.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022]
Abstract
The aim of this observational, longitudinal and retrospective study was to evaluate the fidelity of virtual surgical planning (VSP) performed on Dolphin Imaging & Management Solutions® 11.95 software on hard tissues, using the tools of the open-source software OrtogOnBlender - Blender3D. For this, linear, angular and 7-point anatomical measurements of the skeletal profile were used, and the discrepancies between the VSP and the result after bimaxillary orthognathic surgery were calculated. Pre- and postoperative cone beam CT (CBCT) scans of 43 consecutive patients with class II and III skeletal deformities were evaluated and the results of the VSP were compared to the 1-month postoperative results. All overlapping points presented values within the range considered clinically irrelevant (< 2 mm and < 4°) and differences were not significant (p > 0.05). The comparison of anatomical points showed lower values (≤ 2.11 mm) in point A of class II. For hard tissues, the comparison between VSP and 1-month postoperative tomography demonstrated the faithful results of virtual planning using this software.
Collapse
Affiliation(s)
- Fernanda Lobo
- Department of Dentistry, State University of Maringá (UEM), Maringá PR, Brazil.
| | - Liogi Iwaki Filho
- Department of Dentistry, State University of Maringá (UEM), Maringá PR, Brazil
| | | | - Breno Gabriel da Silva
- Department of Exact Sciences, "Luiz de Queiroz" College of Agriculture, University of São Paulo (ESALQ/USP), Piracicaba, Brazil
| | | | - Yana Miranda Borges
- Science and Technology of Amazonas (IFAM), Federal Institute of Education, Manaus, Brazil
| | | | | | | |
Collapse
|
13
|
Soft-Tissue Simulation for Computational Planning of Orthognathic Surgery. J Pers Med 2021; 11:jpm11100982. [PMID: 34683123 PMCID: PMC8540582 DOI: 10.3390/jpm11100982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/21/2021] [Accepted: 09/25/2021] [Indexed: 11/23/2022] Open
Abstract
Simulation technologies offer interesting opportunities for computer planning of orthognathic surgery. However, the methods used to date require tedious set up of simulation meshes based on patient imaging data, and they rely on complex simulation models that require long computations. In this work, we propose a modeling and simulation methodology that addresses model set up and runtime simulation in a holistic manner. We pay special attention to modeling the coupling of rigid-bone and soft-tissue components of the facial model, such that the resulting model is computationally simple yet accurate. The proposed simulation methodology has been evaluated on a cohort of 10 patients of orthognathic surgery, comparing quantitatively simulation results to post-operative scans. The results suggest that the proposed simulation methods admit the use of coarse simulation meshes, with planning computation times of less than 10 seconds in most cases, and with clinically viable accuracy.
Collapse
|
14
|
Different Modalities to Record and Transfer Natural Head Position to Virtual Planning in Orthognathic Surgery: Case Reports of Asymmetric Patients. J Maxillofac Oral Surg 2021; 20:443-454. [PMID: 34408372 DOI: 10.1007/s12663-020-01376-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/16/2020] [Indexed: 10/24/2022] Open
Abstract
Aim To describe different modalities to record and transfer natural head position (NHP) to 3D facial imaging by using the virtual surgical planning software in three facial asymmetry patients. Case Reports Three patients with facial asymmetries (A, B, and C) were evaluated by means of dental and facial analysis, photographs, cone-beam computed tomography (CBCT) and digitized dental arches. Before starting the VSP workflow with Dolphin Imaging, NHP was recorded by three modalities and transferred to three-dimensional (3D) facial images as follows: (a) facial photographs taken with digital camera and the estimated NHP was transferred to 3D images by comparing lines and planes from both images; (b) cross-line level laser was used to place radiopaque markers on the face skin for recording the estimated NHP, which was transferred to 3D images by alignment of planes and markers in the software; and (c) photographs of the face were processed to generate facial surface mesh by using the Agisoft PhotoScan software, which maintained the same position of the estimated NHP in 3D for aligning the images of the soft tissue with the facial surface mesh by using superimposition. All the three patients underwent bi-maxillary orthognathic surgery. Conclusion There are different modalities using simple and available technologies in the clinical routine, but whose reproducibility, reliability and validation could not be assessed nor compared to each other. There was no trend for better predictability, feasibility and efficiency because the postoperative outcomes were adequate regarding the patients' satisfaction and facial symmetry.
Collapse
|
15
|
Heifetz-Li JJ, Mechas N, Deitrick P. How accurate are patient-specific osteotomy guides and fixation plates in orthognathic surgery? ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
16
|
Position of the mandibular canal before and after bilateral sagittal split ramus osteotomy: a cone beam computed tomographic study. Br J Oral Maxillofac Surg 2021; 60:279-285. [PMID: 34311998 DOI: 10.1016/j.bjoms.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/03/2021] [Indexed: 11/21/2022]
Abstract
The aim of this study was to evaluate the position of the mandibular canal (MC) before and after bilateral sagittal split ramus osteotomy (BSSRO) using cone-beam computed tomography (CT), and to compare the position of the MC in Class II and Class III patients in the preoperative period. Patients were divided into two groups: Class II (n = 38) and Class III (n = 41). Measurements of the superior, inferior, buccal, and lingual distances of the MC in relation to the cortical bone were taken at three levels in the proximal segment of the mandible. Results were analysed using the Kruskal-Wallis test (p < 0.05). In the Class II group the superior distance of the MC at levels 2 and 3, and the inferior distance at level 3 significantly decreased after BSSRO. In the Class III group, no significant differences were found at any level, and the inferior distances at all levels were smaller preoperatively than those in the Class II group. In the Class II group the position of the MC altered in relation to superior and inferior cortical bone after BSSRO. However, the position of the MC remained stable in the Class III group. Our results also suggest a deeper cut in inferior cortical bone in Class III patients.
Collapse
|
17
|
Kim D, Kuang T, Rodrigues YL, Gateno J, Shen SGF, Wang X, Stein K, Deng HH, Liebschner MAK, Xia JJ. A novel incremental simulation of facial changes following orthognathic surgery using FEM with realistic lip sliding effect. Med Image Anal 2021; 72:102095. [PMID: 34090256 DOI: 10.1016/j.media.2021.102095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Abstract
Accurate prediction of facial soft-tissue changes following orthognathic surgery is crucial for surgical outcome improvement. We developed a novel incremental simulation approach using finite element method (FEM) with a realistic lip sliding effect to improve the prediction accuracy in the lip region. First, a lip-detailed mesh is generated based on accurately digitized lip surface points. Second, an improved facial soft-tissue change simulation method is developed by applying a lip sliding effect along with the mucosa sliding effect. Finally, the orthognathic surgery initiated soft-tissue change is simulated incrementally to facilitate a natural transition of the facial change and improve the effectiveness of the sliding effects. Our method was quantitatively validated using 35 retrospective clinical data sets by comparing it to the traditional FEM simulation method and the FEM simulation method with mucosa sliding effect only. The surface deviation error of our method showed significant improvement in the upper and lower lips over the other two prior methods. In addition, the evaluation results using our lip-shape analysis, which reflects clinician's qualitative evaluation, also proved significant improvement of the lip prediction accuracy of our method for the lower lip and both upper and lower lips as a whole compared to the other two methods. In conclusion, the prediction accuracy in the clinically critical region, i.e., the lips, significantly improved after applying incremental simulation with realistic lip sliding effect compared with the FEM simulation methods without the lip sliding effect.
Collapse
Affiliation(s)
- Daeseung Kim
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, 6560 Fannin St, Houston, TX 77030, USA
| | - Tianshu Kuang
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, 6560 Fannin St, Houston, TX 77030, USA
| | - Yriu L Rodrigues
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, 6560 Fannin St, Houston, TX 77030, USA
| | - Jaime Gateno
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, 6560 Fannin St, Houston, TX 77030, USA; Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, 407 E 61st St, New York, NY 10065, USA
| | - Steve G F Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University College of Medicine, 639 Zhi-Zao-Ju Road, Shanghai 200011, China
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University College of Medicine, 639 Zhi-Zao-Ju Road, Shanghai 200011, China
| | - Kirhyn Stein
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, 6560 Fannin St, Houston, TX 77030, USA
| | - Hannah H Deng
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, 6560 Fannin St, Houston, TX 77030, USA
| | - Michael A K Liebschner
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
| | - James J Xia
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, 6560 Fannin St, Houston, TX 77030, USA; Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, 407 E 61st St, New York, NY 10065, USA.
| |
Collapse
|
18
|
Harding J, Hartsfield JK, Mian AS, Allan BP, Naoum S, Lee RJH, Goonewardene MS. Accuracy of mandibular proximal segment position using virtual surgical planning and custom osteosynthesis plates. Int J Oral Maxillofac Surg 2021; 51:219-225. [PMID: 33941394 DOI: 10.1016/j.ijom.2021.04.002] [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: 09/14/2020] [Revised: 02/23/2021] [Accepted: 04/07/2021] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to determine whether the use of custom osteosynthesis plates increased the accuracy of proximal segment position following bilateral sagittal split osteotomy in a cohort of 30 patients when compared to a control group of 25 patients who had surgery with conventional plates. Surgery was performed by a single surgeon between October 2015 and December 2017. Post-surgical cone beam computed tomography scans were segmented using Mimics Innovation Suite (Materialise NV), and surface-based superimposition was achieved using ProPlan CMF (Materialise NV). However, there was a tendency for the rotational error to be smaller in the custom group than in the control group. The root mean square error in both groups and for all variables fell within clinical parameters of 2 mm and 4°. In conclusion, the results of this study indicate that customized mandibular fixation plates do not necessarily improve the accuracy of the proximal segments post-surgically; however they may be of benefit in individual patients.
Collapse
Affiliation(s)
- J Harding
- Orthodontic Department, UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - J K Hartsfield
- Orthodontics and Oral Health Research, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA; Division of Oral Development and Behavioural Sciences, UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - A S Mian
- School of Computer Science and Software Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - B P Allan
- Private Maxillofacial Surgery Practice, Perth, Australia
| | - S Naoum
- Orthodontic Department, UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - R J H Lee
- Orthodontic Department, UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - M S Goonewardene
- Orthodontic Department, UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia.
| |
Collapse
|
19
|
Ferraz FWDS, Iwaki-Filho L, Souza-Pinto GND, Iwaki LCV, Li AT, Cardoso MDA. A comparative study of the accuracy between two computer-aided surgical simulation methods in virtual surgical planning. J Craniomaxillofac Surg 2020; 49:84-92. [PMID: 33376041 DOI: 10.1016/j.jcms.2020.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/22/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The aim of this retrospective and observational study was to compare the accuracy of two different virtual surgical planning (VSP) protocols, namely, the CASS method and the modified CASS method. MATERIALS AND METHODS The patients underwent bimaxillary orthognathic surgery, planned using either the CASS method or the modified CASS method. Linear and angular discrepancies between the VSP outcome and postoperative outcome for both groups were compared for maxilla, mandible, and chin segments. Aside from the comparison between both groups, additional criteria were used to determine the accuracy of the protocol based on a linear and angular difference between planned and actual outcomes of less than 2 mm and 4°, respectively. The intergroup comparisons were performed by one-way ANOVA, with the level of significance set at 5%. RESULTS A total of 21 patients, of both genders, were assigned into group I (n = 11), planned with the CASS method, and group II (n = 10), planned with the modified CASS method. Both the CASS and modified CASS methods presented similar accuracy with regard to linear differences for the maxilla, mandible, and chin segments, except for ΔX for the mandibular segment, where the modified CASS method showed slightly better accuracy. However, there was a statistically significant difference with regard to angular differences in the chin segment, with the CASS method shown to be the more accurate. Aside from Δpitch for the chin segment, no linear or angular differences exceeded 2 mm or 4°. CONCLUSION Although statistically significant differences were found with regard to angular measurements in the chin segment, the accuracy of the modified CASS method for virtual planning can be considered as clinically equivalent, with a performance comparable to that of the CASS method.
Collapse
Affiliation(s)
- Flavio Wellington da Silva Ferraz
- Oral and Maxillofacial Surgery, Hospital Das Clínicas, University of São Paulo (USP), Rua Dr Eneas de Carvalho, 255, 05403-010, São Paulo, São Paulo, Brazil.
| | - Liogi Iwaki-Filho
- Oral and Maxillofacial Surgery, State University of Maringá (UEM), Avenida Mandacaru, 1550, 87080-000, Maringá, Paraná, Brazil.
| | - Gustavo Nascimento de Souza-Pinto
- Oral Radiology and Stomatology, Department of Dentistry, State University of Maringá (UEM), Avenida Mandacaru, 1550, 87080-000, Maringá, Paraná, Brazil.
| | - Lilian Cristina Vessoni Iwaki
- Oral Radiology and Stomatology, Department of Dentistry, State University of Maringá (UEM), Avenida Mandacaru, 1550, 87080-000, Maringá, Paraná, Brazil.
| | - An Tien Li
- Department of Dentistry, School of Health Sciences, University of Brasilia (UNB), Campus Universitário Darcy Ribeiro, Brasília, 70910-900, Distrito Federal, Brazil.
| | - Mauricio de Almeida Cardoso
- Department of Dentistry, São Leopoldo Mandic, Rua Dr José Rocha Junqueira, 13, 13045-755, Campinas, São Paulo, Brazil.
| |
Collapse
|
20
|
Accuracy and reliability of maxillary digital model (MDM) superimposition in evaluating teeth movement in adults compared with CBCT maxillary superimposition. Sci Rep 2020; 10:19384. [PMID: 33168909 PMCID: PMC7653916 DOI: 10.1038/s41598-020-76537-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 10/21/2020] [Indexed: 11/08/2022] Open
Abstract
Superimposition of 3D maxillary digital dental models of different time points based on palatal vault region has been used to evaluate tooth movement during orthodontic treatment. This study evaluated the accuracy and reliability of 3D maxillary digital model (MDM) superimposition in adults by comparing it with CBCT maxillary superimposition. In CBCT maxillary superimposition, voxel-based superimposition was firstly conducted, and MDMs were matched with corresponding CBCT models (CBCT-MDM superimposition). MDM superimposition (palatal vault regional superimposition) were performed on another pair of pre- and posttreatment MDMs. The position and orientation of upper first molars (U6s) and upper central incisors (U1s) on the posttreatment MDMs were compared to assess the accuracy of the MDM superimposition methods. The reliability was validated in both MDM superimposition and CBCT maxillary superimposition. In terms of accuracy, the average linear deviations in U6 and U1 positions were less than ± 0.3 mm, the average angular deviations of U6s and U1s were less than ± 0.2°, both have no significant difference from zero. The ICCs for MDM superimposition ranged from 0.85 to 0.99. The ICCs for CBCT-MDM superimposition were larger than 0.99 in all items. MDM superimposition was an efficient, accurate and reliable method for evaluating teeth movement in adults, although its reliability is slightly lower than CBCT maxillary superimposition.
Collapse
|
21
|
Otranto de Britto Teixeira A, Almeida MADO, Almeida RCDC, Maués CP, Pimentel T, Ribeiro DPB, Medeiros PJD, Quintão CCA, Carvalho FDAR. Three-dimensional accuracy of virtual planning in orthognathic surgery. Am J Orthod Dentofacial Orthop 2020; 158:674-683. [PMID: 33008712 DOI: 10.1016/j.ajodo.2019.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/01/2019] [Accepted: 09/01/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to assess the accuracy of virtual surgical planning (VSP) performed by Dolphin Imaging software (version 11.9; Dolphin Imaging and Management Solutions, Chatsworth, Calif). METHODS Ten people requiring bimaxillary surgery and genioplasty were followed up prospectively. All patients had preoperative cone-beam computed tomography, plaster models, and photographs allowing for VSP. Interocclusal intermediate surgical splints were produced using a 3-dimensional (3D) printer. Postoperative images were acquired 15 days after surgery using cone-beam computed tomography. ITK-Snap (version 3.6; Cognitica, Philadelphia, Pa) allowed the segmentation of reliable 3D models. Geomagic Qualify 2013 (3D Systems, Rock Hill, SC) and MeshValmet (version 3.0) were used to identify the differences between VSP and actual surgical results through the root mean square values and the 3D translational displacement (3-axes) of the 3D centroid of each model. RESULTS Discrepancies between the VSP and the actual result were found at the mandible (P = 0.013) and the chin (P = 0.013) when considering the root mean square values. In addition, 3D centroid differences were found in the transverse and sagittal direction of the right ramus (P = 0.034 and P = 0.005, respectively) and the sagittal aspect of the left ramus (P = 0.025). Considering 2 mm as a threshold of clinical relevance, almost all the bone fragments (maxilla, proximal, and distal mandibular segments) were accurately corrected by surgery, although not in the chin. CONCLUSIONS On the basis of the obtained values, it is possible to consider the Dolphin Imaging software as clinically acceptable for performing virtual orthognathic surgical planning.
Collapse
Affiliation(s)
| | | | | | - Caroline Pelagio Maués
- Department of Orthodontics, School of Dentistry, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thais Pimentel
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Danilo Passeado Branco Ribeiro
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paulo José de Medeiros
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Catia Cardoso Abdo Quintão
- Department of Orthodontics, School of Dentistry, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | |
Collapse
|
22
|
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.
Collapse
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.
| |
Collapse
|
23
|
Farrell BB. Evolving Management of Dentofacial Deformities with Digital Planning and Patient-Specific Fixation. Atlas Oral Maxillofac Surg Clin North Am 2020; 28:59-71. [PMID: 32741515 DOI: 10.1016/j.cxom.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Brian B Farrell
- Carolinas Center for Oral and Facial Surgery, 411 Billingsley Road, Suite 105, Charlotte, NC 28211, USA; Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
| |
Collapse
|
24
|
Tonin RH, Iwaki Filho L, Yamashita AL, Ferraz FWDS, Tolentino EDS, Previdelli ITDS, Brum B, Iwaki LCV. Accuracy of 3D virtual surgical planning for maxillary positioning and orientation in orthognathic surgery. Orthod Craniofac Res 2020; 23:229-236. [PMID: 31925879 DOI: 10.1111/ocr.12363] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/15/2019] [Accepted: 12/31/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This retrospective and observational study evaluated the accuracy of a 3D virtual surgical planning (VSP) for the maxillary positioning and orientation in patients undergoing bimaxillary orthognathic surgery, comparing the planned and postoperative outcomes. SETTING AND SAMPLE POPULATION Seventy consecutive patients of both sexes, who were submitted to bimaxillary orthognathic surgery between 2015 and 2019 were included in our study. MATERIAL AND METHODS The patients were evaluated by fusing preoperative planning and postoperative outcome using cone-beam computed tomography scan evaluation. Three-dimensional VSP and postoperative outcomes were compared by using three linear and three angular measurements. The main outcome interest was the difference between the VSP movement, and the surgical movement obtained. The success criterion adopted was a mean linear difference of <2 mm and a mean angular difference of <4°. RESULTS Results were analysed using a linear mixed model with fixed and random effects, at α = .05. No significant statistical differences were found for linear and angular measurements between the planned and postsurgical outcomes (P > .05). All overlapping points presented values within the range considered clinically irrelevant (<2 mm; <1°). CONCLUSIONS Three-dimensional VSP was executed with a high degree of accuracy. When comparing the planned and postsurgical outcomes, all overlapping points presented values within the range considered clinically irrelevant.
Collapse
Affiliation(s)
| | | | | | - Flávio Wellington da Silva Ferraz
- Oral and Maxillofacial Surgery Department, Clinics Hospital of Medicine School and University Hospital of the University of São Paulo, São Paulo, Brazil
| | | | | | - Beatriz Brum
- Statistic Department, State University of Maringá, Maringá, Brazil
| | | |
Collapse
|
25
|
Elnagar MH, Aronovich S, Kusnoto B. Digital Workflow for Combined Orthodontics and Orthognathic Surgery. Oral Maxillofac Surg Clin North Am 2019; 32:1-14. [PMID: 31699582 DOI: 10.1016/j.coms.2019.08.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article provides an overview of the digital workflow process for Combined orthodontics and Orthognathic surgery treatment starting from data acquisition (3-dimensional scanning, cone-beam computed tomography), data preparation, processing and Creation of a three-dimensional virtual augmented model of the head. Establishing a Proper Diagnosis and Quantification of the Dentofacial Deformity using 3D diagnostic model. Furthermore, performance of 3-dimensional Virtual orthognathic surgical treatment, and the construction of a surgical splint (via 3-dimensional printing) to allow transfer of the treatment plan to the actual patient during surgery.
Collapse
Affiliation(s)
- Mohammed H Elnagar
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, Room 131, Chicago, IL 60612-7211, USA.
| | - Sharon Aronovich
- Department of Oral and Maxillofacial Surgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Budi Kusnoto
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, Room 131, Chicago, IL 60612-7211, USA
| |
Collapse
|
26
|
Bell RB. A History of Orthognathic Surgery in North America. J Oral Maxillofac Surg 2019; 76:2466-2481. [PMID: 30502870 DOI: 10.1016/j.joms.2018.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 10/27/2022]
Abstract
This review highlights the contributions of American oral and maxillofacial surgeons to the field of orthognathic surgery. The present state of the art and science of orthognathic surgery is the harvest of yesterday's innovation and research. An improved understanding of the biological and surgical principles and the routine involvement of orthodontics have fueled widespread adoption of a coordinated approach to the treatment of dentofacial problems. Technologic advances in rigid internal fixation, virtual surgical planning with computer-aided manufacturing of occlusal splints and cutting guides, custom implants, and worldwide interest in the correction of dentofacial and craniofacial deformities have resulted in highly predictable, efficient, and safe treatment, which scarcely resembles the situation 70 years ago.
Collapse
Affiliation(s)
- R Bryan Bell
- Medical Director, Providence Head and Neck Cancer Program, and Associate Member, Earle A. Chiles Research Institute, Robert W. Franz Cancer Center, Providence Cancer Institute Head and Neck Institute, Portland, OR.
| |
Collapse
|
27
|
Jakobsone G, Vuollo V, Pirttiniemi P. Reproducibility of Natural Head Position assessed with stereophotogrammetry. Orthod Craniofac Res 2019; 23:66-71. [PMID: 31514260 DOI: 10.1111/ocr.12344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to assess the stability of Natural Head Position (NHP) over time using the 3dMDface System. SETTING AND SAMPLE POPULATION This was an experimental study. Three-dimensional facial images of 40 students were captured on two different occasions, with an interval of at least two weeks. MATERIALS AND METHODS The images were taken using a stereophotogrammetric device (3dMD). The mirror positioned NHP was obtained in a standing position and then replicated in a sitting position for capturing. The self-balanced NHP was taken in a sitting position. Rapidform 3D software was used for position angle calculations. The angle changes between the positions were calculated for rotations around the x-, y- and z-axes. RESULTS The differences between NHP in the self-balanced and mirror positions recorded on the first and second occasions were 2.43 and 1.75 degrees, respectively, around the x-axis. The average changes in NHP around the x-axis between the self-balanced and mirror balanced positions exceeded 3 degrees at the two-week interval. The differences were smaller for the rotations around the y- and z-axes. Some subjects consistently tended to hold their heads in a more extended position when self-balanced, while others did this when mirror balanced. There was no difference in the reproducibility of NHP between men and women. CONCLUSION The reproducibility of NHP for consecutive stereophotogrammetric captures is generally acceptable. The reproducibility of NHP using the mirror position was slightly better compared with NHP in the sitting self-balanced position.
Collapse
Affiliation(s)
| | - Ville Vuollo
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University, Hospital and University of Oulu, Oulu, Finland
| | - Pertti Pirttiniemi
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University, Hospital and University of Oulu, Oulu, Finland
| |
Collapse
|
28
|
Theoretical Basis for Virtual Skull Orientation According to Three-Dimensional Frankfort Horizontal Plane for Computer-Aided Surgical Simulation. J Craniofac Surg 2019; 30:1902-1905. [PMID: 31449216 DOI: 10.1097/scs.0000000000005595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Computer-aided surgical simulation (CASS) is an evolving technology which has significantly affected surgical correction of dentofacial deformities, a key step of which is orientation of the virtual skull model to allow for analysis and treatment planning. Explored in this study is the coplanarity of a 3-dimensional Frankfort horizontal plane (3D FHP). MATERIALS AND METHODS The 122 17.0 cm field-of-view cone-beam computed-tomogram (CBCT) scans were oriented to a 3D FHP using right porion, right orbitale, and left orbitale. The distance between the 3D FHP and left porion was then measured. The 18 CBCT scans were found to have external fiducial markers which were used for orientation into natural head position (NHP). The distance between left porion and a true horizontal plan coincidental with the right porion was measured. Concordance reliability measures were calculated to compare NHP to 3D FHP. RESULTS The average distance of left porion to 3D FHP was found to be -0.107 mm (SD = 1.148), and the average distance from the coincidental left porion in NHP was found to be 0.846 mm (SD = 2.611). Concordance reliability calculations shows little consistency between the 2 methods of orientation (P = 0.838). CONCLUSIONS The data shows coincidence between left porion and 3D FHP. Orientation of the virtual skull model according to 3D FHP offers a quick and easy method for this important step in CASS. Further study is needed for evaluation of this method in vivo.
Collapse
|
29
|
Comparison of the Planned Versus Actual Jaw Movement Using Splint-Based Virtual Surgical Planning: How Close Are We at Achieving the Planned Outcomes? J Oral Maxillofac Surg 2019; 77:1675-1680. [DOI: 10.1016/j.joms.2019.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 11/23/2022]
|
30
|
Souza Pinto GND, Iwaki Filho L, Previdelli ITDS, Ramos AL, Yamashita AL, Stabile GAV, Stabile CLP, Iwaki LCV. Three-dimensional alterations in pharyngeal airspace, soft palate, and hyoid bone of class II and class III patients submitted to bimaxillary orthognathic surgery: A retrospective study. J Craniomaxillofac Surg 2019; 47:883-894. [DOI: 10.1016/j.jcms.2019.03.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/11/2019] [Accepted: 03/11/2019] [Indexed: 11/29/2022] Open
|
31
|
Accuracy of digital technologies for the scanning of facial, skeletal, and intraoral tissues: A systematic review. J Prosthet Dent 2019; 121:246-251. [DOI: 10.1016/j.prosdent.2018.01.015] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 11/24/2022]
|
32
|
Lee SJ, Yang HJ, Choi MH, Woo SY, Huh KH, Lee SS, Heo MS, Choi SC, Hwang SJ, Yi WJ. Real-time augmented model guidance for mandibular proximal segment repositioning in orthognathic surgery, using electromagnetic tracking. J Craniomaxillofac Surg 2018; 47:127-137. [PMID: 30447987 DOI: 10.1016/j.jcms.2018.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/17/2018] [Accepted: 10/18/2018] [Indexed: 10/28/2022] Open
Abstract
It is essential to reposition the mandibular proximal segment (MPS) as close to its original position as possible during orthognathic surgery. Conventional methods cannot pinpoint the exact position of the condyle in the fossa in real time during repositioning. In this study, based on an improved registration method and a separable electromagnetic tracking tool, we developed a real-time, augmented, model-guided method for MPS surgery to reposition the condyle into its original position more accurately. After virtual surgery planning, using a complex maxillomandibular model, the final position of the virtual MPS model was simulated via 3D rotations. The displacements resulting from the MPS simulation were applied to the MPS landmarks to indicate their final postoperative positions. We designed a new registration body with 24 fiducial points for registration, and determined the optimal point group on the registration body through a phantom study. The registration between the patient's CT image and physical spaces was performed preoperatively using the optimal points. We also developed a separable frame for installing the electromagnetic tracking tool on the patient's MPS. During MPS surgery, the electromagnetic tracking tool was repeatedly attached to, and separated from, the MPS using the separable frame. The MPS movement resulting from the surgeon's manipulation was tracked by the electromagnetic tracking system. The augmented condyle model and its landmarks were visualized continuously in real time with respect to the simulated model and landmarks. Our method also provides augmented 3D coronal and sagittal views of the fossa and condyle, to allow the surgeon to examine the 3D condyle-fossa positional relationship more accurately. The root mean square differences between the simulated and intraoperative MPS models, and between the simulated and postoperative CT models, were 1.71 ± 0.63 mm and 1.89 ± 0.22 mm respectively at three condylar landmarks. Thus, the surgeons could perform MPS repositioning conveniently and accurately based on real-time augmented model guidance on the 3D condyle positional relationship with respect to the glenoid fossa, using augmented and simulated models and landmarks.
Collapse
Affiliation(s)
- Sang-Jeong Lee
- Department of Biomedical Radiation Sciences (Head: Sung-Joon Ye, PhD), Graduate School of Convergence Science and Technology, Seoul National University, South Korea
| | - Hoon Joo Yang
- Orthognathic Surgery Center (Head: Soon Jung Hwang, DDS, MD, PhD), Seoul National University Dental Hospital, South Korea
| | - Min-Hyuk Choi
- Department of Biomedical Radiation Sciences (Head: Sung-Joon Ye, PhD), Graduate School of Convergence Science and Technology, Seoul National University, South Korea
| | - Sang-Yoon Woo
- Department of Biomedical Radiation Sciences (Head: Sung-Joon Ye, PhD), Graduate School of Convergence Science and Technology, Seoul National University, South Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology (Head: Min-Suk Heo, DDS, PhD), School of Dentistry and Dental Research Institute, Seoul National University, South Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology (Head: Min-Suk Heo, DDS, PhD), School of Dentistry and Dental Research Institute, Seoul National University, South Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology (Head: Min-Suk Heo, DDS, PhD), School of Dentistry and Dental Research Institute, Seoul National University, South Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology (Head: Min-Suk Heo, DDS, PhD), School of Dentistry and Dental Research Institute, Seoul National University, South Korea
| | - Soon Jung Hwang
- Department of Oral and Maxillofacial Surgery (Head: Jin-Young Choi, DDS, MD, PhD), School of Dentistry, Dental Research Institute, BK21 Plus, Seoul National University, South Korea.
| | - Won-Jin Yi
- Department of Biomedical Radiation Sciences (Head: Sung-Joon Ye, PhD), Graduate School of Convergence Science and Technology, Seoul National University, South Korea; Department of Oral and Maxillofacial Radiology (Head: Min-Suk Heo, DDS, PhD), School of Dentistry and Dental Research Institute, Seoul National University, South Korea.
| |
Collapse
|
33
|
Lee MK, Lane C, Azeredo F, Landsberger M, Kapadia H, Sheller B, Yen SL. Clinical effectiveness of late maxillary protraction in cleft lip and palate: A methods paper. Orthod Craniofac Res 2018. [PMID: 28643931 DOI: 10.1111/ocr.12182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES A prospective parallel cohort trial was conducted to compare outcomes of patients treated with maxillary protraction vs LeFort 1 maxillary advancement surgery. SETTING AND SAMPLE POPULATION The primary site for the clinical trial is Children's Hospital Los Angeles; the satellite test site is Seattle Children's Hospital. All patients have isolated cleft lip and palate and a skeletal Class III malocclusion. MATERIAL AND METHODS A total of 50 patients, ages 11-14, will be recruited for the maxillary protraction cohort. The maxillary surgery cohort consists of 50 patients, ages 16-21, who will undergo LeFort 1 maxillary advancement surgery. Patients with additional medical or cognitive handicaps were excluded from the study. RESULTS Current recruitment of patients is on track to complete the study within the proposed recruitment period. CONCLUSION This observational trial is collecting information that will examine dental, skeletal, financial and quality-of-life issues from both research cohorts.
Collapse
Affiliation(s)
- M K Lee
- Division of Dentistry, Children's Hospital Los Angeles, Los Angeles, CA, USA.,University of Southern California, Los Angeles, CA, USA
| | - C Lane
- Department of Biostatistics, University of Southern California, Los Angeles, CA, USA
| | - F Azeredo
- Department of Orthodontics, Pontifical Catholic University of Rio Grande do Sul - PUCRS, Porto Alegre, Brazil
| | - M Landsberger
- Division of Dentistry, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - H Kapadia
- Department of Dentistry, Seattle Children's Hospital, Seattle, WA, USA
| | - B Sheller
- Department of Dentistry, Seattle Children's Hospital, Seattle, WA, USA
| | - S L Yen
- Division of Dentistry, Children's Hospital Los Angeles, Los Angeles, CA, USA.,University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
34
|
Stokbro K, Thygesen T. A 3-Dimensional Approach for Analysis in Orthognathic Surgery—Using Free Software for Voxel-Based Alignment and Semiautomatic Measurement. J Oral Maxillofac Surg 2018; 76:1316-1326. [DOI: 10.1016/j.joms.2017.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 10/04/2017] [Accepted: 11/04/2017] [Indexed: 10/18/2022]
|
35
|
Lee R, Goonewardene MS, Mian A, Allan B, Brock D, Trevenen M. Accuracy of orthognathic surgery using 3D computer-assisted surgical simulation. AUSTRALASIAN ORTHODONTIC JOURNAL 2018. [DOI: 10.21307/aoj-2020-055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Objective
To evaluate the accuracy of maxilla and mandibular repositioning during two-jaw orthognathic surgery using computerassisted
surgical simulation (CASS)
Materials and methods
Fifteen patients who underwent two-jaw orthognathic surgery using CASS (VSP,® Orthognathics by 3D Systems) were evaluated to assess the accuracy of the simulation. Translational and rotational discrepancies of the centroids of the maxilla and mandible and the translational discrepancy of the dental midline between the planned and actual outcomes were reported using the root mean square error (RMSE). The number of cases that exceeded limits set for clinical significance, the direction of the error in relation to the direction of planned movement and the differences between segmental and non-segmental procedures were evaluated as secondary outcomes
Results
The largest translational RMSE was 1.53 mm along the y-axis in the maxilla and 1.34 mm along the y-axis in the mandible. The largest rotational RMSE was 1.9° about the x-axis in the maxilla and 1.16° about the x- and y-axes in the mandible. The largest RMSE for the dental midline was 1.6 mm along the y-axis in the maxilla and 1.34 mm along the y-axis in the mandible. A tendency for insufficient advancement of the maxilla was noted
Conclusions
CASS is an efficient and accurate way to develop the surgical plan and transfer the plan to the patient intraoperatively. While CASS is accurate on a population level, there remains the potential for clinically significant errors to occur on an individual basis
Conclusion
The present case indicated that the timely extraction of palatally-placed maxillary lateral incisors facilitated functional appliance therapy in the management of a skeletal Class II problem. The crowding of the lower anterior teeth was relieved and alignment of the upper arch was achieved with full fixed appliance therapy, resulting in improved aesthetics and a stable occlusion at one year review
Collapse
Affiliation(s)
- Richard Lee
- Department of Orthodontics , School of Dentistry, The University of Western Australia , Perth , Australia
| | - Mithran S Goonewardene
- Department of Orthodontics , School of Dentistry, The University of Western Australia , Perth , Australia
| | - Ajmal Mian
- School of Computer Science and Software Engineering , The University of Western Australia , Perth , Australia
| | - Brent Allan
- Department of Orthodontics , School of Dentistry, The University of Western Australia , Perth , Australia
| | - Danny Brock
- Biomedical Engineer, 3D Systems , Littleton , USA
| | - Michelle Trevenen
- Centre for Applied Statistics, School of Mathematics and Statistics, The University of Western Australia , Perth , Australia
| |
Collapse
|
36
|
Zhang X, Kim D, Shen S, Yuan P, Liu S, Tang Z, Zhang G, Zhou X, Gateno J, Liebschner MAK, Xia JJ. An eFTD-VP framework for efficiently generating patient-specific anatomically detailed facial soft tissue FE mesh for craniomaxillofacial surgery simulation. Biomech Model Mechanobiol 2017; 17:387-402. [PMID: 29027022 DOI: 10.1007/s10237-017-0967-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 09/25/2017] [Indexed: 11/26/2022]
Abstract
Accurate surgical planning and prediction of craniomaxillofacial surgery outcome requires simulation of soft tissue changes following osteotomy. This can only be achieved by using an anatomically detailed facial soft tissue model. The current state-of-the-art of model generation is not appropriate to clinical applications due to the time-intensive nature of manual segmentation and volumetric mesh generation. The conventional patient-specific finite element (FE) mesh generation methods are to deform a template FE mesh to match the shape of a patient based on registration. However, these methods commonly produce element distortion. Additionally, the mesh density for patients depends on that of the template model. It could not be adjusted to conduct mesh density sensitivity analysis. In this study, we propose a new framework of patient-specific facial soft tissue FE mesh generation. The goal of the developed method is to efficiently generate a high-quality patient-specific hexahedral FE mesh with adjustable mesh density while preserving the accuracy in anatomical structure correspondence. Our FE mesh is generated by eFace template deformation followed by volumetric parametrization. First, the patient-specific anatomically detailed facial soft tissue model (including skin, mucosa, and muscles) is generated by deforming an eFace template model. The adaptation of the eFace template model is achieved by using a hybrid landmark-based morphing and dense surface fitting approach followed by a thin-plate spline interpolation. Then, high-quality hexahedral mesh is constructed by using volumetric parameterization. The user can control the resolution of hexahedron mesh to best reflect clinicians' need. Our approach was validated using 30 patient models and 4 visible human datasets. The generated patient-specific FE mesh showed high surface matching accuracy, element quality, and internal structure matching accuracy. They can be directly and effectively used for clinical simulation of facial soft tissue change.
Collapse
Affiliation(s)
- Xiaoyan Zhang
- College of Computer Science and Software Engineering, Shenzhen University, Shenzhen, China
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Daeseung Kim
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Shunyao Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th Peoples Hospital, Shanghai Jiaotong University School of Medicine and Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Peng Yuan
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Siting Liu
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Zhen Tang
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Guangming Zhang
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Xiaobo Zhou
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jaime Gateno
- Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College of Cornell University, New York, NY, USA
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Michael A K Liebschner
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA.
| | - James J Xia
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th Peoples Hospital, Shanghai Jiaotong University School of Medicine and Shanghai Key Laboratory of Stomatology, Shanghai, China.
- Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College of Cornell University, New York, NY, USA.
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA.
| |
Collapse
|
37
|
Rangel FA, Maal TJJ, de Koning MJJ, Bronkhorst EM, Bergé SJ, Kuijpers-Jagtman AM. Integration of digital dental casts in cone beam computed tomography scans-a clinical validation study. Clin Oral Investig 2017; 22:1215-1222. [PMID: 28932947 PMCID: PMC5866842 DOI: 10.1007/s00784-017-2203-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 09/04/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Images derived from cone beam computed tomography (CBCT) scans lack detailed information on the dentition and interocclusal relationships needed for proper surgical planning and production of surgical splints. To get a proper representation of the dentition, integration of a digital dental model into the CBCT scan is necessary. The aim of this study was to validate a simplified protocol to integrate digital dental models into CBCT scans using only one scan. MATERIALS AND METHODS Conventional protocol A used one combined upper and lower impression and two CBCT scans. The new protocol B included placement of ten markers on the gingiva, one CBCT scan, and two separate impressions of the upper and lower dentition. Twenty consecutive patients, scheduled for mandibular advancement surgery, were included. To validate protocol B, 3-dimensional reconstructions were made, which were compared by calculating the mean intersurface distances obtained with both protocols. RESULTS The mean distance for all patients for the upper jaw is 0.39 mm and for the lower jaw is 0.30 mm. For ten out of 20 patients, all distances were less than 1 mm. For the other ten patients, all distances were less than 2 mm. CONCLUSIONS Mean distances of 0.39 and 0.30 mm are clinically acceptable and comparable to other studies; therefore, this new protocol is clinically accurate. CLINICAL RELEVANCE This new protocol seems to be clinically accurate. It is less time consuming, gives less radiation exposure for the patient, and has a lower risk for positional errors of the impressions compared to other integration protocols.
Collapse
Affiliation(s)
- Frits A Rangel
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, 309 Dentistry, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Thomas J J Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Martien J J de Koning
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ewald M Bronkhorst
- Department of Preventive and Restorative Dentistry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Stefaan J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, 309 Dentistry, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| |
Collapse
|
38
|
Cottrell DA, Farrell B, Ferrer-Nuin L, Ratner S. Surgical Correction of Maxillofacial Skeletal Deformities. J Oral Maxillofac Surg 2017; 75:e94-e125. [DOI: 10.1016/j.joms.2017.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
39
|
Kim D, Ho DCY, Mai H, Zhang X, Shen SGF, Shen S, Yuan P, Liu S, Zhang G, Zhou X, Gateno J, Liebschner MAK, Xia JJ. A clinically validated prediction method for facial soft-tissue changes following double-jaw surgery. Med Phys 2017; 44:4252-4261. [PMID: 28570001 DOI: 10.1002/mp.12391] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE It is clinically important to accurately predict facial soft-tissue changes prior to orthognathic surgery. However, the current simulation methods are problematic, especially in anatomic regions of clinical significance, e.g., the nose, lips, and chin. We developed a new 3-stage finite element method (FEM) approach that incorporates realistic tissue sliding to improve such prediction. METHODS In Stage One, soft-tissue change was simulated, using FEM with patient-specific mesh models generated from our previously developed eFace template. Postoperative bone movement was applied on the patient mesh model with standard FEM boundary conditions. In Stage Two, the simulation was improved by implementing sliding effects between gum tissue and teeth using a nodal force constraint scheme. In Stage Three, the result of the tissue sliding effect was further enhanced by reassigning the soft-tissue-bone mapping and boundary conditions using nodal spatial constraint. Finally, our methods have been quantitatively and qualitatively validated using 40 retrospectively evaluated patient cases by comparing it to the traditional FEM method and the FEM with sliding effect, using a nodal force constraint method. RESULTS The results showed that our method was better than the other two methods. Using our method, the quantitative distance errors between predicted and actual patient surfaces for the entire face and any subregions thereof were below 1.5 mm. The overall soft-tissue change prediction was accurate to within 1.1 ± 0.3 mm, with the accuracy around the upper and lower lip regions of 1.2 ± 0.7 mm and 1.5 ± 0.7 mm, respectively. The results of qualitative evaluation completed by clinical experts showed an improvement of 46% in acceptance rate compared to the traditional FEM simulation. More than 80% of the result of our approach was considered acceptable in comparison with 55% and 50% following the other two methods. CONCLUSION The FEM simulation method with improved sliding effect showed significant accuracy improvement in the whole face and the clinically significant regions (i.e., nose and lips) in comparison with the other published FEM methods, with or without sliding effect using a nodal force constraint. The qualitative validation also proved the clinical feasibility of the developed approach.
Collapse
Affiliation(s)
- Daeseung Kim
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Dennis Chun-Yu Ho
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Huaming Mai
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Xiaoyan Zhang
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Steve G F Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, 200011, China
| | - Shunyao Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, 200011, China
| | - Peng Yuan
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Siting Liu
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Guangming Zhang
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA
| | - Xiaobo Zhou
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA
| | - Jaime Gateno
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA.,Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY, 10065, USA
| | | | - James J Xia
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA.,Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, 200011, China.,Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY, 10065, USA
| |
Collapse
|
40
|
Li B, Shen S, Jiang W, Li J, Jiang T, Xia JJ, Shen SG, Wang X. A new approach of splint-less orthognathic surgery using a personalized orthognathic surgical guide system: A preliminary study. Int J Oral Maxillofac Surg 2017; 46:1298-1305. [PMID: 28552440 DOI: 10.1016/j.ijom.2017.03.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 10/15/2016] [Accepted: 03/20/2017] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to evaluate a personalized orthognathic surgical guide (POSG) system for bimaxillary surgery without the use of surgical splint. Ten patients with dentofacial deformities were enrolled. Surgeries were planned with the computer-aided surgical simulation method. The POSG system was designed for both maxillary and mandibular surgery. Each consisted of cutting guides and three-dimensionally (3D) printed custom titanium plates to guide the osteotomy and repositioning the bony segments without the use of the surgical splints. Finally, the outcome evaluation was completed by comparing planned outcomes with postoperative outcomes. All operations were successfully completed using the POSG system. The largest root-mean-square deviations were 0.74mm and 1.93° for the maxillary dental arch, 1.10mm and 2.82° for the mandibular arch, 0.83mm and 2.59° for the mandibular body, and 0.98mm and 2.45° for the proximal segments. The results of the study indicated that our POSG system is capable of accurately and effectively transferring the surgical plan without the use of surgical splint. A significant advantage is that the repositioning of the bony segments is independent to the mandibular autorotation, thus eliminates the potential problems associated with the surgical splint.
Collapse
Affiliation(s)
- B Li
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - S Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - W Jiang
- Clinical Translation R&D Center of 3D Printing Technology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J Li
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - T Jiang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J J Xia
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute for Academic Medicine, Houston Methodist Hospital, Texas, USA; Weill Medical College, Cornell University, New York, NY, USA
| | - S G Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - X Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China.
| |
Collapse
|
41
|
Bendrihem R, Vacher C, Fohlen A, Pelage JP. Anatomic basis of Le Fort 1 impaction osteotomy: a radiological study. Surg Radiol Anat 2017; 39:1209-1214. [PMID: 28528359 DOI: 10.1007/s00276-017-1870-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/07/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE In Le Fort 1 osteotomy when a maxillary impaction is necessary, surgeons have to face different anatomical problems. (1) To determine the best bone resection route, they have to consider the situation of dental roots, infraorbital foramen and maxillary artery. (2) In case of Le Fort 1 osteotomy combined with a mandibular sagittal split osteotomy, the palate has to be replaced in horizontal position although there is no anatomical landmark. (3) In case of Gummy smiles, it can be due to either long face or short upper lip. The main objective was to identify safe bony landmarks to perform a Le Fort I osteotomy and to find a reliable way for repositioning the palate horizontally; the secondary objective was to determine the upper lip normal length. METHODS The study was based on 178 facial CT examinations. The following parameters have been used: the vertical length of the upper lip, the vertical heights of the anterior nasal spine, the canine and molar roots, the inferior limit of the pterygomaxillary fossa and the vertical height of the infraorbital foramen on both sides. RESULTS The vertical length from the subnasal point to the upper vermilion was 15.06 ± 3.09 mm, and to the junction of the upper and lower lips was 23.94 ± 3.79 mm. The vertical length from the anterior nasal spine to the incisor alveolar border was 19.70 ± 3.17 mm. The height of the canine root was 17.11 ± 2.60 mm. The height of the highest lateral root of first or second maxillary molars was 11.71 ± 1.83 mm. The vertical length from the inferior limit of the pterygomaxillary fossa (pti point) to the alveolar border of the pterygomaxillary suture was 19.86 ± 3.45 mm. The height from the center of the infraorbital foramen to the alveolar border of the maxilla on a vertical line was not statistically different on right and left sides. CONCLUSIONS According to our results, in impaction Le Fort 1 osteotomy, the bone resection must pass 20 mm above the alveolar border in canine area, and 15 mm above the alveolar border in molar area. The resection has to end less than 20 mm above the inferior border of the pterygomaxillary suture. The vertical height of the infraorbital foramen is a consistent landmark for repositioning of the palate in a horizontal plane.
Collapse
Affiliation(s)
- Rivka Bendrihem
- Department of Radiology, Faculté de Médecine de Caen, CHU de Caen, Avenue de la côte de nacre, 14000, Caen, France.
| | - Christian Vacher
- Department of Anatomy, Faculté de Médecine, Paris-Diderot, Paris, France.,EA 2496, Paris-Descartes, Paris, France.,Department of Oral and Maxillofacial Surgery, Hôpital Beaujon, APHP, Paris, France
| | - Audrey Fohlen
- Department of Radiology, Faculté de Médecine de Caen, CHU de Caen, Avenue de la côte de nacre, 14000, Caen, France
| | - Jean-Pierre Pelage
- Department of Radiology, Faculté de Médecine de Caen, CHU de Caen, Avenue de la côte de nacre, 14000, Caen, France
| |
Collapse
|
42
|
Design, development and clinical validation of computer-aided surgical simulation system for streamlined orthognathic surgical planning. Int J Comput Assist Radiol Surg 2017; 12:2129-2143. [PMID: 28432489 DOI: 10.1007/s11548-017-1585-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE There are many proven problems associated with traditional surgical planning methods for orthognathic surgery. To address these problems, we developed a computer-aided surgical simulation (CASS) system, the AnatomicAligner, to plan orthognathic surgery following our streamlined clinical protocol. METHODS The system includes six modules: image segmentation and three-dimensional (3D) reconstruction, registration and reorientation of models to neutral head posture, 3D cephalometric analysis, virtual osteotomy, surgical simulation, and surgical splint generation. The accuracy of the system was validated in a stepwise fashion: first to evaluate the accuracy of AnatomicAligner using 30 sets of patient data, then to evaluate the fitting of splints generated by AnatomicAligner using 10 sets of patient data. The industrial gold standard system, Mimics, was used as the reference. RESULT When comparing the results of segmentation, virtual osteotomy and transformation achieved with AnatomicAligner to the ones achieved with Mimics, the absolute deviation between the two systems was clinically insignificant. The average surface deviation between the two models after 3D model reconstruction in AnatomicAligner and Mimics was 0.3 mm with a standard deviation (SD) of 0.03 mm. All the average surface deviations between the two models after virtual osteotomy and transformations were smaller than 0.01 mm with a SD of 0.01 mm. In addition, the fitting of splints generated by AnatomicAligner was at least as good as the ones generated by Mimics. CONCLUSION We successfully developed a CASS system, the AnatomicAligner, for planning orthognathic surgery following the streamlined planning protocol. The system has been proven accurate. AnatomicAligner will soon be available freely to the boarder clinical and research communities.
Collapse
|
43
|
Leung MY, Lo J, Leung YY. Accuracy of Different Modalities to Record Natural Head Position in 3 Dimensions: A Systematic Review. J Oral Maxillofac Surg 2016; 74:2261-2284. [PMID: 27235181 DOI: 10.1016/j.joms.2016.04.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Three-dimensional (3D) images are taken with positioning devices to ensure a patient's stability, which, however, place the patient's head into a random orientation. Reorientation of images to the natural head position (NHP) is necessary for appropriate assessment of dentofacial deformities before any surgical planning. The aim of this study was to review the literature systematically to identify and evaluate the various modalities available to record the NHP in 3 dimensions and to compare their accuracy. MATERIALS AND METHODS A systematic literature search of the PubMed, Cochrane Library and Embase databases, with no limitations on publication time or language, was performed in July 2015. The search and evaluations of articles were performed in 4 rounds. The methodologies, accuracies, advantages, and limitations of various modalities to record NHP were examined. RESULTS Eight articles were included in the final review. Six modalities to record NHP were identified, namely 1) stereophotogrammetry, 2) facial markings along laser lines, 3) clinical photographs and the pose from orthography and scaling with iterations (POSIT) algorithm, 4) digital orientation sensing, 5) handheld 3D camera measuring system, and 6) laser scanning. Digital orientation sensing had good accuracy, with mean angular differences from the reference within 1° (0.07 ± 0.49° and 0.12 ± 0.54°, respectively). Laser scanning was shown to be comparable to digital orientation sensing. The method involving clinical photographs and the POSIT algorithm was reported to have good accuracy, with mean angular differences for pitch, roll, and yaw within 1° (-0.17 ± 0.50°). Stereophotogrammetry was reported to have the highest reliability, with mean angular deviations in pitch, roll, and yaw for active and passive stereophotogrammetric devices within 0.1° (0.004771 ± 0.045645° and 0.007572 ± 0.079088°, respectively). CONCLUSIONS This systematic review showed that recording the NHP in 3 dimensions with a digital orientation sensor has good accuracy. Laser scanning was found to have comparable accuracy to digital orientation sensing, but routine clinical use was limited by its high cost and low portability. Stereophotogrammetry and the method using a single clinical photograph and the POSIT algorithm were potential alternatives. Nevertheless, clinical trials are needed to verify their applications in patients. Preferably, digital orientation sensor should be used as a reference for comparison with new proposed methods of recording the NHP in future research.
Collapse
Affiliation(s)
- Ming Yin Leung
- Resident, Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - John Lo
- Honorary Associate Professor, Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Yiu Yan Leung
- Clinical Assistant Professor, Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| |
Collapse
|
44
|
Xia JJ, Gateno J, Teichgraeber JF, Yuan P, Li J, Chen KC, Jajoo A, Nicol M, Alfi DM. Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 2: three-dimensional cephalometry. Int J Oral Maxillofac Surg 2016; 44:1441-50. [PMID: 26573563 DOI: 10.1016/j.ijom.2015.06.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/27/2015] [Accepted: 06/08/2015] [Indexed: 11/25/2022]
Abstract
Three-dimensional (3D) cephalometry is not as simple as just adding a 'third' dimension to a traditional two-dimensional cephalometric analysis. There are more complex issues in 3D analysis. These include how reference frames are created, how size, position, orientation and shape are measured, and how symmetry is assessed. The main purpose of this article is to present the geometric principles of 3D cephalometry. In addition, the Gateno-Xia cephalometric analysis is presented; this is the first 3D cephalometric analysis to observe these principles.
Collapse
Affiliation(s)
- J J Xia
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Oral and Maxillofacial Surgery, Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, NY, USA.
| | - J Gateno
- Oral and Maxillofacial Surgery, Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, NY, USA; Department of Oral and Maxillofacial Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - J F Teichgraeber
- Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, TX, USA
| | - P Yuan
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - J Li
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - K-C Chen
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Department of Oral and Maxillofacial Surgery, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan
| | - A Jajoo
- Department of Mathematics, University of Houston, TX, USA
| | - M Nicol
- Department of Mathematics, University of Houston, TX, USA
| | - D M Alfi
- Oral and Maxillofacial Surgery, Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, NY, USA; Department of Oral and Maxillofacial Surgery, Houston Methodist Hospital, Houston, TX, USA
| |
Collapse
|
45
|
Resection of giant invasive sacral schwannoma using image-based customized osteotomy tools. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:4103-4107. [DOI: 10.1007/s00586-016-4782-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/23/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
|
46
|
Inverted L osteotomy: a new approach via intraoral access through the advances of virtual surgical planning and custom fixation. ORAL AND MAXILLOFACIAL SURGERY CASES 2016. [DOI: 10.1016/j.omsc.2016.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|