1
|
Zhou G, Yu F, Yu H, Xia L, Yuan L, Fang B. Treatment of skeletal class III malocclusion using a combined clear aligner and surgery-early approach : Assessment based on the American Board of Orthodontics Objective Grading System. J Orofac Orthop 2024; 85:359-367. [PMID: 36867218 DOI: 10.1007/s00056-023-00458-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 01/10/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE To evaluate whether clear aligner therapy (CAT) combined with a surgery-early approach can achieve good therapeutic effects in patients with skeletal class III malocclusion. METHODS Thirty consecutive skeletal class III malocclusion cases treated with clear aligners combined with early surgery were selected. Treatment time, lateral cephalograms and American Board of Orthodontics Objective Grading System (ABO-OGS) scores of the treatment models were measured to evaluate the treatment efficiency, facial profile, and occlusion. RESULTS The results showed that early surgery was achieved after 7.71 months of presurgical orthodontics, on average. ANB decreased by 5.57° (P < 0.001), and STissue N Vert to Pog' decreased by 7.29 mm (P = 0.001), both reaching normal values. The posttreatment ABO-OGS scores were 26.600 on average, meeting its standards. CONCLUSIONS With the assistance of CAT, early surgery can be accomplished in patients with skeletal class III malocclusion, improving their facial profile and achieving functional occlusion.
Collapse
Affiliation(s)
- Guoli Zhou
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, 500 Quxi Road, 200011, Shanghai, China
| | - Fei Yu
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, 500 Quxi Road, 200011, Shanghai, China
| | - Hongbo Yu
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, 500 Quxi Road, 200011, Shanghai, China
| | - Lunguo Xia
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, 500 Quxi Road, 200011, Shanghai, China
| | - Lingjun Yuan
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, 500 Quxi Road, 200011, Shanghai, China
| | - Bing Fang
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, 500 Quxi Road, 200011, Shanghai, China.
| |
Collapse
|
2
|
Han W, Yichi Z, Kim BS, Sun M, Chai G. Correcting facial asymmetry through guided plate assisted mandibular angle osteotomy. Front Surg 2024; 11:1391231. [PMID: 39149133 PMCID: PMC11324470 DOI: 10.3389/fsurg.2024.1391231] [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: 02/25/2024] [Accepted: 07/22/2024] [Indexed: 08/17/2024] Open
Abstract
Background Asian women prefer a smooth and narrowed mandibular appearance. The purpose of the retrospective cohort study is to evaluate guide plate-assisted mandibular angle ostectomy (MAO) in improving mandibular symmetry for Asian female patients with mandibular angle hypertrophy (MAH) with normal occlusal relationship. Methods We retrospectively examined 11 patients with asymmetry MAH with normal occlusal relationship who received MAO at Shanghai Ninth People's Hospital between September, 2020, and January, 2022. Preoperative plans were designed based on CT data and executed using metal guide plate during the operation. Preoperative and one-week postoperative CT scans were used to assess measurements including Height_Go, Divergence_Go, ∠ZyZy-GoGo, and osteotomy volume, to evaluate symmetry. For precision, compare the postoperative CT with the preoperative design, assessing osteotomy distance, angle, and volume error. Patient satisfacation was evaluated with Likert Scale in 6-month follow-up. Secondary lipofilling procedures were given as appropriate. Statistical analysis was performed using paired t-tests in SPSS. Results The mean age of the 11 patients was 28.5 years (range 23-34 years). 2 of these underwent lipofilling procedures. No complications were observed during the following-up. Postoperative results were not statistically different from the design, demonstrating a precision of within 2 mm. Height_Go disparity within 5 mm get corrected notably, reducing asymmetry from 15.09% preoperatively to 2.74% postoperatively. Patients satisfaction was rated at 4.5 out of 5 in 6 month follow-up. Conclusions Guide plate-assisted mandibular angle osteotomies achieve effective and precise surgery. This approach demonstrates a safe option for correction for mandibular asymmetry, achieving patient satisfaction.
Collapse
Affiliation(s)
- Wenqing Han
- Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhang Yichi
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Byeong Seop Kim
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mengzhe Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Gang Chai
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
3
|
Pandey R, Kamble R, Kanani H. Revolutionizing Smiles: Advancing Orthodontics Through Digital Innovation. Cureus 2024; 16:e64086. [PMID: 39114257 PMCID: PMC11305434 DOI: 10.7759/cureus.64086] [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: 06/06/2024] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
Orthodontics is undergoing a digital revolution, transforming traditional techniques with modern technology. This evolution is driven by the need for precise diagnosis and treatment planning. Digital platforms, including digital radiography and cone beam computed tomography (CBCT), are replacing conventional methods, enhancing documentation, analysis, and appliance production. Three-dimensional imaging enables customized treatment plans and appliance design using computer-aided design and computer-aided manufacture (CAD/CAM). Integration of digital models and software facilitates treatment simulation and patient communication. Digital videography enhances diagnostic capabilities. Embracing digital processes is essential for improved patient care and practice efficiency in orthodontics. This review article on digital orthodontics aims to provide a comprehensive overview and critical analysis of the current advancements, technologies, applications, benefits, and challenges in the field of orthodontics utilizing digital tools and technologies.
Collapse
Affiliation(s)
- Ruchika Pandey
- Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ranjit Kamble
- Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Harikishan Kanani
- Pediatric Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| |
Collapse
|
4
|
On SW, Cho SW, Park SY, Yi SM, Park IY, Byun SH, Kim JC, Yang BE. Advancements in computer-assisted orthognathic surgery: A comprehensive review and clinical application in South Korea. J Dent 2024; 146:105061. [PMID: 38729289 DOI: 10.1016/j.jdent.2024.105061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES Orthognathic surgery (OS) has evolved with technological advancements, notably through the implementation of computer-assisted orthognathic surgery (CAOS). This article aims to elucidate various types of CAOS and their efficiency and accuracy, supplemented by a thorough literature review focusing on their clinical applications in South Korea. STUDY SELECTION, DATA, AND SOURCES A comprehensive search strategy was employed, including systematic reviews, meta-analyses, randomized controlled trials, and observational studies published until December 2023 in the PubMed, MEDLINE, and Google Scholar databases. The literature search was limited to articles written in English. RESULTS Static CAOS demonstrated high precision, reduced operative time, and high accuracy, suggesting its potential reliability in orthognathic procedures. Dynamic CAOS presented a promising avenue for exploration, showing an accuracy comparable to that of traditional methods. The critical considerations for CAOS include accuracy, time efficiency, and cost-effectiveness. Recent studies have indicated advancements in the time efficiency of static CAOS. Static CAOS requires less equipment and is more cost-effective than dynamic CAOS. CONCLUSIONS CAOS offers clear advantages over conventional OS in terms of surgical convenience and accuracy in implementing the surgical plan. To achieve recognition as the gold standard method for maxillofacial deformity treatment, CAOS must overcome its limitations and undergo continuous verification via well-designed studies. CLINICAL SIGNIFICANCE The introduction of CAOS, mainly static CAOS with high precision and reduced surgical time, signifies a notable advancement in OS. However, rigorous studies are warranted to validate CAOS as the gold standard for treating maxillofacial deformities.
Collapse
Affiliation(s)
- Sung-Woon On
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, South Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea
| | - Seoung-Won Cho
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea
| | - Sang-Yoon Park
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea; Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang 14066, South Korea
| | - Sang-Min Yi
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea; Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang 14066, South Korea
| | - In-Young Park
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang 14066, South Korea; Department of Orthodontics, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea
| | - Soo-Hwan Byun
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea; Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang 14066, South Korea
| | - Jong-Cheol Kim
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea; Daegu Mir Dental Hospital, Daegu 41940, South Korea
| | - Byoung-Eun Yang
- Department of Artificial Intelligence and Robotics in Dentistry, Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, South Korea; Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, South Korea; Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang 14066, South Korea.
| |
Collapse
|
5
|
De Meurechy NKG, Decoste C, Mommaerts MY. On the use of intraoperative 3D-RX C-arm imaging in orthognathic surgery: a prospective non-consecutive case series study. Oral Maxillofac Surg 2024; 28:101-109. [PMID: 36279049 DOI: 10.1007/s10006-022-01119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
CONTEXT Segment and osteosynthesis malposition resulting in patients' complaints (mainly about asymmetries) are encountered in orthofacial/orthognathic surgery. OBJECTIVE, DESIGN, AND SETTING We planned to investigate the usefulness of intraoperative three-dimensional (3D) imaging concerning positioning and fixation of bone segments and osteosynthesis in orthognathic/orthofacial surgery. We performed a prospective study of non-consecutive cases. All patients receiving a bimaxillary osteotomy, genioplasty, and their combinations were included in the study from May 2016 to May 2020. Unilateral and bilateral sagittal split osteotomies were excluded. There were no gender and age limitations. All were intraoperatively examined using the BV Pulsera 3D-RX System (Philips Medical, Eindhoven, The Netherlands). The outcome variables were the percentage of revisions of segment positioning and osteosynthesis. Predictor variables were age, gender, type of surgery, timing (pre- and post-imaging), and surgeon experience (senior vs assistant). RESULTS Forty female and twenty-two male patients were included (mean age 25.25 years ± 7.52 and 29.1 years ± 12.6 respectively). We evaluated 27 genioplasties and 34 Le Fort "type-I" osteotomies. Indications for segment repositioning and redo-osteosynthesis increased after intraoperative imaging as compared to operator's clinical judgment before intraoperative imaging (95% confidence interval; p < .001 and p = .002 respectively). CONCLUSION Suboptimal positioning and fixation of bone segments or osteosynthesis were more apparent with 3D imaging. In addition, some satisfactory cases were also revised for an optimal outcome. As a result, surgeons were prompted to more revisions than judged necessary without intraoperative imaging.
Collapse
Affiliation(s)
- Nikolas K G De Meurechy
- European Face Centre, University Hospital Brussels, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - Christopher Decoste
- European Face Centre, University Hospital Brussels, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - Maurice Y Mommaerts
- European Face Centre, University Hospital Brussels, Laarbeeklaan 101, B-1090, Brussels, Belgium.
| |
Collapse
|
6
|
Barone S, Cevidanes L, Miranda F, Gurgel ML, Anchling L, Hutin N, Bianchi J, Goncalves JR, Giudice A. Enhancing skeletal stability and Class III correction through active orthodontist engagement in virtual surgical planning: A voxel-based 3-dimensional analysis. Am J Orthod Dentofacial Orthop 2024; 165:321-331. [PMID: 38010236 PMCID: PMC10923113 DOI: 10.1016/j.ajodo.2023.09.016] [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: 07/01/2023] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Skeletal stability after bimaxillary surgical correction of Class III malocclusion was investigated through a qualitative and quantitative analysis of the maxilla and the distal and proximal mandibular segments using a 3-dimensional voxel-based superimposition among virtual surgical predictions performed by the orthodontist in close communication with the maxillofacial surgeon and 12-18 months postoperative outcomes. METHODS A comprehensive secondary data analysis was conducted on deidentified preoperative (1 month before surgery [T1]) and 12-18 months postoperative (midterm [T2]) cone-beam computed tomography scans, along with virtual surgical planning (VSP) data obtained by Dolphin Imaging software. The sample for the study consisted of 17 patients (mean age, 24.8 ± 3.5 years). Using 3D Slicer software, automated tools based on deep-learning approaches were used for cone-beam computed tomography orientation, registration, bone segmentation, and landmark identification. Colormaps were generated for qualitative analysis, whereas linear and angular differences between the planned (T1-VSP) and observed (T1-T2) outcomes were calculated for quantitative assessments. Statistical analysis was conducted with a significance level of α = 0.05. RESULTS The midterm surgical outcomes revealed a slight but significantly less maxillary advancement compared with the planned position (mean difference, 1.84 ± 1.50 mm; P = 0.004). The repositioning of the mandibular distal segment was stable, with insignificant differences in linear (T1-VSP, 1.01 ± 3.66 mm; T1-T2, 0.32 ± 4.17 mm) and angular (T1-VSP, 1.53° ± 1.60°; T1-T2, 1.54° ± 1.50°) displacements (P >0.05). The proximal segments exhibited lateral displacement within 1.5° for both the mandibular right and left ramus at T1-VSP and T1-T2 (P >0.05). CONCLUSIONS The analysis of fully digital planned and surgically repositioned maxilla and mandible revealed excellent precision. In the midterm surgical outcomes of maxillary advancement, a minor deviation from the planned anterior movement was observed.
Collapse
Affiliation(s)
- Selene Barone
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy.
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Felicia Miranda
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Marcela Lima Gurgel
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Luc Anchling
- Chemistry and Chemical Engineering School - Digital Sciences School Lyon, Lyon, France
| | - Nathan Hutin
- Chemistry and Chemical Engineering School - Digital Sciences School Lyon, Lyon, France
| | - Jonas Bianchi
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, Calif
| | - Joao Roberto Goncalves
- Department of Pediatric Dentistry, School of Dentist, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Amerigo Giudice
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
| |
Collapse
|
7
|
Straub A, Gubik S, Kübler A, Breitenbuecher N, Vollmer A, Renner T, Müller-Richter U, Hartmann S, Brands R. Comparison of Patient-Specific Condylar Positioning Devices and Manual Methods in Orthognathic Surgery: A Prospective Randomized Trial. J Clin Med 2024; 13:737. [PMID: 38337431 PMCID: PMC10856595 DOI: 10.3390/jcm13030737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND This study investigated whether patient-specific condylar positioning devices (CPDs) are beneficial compared to the conventional manual positioning of the condyles. METHODS In this prospective, randomized trial, patients undergoing orthognathic surgery with a bilateral sagittal split osteotomy of the mandible were included. The ascending ramus was positioned with computer-aided designed and computer-aided manufactured (CAD/CAM) patient-specific devices in the CPD group and manually in the control group. Postoperatively, cone-beam computed tomography (CBCT) was performed to align the virtually planned position with the postoperative result. RESULTS Thirty patients were enrolled in the study, with 14 randomized to the CPD group and 16 to the control group. In the CPD group, the ascending ramus differed in the postoperative CBCT scan from the virtually planned position by 0.8 mm in the left/right, 0.8 mm in the front/back, and 1.3 mm in the cranial/caudal direction. The corresponding control-group values were 1.1 mm, 1.3 mm, and 1.6 mm. CPD and controls differed significantly for the left/right movement of the rami (p = 0.04) but not for the other directions or rotations (p > 0.05). CONCLUSIONS The results demonstrate that both methods are accurate, and postoperative results matched the virtually planned position precisely. It can be assumed that the described CPDs are beneficial when a condylar position different from the preoperative is desired.
Collapse
Affiliation(s)
- Anton Straub
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Pellby D, Bengtsson M. Do Patients Detect Changes in Breathing After Orthognathic Surgery? J Oral Maxillofac Surg 2024; 82:36-46. [PMID: 37858599 DOI: 10.1016/j.joms.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Orthognathic surgery addresses facial aesthetics and function in patients with dentofacial deformities. It is associated with changes in upper airway volume (UAV). If changes in UAV are perceived by asymptomatic patients is unclear. PURPOSE The purpose was to measure associations between changes in UAV and patient-reported benefits using patient-reported outcome measures. STUDY DESIGN A sample presenting dentofacial deformities without reported breathing problems undergoing orthognathic surgery was retrospectively studied. Patients aged 18-30 years with 12-month follow-up were included. Patients with systemic disease, drug abuse, mental health disorder, or temporomandibular joint dysfunction were excluded. PREDICTOR The predictor variable was changes in UAV measured in 3-dimensional computed tomography. Subjects were grouped into increased or decreased UAV. MAIN OUTCOME VARIABLE The primary outcome variable was changes in health-related quality of life measured with Oral Health Impact Profile 49 (OHIP-49). COVARIATES Weight, height, age, sex, and sub-scaled OHIP-49 were registered. Cephalometric measurements of hard tissue movements were recorded. ANALYSES Mean, standard deviation, and a level of statistical significance at P < .05 were used. Differences in OHIP-49 were compared using unpaired t-test. The correlation between covariates and outcomes was analyzed using the Spearman's rank test. Analysis of covariance between the predictor and outcome, adjusted for covariates (body mass index), was performed. RESULTS Fifty-four subjects with a mean age of 20.89 years and 52% males were enrolled. The mean change in UAV was 0.12 cm3 (standard deviation [SD] 9.21, P = .93) with a mean absolute deviation of 7.28 cm3 (SD 5.54). The mean change in OHIP-49 score was 20.93 (SD 28.90). Twenty-seven (50%) subjects had increased UAV (7.4 cm3, SD 6.13) and the other had decreased (-7.17 cm3, SD 5.01) (P = .01). At follow-up, equal levels of mean OHIP-49 score were found, but because of a baseline difference (15.74, P = .048), the subjects with and without increased UAV improved in OHIP-49 score 13.04 (SD 30.53) and 28.81 (SD 25.33), respectively (P = .04). CONCLUSIONS Because equal levels of OHIP-49 score at follow-up, changes in UAV could not be associated with patient-reported health-related quality of life. Patient-reported outcome measure evaluations of orthognathic surgical treatment for airway obstruction should be performed in patients with a perceived impairment.
Collapse
Affiliation(s)
- David Pellby
- Consultant Dentomaxillofacial Radiology, Department of Imaging and Function, Skåne University Hospital, Lund, Sweden
| | - Martin Bengtsson
- Consultant Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
| |
Collapse
|
9
|
Cho RY, Byun SH, Park SY, On SW, Kim JC, Yang BE. Patient-specific plates for facial fracture surgery: A retrospective case series. J Dent 2023; 137:104650. [PMID: 37544353 DOI: 10.1016/j.jdent.2023.104650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVES Surgeons often encounter challenges when treating maxillofacial fractures using conventional methods that involve trimming or bending ready-made titanium plates for open reduction and internal fixation (ORIF) since it can be time-consuming, imprecise, and inconvenient. This retrospective case series aimed to introduce a novel bone reduction method that utilizes virtual planning, patient-specific surgical guides, and titanium plates. METHODS Seven patients with mandibular symphysis or subcondylar fractures resulting from facial trauma underwent cone-beam computed tomography (CBCT) or facial CT scans, and their medical histories were documented. Virtual surgery was conducted based on three-dimensional (3D) stereolithography images derived from CT scans using the FaceGide software (MegaGen, Daegu, Korea). ORIF was performed using patient-specific surgical guides and plates that were designed, printed, and milled. Radiographic, clinical, and occlusal evaluations were conducted at two weeks and six weeks postoperatively. Subsequently, 3D images from virtual surgery and postoperative CT scans were compared. RESULTS The comparison of 3D virtual surgery and postoperative images revealed minimal surface differences of less than 1 mm. T-scan evaluations indicated that there were no statistically significant differences between the two- and six-week postoperative assessments. Favorable clinical outcomes were observed. CONCLUSION This novel method demonstrated stable outcomes in terms of occlusion and healing, with no notable complications. Consequently, this approach may serve as a viable alternative to conventional methods. CLINICAL SIGNIFICANCE Facial fracture surgery that utilizes patient-specific surgical guides and plates within a digital workflow can facilitate meticulous surgical planning, reducing the risk of complications and minimizing operation time.
Collapse
Affiliation(s)
- Ran-Yeong Cho
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Soo-Hwan Byun
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sang-Yoon Park
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sung-Woon On
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Jong-Cheol Kim
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Mir Dental Hospital, Daegu 41940, Republic of Korea
| | - Byoung-Eun Yang
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea.
| |
Collapse
|
10
|
Wang P, Wang Y, Xu H, Huang Y, Shi Y, Chen S, Bai D, Xue C. Effect of offset on the precision of 3D-printed orthognathic surgical splints. Clin Oral Investig 2023; 27:5141-5151. [PMID: 37415046 DOI: 10.1007/s00784-023-05134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE This study evaluated the effect of offset on the precision of three-dimensional (3D)-printed splints, proposing to optimize the splint design to compensate for systematic errors. MATERIALS AND METHODS 14 resin model sets were scanned and offset as a whole by given distances (0.05, 0.10, 0.15, 0.20, 0.25, 0.30, 0.35, and 0.40 mm). Intermediate splints (ISs) and final splints (FSs) were generated from the non-offset and offset models and grouped correspondingly, named as splint type-offset value, IS-0.05, for instance. Dentitions occluded with the splint were scanned. Translational and rotational deviations of the lower dentition relative to the upper dentition were 3D measured. RESULTS Deviations of ISs and FSs were more evident in the vertical and pitch dimensions, and were mostly acceptable in other dimensions. ISs with offset ≥ 0.05 mm showed vertical deviations significantly below 1 mm (P < 0.05) while ISs with 0.10- to 0.30-mm offsets had pitch rotations significantly lower than 1° (P < 0.05). The Pitch of IS-0.35 was significantly larger than ISs with 0.15- to 0.30-mm offsets (P < 0.05). Meanwhile, FSs fit better as the offset increased and FSs with offsets ≥ 0.15 mm all had deviations significantly lower than 1 mm (for translation) or 1° (for rotation) (P < 0.05). CONCLUSIONS Offset affects the precision of 3D-printed splints. Moderate offset values of 0.10 to 0.30 mm are recommendable for ISs. Offset values ≥ 0.15 mm are recommended for FSs in cases with stable final occlusion. CLINICAL RELEVANCE This study found the optimal offset ranges for 3D-printed ISs and FSs via a standardized protocol.
Collapse
Affiliation(s)
- Peiqi Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Yipeng Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Hui Xu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Yixi Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Yu Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Siqi Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Ding Bai
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Chaoran Xue
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China.
| |
Collapse
|
11
|
Malenova Y, Ortner F, Liokatis P, Haidari S, Tröltzsch M, Fegg F, Obermeier KT, Hartung JT, Kakoschke TK, Burian E, Otto S, Sabbagh H, Probst FA. Accuracy of maxillary positioning using computer-designed and manufactured occlusal splints or patient-specific implants in orthognathic surgery. Clin Oral Investig 2023; 27:5063-5072. [PMID: 37382718 PMCID: PMC10492762 DOI: 10.1007/s00784-023-05125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To determine the accuracy of maxillary positioning using computer-designed and manufactured occlusal splints or patient-specific implants in orthognathic surgery. MATERIAL AND METHODS A retrospective analysis of 28 patients that underwent virtually planned orthognathic surgery with maxillary Le Fort I osteotomy either using VSP-generated splints (n = 13) or patient-specific implants (PSI) (n = 15) was conducted. The accuracy and surgical outcome of both techniques were compared by superimposing preoperative surgical planning with postoperative CT scans and measurement of translational and rotational deviation for each patient. RESULTS The 3D global geometric deviation between the planned position and the postoperative outcome was 0.60 mm (95%-CI 0.46-0.74, range 0.32-1.11 mm) for patients with PSI and 0.86 mm (95%-CI 0.44-1.28, range 0.09-2.60 mm) for patients with surgical splints. Postoperative differences for absolute and signed single linear deviations between planned and postoperative position were a little higher regarding the x-axis and pitch but lower regarding the y- and z-axis as well as yaw and roll for PSI compared to surgical splints. There were no significant differences regarding global geometric deviation, absolute and signed linear deviations in the x-, y-, and z-axis, and rotations (yaw, pitch, and roll) between both groups. CONCLUSIONS Regarding accuracy for positioning of maxillary segments after Le Fort I osteotomy in orthognathic surgery patient-specific implants and surgical splints provide equivalent high accuracy. CLINICAL RELEVANCE Patient-specific implants for maxillary positioning and fixation facilitate the concept of splintless orthognathic surgery and can be reliably used in clinical routines.
Collapse
Affiliation(s)
- Yoana Malenova
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany.
| | - Florian Ortner
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Selgai Haidari
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Matthias Tröltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
- Center for Oral, Maxillofacial, and Facial Reconstructive Surgery, Ansbach, Germany
| | - Florian Fegg
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Katharina T Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Jens T Hartung
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Tamara K Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Egon Burian
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Hisham Sabbagh
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital LMU Munich, Munich, Germany
| | - Florian A Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| |
Collapse
|
12
|
Grippaudo C, Lo Giudice A, Saponaro G, Todaro M, Moro A, D’Addona A. The Use of a CAD/CAM Thermoformed Splints System in Closed Reduction of Condylar Fractures. Bioengineering (Basel) 2023; 10:1023. [PMID: 37760125 PMCID: PMC10525750 DOI: 10.3390/bioengineering10091023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Mandibular fractures are very common. Common indications of closed treatment for mandibular fractures are non-displaced or minimally displaced simple fractures in adult compliant patients with good dentition, the absence of occlusal disruption, and fractures in growing children. In closed treatment, the mandible is maintained in centric occlusion with a maxillomandibular fixation (MMF) with orthodontic elastics. Many methods of MMF have been described, often using orthodontic appliances. In recent years, CAD-CAM technology has improved many procedures used in maxillofacial surgery and orthodontics. The device we present is manufactured following a digital workflow, and was designed specifically for MMF. (2) Materials: Two patients with mandibular fractures were treated with an MMF method whose procedure comprised scanning of the dental arches, followed by construction of thermoformed splints on which buttons for the elastics and retention holes are made. The splints were fixed on the dental arches with composite resin at the level of the holes, and were kept in place for the period of healing of the fracture, with the intermaxillary elastics hooked to the buttons. (3) Results: The application time of the splints was very quick. The splints remained stable for the necessary time, without causing particular discomfort to the patients. (4) Conclusions: From our experience, this technique has proved to be reliable and reproducible and could represent a valid tool in the closed treatment of mandibular fractures.
Collapse
Affiliation(s)
- Cristina Grippaudo
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Odontostomatologica e Implantologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy;
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, 95123 Catania, Italy;
| | - Gianmarco Saponaro
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Maxillo Facciale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Mattia Todaro
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Maxillo Facciale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Alessandro Moro
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Maxillo Facciale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Antonio D’Addona
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Odontostomatologica e Implantologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy;
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
| |
Collapse
|
13
|
Onică N, Onică CA, Budală DG, Gelețu GL, Balan M, Baciu ER, Murariu A, Pertea M. The Use of 3D Technology in the Management of Residual Asymmetry following Orthognathic Surgery: A Case Report. Healthcare (Basel) 2023; 11:2172. [PMID: 37570412 PMCID: PMC10418807 DOI: 10.3390/healthcare11152172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
The purpose of this case report was to present the aesthetic result of the reconstruction of facial residual asymmetry after orthognathic surgery using a patient-specific three-dimensional (3D) mold and a custom-made polymethyl methacrylate implant. Through computer-aided design (CAD), the healthy contralateral side of the mandible was superimposed onto the side with the defect. Exocad Gallway (exocad GmbH, Darmstadt, Germany) was used to design the patient-specific implants (PSIs) of the right mandibular angle. Next, the implant mold was created using the Meshmixer software (Version 3.5, Autodesk Inc., San Rafael, CA, USA) and fabricated using additive manufacturing. During the surgical procedure, the patient-specific implant (PSI) was cast inside the resin mold using Simplex P bone cement (Stryker, Mahwah, NJ, USA). The implant was fixed using three screws. Combining both indirect (involving the dental laboratory) and direct (with surgical intervention) approaches, this innovative hybrid method, which incorporates both computer-aided design and additive manufacturing (AM), not only enhanced facial aesthetics, functional rehabilitation, and patient quality of life but also mitigated the potential risks linked to conventional grafting methods.
Collapse
Affiliation(s)
- Neculai Onică
- Independent Researcher, 700612 Iasi, Romania; (N.O.); (C.A.O.)
| | | | - Dana Gabriela Budală
- Department of Implantology, Removable Dentures, Dental Technology, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Gabriela Luminița Gelețu
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (M.B.); (A.M.)
| | - Mihail Balan
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (M.B.); (A.M.)
| | - Elena-Raluca Baciu
- Department of Implantology, Removable Dentures, Dental Technology, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Alice Murariu
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (M.B.); (A.M.)
| | - Mihaela Pertea
- Department of Plastic Surgery, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| |
Collapse
|
14
|
Effect of 3D Printer Type and Use of Protection Gas during Post-Curing on Some Physical Properties of Soft Occlusal Splint Material. Polymers (Basel) 2022; 14:polym14214618. [PMID: 36365611 PMCID: PMC9658356 DOI: 10.3390/polym14214618] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Despite the fact that three-dimensional (3D) printing is frequently used in the manufacturing of occlusal splints, the effects of the 3D printer type and post-curing methods are still unclear. The aim of this study was to investigate the effect of the printer type (digital light processing: DLP; and liquid crystal display: LCD) as well as the post-curing method with two different atmospheric conditions (air and nitrogen gas (N2)) on the mechanical and surface properties of 3D-printed soft-type occlusal splint material. The evaluated properties were flexural strength, flexural modulus, Vickers hardness (VHN), fracture toughness, degree of double bond conversion (DC%), water sorption, water solubility, and 3D microlayer structure. The printer type significantly affected all the evaluated properties. Flexural strength, flexural modulus, and fracture toughness were significantly higher when specimens were printed by a DLP printer, while VHN and DC% were significantly higher, and a smoother surface was noticeably obtained when printed by an LCD printer. The post-curing at an N2 atmosphere significantly enhanced all of the evaluated properties except water sorption, 3D microlayer structure, and fracture toughness. The current results suggested that the printer type and the post-curing methods would have an impact on the mechanical and surface properties of the evaluated material.
Collapse
|
15
|
Ma W, Niu S, Wang L, Peng C, Fu S, Zhang C, Cui Q, Wang S, Li M, Xu Y. Clinical Application of Individualized 3D-Printed Templates in the Treatment of Condylar Osteochondroma. Healthcare (Basel) 2022; 10:2163. [PMID: 36360504 PMCID: PMC9690499 DOI: 10.3390/healthcare10112163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Osteochondroma (OC) is one of the most common benign tumors of the long bones, but it rarely occurs in the maxillofacial skeleton. However, mandibular condylar OC often leads to severe facial deformity in affected patients, including facial asymmetry, deviation of the chin, and malocclusion. This study aimed to explore the clinical application of individualized 3D-printed templates to accurately and effectively treat condylar OC. METHODS A total of 8 patients with mandibular condylar OC were treated from July 2015 to August 2021. The enrolled patients (5 women and 3 men) had a median age of 27 years (range: 21-32 years). All patients exhibited symptoms of facial asymmetry and occlusal disorders preoperatively. The digital software used to virtually design the process consisted of three-dimensional reconstruction, 3D-cephalometry analysis, virtual surgery, individualized templates, and postoperative facial soft-tissue prediction. A set of 3D-printed templates (DOS and DOT) were used in all cases to stabilize the occlusion and guide the osteotomy. Then, pre- and post-operative complications, mouth opening, clinical signs, and the accuracy of the CT imaging analysis were all evaluated. All the measurement data were presented as means ± SD; Bonferroni and Tamhane T2 multiple comparison tests were used to examine the differences between the groups. RESULTS All patients healed uneventfully. None of the patients exhibited facial nerve injury at follow-up. In comparing the condylar segments with T0p and T1, the average deviation of the condylar segments was 0.5796 mm, indicating that the post-operative reconstructed condyles showed a high degree of similarity to the reconstruction results of the virtual surgical plan. CONCLUSIONS Individualized 3D-printed templates simplified surgical procedures and improved surgical accuracy, proving to be an effective method for the treatment of patients with slight asymmetric deformities secondary to condylar OC.
Collapse
Affiliation(s)
- Wen Ma
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Shiwei Niu
- Yunnan Key Laboratory of Stem Cell and Regenerative Medicine, Science and Technology Achievement Incubation Center, Kunming Medical University, Kunming 650500, China
| | - Lidong Wang
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Canbang Peng
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Shuai Fu
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Changbin Zhang
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Qingying Cui
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Sihang Wang
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Ming Li
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Yanhua Xu
- Department of Orthodontics, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| |
Collapse
|
16
|
Simultaneous PSI-Based Orthognathic and PEEK Bone Augmentation Surgery Leads to Improved Symmetric Facial Appearance in Craniofacial Malformations. J Pers Med 2022; 12:jpm12101653. [PMID: 36294792 PMCID: PMC9605459 DOI: 10.3390/jpm12101653] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
(1) The aim of the present study was to compare the outcome of facial symmetry after simultaneous digitally planned patient-specific implant (PSI-) based orthognathic surgery and polyether ether ketone (PEEK) bone augmentation in patients with craniofacial malformations. (2) To evaluate the outcome of the two different surgical approaches (conventional PSI-based orthognathic surgery versus simultaneous PSI-based orthognathic surgery with PEEK bone augmentation), a comparison of five different groups with a combination of the parameters (A) with vs. without laterognathia, (B) syndromic vs. non-syndromic, and (C) surgery with vs. without PEEK bone augmentation was conducted. The digital workflow comprised cone beam CT (CBCT) scans and virtual surgery planning for all patients in order to produce patient specific cutting guides and osteosynthesis plates. Additionally, deformed skulls were superimposed by a non-deformed skull and/or the healthy side was mirrored to produce PSI PEEK implants for augmentation. Retrospective analyses included posterior-anterior conventional radiographs as well as en face photographs taken before and nine months after surgery. (3) Simultaneous orthognathic surgery with PEEK bone augmentation significantly improves facial symmetry compared to conventional orthognathic surgery (6.5%P (3.2-9.8%P) (p = 0.001). (4) PSI-based orthognathic surgery led to improved horizontal bone alignment in all patients. Simultaneous PEEK bone augmentation enhanced facial symmetry even in patients with syndrome-related underdevelopment of both soft and hard tissues.
Collapse
|
17
|
Effect of Nitrogen Gas Post-Curing and Printer Type on the Mechanical Properties of 3D-Printed Hard Occlusal Splint Material. Polymers (Basel) 2022; 14:polym14193971. [PMID: 36235919 PMCID: PMC9571503 DOI: 10.3390/polym14193971] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Although three-dimensional (3D) printing is clinically convenient to fabricate occlusal splints, it is still unclear how the post-curing method and the printer type can affect 3D-printed splints. This study aimed to evaluate the effect of stroboscopic post-curing at a nitrogen gas (N2) atmosphere versus post-curing in an air atmosphere, as well as the printer type (liquid crystal display (LCD) and digital light processing (DLP)) on the mechanical properties of a 3D-printed hard-type occlusal splint material. Flexural strength, flexural modulus, Vickers hardness number (VHN), fracture toughness, degree of double bond conversion (DC), 3D microlayer structure, water sorption, and water solubility were evaluated. The post-curing method significantly affected all evaluated properties except fracture toughness and 3D microlayer structure, while the printer type significantly affected all evaluated properties except flexural strength and flexural modulus. VHN and DC were significantly higher, and the smoother surface was noticeably obtained when printed by LCD printer and post-cured at an N2 atmosphere. The current results suggested that the post-curing method and the printer type would play a role in the mechanical properties of the evaluated material and that the combination of post-curing at an N2 atmosphere and LCD printer could enhance its mechanical properties and surface smoothness.
Collapse
|
18
|
Accuracy of Segmented Le Fort I Osteotomy with Virtual Planning in Orthognathic Surgery Using Patient-Specific Implants: A Case Series. J Clin Med 2022; 11:jcm11195495. [PMID: 36233363 PMCID: PMC9572233 DOI: 10.3390/jcm11195495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background: When maxillary transversal expansion is needed, two protocols of treatment can be used: a maxillary orthodontic expansion followed by a classical bimaxillary osteotomy or a bimaxillary osteotomy with maxillary segmentation. The aim of this study was to assess the accuracy of segmented Le Fort I osteotomy using computer-aided orthognathic surgery and patient-specific titanium plates in patients who underwent a bimaxillary osteotomy for occlusal trouble with maxillary transversal insufficiencies. Methods: A virtual simulation of a Le Fort I osteotomy with maxillary segmentation, a sagittal split ramus osteotomy, and genioplasty (if needed) was conducted on a preoperative three-dimensional (3D) model of each patient’s skull using ProPlan CMF 3.0 software (Materialise, Leuven, Belgium). Computer-assisted osteotomy saw-and-drill guides and patient-specific implants (PSIs, titanium plates) were produced and used during the surgery. We chose to focus on the maxillary repositioning accuracy by comparing the preoperative virtual surgical planning and the postoperative 3D outcome skulls using surface superimpositions and 13 standard dental and bone landmarks. Errors between these preoperative and postoperative landmarks were calculated and compared to discover if segmental maxillary repositioning using PSIs was accurate enough to be safely used to treat transversal insufficiencies. Results: A total of 22 consecutive patients—15 females and 7 males, with a mean age of 27.4 years—who underwent bimaxillary computer-assisted orthognathic surgery with maxillary segmentation were enrolled in the study. All patients presented with occlusion trouble, 13 with Class III malocclusions (59%) and 9 (41%) with Class II malocclusions. A quantitative analysis revealed that, overall, the mean absolute discrepancies for the x-axis (transversal dimension), y-axis (anterior−posterior dimensions), and z-axis (vertical dimension) were 0.59 mm, 0.74 mm, and 0.56 mm, respectively. The total error rate of maxillary repositioning was 0.62 mm between the postoperative cone-beam computed tomography (CBCT) and the preoperatively planned 3D skull. According to the literature, precision in maxilla repositioning is defined by an error rate (clinically relevant) at each landmark of <2 mm and a total error of <2 mm for each patient. Conclusions: A high degree of accuracy between the virtual plan and the postoperative result was observed.
Collapse
|
19
|
Cassoni A, Manganiello L, Barbera G, Priore P, Fadda MT, Pucci R, Valentini V. Three-Dimensional Comparison of the Maxillary Surfaces through ICP-Type Algorithm: Accuracy Evaluation of CAD/CAM Technologies in Orthognathic Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11834. [PMID: 36142107 PMCID: PMC9517090 DOI: 10.3390/ijerph191811834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/11/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE This retrospective study aims to compare the accuracy of two different CAD/CAM systems in orthognathic surgery. The novelty of this work lies in the method of evaluating the accuracy, i.e., using an Iterative Closest Point (ICP) algorithm, which matches a pair of 2D or 3D point clouds with unknown dependencies of the transition from scan s(k) to scan s(k+1). METHODS The study population was composed of ten patients who presented to the Maxillofacial Surgery Department of the University "Sapienza" of Rome for the evaluation and management of skeletal malocclusions. The patients were divided into two groups, depending on the technique used: group 1: splintless group (custom-made cutting guide and plates); group 2: splint group (using a 3D-printed splint). STL files were imported into Geomagic® Control X™ software, which allows for comparison and analysis using an ICP algorithm. The RMSE parameter (3D error) was used to calculate the accuracy. In addition, data were compared in two different patient subgroups. The first subgroup only underwent a monobloc Le Fort I osteotomy (p-value = 0.02), and the second subgroup underwent a Le Fort I osteotomy associated with a segmental osteotomy of the maxilla (p-value = 0.23). RESULTS Group 1 showed a 3D error of 1.22 mm ± SD 0.456, while group 2 showed a 3D error of 1.63 mm ± SD 0.303. These results have allowed us to compare the accuracy of the two CAD/CAM systems (p-value = 0.09). CONCLUSIONS The ICP algorithm provided a reproducible method of comparison. The splintless method would seem more accurate (p-value = 0.02) in transferring the surgical programming into the operating room when only a Le Fort I osteotomy is to be performed.
Collapse
Affiliation(s)
- Andrea Cassoni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
- Oncological and Reconstructive Maxillo—Facial Surgery Unit, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| | - Luigi Manganiello
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Giorgio Barbera
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Paolo Priore
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Maria Teresa Fadda
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
- Oncological and Reconstructive Maxillo—Facial Surgery Unit, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| | - Resi Pucci
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Valentino Valentini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
- Oncological and Reconstructive Maxillo—Facial Surgery Unit, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| |
Collapse
|
20
|
Personalized 3D-printed Titanium Cutting Guide and Prefabricated Osteosynthesis Plate for Mandibular Step Osteotomy to Treat Severe Mandibular Prognathism. J Craniofac Surg 2022; 33:2247-2251. [PMID: 35882014 DOI: 10.1097/scs.0000000000008735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/22/2022] [Indexed: 11/26/2022] Open
Abstract
Mandibular step osteotomy, performed for mandibular prognathism, is a difficult and time-consuming procedure. Virtual computer surgery and computer-aided design & computer-aided manufacturing have demonstrated accurate results in orthognathic surgery, though not used for mandibular step osteotomy yet. In this study, the authors report the case of a 21-year-old man with severe mandibular prognathism, with a reverse overjet of 12 mm. Step osteotomy, a modified method of body osteotomy, was planned virtually and performed using 3-dimensional (3D) printed titanium surgical guides and osteosynthesis plates, using computer-aided design & computer-aided manufacturing. At the 6-month postoperative follow-up, there were no notable complications, and normal healing was observed. Each segment was stably in place with the prefabricated plates. The proximal segments were not sagged medially or laterally. With 3D-printed surgical guides and osteosynthesis plates, intraoperative complications, such as injury to adjacent teeth and nerves, could be avoided. They also showed reasonable accuracy and helped reduce operative time and improve outcomes. Unlike surgical guides made of resin/polyamide, titanium surgical guides can be made thinner, which can reduce the extent of detachment. They also did not undergo any deterioration during the operation. Cutting guides and prefabricated plates using virtual surgical planning and 3D printing have many advantages, including reduced preoperative preparation time and operative time, reduced incidence of intraoperative complications, and improved outcomes. However, limitations still exist and further studies are required.
Collapse
|
21
|
Personal guide assisted orthognathic surgery: application of a T-shaped tooth bone combined supporting osteotomy guide plate and positioning guide plate. J Craniofac Surg 2022; 33:e736-e738. [PMID: 35776922 DOI: 10.1097/scs.0000000000008661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/28/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The precise movement of the maxilla is particularly important for orthognathic surgery, especially for patients with maxillary segmentation. In this preliminary study, the authors present a new tooth bone combined with a supporting osteotomy guide and positioning guide to guide the osteotomy and reduction of the maxilla. Through our preoperative simulation and postoperative image fusion, the authors found that the overlapping area is more than 90%. According to compare of the virtual plans and the postoperative results based on distances from the maxillary land- marks to the horizontal plane, sagittal plane, and coronal plane, the surgical error was about 2mm. Our T-shaped guide provides a reliable method for patients with maxillary segmental osteotomy, which may be a useful alternative to the intermediate.
Collapse
|
22
|
Sánchez-Jáuregui E, Baranda-Manterola E, Ranz-Colio Á, Bueno de Vicente Á, Acero-Sanz J. Custom made cutting guides and osteosynthesis plates versus CAD/CAM occlusal splints in positioning and fixation of the maxilla in orthognathic surgery: A prospective randomized study. J Craniomaxillofac Surg 2022; 50:609-614. [PMID: 35760659 DOI: 10.1016/j.jcms.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/22/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022] Open
Abstract
The aim of this study is to compare the accuracy of maxilla positioning in orthognathic surgery with the use of custom-made devices (cutting guides and patient-fitted osteosynthesis plates) comparing to CAD/CAM splints. A prospective randomized study was performed. Patients with dentofacial deformities undergoing orthognathic surgery were compared, using customized guides (experimental group) vs. CAD/CAM surgical splints (control group) for the repositioning of the upper maxilla. Preoperative and postoperative CT scans were used to compare positioning and fixation of the maxilla in the three planes of space. A total of 30 patients were included in the study (15 patients in each study group). The mean error obtained with customized guides was 0.8 mm (range 0.1-1.9) in the anterior-posterior axis, 0.4 mm (range 0-1.4) in the vertical axis and 0.2 mm (range 0-1.1) in the horizontal axis. There were statistically significant differences in the anterior-posterior and vertical axes in favour of the customized implants, whereas there were no differences in the horizontal plane. Furthermore, there was a mean reduction of the operative time of 36.5 min in the experimental group. Within the limitations of the study it seems that patient specific surgical guides should be preferred when accuracy of repositioning of the maxilla and saving operative time are the priority.
Collapse
Affiliation(s)
- Eduardo Sánchez-Jáuregui
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal (University of Alcalá de Henares), Madrid, Spain.
| | - Elena Baranda-Manterola
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal (University of Alcalá de Henares), Madrid, Spain.
| | - Álvaro Ranz-Colio
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal (University of Alcalá de Henares), Madrid, Spain.
| | - Ángela Bueno de Vicente
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal (University of Alcalá de Henares), Madrid, Spain.
| | - Julio Acero-Sanz
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal (University of Alcalá de Henares), Madrid, Spain.
| |
Collapse
|
23
|
Wang Y, Wang P, Xiang X, Xu H, Tang Y, Zhou Y, Bai D, Xue C. Effect of occlusal coverage depths on the precision of 3D-printed orthognathic surgical splints. BMC Oral Health 2022; 22:218. [PMID: 35655203 PMCID: PMC9161535 DOI: 10.1186/s12903-022-02247-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Precise orthognathic surgical splints are important in surgical-orthodontic treatment. This study aimed to propose a standardized protocol for three-dimensional (3D)-printed splints and assess the precision of splints with different occlusal coverage on the dentition (occlusal coverage depth, OCD), thus optimizing the design of 3D-printed splints to minimize the seemingly unavoidable systematic errors. METHODS Resin models in optimal occlusion from 19 patients were selected and scanned. Intermediate splints (ISs) and final splints (FSs) with 2-mm, 3-mm, 4-mm, and 5-mm OCDs were fabricated and grouped as IS-2, IS-3, IS-4, IS-5, FS-2, FS-3, FS-4, and FS-5, respectively. The dentitions were occluded with each splint and scanned as a whole to compare with the original occlusion. Translational and rotational deviations of the lower dentition and translational deviations of the landmarks were measured. RESULTS For vertical translation, the lower dentitions translated inferiorly to the upper dentition in most of the splints, and the translation increased as OCD got larger. Vertical translations of the dentitions in 89.47% of IS-2, 68.42% of IS-3, 42.11% of IS-4, 10.53% of IS-5, 94.74% of FS-2, 63.16% of FS-3, 26.32% of FS-4, and 21.05% of FS-5 splints were below 1 mm, respectively. For pitch rotation, the lower dentitions rotated inferiorly and posteriorly in most groups, and the rotation increased as OCD got larger. Pitch rotations of the dentitions in 100% of IS-2, 89.47% of IS-3, 57.89% of IS-4, 52.63% of IS-5, 100.00% of FS-2, 78.95% of FS-3, 52.63% of FS-4, and 47.37% of FS-5 splints were below 2°, respectively. On the other hand, the transversal and sagittal translations, roll and yaw rotations of most groups were clinically acceptable (translation < 1 mm and rotation < 2°). The deviations of ISs and FSs showed no statistical significance at all levels of coverage (P > 0.05). CONCLUSIONS A protocol was proposed to generate 3D-printed ISs and FSs with normalized basal planes and standardized OCDs. Deviations of the ISs and FSs were more evident in the vertical dimension and pitch rotation and had a tendency to increase as the OCD got larger. ISs and FSs with both 2-mm and 3-mm OCD are recommendable regarding the precision relative to clinical acceptability. However, considering the fabrication, structural stability, and clinical application, ISs and FSs with 3-mm OCD are recommended for accurate fitting.
Collapse
Affiliation(s)
- Yipeng Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Peiqi Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Xiang Xiang
- School of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Hui Xu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Yuting Tang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Yumeng Zhou
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Ding Bai
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Chaoran Xue
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China.
| |
Collapse
|
24
|
Zou B, Kim JH, Kim SH, Choi TH, Shin Y, Kook YA, Lee NK. Accuracy of a surface-based fusion method when integrating digital models and the cone beam computed tomography scans with metal artifacts. Sci Rep 2022; 12:8034. [PMID: 35577911 PMCID: PMC9110746 DOI: 10.1038/s41598-022-11677-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/22/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractThe aim of this study was to evaluate the intra- and inter-observer reliability of maxillary digital dental model integration into cone-beam computed tomography (CBCT) scans to reconstruct three-dimensional (3D) skeletodental models for orthognathic patients. This retrospective study consisted of CBCT and digital maxillary dentition images of 20 Class III orthognathic patients. After two repeated fusions of digital cast images with reconstructed CBCT images by a digital engineer and an orthodontist respectively, the 3D coordinate values of the canines, first molars, and central incisors were evaluated. The intra- and inter-observer reliability of 3D positions of maxillary teeth were compared using intraclass correlation coefficients (ICCs). Intra-observer reliability of x-, y-, and z-coordinate values of maxillary teeth showed significant and excellent agreement in an engineer (0.946 ≤ ICC ≤ 1.000) and an orthodontist (0.876 ≤ ICC ≤ 1.000). The inter-observer reliability of the y- and z-coordinates of each tooth was significantly excellent or good, but that of the x-coordinates showed insignificantly poor to moderate agreement. This study showed that the integration of maxillary digital models into CBCT scans was clinically reliable. However, considering the low inter-observer reliability on the x-coordinates of dentition, clinical experience and repeated learning are needed for accurate application of digital skeletodental model in orthognathic patients.
Collapse
|
25
|
Chen H, Jiang N, Bi R, Liu Y, Li Y, Zhao W, Zhu S. Comparison of the accuracy of maxillary repositioning between using splints and templates in two-jaw orthognathic surgery. J Oral Maxillofac Surg 2022; 80:1331-1339. [DOI: 10.1016/j.joms.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
|
26
|
Chu Y, Ye B, Wu Q, Wang Y, Wang P, Li J. The accuracy of virtual surgical planning in segmental Le Fort I surgery: A comparison of planned and actual outcome. J Plast Reconstr Aesthet Surg 2022; 75:2719-2726. [PMID: 35667995 DOI: 10.1016/j.bjps.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/01/2022] [Accepted: 04/12/2022] [Indexed: 02/05/2023]
Abstract
Segmental Le Fort I surgery is an effective technique to correct complicated dentomaxillofacial deformities. This retrospective study evaluated the accuracy of segmental Le Fort I surgery under the guidance of virtual surgical planning (VSP). A total of 129 patients who accepted segmental Le Fort I surgery were investigated in this study. VSP was transferred to segmental surgery with different pieces precisely with the aid of 3D-printed surgical templates and splints. The surgical result was evaluated by postoperative complications, color distance maps, and quantitative accuracy analysis. Outcomes showed that the VSP was successfully transferred to actual surgery with high accuracy. The overall mean linear difference was 1.28 mm, and the overall mean angular difference was 2.4°. Except for one case of root injury, there was no serious complication recorded. The results suggested that VSP was a reliable assistance for segmental Le Fort I surgery.
Collapse
Affiliation(s)
- Yuxian Chu
- State Key Laboratory of Oral Diseases and Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Bin Ye
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthognathic & TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Cheng du, China
| | - Qionghui Wu
- State Key Laboratory of Oral Diseases and Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Yu Wang
- State Key Laboratory of Oral Diseases and Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Peng Wang
- State Key Laboratory of Oral Diseases and Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Jihua Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthognathic & TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Cheng du, China.
| |
Collapse
|
27
|
Chow W, He Z, Liu Y, Song J, Xu C, Luo E. Intraoperative condylar positioning techniques on mandible in orthognathic surgery. Orthod Craniofac Res 2022; 25:449-458. [PMID: 35108447 DOI: 10.1111/ocr.12568] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/29/2021] [Accepted: 01/22/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE The surgical condylar displacement often resulted in relapse and serious symptoms of temporomandibular joint disorders (TMD) after orthognathic surgery. To minimize the displacement, numerous techniques have been proposed. To verify their accuracy in positioning and effectiveness in preventing postoperative TMD and relapse, we reviewed the literature related to intraoperative condylar positioning techniques on the mandible in this study. METHODS The literature on condylar positioning techniques was reviewed with 2 charts, including the non-computer-assisted and the computer-assisted positioning methods. The pre- and postoperative alterations of condyles, the postoperative temporomandibular joint (TMJ) function, and surgical relapse were analyzed regarding the techniques. The clinical usage and characteristics were reviewed as well. RESULTS A total of 22 articles, including 907 patients, have been reported since 2001. Nearly all methods reach a considerable positioning accuracy within the range of 1-2 mm and 1-2° from the preoperative position. We ranked the accuracy of the methods from high to low: CAD/CAM CPDs>CAD/CAM titanium plate positioning>manual positioning>computer-assisted navigation systems>imaging positioning systems. Most skeletal class II and class III patients achieved great occlusion and had no TMJ dysfunction or relapse after condylar positioning. CONCLUSION Both the non-computer-assisted and computer-assisted condylar positioning techniques reach considerable accuracy in locating the preoperative condyle position and preventing TMJ dysfunction and surgical relapse. Different levels of surgeons and cases can benefit from multiple suggested positioning methods. Further research with large samples and long-term follow-up is worth looking forward to upgrading the current methods, improving the clinical utility, and developing new positioning techniques.
Collapse
Affiliation(s)
- WingYan Chow
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Diseases &, Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ze He
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Diseases &, Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yao Liu
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Diseases &, Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jian Song
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Diseases &, Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - ChunWei Xu
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Diseases &, Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - En Luo
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Diseases &, Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
28
|
Assessment of an Artificial Intelligence Mandibular Osteotomy Design System: A Retrospective Study. Aesthetic Plast Surg 2022; 46:1303-1313. [PMID: 35048148 DOI: 10.1007/s00266-021-02698-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/15/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND In this study, an AI osteotomy software was developed to design the presurgical plan of mandibular angle osteotomy, which is followed by the comparison between the software-designed presurgical plan and the traditional manual presurgical plan, thus assessing the practicability of applying the AI osteotomy software in clinical practices. METHODS (1) Develop an AI osteotomy software: design an algorithm based on convolutional neural networks capable of learning feature point and processing clustering segmentation; then, select 2296 cases of successful 3D mandibular angle osteotomy presurgical plans, followed by using those 2296 cases to train the deep learning algorithm; (2) compare the osteotomy presurgical plan of AI osteotomy software and that of manual: first step: randomly selecting 80 cases of typical female head 3D CTs, and designing those 80 cases by means of AI osteotomy software designing (group A) and manually designing (group B), respectively; second step: comparing several indexes of group A and those of group B, including the efficiency index (time from input original CT data to osteotomy presurgical plan output), the safety index (the minimum distance from the osteotomy plane to the mandibular canal), the symmetry indexes (bilateral difference of mandibular angle, mandibular ramus height and mandibular valgus angle) and aesthetic indexes (width ratio between middle and lower faces (M/L), mandibular angle and mandibular valgus angle). RESULTS The efficiency index: the design time of group A is 1.768 ± 0.768 min and that of group B is 26.108 ± 1.137 min, with P = 0.000; the safety index: The minimum distances from the osteotomy plane to the mandibular canal are 3.908 ± 0.361mm and 3.651 ± 0.437mm, p = 0.117 in groups A and B, respectively; The symmetry indexes: Bilateral differences of mandibular angle are 1.824 ± 1.834° and 1.567 ± 1.059° in groups A and B, respectively, with P = 0.278; bilateral differences of mandibular ramus height are 2.083 ± 1.263 and 2.965 ± 1.433, respectively, with P = 0.119 in groups A and B; Aesthetic indexes: M/L in groups A and B is 1.364 ± 0.074 and 1.371 ± 0.067, respectively, with P = 0.793; mandibular angles in groups A and B are 127.724 ± 5.800° and 127.242 ± 5.545°, respectively, with P = 0.681; Valgus angles in groups A and B are 11.474 ± 5.380 and 9.743 ± 4.620, respectively, with P = 0.273. CONCLUSIONS With high efficiency, as well as safety, symmetry and aesthetics equivalent to those of a manual design, the AI osteotomy software designing can be used as an alternative method for manual osteotomy designing. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Collapse
|
29
|
Jones JP, Amarista FJ, Jeske NA, Szalay D, Ellis E. Comparison of the Accuracy of Maxillary Positioning with Interim Splints versus Patient Specific Guides and Plates in Executing a Virtual Bimaxillary Surgical Plan. J Oral Maxillofac Surg 2022; 80:827-837. [DOI: 10.1016/j.joms.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 11/25/2022]
|
30
|
Apostolakis D, Michelinakis G, Kamposiora P, Papavasiliou G. The current state of Computer Assisted Orthognathic Surgery: A narrative review. J Dent 2022; 119:104052. [DOI: 10.1016/j.jdent.2022.104052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 12/23/2022] Open
|
31
|
The Use of Computer-Guided Half Propeller Genioplasty for the Correction of Mandibular Asymmetry (A Mandibular Orthognathic Surgery Without a Condylar Intervention Technical Strategy). J Craniofac Surg 2021; 33:1879-1882. [PMID: 34907947 DOI: 10.1097/scs.0000000000008431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/27/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Mandibular asymmetry is a facial deformity that results from multiple causes; among these are growth deficiency like hemifacial microsomia and growth excess as in condylar hyperplasia. The facial asymmetry caused by condylar hyperplasia has been treated over the years with different surgical and nonsurgical modalities dependent on the age of the patient and the severity of the condition. The authors in this article introduce a modified version of the propeller genioplasty technique. MATERIALS AND METHODS A new surgical technique "modified propeller genioplasty" is introduced for the management of facial asymmetry. Virtual surgical planning of the osteotomies and segment repositioning was done virtually. A cutting guide, positioning guides and 3D model of the corrected chin were 3D printed, to facilitate replication of the virtually planned osteotomies, prebending of plates, and segment repositioning. RESULTS The esthetically accepted result was achieved using this technique with minimal postoperative complications. CONCLUSIONS The technique appeared to be accurate, simple, and more cost efficient when compared to patient-specific plates.
Collapse
|
32
|
Surgical Accuracy of Positioning the Maxilla in Patients With Skeletal Class II Malocclusion Using Computer-Aided Design and Computer-Aided Manufacturing-Assisted Orthognathic Surgery. J Craniofac Surg 2021; 33:1479-1483. [PMID: 34907951 DOI: 10.1097/scs.0000000000008407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the surgical accuracy of positioning the maxilla in patients with skeletal class II malocclusion using computer-aided design and computer-aided manufacturing (CAD/CAM)-assisted orthognathic surgery. MATERIALS AND METHODS The samples consisted of 10 patients with skeletal class II malocclusion, whose cone-beam computed tomographys taken before and immediately after surgery were available and who underwent bimaxillary orthognathic surgery by a single surgeon using Le Fort I osteotomy and bilateral sagittal split ramus osteotomy at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, South Korea between January 2018 and December 2019. After virtual surgical planning was performed using the FACEGIDE system (Korea), surgical cutting guides, intermediate splints, and custom-made titanium mini-plates were fabricated using CAD/CAM technique. Using 8 landmarks (anterior nasal spine, point A, #16, #13, contact point between #11 and #21, #23, #26, posterior nasal spine), the mean differences between the virtually planned (Virtual) and actual postsurgical position of the maxilla (Actual) in the three-dimensional coordinates (ΔActual-Virtual) and their mean absolute deviations were investigated. RESULTS The mean differences of 8 landmarks were 0.42 mm left side movement in the transverse coordinate, 0.15 mm forward movement in the sagittal coordinate and 0.10 mm downward movement in the vertical coordinate. Their mean absolute deviations were 0.98, 0.67, and 0.62 mm in the sagittal, vertical, and transverse coordinates, respectively. CONCLUSIONS Since the mean difference was less than 0.5 mm and the range of error was less than 1.0 mm, CAD/CAM-assisted orthognathic surgery might have a high degree of surgical accuracy and clinical relevance in the positioning of the maxilla.
Collapse
|
33
|
Randomized Clinical Trial of the Accuracy of Patient-Specific Implants versus CAD/CAM Splints in Orthognathic Surgery. Plast Reconstr Surg 2021; 148:1101-1110. [PMID: 34705785 PMCID: PMC8542074 DOI: 10.1097/prs.0000000000008427] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background: The maxilla position is essential for the aesthetic and functional outcomes of orthognathic surgery. Previous studies demonstrated the advantages of patient-specific implants in orthognathic surgery. However, more data are needed to confirm the superiority of patient-specific implants over surgical splints created with computer-aided design/computer-aided manufacturing (CAD/CAM). This randomized controlled trial aimed to compare the accuracy of patient-specific implants and CAD/CAM splints for maxilla repositioning in orthognathic surgery. Methods: Patients (n = 64) who required orthognathic surgery were randomly assigned to use either patient-specific implants (patient-specific implant group) or CAD/CAM surgical splints (splint group) to reposition the maxilla. The outcome evaluation was completed by comparing virtual plans with actual results. The primary outcome was the discrepancies of the centroid position of the maxilla. Other translation and orientation discrepancies of the maxilla were also assessed. Results: The authors analyzed 27 patients in the patient-specific implant group and 31 in the splint group. The maxilla position discrepancy was 1.41 ± 0.58 mm in the patient-specific implant group and 2.20 ± 0.94 mm in the splint group; the between-group difference was significant (p < 0.001). For the patient-specific implant group, the largest translation discrepancy was 1.02 ± 0.66 mm in the anteroposterior direction, and the largest orientation discrepancy was 1.85 ± 1.42 degrees in pitch. For the splint group, the largest translation discrepancy was 1.23 ± 0.93 mm in the mediolateral direction, and the largest orientation discrepancy was 1.72 ± 1.56 degrees in pitch. Conclusion: The result showed that using patient-specific implants in orthognathic surgery resulted in a more accurate maxilla position than CAD/CAM surgical splints. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
Collapse
|
34
|
Carvalho FSR, de Oliveira Barbosa DI, Torquato IF, Britto de Souza AM, Dalcico R, Chaves FN, Costa FWG. The Use of Surgical Splints in Orthognathic Surgery: A Bibliometric Study. Indian J Plast Surg 2021; 55:26-30. [PMID: 35444748 PMCID: PMC9015826 DOI: 10.1055/s-0041-1734570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction
Orthognathic surgeries require the use of surgical splints (SS) to stabilize the occlusion and the segments fixed with plates and screws. Technological advances in the field of computing and the possibility of generating three-dimensional (3D) images have brought different possibilities for making SS, which has generated greater predictability and customization of surgical plans. The bibliometric study can have a qualitative character through the scope of articles in a certain area of knowledge. It is a selection process that can track a topic or scientific production.
Methods
The present study aimed to carry out a bibliometric literature review, in order to assess the evolution of the use of SS and the different planning protocols in orthognathic surgery. The Scopus database was used, with the terms “splint” and “orthognathic surgery.”
Results
A total of 331 articles were found. These were exported to Rayyan for application of the inclusion and exclusion criteria and selection of articles. A total of 76 references were selected and exported to the VOSviewer application for the analysis of bibliometric data.
Conclusions
Orthognathic surgery was initially not associated with any computerized technological resource; however, it underwent updates between the years 2010 to 2012. These advances allowed surgical planning to become faster, cheaper, and more accurate.
Collapse
Affiliation(s)
| | | | | | | | - Roberta Dalcico
- Dentistry Course, University of Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil
| | - Filipe Nobre Chaves
- Postgraduate Program in Health Science and Dentistry School, Federal University of Ceará (UFC) - campus Sobral, Sobral, Ceará, Brazil
| | - Fábio Wildson Gurgel Costa
- Department of Radiology, Graduate Program in Dentistry, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| |
Collapse
|
35
|
Chen C, Sun N, Jiang C, Liu Y, Sun J. Accurate transfer of bimaxillary orthognathic surgical plans using computer-aided intraoperative navigation. Korean J Orthod 2021; 51:321-328. [PMID: 34556586 PMCID: PMC8461385 DOI: 10.4041/kjod.2021.51.5.321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
Objective To examine the accuracy of computer-aided intraoperative navigation (Ci-Navi) in bimaxillary orthognathic surgery by comparing preoperative planning and postoperative outcome. Methods The study comprised 45 patients with congenital dentomaxillofacial deformities who were scheduled to undergo bimaxillary orthognathic surgery. Virtual bimaxillary orthognathic surgery was simulated using Mimics software. Intraoperatively, a Le Fort I osteotomy of the maxilla was performed using osteotomy guide plates. After the Le Fort I osteotomy and bilateral sagittal split ramus osteotomy of the mandible, the mobilized maxilla and the distal mandibular segment were fixed using an occlusal splint, forming the maxillomandibular complex (MMC). Realtime Ci-Navi was used to lead the MMC in the designated direction. Osteoplasty of the inferior border of the mandible was performed using Ci-Navi when facial symmetry and skeletal harmony were of concern. Linear and angular distinctions between preoperative planning and postoperative outcomes were calculated. Results The mean linear difference was 0.79 mm (maxilla: 0.62 mm, mandible: 0.88 mm) and the overall mean angular difference was 1.20°. The observed difference in the upper incisor point to the Frankfort horizontal plane, midfacial sagittal plane, and coronal plane was < 1 mm in 40 cases. Conclusions This study demonstrates the role of Ci-Navi in the accurate positioning of bone segments during bimaxillary orthognathic surgery. Ci-Navi was found to be a reliable method for the accurate transfer of the surgical plan during an operation.
Collapse
Affiliation(s)
- Chen Chen
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ningning Sun
- Department of Emergency Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chunmiao Jiang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yanshan Liu
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jian Sun
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Department of Emergency Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| |
Collapse
|
36
|
Tondin GM, Leal MDOCD, Costa ST, Grillo R, Jodas CRP, Teixeira RG. Evaluation of the accuracy of virtual planning in bimaxillary orthognathic surgery: Systematic review. Br J Oral Maxillofac Surg 2021; 60:412-421. [PMID: 35120785 DOI: 10.1016/j.bjoms.2021.09.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/05/2021] [Indexed: 11/27/2022]
Abstract
The purpose of this research was to evaluate the accuracy of virtual planning in bimaxillary orthognathic surgery in bone by comparing the mean linear and angular measurements of the surgical plan with the actual surgical result. Electronic databases, MEDLINE via PubMed, Web of Science, SCOPUS, the Cochrane Library, grey literature, and the American clinical trials registry (www.ClinicalTrials.gov), were accessed as search engines. The studies consisted of publications on the assessment of accuracy in virtual planning in bimaxillary orthognathic surgery between 2010 and 2020. After application of the eligibility criteria, 26 articles were included, and their quality was evaluated using the methodological index for non-randomised studies (MINORS) tool and Cohen's kappa statistic in the MedCalc program (MedCalc Software Ltd). Evidence obtained by comparing the planning and surgical results, both in the maxilla and mandible, showed that there is great accuracy in virtual planning in bimaxillary orthognathic surgery.
Collapse
Affiliation(s)
- Gustavo Marques Tondin
- São Leopoldo Mandic College, Buccomaxillofacial Surgery and Traumatology Department, Campinas, São Paulo, Brazil
| | - Marilia de Oliveira Coelho Dutra Leal
- Institute of Legal Medicine - RR, Brazil/Pos PhD Pathology - Histology Department, Dentistry School, Campinas State University, Piracicaba, São Paulo, Brazil
| | - Sarah Teixeira Costa
- Institute of Criminalistics- SP, Brazil/Dentistry School, Presidente Tancredo Neves University Center, São João del Rei, Minas Gerais, Brazil.
| | - Ricardo Grillo
- São Leopoldo Mandic College, Buccomaxillofacial Surgery and Traumatology Department, Campinas, São Paulo, Brazil
| | | | - Rubens Gonçalves Teixeira
- São Leopoldo Mandic College, Buccomaxillofacial Surgery and Traumatology Department, Campinas, São Paulo, Brazil
| |
Collapse
|
37
|
Randomized Controlled Clinical Trial to Assess the Utility of Computer-Aided Intraoperative Navigation in Bimaxillary Orthognathic Surgery. J Craniofac Surg 2021; 32:2205-2209. [PMID: 33538444 DOI: 10.1097/scs.0000000000007512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Accurate application of the preoperative surgical plan in actual surgical settings is of paramount importance in orthognathic surgery. This randomized controlled clinical trial aimed to evaluate the accuracy of computer-aided intraoperative navigation (Ci-Navi) compared with that of conventional navigation methods in bimaxillary orthognathic surgery. Fifty-two patients were randomly divided into 2 groups. Group A (n = 26) patients underwent surgery assisted with Ci-Navi and group B (n = 26) patients underwent surgery assisted with conventional intraoperative navigation methods. During the operation, after LeFort I osteotomy, the mobile maxilla was repositioned to the designated position either using assistance from real-time Ci-Navi (group A) or using an intermediate splint (group B). Intra- and intergroup linear and angular differences between preoperative planning and postoperative outcomes were calculated. In group A, the overall mean linear difference was 0.79 mm (0.62 mm for the maxilla and 0.88 mm for the mandible) and the overall mean angular difference was 1.20°. In 23 cases, the difference from the upper incisor point to the Frankfort horizontal plane, midfacial sagittal plane, and coronal plane was less than 1 mm. In group B, the overall mean linear difference was 1.98 mm (1.76 mm for the maxilla and 2.02 mm for the mandible) and the overall mean angular difference was 2.08°. The difference from the upper incisor point to the Frankfort horizontal plane, midfacial sagittal plane, and coronal plane was less than 1 mm in 15 cases. This study demonstrates the utility of Ci-Navi is superior to the conventional methods in aiding the accurate repositioning of bony segments in bimaxillary orthognathic surgery.
Collapse
|
38
|
Lo LJ, Niu LS, Liao CH, Lin HH. A novel CAD/CAM composite occlusal splint for intraoperative verification in single-splint two-jaw orthognathic surgery. Biomed J 2021; 44:353-362. [PMID: 34144940 PMCID: PMC8358214 DOI: 10.1016/j.bj.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 06/22/2019] [Accepted: 03/02/2020] [Indexed: 11/08/2022] Open
Abstract
Background Previous computer-generated splints were designed and produced without modification than the traditional occlusal splints, which did not facilitate surgeon's intraoperative judgment in the single-splint two-jaw orthognathic surgery. Modifications of the digital occlusal splint can be achieved using computer-aided design and computer-aided manufacturing (CAD/CAM) software. This study reported the design, clinical application and validation of a novel CAD/CAM occlusal splint. Methods The maxillary and mandibular segments were fixed into the final occlusal splint and moved to the planned position according to the 3-dimensional simulation. The composite occlusal splint has 4 orthogonal bars to facilitate intraoperative assessment of the dental and skeletal midline, facial soft tissue midline, occlusal plane, upper tooth show, facial symmetry and facial bone position. To validate the surgical outcome, 5 parameters including pitch, roll and yaw rotations, midline deviation and chin position were measured on the virtual plan and the postoperative cone-beam computed tomography images to quantify the difference. Results The results showed no significant differences in the 5 parameters between the simulation and postoperative images. The root-mean-square difference between the conventional splints and CAD/CAM surgical splint ranged from 0.18 to 0.31 mm by superimposition of the two image models. All patients were satisfied with the treatment outcomes. Overall, this novel occlusal splint is ideal for verification of the maxillomandibular position during surgery. Conclusion The novel composite occlusal splint provided useful and informative check to verify the maxillomandibular complex (MMC) position and facial appearance in single-splint two-jaw orthognathic surgery.
Collapse
Affiliation(s)
- Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, and Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lien-Shin Niu
- Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hao Liao
- Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Hsia Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
39
|
Grillo R. Orthognathic Surgery: A Bibliometric Analysis of the Top 100 Cited Articles. J Oral Maxillofac Surg 2021; 79:2339-2349. [PMID: 34245705 DOI: 10.1016/j.joms.2021.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/19/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE An increasing number of articles on orthognathic surgery are published every year. This paper aims to provide a list of the top 100 cited articles on orthognathic surgery to help any professional level with interest in this topic and to map the trends of orthognathic surgery publications over time. METHODS A bibliographic search (retrospective study) following STROBE guidelines was performed on Google Scholar (GS) and Dimensions with the term "orthognathic surgery" in the title, abstract, and keywords. The number of citations, citations per year, authors, and publication year were evaluated. A ranking was created in GS citations order with the top 100 cited articles and variables discussed individually. A graphical illustration of keywords was created using VOSviewer. These steps are fundamental in creating this list and relating it to all published articles on the topic. RESULTS A helpful list of the top 100 articles was developed to help professionals in entirely different manners. Virtual planning and complications in orthognathic surgery were the most cited topics, with a 95% confidence interval (P < .05). Some curiosities are discussed, such as increasing interest in surgery first and the relation between airway/obstructive sleep apnea and orthognathic surgery. CONCLUSIONS Bibliometric and altmetric analysis for free using Google Scholar and Dimensions is laborious but possible. Bibliometrics is a powerful tool to become actualized at any health professional level, from students to academics; and could save considerable effort and time for parties interested in the topic. Appropriate keywords are a crucial step to wider article dissemination.
Collapse
Affiliation(s)
- Ricardo Grillo
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Faculdade São Leopoldo Mandic, Campinas, Brazil.
| |
Collapse
|
40
|
da Costa Senior O, Vaes L, Mulier D, Jacobs R, Politis C, Shaheen E. Three dimensional assessment of segmented Le Fort I osteotomy planning and follow-up: A validation study. J Dent 2021; 111:103707. [PMID: 34077799 DOI: 10.1016/j.jdent.2021.103707] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/14/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES The planning accuracy and stability during follow-up of segmented Le Fort I osteotomy, often evaluated using 2D cephalometry and dental cast analysis, is controversial. The aim of this study is to develop and validate a 3D semi-automatic, voxel-based registration assessment protocol to evaluate planning accuracy and stability of segmented Le Fort I osteotomy with individualization of the maxillary segments. METHODS Preoperative, immediate postoperative and six months postoperative CBCT images were used to evaluate accuracy and stability of the individual segments in 20 patients (13 female; 7 male) who underwent segmented Le Fort I osteotomy. Three translational (left/right, intrusion/extrusion, anterior/posterior) and three rotational (pitch, roll, yaw) dimensions were calculated for each maxillary segment by means of a user-friendly module. Inter- and intra-observer Inter Class Coefficient (ICC) and mean absolute difference (MAD) were calculated. RESULTS The inter- and intra-observer reliability ICC varied between 0.93 and 0.99 for the translational and rotational accuracy and stability assessments, indicating excellent reliability. The MAD ranged between 0.21 mm and 0.32 mm for the translational error and between 0.6° and 0.9° for the rotational dimension. CONCLUSIONS The 3D assessment protocol for accuracy of segmented Le Fort I planning and short-term follow-up, proved to have high reliability with only a small margin of error. CLINICAL SIGNIFICANCE The proposed 3D assessment protocol allows future in-depth analysis of segmented Le Fort I osteotomy and might implicate future improvement where necessary.
Collapse
Affiliation(s)
- Oliver da Costa Senior
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium.
| | - Lukas Vaes
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium
| | - Delphine Mulier
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium
| |
Collapse
|
41
|
Lee JS, Park TH, Ryu JY, Kim DK, Oh EJ, Kim HM, Shim JH, Yun WS, Huh JB, Moon SH, Kang SS, Chung HY. Osteogenesis of 3D-Printed PCL/TCP/bdECM Scaffold Using Adipose-Derived Stem Cells Aggregates; An Experimental Study in the Canine Mandible. Int J Mol Sci 2021; 22:ijms22115409. [PMID: 34063742 PMCID: PMC8196585 DOI: 10.3390/ijms22115409] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/20/2022] Open
Abstract
Three-dimensional (3D) printing is perceived as an innovative tool for change in tissue engineering and regenerative medicine based on research outcomes on the development of artificial organs and tissues. With advances in such technology, research is underway into 3D-printed artificial scaffolds for tissue recovery and regeneration. In this study, we fabricated artificial scaffolds by coating bone demineralized and decellularized extracellular matrix (bdECM) onto existing 3D-printed polycaprolactone/tricalcium phosphate (PCL/TCP) to enhance osteoconductivity and osteoinductivity. After injecting adipose-derived stem cells (ADSCs) in an aggregate form found to be effective in previous studies, we examined the effects of the scaffold on ossification during mandibular reconstruction in beagle dogs. Ten beagles were divided into two groups: group A (PCL/TCP/bdECM + ADSC injection; n = 5) and group B (PCL/TCP/bdECM; n = 5). The results were analyzed four and eight weeks after intervention. Computed tomography (CT) findings showed that group A had more diffuse osteoblast tissue than group B. Evidence of infection or immune rejection was not detected following histological examination. Goldner trichrome (G/T) staining revealed rich ossification in scaffold pores. ColI, Osteocalcin, and Runx2 gene expressions were determined using real-time polymerase chain reaction. Group A showed greater expression of these genes. Through Western blotting, group A showed a greater expression of genes that encode ColI, Osteocalcin, and Runx2 proteins. In conclusion, intervention group A, in which the beagles received the additional ADSC injection together with the 3D-printed PCL/TCP coated with bdECM, showed improved mandibular ossification in and around the pores of the scaffold.
Collapse
Affiliation(s)
- Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (J.S.L.); (T.H.P.); (J.Y.R.); (E.J.O.); (H.M.K.)
| | - Tae Hyun Park
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (J.S.L.); (T.H.P.); (J.Y.R.); (E.J.O.); (H.M.K.)
| | - Jeong Yeop Ryu
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (J.S.L.); (T.H.P.); (J.Y.R.); (E.J.O.); (H.M.K.)
| | - Dong Kyu Kim
- TINA Aesthetic Surgical Clinic, Daegu 41938, Korea;
| | - Eun Jung Oh
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (J.S.L.); (T.H.P.); (J.Y.R.); (E.J.O.); (H.M.K.)
- Cell & Matrix Research Institute, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Hyun Mi Kim
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (J.S.L.); (T.H.P.); (J.Y.R.); (E.J.O.); (H.M.K.)
- Cell & Matrix Research Institute, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Jin-Hyung Shim
- Department of Mechanical Engineering, Korea Polytechnic University, 237 Sangidaehak-Ro, Siheung-si 15073, Gyeonggi-do, Korea; (J.-H.S.); (W.-S.Y.)
- Research Institute, T&R Biofab Co., Ltd. 242 Pangyo-ro, Seongnam-si 13487, Gyeonggi-do, Korea;
| | - Won-Soo Yun
- Department of Mechanical Engineering, Korea Polytechnic University, 237 Sangidaehak-Ro, Siheung-si 15073, Gyeonggi-do, Korea; (J.-H.S.); (W.-S.Y.)
- Research Institute, T&R Biofab Co., Ltd. 242 Pangyo-ro, Seongnam-si 13487, Gyeonggi-do, Korea;
| | - Jung Bo Huh
- Department of Prosthodontics, Dental Research Institute, Institute of Translational Dental Science, School of Dentistry, Pusan National University, Yangsan-si 50612, Korea;
| | - Sung Hwan Moon
- Research Institute, T&R Biofab Co., Ltd. 242 Pangyo-ro, Seongnam-si 13487, Gyeonggi-do, Korea;
| | - Seong Soo Kang
- College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea;
| | - Ho Yun Chung
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (J.S.L.); (T.H.P.); (J.Y.R.); (E.J.O.); (H.M.K.)
- Cell & Matrix Research Institute, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- BK21 FOUR KNU Convergence Educational Program of Biomedical Science for Creative Future Talents, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- Correspondence: or ; Tel.: +82-53-420-5692; Fax: +82-53-425-3879
| |
Collapse
|
42
|
Gerbino G, Autorino U, Giaccone E, Novaresio A, Ramieri G. Virtual planning and CAD/CAM-assisted distraction for maxillary hypoplasia in cleft lip and palate patients: Accuracy evaluation and clinical outcome. J Craniomaxillofac Surg 2021; 49:799-808. [PMID: 33906808 DOI: 10.1016/j.jcms.2021.03.004] [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: 06/30/2020] [Revised: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022] Open
Abstract
The aim of this prospective study was to report the experience with a specific guided distraction protocol for the treatment of CLP patients with severe midface hypoplasia. From January 2016 to April 2019, six consecutive, non-growing, CLP patients with maxillary hypoplasia underwent a specific distraction protocol based on the use of VSP, CAD/CAM-generated surgical splints, cutting guides, prebent internal maxillary distractors, early removal of distractors, and acute callus manipulation and fixation. STL files for VSP, using multislice CT scans taken preoperatively (T0) and 3 months after distractor removal (T1) were superimposed using the free software 3D Slicer and Geomagic Wrap to evaluate the accuracy of maxillary repositioning and assess 3D bone changes. Clinical outcome was evaluated at the 1-year follow-up (T2). The patients and surgeon were satisfied with the occlusal and aesthetic outcomes. A maximum difference of 2 mm between the VSP and the actual surgical outcome was chosen as the success criterion for accuracy. The average linear difference for selected points was <2 mm in four patients and >2 mm in two patients. The average distance of the postoperative maxilla from the VSP model was 2.28 mm (median 1.85), while the average forward movement of the maxilla was 10.18 mm The protocol used is effective and accurate in the correction of severe maxillary hypoplasia in CLP patients. Early removal of the distractor and stabilization with plates reduces patient discomfort and does not jeopardize stability. This protocol should be reserved for complex cases due to the costs of the procedure, which are not negligible.
Collapse
Affiliation(s)
- Giovanni Gerbino
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Torino, Italy
| | - Umberto Autorino
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Torino, Italy.
| | - Elena Giaccone
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Torino, Italy
| | - Andrea Novaresio
- Department of Surgical Sciences, University of Torino, Department of Management and Production Engineering, Politecnico of Torino, Italy
| | - Gugliemo Ramieri
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Torino, Italy
| |
Collapse
|
43
|
Oh HJ, Moon JH, Ha H, Son IS, Lee YC, Lee SJ, Sohn HB, Seo BM. Virtually-Planned Orthognathic Surgery Achieves an Accurate Condylar Position. J Oral Maxillofac Surg 2021; 79:1146.e1-1146.e25. [PMID: 33539812 DOI: 10.1016/j.joms.2020.12.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Accuracy in orthognathic surgery with virtual planning has been reported, but detailed analysis of accuracy according to anatomic location, including the mandibular condyle, is insufficient. The purpose of this study was to compare the virtual plan and surgical outcomes and analyze the degree and distribution of errors according to each anatomic location. PATIENTS AND METHODS This retrospective cohort study evaluated skeletal class III patients, treated with bimaxillary surgery. The primary predictor was anatomic locations that consisted of right and left condyles, maxilla, and the distal segment of the mandible. Other variables were age and gender. The primary outcome was surgical accuracy, defined as mean 3-dimensional distance error, mean absolute error, and mean error along the horizontal, vertical, and anteroposterior axes between the virtual plan and surgical outcomes. Landmarks were compared using a computational method based on affine transformation with a 1-time landmark setting. The mean errors were visualized with multidimensional scattergrams. Bivariate and regression statistics were computed. RESULTS This study included 52 patients, 26 men and 26 women, with a mean age of 21 years and 3 months. The mean 3D distance errors for condylar landmarks, maxillary landmarks, and landmarks on the distal segment of the mandible were 1.03, 1.25, and 2.24 mm, respectively. Condylar landmarks, maxillary landmarks, and the landmarks on the distal segment of the mandible were positioned at 0.49 mm inferior, 0.28 mm anterior, and 1.25 mm inferior, respectively. The landmark errors for the distal segment of the mandible exhibited a wider distribution than those for condylar and maxillary landmarks. CONCLUSIONS Agreement between the planned and actual outcome aided by virtual surgical planning was highest for the condyles, followed by the maxilla, and the distal segment of the mandible. It is important to consider the tendency for surgical errors in each anatomic location during operations.
Collapse
Affiliation(s)
- Hyun Jun Oh
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, Graduate School, Seoul National University, Seoul, Korea
| | - Jun-Ho Moon
- Graduate Student, Department of Orthodontics, Graduate School, Seoul National University, Seoul, Korea
| | - Hyunbin Ha
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, Graduate School, Seoul National University, Seoul, Korea
| | - In Seon Son
- Researcher, BOS Research Institute, Seoul, Korea
| | - Yong-Chan Lee
- Private Practitioner, Department of Oral and Maxillofacial Surgery, Bestian Seoul Hospital, Seoul, Korea
| | - Shin-Jae Lee
- Professor, Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Hong-Bum Sohn
- Private Practitioner, Department of Orthodontics, Eton Dental Hospital, Seoul, Korea
| | - Byoung-Moo Seo
- Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea.
| |
Collapse
|
44
|
Perea-Lowery L, Gibreel M, Vallittu PK, Lassila L. Evaluation of the mechanical properties and degree of conversion of 3D printed splint material. J Mech Behav Biomed Mater 2020; 115:104254. [PMID: 33333480 DOI: 10.1016/j.jmbbm.2020.104254] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/26/2020] [Accepted: 12/06/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the effect of post-curing method, printing layer thickness, and water storage on the mechanical properties and degree of conversion of a light-curing methacrylate based resin material (IMPRIMO® LC Splint), used for the fabrication of 3D printed occlusal splints and surgical guides. METHODS 96 bar-shaped specimens were 3D printed (Asiga MAX), half of them with a layer thickness of 100 μm (Group A), and half with 50 μm (Group B). Each group was divided in three subgroups based on the post-curing method used: post-curing with light emitting diode (LED) and nitrogen gas; post-curing with only LED; and non-post-curing. Half of the specimens from each subgroup were water-stored for 30 days while the other half was dry-stored (n = 8). Flexural strength and flexural modulus were evaluated. Additional specimens were prepared and divided in the same way for surface hardness (n = 96), fracture toughness, and work of fracture (n = 96). Five specimens were selected from each subgroup for evaluating the degree of conversion (DC). Data were collected and statistically analyzed with 1-way, 2-way ANOVA, and Tukey post-hoc analysis (α = 0.05). RESULTS The 2-way ANOVA showed that the post-curing method and water storage significantly affected the investigated mechanical properties (P < 0.001). The 1-way ANOVA revealed a statistically significant difference among the tested groups on the investigated properties (P < 0.001). After water storage, the 100 μm subgroup post-cured with only LED showed higher flexural strength (51 ± 9) than the 50 μm and 100 μm subgroups that were post-cured with LED in addition to nitrogen gas atmosphere (38 ± 5, 30 ± 3) (p < 0.05). The 50 μm subgroup post-cured with only LED showed the highest significant flexural modulus values (1.7 ± 0.08) (p < 0.05). However, the 50 μm subgroup post-cured with LED plus nitrogen showed significantly higher surface hardness values (p < 0.05) among the investigated groups. The non-post-cured subgroups showed the lowest values, which were significantly different from the other subgroups (p < 0.05). CONCLUSION The post-curing method, water storage, and printing layer thickness play a role in the mechanical properties of the investigated 3D Printed occlusal splints material. The combination of heat and light within the post-curing unit can enhance the mechanical properties and degree of conversion of 3D printed occlusal splints. Flexural strength and surface hardness can increase when decreasing printing layer thickness.
Collapse
Affiliation(s)
- Leila Perea-Lowery
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B (2nd Floor), FI-20520, Turku, Finland.
| | - Mona Gibreel
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B (2nd Floor), FI-20520, Turku, Finland
| | - Pekka K Vallittu
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B (2nd Floor), FI-20520, Turku, Finland; City of Turku Welfare Division, Oral Health Care, Lemminkäisenkatu 2, FI-20520, Turku, Finland
| | - Lippo Lassila
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B (2nd Floor), FI-20520, Turku, Finland
| |
Collapse
|
45
|
Palazzo G, Ronsivalle V, Oteri G, Lo Giudice A, Toro C, Campagna P, Patini R, Bocchieri S, Bianchi A, Isola G. Comparison between Additive and Subtractive CAD-CAM Technique to Produce Orthognathic Surgical Splints: A Personalized Approach. J Pers Med 2020; 10:jpm10040273. [PMID: 33322616 PMCID: PMC7768501 DOI: 10.3390/jpm10040273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023] Open
Abstract
The present study aimed to evaluate the accuracy of digitally designed surgical splints generated with milling technology (material subtractive procedure) and with 3D printing technology (material additive procedure) through a customized approach in the planning of surgical orthognathic splints. Cone beam computed tomography (CBCT) examinations and scanned dental models of 10 subjects who had required surgical treatment of skeletal malocclusion were included. Simulation of the orthognathic surgery was performed according to dento-skeletal and aesthetic characteristics of the subjects and the visual treatment objective (VTO), using Dolphin3D software (Dolphin Imaging, version 11.0, Chatsworth, CA, USA). Afterward, the Appliance Designer software (3Shape A/S, Copenhagen, Denmark) was used to digitally design the surgical splints that were generated twice using laser stereolithography technology (DWS 0.29D, DWS, Vicenza, Italy) and milling technology (Sirona inLab MC X5). Finally, each physical splint was digitalized using a desktop scanner (D500 3D, 3Shape A/S, Copenhagen, Denmark) in order to perform deviation analysis using the original project as a reference. The relative percentage of matching (trueness) was calculated (Geomagic Control X software (3D Systems, version 2018.1.1, 3D Systems, Rock Hill, SC, USA). An Independent Student's t-test was used to statistically analyze the data. The milled splints showed a lower value of root to mean square (RMS) relative to the original project (0.20 mm ± 0.018) compared to the prototyped splints (0.31 ± 0.021) (p < 0.001). According to the present findings, surgical splints generated with milling technology present higher trueness compared with 3D printing technology.
Collapse
Affiliation(s)
- Giuseppe Palazzo
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
| | - Vincenzo Ronsivalle
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
| | - Giacomo Oteri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, School of Dentistry, University of Messina, Via Consolare Valeria 1, 98123 Messina, Italy;
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
| | - Corrado Toro
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
| | - Paola Campagna
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
| | - Romeo Patini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Dentistry and Maxillofacial Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: (R.P.); (G.I.); Tel.: +39-06-3015-4286 (R.P.); +39-09-5743-5359 (G.I.)
| | - Salvatore Bocchieri
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
| | - Alberto Bianchi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.P.); (V.R.); (A.L.G.); (C.T.); (P.C.); (S.B.); (A.B.)
- Correspondence: (R.P.); (G.I.); Tel.: +39-06-3015-4286 (R.P.); +39-09-5743-5359 (G.I.)
| |
Collapse
|
46
|
Alkhayer A, Piffkó J, Lippold C, Segatto E. Accuracy of virtual planning in orthognathic surgery: a systematic review. Head Face Med 2020; 16:34. [PMID: 33272289 PMCID: PMC7716456 DOI: 10.1186/s13005-020-00250-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/24/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The elaboration of a precise pre-surgical plan is essential during surgical treatment of dentofacial deformities. The aim of this study was to evaluate the accuracy of computer-aided simulation compared with the actual surgical outcome, following orthognathic surgery reported in clinical trials. METHODS Our search was performed in PubMed, EMBASE, Cochrane Library and SciELO for articles published in the last decade. A total of 392 articles identified were assessed independently and in a blinded manner using eligibility criteria, out of which only twelve articles were selected for inclusion in our research. Data were presented using intra-class correlation coefficient, and linear and angular differences in three planes. RESULTS The comparison of the accuracy analyses of the examined method has shown an average translation (< 2 mm) in the maxilla and also in the mandible (in three planes). The accuracy values for pitch, yaw, and roll (°) were (< 2.75, < 1.7 and < 1.1) for the maxilla, respectively, and (< 2.75, < 1.8, < 1.1) for the mandible. Cone-beam computed tomography (CBCT) with intra-oral scans of the dental casts is the most used imaging protocols for virtual orthognathic planning. Furthermore, calculation of the linear and angular differences between the virtual plan and postoperative outcomes was the most frequented method used for accuracy assessment (10 out of 12 studies) and a difference less than 2 mm/° was considered acceptable and accurate. When comparing this technique with the classical planning, virtual planning appears to be more accurate, especially in terms of frontal symmetry. CONCLUSION Virtual planning seems to be an accurate and reproducible method for orthognathic treatment planning. However, more clinical trials are needed to clearly determine the accuracy and validation of the virtual planning in orthognathic surgery.
Collapse
Affiliation(s)
- Ali Alkhayer
- Craniofacial Unit, Department of Oral & Maxillofacial Surgery, University of Szeged, Tisza Lajos krt. 97, Szeged, Hungary
| | - József Piffkó
- Department of Oral & Maxillofacial Surgery, Faculty of Medicine, University of Szeged, Kálvária sugárút. 57, Szeged, Hungary
| | - Carsten Lippold
- Department of Orthodontics, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W30, Waldeyerstraße 30, 48149, Münster, Germany.
| | - Emil Segatto
- Craniofacial Unit, Department of Oral & Maxillofacial Surgery, University of Szeged, Tisza Lajos krt. 97, Szeged, Hungary
| |
Collapse
|
47
|
New protocol for in-house management of computer assisted orthognathic surgery. Br J Oral Maxillofac Surg 2020; 58:e265-e271. [DOI: 10.1016/j.bjoms.2020.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 07/16/2020] [Indexed: 11/17/2022]
|
48
|
Chen H, Bi R, Hu Z, Chen J, Jiang N, Wu G, Li Y, Luo E, Zhu S. Comparison of three different types of splints and templates for maxilla repositioning in bimaxillary orthognathic surgery: a randomized controlled trial. Int J Oral Maxillofac Surg 2020; 50:635-642. [PMID: 33131986 DOI: 10.1016/j.ijom.2020.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/02/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023]
Abstract
The selection and implementation of a plan for maxillary surgery is of the utmost importance in achieving the desired outcome for the patient undergoing two-jaw orthognathic surgery. Some splint-based and splintless methods, accompanied by computer-assisted techniques, are helpful in improving surgical plan implementation. However, randomized controlled trials focused on this procedure are lacking. This study included 61 patients who underwent bimaxillary surgeries. The patients were randomly assigned to a conventional resin occlusal splint (CROS) group, a digital occlusal splint (DOS) group, or a digital templates (DT) group, in a 1:1:1 ratio. The mean linear distance between the planned and actual postoperative positions of eight selected points on the surfaces of the maxillary teeth was selected as the outcome measure. The distance was significantly smaller in the DT group (1.17±0.66mm) when compared to both the CROS group (2.55±0.95mm, P<0.05) and DOS group (2.15±1.12mm, P<0.05). However, the difference between the CROS group and DOS group was not statistically significant. These findings indicate that using digital templates results in the best performance in transferring the surgical plan to the operation environment as compared to the other two types of splints. This suggests that the application of digital templates could provide a reliable treatment option.
Collapse
Affiliation(s)
- H Chen
- Department of Orthognathic and TMJ Surgery, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - R Bi
- Department of Orthognathic and TMJ Surgery, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Z Hu
- Orthodontic Department, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - J Chen
- Orthodontic Department, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - N Jiang
- Department of Orthognathic and TMJ Surgery, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - G Wu
- Department of Plastic and Aesthetic Surgery, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Y Li
- Department of Orthognathic and TMJ Surgery, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - E Luo
- Department of Orthognathic and TMJ Surgery, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - S Zhu
- Department of Orthognathic and TMJ Surgery, State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| |
Collapse
|
49
|
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
|
50
|
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
|