1
|
Ajmera DH, Singh P, Leung YY, Khambay BS, Gu M. Establishment of the mid-sagittal reference plane for three-dimensional assessment of facial asymmetry: a systematic review : Establishment of the mid-sagittal reference plane: a systematic review. Clin Oral Investig 2024; 28:242. [PMID: 38575839 PMCID: PMC10995046 DOI: 10.1007/s00784-024-05620-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To systematically review the literature for mid-sagittal plane establishment approaches to identify the most effective method for constructing the mid-sagittal plane for the evaluation of facial asymmetry. MATERIALS AND METHODS Six electronic databases (PubMed, Medline (via Ovid), EMBASE (via Ovid), Cochrane Library, Web of Science, and Scopus) and grey literature were searched for the studies that computed the mid-sagittal reference plane three-dimensionally, using a combination of MeSH terms and keywords. The methodological quality and the level of evidence for the included studies were analyzed using QUADAS-2 and GRADE, respectively. RESULTS The preliminary search yielded 6746 records, of which 42 articles that met the predefined inclusion criteria were included in the final analysis. All the included articles reported the construction of the mid-sagittal reference plane (MSP) using varied methods. The risk of bias and concerns regarding the applicability of the included studies were judged to be 'low'. The level of evidence was determined to be 'low' for the effectiveness of the technique and 'moderate' for the ease of clinical applicability. CONCLUSION Despite methodological heterogeneity, this review substantiates the comparable efficacy of cephalometric and morphometric MSP construction methods. A fully automated morphometric MSP holds promise as a viable option for routine clinical use. Nevertheless, future prospective studies with an emphasis on the impact, accuracy, and clinical applicability of MSP construction techniques in cases of facial asymmetry are required. CLINICAL RELEVANCE The present review will assist clinicians in selecting the most suitable method for MSP construction, leading to improved treatment planning and ultimately more favorable treatment outcomes.
Collapse
Affiliation(s)
- Deepal Haresh Ajmera
- Discipline of Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Pradeep Singh
- Discipline of Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Yiu Yan Leung
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Balvinder S Khambay
- Discipline of Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
- Orthodontics Department, School of Dentistry, University of Birmingham, Birmingham, UK.
- Discipline of Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong SAR, China.
| | - Min Gu
- Discipline of Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
2
|
Lyu L, Zhang MJ, Wen AN, Wang S, Zhao YJ, Yong wang, Yu TT, Liu D. 3D facial mask for facial asymmetry diagnosis. Heliyon 2024; 10:e26734. [PMID: 38444476 PMCID: PMC10912245 DOI: 10.1016/j.heliyon.2024.e26734] [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: 06/07/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
Objectives Facial asymmetry is a common problem seen in orthodontic clinics that may affect patient esthetics. In some instances, severe asymmetry that affects patient esthetics may cause psychological issues. An objective method is therefore required to help orthodontists identify asymmetry issues. Materials and methods We used three-dimensional (3D) facial images and landmark-based anthropometric analysis to construct a 3D facial mask to evaluate asymmetry. The landmark coordinates were transformed using a symmetric 3D face model to evaluate the efficacy of this method. Patients with facial asymmetry were recruited to conduct mirror and overlap analysis to form color maps, which were used to verify the utility of the novel soft tissue landmark-based method. Results The preliminary results demonstrated that the asymmetry evaluation method had a similar response rate compared to diagnosis using mirror and overlap 3D images, and could therefore identify 3D asymmetry problems. Conclusions By using 3D facial scans and 3D anthropometric analysis, we developed a preliminary evaluation method that provides objective parameters to clinically evaluate patient facial asymmetry and aid in the diagnosis of asymmetric areas. Clinical relevance This study presents a novel facial asymmetry diagnostic method that has the potential to aid clinical decisions during problem identification, treatment planning, and efficacy evaluation.
Collapse
Affiliation(s)
- Liang Lyu
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Ming-Jin Zhang
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Ao-Nan Wen
- National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
- Center of Digital Dentistry/Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Center of Stomatology, Beijing, China
- Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Shuo Wang
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Yi-Jiao Zhao
- National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
- Center of Digital Dentistry/Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Center of Stomatology, Beijing, China
- Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Yong wang
- National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
- Center of Digital Dentistry/Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Center of Stomatology, Beijing, China
- Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Ting-Ting Yu
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Dawei Liu
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
| |
Collapse
|
3
|
Ho CT, Denadai R, Lo LJ, Lin HH. Average Three-Dimensional Skeletofacial Model as a Template for Bone Repositioning during Virtual Orthognathic Surgery. Plast Reconstr Surg 2024; 153:435-444. [PMID: 36940142 DOI: 10.1097/prs.0000000000010449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Virtual planning has revolutionized orthognathic surgery. This study presents a computer-assisted method for constructing average three-dimensional skeletofacial models that can be applied as templates for surgical planning for maxillomandibular repositioning. METHODS The authors used the images of 60 individuals (30 women and 30 men) who had never undergone orthognathic surgery to construct an average three-dimensional skeletofacial model for male participants and one for female participants. The authors validated the accuracy of the newly developed skeletofacial models by comparing their images with 30 surgical simulation images (ie, skulls) that had been created using three-dimensional cephalometric normative data. The comparison was conducted by superimposing surgical simulation images created using the authors' models with the previously created images to analyze their differences, particularly differences in the jawbone position. RESULTS For all participants, the authors compared the jaw position in the surgical simulation images created using the authors' average three-dimensional skeletofacial models with that in the images created using three-dimensional cephalometric normative data. The results revealed that the planned maxillary and mandibular positions were similar in both images and that the differences between all facial landmarks were less than 1 mm, except for one dental position. Most studies have reported less than 2 mm to be the success criterion for the distance difference between planned and outcome images; thus, the authors' data indicate high consistency between the images in terms of jawbone position. CONCLUSION The authors' average three-dimensional skeletofacial models provide an innovative template-assisted orthognathic surgery planning modality that can enhance the fully digital workflow for virtual orthognathic surgical planning. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
Collapse
Affiliation(s)
- Cheng Ting Ho
- From the Division of Craniofacial Orthodontics, Department of Dentistry
| | - Rafael Denadai
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Hsiu-Hsia Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital
| |
Collapse
|
4
|
Sato N, Denadai R, Hung YT, Chung KH, Chou PY, Pai BCJ, Lo LJ, Lin HH. Single-Splint, 2-Jaw Orthognathic Surgery for Correction of Facial Asymmetry: 3-Dimensional Planning and Surgical Execution. J Craniofac Surg 2023:00001665-990000000-01254. [PMID: 38018966 DOI: 10.1097/scs.0000000000009912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/28/2023] [Indexed: 11/30/2023] Open
Abstract
Three-dimensional (3D) planning of orthognathic surgery (OGS) improves the treatment of facial asymmetry and malocclusion, but no consensus exists among clinicians regarding technical details. This study verified the consistency of authors' workflow and strategies between 3D planning and surgical execution for facial asymmetry. This retrospective study recruited consecutive patients (n=54) with nonsyndromic facial asymmetry associated with malocclusion. The stepwise workflow included orthodontic treatment, 3D imaging-based evaluation, planning, and transferring the virtual of single-splint 2-jaw OGS to actual surgery in all patients. Seven landmark-based measurements were selected for postoperative assessment of facial symmetry. Fifty patients had no anesthetic/surgical-related episode and procedure-related complications. Others experienced wound infection (n=1), transient TMJ discomfort (n=1), and facial numbness (n=3). Two cases had minor residual asymmetry (cheek and chin, respectively), but did not request revisionary bone or soft tissue surgery. Comparisons between the planned and postoperative 3D images with quantitative measurement revealed acceptable outcome data. The results showed a significant increase in facial symmetry at 7 landmark-based postoperative measurements for both male and female. This 3D-assisted pathway of OGS permitted achievement of consistent satisfactory results in managing facial asymmetry, with low rate of complications and secondary management.
Collapse
Affiliation(s)
- Nobuhiro Sato
- Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Sao Paulo, Brazil
| | - Yi-Tan Hung
- Image Lab and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | | | - Pang-Yun Chou
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Betty C J Pai
- Department of Craniofacial Orthodontics and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Hsia Lin
- Image Lab and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
5
|
Pei J, Liao X, Ge L, Liu J, Jiang X. Anterior cerebral falx plane in MR images to estimate the craniofacial midline. Sci Rep 2023; 13:16489. [PMID: 37779134 PMCID: PMC10543626 DOI: 10.1038/s41598-023-42807-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023] Open
Abstract
Multiple methods have been proposed for evaluating the symmetry of facial contour by utilizing the median sagittal plane of the skull as a reference and measuring the maxillofacial region. To replace the manual mark point analysis method, we used the anterior cerebral falx plane in MRI images as an indicator of the craniofacial midline. The MRI examination data of 30 individuals were analyzed with a MeVisLab workstation. Two independent examiners performed 15 anthropometric measurements (4 angular, 11 linear) and compared the MRI-based anterior cerebral falx plane with the manual mark point analysis of the craniofacial midline estimation. All measurements were repeated after 3 weeks. Statistical analyses included the repeatability and reproducibility of the 2 methods based on intra-observer and inter-observer correlation coefficients (ICCs), respectively. Precision was estimated by intergroup comparison of the coefficient of variation. The anterior falx plane derived from the MRI data resulted in an intra-observer ICC of 0.869 ± 0.065 (range 0.733-0.936) and inter-observer ICC of 0.876 ± 0.0417 (0.798-0.932) for all measurements, showing significant correlations with the ICC values obtained by the mark point method (p < 0.05). The coefficient of variation showed that the precisions of the 2 methods were statistically comparable. We conclude that, for MRI-based craniofacial midline estimation, measurements made using the anterior cerebral falx plane are as precise, repeatable, and reproducible as those using the manual mark point analysis method. It has a high potential for application in radiation-free 3-dimensional craniofacial analysis.
Collapse
Affiliation(s)
- Jun Pei
- Affiliated Hospital of Chifeng University, Yuanlin Road 98, Chi Feng, 150400, Neimenggu, China
| | - Xu Liao
- Affiliated Hospital of Chifeng University, Yuanlin Road 98, Chi Feng, 150400, Neimenggu, China
| | - Lingling Ge
- Affiliated Hospital of Chifeng University, Yuanlin Road 98, Chi Feng, 150400, Neimenggu, China
| | - Jianwei Liu
- Affiliated Hospital of Chifeng University, Yuanlin Road 98, Chi Feng, 150400, Neimenggu, China
| | - Xiling Jiang
- Affiliated Hospital of Chifeng University, Yuanlin Road 98, Chi Feng, 150400, Neimenggu, China.
| |
Collapse
|
6
|
Lo LJ, Lin HH. Applications of three-dimensional imaging techniques in craniomaxillofacial surgery: A literature review. Biomed J 2023; 46:100615. [PMID: 37343928 PMCID: PMC10339193 DOI: 10.1016/j.bj.2023.100615] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/02/2023] [Accepted: 06/10/2023] [Indexed: 06/23/2023] Open
Abstract
Three-dimensional (3D) imaging technologies are increasingly used in craniomaxillofacial (CMF) surgery, especially to enable clinicians to get an effective approach and obtain better treatment results during different preoperative and postoperative phases, namely during image acquisition and diagnosis, virtual surgical planning (VSP), actual surgery, and treatment outcome assessment. The article presents an overview of 3D imaging technologies used in the aforementioned phases of the most common CMF surgery. We searched for relevant studies on 3D imaging applications in CMF surgery published over the past 10 years in the PubMed, ProQuest (Medline), Web of Science, Science Direct, Clinical Key, and Embase databases. A total of 2094 articles were found, of which 712 were relevant. An additional 26 manually searched articles were included in the analysis. The findings of the review demonstrated that 3D imaging technology is becoming increasingly popular in clinical practice and an essential tool for plastic surgeons. This review provides information that will help researchers and clinicians consider the use of 3D imaging techniques in CMF surgery to improve the quality of surgical procedures and achieve satisfactory treatment outcomes.
Collapse
Affiliation(s)
- Lun-Jou Lo
- Plastic & Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Hsiu-Hsia Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| |
Collapse
|
7
|
Kormi E, Peltola E, Lusila N, Heliövaara A, Leikola J, Suojanen J. Unilateral Cleft Lip and Palate Has Asymmetry of Bony Orbits: A Retrospective Study. J Pers Med 2023; 13:1067. [PMID: 37511680 PMCID: PMC10381611 DOI: 10.3390/jpm13071067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
Facial asymmetry is common in unilateral clefts. Since virtual surgical planning (VSP) is becoming more common and automated segmentation is utilized more often, the position and asymmetry of the orbits can affect the design outcome. The aim of this study is to evaluate whether non-syndromic unilateral cleft lip and palate (UCLP) patients requiring orthognathic surgery have asymmetry of the bony orbits. Retrospectively, we analyzed the preoperative cone-beam computed tomography (CBCT) or computed tomography (CT) data of UCLP (n = 15) patients scheduled for a Le Fort 1 (n = 10) or bimaxillary osteotomy (n = 5) with VSP at the Cleft Palate and Craniofacial Center, Helsinki University Hospital. The width, height, and depth of the bony orbit and the distance between the sella turcica and infraorbital canal were measured. A volumetric analysis of the orbits was also performed. The measurements were tested for distribution, and the cleft side and the contralateral side were compared statistically with a two-sided paired t-test. To assess asymmetry in the non-cleft population, we performed the same measurements of skeletal class III patients undergoing orthognathic surgery at Päijät-Häme Central Hospital (n = 16). The volume of bony orbit was statistically significantly smaller (p = 0.014), the distance from the infraorbital canal to sella turcica was shorter (p = 0.019), and the anatomical location of the orbit was more medio-posterior on the cleft side than on the contralateral side. The non-cleft group showed no statistically significant asymmetry in any measurements. According to these preliminary results, UCLP patients undergoing orthognathic surgery show asymmetry of the bony orbit not seen in skeletal class III patients without a cleft. This should be considered in VSP for the correction of maxillary hypoplasia and facial asymmetry in patients with UCLP.
Collapse
Affiliation(s)
- Eeva Kormi
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Päijät-Häme Central Hospital, 15850 Lahti, Finland
| | - Elina Peltola
- HUS Diagnostic Center, Radiology, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Niilo Lusila
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Radiology, Päijät-Häme Central Hospital, 15850 Lahti, Finland
| | - Arja Heliövaara
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Junnu Leikola
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Juho Suojanen
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Päijät-Häme Central Hospital, 15850 Lahti, Finland
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital, 00029 Helsinki, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| |
Collapse
|
8
|
Hattori Y, Pai BCJ, Saito T, Chou PY, Lu TC, Chang CS, Chen YR, Lo LJ. Long-term treatment outcome of patients with complete bilateral cleft lip and palate: a retrospective cohort study. Int J Surg 2023; 109:1656-1667. [PMID: 37073546 PMCID: PMC10389451 DOI: 10.1097/js9.0000000000000406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/06/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Patients with cleft lip and palate have functional and esthetic impairment and typically require multiple interventions in their life. Long-term evaluation following a treatment protocol, especially for patients with complete bilateral cleft lip and palate (BCLP), is important but was rarely reported in the literature. PATIENTS AND METHODS A retrospective review was conducted on all patients with complete BCLP born between 1995 and 2002 and treated at our center. Inclusion criteria were having adequate medical records and receiving continuous multidisciplinary team care at least until 20 years of age. Exclusion criteria were lack of regular follow-up and congenital syndromic abnormalities. The medical records and photos were reviewed, and facial bone development was evaluated using cephalometric analysis. RESULTS A total of 122 patients were included, with a mean age of 22.1 years at the final evaluation in this study. Primary one-stage cheiloplasty was performed in 91.0% of the patients, and 9.0% underwent two-stage repair with an initial adhesion cheiloplasty. All patients underwent two-flap palatoplasty at an average of 12.3 months. Surgical intervention for velopharyngeal insufficiency was required in 59.0% of patients. Revisional lip/nose surgery was performed in 31.1% during growing age and in 64.8% after skeletal maturity. Orthognathic surgery was applied in 60.7% of patients with retruded midface, of which 97.3% underwent two-jaw surgery. The average number of operations to complete the treatment was 5.9 per patient. CONCLUSION Patients with complete BCLP remain the most challenging group to treat among the cleft. This review revealed certain suboptimal results, and modifications have been made to the treatment protocol. Longitudinal follow-up and periodic assessment help to establish an ideal therapeutic strategy and improve overall cleft care.
Collapse
Affiliation(s)
- Yoshitsugu Hattori
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Betty C.-J. Pai
- Department of Craniofacial Orthodontics and Craniofacial Research Center, Chang Gung Memorial Hospital, Kwei Shan, Taoyuan, Taiwan
| | - Takafumi Saito
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Pang-Yun Chou
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Ting-Chen Lu
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Chun-Shin Chang
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Yu-Ray Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| |
Collapse
|
9
|
Simon B, Mangano FG, Pál A, Simon I, Pellei D, Shahbazi A, Vág J. Palatal asymmetry assessed by intraoral scans: effects of sex, orthodontic treatment, and twinning. A retrospective cohort study. BMC Oral Health 2023; 23:305. [PMID: 37202781 DOI: 10.1186/s12903-023-02993-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/27/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Symmetry is critical in perceived attractiveness, especially in female faces. The palate determines the teeth' alignment and supports facial soft tissues. Therefore, the study aimed to assess the effects of sex, orthodontic treatment, age, and heritability on the directional, anti-, and fluctuational asymmetry in the digital palatal model. METHODS The palate of 113 twins, 86 female and 27 male subjects, with and without previous orthodontic treatment, were scanned by the Emerald (Planmeca) intraoral scanner. Three lines were constructed horizontally in the digital model, one between the right and left first upper molars and two between the first molars and incisive papilla. Two observers calculated the left and right angles between the mid-sagittal plane and molar-papilla lines. The intraclass correlation coefficient was used to assess the inter-observer absolute agreement. The directional symmetry was determined by comparing the mean left and right angles. The antisymmetry was estimated from the distribution curve of the signed side difference. The fluctuating asymmetry was approximated from the magnitude of the absolute side difference. Finally, the genetic background was assessed by correlating the absolute side difference between monozygotic twin siblings. RESULTS The right angle (31.1 degrees) was not significantly different from the left one (31.6 degrees). The signed side difference followed a normal distribution with a mean of -0.48 degrees. The absolute side difference (2.29 degrees, p < 0.001) was significantly different from zero and negatively correlated (r=-0.46, p < 0.05) between siblings. None of the asymmetries was affected by sex, orthodontic treatment or age. CONCLUSIONS The palate illustrates neither directional asymmetry nor antisymmetry, indicating that most people's palates are symmetric. However, the significant fluctuating asymmetry suggests that some subject has considerable asymmetry but is not influenced by sex, orthodontic treatment, age, and genetics. The proposed digital method is a reliable and non-invasive tool that could facilitate achieving a more symmetrical structure during orthodontic and aesthetic rehabilitation. TRIAL REGISTRATION The Clinicatrial.gov registration number is NCT05349942 (27/04/2022).
Collapse
Affiliation(s)
- Botond Simon
- Department of Restorative Dentistry and Endodontics, Semmelweis University, Budapest, Hungary.
| | - Francesco Guido Mangano
- Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russia
| | - Adrienn Pál
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
| | - István Simon
- Department of Paediatric Dentistry and Orthodontics, Semmelweis University, Budapest, Hungary
| | - Dalma Pellei
- Department of Restorative Dentistry and Endodontics, Semmelweis University, Budapest, Hungary
| | - Arvin Shahbazi
- Department of Restorative Dentistry and Endodontics, Semmelweis University, Budapest, Hungary
- Department of Anatomy, Histology and Embryology (Oral Morphology Group), Semmelweis University, Budapest, Hungary
- Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - János Vág
- Department of Restorative Dentistry and Endodontics, Semmelweis University, Budapest, Hungary
| |
Collapse
|
10
|
Onică N, Onică CA, Tatarciuc M, Baciu ER, Vlasie GL, Ciofu M, Balan M, Gelețu GL. Managing Predicted Post-Orthognathic Surgical Defects Using Combined Digital Software: A Case Report. Healthcare (Basel) 2023; 11:healthcare11091219. [PMID: 37174761 PMCID: PMC10178701 DOI: 10.3390/healthcare11091219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
For facial abnormalities, recent developments in virtual surgical planning (VSP) and the virtual design of surgical splints are accessible. Software companies have worked closely with surgical teams for accurate outcomes, but they are only as reliable as the data provided to them. The current case's aim was to show a fully digitized workflow using a combination of three digital software to correct predicted post-upward sliding genioplasty defects. To reach our goal, we presented a 28-year-old man with long-face syndrome for orthodontic treatment. Before orthognathic surgery, a clinical and paraclinical examination was performed. For a virtual surgical plan, we used the dedicated surgical planning software NemoFab (Nemotec, Madrid, Spain) and Autodesk MeshMixer (Autodesk Inc., San Rafael, CA, USA). To create the design of the digital guides, DentalCAD 3.0 Galway (exocad GmbH, Darmstadt, Germany) and Autodesk MeshMixer (Autodesk Inc., San Rafael, CA, USA) were used. The patient had undergone bilateral sagittal split osteotomy in addition to Le Fort 1 osteotomy and genioplasty, followed by mandible base recontouring ostectomy. Stable fixation was used for each osteotomy. Based on our case, the current orthognathic surgery planning software was not able to perform all the necessary operations autonomously; therefore, future updates are eagerly awaited.
Collapse
Affiliation(s)
- Neculai Onică
- Specialist Oral and Maxillofacial Surgery, Private Practice, 700612 Iasi, Romania
| | | | - Monica Tatarciuc
- Department of Implantology, Removable Dentures, Dental Technology, Faculty of Dental Medicine, University of Medicine and Pharmacy, "Grigore T. Popa", 700115 Iasi, Romania
| | - 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
| | | | - Mihai Ciofu
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
| | - Mihail Balan
- Department of Surgery, 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
| |
Collapse
|
11
|
Seo HJ, Choi YK. Current trends in orthognathic surgery. Arch Craniofac Surg 2022; 22:287-295. [PMID: 34974683 PMCID: PMC8721433 DOI: 10.7181/acfs.2021.00598] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/20/2022] Open
Abstract
Orthognathic surgery has steadily evolved, gradually expanding its scope of application beyond its original purpose of simply correcting malocclusion and the facial profile. For instance, it is now used to treat obstructive sleep apnea and to achieve purely cosmetic outcomes. Recent developments in three-dimensional digital technology are being utilized throughout the entire process of orthognathic surgery, from establishing a surgical plan to printing the surgical splint. These processes have made it possible to perform more sophisticated surgery. The goal of this review article is to introduce current trends in the field of orthognathic surgery and controversies that are under active discussion. The role of a plastic surgeon is not limited to performing orthognathic surgery itself, but also encompasses deep involvement throughout the entire process, including the set-up of surgical occlusion and overall surgical planning. The authors summarize various aspects in the field of orthognathic surgery with the hope of providing helpful information both for plastic surgeons and orthodontists who are interested in orthognathic surgery.
Collapse
Affiliation(s)
- Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Youn-Kyung Choi
- Department of Orthodontics, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| |
Collapse
|
12
|
Postoperative Edema Resolution Post-Orthognathic Triple Jaw Surgery: A Three-Dimensional Volumetric Analysis. J Craniofac Surg 2021; 33:512-516. [PMID: 34619733 DOI: 10.1097/scs.0000000000008270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The final result following orthognathic surgery may be hidden for months due to postoperative swelling. However, no substantial evidence supports this time estimate. Our study aims to three-dimensionally quantify volumetric changes in facial edema following triple-jaw surgery. MATERIALS AND METHODS This was a retrospective, three-dimensional (3D) study of patients who underwent primary orthognathic triple jaw surgery (Le Fort I, Bilateral Sagittal Split Osteotomy (BSSO), and osseous genioplasty) by the senior author (DMS). Vectra 3D Software (Canfield, Fairfield, NJ) was used to assess and quantify volumetric changes between serial 3D photos. An inverse line of best-fit was plotted to assess reduction in postoperative facial edema. The effects of gender, age, body mass index, and tranexamic acid administration on swelling resolution were analyzed through mixed linear model analysis. RESULTS A total of 46 patients (198 images) met the study criteria. The equation for the inverse function line of best fit was y = -13.14ln (x) + 39.54 (P < 0.01). On average, 60% of the swelling resolved in 1 month, 84% after 6 months, and nearly 93% after 12 months. There were no significant differences in the rate of swelling resolution when accounting for age, gender, body mass index, or tranexamic acid administration. CONCLUSIONS Most facial edema resolved during the first month following triple jaw surgery, with significant reduction in swelling between 6 and 12 months postoperatively. After 1 year, approximately 10% of the initial edema remained.
Collapse
|
13
|
Quast A, Santander P, Kahlmeier T, Moser N, Schliephake H, Meyer-Marcotty P. Predictability of maxillary positioning: a 3D comparison of virtual and conventional orthognathic surgery planning. Head Face Med 2021; 17:27. [PMID: 34256775 PMCID: PMC8276391 DOI: 10.1186/s13005-021-00279-x] [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: 01/15/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background Virtual surgery planning (VSP) is believed to reduce inaccuracies in maxillary positioning compared to conventional surgery planning (CSP) due to the elimination of face-bow transfer and laboratory steps. However, there is still a lack of comparative studies for the accuracy of splint-based maxillary positioning in CSP versus VSP. Therefore, the objective of this retrospective, observational study was to compare if splints produced by VSP and CSP reach postoperative outcomes within clinically acceptable limits. Methods The planned and actual postoperative results of 52 patients (VSP: n = 26; CSP: n = 26) with a mean age of 24.4 ± 6.2 years were investigated by three-dimensional (3D) alignment with planning software. The conventional treatment plan was digitized, so that the evaluation of both methods was performed in the same manner using the same coordinate system. Inaccuracies were measured by sagittal, vertical and transversal deviations of the upper central incisors and the inclination of the maxillary occlusal plane between the planned and achieved maxillary positions. Results Both methods demonstrated significant differences between the planned and actual outcome. The highest inaccuracies were observed in vertical impaction and midline correction. No significant differences between CSP and VSP were observed in any dimension. Errors in vertical and sagittal dimension intensified each other. Conclusions In conclusion, splint-based surgeries reached similar results regardless of the applied planning method and splint production.
Collapse
Affiliation(s)
- Anja Quast
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Petra Santander
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Timon Kahlmeier
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Norman Moser
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Philipp Meyer-Marcotty
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| |
Collapse
|
14
|
Ho CT, Lai HC, Lin HH, Denadai R, Lo LJ. Outcome of full digital workflow for orthognathic surgery planning in the treatment of asymmetric skeletal class III deformity. J Formos Med Assoc 2021; 120:2100-2112. [PMID: 34092467 DOI: 10.1016/j.jfma.2021.05.014] [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: 07/16/2020] [Revised: 03/25/2021] [Accepted: 05/03/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/PURPOSE Studies have reported the advantages of digital imaging-assisted orthognathic surgery planning, but there is scarce information about a full digital planning modality. This study evaluated the 3D cephalometric-based and patient-reported outcomes of a full digital workflow for orthognathic surgery planning in the treatment of asymmetric maxillomandibular disharmony. METHODS A postoperative 3D image dataset of 30 Taiwanese Chinese patients with asymmetric skeletal Class III deformities who underwent full digital planning for two-jaw surgery were retrieved from the authors' database. The 3D cephalometric data (dental, skeletal, and soft tissue evaluations) were compared to the ethnicity-matched 3D cephalometric normative values. Patient-reported outcome measure tools regarding postoperative overall appearance and satisfaction with facial areas (ranging from 0 to 100 and 0 to 10, respectively) were administered. The number of needed or requested revisionary surgery was collected. RESULTS No difference (all p > 0.05) was observed between the orthognathic-surgery-treated patients and the normative value for most of the tested 3D cephalometric parameters, with the exception (p < 0.05) of three mandible and occlusal-plane-related parameters. Both patient-reported outcome measure tools showed that patients' satisfaction with their postoperative appearance was high for overall face (89.7 ± 4.5) and specific facial regions (nose, 7.1 ± 1.3; lip, 8.3 ± 1.6; upper gum, 8.5 ± 1.2; cheek, 8.8 ± 1.1; chin, 9.2 ± 1.2; and teeth, 9.3 ± 0.8), with no need for revisionary surgery. CONCLUSION The patients treated with a full 3D digital planning-assisted two-jaw surgery had a similar 3D dental relation, facial convexity, and symmetry compared to healthy ethnicity-matched individuals, and they reported higher satisfaction levels with their postoperative facial appearance results.
Collapse
Affiliation(s)
- Cheng-Ting Ho
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Chih Lai
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Hsia Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Rafael Denadai
- Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Lun-Jou Lo
- Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
15
|
Ho CT, Lai HC, Lin HH, Lo LJ, Denadai R. Cheek soft tissue prediction in cleft orthognathic surgery: A 3D computer-assisted investigation with comparative analysis. J Plast Reconstr Aesthet Surg 2021; 74:2683-2693. [PMID: 33906812 DOI: 10.1016/j.bjps.2021.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 01/31/2021] [Accepted: 03/11/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The Le Fort I maxillary advancement and rotational movement have been adopted to treat patients with cleft-related skeletal Class III pattern and anteromedial cheek soft tissue deficiency, but cleft-specific cheek soft tissue prediction data are insufficient. This 3D imaging-based study addressed the issue. METHODS 3D craniofacial soft tissue and bone models were created from 32 consecutive patients who received computer-aided two-jaw orthognathic surgery for the correction of cleft-related Class III deformity and cheek soft tissue deficiency. Using superimposed 3D models, the cheek volumetric change, the cheek sagittal movement, and the 3D cheek mass position were calculated. 3D data from orthognathic surgery-treated patients with no cleft (noncleft cohort) and individuals with no facial deformity (3D norm value) were retrieved for comparative analysis. RESULTS Surgical maxillary advancement (p < 0.001) but not maxillary clockwise rotation (p > 0.05) had a significant impact on the cheek soft tissue change, with prediction models showing that maxillary advancement elucidated 77 and 79% of this change on the cleft and noncleft sides, respectively. Cleft cohort (0.46±0.12) had a significantly (p < 0.001) smaller cheek soft-to-hard tissue ratio than that of the noncleft cohort (0.73±0.13). Cleft maxillary advancements >4 mm resulted in a 3D cheek mass position (2.1±1.1 mm) similar (p > 0.05) to the 3D norm value (2.2±1.2 mm), but different (p = 0.037) from the noncleft cohort (2.38±0.7 mm). CONCLUSION This study showed that maxillary advancement but not the maxillary rotation affects the cheek soft tissue change, and the predictive values and comparative data could assist the orthodontist-surgeon interaction during preoperative planning and patient counseling.
Collapse
Affiliation(s)
- Cheng-Ting Ho
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Chih Lai
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiu-Hsia Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Rafael Denadai
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
16
|
Chuang KT, Denadai R, Yong JH, Chou PY, Chen YR. Long-Term Photogrammetric- and Panel Assessment-Based Outcome Study of Staged Reconstructive Approach for Hypertelorism Correction. Ann Plast Surg 2021; 86:S52-S57. [PMID: 33346538 DOI: 10.1097/sap.0000000000002633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The surgical management of hypertelorism is challenging for plastic surgeons, and limited long-term outcome data are available. The purpose of this long-term study was to report a single-surgeon experience with a staged reconstructive protocol for hypertelorism correction. METHODS This retrospective study reviewed the records of patients with hypertelorism who were surgically managed by a single surgeon between 1978 and 2000. Bone (orbital box osteotomy and orthognathic surgery) and soft tissue (rhinoplasty and epicanthoplasty) surgeries were performed based on a patient-specific surgical protocol. Included patients were divided into a childhood group and an adolescence or adulthood group according to their age at orbital repositioning (≤12 and >12 years, respectively). Patients were invited for clinical interviews in February 2020 to evaluate whether requests for revision surgery had been made. The photogrammetric analysis-based hypertelorism index was calculated at preoperative and long-term postoperative times. Satisfaction with the long-term outcome was judged by both surgical professionals and laypeople. RESULTS In total, 14 patients with hypertelorism of different etiologies were included, with no request for revision surgery during an average follow-up of 29 years. The preoperative hypertelorism index was higher than the long-term postoperative evaluation (all, P < 0.05) for both childhood and adolescence or adulthood groups. Intergroup comparison revealed no significant difference for the hypertelorism index and panel assessment-based satisfaction with long-term outcome analysis (all, P > 0.05). CONCLUSIONS Considering the complexity and wide spectrum of clinical presentation of soft tissue and bone deformities in hypertelorism and current outcomes, the surgical approach to these patients should be staged and individualized for achievement of a balanced result between functional (orbital, occlusion, and psychosocial) and aesthetic parameters.
Collapse
Affiliation(s)
- Kai-Ti Chuang
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | | | | | | | | |
Collapse
|
17
|
Ho CT, Denadai R, Lin HH, Lo LJ. Three-Dimensional Computer-Assisted Orthognathic Surgery: Traditional Hybrid Versus Full Digital Planning Models. Ann Plast Surg 2021; 86:S70-S77. [PMID: 33346531 DOI: 10.1097/sap.0000000000002622] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Three-dimensional (3D) computer-aided planning has truly revolutionized orthognathic surgery (OGS) treatment, but no study has compared the traditional hybrid and full 3D digital planning models. This study compared these virtual planning models in the treatment of asymmetric maxillomandibular disharmony. METHODS Young adult patients with an asymmetric skeletal class III deformity who underwent 3D computer-aided 2-jaw OGS using hybrid (alginate dental impression, 2D cephalometric tracings, manual-guided stone model surgery, occlusion setup, and splint fabrication; n = 30) or full digital (laser-scanned dentition, 3D cephalometric tracings, virtual-based occlusion setup and surgery, and computer-generated surgical splint; n = 30) planning models were consecutively recruited. Preoperative and postoperative 3D cephalometric analyses (dental relation, skeletal assessments based on sagittal and frontal views, and soft tissue evaluations) were adopted for intragroup and intergroup comparisons. Postoperative patient-perceived satisfaction with facial appearance was also recorded. RESULTS Both hybrid and full digital planning groups had significant (all P < 0.05) improvements after surgery with respect to facial convexity, incisor overjet, and frontal symmetry parameters. The full 3D digital planning-based OGS treatment had similar (all P > 0.05) 3D cephalometric-derived outcomes (preoperative, postoperative, and treatment-induced change data) and patient-perceived outcomes compared with the traditional hybrid 3D planning method. CONCLUSIONS For the decision-making process in selecting the planning model, multidisciplinary teams could consider additional parameters such as patient comfort, storage needs, convenience for data reuse, overall planning time, availability, and costs.
Collapse
Affiliation(s)
- Cheng-Ting Ho
- From the Division of Craniofacial Orthodontics, Department of Dentistry
| | | | | | | |
Collapse
|
18
|
Chen Z, Mo S, Fan X, You Y, Ye G, Zhou N. A Meta-analysis and Systematic Review Comparing the Effectiveness of Traditional and Virtual Surgical Planning for Orthognathic Surgery: Based on Randomized Clinical Trials. J Oral Maxillofac Surg 2020; 79:471.e1-471.e19. [PMID: 33031773 DOI: 10.1016/j.joms.2020.09.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To explore the advantages of virtual surgical planning (VSP) and traditional surgical planning (TSP) to determine whether the current VSP technique is superior to the TSP technique for orthognathic surgery. METHODS An electronic search was carried out in the CENTRAL, PubMed, and Embase databases to identify randomized clinical trials (RCTs) that compared the VSP and TSP techniques regarding their surgical accuracy for hard tissue, prediction precision for soft tissue, required time for planning and surgery, cost and patient-reported outcomes. RESULTS Eight articles from 5 RCTs, involving 199 patients, were identified. The findings showed that the VSP and TSP techniques were similar in surgical accuracy for hard tissue in the sagittal plane, although the VSP technique was significantly more accurate in certain reference areas, especially in the anterior area of the maxilla. Both the VSP and TSP techniques had significantly better surgical accuracy for the maxilla than for the mandible. The VSP technique showed clinically significantly greater precision for soft tissue prediction in the sagittal plane. Patients who were treated via the VSP technique presented a more symmetrical frontal view, regardless of whether hard or soft tissue was involved. The VSP technique required more time for software planning, but it showed an advantage in time savings when considering the entire preoperative process. Accompanied by the use of an accurate computer-aided splint, the VSP technique could effectively reduce the operative time. Apart from the initial financial investment of software and hardware, the total cost of the VSP technique was similar to that of the TSP technique. Patients who were treated via the VSP or TSP technique showed similar improvements in quality-of-life. CONCLUSIONS Currently, the VSP technique has become a good alternative to the TSP technique for orthognathic surgery, especially regarding frontal-esthetic considerations. Studies reporting indicators with good representativeness and sensitivity using an identical comparative method are recommended.
Collapse
Affiliation(s)
- Zhixing Chen
- PhD Candidate, Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical University, Nanning, China; Guangxi Key Laboratory of the Rehabilitation and Reconstruction of Oral and Maxillofacial Research; Guangxi Colleges and Universities Key Laboratory of Treatment and Research for Oral and Maxillofacial Surgery Disease; Medical Scientific Research Center, Nanning, China
| | - Shuixue Mo
- Professor and Department Chair, Department of Orthodontics, College of Stomatology, Guangxi Medical University, Nanning, China
| | - Xuemin Fan
- Resident, Medicine Master, Department of Orthodontics, College of Stomatology, Guangxi Medical University, Nanning, China
| | - Yuting You
- Resident, Medicine Master, Department of Orthodontics, College of Stomatology, Guangxi Medical University, Nanning, China
| | - Guangrong Ye
- Resident, Medicine Master, Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical University, Nanning, China
| | - Nuo Zhou
- Professor and Vice President, Guangxi Medical University, Nanning, China.
| |
Collapse
|
19
|
Denadai R, Chen YR, Lo LJ. Three-Dimensional Computer-Assisted Single-Splint 2-Jaw Cleft Orthognathic Surgery: Toward Patient-Centered Surgical Rationale. Cleft Palate Craniofac J 2020; 57:1428-1433. [PMID: 32815390 DOI: 10.1177/1055665620949113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Skeletally mature patients with cleft lip and palate commonly present with skeletofacial deformities characterized by varying degrees of intrinsic and acquired dentoskeletal and soft tissue abnormalities. These abnormalities are associated with scarring from previous surgeries and the asymmetric midline and facial contour that impose challenges for adequate reconstruction. These patients frequently require 2-jaw orthognathic surgery to improve occlusal function and for correction of facial deformities. In this article, we have detailed a 3-dimensional computer-assisted single-splint 2-jaw orthognathic surgery technique as a surgical approach for cleft skeletofacial reconstruction, allowing for the surgery to be tailored according to the specific needs and requests of the patients. Further, we have addressed the multidimensionality and specificities of cleft treatment, the wide versatility, adaptability, and applicability of this technique, and the patient-centered rationale for the adoption of this method.
Collapse
Affiliation(s)
- Rafael Denadai
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Sao Paulo, Brazil
| | - Yu-Ray Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| |
Collapse
|