1
|
Kim SH, Lee SM, Park JH, Yang S, Kim JW. Effectiveness of individualized 3D titanium-printed Orthognathic osteotomy guides and custom plates. BMC Oral Health 2023; 23:255. [PMID: 37138237 PMCID: PMC10155400 DOI: 10.1186/s12903-023-03000-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/29/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Computer-aided design/manufacturing (CAD/CAM) technology was developed to improve surgical accuracy and minimize errors in surgical planning and orthognathic surgery. However, its accurate implementation during surgery remains a challenge. Hence, we compared the accuracy and stability of conventional orthognathic surgery and the novel modalities, such as virtual simulation and three-dimensional (3D) titanium-printed customized surgical osteotomy guides and plates. METHODS This prospective study included 12 patients who were willing to undergo orthognathic surgery. The study group consisted of patients who underwent orthognathic two-jaw surgery using 3D-printed patient-specific plates processed by selective laser melting and an osteotomy guide; orthognathic surgery was also performed by the surgeon directly bending the ready-made plate in the control group. Based on the preoperative computed tomography images and intraoral 3D scan data, a 3D virtual surgery plan was implemented in the virtual simulation module, and the surgical guide and bone fixation plate were fabricated. The accuracy and stability were evaluated by comparing the results of the preoperative virtual simulation (T0) to those at 7 days (T1) and 6 months (T2) post-surgery. RESULT The accuracy (ΔT1‒T0) and stability (ΔT2‒T1) measurements, using 11 anatomical references, both demonstrated more accurate results in the study group. The mean difference of accuracy for the study group (0.485 ± 0.280 mm) was significantly lower than in the control group (1.213 ± 0.716 mm) (P < 0.01). The mean operation time (6.83 ± 0.72 h) in the control group was longer than in the study group (5.76 ± 0.43 h) (P < 0.05). CONCLUSION This prospective clinical study demonstrated the accuracy, stability, and effectiveness of using virtual preoperative simulation and patient-customized osteotomy guides and plates for orthognathic surgery.
Collapse
Affiliation(s)
- Se-Hyang Kim
- Graduate School of Clinical Dentistry, Ewha Womans University, Seoul, South Korea
| | - Sung-Min Lee
- Department of Oral and Maxillofacial Surgery, School of Medicine, Ewha Womans University, Anyangcheon-Ro 1071, Yangcheon-Gu, Seoul, 158-710, Korea
| | - Jung-Hyun Park
- Graduate School of Clinical Dentistry, Ewha Womans University, Seoul, South Korea
- Department of Oral and Maxillofacial Surgery, School of Medicine, Ewha Womans University, Anyangcheon-Ro 1071, Yangcheon-Gu, Seoul, 158-710, Korea
| | - Sook Yang
- Cusmedi Co., Ltd., Gyeonggi-Do, Suwon-Si, 400815, South Korea
| | - Jin-Woo Kim
- Graduate School of Clinical Dentistry, Ewha Womans University, Seoul, South Korea.
- Department of Oral and Maxillofacial Surgery, School of Medicine, Ewha Womans University, Anyangcheon-Ro 1071, Yangcheon-Gu, Seoul, 158-710, Korea.
| |
Collapse
|
2
|
Kim JW, Kim JC, Jeong CG, Cheon KJ, Cho SW, Park IY, Yang BE. The accuracy and stability of the maxillary position after orthognathic surgery using a novel computer-aided surgical simulation system. BMC Oral Health 2019; 19:18. [PMID: 30646896 PMCID: PMC6334449 DOI: 10.1186/s12903-019-0711-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/04/2019] [Indexed: 01/28/2023] Open
Abstract
Background Many reports have been published on orthognathic surgery (OGS) using computer-aided surgical simulation (CASS). The purpose of this study was to evaluate the accuracy of the maxillary repositioning and the stability of the maxilla in patients who underwent OGS using a newly developed CASS program, a customized osteotomy guide, and a customized miniplate. Methods Thirteen patients who underwent OGS from 2015 to 2017 were included. All patients underwent a bimaxillary operation. First, a skull-dentition hybrid 3D image was rendered by merging the cone beam computed tomography (CBCT) images with the dentition scan file. After virtual surgery (VS) using the FaceGide® program, patient-customized osteotomy guides and miniplates were then fabricated and used in the actual operation. To compare the VS with the actual surgery and postoperative skeletal changes, each reference point marked on the image was compared before the operation (T0) and three days (T1), four months (T2), and a year (T3) after the operation, and with the VS (Tv). The differences between ΔTv (Tv-T0) and ΔT1 (T1-T0) were statistically compared using tooth-based reference points. The superimposed images of Tv and T1 were also investigated at eight bone-based reference points. The differences between the reference points of the bone surface were examined to evaluate the stability of the miniplate on the maxilla over time. Results None of the patients experienced complications. There were no significant differences between the reference points based on the cusp tip between ΔTv and ΔT1 (p > 0.01). Additionally, there were no significant differences between the Tv and T1 values of the bone surface (p > 0.01). The mean difference in the bone surface between Tv and T1 was 1.01 ± 0.3 mm. Regarding the stability of the miniplate, there were no significant differences between the groups. The difference in the bone surface between T1 and T3 was − 0.37 ± 0.29 mm. Conclusions VS was performed using the FaceGide® program, and customized materials produced based on the VS were applied in actual OGS. The maxilla was repositioned in almost the same manner as in the VSP plan, and the maxillary position remained stable for a year.
Collapse
Affiliation(s)
- Ju-Won Kim
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 11, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14066, Anyang, Republic of Korea.,Graduate School of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea.,Institute of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea
| | - Jong-Cheol Kim
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 11, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14066, Anyang, Republic of Korea.,Mir Dental Hospital, 12 Gongpyoungro Jung-gu Daegu, 41940, Daegu, Republic of Korea
| | - Chun-Gi Jeong
- Mir Dental Hospital, 12 Gongpyoungro Jung-gu Daegu, 41940, Daegu, Republic of Korea
| | - Kyeong-Jun Cheon
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 11, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14066, Anyang, Republic of Korea.,Graduate School of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea
| | - Seoung-Won Cho
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 11, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14066, Anyang, Republic of Korea.,Graduate School of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea
| | - In-Young Park
- Division of Orthodontics, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.,Graduate School of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea.,Institute of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea
| | - Byoung-Eun Yang
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 11, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14066, Anyang, Republic of Korea. .,Graduate School of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea. .,Institute of Clinical Dentistry, Hallym University, Chuncheon, Republic of Korea.
| |
Collapse
|
3
|
Wang L, Ren Y, Gao Y, Tang Z, Chen KC, Li J, Shen SGF, Yan J, Lee PKM, Chow B, Xia JJ, Shen D. Estimating patient-specific and anatomically correct reference model for craniomaxillofacial deformity via sparse representation. Med Phys 2016; 42:5809-16. [PMID: 26429255 DOI: 10.1118/1.4929974] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE A significant number of patients suffer from craniomaxillofacial (CMF) deformity and require CMF surgery in the United States. The success of CMF surgery depends on not only the surgical techniques but also an accurate surgical planning. However, surgical planning for CMF surgery is challenging due to the absence of a patient-specific reference model. Currently, the outcome of the surgery is often subjective and highly dependent on surgeon's experience. In this paper, the authors present an automatic method to estimate an anatomically correct reference shape of jaws for orthognathic surgery, a common type of CMF surgery. METHODS To estimate a patient-specific jaw reference model, the authors use a data-driven method based on sparse shape composition. Given a dictionary of normal subjects, the authors first use the sparse representation to represent the midface of a patient by the midfaces of the normal subjects in the dictionary. Then, the derived sparse coefficients are used to reconstruct a patient-specific reference jaw shape. RESULTS The authors have validated the proposed method on both synthetic and real patient data. Experimental results show that the authors' method can effectively reconstruct the normal shape of jaw for patients. CONCLUSIONS The authors have presented a novel method to automatically estimate a patient-specific reference model for the patient suffering from CMF deformity.
Collapse
Affiliation(s)
- Li Wang
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
| | - Yi Ren
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
| | - Yaozong Gao
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
| | - Zhen Tang
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas 77030
| | - Ken-Chung Chen
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas 77030
| | - Jianfu Li
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas 77030
| | - Steve G F Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Jin Yan
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Philip K M Lee
- Hong Kong Dental Implant and Maxillofacial Centre, Hong Kong 999077, China
| | - Ben Chow
- Hong Kong Dental Implant and Maxillofacial Centre, Hong Kong 999077, China
| | - James J Xia
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas 77030; Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, New York 10065; and Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Dinggang Shen
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599 and Department of Brain and Cognitive Engineering, Korea University, Seoul 02841, South Korea
| |
Collapse
|
4
|
Computer-assisted orthognathic surgery: waferless maxillary positioning, versatility, and accuracy of an image-guided visualisation display. Br J Oral Maxillofac Surg 2013; 51:827-33. [DOI: 10.1016/j.bjoms.2013.06.014] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 06/30/2013] [Indexed: 11/22/2022]
|
5
|
Hernández-Alfaro F, Guijarro-Martínez R. New protocol for three-dimensional surgical planning and CAD/CAM splint generation in orthognathic surgery: an in vitro and in vivo study. Int J Oral Maxillofac Surg 2013; 42:1547-56. [DOI: 10.1016/j.ijom.2013.03.025] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 02/10/2013] [Accepted: 03/20/2013] [Indexed: 10/26/2022]
|
6
|
Zinser MJ, Sailer HF, Ritter L, Braumann B, Maegele M, Zöller JE. A Paradigm Shift in Orthognathic Surgery? A Comparison of Navigation, Computer-Aided Designed/Computer-Aided Manufactured Splints, and “Classic” Intermaxillary Splints to Surgical Transfer of Virtual Orthognathic Planning. J Oral Maxillofac Surg 2013; 71:2151.e1-21. [DOI: 10.1016/j.joms.2013.07.007] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/02/2013] [Accepted: 07/05/2013] [Indexed: 11/25/2022]
|
7
|
Tai-Hong Kuo, Tung-Yiu Wong, Tung-Chin Wu, Jing-Jing Fang. Optical Tracking-Based Model Surgery for Orthognathic Surgical Planning Using a Quantifying Evaluation Method. ACTA ACUST UNITED AC 2012; 16:1193-9. [DOI: 10.1109/titb.2012.2204894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
8
|
Accuracy of a computer-aided surgical simulation protocol for orthognathic surgery: a prospective multicenter study. J Oral Maxillofac Surg 2012; 71:128-42. [PMID: 22695016 DOI: 10.1016/j.joms.2012.03.027] [Citation(s) in RCA: 278] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 03/06/2012] [Accepted: 03/07/2012] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this prospective multicenter study was to assess the accuracy of a computer-aided surgical simulation (CASS) protocol for orthognathic surgery. MATERIALS AND METHODS The accuracy of the CASS protocol was assessed by comparing planned outcomes with postoperative outcomes of 65 consecutive patients enrolled from 3 centers. Computer-generated surgical splints were used for all patients. For the genioplasty, 1 center used computer-generated chin templates to reposition the chin segment only for patients with asymmetry. Standard intraoperative measurements were used without the chin templates for the remaining patients. The primary outcome measurements were the linear and angular differences for the maxilla, mandible, and chin when the planned and postoperative models were registered at the cranium. The secondary outcome measurements were the maxillary dental midline difference between the planned and postoperative positions and the linear and angular differences of the chin segment between the groups with and without the use of the template. The latter were measured when the planned and postoperative models were registered at the mandibular body. Statistical analyses were performed, and the accuracy was reported using root mean square deviation (RMSD) and the Bland-Altman method for assessing measurement agreement. RESULTS In the primary outcome measurements, there was no statistically significant difference among the 3 centers for the maxilla and mandible. The largest RMSDs were 1.0 mm and 1.5° for the maxilla and 1.1 mm and 1.8° for the mandible. For the chin, there was a statistically significant difference between the groups with and without the use of the chin template. The chin template group showed excellent accuracy, with the largest positional RMSD of 1.0 mm and the largest orientation RMSD of 2.2°. However, larger variances were observed in the group not using the chin template. This was significant in the anteroposterior and superoinferior directions and the in pitch and yaw orientations. In the secondary outcome measurements, the RMSD of the maxillary dental midline positions was 0.9 mm. When registered at the body of the mandible, the linear and angular differences of the chin segment between the groups with and without the use of the chin template were consistent with the results found in the primary outcome measurements. CONCLUSIONS Using this computer-aided surgical simulation protocol, the computerized plan can be transferred accurately and consistently to the patient to position the maxilla and mandible at the time of surgery. The computer-generated chin template provides greater accuracy in repositioning the chin segment than the intraoperative measurements.
Collapse
|
9
|
Shehab MF, Barakat AA, AbdElghany K, Mostafa Y, Baur DA. A novel design of a computer-generated splint for vertical repositioning of the maxilla after Le Fort I osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 115:e16-25. [PMID: 23312923 DOI: 10.1016/j.oooo.2011.09.035] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 09/22/2011] [Accepted: 09/30/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy of a novel tooth/bony-supported virtual splint design to control the maxillary vertical, rotational, and anteroposterior intraoperative movements. STUDY DESIGN A tooth/bone-borne splint was designed to position the osteotomized maxilla intraoperatively. Lateral cephalometric radiographs were obtained 1 week before the operation and 1 week after to compare the planned and actual movements of the maxilla. RESULTS The paired t test showed no significant difference between the planned and actual movements in both the vertical and horizontal measurements (P ≤ .05). The difference between the planned and actual horizontal movements in 4 (66.7%) of the 6 patients was 1 mm or less. For the vertical movements, 5 (83.3%) of the 6 patients showed a difference equal to or less than 1 mm. CONCLUSIONS The 2-piece surgical stent showed accurate control on the osteotomized maxilla and succeeded its repositioning to the preplanned positions.
Collapse
Affiliation(s)
- Mohamed F Shehab
- Faculty of Oral and Dental Medicine, Oral & Maxillofacial Surgery Department, Cairo University, Cairo, Egypt.
| | | | | | | | | |
Collapse
|
10
|
Zinser MJ, Mischkowski RA, Sailer HF, Zöller JE. Computer-assisted orthognathic surgery: feasibility study using multiple CAD/CAM surgical splints. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:673-87. [PMID: 22668627 DOI: 10.1016/j.oooo.2011.11.009] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 11/06/2011] [Accepted: 11/15/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE We present a virtual planning protocol incorporating a patented 3-surgical splint technique for orthognathic surgery. The purpose of this investigation was to demonstrate the feasibility and validity of the method in vivo. MATERIALS AND METHODS The protocol consisted of (1) computed tomography (CT) or cone-beam computed tomography (CBCT) maxillofacial imaging, optical scan of articulated dental study models, segmentation, and fusion; (2) diagnosis and virtual treatment planning; (3) computed-assisted design and manufacture (CAD/CAM) of the surgical splints; and (4) intraoperative surgical transfer. Validation of the accuracy of the technique was investigated by applying the protocol to 8 adult class III patients treated with bimaxillary osteotomies. The virtual plan was compared with the postoperative surgical result using image fusion of CT/CBCT dataset by analysis of measurements between hard and soft tissue landmarks relative to reference planes. RESULTS The virtual planning approach showed clinically acceptable precision for the position of the maxilla (<0.23 mm) and condyle (<0.19 mm), marginal precision for the mandible (<0.33 mm), and low precision for the soft tissue (<2.52 mm). CONCLUSIONS Virtual diagnosis, planning, and use of a patented CAD/CAM surgical splint technique provides a reliable method that may offer an alternate approach to the use of arbitrary splints and 2-dimensional planning.
Collapse
Affiliation(s)
- Max J Zinser
- Department of Cranio-Maxillo-Facial Surgery, University of Cologne, Germany.
| | | | | | | |
Collapse
|
11
|
Olszewski R. Surgical Engineering in Cranio-Maxillofacial Surgery: A Literature Review. JOURNAL OF HEALTHCARE ENGINEERING 2012. [DOI: 10.1260/2040-2295.3.1.53] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
12
|
Gateno J, Xia JJ, Teichgraeber JF. New Methods to Evaluate Craniofacial Deformity and to Plan Surgical Correction. Semin Orthod 2011; 17:225-234. [PMID: 21927548 DOI: 10.1053/j.sodo.2011.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The success of cranio-maxillofacial (CMF) surgery depends not only on surgical techniques, but also upon an accurate surgical plan. Unfortunately, traditional planning methods are often inadequate for planning complex cranio-maxillofacial deformities. To this end, we developed 3D computer-aided surgical simulation (CASS) technique. Using our CASS method, we are able to treat patients with significant asymmetries in a single operation which in the past was usually completed in two stages. The purpose of this article is to introduce our CASS method in evaluating craniofacial deformities and planning surgical correction. In addition, we discuss the problems associated with the traditional surgical planning methods. Finally, we discuss the strength and pitfalls of using three-dimensional measurements to evaluate craniofacial deformity.
Collapse
Affiliation(s)
- Jaime Gateno
- Chairman, Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute, Houston, TX; Professor of Clinical Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY; and Associate Professor, Department of Pediatric Plastic Surgery, The University of Texas Health Science Center at Houston, TX
| | | | | |
Collapse
|
13
|
Xia JJ, Shevchenko L, Gateno J, Teichgraeber JF, Taylor TD, Lasky RE, English JD, Kau CH, McGrory KR. Outcome study of computer-aided surgical simulation in the treatment of patients with craniomaxillofacial deformities. J Oral Maxillofac Surg 2011; 69:2014-24. [PMID: 21684451 PMCID: PMC3119456 DOI: 10.1016/j.joms.2011.02.018] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 02/09/2011] [Accepted: 02/09/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to determine whether the surgical outcomes achieved with computer-aided surgical simulation (CASS) are better than those achieved with traditional methods. MATERIALS AND METHODS Twelve consecutive patients with craniomaxillofacial (CMF) deformities were enrolled. According to the CASS clinical protocol, a 3-dimensional computer composite skull model for each patient was generated and reoriented to the neutral head posture. These models underwent 2 virtual surgeries: 1 was based on CASS (experimental group) and the other was based on traditional methods 1 year later (control group). Once the 2 virtual surgeries were completed, 2 experienced oral and maxillofacial surgeons at 2 different settings evaluated the 2 surgical outcomes. They were blinded to the planning method used on the virtual models and each other's evaluation results. The primary outcome was overall CMF skeletal harmony. The secondary outcomes were individual maxillary, mandibular, and chin harmonies. Statistical analyses were performed. RESULTS Overall CMF skeletal harmony achieved with CASS was statistically significantly better than that achieved with traditional methods. In addition, the maxillary and mandibular surgical outcomes achieved with CASS were significantly better. Furthermore, although not included in the statistical model, the chin symmetry achieved by CASS tended to be better. A regression model was established between mandibular symmetry and overall CMF skeletal harmony. CONCLUSION The surgical outcomes achieved with CASS are significantly better than those achieved with traditional planning methods. In addition, CASS enables the surgeon to better correct maxillary yaw deformity, better place proximal/distal segments, and better restore mandibular symmetry. The critical step in achieving better overall CMF skeletal harmony is to restore mandibular symmetry.
Collapse
Affiliation(s)
- James J Xia
- Department of Oral and Maxillofacial Surgery, Methodist Hospital Research Institute, Houston, TX 77030, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Using a Clinical Protocol for Orthognathic Surgery and Assessing a 3-Dimensional Virtual Approach: Current Therapy. J Oral Maxillofac Surg 2011; 69:623-37. [DOI: 10.1016/j.joms.2010.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 09/02/2010] [Accepted: 11/01/2010] [Indexed: 11/17/2022]
|
15
|
Pohlenz P, Gröbe A, Petersik A, von Sternberg N, Pflesser B, Pommert A, Höhne KH, Tiede U, Springer I, Heiland M. Virtual dental surgery as a new educational tool in dental school. J Craniomaxillofac Surg 2010; 38:560-4. [DOI: 10.1016/j.jcms.2010.02.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 12/16/2009] [Accepted: 02/10/2010] [Indexed: 01/22/2023] Open
|
16
|
Xia JJ, Gateno J, Teichgraeber JF. New clinical protocol to evaluate craniomaxillofacial deformity and plan surgical correction. J Oral Maxillofac Surg 2009; 67:2093-106. [PMID: 19761903 PMCID: PMC2763487 DOI: 10.1016/j.joms.2009.04.057] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 03/26/2009] [Accepted: 04/21/2009] [Indexed: 11/28/2022]
Affiliation(s)
- James J Xia
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Methodist Hospital Research Institute, Houston, TX 77030, USA.
| | | | | |
Collapse
|
17
|
The accuracy of two-dimensional planning for routine orthognathic surgery. Br J Oral Maxillofac Surg 2009; 48:271-5. [PMID: 19632014 DOI: 10.1016/j.bjoms.2009.06.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2009] [Indexed: 11/20/2022]
Abstract
Two-dimensional cephalometric planning software should be helpful for prediction of hard tissue outcome after bilateral sagittal split ramus osteotomy (BSSRO) or bimaxillary osteotomy, but transferring two-dimensional data to three-dimensions (including mock operation and surgery) may result in errors. The objective of this retrospective study was to analyze deviations between predicted results and postoperative outcome using cephalometric analyses, and to evaluate this procedure for daily use. Fifty-four subjects (mean (SD) age 26 (8) years) had a BSSRO (n=21) alone or in combination with Le Fort I osteotomy (n=33). Predictions were made for each case by cephalometric planning software and mock operations done with study models. Postoperative cephalograms were obtained after 14 days and compared with predicted cephalograms for sagittal (SNA, SNB, ANB,) and vertical (ArMeGo, ML-NSL, NL-NSL) measurements. Mean (SD) differences for all measurements varied between 1.3 degrees (1.1 degrees) and 2.2 degrees (1.6 degrees) for BSSRO; and between 1.1 degrees (1.3 degrees) and 2.2 degrees (1.6 degrees) for bimaxillary osteotomy. There were no significant differences between measurements or operations, indicating that the predictions were accurate. A difference of up to 8.5 degrees could be measured in a single case. Cephalometric prediction therefore remains an accurate tool for planning, particularly maxillary rearrangement in the vertical and sagittal dimension for routine operations. If greater shifts in the transversal dimension are necessary, exact planning should be adapted with three-dimensional planning devices to avoid significant differences.
Collapse
|
18
|
Olszewski R, Tran Duy K, Raucent B, Hebda A, Reychler H. Communicating a clinical problem to the engineers: towards a common methodology. Int J Oral Maxillofac Surg 2008; 37:269-74. [DOI: 10.1016/j.ijom.2007.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Revised: 06/26/2007] [Accepted: 12/14/2007] [Indexed: 11/15/2022]
|
19
|
Uechi J, Okayama M, Shibata T, Muguruma T, Hayashi K, Endo K, Mizoguchi I. A novel method for the 3-dimensional simulation of orthognathic surgery by using a multimodal image-fusion technique. Am J Orthod Dentofacial Orthop 2006; 130:786-98. [PMID: 17169742 DOI: 10.1016/j.ajodo.2006.03.025] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Revised: 02/24/2006] [Accepted: 03/07/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The aim of this study was to establish a novel method for simulating orthognathic surgery in 3-dimensional (3D) space. METHODS This system mainly consists of 6 procedures: (1) reconstruction of a virtual skull model (VS) from presurgical computed tomography scans; (2) reconstruction of virtual dentition models from 3D surface scanning of dental casts occluded at presurgical and postsurgical intercuspal positions (VD1 and VD2, respectively); (3) reconstruction of a preliminary fusion model of VS and VD1 by an initial intermodality registration; (4) reconstruction of another preliminary fusion model of VS, VD1, and VD2 by a second intramodality registration; (5) repositioning of bony segments by a third intramodality registration and reconstruction of final fusion models at presurgery and postsurgery; and (6) 3D analysis of the movement of bony segments. To test this system, 2 patients with severe skeletal deformities, who had undergone presurgical orthodontic treatment, were used as models. Registration accuracy was determined by the root mean squared distance between the corresponding fiducial markers in a set of 2 images. RESULTS AND CONCLUSIONS The sum of the root mean squared error of the 3 registration processes was less than 0.4 mm in both patients. This simulation system could be used to precisely realize the presurgical and postsurgical occlusal relationships and craniofacial morphology of a patient with severe skeletal deformities, and to quantitatively describe the movement of a given anatomical point of bony segments. It is assumed that there could be significant benefits in sharing visual and quantitative 3D information from this simulation system among orthodontists and surgeons.
Collapse
Affiliation(s)
- Jun Uechi
- Department of Orthodontics, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-tobetsu, Japan.
| | | | | | | | | | | | | |
Collapse
|
20
|
Tsuji M, Noguchi N, Shigematsu M, Yamashita Y, Ihara K, Shikimori M, Goto M. A new navigation system based on cephalograms and dental casts for oral and maxillofacial surgery. Int J Oral Maxillofac Surg 2006; 35:828-36. [PMID: 16690251 DOI: 10.1016/j.ijom.2006.02.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Revised: 01/20/2006] [Accepted: 02/27/2006] [Indexed: 10/24/2022]
Abstract
Intraoperative navigation systems help surgeons to accurately carry out preoperative plans without injuring anatomically important structures. A system is evaluated that uses cephalograms instead of computed tomographic (CT) scans to create images. Three-dimensional (3D) dental casts provide registration between imaging data and the patient. Cephalograms are widely employed in orthognathic and oral and maxillofacial surgery and expose patients to lower doses of radiation than CT. The system uses a dental cast to register the operation field to a pair of frontal and lateral cephalograms. The cast is transformed to 3D data with a laser scanner and a programme that runs on a personal computer. 3D data describing the dental cast, cephalograms and the oral and maxillofacial region of the patient are integrated with specialized software. The optical tracking system for navigation uses charged-coupled-device (CCD) video cameras and light-emitting diodes (LEDs). Two CCD video cameras follow the 3D coordinates of LED assemblies attached to the head, lower jaw and a handpiece. Errors occurring when a dental cast was transformed to 3D data ranged from 0.08 to 0.21 mm. Mean errors were 0.71 mm (0.21-1.09 mm) for the right maxillary central incisor, 0.62 mm (0.04-1.69 mm) for the right maxillary 2nd molar and 1.02 mm (0.23-1.47 mm) for the left maxillary 2nd molar. This surgical navigation system is sufficiently accurate for use in oral and maxillofacial surgery.
Collapse
Affiliation(s)
- M Tsuji
- Department of Oral and Maxillofacial Surgery, Saga Medical School, 5-1-1 Nabeshima, Saga 849-0937, Japan.
| | | | | | | | | | | | | |
Collapse
|
21
|
Numminen K, Sipilä O, Mäkisalo H. Preoperative hepatic 3D models: virtual liver resection using three-dimensional imaging technique. Eur J Radiol 2006; 56:179-84. [PMID: 15890482 DOI: 10.1016/j.ejrad.2005.03.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Revised: 03/05/2005] [Accepted: 03/08/2005] [Indexed: 02/06/2023]
Abstract
Emerging new techniques for liver resections set new requirements for the preoperative imaging and planning. Open surgery is a three-dimensional procedure and planning of the resection line may be difficult when basing on conventional two-dimensional CTs or MRIs, although all the information is there. With multidetector-row CT (MDCT), thin slices can be obtained with excellent temporal resolution, and precise three-dimensional (3D) models can be created. We regard 3D imaging technique useful in most liver resections. It improves the surgeon's knowledge of liver anatomy and makes even more complicated liver resections safe. Better knowledge of three-dimensional appearances of liver structures may further improve the results of curative liver surgery. However, before becoming a routine clinical procedure, research and development are still needed. Also, careful testing and evaluation of the methods have to be performed. In the future, 3D models will probably play an important role in the preoperative planning of liver resections.
Collapse
Affiliation(s)
- Kirsti Numminen
- Helsinki Medical Imaging Center, Helsinki University Central Hospital, Department of Radiology, Kasarmikatu 11, 00130 Helsinki, Finland.
| | | | | |
Collapse
|
22
|
Mommaerts MY, Polsbroek R, Santler G, Correia PEGS, Abeloos JVS, Ali N. Anterior transmandibular osteodistraction: clinical and model observations. J Craniomaxillofac Surg 2005; 33:318-25. [PMID: 16139505 DOI: 10.1016/j.jcms.2005.02.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2004] [Accepted: 02/24/2005] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The aim of this paper was to study the effect of transmandibular distraction on the periodontal and dental structures, and the initial movements of the mandibular halves, when using an axial plane non-rigid bone-borne distractor (TMD). MATERIAL AND METHODS Fourteen patients undergoing bimaxillary transverse osteodistraction had their six lower anterior teeth assessed for mobility, sensitivity, and pocket depth. Recordings were made pre-operatively, post-distraction, post-consolidation and at 1-year follow-up. Selected landmarks on pre-operative and post-consolidation models were also digitised in three dimensions to study individual tooth movements, and positional changes of the mandibular halves. RESULTS Pockets depths around the incisor teeth increased during the consolidation period (probably due to reduced oral hygiene), but returned to normal by the 1-year post-operative consultation. Tooth mobility increased temporarily in the active phase (central incisors, lateral incisors) and in the consolidation phase (lateral incisors, canine teeth). Sensitivity to cold was temporarily lost in the incisor teeth, probably as a result of 'apical contusion'. One central incisor was inadvertently apically osteotomized and needed root canal treatment. The angle between the mandibular halves closed by 9.4 degrees. CONCLUSION Periodontal and dental morbidity is transient and limited to the distraction and consolidation period, as long as the tooth apices are avoided when the osteotomy is performed. A step-design osteotomy may be preferable when the central incisor apices are close to each other. The transmandibular distractor (TMD) allows for rotation at the temporomandibular joints.
Collapse
Affiliation(s)
- Maurice Y Mommaerts
- Division of Maxillo-Facial Surgery, Department of Surgery, General Hospital St. Jan, Bruges, Belgium.
| | | | | | | | | | | |
Collapse
|
23
|
Gateno J, Xia J, Teichgraeber JF, Rosen A. A new technique for the creation of a computerized composite skull model. J Oral Maxillofac Surg 2003; 61:222-7. [PMID: 12619001 DOI: 10.1053/joms.2003.50033] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The goals of this study were to develop a technique for creating a computerized composite skull model and to test its accuracy. The computerized composite skull model is the combination of a 3-dimensional (3D) computed tomography (CT) bone model with digital dental models. MATERIALS AND METHODS A dry skull with intact dentition was used in development of the technique. The creation of the computerized composite skull model was divided into 3 steps. The first step was to create digital dental models. The second step was to create a 3D CT bone model of the craniomaxillofacial skeleton. The last step was to incorporate the digital dental models into the 3D CT skull model, creating a computerized composite skull model. The accuracy of the computerized composite skull model was assessed. Bone-to-bone, tooth-to-tooth, and bone-to-tooth measurements were made on the computerized composite skull model and the dry skull. Pearson correlation coefficient and linear regression tests were performed. RESULTS A technique to create a computerized composite skull model was developed. This computerized model not only represented bony structures from CT data but also reproduced dentition from digital dental models. For the bone-to-bone measurements, the mean difference between the computerized composite skull model and the dry skull was 0.5 +/- 0.6 mm. For the tooth-to-tooth measurements, the mean difference was 0.1 +/- 0.2 mm. For the bone-to-tooth measurements, the mean difference was 0.2 +/- 0.3 mm. CONCLUSIONS This study showed the feasibility of creating a computerized composite skull model as well as its accuracy.
Collapse
Affiliation(s)
- Jaime Gateno
- Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | | | | | | |
Collapse
|
24
|
Zemann W, Santler G, Kärcher H. Analysis of midface asymmetry in patients with cleft lip, alveolus and palate at the age of 3 months using 3D-COSMOS measuring system. J Craniomaxillofac Surg 2002; 30:148-52. [PMID: 12220993 DOI: 10.1054/jcms.2002.0284] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Patients suffering from unilateral cleft lip, alveolus and palate exhibit a varying degree of asymmetry of the midface. Evaluation of this asymmetry can be carried out by means of 3D-CT, or a laser surface scanner. MATERIAL AND METHODS In this paper, 3D-CT-scan data of 21 patients with unilateral clefts of lip, alveolus and palate were analysed using three-dimensional models. Evaluations of the 3D-models were carried out with the computer-aided 3D-operation simulator 3D-Cosmos. RESULTS Asymmetry was found in the orbital, nasal and maxillary regions. The infraorbital rims were displaced craniocaudally and horizontally as well as laterally of the cleft-sided piriform aperture. This asymmetry corresponded to a dislocation of the maxillary segment on the cleft side. A deficit in volume was not reliably found.
Collapse
Affiliation(s)
- W Zemann
- Department of Oral and Maxillofacial Surgery, University Clinic of Dentistry, Medical School University of Graz, Austria.
| | | | | |
Collapse
|