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Stamm T, Kanemeier M, Dirksen D, Middelberg C, Hohoff A, Kleinheinz J, Schmid JQ. The Position of the Virtual Hinge Axis in Relation to the Maxilla in Digital Orthognathic Surgery Planning-A k-Means Cluster Analysis. J Clin Med 2023; 12:jcm12103582. [PMID: 37240688 DOI: 10.3390/jcm12103582] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of this study was to investigate a possible relation between skeletal phenotypes and virtual mounting data in orthognathic surgery patients. A retrospective cohort study including 323 female (26.1 ± 8.7 years) and 191 male (27.9 ± 8.3 years) orthognathic surgery patients was conducted. A k-means cluster analysis was performed on the mounting parameters: the angle α between the upper occlusal plane (uOP) and the axis orbital plane (AOP); the perpendicular distance (AxV) from the uOP to the hinge axis; and the horizontal length (AxH) of the uOP from upper incisor edge to AxV, with subsequent statistical analysis of related cepalometric values. Three clusters of mounting data were identified, representing three skeletal phenotypes: (1) balanced face with marginal skeletal class II or III and α=8∘, AxV = 36 mm and AxH = 99 mm; (2) vertical face with skeletal class II and α=11∘, AxV = 27 mm and AxH = 88 mm; (3) horizontal face with class III and α=2∘, AxV = 36 mm and AxH = 86 mm. The obtained data on the position of the hinge axis can be applied to any digital planning in orthognathic surgery using CBCT or a virtual articulator, provided that the case can be clearly assigned to one of the calculated clusters.
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Affiliation(s)
- Thomas Stamm
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
| | - Moritz Kanemeier
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
| | - Dieter Dirksen
- Department of Prosthetic Dentistry and Biomaterials, University of Münster, 48149 Münster, Germany
| | | | - Ariane Hohoff
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, University of Münster, 48149 Münster, Germany
| | - Jonas Q Schmid
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
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Bohner L, Lustosa RM, Stamm T, Hanisch M, Kleinheinz J, Jung S. Influence of marginal incision and Le Fort I osteotomy on periodontal tissues: a prospective longitudinal study. Odontology 2023; 111:201-206. [PMID: 35737145 PMCID: PMC9810686 DOI: 10.1007/s10266-022-00721-9] [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: 03/03/2022] [Accepted: 05/30/2022] [Indexed: 01/12/2023]
Abstract
The purpose of this prospective study was to evaluate whether the surgical protocol involving marginal incision and Le Fort I osteotomy affects the periodontal outcome. Twenty-nine patients requiring surgical correction of maxillary dysgnathia were selected for this study. Periodontal conditions of maxillary anterior teeth were assessed prior to the surgery (T0), one month (T1), and 6 months (T2) after the surgical procedure. Interdental papillae loss, periodontal parameters and aesthetic outcomes in the anterior zone were assessed. Statistical analysis was performed with Friedman´s test and within ANOVA (p ≤ 0.05) followed by post-hoc tests. Papilla height decreased from T0 to T1 (p = 0.003), followed by an increase from T1 to T2 (p = 0.040). PPD (T0 = 1.72 ± 0.46; T2 = 2.13 ± 0.43) and CAL (T0 = 1.24 ± 0.55; T2 = 1.99 ± 0.70) increased after 6 months. There were statistically significant differences in aesthetic score among T0, T1 and T2. Periodontal changes after orthognathic surgery were within acceptable biological levels. Although a change in papillae height was reported after the surgery, initial values were recovered after 6 months. Surgical incision design might improve the outcome of Le-Fort I osteotomy. Anterior aesthetic zone may benefit from a marginal incision design, as it respects vascularization principle and may ensure a wound healing without complications.
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Affiliation(s)
- Lauren Bohner
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1 Gebäude W30, 48149 Muenster, Germany
| | - Rômulo Maciel Lustosa
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1 Gebäude W30, 48149 Muenster, Germany ,Department of Periodontology, State University of Maringá, Maringá, A. Colombo 5790, 87020-900 Brazil
| | - Thomas Stamm
- Department of Orthodontics, University Hospital Muenster, Albert-Schweitzer-Campus 1 Gebäude W30, 48149 Muenster, Germany
| | - Marcel Hanisch
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1 Gebäude W30, 48149 Muenster, Germany
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1 Gebäude W30, 48149 Muenster, Germany
| | - Susanne Jung
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1 Gebäude W30, 48149 Muenster, Germany
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Safrany-Fark A, Laczi B, Nagy A, Lengyel L, Piffko J, Segatto E. A novel approach for determining instantaneous centers of rotation of the mandible with an intraoral scanner: A preliminary study. PLoS One 2023; 18:e0285162. [PMID: 37134120 PMCID: PMC10156001 DOI: 10.1371/journal.pone.0285162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 04/17/2023] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Recording and reproducing mandibular movements have been of key importance in the practice of dentistry for over a century. Recently, it has become possible to use digital technologies for these tasks. This study presents a preliminary method to try to identify the mandibular instantaneous centres of rotation based solely on intraoral scanners. METHODS The dentitions of four participants were scanned, multiple inter-occlusal registrations and buccal scans were performed in closed and opened positions. Blender software was used to align the meshes during the post-scan digital workflow. Bite alignment accuracy was assessed and then improved with a strict exclusion protocol. An automated algorithm was used to find rotations between closed stage and open stage meshes. RESULTS Our exclusion protocol reduced the bite alignment error significantly (p = 0.001) and the root-mean-square error value of the meshes decreased from 0.09 mm (SD = 0.15) to 0.03 mm (SD = 0.017). However, the remaining translational error caused an unexpectedly large shift in the axis of rotation (mean = 1.35 mm, SD = 0.77) with a 41.83: 1 ratio. As found in other studies, our results showed even a small amount of error during registration can shift the axis of rotation a large amount. This phenomenon will compromise the results of common pantographic methods which assume a rotation axis of the condyle. It also adds valuable information to the concept of instantaneous centers of rotation by revealing their true characteristics.
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Affiliation(s)
- Arpad Safrany-Fark
- Department of Oral and Maxillofacial Surgery, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Balazs Laczi
- Faculty of Science and Informatics, Department of Image Processing and Computer Graphics, Institute of Informatics, University of Szeged, Szeged, Hungary
| | - Antal Nagy
- Faculty of Science and Informatics, Department of Image Processing and Computer Graphics, Institute of Informatics, University of Szeged, Szeged, Hungary
| | - Laura Lengyel
- Department of Oral and Maxillofacial Surgery, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Jozsef Piffko
- Department of Oral and Maxillofacial Surgery, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Emil Segatto
- Department of Oral and Maxillofacial Surgery, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
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Non-Surgical Transversal Dentoalveolar Compensation with Completely Customized Lingual Appliances versus Surgically Assisted Rapid Palatal Expansion in Adults-The Amount of Posterior Crossbite Correction. J Pers Med 2022; 12:jpm12111893. [PMID: 36422069 PMCID: PMC9694179 DOI: 10.3390/jpm12111893] [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: 09/18/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to compare the crossbite correction of a group (n = 43; f/m 19/24; mean age 27.6 ± 9.5 years) with surgically assisted rapid palatal expansion (SARPE) versus a non-surgical transversal dentoalveolar compensation (DC) group (n = 38; f/m 25/13; mean age 30.4 ± 12.9 years) with completely customized lingual appliances (CCLA). Arch width was measured on digital models at the canines (C), second premolars (P2), first molars (M1) and second molars (M2). Measurements were obtained before treatment (T0) and at the end of lingual treatment (T1) or after orthodontic alignment prior to a second surgical intervention for three-dimensional bite correction. There was no statistically significant difference (p > 0.05) in the amount of total crossbite correction between the SARPE and DC-CCLA group at C, P2, M1 and M2. Maxillary expansion was greater in the SARPE group and mandibular compression was greater in the DC-CCLA group. Crossbite correction in the DC-CCLA group was mainly a combination of maxillary expansion and mandibular compression. Dentoalveolar compensation with CCLAs as a combination of maxillary expansion and mandibular compression seems to be a clinically effective procedure to correct a transverse maxillo-mandibular discrepancy without the need for surgical assistance.
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Wang H, Chi Y, Huang H, Su S, Xue H, Hou J. Combined use of 3D printing and computer-assisted navigation in the clinical treatment of multiple maxillofacial fractures. Asian J Surg 2022:S1015-9584(22)01374-4. [DOI: 10.1016/j.asjsur.2022.09.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022] Open
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Surgical Classification for Preclinical Rat Femoral Bone Defect Model: Standardization Based on Systematic Review, Anatomical Analysis and Virtual Surgery. Bioengineering (Basel) 2022; 9:bioengineering9090476. [PMID: 36135022 PMCID: PMC9495991 DOI: 10.3390/bioengineering9090476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 12/03/2022] Open
Abstract
Though surgical techniques profoundly influence in vivo experiments, significant heterogeneity exists in current surgeries for inducing rat femoral bone defects. Such variations reduce the reproducibility and comparability of preclinical studies, and are detrimental to clinical translation. The purposes of this study were: (1) to conduct a systematic review of rat femoral defect models, summarizing and analyzing the surgical techniques; (2) to analyze surgical design and potential pitfalls via 3D anatomy and virtual surgeries for fostering future precision research; and (3) to establish a surgical classification system, for improving the reproducibility and comparability among studies, avoiding unnecessary repetitive experiments. The online database PubMed was searched to identify studies from January 2000 to June 2022 using keywords, including rat, femur, bone defect. Eligible publications were included for a review of surgical methods. Anatomical analysis and virtual surgeries were conducted based on micro-CT reconstruction of the rat femur for further investigation and establishment of a classification system. A total of 545 publications were included, revealing marked heterogeneity in surgical methods. Four major surgical designs were reported for inducing defects from the proximal to distal femur: bone tunnel, cortical window, segmental defect, and wedge-shaped defect. Anatomical analysis revealed potential pitfalls hindering efficient clinical translation. A classification system was established according to the anatomical region, surgical design, and fixation devices. This systematic review in combination with 3D analysis and virtual surgery provides a general overview of current surgical approaches to inducing femoral defects in rats, and establishes a surgical classification facilitating preclinical research of quality and translational value.
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Stamm T, Andriyuk E, Kleinheinz J, Jung S, Dirksen D, Middelberg C. In Vivo Accuracy of a New Digital Planning System in Terms of Jaw Relation, Extent of Surgical Movements and the Hierarchy of Stability in Orthognathic Surgery. J Pers Med 2022; 12:jpm12050843. [PMID: 35629264 PMCID: PMC9147622 DOI: 10.3390/jpm12050843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
This retrospective cohort study compares the virtual planned and postoperative jaw positions in patients undergoing orthognathic surgery. Surgery was virtually planned with the Digital Münster Model Surgery system (DMMS). Primary outcome: Spatial difference in the maxillo-mandibulo relation between virtual planning and postoperative result. Secondary outcome: Possible relationship between the measured differences and surgical movements as well as the postoperative stability according to Proffit. Ninety female and sixty-one male patients were included in the study. The average translation errors were 0.54 ± 0.50 mm (anteroposterior), 0.37 ± 0.33 mm (mediolateral), and 0.33 ± 0.28 mm (superoinferior). Orientation errors were 0.86 ± 0.79 degrees (yaw), 0.54 ± 0.48 degrees (roll), and 0.90 ± 0.72 degrees (pitch). The surgical procedures do not differ with respect to their error sizes. Maxilla forward and class II maxilla up with mandible forward are the most precise procedures. Most significant differences were found in the anteroposterior direction, whereby the extent of the surgical movement has no effect on the magnitude of the error. The process of planning with the DMMS followed by surgery is highly accurate and shows error values well below the clinically accepted limit of two millimeters in translation and four degrees in rotation.
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Affiliation(s)
- Thomas Stamm
- Department of Orthodontics, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany; (T.S.); (C.M.)
| | - Eugenia Andriyuk
- Department of Orthodontics, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany; (T.S.); (C.M.)
- Correspondence:
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany; (J.K.); (S.J.)
| | - Susanne Jung
- Department of Cranio-Maxillofacial Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany; (J.K.); (S.J.)
| | - Dieter Dirksen
- Department of Prosthetic Dentistry and Biomaterials, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
| | - Claudius Middelberg
- Department of Orthodontics, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany; (T.S.); (C.M.)
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