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Shi J, Lin G, Bao R, Zhang Z, Tang J, Chen W, Chen H, Zuo X, Feng Q, Liu S. An automated method for assessing condyle head changes in patients with skeletal class II malocclusion based on Cone-beam CT images. Dentomaxillofac Radiol 2024; 53:325-335. [PMID: 38696751 PMCID: PMC11211682 DOI: 10.1093/dmfr/twae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/01/2024] [Accepted: 04/06/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVES Currently, there is no reliable automated measurement method to study the changes in the condylar process after orthognathic surgery. Therefore, this study proposes an automated method to measure condylar changes in patients with skeletal class II malocclusion following surgical-orthodontic treatment. METHODS Cone-beam CT (CBCT) scans from 48 patients were segmented using the nnU-Net network for automated maxillary and mandibular delineation. Regions unaffected by orthognathic surgery were selectively cropped. Automated registration yielded condylar displacement and volume calculations, each repeated three times for precision. Logistic regression and linear regression were used to analyse the correlation between condylar position changes at different time points. RESULTS The Dice score for the automated segmentation of the condyle was 0.971. The intraclass correlation coefficients (ICCs) for all repeated measurements ranged from 0.93 to 1.00. The results of the automated measurement showed that 83.33% of patients exhibited condylar resorption occurring six months or more after surgery. Logistic regression and linear regression indicated a positive correlation between counterclockwise rotation in the pitch plane and condylar resorption (P < .01). And a positive correlation between the rotational angles in both three planes and changes in the condylar volume at six months after surgery (P ≤ .04). CONCLUSIONS This study's automated method for measuring condylar changes shows excellent repeatability. Skeletal class II malocclusion patients may experience condylar resorption after bimaxillary orthognathic surgery, and this is correlated with counterclockwise rotation in the sagittal plane. ADVANCES IN KNOWLEDGE This study proposes an innovative multi-step registration method based on CBCT, and establishes an automated approach for quantitatively measuring condyle changes post-orthognathic surgery. This method opens up new possibilities for studying condylar morphology.
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Affiliation(s)
- Jiayu Shi
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
| | - Guoye Lin
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, 510515, China
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, 510515, China
| | - Rui Bao
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
| | - Zhen Zhang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
| | - Jin Tang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
| | - Wenyue Chen
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
| | - Hongjin Chen
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
| | - Xinwei Zuo
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
| | - Qianjin Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, 510515, China
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, 510515, China
| | - Shuguang Liu
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
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Bencherqui S, Barone S, Cevidanes L, Perrin JP, Corre P, Bertin H. 3D analysis of condylar and mandibular remodeling one year after intra-oral ramus vertical lengthening osteotomy. Clin Oral Investig 2024; 28:114. [PMID: 38267793 PMCID: PMC10904022 DOI: 10.1007/s00784-024-05504-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES Among the existing techniques for the correction of mandibular posterior vertical insufficiency (PVI), the intra-oral ramus vertical lengthening osteotomy (IORVLO) can be proposed as it allows simultaneous correction of mandibular height and retrusion. This study assessed the 3D morpho-anatomical changes of the ramus-condyle unit and occlusal stability after IORVLO. MATERIALS AND METHODS This retrospective analysis compared immediate and 1-year post-operative 3D CBCT reconstructions. The analysis focused on the condylar height (primary endpoint) and on the changes in condylar (condylar diameter, condylar axis angle) and mandibular (ramus height, Frankfort-mandibular plane angle, gonion position, intergonial distance, angular remodeling) parameters. Additionally, this analysis investigated the maxillary markers and occlusal stability. RESULTS On the 38 condyles studied in 21 included patients (mean age 23.7 ± 3.9 years), a condylar height (CH) loss of 0.66 mm (p < 0,03) was observed, with no correlation with the degree of ramus lengthening (mean 13.3 ± 0.76 mm). Only one patient presented an occlusal relapse of Class II, but a 3.4 mm (28%) condylar diameter loss and a 33% condylar volume reduction with loss of 1 mm and 3.4 mm in CH and condyle diameter, respectively. A mean 3.56 mm (p < 0.001) decrease in ramus height was noted, mainly due to bone resorption in the mandibular angles. CONCLUSION This study confirms the overall stability obtained with IORVLO for the correction of PVI. CLINICAL RELEVANCE This study aims to precise indication of IORVLO, and to validate the clinical and anatomical stability of results.
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Affiliation(s)
- Samy Bencherqui
- Nantes Université, CHU Nantes, Service de Chirurgie Maxillo-Faciale Et Stomatologie, 44000, Nantes, France.
| | - Selene Barone
- School of Dentistry, Department of Health Sciences, Magna, Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Lucia Cevidanes
- Department of Orthodontics & Ped Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Jean-Philippe Perrin
- Nantes Université, CHU Nantes, Service de Chirurgie Maxillo-Faciale Et Stomatologie, 44000, Nantes, France
| | - Pierre Corre
- Nantes Université, CHU Nantes, Service de Chirurgie Maxillo-Faciale Et Stomatologie, 44000, Nantes, France
- Nantes Université, Oniris, Univ Angers, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000, Nantes, France
| | - Hélios Bertin
- Nantes Université, CHU Nantes, Service de Chirurgie Maxillo-Faciale Et Stomatologie, 44000, Nantes, France
- Nantes Université, Oniris, Univ Angers, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000, Nantes, France
- Nantes Université, Univ Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, 44000, Nantes, France
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Inchingolo AM, Patano A, Piras F, de Ruvo E, Ferrante L, Noia AD, Dongiovanni L, Palermo A, Inchingolo F, Inchingolo AD, Dipalma G. Orthognathic Surgery and Relapse: A Systematic Review. Bioengineering (Basel) 2023; 10:1071. [PMID: 37760172 PMCID: PMC10525849 DOI: 10.3390/bioengineering10091071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 08/25/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND This review aimed to analyze the relapse in orthognathic surgery. METHODS PubMed, Scopus, and Web of Science databases were used to find papers that matched our topic dating from 1 January 2012 up to November 2022. Inclusion criteria were (1) human studies, (2) open access studies, (3) studies concerning the correlation between orthognathic surgery and relapse. Exclusion criteria were: (1) in vitro or animal studies, (2) off-topic studies, (3) reviews, (4) other languages than English. RESULTS A total of 482 results were obtained resulting in 323 publications after duplicate removal (158). After screening and eligibility phases 247 records were excluded: 47 reviews, 5 in animals, 35 in vitro, 180 off-topic. The authors successfully retrieved the remaining 78 papers and evaluated their eligibility. A total of 14 studies from these were ultimately included in the review. CONCLUSION Using cephalometric examinations and digital study models, these studies reveal that the relapse after orthognathic surgery is an event that occurs in most of the cases. The limitation of our research is that most of the studies are retrospective and use small sample sizes. A future research goal should be to conduct long-term clinical trials with larger numbers of samples.
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Affiliation(s)
- Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Assunta Patano
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Fabio Piras
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Elisabetta de Ruvo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Laura Ferrante
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Angela Di Noia
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Leonardo Dongiovanni
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Andrea Palermo
- Implant Dentistry College of Medicine and Dentistry, Birmingham B4 6BN, UK;
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
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Mashkina AA, Chkadua TZ, Ermolin VI, Isaichikova OV, Romanovsky MA. [Three-dimensional assessment of positional changes of the mandibular condyles following orthognathic surgery]. STOMATOLOGIIA 2023; 102:19-27. [PMID: 36800781 DOI: 10.17116/stomat202310201119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
THE AIM THE STUDY This study aims to assess the postoperative condylar displacement after orthognathic surgery using three-dimensional analysis of computed tomography. MATERIAL AND METHODS This retrospective study included 64 condyles from 32 patients with skeletal Class II (Group 1, n=16) and III (Group 2, n=16) deformities. All patients underwent a bimaxillary surgery. The three-dimensional CT images were evaluated to assess condylar displacement. RESULTS The condyle exhibited mainly superior and lateral torque immediately after surgery. Posterior displaced condyles were found in two cases in group 1 (Class II malocclusion). CONCLUSION The present study found the condyle displacement that can be mistaken as posterior displacement of condyle in analysis of sagittal sections of CT scans.
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Affiliation(s)
- A A Mashkina
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - T Z Chkadua
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - V I Ermolin
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | | | - M A Romanovsky
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Togninalli D, Antonarakis GS, Schatz JP. Condylar resorption following mandibular advancement or bimaxillary osteotomies: A systematic review of systematic reviews. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e948-e955. [PMID: 35263683 DOI: 10.1016/j.jormas.2022.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
Several systematic reviews have been published on the effects of mandibular surgery on condylar remodeling without reaching a consensus. The purpose of this systematic review of systematic reviews was to assess the impact of mandibular advancement or bimaxillary surgeries on condylar resorption. A literature search, using several electronic databases, was carried out by two reviewers independently. Article preselection was based on titles and abstracts, and final article selection based on full-text analysis of preselected studies. After final study selection, the quality of studies was assessed using the AMSTAR 2 tool. A decision algorithm was subsequently established to choose the best body of evidence. From an initial yield of 1'848 articles, 23 systematic reviews were identified for further analysis, with ten studies being included in the final selection. Despite the generally low quality of the reviews, certain associations could be made: young patients, female patients, and those with a high mandibular plane angle are more prone to condylar resorption following mandibular advancement osteotomies, especially if anterior rotation of the mandible is performed during surgery. Patients undergoing bimaxillary surgery also appear to have a higher risk of developing condylar resorption. In conclusion, these results confirm the multi-factorial nature of condylar resorption, stressing the need for well-controlled prospective studies with long-term follow-up to clearly identify potential risk factors associated with orthognathic surgery.
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Affiliation(s)
- David Togninalli
- Department of Orthodontics, University Clinic of Dental Medicine, Faculty of Medicine, University of Geneva, Switzerland
| | - Gregory S Antonarakis
- Department of Orthodontics, University Clinic of Dental Medicine, Faculty of Medicine, University of Geneva, Switzerland
| | - Jean-Paul Schatz
- Department of Orthodontics, University Clinic of Dental Medicine, Faculty of Medicine, University of Geneva, Switzerland
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Condylar Reshape in Orthognathic Surgery: Morphovolumetric and Densitometric Analysis Based on 3D Imaging and Digital Workflow. J Maxillofac Oral Surg 2022; 21:501-509. [PMID: 35712406 PMCID: PMC9192879 DOI: 10.1007/s12663-022-01689-3] [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: 10/17/2021] [Accepted: 01/18/2022] [Indexed: 10/25/2022] Open
Abstract
Abstract
Background
Condylar remodelling (CR) is a complex of phenomena that generates in response of the temporo-mandibular joint to forces and stress to maintain a morphological, functional and occlusal homeostasis. The most worrying aspect of the condylar reshape is the condylar resorption which implies fast loss of vertical dimension (>6% of pre-surgical value), mandibular retraction and open bite with preserved articular function.
Materials and Methods
Six parameters were analysed to study the condyles of twelve patients that underwent orthognathic surgery. The digital workflow was then described to make it reproducible enabling a more in-depth study of the reshaping processes that involving the condyle after a great stress like the surgery.
Results
The results of our study showed many statistically significant variations of the studied parameters. In all patients, it was noticed a decreased bone density (p = 0,002 per side).
Objectives
The aim of our study, with the aid of the contemporary 3D imaging and digital modelling and workflow technologies, is to investigate and analyse quantitatively and qualitatively the adaptative processes occurring in CR following bimaxillary repositioning. To the best of our knowledge, this is the only paper that investigates the CR considering six different variables at once.
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Barone S, Cosentini G, Bennardo F, Antonelli A, Giudice A. Incidence and management of condylar resorption after orthognathic surgery: An overview. Korean J Orthod 2022; 52:29-41. [PMID: 35046140 PMCID: PMC8770964 DOI: 10.4041/kjod.2022.52.1.29] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/14/2021] [Accepted: 09/24/2021] [Indexed: 12/14/2022] Open
Abstract
Objective Condylar resorption (CR) is one of the major post-surgical complications of orthognathic surgery. This systematic review (SR) aimed to evaluate epidemiological data, risk factors, and therapeutical management of CR. Methods Six databases were screened by two investigators until September 2020 to obtain all SRs. After reading the titles and abstracts, eligible SRs were determined and data extraction was performed. Using the latest version of A Measurement Tool to Assess Systematic Reviews, the methodological quality of the included SRs was determined. Results Ten SRs with low or critically-low methodological quality were included in this review. Mandibular hypoplasia on the sagittal plane and hyperdivergent growth pattern on the vertical plane were the most common skeletal alterations in which CR could occur after orthognathic surgery. Post-operative condylar changes were analyzed both on two-dimensional and three-dimensional (3D) radiographic examinations. The incidence of CR was not related to the fixation method. Based on the severity of the pathological conditions, management of CR can include conservative or surgical therapy. Conclusions Despite the limited evidence in literature, CR is considered a consequence of orthognathic surgery. However, an accurate diagnosis of CR and a better orthognathic surgical planning must include 3D radiographic examinations to improve pre- and post-surgical comparison. Well-designed studies with long-term follow-up and 3D data are needed to clarify the findings of this analysis..
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Affiliation(s)
- Selene Barone
- aDepartment of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giorgio Cosentini
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Francesco Bennardo
- aDepartment of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Alessandro Antonelli
- aDepartment of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Amerigo Giudice
- aDepartment of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
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van Luijn R, Baan F, Shaheen E, Bergé S, Politis C, Maal T, Xi T. Three-dimensional analysis of condylar remodeling and skeletal relapse following LeFort-I osteotomy: A one-year follow-up bicenter study. J Craniomaxillofac Surg 2021; 50:40-45. [PMID: 34654618 DOI: 10.1016/j.jcms.2021.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 07/28/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of the study was to quantify the postoperative condylar remodeling after Le Fort I surgery. Patients treated with a Le Fort I osteotomy were investigated. CBCT scans were acquired preoperatively, one week and one year postoperatively. A preoperative 3D cephalometric analysis was performed on the preoperative CBCT. Surgical movements were quantified using a voxel-registration based method (OrthoGnaticAnalyser). After rendering of the condyles from the CBCT, a volumetric analysis was performed. The correlation between the surgical movement of the maxilla and the postoperative condylar volume changes was determined with analysis of variance. RESULTS: A total of 45 subjects were included in this study. 47 of 90 condyles (52%) showed a mean volume reduction of 93 mm3 (4.9 volume-%) postoperatively. The maxilla was impacted in 12 patients (2.44 ± 2.49 mm) and extruded in 33 patients (1.78 ± 1.29 mm). The maxillary impaction group showed a volume reduction of 50 ± 122 mm3 and the extrusion group showed a mean volume gain of 21 ± 139 mm3 (p = 0.028). CONCLUSION: Clinicians should be aware of potential condylar remodeling following solitary Le Fort I osteotomies, particularly in female patients with maxillary impaction.
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Affiliation(s)
- Rik van Luijn
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
| | - Frank Baan
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands.
| | - Eman Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
| | - Stefaan Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands.
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
| | - Thomas Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands.
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands.
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