[Comparison of the virtual surgical planning position of maxilla and condyle with the postoperative real position in patients with mandibular protrusion]

OBJECTIVE

To compare the difference between virtual surgical planning (VSP) position and postoperative real position of maxilla and condyle, and to explore the degree of intraoperative realization of VSP after orthognathic surgery.

METHODS

In this study, 36 patients with mandibular protrusion deformity from January 2022 to December 2022 were included. All the patients had been done bilateral sagittal split ramus osteotomy (SSRO) combined with Le Fort Ⅰ osteotomy under guidance of VSP. The VSP data (T0) and 1-week postoperative CT (T1) were collected, the 3D model of postoperative CT was established and segmented into upper and lower jaws in CCMF Plan software. At the same time, accor-ding to the morphology of palatal folds, the virtual design was registered with the postoperative model, and the unclear maxillary dentition in the postoperative model was replaced. Then the postoperative model was matched with VSP model by registration of upper skull anatomy that was not affected by the operation. The three-dimensional reference plane and coordinate system were established. Selecting anatomical landmarks and their connections of condyle and maxilla for the measurement, we compared the coordinate changes of marker points in three directions, and the angle changes between the line connecting the marker points and the reference plane to analyze the positional deviation and the angle deviation of the postoperative condyle and maxilla compared to VSP.

RESULTS

The postoperative real position of the maxilla deviates from the VSP by nearly 1 mm in the horizontal and vertical directions, and the anteroposterior deviation was about 1.5 mm. In addition, most patients had a certain degree of counterclockwise rotation of the maxilla after surgery. Most of the bilateral condyle moved forward, outward and downward (the average distance deviation was 0.15 mm, 1.54 mm, 2.19 mm, respectively), and rotated forward, outward and upward (the average degree deviation was 4.32°, 1.02°, 0.86°, respectively) compared with the VSP.

CONCLUSION

VSP can be mostly achieved by assistance of 3D printed occlusal plates, but there are certain deviations in the postoperative real position of maxilla and condyle compared with VSP, which may be related to the rotation axis of the mandible in the VSP. It is necessary to use patient personalized condylar rotation axis for VSP, and apply condylar positioning device to further improve surgical accuracy.

[Comparing study on the hyoid bone position after treatment of class Ⅲ malocclusion using improved appliance FR Ⅲ]

OBJECTIVE

This study aims to compare the changes of hyoid bone position before and after treatment of Angle class Ⅲ malocclusion using improved appliance FR Ⅲ.

METHODS

Forty patients with Angle class Ⅲ malocclusion were chosen and divided into two groups, namely, experimental and control. Each group had 20 patients. The young patients in the experi-mental group were treated using improved appliance FR Ⅲ, whereas those in the control group were treated using classic appliance FR Ⅲ. The hyoid bone position of the two groups were comparatively analyzed using an X-ray film before and after treatment.

RESULTS

Compared with the condition before treatment, the condition after treatment showed that the hyoid bone position of young patients with Angle class Ⅲ malocclusion treated using improved appliance FR Ⅲ, H-FH, H-S, H-Ptm, and Ar-H-Me exhibited an increased angle (P<0.01), whereas the hyoid bone position of those treated using H-MP and H-Gn showed a decreased angle (P<0.01). The hyoid bone position of young patients with Angle class Ⅲ malocclusion treated using classic appliance FR Ⅲ, H-FH, H-S, and H-Ptm had an increased angle (P<0.05). Moreover, the hyoid bone position of those treated using Ar-H-Me had an increased angle (P<0.01), and the hyoid bone position of those treated using H-MP and H-RGn had a decreased angle (P<0.05).

CONCLUSIONS

Compared with the hyoid bone position before treatment, the hyoid bone position after treatment of the young patients with Angle class Ⅲ malocclusion treated using improved appliance FR Ⅲ may move backward and downward, and the mandibular and hyoid bone position may move through clockwise rotation. The mandibular and hyoid bone position of young patients with Angle class Ⅲ malocclusion treated using classic appliance FR Ⅲ obtained a large angle by moving clockwise. The man-dibular bone moves backward and downward, thereby improving the hyoid bone in backward and upward directions. This condition makes a significant difference in treating the hyoid bone position of young patients with functional Angle class Ⅲ malocclusion.
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