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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.
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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.
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Yoo HJ, Hartsfield JK, Mian AS, Allan BP, Naoum S, Lee RJH, Goonewardene MS. Accuracy of mandibular repositioning surgery using new technology: Computer-aided design and manufacturing customized surgical cutting guides and fixation plates. Am J Orthod Dentofacial Orthop 2023; 163:357-367.e3. [PMID: 36503861 DOI: 10.1016/j.ajodo.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/01/2021] [Accepted: 12/01/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Recent 3-dimensional technology advancements have resulted in new techniques to improve the accuracy of intraoperative transfer. This study aimed to validate the accuracy of computer-aided design and manufacturing (CAD-CAM) customized surgical cutting guides and fixation plates on mandibular repositioning surgery performed in isolation or combined with simultaneous maxillary repositioning surgery. METHODS Sixty patients who underwent mandibular advancement surgery by the same surgeon were retrospectively evaluated by 3-dimensional surface-based superimposition. A 3-point coordinate system (x, y, z) was used to identify the linear and angular discrepancies between the planned movements and actual outcomes. Wilcoxon rank sum test was used to compare the outcomes between the mandible-only and the bimaxillary surgery groups with significance at P <0.05. Pearson correlation coefficient compared planned mandible advancement to the outcome from advancement planned. The centroid, which represents the mandible as a single unit, was computed from 3 landmarks, and the discrepancies were evaluated by the root mean square error (RMSE) for clinical significance set at 2 mm for linear discrepancies and 4° for angular discrepancies. RESULTS There was no statistically significant difference between the planned and actual position of the mandible in either group when considering absolute values of the differences. When considering raw directional data, a statistically significant difference was identified in the y-axis suggesting a tendency for under-advancement of the mandible in the bimaxillary group. The largest translational RMSE for the centroid was 0.77 mm in the sagittal dimension for the bimaxillary surgery group. The largest rotational RMSE for the centroid was 1.25° in the transverse dimension for the bimaxillary surgery group. Our results show that the precision and clinical feasibility of CAD-CAM customized surgical cutting guides and fixation plates on mandibular repositioning surgery is well within clinically acceptable parameters. CONCLUSION Mandibular repositioning surgery can be performed predictably and accurately with the aid of CAD-CAM customized surgical cutting guides and fixation plates with or without maxillary surgery.
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Affiliation(s)
- Ho Jin Yoo
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - James K Hartsfield
- Division of Orthodontics, Department of Oral Health Science, College of Dentistry, and Department of Microbiology, Immunology and Molecular Genetics, College of Medicine, University of Kentucky, Lexington, KY; Division of Oral Development and Behavioural Sciences, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - Ajmal S Mian
- School of Computer Science and Software Engineering, the University of Western Australia, Crawley, Western Australia, Australia
| | - Brent P Allan
- Private practice, Perth, Western Australia, Australia; Department of Orthodontics, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Steven Naoum
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - Richard J H Lee
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia
| | - Mithran S Goonewardene
- Department of Orthodontics, School of Dentistry, the University of Western Australia, Nedlands, Western Australia, Australia.
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Three-Dimensional Accuracy and Stability of Personalized Implants in Orthognathic Surgery: A Systematic Review and a Meta-Analysis. J Pers Med 2023; 13:jpm13010125. [PMID: 36675786 PMCID: PMC9867342 DOI: 10.3390/jpm13010125] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
This systematic review aimed to determine the accuracy/stability of patient-specific osteosynthesis (PSI) in orthognathic surgery according to three-dimensional (3D) outcome analysis and in comparison to conventional osteosynthesis and computer-aided designed and manufactured (CAD/CAM) splints or wafers. The PRISMA guidelines were followed and six academic databases and Google Scholar were searched. Records reporting 3D accuracy/stability measurements of bony segments fixated with PSI were included. Of 485 initial records, 21 met the eligibility (566 subjects), nine of which also qualified for a meta-analysis (164 subjects). Six studies had a high risk of bias (29%), and the rest were of low or moderate risk. Procedures comprised either single-piece or segmental Le Fort I and/or mandibular osteotomy and/or genioplasty. A stratified meta-analysis including 115 subjects with single-piece Le Fort I PSI showed that the largest absolute mean deviations were 0.5 mm antero-posteriorly and 0.65° in pitch. PSIs were up to 0.85 mm and 2.35° more accurate than conventional osteosynthesis with CAD/CAM splint or wafer (p < 0.0001). However, the clinical relevance of the improved accuracy has not been shown. The literature on PSI for multi-piece Le Fort I, mandibular osteotomies and genioplasty procedure is characterized by high methodological heterogeneity and a lack of randomized controlled trials. The literature is lacking on the 3D stability of bony segments fixated with PSI.
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Three-dimensional condylar displacement and remodelling following correction of asymmetric mandibular prognathism with maxillary canting. Int J Oral Maxillofac Surg 2021; 51:813-822. [PMID: 34924271 DOI: 10.1016/j.ijom.2021.12.003] [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: 04/23/2021] [Revised: 09/11/2021] [Accepted: 12/03/2021] [Indexed: 02/05/2023]
Abstract
The aim of this study was to investigate the three-dimensional condylar displacement and long-term remodelling following the correction of asymmetric mandibular prognathism with maxillary canting. Thirty consecutive patients (60 condyles) with asymmetric mandibular prognathism >4 mm and occlusal canting >3 mm, treated by Le Fort I osteotomy and bilateral sagittal split ramus osteotomy, were included. Spiral computed tomography scans obtained at different periods during long-term follow-up (mean 17 ± 7.2 months) were gathered and processed using ITK-SNAP and 3D Slicer. The condyles were subjected to translational and rotational displacements immediately after the surgery (T2), which had not fully returned to the original preoperative positions at the last follow-up (T3). Condylar remodelling was observed at the last follow-up (T3), with the shorter side condyles subjected to higher surface resorption and overall condylar volume loss. The overall condylar volume on the shorter side was significantly reduced compared to the volume on the elongated side (-11.9 ± 90.6 vs -131.7 ± 138.2 mm3; P = 0.001). About 73%, 87%, 53%, and 54% of the shorter side condyles experienced resorption on the posterior, superior, medial, and lateral surfaces, respectively; in contrast, only 50% of the elongated side condyles showed resorption on the superior surface. Higher preoperative asymmetry was significantly correlated with increased postoperative condylar displacement (P < 0.05). The vertical asymmetry and the vector of condylar displacement were associated with the resultant remodelling process. It is concluded that condylar resorption of the shorter side condyle, which may affect the long-term surgical stability, has to be considered.
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Abotaleb BM, Bi R, Liu Y, Jiang N, Telha W, Zhu S. Three-dimensional condylar displacement and remodelling in patients with asymmetrical mandibular prognathism following bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2021; 51:509-517. [PMID: 34446294 DOI: 10.1016/j.ijom.2021.08.008] [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: 12/08/2020] [Revised: 05/25/2021] [Accepted: 08/10/2021] [Indexed: 02/08/2023]
Abstract
This study aims to assess the postoperative condylar displacement and the long-term condylar remodelling in patients with mandibular prognathism with transverse asymmetry after bilateral sagittal split ramus osteotomy (BSSRO). Forty-one consecutive patients (82 condyles) with a transverse mandibular asymmetry of more than 4 mm without occlusal canting treated by BSSRO were included. The preoperative (T1), immediate postoperative (T2) and long-term follow-up of an average of 16.2 months (T3) spiral computed tomography scans were gathered and processed to measure the condylar displacement and remodelling based on cranial base voxel-based and rigid regional registrations. The statistical analysis revealed that the majority of condyles (T1-T2) were transitionally displaced forwards, downwards and laterally, and were not fully returned to the preoperative position at T3. Condylar lateral displacement was significantly higher on the deviated side (DS) (P = 0.035). Non-deviated side (NDS) condyles were mainly subjected to upward pitch, medial yaw and medial roll compared with downward pitch, lateral yaw and lateral roll on DS. Condylar remodelling at T3 was observed, with the superior and posterior surfaces commonly subjected to bone resorption, whereas the anterior and medial surfaces were commonly subjected to bone apposition. Condylar volumetric changes were relatively comparable on NDS (3 ± 85.2 mm3) and DS (8.3 ± 111.7 mm3) condyles. Age, amount of preoperative asymmetry and follow-up period were not correlated with the condylar remodelling. Transitional and rotational displacements were to some extent significantly correlated with the condylar remodelling on both sides. Consequently, passive condylar seating without torque might prevent the long-term unfavourable condylar remodelling.
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Affiliation(s)
- B M Abotaleb
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen.
| | - R Bi
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Y Liu
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - N Jiang
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - W Telha
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - S Zhu
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
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