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Trevisiol L, Bersani M, Martinez Garza A, Alvarado E, Arnett GW, D'Agostino A. Accuracy of virtual surgical planning in bimaxillary orthognathic surgery with mandible first sequence: A retrospective study. J Craniomaxillofac Surg 2023:S1010-5182(23)00093-8. [PMID: 37355372 DOI: 10.1016/j.jcms.2023.05.015] [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: 08/31/2022] [Revised: 02/27/2023] [Accepted: 05/23/2023] [Indexed: 06/26/2023] Open
Abstract
The aim of this study was to verify treatment accuracy using virtual surgical planning (VSP) with a mandible-first sequence and strict surgical protocol to determine what surgical and methodological factors might influence outcomes. VSP transfer accuracy was evaluated retrospectively through a modified method involving voxel-based superimposition in patients who had undergone bimaxillary surgery with a mandible-first sequence to correct dentoskeletal deformities. Data analysis showed that the movements planned and those executed were substantially equivalent (p < 0.01), with the exception of mandibular and maxillary sagittal movements that were 0.72 ± 0.90 mm and 1.41 ± 1.04 mm smaller, respectively, than planned. This study showed that a mandible-first sequence is accurate for transferring virtual surgical planning intraoperatively. There are several factors involved in the proper transfer of virtual planning beyond the software, such as surgical technique and sequencing. Inaccurate sagittal movements and maxillary repositioning seem to depend mainly on surgical factors.
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Affiliation(s)
- Lorenzo Trevisiol
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Massimo Bersani
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy.
| | | | | | | | - Antonio D'Agostino
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
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Surgery First and Surgery Early Treatment Approach in Orthognathic Surgery. Oral Maxillofac Surg Clin North Am 2022; 35:71-82. [DOI: 10.1016/j.coms.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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de Waard O, Bruggink R, Baan F, Reukers HAJ, Bronkhorst EM, Kuijpers-Jagtman AM, Ongkosuwito EM. Operator Performance of the Digital Setup Fabrication for Orthodontic–Orthognathic Treatment: An Explorative Study. J Clin Med 2021; 11:jcm11010145. [PMID: 35011886 PMCID: PMC8745578 DOI: 10.3390/jcm11010145] [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: 11/30/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to explore the operator performance of the fabrication of digital orthodontic setups integrated into cone beam computed tomography (CBCT) scans. Fifteen patients who underwent a combined orthodontic–orthognathic surgical treatment were included. The pre-treatment digital dental models and CBCT scans were fused, and four operators made virtual setups twice for all patients. Differences between the virtual setups were calculated by recording tooth crown movement from the pre-treatment model to the virtual setup. To examine performance, Pearson’s correlation coefficients, duplicate measurement errors, and inter-operator differences were calculated. For intra-operator performance, correlation values varied among tooth types, with mean correlation values from 0.66 to 0.83 for the maxilla and 0.70 to 0.83 for the mandible. For inter-operator performance, mean correlation values varied from 0.40 to 0.87 for the maxilla and from 0.44 to 0.80 for the mandible. Rotational mean differences exceeded the range of clinical acceptance (>2 degrees) at 18% for the maxilla and 20.8% for the mandible, and translational mean differences exceeded the range of clinical acceptance (0.6 mm) at 9.7% and 26% for the maxilla and mandible, respectively. The intra- and inter-operator performance of digital orthodontic setup construction for virtual three-dimensional orthognathic planning shows significant errors.
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Affiliation(s)
- Olivier de Waard
- Department of Dentistry—Orthodontics and Craniofacial Biology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (R.B.); (F.B.); (E.M.O.)
- Correspondence: ; Tel.: +31-24-3618824
| | - Robin Bruggink
- Department of Dentistry—Orthodontics and Craniofacial Biology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (R.B.); (F.B.); (E.M.O.)
- Radboudumc 3D Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Frank Baan
- Department of Dentistry—Orthodontics and Craniofacial Biology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (R.B.); (F.B.); (E.M.O.)
- Radboudumc 3D Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | | | - Ewald M. Bronkhorst
- Department of Dentistry, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, Medical Faculty, University of Bern, CH-3010 Bern, Switzerland
- Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Edwin M. Ongkosuwito
- Department of Dentistry—Orthodontics and Craniofacial Biology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (R.B.); (F.B.); (E.M.O.)
- Radboudumc 3D Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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da Costa Senior O, Smeets M, Willaert R, Shaheen E, Jacobs R, Politis C. Complications Following One-Stage Versus Two-Stage Surgical Treatment of Transverse Maxillary Hypoplasia. J Oral Maxillofac Surg 2021; 79:1531-1539. [PMID: 33757746 DOI: 10.1016/j.joms.2021.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Contemporary literature suggests a similar transverse stability of a surgical-assisted rapid palatal expansion and a segmented Le Fort I osteotomy. The aim of this study was to compare postoperative complications of 1-stage (segmental maxillary osteotomy) and 2-stage (surgical-assisted rapid palatal expansion followed by Le Fort I osteotomy) treated patients to determine the preferred treatment strategy. MATERIALS AND METHODS This retrospective study included 74 consecutive patients (age range: 14 - 57 years; 36 males, 38 females) with a moderate transverse maxillary hypoplasia: 32 patients were treated in a 1-stage protocol and 42 in a 2-stage protocol with a postoperative follow-up of at least 1 year. Dental complications such as loss of teeth, gingival dehiscence, periodontal bone loss, apical root resorption, and surgical complications such as pain, hemorrhage, altered neurosensitivity, wound infection, aseptic necrosis were analyzed. Univariate analysis consisted of a generalized linear model with logit link or Fisher exact test. RESULTS No significant difference was found for group characteristics except for longer orthodontic treatment time in the 2-stage group. Incidence and severity of complications were comparable for the 1-stage and 2-stage patients. Only overall pain was significantly greater in the 2-stage patient group (P = .038). CONCLUSIONS Considering a similar complication rate and transversal stability, the choice between 1-stage and 2-stage approach for patients with a moderate transverse maxillary hypoplasia should be patient specific.
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Affiliation(s)
- Oliver da Costa Senior
- Junior Resident, University Hospitals Leuven, Campus Sint-Rafaël, Department of Oral and Maxillofacial Surgery, Leuven, Belgium; and OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.
| | - Maximiliaan Smeets
- Junior Resident, University Hospitals Leuven, Campus Sint-Rafaël, Department of Oral and Maxillofacial Surgery, Leuven, Belgium; and OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Robin Willaert
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium; and Member of Staff, University Hospitals Leuven, Campus Sint-Rafaël, Department of Oral and Maxillofacial Surgery, Leuven, Belgium
| | - Eman Shaheen
- Engineer, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium; and Department Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium; and Head of Department, Professor, University Hospitals Leuven, Campus Sint-Rafaël, Department of Oral and Maxillofacial Surgery, Leuven, Belgium
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Hsu LF, Cheng YC, Peng HH, Yao CCJ. Simplified orthognathic surgical treatment using non-surgical asymmetric maxillary expansion: A case report. Int Orthod 2020; 18:839-849. [PMID: 32839141 DOI: 10.1016/j.ortho.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/30/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Transverse problems can be exacerbated by highly compensated occlusion in patients with skeletal asymmetry, which makes pre-surgical decompensation harder to achieve. OBJECTIVE This case report describes a case of combined orthognathic surgery with facial asymmetry. We used pre-orthodontic surgical simulation to visualize the goal for presurgical orthodontics, planning for a one-jaw surgical treatment option. METHODS The planned asymmetric expansion was performed using a maxillary skeletal expander (MSE II) with surgical corticopuncture over only the left side before MSE activation. Surgery was performed to achieve mandibular left outward yaw rotation to correct the patient's facial asymmetry after the planned amount of expansion was reached. RESULTS The results showed substantial improvement of facial aesthetics as well as skeletal symmetry. Cooperation and communication between surgeon and orthodontist ensured that the final results were satisfactory.
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Affiliation(s)
- Li-Fang Hsu
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan Department of Dentistry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yu-Cheng Cheng
- Department of Oral & Maxillofacial Surgery, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Hsin-Hui Peng
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan, Department of Dentistry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chung-Chen Jane Yao
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan. Division of Orthodontics and Dentofacial Orthopaedics, Department of Dentistry, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
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Baan F, de Waard O, Bruggink R, Xi T, Ongkosuwito EM, Maal TJJ. Virtual setup in orthodontics: planning and evaluation. Clin Oral Investig 2019; 24:2385-2393. [PMID: 31720852 DOI: 10.1007/s00784-019-03097-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/22/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the clinical accuracy of virtual orthodontic setups by using a new CBCT-based approach. MATERIALS AND METHODS Ten patients who underwent pre-surgical orthodontics were included in this study. Pre-treatment and pre-surgical cone-beam CT (CBCT) scans and digital dental models were available. The pre-treatment digital dental model was used to create an orthodontic virtual setup. The digital dental models were fused with the corresponding CBCT scans, and the two CBCT scans were aligned using voxel-based matching. Moving each individual tooth from the virtual setup to the final outcome allows the calculation of the accuracy of the virtual setup by using an iterative closest point algorithm. Differences between virtual setup and final outcome were recorded as well as the ICC between two observers. RESULTS The inter-observer variability showed a high level of agreement between the observers. The largest mean difference between observers was found in the cranial/caudal direction (0.36 ± 0.30 mm) and the roll rotation (1.54 ± 0.98°). Differences between the virtual setup and final outcome were small in the translational direction (0.45 ± 0.48 mm). Rotational mean differences were larger with the pitch of the incisors (0.00 ± 7.97°) and molars (0.01 ± 10.26°) as largest difference. Excessive extrusion of all upper teeth and more anterior movement than planned were seen for both upper and lower arch. Lower molars showed less extrusion. CLINICAL RELEVANCE The data of this study can be used to obtain more insight in the accuracy and achievability of orthodontic virtual setup. Tooth movement can now be studied in more details which can lead to new insights.
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Affiliation(s)
- F Baan
- Radboudumc 3D Lab, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands.
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Philips van Leydenlaan 25, 6525, EX, Nijmegen, The Netherlands.
| | - O de Waard
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Philips van Leydenlaan 25, 6525, EX, Nijmegen, The Netherlands
| | - R Bruggink
- Radboudumc 3D Lab, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Philips van Leydenlaan 25, 6525, EX, Nijmegen, The Netherlands
| | - T Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - E M Ongkosuwito
- Radboudumc 3D Lab, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
- Amalia Cleft and Craniofacial Centre, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - T J J Maal
- Radboudumc 3D Lab, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
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Bone-borne surgically assisted rapid maxillary expansion: A retrospective three-dimensional evaluation of the asymmetry in expansion. J Craniomaxillofac Surg 2018; 46:1329-1335. [PMID: 29861407 DOI: 10.1016/j.jcms.2018.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 04/26/2018] [Accepted: 05/07/2018] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Asymmetrical expansion occurs in patients treated with Surgically Assisted Rapid Maxillary Expansion (SARME). In the clinical setting, this asymmetrical expansion is seen in multiple directions. However, the frequency, actual directions and amount of asymmetry are unclear. Hence, the aim of this study was to analyze the directions and amount of asymmetrical lateral expansion in non-syndromic patients with transversal maxillary hypoplasia on employing bone-borne transpalatal distraction by means of SARME. Treatment involved corticotomies of all four bony supports, including pterygomaxillary disjunction. MATERIALS AND METHODS A retrospective case series was formed from patients treated with SARME. Pre- and postdistraction Cone Beam Computed Tomography scans were superimposed. A reference frame was created to analyze lateral expansion asymmetries in five directions. RESULTS Clinical relevant asymmetries (>3.0 mm) in at least one of the investigated directions occurred in 55% of the patients. Lateral expansion asymmetries occurred mostly in the inferior-anterior part between the left and right segment and asymmetry in total expansion was noted between the anterior and posterior part of the maxilla. CONCLUSION This study confirms the clinical suspicion that using SARME with a bone-borne distractor and pterygomaxillary disjunction to treat non-syndromic patients with transversal maxillary hypoplasia, results in regular asymmetrical lateral expansion.
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Kim JH, Park YC, Yu HS, Kim MK, Kang SH, Choi YJ. Accuracy of 3-Dimensional Virtual Surgical Simulation Combined With Digital Teeth Alignment: A Pilot Study. J Oral Maxillofac Surg 2017; 75:2441.e1-2441.e13. [PMID: 28826784 DOI: 10.1016/j.joms.2017.07.161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the accuracy of virtual surgical simulation combined with digital teeth alignment and the applicability of this technique to the diagnosis and establishment of a 3-dimensional (3D) visualized treatment objective for orthognathic surgery by comparing virtual simulation images with actual post-treatment images. MATERIALS AND METHODS This retrospective study included patients who underwent computed tomography (CT) before and after treatment. The 3D digital images were constructed from the initial CT images and dental cast scan data, and virtual surgical simulation combined with digital teeth alignment was performed. Accuracy of the virtual simulation was analyzed by comparing the distances of skeletal and dental landmarks in the horizontal, sagittal, and coronal reference planes with those on post-treatment images using the Wilcoxon signed rank test. Intraclass correlation coefficients were calculated to evaluate the degree of concordance between the 2 images. RESULTS The study sample included 11 patients (mean age, 18.8 yr). Most landmarks had differences smaller than 2 mm in the 3 reference planes between virtual simulation and post-treatment images; these differences were not statistically significant (P > .05). Most skeletal landmarks, except the A point, B point, and gonion, showed normal to high concordance between the virtual simulation and post-treatment images in the 3 reference planes (P < .05); dental landmarks exhibited a broad range of concordance. CONCLUSION The 3D virtual surgical simulation combined with digital teeth alignment using pretreatment CT images yielded results sufficiently accurate to be used for the diagnosis and establishment of visualized treatment objectives for orthognathic surgery.
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Affiliation(s)
- Jung-Hoon Kim
- Faculty, Department of Orthodontics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Young-Chel Park
- Professor Emeritus, Department of Orthodontics, The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung-Seog Yu
- Professor, Department of Orthodontics, The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Moon-Key Kim
- Faculty, Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang-Hoon Kang
- Faculty, Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yoon Jeong Choi
- Associate Professor, Department of Orthodontics, The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea.
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