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Beek DM, Baan F, Liebregts J, Nienhuijs M, Bergé S, Maal T, Xi T. A learning curve in 3D virtual surgical planned orthognathic surgery. Clin Oral Investig 2023:10.1007/s00784-023-05013-2. [PMID: 37083986 DOI: 10.1007/s00784-023-05013-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/29/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES To assess the surgical accuracy of 3D virtual surgical planned orthognathic surgery and the influence of posterior impaction and magnitude of the planned movements on a possible learning curve. MATERIALS AND METHODS This prospective cohort study included subjects who underwent bimaxillary surgery between 2016 and 2020 at the Department of Oral and Maxillofacial Surgery of the Radboud University Medical Center, Nijmegen. 3D virtual surgical planning (VSP) was performed with CBCT data and digitalized dentition data. By using voxel-based matching with pre- and postoperative CBCT data the maxillary movements were quantified in six degrees of freedom. The primary outcome variable, surgical accuracy, was defined as the difference between the planned and achieved maxillary movement. RESULTS Based on 124 subjects, the surgical accuracy increased annually from 2016 to 2020 in terms of vertical translations (0.82 ± 0.28 mm; p = 0.038) and yaw rotations (0.68 ± 0.22°; p = 0.028). An increase in surgical accuracy was observed when combining all six degrees of freedom (p = 0.021) and specifically between 2016 and 2020 (p = 0.004). An unfavorable learning curve was seen with posterior impaction and with a greater magnitude of movements. CONCLUSION The present study demonstrated a significant increase in surgical accuracy annually and therefore supports the presence of a learning curve. CLINICAL RELEVANCE Cases with planned maxillary posterior impaction and/or a great magnitude of jaw movements should be transferred from the 3D VSP with extra care to obtain a satisfactory surgical accuracy.
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Affiliation(s)
- Dirk-Melle Beek
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Frank Baan
- Radboudumc 3D Lab, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Jeroen Liebregts
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Marloes Nienhuijs
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Stefaan Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Thomas Maal
- Radboudumc 3D Lab, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, the Netherlands.
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Hong M, Kim MJ, Shin HJ, Cho HJ, Baek SH. Three-dimensional surgical accuracy between virtually planned and actual surgical movements of the maxilla in two-jaw orthognathic surgery. Korean J Orthod 2020; 50:293-303. [PMID: 32938822 PMCID: PMC7500567 DOI: 10.4041/kjod.2020.50.5.293] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To investigate the three-dimensional (3D) surgical accuracy between virtually planned and actual surgical movements (SM) of the maxilla in two-jaw orthognathic surgery. Methods The sample consisted of 15 skeletal Class III patients who underwent two-jaw orthognathic surgery performed by a single surgeon using a virtual surgical simulation (VSS) software. The 3D cone-beam computed tomography (CBCT) images were obtained before (T0) and after surgery (T1). After merging the dental cast image onto the T0 CBCT image, VSS was performed. SM were classified into midline correction (anterior and posterior), advancement, setback, anterior elongation, and impaction (total and posterior). The landmarks were the midpoint between the central incisors, the mesiobuccal cusp tip (MBCT) of both first molars, and the midpoint of the two MBCTs. The amount and direction of SM by VSS and actual surgery were measured using 3D coordinates of the landmarks. Discrepancies less than 1 mm between VSS and T1 landmarks indicated a precise outcome. The surgical achievement percentage (SAP, [amount of movement in actual surgery/amount of movement in VSS] × 100) (%) and precision percentage (PP, [number of patients with precise outcome/number of total patients] × 100) (%) were compared among SM types using Fisher’s exact and Kruskal–Wallis tests. Results Overall mean discrepancy between VSS and actual surgery, SAP, and PP were 0.13 mm, 89.9%, and 68.3%, respectively. There was no significant difference in the SAP and PP values among the seven SM types (all p > 0.05). Conclusions VSS could be considered as an effective tool for increasing surgical accuracy.
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Affiliation(s)
- Mihee Hong
- Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, Korea
| | | | | | | | - Seung-Hak Baek
- Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, Korea
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Liebregts J, Baan F, de Koning M, Ongkosuwito E, Bergé S, Maal T, Xi T. Achievability of 3D planned bimaxillary osteotomies: maxilla-first versus mandible-first surgery. Sci Rep 2017; 7:9314. [PMID: 28839184 PMCID: PMC5571157 DOI: 10.1038/s41598-017-09488-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/27/2017] [Indexed: 11/09/2022] Open
Abstract
The present study was aimed to investigate the effects of sequencing a two-component surgical procedure for correcting malpositioned jaws (bimaxillary osteotomies); specifically, surgical repositioning of the upper jaw-maxilla, and the lower jaw-mandible. Within a population of 116 patients requiring bimaxillary osteotomies, the investigators analyzed whether there were statistically significant differences in postoperative outcome as measured by concordance with a preoperative digital 3D virtual treatment plan. In one group of subjects (n = 58), the maxillary surgical procedure preceded the mandibular surgery. In the second group (n = 58), the mandibular procedure preceded the maxillary surgical procedure. A semi-automated analysis tool (OrthoGnathicAnalyser) was applied to assess the concordance of the postoperative maxillary and mandibular position with the cone beam CT-based 3D virtual treatment planning in an effort to minimize observer variability. The results demonstrated that in most instances, the maxilla-first surgical approach yielded closer concordance with the 3D virtual treatment plan than a mandibular-first procedure. In selected circumstances, such as a planned counterclockwise rotation of both jaws, the mandible-first sequence resulted in more predictable displacements of the jaws.
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Affiliation(s)
- Jeroen Liebregts
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands
| | - Frank Baan
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands
| | - Martien de Koning
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands
| | - Edwin Ongkosuwito
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, Philips van Leydenlaan 25, 6525, EX, Nijmegen, The Netherlands
| | - Stefaan Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands
| | - 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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Oz AZ, Akcan CA, El H, Ciger S. Evaluation of the soft tissue treatment simulation module of a computerized cephalometric program. Eur J Dent 2014; 8:229-233. [PMID: 24966775 PMCID: PMC4054055 DOI: 10.4103/1305-7456.130614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: The purpose of this study is to compare the accuracy of the treatment simulation module of Quick Ceph Studio (QCS) program to the actual treatment results in Class II Division 1 patients. Design: Retrospective study. Materials and Methods: Twenty-six skeletal Class II patients treated with functional appliances were included. T0 and T1 lateral cephalograms were digitized using QCS. Before applying treatment simulation to the digitized cephalograms, the actual T0-T1 difference was calculated for the SNA, SNB, ANB angles, maxillary incisor inclination, and protrusion and mandibular incisor inclination and protrusion values. Next, using the treatment simulation module, the aforementioned values for the T0 cephalograms were manually entered to match the actual T1 values taking into account the T0-T1 differences. Paired sample t-test were applied to determine the difference between actual and treatment simulation measurements. Results: No significant differences were found for the anteroposterior location of the landmarks. Upper lip, soft tissue A point, soft tissue pogonion, and soft tissue B point measurements showed statistically significant difference between actual and treatment simulation in the vertical plane. Conclusion: Quick Ceph program was reliable in terms of reflecting the sagittal changes that would probably occur with treatment and growth. However, vertical positions of the upper lip, soft tissue pogonion, soft tissue A point, and soft tissue B point were statistically different from actual results.
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Affiliation(s)
- Aslihan Zeynep Oz
- Department of Orthodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkiye
| | - Cenk Ahmet Akcan
- Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkiye
| | - Hakan El
- Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkiye
| | - Semra Ciger
- Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkiye
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Kolokitha OE, Chatzistavrou E. Factors influencing the accuracy of cephalometric prediction of soft tissue profile changes following orthognathic surgery. J Maxillofac Oral Surg 2011; 11:82-90. [PMID: 23450114 DOI: 10.1007/s12663-011-0253-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 06/13/2011] [Indexed: 11/29/2022] Open
Abstract
The cephalometric prediction of orthognathic treatment outcome is an important part of the surgical planning and the process of informed consent. The orthodontic and surgical changes must be described accurately prior to treatment in order to assess the treatment's feasibility, to optimize case management and to increase patient's understanding and acceptance of the recommended treatment. The aim of the present article was to investigate on the factors that could influence the accuracy of cephalometric prediction in planning orthognathic surgery. Review of the literature revealed that, besides factors directly related to the prediction method and its use, there exist a considerable number of factors which could affect significantly the accuracy of soft tissue response. These factors could be biological ones such as relapse, centre of mandibular rotation and individual variation in response to treatment and others such as gender, race, pre-operative soft tissue thickness and data bases for mean ratios of soft to hard tissue movement changes. Some of the factors affecting the accuracy of prediction of soft tissue response following orthognathic surgery are inevitable and there are others, difficult to control and predict. However, patients should be informed that predictions are only a guide, may not represent the actual result of the surgical outcome, and as such they should be implemented.
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Affiliation(s)
- Olga-Elpis Kolokitha
- Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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