1
|
Lin YH, Yao CF, Chen YA, Liao YF, Chen YR. Three-dimensional positioning of the maxilla using novel intermediate splints in maxilla-first orthognathic surgery for correction of skeletal class III deformity. Clin Oral Investig 2024; 28:141. [PMID: 38340152 DOI: 10.1007/s00784-024-05526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES Successful orthognathic surgery requires accurate transfer of the intraoperative surgical plan. This study aimed to (1) evaluate the surgical error of a novel intermediate splint in positioning the maxilla during maxilla-first orthognathic surgery and (2) determine factors influencing surgical error. MATERIALS AND METHODS This prospective study examined 83 patients who consecutively underwent Le Fort I osteotomy for correction of skeletal class III deformity using a novel intermediate splint and a bilateral sagittal split osteotomy. Surgical error was the outcome variable, measured as the difference in postoperative translational and rotational maxillary position from the virtual plan. Measures included asymmetry, need and amount for mandibular opening during fabrication of intermediate splints, and planned and achieved skeletal movement. RESULTS Mean errors in translation for vertical, sagittal, and transversal dimensions were 1.0 ± 0.7 mm, 1.0 ± 0.6 mm, and 0.7 ± 0.6 mm, respectively; degrees in rotation for yaw, roll, and pitch were 0.8 ± 0.6, 0.6 ± 0.4, and 1.6 ± 1.1, respectively. The transverse error was smaller than sagittal and vertical errors; error for pitch was larger than roll and yaw (both p < 0.001). Error for sagittal, transverse, and roll positioning was affected by the achieved skeletal movement (roll, p < 0.05; pitch and yaw, p < 0.001). Surgical error of pitch positioning was affected by planned and achieved skeletal movement (both p < 0.001). CONCLUSIONS Using the novel intermediate splint when performing Le Fort I osteotomy allowed for accurate positioning of the maxilla. CLINICAL RELEVANCE The novel intermediate splint for maxillary positioning can be reliably used in clinical routines.
Collapse
Affiliation(s)
- Yi-Hsuan Lin
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chuan-Fong Yao
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ying-An Chen
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Fang Liao
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, No. 123, Dinghu Road, Guishan District, Taoyuan City, 333, Taiwan.
| | - Yu-Ray Chen
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| |
Collapse
|
2
|
Ying X, Tian K, Zhang K, Ma X, Guo H. Accuracy of virtual surgical planning in segmental osteotomy in combination with bimaxillary orthognathic surgery with surgery first approach. BMC Oral Health 2021; 21:529. [PMID: 34654418 PMCID: PMC8518167 DOI: 10.1186/s12903-021-01892-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/06/2021] [Indexed: 11/22/2022] Open
Abstract
Background This study aimed to assess the accuracy of virtual surgical planning (VSP) in segmental osteotomy in combination with bimaxillary orthognathic surgery with surgery first approach (SFA) by means of three-dimensional (3D) measuring and superimposition, so as to promote the application of digital technology in combined orthodontic-orthognathic treatment. Methods 20 patients treated with segmental osteotomy in combination with bimaxillary orthognathic surgery with SFA from 2018 to 2020 were included. All of them acquired VSP performed by ProPlan CMF 3.0 software (Materialise Corporation, Belgium). The preoperative (T0) 3D model of VSP and the postoperative (T1) 3D model, reconstructed by the cone-beam computed tomography (CBCT) data acquired one week after surgery, were compared by measuring the 3D coordinates of the landmarks as well as 3D model superimposition for deviation analysis. The deviation analysis was achieved by Geomagic Studio 2013 (3D Systems Corporation, USA). The differences which represented the accuracy of VSP were evaluated by the root mean square deviation (RMSD) and the Bland–Altman method. Results There was no statistically significant difference between the 3D coordinates of T1 and T0 (P > 0.05), and the mean overall RMSD was 1.37 mm, within the clinical relevance of 2 mm. The RMSD of sagittal direction (1.76 mm) was greater than that of coronal and vertical directions (1.09 mm and 1.24 mm), and the RMSD of maxillary and mandibular aspects were basically equal (1.30 mm and 1.45 mm). The Bland–Altman method showed the T0 and T1 measurements were in good agreement. The mean RMSD obtained from the deviation analysis was 1.85 mm, within the clinical relevance. Conclusions VSP in segmental osteotomy in combination with bimaxillary orthognathic surgery with SFA proved to acquire accurate outcome in this study.
Collapse
Affiliation(s)
- Xiaowu Ying
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, 100050, China
| | - Kaiyue Tian
- Department of Oral and Maxillofacial Plastic and Trauma, School of Stomatology, Capital Medical University, Beijing, China
| | - Kaiyu Zhang
- Department of Oral and Maxillofacial Plastic and Trauma, School of Stomatology, Capital Medical University, Beijing, China
| | - Xiaohui Ma
- Department of Oral and Maxillofacial Plastic and Trauma, School of Stomatology, Capital Medical University, Beijing, China
| | - Hongming Guo
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, 100050, China.
| |
Collapse
|
3
|
Chen C, Sun N, Jiang C, Liu Y, Sun J. Accurate transfer of bimaxillary orthognathic surgical plans using computer-aided intraoperative navigation. Korean J Orthod 2021; 51:321-328. [PMID: 34556586 PMCID: PMC8461385 DOI: 10.4041/kjod.2021.51.5.321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
Objective To examine the accuracy of computer-aided intraoperative navigation (Ci-Navi) in bimaxillary orthognathic surgery by comparing preoperative planning and postoperative outcome. Methods The study comprised 45 patients with congenital dentomaxillofacial deformities who were scheduled to undergo bimaxillary orthognathic surgery. Virtual bimaxillary orthognathic surgery was simulated using Mimics software. Intraoperatively, a Le Fort I osteotomy of the maxilla was performed using osteotomy guide plates. After the Le Fort I osteotomy and bilateral sagittal split ramus osteotomy of the mandible, the mobilized maxilla and the distal mandibular segment were fixed using an occlusal splint, forming the maxillomandibular complex (MMC). Realtime Ci-Navi was used to lead the MMC in the designated direction. Osteoplasty of the inferior border of the mandible was performed using Ci-Navi when facial symmetry and skeletal harmony were of concern. Linear and angular distinctions between preoperative planning and postoperative outcomes were calculated. Results The mean linear difference was 0.79 mm (maxilla: 0.62 mm, mandible: 0.88 mm) and the overall mean angular difference was 1.20°. The observed difference in the upper incisor point to the Frankfort horizontal plane, midfacial sagittal plane, and coronal plane was < 1 mm in 40 cases. Conclusions This study demonstrates the role of Ci-Navi in the accurate positioning of bone segments during bimaxillary orthognathic surgery. Ci-Navi was found to be a reliable method for the accurate transfer of the surgical plan during an operation.
Collapse
Affiliation(s)
- Chen Chen
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ningning Sun
- Department of Emergency Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chunmiao Jiang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yanshan Liu
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jian Sun
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Department of Emergency Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| |
Collapse
|
4
|
Accuracy and cost effectiveness of a waferless osteotomy approach, using patient specific guides and plates in orthognathic surgery: a systematic review. Br J Oral Maxillofac Surg 2021; 60:537-546. [PMID: 35305840 DOI: 10.1016/j.bjoms.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/03/2021] [Indexed: 11/21/2022]
Abstract
The aim of this systematic review is to evaluate the accuracy of waferless osteotomy procedures in orthognathic surgery with a secondary aim to determine the cost-effectiveness of the procedure. A literature search was conducted on the databases PubMed and Scopus, with PRISMA guidelines followed. An initial yield of 4149 articles were identified, ten of which met the desired inclusion criteria. The total sample of patients undergoing waferless osteotomies included in this review was 142 patients. Nine of the studies used surgical cutting guides along with customised surgical plates to eliminate the surgical wafer and one study used pre-bent locking plates instead of customised plates. The eligible articles determined their surgical accuracy by comparing the positions of bony or dental landmarks on the pre-operative and post-operative images. The articles all reported acceptable accuracy within previously established clinical parameters. The majority of authors concluded that it is an accurate surgical approach and can be cost effective which is often a barrier to novel techniques however there were studies that contrasted the view of the cost efficacy. Due to the lack of published randomised controlled trials, current evidence is not strong enough to recommend the use of surgical cutting guides and customised/pre-bent plates for orthognathic surgery.
Collapse
|
5
|
Greenberg S, Buchbinder D, Turner MD, Dhillon P, Afshar AA. Three-Dimensional Repositioning of the Maxilla in Orthognathic Surgery Using Patient-Specific Titanium Plates: A Case Series. J Oral Maxillofac Surg 2020; 79:902-913. [PMID: 33359102 DOI: 10.1016/j.joms.2020.11.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Successful orthognathic surgery is fundamentally based on accurately carrying out the intended surgical plan intraoperatively. The purpose of this study was to evaluate the accuracy of bone-borne patient-specific maxillary cutting guides and 3-dimensional (3D)-printed plates in repositioning the maxilla during bimaxillary orthognathic surgery. MATERIALS AND METHODS This was a retrospective case series consisting of patients who had undergone Le Fort I osteotomy with a patient-specific cutting guide and 3D-printed plate as well as a bilateral sagittal split osteotomy and had 6-week postoperative cone-beam computed tomography studies. The primary outcome variable was the difference between the position of the postoperative maxilla and the virtually planned maxilla measured at 10 landmarks in 3 dimensions. Other study variables included the preoperative diagnosis and planned surgical movement at each landmark. Descriptive statistics were tabulated, and bivariate analyses were performed. RESULTS A total of 10 patients were included in this study. The mean age was 25.7 ± 8.1 years, and there were 5 female patients. The median planned surgical movement was 0.350 mm on the x-axis (right-left), 3.750 mm on the y-axis (anterior-posterior), and 1.704 mm on the z-axis (superior-inferior). The median absolute discrepancy between the postoperative position and the planned position on the x-axis, y-axis, and z-axis was 0.638, 0.798, and 0.481 mm, respectively. There was no significant difference in the discrepancies between the x-axis and y-axis (P = .575), x-axis and z-axis (P = .332), and y-axis and z-axis (P = .114). CONCLUSIONS Using a patient-specific cutting guide and 3D-printed plate when performing Le Fort I osteotomy allows for accurate 3-dimensional positioning of the maxilla in accordance with the surgical plan.
Collapse
Affiliation(s)
- Seth Greenberg
- Chief Resident, Division of Oral and Maxillofacial Surgery, Department of Otolaryngology, Head and Neck Surgery, Mount Sinai West / Downtown and Jacobi Medical Center, New York, NY.
| | - Daniel Buchbinder
- Chief, Division of Oral and Maxillofacial Surgery, Department of Otolaryngology, Head and Neck Surgery, Mount Sinai West / Downtown, New York, NY
| | - Michael D Turner
- Chief, Division of Oral and Maxillofacial Surgery, Department of Otolaryngology, Head and Neck Surgery, Mount Sinai Hospital, New York, NY
| | - Prince Dhillon
- Graduated Resident, Division of Oral and Maxillofacial Surgery, Department of Otolaryngology, Head and Neck Surgery, Mount Sinai West / Downtown and Jacobi Medical Center, New York, NY
| | - Alex Ali Afshar
- Resident, Division of Oral and Maxillofacial Surgery, Department of Otolaryngology, Head and Neck Surgery, Mount Sinai Hospital, New York, NY
| |
Collapse
|
6
|
Wong A, Goonewardene MS, Allan BP, Mian AS, Rea A. Accuracy of maxillary repositioning surgery using CAD/CAM customized surgical guides and fixation plates. Int J Oral Maxillofac Surg 2020; 50:494-500. [PMID: 32919821 DOI: 10.1016/j.ijom.2020.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/23/2020] [Accepted: 08/20/2020] [Indexed: 11/16/2022]
Abstract
The advent of three-dimensional imaging and computer-aided surgical simulation (CASS) have brought about a paradigm shift in surgical planning. The aim of this study was to assess the accuracy of maxillary repositioning surgery using computer-aided design and manufacturing (CAD/CAM) customized titanium surgical guides and fixation plates. Thirty consecutive adult patients, 13 male and 17 female, with a mean age of 29.2 years and 25.5 years, respectively, requiring Le Fort I maxillary osteotomy, with or without simultaneous mandibular surgery, were evaluated retrospectively. All orthognathic surgeries were performed by one experienced surgeon. The pre-surgical and post-surgical volumetric imaging were superimposed to assess the linear and angular differences between the planned and actual positions of the maxilla following surgery. With the use of the CAD/CAM titanium surgical guides and fixation plates, all surgical movements were within 2mm and 4° of the planned movements, which is considered clinically insignificant. The overall root mean square error between the planned and actual surgical movements was 0.38mm in the transverse dimension, 0.64mm in the anteroposterior dimension, and 0.55mm in the vertical dimension. In regard to the centroid of the maxilla, the absolute angular difference of the maxillary centroid was 1.06° in pitch, 0.47° in roll, and 0.49° in yaw. Maxillary repositioning surgery can be performed with high accuracy using CAD/CAM titanium surgical guides and fixation plates.
Collapse
Affiliation(s)
- A Wong
- Orthodontic Department, School of Dentistry, The University of Western Australia, Nedlands, Western Australia, Australia.
| | - M S Goonewardene
- Orthodontic Department, School of Dentistry, The University of Western Australia, Nedlands, Western Australia, Australia.
| | - B P Allan
- Private Maxillofacial Surgical Practice, Perth, Australia.
| | - A S Mian
- School of Computer Science and Software Engineering, The University of Western Australia (M017), Crawley, Western Australia, Australia.
| | - A Rea
- UWA Centre for Applied Statistics, School of Mathematics and Statistics, The University of Western Australia, Nedlands, Western Australia, Australia.
| |
Collapse
|
7
|
Kwon TG, Miloro M, Han MD. How Accurate Is 3-Dimensional Computer-Assisted Planning for Segmental Maxillary Surgery? J Oral Maxillofac Surg 2020; 78:1597-1608. [DOI: 10.1016/j.joms.2020.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
|
8
|
Figueiredo CE, Paranhos LR, da Silva RP, Herval ÁM, Blumenberg C, Zanetta-Barbosa D. Accuracy of orthognathic surgery with customized titanium plates-Systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:88-97. [PMID: 32622000 DOI: 10.1016/j.jormas.2020.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/24/2020] [Indexed: 10/23/2022]
Abstract
This systematic review aimed to evaluate the accuracy of customized titanium plates in orthognathic surgery compared to standard outcome in virtual surgical planning. PRISMA and JBI guidelines were followed. Research protocol was registered in PROSPERO. Six databases and two gray literature repositories were used as sources of research articles. Descriptive clinical studies, that performed orthognathic surgery using custom titanium plates, were included. Risk of bias was assessed by "The Joanna-Briggs Institute Critical Appraisal tools for use in Systematic Reviews Checklist for Case Series". Of the 11,916 studies initially identified, seven met the eligibility criteria and were included. The studies were published between 2015 and 2019. Most of the studies (57%) had a low risk of bias, while one had a high risk of bias. Total sample included 74 patients with 63 bimaxillary surgeries and 11 unimaxillary surgeries. All studies showed acceptable accuracy within previously established clinical parameters. Although the eligible articles assessed the accuracy of the orthognathic surgery with respect to virtual planning, the wide variability of evaluation methodologies made it impossible to calculate a combined accuracy measure. It was not possible to perform a meta-analysis, so a pragmatic recommendation on the use of these plates is not possible.
Collapse
Affiliation(s)
- C E Figueiredo
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - L R Paranhos
- Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil.
| | - R P da Silva
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Á M Herval
- Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - C Blumenberg
- Centre for Epidemiological Research, International Centre for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - D Zanetta-Barbosa
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| |
Collapse
|
9
|
Hsu PJ, Denadai R, Pai BCJ, Lin HH, Lo LJ. Outcome of facial contour asymmetry after conventional two-dimensional versus computer-assisted three-dimensional planning in cleft orthognathic surgery. Sci Rep 2020; 10:2346. [PMID: 32047228 PMCID: PMC7012815 DOI: 10.1038/s41598-020-58682-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/15/2020] [Indexed: 02/08/2023] Open
Abstract
Computer-assisted 3D planning has overcome the limitations of conventional 2D planning-guided orthognathic surgery (OGS), but difference for facial contour asymmetry outcome has not been verified to date. This comparative study assessed the facial contour asymmetry outcome of consecutive patients with unilateral cleft lip and palate who underwent 2D planning (n = 37)- or 3D simulation (n = 38)-guided OGS treatment for correction of maxillary hypoplasia and skeletal Class III malocclusion between 2010 and 2018. Normal age-, gender-, and ethnicity-matched individuals (n = 60) were enrolled for comparative analyses. 2D (n = 60, with 30 images for each group) and 3D (n = 43, with 18 and 25 images for 2D planning and 3D simulation groups, respectively) photogrammetric-based facial contour asymmetry-related measurements were collected from patients and normal individuals. The facial asymmetry was further verified by using subjective perception of a panel composed of 6 blinded raters. On average, the facial contour asymmetry was significantly (all p < 0.05) reduced after 3D virtual surgery planning for all tested parameters, with no significant differences between post-OGS 3D simulation-related values and normal individuals. No significant differences were observed for pre- and post-OGS values in conventional 2D planning-based treatment, with significant (all p < 0.05) differences for all normal individuals-related comparisons. This study suggests that 3D planning presents superior facial contour asymmetry outcome than 2D planning.
Collapse
Affiliation(s)
- Po-Jung Hsu
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Rafael Denadai
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Betty C J Pai
- Department of Craniofacial Orthodontics and Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiu-Hsia Lin
- Image Lab and Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
10
|
A Modified Method Using Double Computed Tomography Scan Procedure to Maintain Mandibular Width in Mandibular Reconstruction. J Craniofac Surg 2019; 31:e126-e130. [PMID: 31764568 DOI: 10.1097/scs.0000000000006047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the use of a modified template system and double computed tomography scan procedure to maintain mandibular width in cases of mandibular reconstruction. STUDY DESIGN Ten patients who underwent mandibular reconstruction with a fibular flap were enrolled. The surgeries were planned with a computer-aided surgical simulation (CASS) planning method. Following double computed tomography scan procedure, the template system was designed in a computer and was fabricated using a three-dimensional printing technique. The cutting guides were designed with the holes of the conventional reconstruction plate on the remnant mandibular segments. After surgery, the outcome evaluation was compared by first superimposing the post-operative computed tomography model onto the planned model and then measuring the differences between the planned and actual outcomes. RESULTS All surgeries were completed successfully using the template system. With the use of the templates, the largest linear root-mean-square deviation (RMSD) between the planned and post-operative remnant segments was 1.01 mm, and the largest angular RMSD was 4.05°. CONCLUSIONS The authors conclude that this template system and double computed tomography scan procedure provides a reliable method to maintain mandibular width in mandibular reconstruction using a fibular flap.
Collapse
|
11
|
Lartizien R, Zaccaria I, Noyelles L, Bettega G. Quantification of the inaccuracy of conventional articulator model surgery in Le Fort 1 osteotomy: evaluation of 30 patients controlled by the Orthopilot ® navigation system. Br J Oral Maxillofac Surg 2019; 57:672-677. [PMID: 31256987 DOI: 10.1016/j.bjoms.2019.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
Occlusal splints are commonly used to position the maxilla during traditional orthognathic surgery. We aimed to quantify the inaccuracy of the maxillary positioning (in three dimensions) in traditional model surgery with the Orthopilot® navigation system. Thirty Le Fort I osteotomies were made using a standard technique. The position of the maxilla was recorded by the navigation system and defined by three values of translation and three of rotation. The recorded data were compared with the planned data. The accuracy of positioning was classified in distinct classes with three major criteria (conformity, non-conformity, and failure) according to the discrepancy. The positioning of the maxilla was in conformity with operative planning in 3/30 of our Le Fort I osteotomies (95% CI 2% to 27%) and in failure in 22/30 (95% CI 54% to 88%). The dispersion of the discrepancy was more important in the sagittal plane, particularly for the sagittal rotation and for the back-front translation, which reflected greater inaccuracy in this plan. The frontal orientation of the maxilla was better controlled. The risk of maxillary malposition was proportional to the planned maxillary advancement.
Collapse
Affiliation(s)
- R Lartizien
- Maxillofacial surgery department, Annecy Genevois Hospital, 1 avenue de l'hôpital, 74370, Epagny Metz-Tessy, France; Université Grenoble Alpes, Medicine Faculty, 23 Avenue Maquis du Grésivaudan, 38700, La Tronche, France.
| | - I Zaccaria
- Clinical research department, Annecy Genevois Hospital, 1 avenue de l'hôpital, 74370, Epagny Metz-Tessy, France
| | - L Noyelles
- Maxillofacial surgery department, Annecy Genevois Hospital, 1 avenue de l'hôpital, 74370, Epagny Metz-Tessy, France
| | - G Bettega
- Maxillofacial surgery department, Annecy Genevois Hospital, 1 avenue de l'hôpital, 74370, Epagny Metz-Tessy, France
| |
Collapse
|
12
|
Ahn J, Choi H, Hong J, Hong J. Tracking Accuracy of a Stereo Camera-Based Augmented Reality Navigation System for Orthognathic Surgery. J Oral Maxillofac Surg 2019; 77:1070.e1-1070.e11. [DOI: 10.1016/j.joms.2018.12.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 10/27/2022]
|
13
|
Tomomatsu N, Kurohara K, Nakakuki K, Yoshitake H, Kanemaru T, Yamaguchi S, Yoda T. Influence of the anatomical form of the posterior maxilla on the reliability of superior maxillary repositioning by Le Fort I osteotomy. Int J Oral Maxillofac Surg 2018; 48:612-619. [PMID: 30503635 DOI: 10.1016/j.ijom.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/03/2018] [Accepted: 11/13/2018] [Indexed: 11/18/2022]
Abstract
Certain patients with facial deformities require superior repositioning of the maxilla via Le Fort I osteotomy; however, the magnitude of superior repositioning of the maxilla is often less than expected. In this study, the correlation between the accuracy of superior repositioning of the maxilla and the anatomical form of the maxillary posterior region was examined. Seventy-five patients who underwent Le Fort I osteotomy without forward movement of the maxilla but with superior repositioning of the maxilla were included in this study. The bone volume around the descending palatine artery (DPA), the angle of the junction between the pterygoid process and the tuberosity, and the distance between the upper second molar and the pterygoid process were measured via three-dimensional analysis. A significant negative correlation (r=-0.566) was found between the bone volume around the DPA and the ratio of repositioning (actual movement divided by expected movement). It is possible that the superior repositioning of the maxilla expected prior to surgery was not sufficiently attained because of the large volume of bone around the DPA. The results of this study show that in some patients, superior repositioning was not achieved at the expected level because of bone interference attributable to the anatomical form of the maxillary posterior region.
Collapse
Affiliation(s)
- N Tomomatsu
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Kurohara
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan; Department of Oral and Maxillofacial Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
| | - K Nakakuki
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - H Yoshitake
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Kanemaru
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - S Yamaguchi
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Yoda
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
14
|
Surgical Accuracy in Inferior Maxillary Reposition. J Oral Maxillofac Surg 2018; 76:2618-2624. [DOI: 10.1016/j.joms.2018.05.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/05/2018] [Accepted: 05/14/2018] [Indexed: 11/21/2022]
|
15
|
Govaerts D, Shaheen E, Coopman R, De Mol A, Sun Y, Politis C. Accuracy of Le Fort I osteotomy in bimaxillary splint-based orthognathic surgery: focus on posterior maxillary movements. Int J Oral Maxillofac Surg 2018; 47:1398-1404. [DOI: 10.1016/j.ijom.2018.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/27/2018] [Accepted: 05/04/2018] [Indexed: 11/28/2022]
|
16
|
Reaching the vertical versus horizontal target position in multi-segmental Le Fort I osteotomy is more difficult, but yields comparably stable results to one-segment osteotomy. Int J Oral Maxillofac Surg 2018; 47:456-464. [DOI: 10.1016/j.ijom.2017.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/09/2017] [Accepted: 10/09/2017] [Indexed: 11/24/2022]
|
17
|
Resnick CM, Kim S, Yorlets RR, Calabrese CE, Peacock ZS, Kaban LB. Evaluation of Andrews' Analysis as a Predictor of Ideal Sagittal Maxillary Positioning in Orthognathic Surgery. J Oral Maxillofac Surg 2018; 76:2169-2176. [PMID: 29654777 DOI: 10.1016/j.joms.2018.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/24/2018] [Accepted: 03/09/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE There is no universally accepted method for determining the ideal sagittal position of the maxilla in orthognathic surgery. In "Element II" of "The Six Elements of Orofacial Harmony," Andrews used the forehead to define the goal maxillary position. The purpose of this study was to compare how well this analysis correlated with postoperative findings in patients who underwent bimaxillary orthognathic surgery planned using other guidelines. The authors hypothesized that the Andrews analysis would more consistently reflect clinical outcomes than standard angular and linear measurements. MATERIALS AND METHODS This is a retrospective cohort study of patients who had bimaxillary orthognathic surgery and achieved an acceptable esthetic outcome. Patients with no maxillary sagittal movement, obstructive sleep apnea, cleft or craniofacial diagnoses, or who were non-Caucasian were excluded. Treatment plans were developed using photographs, radiographs, and standard cephalometric measurements. The Andrews analysis, measuring the distance from the maxillary incisor to the goal anterior limit line, and standard measurements were applied to end-treatment records. The Andrews analysis was statistically compared with standard methods. RESULTS There were 493 patients who had orthognathic surgery from 2007 through 2014, and 60 (62% women; mean age, 22.1 ± 6.8 yr) met the criteria for inclusion in this study. The mean Andrews distances were -4.8 ± 2.9 mm for women and -8.6 ± 4.6 mm for men preoperatively and -0.6 ± 2.1 mm for women and -1.9 ± 3.4 mm for men postoperatively. For women, the Andrews analysis was closer to the goal value (0 mm) postoperatively than any standard measurement (P < .001). For men, the linear distance from the A point to a vertical line tangent to the nasion from the McNamara analysis performed best (P < .001), followed by the Andrews analysis. CONCLUSION The Andrews analysis correlated well with the final esthetic sagittal maxillary position in the present sample, particularly for women, and could be a useful tool for orthognathic surgical planning.
Collapse
Affiliation(s)
- Cory M Resnick
- Assistant Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Somi Kim
- Instructor of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
| | - Rachel R Yorlets
- Clinical Research Manager, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Carly E Calabrese
- Clinical Research Specialist, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Zachary S Peacock
- Assistant Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
| | - Leonard B Kaban
- Walter C. Guralnick Distinguished Professor and Chairman Emeritus, Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, and Massachusetts General Hospital, Boston, MA.
| |
Collapse
|
18
|
Tran NH, Tantidhnazet S, Raocharernporn S, Kiattavornchareon S, Pairuchvej V, Wongsirichat N. Accuracy of Three-Dimensional Planning in Surgery-First Orthognathic Surgery: Planning Versus Outcome. J Clin Med Res 2018; 10:429-436. [PMID: 29581806 PMCID: PMC5862091 DOI: 10.14740/jocmr3372w] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 02/20/2018] [Indexed: 11/11/2022] Open
Abstract
Background The benefit of computer-assisted planning in orthognathic surgery (OGS) has been extensively documented over the last decade. This study aimed to evaluate the accuracy of three-dimensional (3D) virtual planning in surgery-first OGS. Methods Fifteen patients with skeletal class III malocclusion who underwent bimaxillary OGS with surgery-first approach were included. A composite skull model was reconstructed using data from cone-beam computed tomography and stereolithography from a scanned dental cast. Surgical procedures were simulated using Simplant O&O software, and the virtual plan was transferred to the operation room using 3D-printed splints. Differences of the 3D measurements between the virtual plan and postoperative results were evaluated, and the accuracy was reported using root mean square deviation (RMSD) and the Bland-Altman method. Results The virtual planning was successfully transferred to surgery. The overall mean linear difference was 0.88 mm (0.79 mm for the maxilla and 1 mm for the mandible), and the overall mean angular difference was 1.16°. The RMSD ranged from 0.86 to 1.46 mm and 1.27° to 1.45°, within the acceptable clinical criteria. Conclusion In this study, virtual surgical planning and 3D-printed surgical splints facilitated the diagnosis and treatment planning, and offered an accurate outcome in surgery-first OGS.
Collapse
Affiliation(s)
- Ngoc Hieu Tran
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, 6 Yothi Street Rachathewee District, Bangkok 10400, Thailand
| | - Syrina Tantidhnazet
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, 6 Yothi Street Rachathewee District, Bangkok 10400, Thailand; Natthamet Wongsirichat, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, 6 Yothi Street Rachathewee District, Bangkok 10400, Thailand.
| | - Somchart Raocharernporn
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, 6 Yothi Street Rachathewee District, Bangkok 10400, Thailand
| | - Sirichai Kiattavornchareon
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, 6 Yothi Street Rachathewee District, Bangkok 10400, Thailand
| | - Verasak Pairuchvej
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, 6 Yothi Street Rachathewee District, Bangkok 10400, Thailand
| | - Natthamet Wongsirichat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, 6 Yothi Street Rachathewee District, Bangkok 10400, Thailand
| |
Collapse
|
19
|
Dreiseidler T, Lentzen MP, Zirk M, Safi AF, Zoeller JE, Kreppel M. Systematic three-dimensional analysis of wafer-based maxillary repositioning procedures in orthognathic surgery. J Craniomaxillofac Surg 2017; 45:1828-1834. [PMID: 28927954 DOI: 10.1016/j.jcms.2017.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 07/20/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Little is known about the three-dimensional (3D) transfer accuracy in maxillary repositioning procedures based on conventionally manufactured dental-mounted wafers. The purpose of the present study was a systematic 3D analysis for wafer-based maxillary positioning in orthognathic surgery. MATERIALS AND METHODS A total of 92 patients underwent Le Fort I in addition to mandibular bilateral sagittal split osteotomies (BSSO). Alignment of the pre- and postsurgical CBCT data sets allowed measuring maxillary position changes in axial, sagittal and transversal directions. RESULTS The highest achieved absolute transfer inaccuracies were 1.37 mm, ±0.84 in the sagittal direction, followed by 1.15 mm, ±0.69 in the axial, as well as 1.05 mm, ±0.79 in the transversal direction. The largest relative deviations could be found for repositions in the transversal plane (109.4%, ±4.5), followed by the axial (66.2%, ±51.5) and sagittal plane (49.3%, ±2.2). Significant transfer accuracy differences of repositioning procedures in the sagittal direction, mainly advancement procedures, could be detected if performed with (1.75 mm, ±0.90) or without (1.18 mm, ±0.78) additional rotational correction component. No significant differences were found between unidirectional and multidirectional maxillary correction procedures. CONCLUSION The present study for the first time delivers systematic 3D accuracy data of wafer-based maxillary positioning procedures, attesting to its feasibility but also further encouraging the search for improvement strategies.
Collapse
Affiliation(s)
- Timo Dreiseidler
- University of Cologne, Dept. of Craniomaxillofacial and Plastic Surgery (Head: Professor Dr. Dr. Joachim E. Zoeller), Kerpener Straße 62, D-50924 Cologne, Germany.
| | - Max-Philipp Lentzen
- University of Cologne, Dept. of Craniomaxillofacial and Plastic Surgery (Head: Professor Dr. Dr. Joachim E. Zoeller), Kerpener Straße 62, D-50924 Cologne, Germany
| | - Matthias Zirk
- University of Cologne, Dept. of Craniomaxillofacial and Plastic Surgery (Head: Professor Dr. Dr. Joachim E. Zoeller), Kerpener Straße 62, D-50924 Cologne, Germany
| | - Ali-Farid Safi
- University of Cologne, Dept. of Craniomaxillofacial and Plastic Surgery (Head: Professor Dr. Dr. Joachim E. Zoeller), Kerpener Straße 62, D-50924 Cologne, Germany
| | - Joachim E Zoeller
- University of Cologne, Dept. of Craniomaxillofacial and Plastic Surgery (Head: Professor Dr. Dr. Joachim E. Zoeller), Kerpener Straße 62, D-50924 Cologne, Germany
| | - Matthias Kreppel
- University of Cologne, Dept. of Craniomaxillofacial and Plastic Surgery (Head: Professor Dr. Dr. Joachim E. Zoeller), Kerpener Straße 62, D-50924 Cologne, Germany
| |
Collapse
|
20
|
Dreiseidler T, Ritter L, Zirk M, Kreppel M, Richter DF, Zoeller JE. Distance-dependent accuracy in Le Fort I maxillary repositioning procedures. Br J Oral Maxillofac Surg 2017; 55:815-821. [PMID: 28843967 DOI: 10.1016/j.bjoms.2017.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
It has been hypothesised that, in maxillary repositioning procedures, longer distances correlate with less accurate transfers and particularly the repositioning forces of facial skin and muscles that increase exponentially. However, this has not to our knowledge been confirmed. The purpose of this study was to search for differences in the accuracy of transfer from maxillary repositioning procedures parallel to the three orthogonal planes and with respect to three different anatomical landmarks of the first molar left and right (M1L and M1R) and the first incisor (I). Cone-beam computed tomography (CT) datasets taken before and after operation for 92 patients who had Le Fort I maxillary repositioning procedures were aligned to measure the changes in the maxillary position in the axial, sagittal, and transverse directions. Differences between planned distances and those achieved were calculated and analysed with Pearsons correlation coefficient. The strongest significant correlations between the extent of planned repositioning distances and achieved differences (error) were detected in the sagittal plane for the anatomical landmarks of the right (M1R) and left first molar (M1L). Correlations became weaker if a limited planned distance ranging from 0-4mm was compared with a complete observed range that reached up to 12mm. Our results show for the first time to our knowledge that the accuracy of transfer of wafer-based maxillary positioning procedures depends on the distance being moved. Longer distances correlate with less accuracy, particularly in the sagittal plane and in the first molar region.
Collapse
Affiliation(s)
- T Dreiseidler
- Dept. of Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany.
| | | | - M Zirk
- Dept. of Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| | - M Kreppel
- Dept. of Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| | - D F Richter
- Dept. of Plastic Surgery, Dreifaltigkeitskrankenhaus Wesseling, Germany
| | - J E Zoeller
- Dept. of Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| |
Collapse
|
21
|
Application of A Novel Three-dimensional Printing Genioplasty Template System and Its Clinical Validation: A Control Study. Sci Rep 2017; 7:5431. [PMID: 28710459 PMCID: PMC5511285 DOI: 10.1038/s41598-017-05417-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/30/2017] [Indexed: 11/08/2022] Open
Abstract
The purpose of this control study was to assess the accuracy and clinical validation of a novel genioplasty template system. Eighty-eight patients were enrolled and divided into 2 groups: experimental group (using genioplasty templates) and control group (without genioplasty templates). For the experimental group, the templates were designed based on computerized surgical plan and manufactured using three-dimensional printing technique. The template system included a cutting guide and a pair of repositioning guides. For the control group, traditional intraoperative measurements were used without genioplasty templates. The outcome evaluation was completed by comparing planned outcomes with postoperative outcomes. Linear and angular differences for the chin was measured and reported using root mean square deviation (RMSD) and the Bland-Altman method. All surgeries were successfully completed. There was no difficulty to use genioplasty templates. For the experimental group, the largest RMSDs were 1.1 mm in anteroposterior direction and 2.6° in pitch orientation. For the control group without templates, the largest RMSDs were 2.63 mm in superoinferior direction and 7.21° in pitch orientation. Our findings suggest that this genioplasty template system provides greater accuracy in repositioning the chin than traditional intraoperative measurements, and the computerized plan can be transferred accurately to the patient for genioplasty.
Collapse
|
22
|
Lin X, Li B, Wang X, Shen SG. Accuracy of maxillary repositioning by computer-aided orthognathic surgery in patients with normal temporomandibular joints. Br J Oral Maxillofac Surg 2017; 55:504-509. [DOI: 10.1016/j.bjoms.2017.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 02/13/2017] [Indexed: 10/19/2022]
|
23
|
Baan F, Liebregts J, Xi T, Schreurs R, de Koning M, Bergé S, Maal T. A New 3D Tool for Assessing the Accuracy of Bimaxillary Surgery: The OrthoGnathicAnalyser. PLoS One 2016; 11:e0149625. [PMID: 26901524 PMCID: PMC4762705 DOI: 10.1371/journal.pone.0149625] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 02/03/2016] [Indexed: 11/18/2022] Open
Abstract
AIM The purpose of this study was to present and validate an innovative semi-automatic approach to quantify the accuracy of the surgical outcome in relation to 3D virtual orthognathic planning among patients who underwent bimaxillary surgery. MATERIAL AND METHOD For the validation of this new semi-automatic approach, CBCT scans of ten patients who underwent bimaxillary surgery were acquired pre-operatively. Individualized 3D virtual operation plans were made for all patients prior to surgery. During surgery, the maxillary and mandibular segments were positioned as planned by using 3D milled interocclusal wafers. Consequently, post-operative CBCT scan were acquired. The 3D rendered pre- and postoperative virtual head models were aligned by voxel-based registration upon the anterior cranial base. To calculate the discrepancies between the 3D planning and the actual surgical outcome, the 3D planned maxillary and mandibular segments were segmented and superimposed upon the postoperative maxillary and mandibular segments. The translation matrices obtained from this registration process were translated into translational and rotational discrepancies between the 3D planning and the surgical outcome, by using the newly developed tool, the OrthoGnathicAnalyser. To evaluate the reproducibility of this method, the process was performed by two independent observers multiple times. RESULTS Low intra-observer and inter-observer variations in measurement error (mean error < 0.25 mm) and high intraclass correlation coefficients (> 0.97) were found, supportive of the observer independent character of the OrthoGnathicAnalyser. The pitch of the maxilla and mandible showed the highest discrepancy between the 3D planning and the postoperative results, 2.72° and 2.75° respectively. CONCLUSION This novel method provides a reproducible tool for the evaluation of bimaxillary surgery, making it possible to compare larger patient groups in an objective and time-efficient manner in order to optimize the current workflow in orthognathic surgery.
Collapse
Affiliation(s)
- Frank Baan
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jeroen Liebregts
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- * E-mail:
| | - Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Martien de Koning
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Stefaan Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Thomas Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
24
|
Li B, Shen SG, Yu H, Li J, Xia JJ, Wang X. A new design of CAD/CAM surgical template system for two-piece narrowing genioplasty. Int J Oral Maxillofac Surg 2015; 45:560-6. [PMID: 26725914 DOI: 10.1016/j.ijom.2015.10.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/28/2015] [Accepted: 10/15/2015] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to develop and validate a new chin template system for a two-piece narrowing genioplasty. Nine patients with wide chin deformities were enrolled. Surgeries were planned with the computer-aided surgical simulation (CASS) planning method. Surgical splints and chin templates were designed in a computer and fabricated using a three-dimensional printing technique. The chin template system included a cutting guide and a repositioning guide for a two-piece narrowing genioplasty. These guides were also designed to avoid the mental foramen area and inferior alveolar nerve loops during the osteotomy, for nerve protection. After surgery, the outcome evaluation was completed by first superimposing the postoperative computed tomography model onto the planned model, and then measuring the differences between the planned and actual outcomes. All surgeries were completed successfully using the chin template system. No inferior alveolar nerve damage was seen in this study. With the use of the chin templates, the largest linear root mean square deviation (RMSD) between the planned and the postoperative chin segments was 0.7mm and the largest angular RMSD was 4.5°. The results showed that the chin template system provides a reliable method of transfer for two-piece osseous narrowing genioplasty planning.
Collapse
Affiliation(s)
- B Li
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China
| | - S G Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China
| | - H Yu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China
| | - J Li
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - J J Xia
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China; Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, New York, NY, USA
| | - X Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China.
| |
Collapse
|
25
|
Abstract
Rapid prototyping (RP) technologies have found many uses in dentistry, and especially oral and maxillofacial surgery, due to its ability to promote product development while at the same time reducing cost and depositing a part of any degree of complexity theoretically. This paper provides an overview of RP technologies for maxillofacial reconstruction covering both fundamentals and applications of the technologies. Key fundamentals of RP technologies involving the history, characteristics, and principles are reviewed. A number of RP applications to the main fields of oral and maxillofacial surgery, including restoration of maxillofacial deformities and defects, reduction of functional bone tissues, correction of dento-maxillofacial deformities, and fabrication of maxillofacial prostheses, are discussed. The most remarkable challenges for development of RP-assisted maxillofacial surgery and promising solutions are also elaborated.
Collapse
Affiliation(s)
- Qian Peng
- Xiangya Stomatological Hospital, Central South University , Changsha, Hunan 410008 , China
| | | | | | | |
Collapse
|
26
|
Keyhole System: A Computer-Assisted Designed and Computer-Assisted Manufactured Maxillomandibular Complex Repositioner in Orthognathic Surgery. J Oral Maxillofac Surg 2015; 73:2024-9. [PMID: 25869979 DOI: 10.1016/j.joms.2015.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/04/2015] [Accepted: 03/06/2015] [Indexed: 11/21/2022]
Abstract
Currently, virtual orthognathic surgery using the CAD/CAM program and three-dimensional printing technology has provided a valuable tool supporting accurate surgical planning and precise surgery. However, despite the advancements in CAD/CAM virtual surgical planning, accurately reproducing surgical planning from a virtual surgery to the operating field is still challenging. Here, we report the Keyhole system as a method that has constantly provided us with consistent results during double-jaw surgery, especially during this age of ever increasing aesthetic demand from patients.
Collapse
|
27
|
Stokbro K, Aagaard E, Torkov P, Bell R, Thygesen T. Virtual planning in orthognathic surgery. Int J Oral Maxillofac Surg 2014; 43:957-65. [DOI: 10.1016/j.ijom.2014.03.011] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 03/14/2014] [Accepted: 03/19/2014] [Indexed: 10/25/2022]
|
28
|
Accuracy of maxillary repositioning in two-jaw surgery with conventional articulator model surgery versus virtual model surgery. Int J Oral Maxillofac Surg 2014; 43:732-8. [DOI: 10.1016/j.ijom.2013.11.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 10/01/2013] [Accepted: 11/12/2013] [Indexed: 11/21/2022]
|
29
|
The Accuracy of Image-Guided Navigation for Maxillary Positioning in Bimaxillary Surgery. J Craniofac Surg 2014; 25:1095-9. [DOI: 10.1097/scs.0000000000000633] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
30
|
Tabrizi R, Zamiri B, Kazemi H. Correlation of clinical predictions and surgical results in maxillary superior repositioning. J Craniofac Surg 2014; 25:e220-3. [PMID: 24769611 DOI: 10.1097/scs.0000000000000415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This is a prospective study to evaluate the accuracy of clinical predictions related to surgical results in subjects who underwent maxillary superior repositioning without anterior-posterior movement. Surgeons' predictions according to clinical (tooth show at rest and at the maximum smile) and cephalometric evaluation were documented for the amount of maxillary superior repositioning. Overcorrection or undercorrection was documented for every subject 1 year after the operations. Receiver operating characteristic curve test was used to find a cutoff point in prediction errors and to determine positive predictive value (PPV) and negative predictive value. Forty subjects (14 males and 26 females) were studied. Results showed a significant difference between changes in the tooth show at rest and at the maximum smile line before and after surgery. Analysis of the data demonstrated no correlation between the predictive data and the surgical results. The incidence of undercorrection (25%) was more common than overcorrection (7.5%). The cutoff point for errors in predictions was 5 mm for tooth show at rest and 15 mm at the maximum smile. When the amount of the presurgical tooth show at rest was more than 5 mm, 50.5% of clinical predictions did not match the clinical results (PPV), and 75% of clinical predictions showed the same results when the tooth show was less than 5 mm (negative predictive value). When the amount of presurgical tooth shown in the maximum smile line was more than 15 mm, 75% of clinical predictions did not match with clinical results (PPV), and 25% of the predictions had the same results because the tooth show at the maximum smile was lower than 15 mm. Clinical predictions according to the tooth show at rest and at the maximum smile have a poor correlation with clinical results in maxillary superior repositioning for vertical maxillary excess. The risk of errors in predictions increased when the amount of superior repositioning of the maxilla increased. Generally, surgeons have a tendency to undercorrect rather than overcorrect, although clinical prediction is an original guideline for surgeons, and it may be associated with variable clinical results.
Collapse
Affiliation(s)
- Reza Tabrizi
- From the Oral and Maxillofacial Surgery, Shiraz University of Medical Science, Shiraz, Iran
| | | | | |
Collapse
|
31
|
Sun Y, Luebbers HT, Agbaje JO, Schepers S, Vrielinck L, Lambrichts I, Politis C. Accuracy of Upper Jaw Positioning With Intermediate Splint Fabrication After Virtual Planning in Bimaxillary Orthognathic Surgery. J Craniofac Surg 2013; 24:1871-6. [DOI: 10.1097/scs.0b013e31829a80d9] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
32
|
Borumandi F, Brandtner C, Krenkel C, Gaggl A. Navigated repositioning of the maxilla: technical note. Br J Oral Maxillofac Surg 2013; 51:568-9. [DOI: 10.1016/j.bjoms.2013.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 02/10/2013] [Indexed: 11/27/2022]
|
33
|
Accuracy of analytic model planning in bimaxillary surgery. Int J Oral Maxillofac Surg 2013; 42:807-13. [DOI: 10.1016/j.ijom.2013.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 01/02/2013] [Accepted: 02/18/2013] [Indexed: 11/18/2022]
|
34
|
Bai S, Shang H, Liu Y, Zhao J, Zhao Y. Computer-Aided Design and Computer-Aided Manufacturing Locating Guides Accompanied With Prebent Titanium Plates in Orthognathic Surgery. J Oral Maxillofac Surg 2012; 70:2419-26. [DOI: 10.1016/j.joms.2011.12.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 12/06/2011] [Accepted: 12/12/2011] [Indexed: 11/28/2022]
|
35
|
An accurate maxillary superior repositioning technique without intraoperative measurement in bimaxillary orthognathic surgery. Int J Oral Maxillofac Surg 2012; 41:949-51. [DOI: 10.1016/j.ijom.2012.03.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 03/23/2012] [Indexed: 11/21/2022]
|
36
|
Paniagua B, Cevidanes L, Zhu H, Styner M. Outcome quantification using SPHARM-PDM toolbox in orthognathic surgery. Int J Comput Assist Radiol Surg 2011; 6:617-26. [PMID: 21161693 PMCID: PMC3088776 DOI: 10.1007/s11548-010-0539-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 10/26/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Quantification of surgical outcomes in longitudinal studies has led to significant progress in the treatment of dentofacial deformity, both by offering options to patients who might not otherwise have been recommended for treatment and by clarifying the selection of appropriate treatment methods. Most existing surgical treatments have not been assessed in a systematic way. This paper presents the quantification of surgical outcomes in orthognathic surgery via our localized shape analysis framework. METHODS In our setting, planning and surgical simulation is performed using the surgery planning software CMFapp. We then employ the SPHARM-PDM to measure the difference between pre-surgery and virtually simulated post-surgery models. This SPHARM-PDM shape framework is validated for use with craniofacial structures via simulating known 3D surgical changes within CMFapp. RESULTS Our results show that SPHARM-PDM analysis accurately measures surgical displacements, compared with known displacement values. Visualization of color maps of virtually simulated surgical displacements describe corresponding surface distances that precisely describe location of changes, and difference vectors indicate directionality and magnitude of changes. CONCLUSIONS SPHARM-PDM-based quantification of surgical outcome is feasible. When compared to prior solutions, our method has the potential to make the surgical planning process more flexible, increase the level of detail and accuracy of the plan, yield higher operative precision and control and enhance the follow-up and documentation of clinical cases.
Collapse
Affiliation(s)
- Beatriz Paniagua
- Department of Orthodontics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lucia Cevidanes
- Department of Orthodontics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - HongTu Zhu
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Martin Styner
- Department of Psychiatry and Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
37
|
Gil JN, Campos FEB, Claus JDP, Gil LF, Marin C, de Freitas SFT. Medial canthal region as an external reference point in orthognathic surgery. J Oral Maxillofac Surg 2010; 69:352-5. [PMID: 21122967 DOI: 10.1016/j.joms.2010.07.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 06/20/2010] [Accepted: 07/16/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this investigation was to evaluate the effectiveness of using the medial canthal region (MCR) as an external reference point to determine the vertical dimension during maxillary repositioning as planned in model surgery and predictive tracing. MATERIALS AND METHODS The analyzed group consisted of 43 consecutive patients who underwent maxillary or bimaxillary orthognathic surgery. Before downfracture, the vertical height was established from the distance of the MCR to the incisal edge of the right upper central incisor (UCI). The vertical dimension was obtained with frequent measurements by use of calipers as desired during cephalometric tracing and model surgery. After rigid fixation, the vertical height was verified again. The UCI was traced from the postoperative cephalogram and predictive tracing onto a preoperative tracing. Repositioning of the maxilla and postsurgical movements of the UCI were registered at the horizontal and vertical planes. Comparison was made between the predicted maxillary position on the cephalometric tracing and the actual position, as well as between the planned maxillary position in model surgery and the actual position. RESULTS The mean difference between the planned UCI position on predictive tracing and postsurgical position was 0.30 mm (SD, 0.21 mm; P > .05) in the vertical plane. The variation between the planned maxillary position in model surgery and the actual position was 0.37 mm (SD, 0.31 mm; P > .05) in the vertical plane. CONCLUSIONS Good surgical accuracy in positioning the mobilized maxilla can be achieved by use of the MCR as an external reference point.
Collapse
Affiliation(s)
- José Nazareno Gil
- Oral and Maxillofacial Surgery Department, Santa Catarina Federal University, Florianópolis, Brazil.
| | | | | | | | | | | |
Collapse
|
38
|
|
39
|
Bai S, Bo B, Bi Y, Wang B, Zhao J, Liu Y, Feng Z, Shang H, Zhao Y. CAD/CAM surface templates as an alternative to the intermediate wafer in orthognathic surgery. ACTA ACUST UNITED AC 2010; 110:e1-7. [DOI: 10.1016/j.tripleo.2010.05.052] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 05/11/2010] [Accepted: 05/21/2010] [Indexed: 11/17/2022]
|
40
|
Tucker S, Cevidanes LHS, Styner M, Kim H, Reyes M, Proffit W, Turvey T. Comparison of actual surgical outcomes and 3-dimensional surgical simulations. J Oral Maxillofac Surg 2010; 68:2412-21. [PMID: 20591553 DOI: 10.1016/j.joms.2009.09.058] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 09/14/2009] [Indexed: 11/18/2022]
Abstract
PURPOSE The advent of imaging software programs has proved to be useful for diagnosis, treatment planning, and outcome measurement, but precision of 3-dimensional (3D) surgical simulation still needs to be tested. This study was conducted to determine whether the virtual surgery performed on 3D models constructed from cone-beam computed tomography (CBCT) can correctly simulate the actual surgical outcome and to validate the ability of this emerging technology to recreate the orthognathic surgery hard tissue movements in 3 translational and 3 rotational planes of space. MATERIALS AND METHODS Construction of pre- and postsurgery 3D models from CBCTs of 14 patients who had combined maxillary advancement and mandibular setback surgery and 6 patients who had 1-piece maxillary advancement surgery was performed. The postsurgery and virtually simulated surgery 3D models were registered at the cranial base to quantify differences between simulated and actual surgery models. Hotelling t tests were used to assess the differences between simulated and actual surgical outcomes. RESULTS For all anatomic regions of interest, there was no statistically significant difference between the simulated and the actual surgical models. The right lateral ramus was the only region that showed a statistically significant, but small difference when comparing 2- and 1-jaw surgeries. CONCLUSIONS Virtual surgical methods were reliably reproduced. Oral surgery residents could benefit from virtual surgical training. Computer simulation has the potential to increase predictability in the operating room.
Collapse
Affiliation(s)
- Scott Tucker
- Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | | | | | | | | | | | | |
Collapse
|
41
|
Langer B. The segmental down fracture for vertical bone augmentation: case report. Clin Implant Dent Relat Res 2010; 12 Suppl 1:e126-31. [PMID: 20455904 DOI: 10.1111/j.1708-8208.2010.00276.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this singular case report is to describe correction of a severe vertical bone and soft tissue deficiency in the maxillary esthetic zone. The defect was corrected by using a single stage segmental down fracture technique. Treatment results were followed for 9 years, revealing stable bone, soft tissue, and bone levels adjacent to the dental implants.
Collapse
Affiliation(s)
- Burton Langer
- Beth Israel Hospital, New York City, NY Y. 10021, USA.
| |
Collapse
|
42
|
Accuracy of maxillary positioning in bimaxillary surgery. Br J Oral Maxillofac Surg 2009; 47:446-9. [PMID: 19577828 DOI: 10.1016/j.bjoms.2009.06.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2009] [Indexed: 11/22/2022]
Abstract
The aim of the study was to investigate the accuracy of a modified pin system for the vertical control of maxillary repositioning in bimaxillary osteotomies. The preoperative cephalograms of 239 consecutive patients who were to have bimaxillary osteotomies were superimposed on the postoperative films. Planned and observed vertical and horizontal movements of the upper incisor were analysed statistically. The mean deviations of -0.07 mm (95% confidence intervals (CIs) -0.17 to 0.04 mm) for the vertical movement and 0.12 mm (95% CI -0.06 to 0.30 mm) for the horizontal movement did not differ significantly from zero. Comparison of the two variances between intrusion and extrusion of the maxilla did not differ significantly either (p=0.51). These results suggest that the modified pin system for vertical control combined with interocclusal splints provides accurate vertical positioning of the anterior maxilla in orthognathic surgery.
Collapse
|
43
|
Choi JY, Choi JP, Baek SH. Surgical accuracy of maxillary repositioning according to type of surgical movement in two-jaw surgery. Angle Orthod 2009; 79:306-11. [PMID: 19216601 DOI: 10.2319/030608-136.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Accepted: 04/01/2008] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare the surgical accuracy of the maxillary repositioning according to the maxillary surgical movement type (SMT) in two-jaw orthognathic surgery (TJOS). MATERIALS AND METHODS The samples consisted of 52 Korean young adult patients with skeletal Class III malocclusion treated with TJOS by one surgeon. Lateral cephalograms were taken 1 month before (T0) and 1 day after surgery (T1). The samples were allocated into maxillary advancement (MA), total setback (MS), impaction (MI), and elongation (ME) according to SMT. The distance from the upper incisor tip and the mesiobuccal cusp tip of the upper first molar to the horizontal and vertical reference lines at T0 and T1 were measured. Any discrepancy between the surgical treatment objective (STO) and the surgical result less than 1 mm was regarded as accurate. The accuracy rate (AR [number of the accurate sample/number of the sample] x 1000) and the surgical achievement ratio (SAR [amount of movement in surgical result/amount of movement in STO] x100) were calculated. Analysis variance (ANOVA) and crosstab analyses were used for statistical analysis. RESULTS Although the MS (69.2%) and MI (69.0%) showed a lower AR than the MA (87.5%) and ME (83.3%), there was no significant difference in the distribution of accurate and inaccurate samples among the groups. The mean discrepancy between the STO and the surgical result was less than 1 mm in all groups. Although the ME (93.54%) showed a tendency of undercorrection and the MS (107.10%) and MI (105.42%) a tendency of overcorrection, there was no significant difference in SAR among the groups. CONCLUSIONS If the surgical plan and procedure is done with caution, the MS and MI can be regarded as just as accurate a procedure as the MA and ME.
Collapse
Affiliation(s)
- Jin-Young Choi
- Department of Oral and Maxillofacial Surgery, Seoul national University, Seoul, South Korea
| | | | | |
Collapse
|
44
|
Xia JJ, Gateno J, Teichgraeber JF, Christensen AM, Lasky RE, Lemoine JJ, Liebschner MAK. Accuracy of the Computer-Aided Surgical Simulation (CASS) System in the Treatment of Patients With Complex Craniomaxillofacial Deformity: A Pilot Study. J Oral Maxillofac Surg 2007; 65:248-54. [PMID: 17236929 DOI: 10.1016/j.joms.2006.10.005] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Revised: 04/01/2006] [Accepted: 10/05/2006] [Indexed: 11/27/2022]
Abstract
PURPOSE Current surgical planning methods are usually not adequate for the treatment of patients with complex craniomaxillofacial (CMF) deformities. To this end, we have developed a 3-dimensional (3D) computer-aided surgical simulation (CASS) planning method for the treatment of patients with complex CMF deformities. The purpose of this pilot study was to evaluate the accuracy of this technique in the treatment of patients with complex CMF deformities. PATIENTS AND METHODS Five patients with complex CMF deformities were enrolled. Surgeries were planned with the CASS planning method. Surgical plans were transferred to patients at the time of surgery via computer-generated splints. After surgery, outcome evaluation was completed by first superimposing the postoperative computed tomography (CT) model onto the planned model, and then measuring the differences between planned and actual outcomes. The criteria used to determine the accuracy of the technique were as follows: a linear difference between planned and actual outcomes of less than 2 mm, and an angular difference of less than 4 degrees . RESULTS All patients underwent surgery as planned. With the use of CASS planning, medians of the differences between planned and actual postoperative outcomes were limited to 0.9 mm and 1.7 degrees . CONCLUSION The results of this pilot study are promising. They will be used as the basis of calculations needed to determine the sample size for a larger and more comprehensive study that will be undertaken to assess the accuracy of CASS planning methods.
Collapse
Affiliation(s)
- James J Xia
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute, Houston, TX 77096, USA.
| | | | | | | | | | | | | |
Collapse
|
45
|
Miles BA, Hansen BJ, Stella JP. Polyvinylsiloxane as an alternative material for the intermediate orthognathic occlusal splint. J Oral Maxillofac Surg 2006; 64:1318-21. [PMID: 16860234 DOI: 10.1016/j.joms.2006.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Indexed: 11/23/2022]
Affiliation(s)
- Brett A Miles
- Division of Oral and Maxillofacial Surgery, Department of Otolaryngology/Head and Neck Surgery, Parkland Memorial Hospital, The University of Texas Southwestern Medical Center, Dallas, TX 75235-9109, USA.
| | | | | |
Collapse
|