A New Software Suite in Orthognathic Surgery : Patient Specific Modeling, Simulation and Navigation

2018 ◽  
Vol 26 (1) ◽  
pp. 5-20 ◽  
Author(s):  
Jean-Christophe Lutz ◽  
Alexandre Hostettler ◽  
Vincent Agnus ◽  
Stéphane Nicolau ◽  
Daniel George ◽  
...  
Keyword(s):  
Navigation System ◽  
Orthognathic Surgery ◽  
Soft Tissues ◽  
Maxillofacial Surgery ◽  
Patient Specific ◽  
Routine Practice ◽  
Software Suite ◽  
Augmented Virtuality ◽  
Dentofacial Deformities ◽  
Surgery Patient

Orthognathic surgery belongs to the scope of maxillofacial surgery. It treats dentofacial deformities consisting in discrepancy between the facial bones (upper and lower jaws). Such impairment affects chewing, talking, and breathing and can ultimately result in the loss of teeth. Orthognathic surgery restores facial harmony and dental occlusion through bone cutting, repositioning, and fixation. However, in routine practice, we face the limitations of conventional tools and the lack of intraoperative assistance. These limitations occur at every step of the surgical workflow: preoperative planning, simulation, and intraoperative navigation. The aim of this research was to provide novel tools to improve simulation and navigation. We first developed a semiautomated segmentation pipeline allowing accurate and time-efficient patient-specific 3D modeling from computed tomography scans mandatory to achieve surgical planning. This step allowed an improvement of processing time by a factor of 6 compared with interactive segmentation, with a 1.5-mm distance error. Next, we developed a software to simulate the postoperative outcome on facial soft tissues. Volume meshes were processed from segmented DICOM images, and the Bullet open source mechanical engine was used together with a mass-spring model to reach a postoperative simulation accuracy <1 mm. Our toolset was completed by the development of a real-time navigation system using minimally invasive electromagnetic sensors. This navigation system featured a novel user-friendly interface based on augmented virtuality that improved surgical accuracy and operative time especially for trainee surgeons, therefore demonstrating its educational benefits. The resulting software suite could enhance operative accuracy and surgeon education for improved patient care.

scholarly journals Impact factors on oral health related quality of life in patients requiring orthognathic surgery

RSBO ◽  
2021 ◽  
Vol 17 (2) ◽  
pp. 106-111
Author(s):  
Juliana Reuter Pereira ◽  
Grasielle Vicentini ◽  
Michelle Nascimento Meger ◽  
Nelson Luis Barbosa Rebellato ◽  
Rafaela Scariot ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Oral Health ◽  
Orthognathic Surgery ◽  
Maxillofacial Surgery ◽  
Health Related Quality ◽  
Facial Profile ◽  
Dentofacial Deformities ◽  
Related Quality ◽  
Health Related

Individuals with dentofacial deformities have a greater negative impact on oral health and in quality of life. The aim of this study was identified the main factors involved in the perception of the oral health related quality of life in individuals with dentofacial deformities. Material and methods: In a crosssectional study, were evaluated 72 individuals in preoperative period of orthognathic surgery at the Oral and Maxillofacial Surgery Service at Federal University of Paraná and at Positivo University. The age, gender, facial profile, presence or absence of asymmetry and temporomandibular disorders (TMD) symptoms were accessed. Through the Oral Health Impact Profile-14 (OHIP-14) the perceptions about oral health related quality of life of the patients was accessed. The TMD symptoms were evaluated with Fonseca anamnestic index. Data were submitted to descriptive and inferential statistical analysis with a significance level of 0.05. Results: The OHIP-14 mean score was higher with increasing age (p= 0.007), in females (p= 0.076), asymmetric patients (p= 0.030). and according to the increase in reported TMD symptoms (p= 0.001). Individuals with no TMD symptoms had an OHIP-14 mean of 8.86±8.06; individuals with mild TMD had a mean of 15±6.28, moderate TMD had a mean of 20.6 ± 9.44 and severe TMD had a mean of 26.42±7.66. There were no differences between OHIP-14 and type of facial profile (p= 0.725). Conclusion: It is concluded that increasing age, female gender, presence of asymmetry and the severity of TMD symptoms are important factors related to poor oral health related quality of life in individuals with dentofacial deformities.

scholarly journals Integration of Digital Dental Casts in Cone-Beam Computed Tomography Scans

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Frits A. Rangel ◽  
Thomas J. J. Maal ◽  
Stefaan J. Bergé ◽  
Anne Marie Kuijpers-Jagtman
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Orthognathic Surgery ◽  
Soft Tissues ◽  
Average Distance ◽  
Maxillofacial Surgery ◽  
Digital Data ◽  
Cone Beam ◽  
Novel Method ◽  
Dental Casts

Cone-beam computed tomography (CBCT) is widely used in maxillofacial surgery. The CBCT image of the dental arches, however, is of insufficient quality to use in digital planning of orthognathic surgery. Several authors have described methods to integrate digital dental casts into CBCT scans, but all reported methods have drawbacks. The aim of this feasibility study is to present a new simplified method to integrate digital dental casts into CBCT scans. In a patient scheduled for orthognathic surgery, titanium markers were glued to the gingiva. Next, a CBCT scan and dental impressions were made. During the impression-taking procedure, the titanium markers were transferred to the impression. The impressions were scanned, and all CBCT datasets were exported in DICOM format. The two datasets were matched, and the dentition derived from the scanned impressions was transferred to the CBCT of the patient. After matching the two datasets, the average distance between the corresponding markers was 0.1 mm. This novel method allows for the integration of digital dental casts into CBCT scans, overcoming problems such as unwanted extra radiation exposure, distortion of soft tissues due to the use of bite jigs, and time-consuming digital data handling.

scholarly journals PSI-Guided Mandible-First Orthognathic Surgery: Maxillo-Mandibular Position Accuracy and Vertical Dimension Adjustability.

2021 ◽  
Author(s):  
Giovanni Badiali ◽  
Mirko Bevini ◽  
Ottavia Lunari ◽  
Elisa Lovero ◽  
Federica Ruggiero ◽  
...  
Keyword(s):  
Orthognathic Surgery ◽  
Surgical Planning ◽  
Three Dimensional ◽  
Patient Specific ◽  
Pitch Range ◽  
Surgery Patient ◽  
Novel Approach ◽  
Mandibular Position ◽  
3D Printed

Abstract In orthognathic surgery, patient-specific osteosynthesis implants (PSIs) represent a novel approach for the reproduction of the virtual surgical planning on the patient. The aim of this study is to analyse the quality of maxillo-mandibular positioning using a hybrid mandible-first mandibular-PSI guided procedure on twenty-two patients while the upper maxilla was fixed using manually-bent stock titanium miniplates. The virtual surgical plan was used to guide the design of PSIs and positioning guides, which were then 3D printed using biocompatible materials. A CBCT scan was performed one month after surgery and postoperative facial skeletal models were segmented for comparison against the surgical plan. A three-dimensional cephalometric analysis was carried out on both planned and obtained anatomies. A Spearman correlation matrix was computed on the calculated discrepancies, in order to achieve a more comprehensive description of maxillo-mandibular displacement. Intraoperatively, all PSIs were successfully applied. The procedure was found to be accurate in planned maxillo-mandibular positioning reproduction, while maintaining a degree of flexibility to allow for aesthetics-based verticality correction in a pitch range between-5.31 and +1.79 mm. Such correction did not significantly affect the achievement of planned frontal symmetry.

scholarly journals PSI-Guided Mandible-First Orthognathic Surgery: Maxillo-Mandibular Position Accuracy and Vertical Dimension Adjustability

2021 ◽  
Vol 11 (11) ◽  
pp. 1237
Author(s):  
Giovanni Badiali ◽  
Mirko Bevini ◽  
Ottavia Lunari ◽  
Elisa Lovero ◽  
Federica Ruggiero ◽  
...  
Keyword(s):  
Orthognathic Surgery ◽  
Surgical Planning ◽  
Three Dimensional ◽  
Patient Specific ◽  
Pitch Range ◽  
Surgery Patient ◽  
Novel Approach ◽  
Mandibular Position ◽  
3D Printed

In orthognathic surgery, patient-specific osteosynthesis implants (PSIs) represent a novel approach for the reproduction of the virtual surgical planning on the patient. The aim of this study is to analyse the quality of maxillo-mandibular positioning using a hybrid mandible-first mandibular-PSI-guided procedure on twenty-two patients while the upper maxilla was fixed using manually bent stock titanium miniplates. The virtual surgical plan was used to design PSIs and positioning guides, which were then 3D printed using biocompatible materials. A Cone Beam Computed Tomography (CBCT) scan was performed one month after surgery and postoperative facial skeletal models were segmented for comparison against the surgical plan. A three-dimensional cephalometric analysis was carried out on both planned and obtained anatomies. A Spearman correlation matrix was computed on the calculated discrepancies in order to achieve a more comprehensive description of maxillo-mandibular displacement. Intraoperatively, all PSIs were successfully applied. The procedure was found to be accurate in planned maxillo-mandibular positioning reproduction, while maintaining a degree of flexibility to allow for aesthetics-based verticality correction in a pitch range between −5.31 and +1.79 mm. Such a correction did not significantly affect the achievement of planned frontal symmetry.

Correction of Facial Asymmetry Using Patient-Specific Implants: A Case Report

2020 ◽  
Vol 37 (3) ◽  
pp. 109-113
Author(s):  
Manolis Manolakakis ◽  
Ryan Richards
Keyword(s):  
Orthognathic Surgery ◽  
Treatment Options ◽  
Facial Asymmetry ◽  
Patient Specific ◽  
Facial Aesthetics ◽  
Rapid Palatal Expansion ◽  
Orthodontic Therapy ◽  
Alloplastic Implants ◽  
Dentofacial Deformities ◽  
Tear Trough Deformity

Dentofacial deformities can have a profound impact on patients’ function and facial aesthetics. Traditionally, dentofacial deformities and malocclusion have been managed with growth modification, orthodontic therapy, and orthognathic surgery, or a combination of these modalities. The aim of this article is to discuss the use of patient-specific alloplastic implants as an adjunct or alternative to orthognathic surgery in patients with dentofacial deformities. A 40-year-old man who previously underwent surgically assisted rapid palatal expansion followed by LeFort I osteotomy advancement, intraoral vertical ramus osteotomy setback (IVRO), rhinoplasty, and fat transfer to the malar region presented with a chief complaint of dissatisfaction due to significant facial asymmetry. Tear trough deformity, concave nasal dorsum with nasal tip deviation to the left, submalar fullness, chin deviation to the right, and a poorly defined mandibular border outline were all noted on physical examination. The patient was treated with lower lid blepharoplasty with fat repositioning, buccal fat pad reduction (bichectomy), and patient-specific malar and mandibular border implants. In a patient who has a moderate-to-severe malocclusion and dentofacial deformity, traditional treatment includes orthodontic correction and orthognathic surgery. Patients undergoing primary orthognathic surgery can benefit from alloplastic implants. For patients who have residual maxillary or mandibular asymmetry after orthognathic surgery, the treatment options are secondary orthognathic procedures or facial implants. These patients can benefit from treatment with alloplastic facial implants as an adjunct or alternative to orthognathic surgery to normalize skeletal contours and improve facial aesthetics. Patient-specific alloplastic implants can be used as a powerful adjunct or alternative to orthognathic surgery. Patients with mild occlusal and skeletal deformities who have traditionally been treated with orthodontic therapy alone can benefit from evaluation of alloplastic implants. Patients with residual asymmetries after orthognathic surgery can benefit from alloplastic implants as an adjunct with secondary osteotomies or as an alternative altogether.

scholarly journals Automatic modelling of human musculoskeletal ligaments – Framework overview and model quality evaluation

2021 ◽  
pp. 1-14
Author(s):  
Noura Hamze ◽  
Lukas Nocker ◽  
Nikolaus Rauch ◽  
Markus Walzthöni ◽  
Matthias Harders ◽  
...  
Keyword(s):  
Statistical Model ◽  
Soft Tissues ◽  
Automatic Generation ◽  
Cadaveric Study ◽  
Patient Specific ◽  
Mean Square ◽  
Shape Modelling ◽  
Morphological Studies ◽  
Insertion Sites ◽  
Mean Square Errors

BACKGROUND: Accurate segmentation of connective soft tissues in medical images is very challenging, hampering the generation of geometric models for bio-mechanical computations. Alternatively, one could predict ligament insertion sites and then approximate the shapes, based on anatomical knowledge and morphological studies. OBJECTIVE: In this work, we describe an integrated framework for automatic modelling of human musculoskeletal ligaments. METHOD: We combine statistical shape modelling with geometric algorithms to automatically identify insertion sites, based on which geometric surface/volume meshes are created. As clinical use case, the framework has been applied to generate models of the forearm interosseous membrane. Ligament insertion sites in the statistical model were defined according to anatomical predictions following a published approach. RESULTS: For evaluation we compared the generated sites, as well as the ligament shapes, to data obtained from a cadaveric study, involving five forearms with 15 ligaments. Our framework permitted the creation of models approximating ligaments’ shapes with good fidelity. However, we found that the statistical model trained with the state-of-the-art prediction of the insertion sites was not always reliable. Average mean square errors as well as Hausdorff distances of the meshes could increase by an order of magnitude, as compared to employing known insertion locations of the cadaveric study. Using those, an average mean square error of 0.59 mm and an average Hausdorff distance of less than 7 mm resulted, for all ligaments. CONCLUSIONS: The presented approach for automatic generation of ligament shapes from insertion points appears to be feasible but the detection of the insertion sites with a SSM is too inaccurate, thus making a patient-specific approach necessary.

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