3D WORKFLOW IN ORTHOGNATHIC SURGERY : FROM PLANNING TO CAD-CAM SPLINTS

Background: Technological progress has led to the transition to digital methods to perform surgical planning and to obtain surgical splints with CAD/CAM technologies. The present study aimed to compare the accuracy of jaw repositioning in bimaxillary orthognathic surgery using traditional and digital surgical planning in skeletal class III patients. Methods: This study included 60 skeletal class III patients divided into two groups based on the method used to perform surgical planning: traditional (T, n = 30) and digital (D, n = 30). For each patient, a 2D presurgical Visual Treatment Objective (VTO) was prepared and the outcome of the surgery was compared with that planned by using determined cephalometric measurements (ANB, SNA, SNB, Ar-Go-Me, S-Ar-Go). Statistical analysis showed that the measurements planned and those obtained after surgery were equivalent in Group D. For Group T, the analysis showed equivalence only for one of the considered measurements (ANB). By comparing the results of the two groups, Group D presented a lower level of error than Group T. Conclusions: Digital surgical planning performed significantly better in terms of accuracy of jaw repositioning than the traditional protocol.

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Surface Topography-Based Positioning Accuracy of Maxillary Templates Fabricated by the CAD/CAM Technique for Orthognathic Surgery without an Intermediate Splint

Applied Sciences ◽

10.3390/app9224928 ◽

2019 ◽

Vol 9 (22) ◽

pp. 4928

Author(s):

Jeong Han ◽

Soon Hwang

Keyword(s):

Surface Topography ◽

Computer Aided Design ◽

Orthognathic Surgery ◽

Mean Deviation ◽

Lateral Direction ◽

Positioning Accuracy ◽

Actual Position ◽

Computer Aided ◽

Cad Cam ◽

The Mean

Computer-aided design/computer-aided manufacturing (CAD/CAM)-based maxillary templates can transfer a surgical plan accurately only when the template is positioned correctly. Our study aimed to evaluate the positioning accuracy of the CAD/CAM-based template for maxillary orthognathic surgery using dry skulls. After reconstruction of a three-dimensional (3D) virtual skull model, a surface-based surgical template for Le Fort I osteotomy was designed and fabricated using CAD/CAM and 3D printing technology. To determine accuracy, the deviation of the template between the planned and the actual position and the fitness of the template were evaluated. The mean deviation was 0.41 ± 0.30 mm in the medio-lateral direction, 0.55 ± 0.59 mm in the antero-posterior direction, and 0.69 ± 0.59 mm in the supero-inferior direction. The root mean square deviation between the planned and the actual position of the template was 1.21 ± 0.54 mm. With respect to the fitness of the template, the mean distance between the inner surface of the template and the underlying bone surface was 0.76 ± 0.24 mm. CAD/CAM-based templates showed precise positioning and good fitness. These results suggest that surface topography-based CAD-CAM templates can be considered as an alternative solution in replacing the traditional intermediate splints for the transfer of surgical plans.

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Accuracy Evaluation of Virtual Surgical Planning (VSP) in Orthognathic Surgery: Comparison Between CAD/CAM Fabricated Surgical Splint and CAD/CAM Cutting Guides with PSI

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2019.06.020 ◽

2019 ◽

Vol 77 (9) ◽

pp. e4-e5

Author(s):

R. Pucci ◽

P. Priore ◽

L. Manganiello ◽

A. Cassoni ◽

V. Valentini

Keyword(s):

Orthognathic Surgery ◽

Surgical Planning ◽

Accuracy Evaluation ◽

Virtual Surgical Planning ◽

Cad Cam ◽

Cutting Guides

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The Role of Virtual Surgical Planning in Increasing the Predictability in Orthognathic Surgery

Journal of Dental and Maxillofacial Surgery ◽

10.18314/jdms.v2i1.1633 ◽

2019 ◽

pp. 136-141

Author(s):

Faisal A Quereshy ◽

Nikolay Levintov ◽

Justin L Nguyen ◽

Maria A DeLeonibus ◽

Catherine Demko ◽

...

Keyword(s):

Surgical Outcomes ◽

Orthognathic Surgery ◽

Surgical Planning ◽

Predictor Variable ◽

Outcome Variable ◽

Virtual Surgical Planning ◽

Equal Variance ◽

Modeling Software ◽

Cad Cam ◽

Medical Modeling

Purpose: To evaluate our surgical outcomes by comparing our surgical plan to the outcome of the surgery and evaluate our efficacy using Virtual Surgical Planning and Medical Modeling software. Our aim is to determine the quality and validity of Virtual Surgical Planning when comparing pre-surgical plans with post-surgical outcomes. Patients and Methods: A cohort study was conducted for patients who underwent orthognathic surgery at a single institution. Utilizing virtual plans and models, select points for the virtual plans were compared and superimposed with that of the actual surgical movements. The primary predictor variable were the pre-surgical virtual plans of movements; the outcome variable consisted of the actual post-surgical movements. Statistical analysis was computed via IBM SPSS Version 25 software utilizing a paired t-test assuming equal variance with alpha (p<0.05). The sample of patients included those who had pre-operative and post-operative cone beam computed tomography scans, a virtual surgical plan, CAD/CAM splints, and LeFort I osteotomy and bilateral sagittal split osteotomy.Results: The study consisted of ten patients between the ages of 18-51 years old. Pre and post surgical plans were superimposed and four points of measurement were compared along 3 dimensional planes. There were no statistical significant associations between the virtually planned and post surgical planned values.Conclusion: Our results suggest that the use of virtual surgical planning in orthognathic surgery yields favorable and accurate surgical outcomes regarding rotational movements with minor degrees of discrepancies.

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