Objective: To evaluate the surgical accuracy of positioning the maxilla in patients with skeletal class II malocclusion using computer-aided design and computer-aided manufacturing (CAD/ CAM)-assisted orthognathic surgery. Materials and Methods: The samples consisted of 10 patients with skeletal class II malocclusion, whose cone-beam computed tomographys taken before and immediately after surgery were available and who underwent bimaxillary orthognathic surgery by a single surgeon using Le Fort I osteotomy and bilateral sagittal split ramus osteotomy at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, South Korea between January 2018 and December 2019. After virtual surgical planning was performed using the FACEGIDE system (Korea), surgical cutting guides, intermediate splints, and custom-made titanium mini-plates were fabricated using CAD/CAM technique. Using 8 landmarks (anterior nasal spine, point A, #16, #13, contact point between #11 and #21, #23, #26, posterior nasal spine), the mean differences between the virtually planned (Virtual) and actual postsurgical position of the maxilla (Actual) in the three-dimensional coordinates (ΔActual-Virtual) and their mean absolute deviations were investigated. Results: The mean differences of 8 landmarks were 0.42 mm left side movement in the transverse coordinate, 0.15 mm forward movement in the sagittal coordinate and 0.10 mm downward movement in the vertical coordinate. Their mean absolute deviations were 0.98, 0.67, and 0.62 mm in the sagittal, vertical, and transverse coordinates, respectively. Conclusions: Since the mean difference was less than 0.5 mm and the range of error was less than 1.0 mm, CAD/CAM-assisted orthognathic surgery might have a high degree of surgical accuracy and clinical relevance in the positioning of the maxilla.

Systemic sclerosis is a complex autoimmune connective tissue disease of unknown cause that causes sclerosis and inflammation of the skin and subcutaneous tissue. Sclerosis involving the face can lead to microstomia, leading to difficulties with mastication, phonation, and oral hygiene. Although many agents have been used to treat internal organ involvement, they often have compromised efficacy on cutaneous manifestation including facial dermal sclerosis. In this case presentation, we will introduce a surgical technique to correct scleroderma-induced microstomia.

Computer-aided design and computer-aided manufacturing (CAD-CAM) techniques are leading to new and refined approaches to reconstructive surgery. While used mainly in craniofacial reconstruction so far, CAD-CAM technology has the potential for advances in every area of plastic and reconstructive surgery. Here we are reporting 4 different cases of maxillofacial defects reconstruction and the purpose of this report is to introduce a new methodology for contour restoration of the maxillofacial defects using CAD-CAM custom-made titanium prosthesis. With the help of CAD-CAM technology the rigid fixation of the custom-made titanium implants successfully restores the contour of maxillofacial defects in more symmetrical and aesthetic shape. However, without this technology restoring large defect is difficult as it requires strong prosthetic material like titanium use to restore the mandibular angle and border defects. We think that titanium prosthesis is an excellent choice for efficient and durable reconstruction of such large maxillofacial defects.