3D virtual planning in orthognathic surgery and CAD/CAM surgical splints generation in one patient with craniofacial microsomia: a case report

Abstract

Objective: In this case report, the feasibility and precision of tridimensional (3D) virtual planning in one patient with craniofacial microsomia is tested using Nemoceph 3D-OS software (Software Nemotec SL, Madrid, Spain) to predict postoperative outcomes on hard tissue and produce CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) surgical splints. Methods: The clinical protocol consists of 3D data acquisition of the craniofacial complex by cone-beam computed tomography (CBCT) and surface scanning of the plaster dental casts. The ''virtual patient'' created underwent virtual surgery and a simulation of postoperative results on hard tissues. Surgical splints were manufactured using CAD/CAM technology in order to transfer the virtual surgical plan to the operating room. Intraoperatively, both CAD/CAM and conventional surgical splints are comparable. A second set of 3D images was obtained after surgery to acquire linear measurements and compare them with measurements obtained when predicting postoperative results virtually.Results: It was found a high similarity between both types of surgical splints with equal fitting on the dental arches. The linear measurements presented some discrepancies between the actual surgical outcomes and the predicted results from the 3D virtual simulation, but caution must be taken in the analysis of these results due to several variables. Conclusions: The reported case confirms the clinical feasibility of the described computer-assisted orthognathic surgical protocol. Further progress in the development of technologies for 3D image acquisition and improvements on software programs to simulate postoperative changes on soft tissue are required.

Clinical Computing in Dentistry

“…In today's reality, current trends of technologies are at optimum acceleration in a wide range. Virtual reality technology is defined as a method by which an environment is three dimensionally simulated or replicated, giving the user a sense of being inside it, controlling it and personally interacting with it [3,4]. Designing of a new product brings in the significance and wide usage of VR and the incorporation of 3D modelling in it [1].…”

“…Comprehensive visualization and records of the craniofacial complex are important goals in orthodontic imaging which have been conventionally achieved by means of plaster dental casts, photographs and radiographs. However, cone-beam computed tomography (CBCT) has gained considerable acclaim worldwide as a viable tri-dimensional (3D) imaging modality [3].…”

CAD/CAM splint and surgical navigation allows accurate maxillary segment positioning in Le Fort I osteotomy

“…There have been reports on using CAD/CAM splints designed by simulation software for orthognathic surgery and fabricated using rapid prototyping technology as intermediate splints for maxillary repositioning to accurately reflect the virtual surgical planning results during the actual surgery [2, 3, 4, 5, 6]. However, there is no definitive evidence that maxillary repositioning using CAD/CAM splints is more accurate than that using the conventional method.…”

Orientation of Cone-Beam Computed Tomography Image: Pursuit of Perfect Orientation Plane in Three Dimensions—A Retrospective Cross-Sectional Study

“…The virtual 3D models generated from CBCT images have been used for treatment planning and to assess the treatment and growth changes. [6][7][8][9] In recent years, various 3D software programs have been introduced for the analysis of CBCT data 10,11 and 3D cephalometric analysis. [12][13][14] During CBCT acquisition, the patient's head is stabilized throughout the scanning procedure by various methods, such as the chin rest and head-positioning devices, which hold the patient's head in a stable but random orientation.…”