Accuracy of a CAD/CAM surgical template for mandibular distraction: a preliminary study

Li, B.; Sun, Hao; Zeng, Fan-Yun; Zhang, T.; Wang, X.

doi:10.1016/j.bjoms.2018.09.001

Cited by 17 publications

(11 citation statements)

References 22 publications

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“…[5][6][7] Virtual planning and additive manufacturing have demonstrated the ability to facilitate surgery, helping obtain more accurate and predictive outcomes while reducing risks and operative time. [11][12][13][14] The present case demonstrates the coordination and communication required between surgeon and engineers to produce the best surgical plan and consequently, the development of novel ideas such as a 3D printed spacer.…”

Section: Discussionmentioning

confidence: 86%

Development and surgical application of a custom implant that enables a vertical vector of mandibular distraction

Alvarez

Dovgalski

Evans

et al. 2020

Proc Inst Mech Eng H

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Hemifacial microsomia is a congenital malformation that involves the underdevelopment of the mandible and the ear leading to facial asymmetry. Distraction osteogenesis is the gold standard surgical procedure for severe cases of hemifacial microsomia in which two sectioned bone parts are lengthened gradually to promote bony infill. The final shape of the bone depends on the position of the distractor and the vector of distraction. This article presents a complex clinical case of a 7-year-old patient with severe hemifacial microsomia that required distraction to correct mandibular asymmetry. Digital technology was applied to virtually plan the surgery pre-operatively. Optimal symmetrisation required a vertical vector of distraction that none of the ‘off-the-shelf’ distractors could provide. Consequently, a three-dimensional printed titanium implant was designed as a spacer to be attached to the inferior plate of a standard distractor, allowing the achievement of a vertical vector. By adding the spacer, the inferior footplate of the distractor was not directly fixed to bone and the vector of distraction was not dictated by the anatomical contour of the patient but by the shape of the spacer. Surgical guides were created to translate the virtual plan to the operating room. The guides prevented potential damage to tooth buds and the inferior alveolar nerve. This article describes the three-dimensional computer-aided design and additive manufacture of the custom devices that delivered the following: (1) symmetrisation of the mandible after distraction surgery without manipulation of the healthy side of the mandible; (2) a feasible and safer surgical solution; and (3) an innovative method that enables a wider range of vectors of distraction, bringing new prospects to the treatment of distraction osteogenesis in the future.

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Section: Discussionmentioning

confidence: 86%

Development and surgical application of a custom implant that enables a vertical vector of mandibular distraction

Alvarez

Dovgalski

Evans

et al. 2020

Proc Inst Mech Eng H

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“…This may be evidenced by another template-based in-vivo distraction study for condylar lengthening for hemifacial microsomia, which showed a dimensiondependent discrepancy of 0.93 mm between simulation and surgical results in the anteroposterior direction, and 4.64 mm in the horizontal plane [16]. Another study evaluated the position error of pediatric navigational distraction, finding a mean angular error of 3.7°i n the horizontal plane and 6.2°in the sagittal plane, yielding 3.98 mm in distance at the distractor [5].…”

Section: Discussionmentioning

confidence: 91%

“…In addition, positioning guides are generally 3D printed using medical resin or metal [16,17]. Appropriate material choice depends on production requirements, biomechanical characteristics, and application, whether osteotomy guide, distraction device positioner, or drill guide for fixation plate.…”

Section: Discussionmentioning

confidence: 99%

Fully-customized distraction assembly for maxillofacial distraction osteogenesis: a novel device and its experimental accuracy verification

Kang

Tak

Park³

et al. 2020

Head Face Med

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Background A new distraction osteogenesis assembly system comprising a fully customized CAD/CAM-based fixation unit and ready-made distraction unit was developed. The aim of this study was to introduce our new distraction system and to evaluate its accuracy level in a sampled mandibular distraction osteogenesis. Methods Our system consists of a fully customized CAD/CAM-based fixation plate unit with two plates for each moving and anchoring part, and a ready-made distraction unit with attachment slots for fixation plates. The experimental distractions were performed on 3D-printed mandibles for one control and two experimental groups (N = 10 for each group). All groups had reference bars on the chin region and teeth to measure distraction accuracy. The control group had the classical ready-made distraction system, and experimental groups 1 and 2 were fitted with our new distraction assembly using a different distractor-positioning guide design. All distracted experimental mandibles were scanned by CT imaging, then superimposed on a 3D simulation to get their discrepancy levels. Results The measured 3D distances between the reference landmarks of the surgical simulations and the experimental surgeries for the three groups were significantly different (p < 0.0001) by statistical analysis. The errors were greater in the control group (with a total average of 19.18 ± 3.73 mm in 3D distance between the simulated and actual reference points) than those in the two experimental groups (with an average of 3.68 ± 1.41 mm for group 1 and 3.07 ± 1.39 mm for group 2). The customized distraction assembly with 3D-printed bone plate units in group 1 and 2, however, did not show any significant differences between simulated and actual distances (p > 0.999). Conclusion Our newly-developed distraction assembly system with CAD/CAM plate for the distraction osteogenesis of the mandible produced a greater level of accuracy than that of a conventional distraction device. The system appears to address existing shortcomings of conventional distraction devices, including inaccuracy in vector-controlled movement of the system. However, it also needs to be further developed to address the requirements and anatomical characteristics of specific regions.

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“…These systems can simultaneously be used to plan surgical cuts making it possible to avoid any important anatomical structures, such as the inferior alveolar nerve or developing teeth. These types of planning systems have simplified a previously arduous task whilst also maximizing the treatment possibilities and improving the final outcomes [31]. The CBCT exam is necessary to accurately visualize soft tissues.…”

Section: Distraction Osteogenesismentioning

confidence: 99%

Application of Three-Dimensional Digital Technology in Orthodontics: The State of the Art

et al. 2022

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Three-dimensional technologies are one of the most recent and relevant advancements in the field of Dentistry. These systems, including intraoral scans, 3D imaging exams (CAT scan, CBCT and MRI), CAD/CAM 3D printing devices and 3D computer software, have enabled clinicians to greatly improve patient care along with reducing treatment planning time. The present descriptive study aims to explore possible applications of 3D technologies during the diagnosis, treatment plan, case monitoring and result assessment in orthodontics. The overall upgrade provided by these technologies can improve the clinicians’ workflow and effectiveness by simplifying conventional techniques considered to be especially arduous.

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Accuracy of a CAD/CAM surgical template for mandibular distraction: a preliminary study

Cited by 17 publications

References 22 publications

Development and surgical application of a custom implant that enables a vertical vector of mandibular distraction

Development and surgical application of a custom implant that enables a vertical vector of mandibular distraction

Fully-customized distraction assembly for maxillofacial distraction osteogenesis: a novel device and its experimental accuracy verification

Application of Three-Dimensional Digital Technology in Orthodontics: The State of the Art

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