Computer Aided Orthognathic Surgery: A General Method for Designing and Manufacturing Personalized Cutting/Repositioning Templates

Brigida, Liliana Di; Naddeo, Alessandro; Cappetti, Nicola; Borri, Antonio; Cortese, Antonio

doi:10.3390/app12073600

Cited by 3 publications

(2 citation statements)

References 39 publications

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“…In addition, through this process, maxillomandibular complex can be adjusted to be symmetrical to the patient’s true sagittal plane 27,28 . These are possible because the true sagittal plane and the horizontal plane can be used as a reference by reorienting the patient’s skull image to suit the patient’s NHP 29 …”

Section: Discussionmentioning

confidence: 99%

“…Moreover, all patients recognized that facial asymmetry was highly improved and was satisfied with the results of the surgery. Considering these aspects, it can be seen that all limitations of the conventional orthognathic method can be overcome by applying VSP and CAD/CAM technologies to the treatment of patients with facial asymmetry 27–29 . To obtain these excellent results, it can be said that the most important process is to set the patient’s NHP well and reorient the skull image accordingly.…”

Section: Discussionmentioning

confidence: 99%

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The Accuracy and Stability of Intentional Change of Frontal-Ramal Inclination in Orthognathic Surgery for Facial Asymmetry Patients

Meny

Jeong³

et al. 2023

Journal of Craniofacial Surgery

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Facial asymmetry can be defined as differences in the left and right sides of the face, and most of the patients with facial asymmetry have different left and right frontal-ramal inclinations (FRIs). Restoring the symmetry of both FRIs is important in the surgery of facial asymmetry patients, but it is very difficult to achieve perfect symmetry through conventional orthognathic surgery. However, by using 3-dimensional (3D) virtual planning and CAD/CAM technolo gies, intentional change of FRIs can be possible so the symmetry can be improved. The purpose of this study is to evaluate the surgical accuracy and long-term stability of intentional change of FRIs by 3D virtual surgery, CAD/CAM-assisted orthognathic surgery for patients with facial asymmetry. The study included 20 patients who had undergone orthognathic surgery for skeletal class III malocclusion from January 2019 to December 2021. To evaluate the accuracy of surgery, 3D facial cone beam computed tomography (CBCT) taken immediately after surgery (T1) and virtual surgery data (Tv) were measured and the difference values were calculated. The evaluation of the long-term stability of intentional change of FRI was performed by measuring T1 and T2 (3D facial cone beam computed tomography images taken 6 mo after surgery) and the difference values were calculated. The difference values of FRIs in the left and right proximal segments of each patient were calculated. And then, for comparison depending on the direction of rotation, increased FRI groups (n=20, medial rotation) and decreased FRI groups (n=20, lateral rotation) were analyzed separately. As a result, all difference values at both (ΔT1−Tv) and (ΔT2−T1) were <1 degree. As a result of analyzing the entire FRI by dividing it into decreasing and increasing groups, the mean value of (ΔT1−Tv) was 0.225 degrees for the decreasing group and 0.275 degrees for the increasing group. It means that the proximal segment moved less than the movement implemented by the virtual surgery through actual surgery but it shows a very small error, which means that the overall operation almost accurately implements the virtual surgical planning. Compared with (ΔT1−Tv), the mean value of (ΔT2−T1) showed a much smaller error value, and no specific tendency was observed. This indicates that the stability after surgery is very good. Based on this study, using 3D virtual surgery planning and CAD/CAM technologies for treating patients with facial asymmetry was very useful, and surgery could be performed accurately and predictably. In particular, left-right symmetry was almost perfectly achieved through virtual simulation and could be implemented through actual surgery. Therefore, it can be said that the use of these 3D technologies is recommended for the surgical approach of facial asymmetry.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Accuracy and Stability of Intentional Change of Frontal-Ramal Inclination in Orthognathic Surgery for Facial Asymmetry Patients

Meny

Jeong³

et al. 2023

Journal of Craniofacial Surgery

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A New Method to Design and Manufacture a Low-Cost Custom-Made Template for Mandible Cut and Repositioning Using Standard Plates in BSSO Surgery

Di Brigida,

Cortese,

Cataldo

et al. 2024

Bioengineering

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In this study, a new methodology for designing and creating a custom-made template for maxillofacial surgery has been developed. The custom-made template can be used both for cutting and repositioning of the mandible arches for executing a BSSO (bilateral sagittal split osteotomy) treatment. The idea was developed in order to give the possibility of using a custom-made template with standard plates, thus reducing long times, high costs and low availability of custom-made plates; this represents the proof of novelty of the proposed template, based on a well-established methodology. The methodology was completely developed in the CAD virtual environment and, after the surgeons’ assessment, an in-vitro experiment by a maxillofacial surgeon was performed in order to check the usability and the versatility of the system, thanks to the use of additive manufacturing technologies. When computer-aided technologies are used for orthognathic surgery, there are significant time and cost savings that can be realised, as well as improved performance. The cost of the whole operation is lower than the standard one, thanks to the use of standard plates. To carry out the procedures, the proposed methodology allows for inexpensive physical mock-ups that enable the BSSO procedure to be performed.

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Efficacy of the Coronoid Notch and Occlusal Plane As Predictable Landmarks for Determining the Medial Cut Height in Bilateral Sagittal Split Osteotomy: A Split-Mouth Observational Study

Saikrishna Yalagala,

Somasundaram,

Raja

et al. 2024

Cureus

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Aim: This split-mouth observational study was conducted to assess the reliability and safety of using the coronoid notch and occlusal plane as landmarks to aid surgeons during bilateral sagittal split osteotomy (BSSO). Materials and methods: Thirteen patients between the ages of 18 and 30 years, with class II and class III mandibular skeletal malocclusion requiring BSSO, were randomly selected and assigned to each of the study and control groups. A split-mouth study was chosen to conduct this research. Cone beam computed tomography (CBCT) imaging was conducted before the surgery to evaluate the anatomical structure, and three predefined points were marked at the superiormost point of the mandibular foramen, the inferiormost point of the mandibular foramen, and the deepest point of the sigmoid notch. A conventional sagittal split osteotomy was carried out in the control group. Preoperative values were obtained in the study group using the CBCT imaging technique by drawing an imaginary line from the inferiormost part of the mandibular foramen to the line corresponding to the occlusal plane that extended beyond the last molar. The lingual flap reflection was restricted to the internal oblique ridge. The posterior border of the mandible was not reflected. The measurements acquired via CBCT imaging were accurately transferred to the intraoperative surgical site using a vernier caliper. This facilitated the precise completion of the horizontal osteotomy, ascending ramus cuts, and vertical osteotomies. BSSO was performed, the mandibular setback or advancement was done with intermaxillary fixation, and the procedure was completed by rigid fixation. Types of lingual splits, types of lateral bone cut ends (LBCEs), any unfavorable split, and the time taken for the surgery (in minutes) were assessed. Results: The surgery time in the control group (20.1538 ± 2.85325 min) was found to be higher than that in the study group (17.6154 ± 3.59487 min), with a p-value of 0.02. No significant differences were observed when assessing the presence of unfavorable splits in both groups (p = 0.500). Buccal LBCEs were the most prevalent, followed by inferior types. Type I lingual split was the most common in the study group (70%). Conclusion: This technique offers a dependable anatomical reference and significantly reduces surgical time for beginners. Additionally, the patterns of the lingual split were correlated with the types of lateral bone cut ends.

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Computer Aided Orthognathic Surgery: A General Method for Designing and Manufacturing Personalized Cutting/Repositioning Templates

Cited by 3 publications

References 39 publications

The Accuracy and Stability of Intentional Change of Frontal-Ramal Inclination in Orthognathic Surgery for Facial Asymmetry Patients

The Accuracy and Stability of Intentional Change of Frontal-Ramal Inclination in Orthognathic Surgery for Facial Asymmetry Patients

A New Method to Design and Manufacture a Low-Cost Custom-Made Template for Mandible Cut and Repositioning Using Standard Plates in BSSO Surgery

Efficacy of the Coronoid Notch and Occlusal Plane As Predictable Landmarks for Determining the Medial Cut Height in Bilateral Sagittal Split Osteotomy: A Split-Mouth Observational Study

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