Design, development and clinical validation of computer-aided surgical simulation system for streamlined orthognathic surgical planning

Abstract

Purpose There are many proven problems associated with traditional surgical planning methods for orthognathic surgery. To address these problems, we developed a computer-aided surgical simulation (CASS) system, the AnatomicAligner, to plan orthognathic surgery following our streamlined clinical protocol. Methods The system includes six modules: image segmentation and three-dimensional (3D) reconstruction, registration and reorientation of models to neutral head posture, 3D cephalometric analysis, virtual osteotomy, surgical simulation, and surgical splint generation. The accuracy of the system was validated in a stepwise fashion: first to evaluate the accuracy of AnatomicAligner using 30 sets of patient data, then to evaluate the fitting of splints generated by AnatomicAligner using 10 sets of patient data. The industrial gold standard system, Mimics, was used as the reference. Result When comparing the results of segmentation, virtual osteotomy and transformation achieved with AnatomicAligner to the ones achieved with Mimics, the absolute deviation between the two systems was clinically insignificant. The average surface deviation between the two models after 3D model reconstruction in AnatomicAligner and Mimics was 0.3 mm with a standard deviation (SD) of 0.03 mm. All the average surface deviations between the two models after virtual osteotomy and transformations were smaller than 0.01 mm with a SD of 0.01 mm. In addition, the fitting of splints generated by AnatomicAligner was at least as good as the ones generated by Mimics. Conclusion We successfully developed a CASS system, the AnatomicAligner, for planning orthognathic surgery following the streamlined planning protocol. The system has been proven accurate. AnatomicAligner will soon be available freely to the boarder clinical and research communities.

Both the Observer's Expertise and the Subject's Facial Symmetry Can Affect Anatomical Position of the Head

“…Initial results have been promising. 22,23 Currently, we are collecting data to validate this algorithm.…”

Novel condylar repositioning method for 3D-printed models

“…The first medical fabrication laboratory in Japan was established at Tokyo Dental College—the “Fab Lab TDC”—in December 2013 [1]. Techniques to construct full-scale 3D models, such as of the jaw, based on computed tomography (CT) and magnetic resonance imaging (MRI) modalities have been reported recently [1–3]. We have also created preoperative 3D-printed models of cases for tumors in maxilla and mandible, jaw deformities, and used them primarily consultation to patients and for preoperative simulations.…”

“…However, while models created with a separate mandible and maxilla have good operability, it can be difficult to fully restore the position of the mandibular condyle after simulations. To fully restore the position of the condyle, methods have been reported that include the manufacture of a device to maintain the configuration of the mandible and embedding of magnets into the joint [3]. …”

Comparative analysis of poly-glycolic acid-based hybrid polymer starter matrices for in vitro tissue engineering

“…Multiple disciplines, such as cell biology, biomaterial research and biomedical engineering have contributed to the advances of tissue engineering technologies. Any tissue engineering approach is composed of three major components: (1) cells, (2) biocompatible scaffolds, and (3) suitable biochemical (e.g. growth factors) and physical (e.g.…”

“…A variety of synthetic biodegradable polymers has been investigated as TE scaffold materials, though the main disadvantage of these materials is their lack of functional groups [2,3]. This results in limited capacity to combine with bioactive elements to reinforce their cell affinity [3].…”