Does Mandible-First Sequencing Increase Maxillary Surgical Accuracy in Bimaxillary Procedures?

Stokbro, Kasper; Liebregts, Jeroen; Baan, Frank; Bell, R. Bryan; Maal, T.J.J.; Thygesen, Torben; Xi, Tong

doi:10.1016/j.joms.2019.03.023

Cited by 24 publications

(14 citation statements)

References 28 publications

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“…This displacement, however measurable, was not clinically significant and did not impact on the resulting occlusion. This finding was also present in other authors' work, albeit it appears that in our cohort the extent of this retroposion is of a slightly lesser extent [16,17].…”

Section: Discussionsupporting

confidence: 92%

“…When analysing the single studies upon which such meta-analysis is based, together with other similar studies [16][17][18][19], the variety of analysis methods used is ample, and a direct comparison with our study cannot be carried out. Our group is subsequently prospecting a future study to properly investigate the actual increase in precision of PSIbased procedures, while keeping biases and methodological differences at a minimum.…”

Section: Discussionmentioning

confidence: 99%

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PSI-Guided Mandible-First Orthognathic Surgery: Maxillo-Mandibular Position Accuracy and Vertical Dimension Adjustability

Badiali

Bevini

Lunari

et al. 2021

JPM

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In orthognathic surgery, patient-specific osteosynthesis implants (PSIs) represent a novel approach for the reproduction of the virtual surgical planning on the patient. The aim of this study is to analyse the quality of maxillo-mandibular positioning using a hybrid mandible-first mandibular-PSI-guided procedure on twenty-two patients while the upper maxilla was fixed using manually bent stock titanium miniplates. The virtual surgical plan was used to design PSIs and positioning guides, which were then 3D printed using biocompatible materials. A Cone Beam Computed Tomography (CBCT) scan was performed one month after surgery and postoperative facial skeletal models were segmented for comparison against the surgical plan. A three-dimensional cephalometric analysis was carried out on both planned and obtained anatomies. A Spearman correlation matrix was computed on the calculated discrepancies in order to achieve a more comprehensive description of maxillo-mandibular displacement. Intraoperatively, all PSIs were successfully applied. The procedure was found to be accurate in planned maxillo-mandibular positioning reproduction, while maintaining a degree of flexibility to allow for aesthetics-based verticality correction in a pitch range between −5.31 and +1.79 mm. Such a correction did not significantly affect the achievement of planned frontal symmetry.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

PSI-Guided Mandible-First Orthognathic Surgery: Maxillo-Mandibular Position Accuracy and Vertical Dimension Adjustability

Badiali

Bevini

Lunari

et al. 2021

JPM

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“…The difference of 0.20 mm is orthodontically correctable [33][34][35] and would not have a visible influence on the facial profile [36][37][38] . Furthermore, 0.20 mm is smaller than the presented incongruences between postoperative outcome and virtual surgical planning 39 . Therefore, the virtual occlusion tool presented here can be utilized in daily clinical practice.…”

Section: Discussionmentioning

confidence: 71%

Virtual occlusion in orthognathic surgery

Baan

Meggelen

Verhulst

et al. 2021

International Journal of Oral and Maxillofacial Surgery

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The aim of this retrospective study was to determine whether a virtually created occlusion is as accurate as a conventionally created occlusion. Seventeen orthognathic patients were included in the study, which was conducted in a university clinic. Plaster cast models were obtained and digitized. Two experienced observers created the conventional (gold standard) and virtual occlusion to assess inter-observer variability. One observer created the conventional and virtual occlusion a second time to assess the intra-observer variability. The criterion for accepting the virtual occlusion was that the difference between the gold standard and the virtual occlusion was not larger than the intra-observer variability for the gold standard. A non-parametric Kruskal-Wallis H test was performed to detect statistically significant differences between the intra-and inter-observer groups for both the conventional and virtual occlusion. No statistically significant differences were found between the different groups. The difference between the conventional and virtual occlusion group was 0.20 mm larger than the intra-observer variability of the gold standard. The virtual occlusion tool presented here can be utilized in daily clinical practice and makes the use of physical dental models redundant.

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“…The previous studies on surgical accuracy found a much larger variation between the virtual surgical plan and the obtained reposition. 11,20 It is unknown how much of the surgical inaccuracy is caused by early skeletal relapse, and the problem of skeletal instability may therefore be larger than reported in this study. Thus, it is still advisable to increase the skeletal stability in inferior maxillary repositioning using bone grafting or 3D patient-specific, printed plates.…”

Section: Discussionmentioning

confidence: 83%

Inferior Maxillary Repositioning Remains Stable 1 Year After Surgery but Entails a High Risk of Osteosynthesis Failure

Stokbro

Thygesen

Marcussen

2020

Journal of Oral and Maxillofacial Surgery

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Purpose: Inferior maxillary repositioning is among the most unstable orthognathic procedures. The overall purpose of this study was to measure skeletal stability after inferior maxillary repositioning.Method: The authors implemented a retrospective cohort study. The study cohort was derived from all orthognathic patients treated between January 2011 and December 2013 in Odense University Hospital. Inclusion criteria were orthognathic surgery with inferior maxillary reposition in patients with no maxillary segmentation or cleft lip/palate. Exclusion criteria were non-attendance at followup or requiring reoperation before the 1-year follow-up. The primary predictor variable was the time from 1-week follow-up to 1-year follow-up. The primary outcome variable was maxillary skeletal movement. Other variables of interest were age, sex, preoperative occlusal relationship, obtained maxillary movement, and type of surgery (mono-or bimaxillary procedure). Skeletal stability was measured at the centroid, anterior, and posterior nasal spines using the semi-automatic measurement technique. Skeletal stability was clinically defined as less than 2 mm movement in any direction. Positive directions of the 3 axes were right, anterior, and superior. The data were analyzed by mixed model linear regression analysis and 1-sample t-tests.Results: In total, 17 patients were included in the study (mean age 28, 35% female, 59% bimaxillary surgeries). Inferior maxillary repositioning was stable with less than 0.3 mm mean skeletal movement in any direction. Only 1 patient had a relapse of more than 1 mm in the posterior direction and none exceeded 2 mm. However, 3 patients were excluded from this analysis, since they required reoperation during the first year after surgery due to osteosynthesis failure. Conclusion:Inferior maxillary repositioning was stable during the first year after surgery; however, there was a high complication rate (15%). Thus, this procedure may still benefit from use of more rigid patient-specific, printed plates to increase postoperative stability.

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Does Mandible-First Sequencing Increase Maxillary Surgical Accuracy in Bimaxillary Procedures?

Cited by 24 publications

References 28 publications

PSI-Guided Mandible-First Orthognathic Surgery: Maxillo-Mandibular Position Accuracy and Vertical Dimension Adjustability

PSI-Guided Mandible-First Orthognathic Surgery: Maxillo-Mandibular Position Accuracy and Vertical Dimension Adjustability

Virtual occlusion in orthognathic surgery

Inferior Maxillary Repositioning Remains Stable 1 Year After Surgery but Entails a High Risk of Osteosynthesis Failure

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