CAD/CAM Splint and Surgical Navigation Allows Accurate Maxillary Segment Positioning in Le Fort I Osteotomy

Overview

Journal Heliyon

Specialty Social Sciences

Date 2019 Aug 3

PMID 31372564

Citations 2

Authors

Tatsuo Shirota

Sunao Shiogama

Yusuke Asama

Motohiro Tanaka

Yuji Kurihara

Hiroshi Ogura

Takaaki Kamatani

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the accuracy of the maxillary segment positioning method using a splint fabricated by computer-aided design/computer-aided manufacturing (CAD/CAM) and surgical navigation in patients who required two-jaw surgery.

Methods: Subjects were 35 patients requiring two-jaw surgery. A 3-dimensional (3D) skull model was prepared using cone-beam computed tomography (CBCT) data and dentition model scan data. Two-jaw surgery was simulated using this model, and a splint for maxillary positioning was fabricated by CAD/CAM. Using coordinate transformation software, the coordinate axis of surgical simulation data was merged with the navigation system, and data were imported to the navigation system. The maxillary segment was placed using the CAD/CAM splint, and consistency of the maxillary segment position with that planned by simulation was confirmed using the navigation system. CBCT taken at 4 weeks postoperatively and the prediction image fabricated using surgical simulation were superimposed. Predicted movement distances (PMD) at 6 arbitrary measurement points and actual movement distance (AMD) in surgery were measured. Differences of 3D measurements between the surgical simulation and postoperative results were evaluated.

Results: No significant differences were seen between PMD and AMD at most measurement points on the X and Y axes. Although significant differences between PMD and AMD were seen on the Z axis, no difference was evident between linear distance on the estimated image and postoperative CBCT image at most measurement points in 3D space. Mean error at measurement points between the PMD and AMD ranged from 0.57 mm to 0.78 mm on the X axis, 0.64 mm-1.03 mm on the Y axis, and 0.84 mm-0.90 mm in the Z axis.

Conclusion: Position of the maxillary segment moved by the CAD/CAM splint in Le Fort I osteotomy was almost consistent with the position established by simulation using the navigation system, confirming clinical accuracy.

Citing Articles

Novel CAD/CAM-splint-based navigation protocol enhances intraoperative maxillary position control in orthognathic surgery: a case control study.

Schrader F, Saigo L, Kubler N, Rana M, Wilkat M Head Face Med. 2025; 21(1):1.

PMID: 39794777 PMC: 11721267. DOI: 10.1186/s13005-024-00477-3.

In Vivo Accuracy of a New Digital Planning System in Terms of Jaw Relation, Extent of Surgical Movements and the Hierarchy of Stability in Orthognathic Surgery.

Stamm T, Andriyuk E, Kleinheinz J, Jung S, Dirksen D, Middelberg C J Pers Med. 2022; 12(5).

PMID: 35629264 PMC: 9147622. DOI: 10.3390/jpm12050843.

Distraction Osteogenesis Versus Orthognathic Surgery: Demystifying Differences in Concepts, Techniques and Outcomes.

Ramanathan M, Kiruba G, Christabel A, Parameswaran A, Kapoor S, Sailer H J Maxillofac Oral Surg. 2020; 19(4):477-489.

PMID: 33071493 PMC: 7524963. DOI: 10.1007/s12663-020-01414-y.

References

Marmulla R, Muhling J, Luth T, Hassfeld S . Physiological shift of facial skin and its influence on the change in precision of computer-assisted surgery. Br J Oral Maxillofac Surg. 2005; 44(4):273-8. DOI: 10.1016/j.bjoms.2005.06.011. View

Mazzoni S, Badiali G, Lancellotti L, Babbi L, Bianchi A, Marchetti C . Simulation-guided navigation: a new approach to improve intraoperative three-dimensional reproducibility during orthognathic surgery. J Craniofac Surg. 2010; 21(6):1698-705. DOI: 10.1097/SCS.0b013e3181f3c6a8. View

Aboul-Hosn Centenero S, Hernandez-Alfaro F . 3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results - our experience in 16 cases. J Craniomaxillofac Surg. 2011; 40(2):162-8. DOI: 10.1016/j.jcms.2011.03.014. View

Patcas R, Markic G, MULLER L, Ullrich O, Peltomaki T, Kellenberger C . Accuracy of linear intraoral measurements using cone beam CT and multidetector CT: a tale of two CTs. Dentomaxillofac Radiol. 2012; 41(8):637-44. PMC: 3528205. DOI: 10.1259/dmfr/21152480. View

Zinser M, Mischkowski R, Sailer H, Zoller J . Computer-assisted orthognathic surgery: feasibility study using multiple CAD/CAM surgical splints. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 113(5):673-87. DOI: 10.1016/j.oooo.2011.11.009. View

Hsu S, Gateno J, Bell R, Hirsch D, Markiewicz M, Teichgraeber J . Accuracy of a computer-aided surgical simulation protocol for orthognathic surgery: a prospective multicenter study. J Oral Maxillofac Surg. 2012; 71(1):128-42. PMC: 3443525. DOI: 10.1016/j.joms.2012.03.027. View

Polley J, Figueroa A . Orthognathic positioning system: intraoperative system to transfer virtual surgical plan to operating field during orthognathic surgery. J Oral Maxillofac Surg. 2013; 71(5):911-20. DOI: 10.1016/j.joms.2012.11.004. View

Venosta D, Sun Y, Matthews F, Kruse A, Lanzer M, Gander T . Evaluation of two dental registration-splint techniques for surgical navigation in cranio-maxillofacial surgery. J Craniomaxillofac Surg. 2013; 42(5):448-53. DOI: 10.1016/j.jcms.2013.05.040. View

Zinser M, Mischkowski R, Dreiseidler T, Thamm O, Rothamel D, Zoller J . Computer-assisted orthognathic surgery: waferless maxillary positioning, versatility, and accuracy of an image-guided visualisation display. Br J Oral Maxillofac Surg. 2013; 51(8):827-33. DOI: 10.1016/j.bjoms.2013.06.014. View

10.

Li B, Zhang L, Sun H, Shen S, Wang X . A new method of surgical navigation for orthognathic surgery: optical tracking guided free-hand repositioning of the maxillomandibular complex. J Craniofac Surg. 2014; 25(2):406-11. DOI: 10.1097/SCS.0000000000000673. View

11.

Chang H, Lin H, Chortrakarnkij P, Kim S, Lo L . Intraoperative navigation for single-splint two-jaw orthognathic surgery: From model to actual surgery. J Craniomaxillofac Surg. 2015; 43(7):1119-26. DOI: 10.1016/j.jcms.2015.06.009. View

12.

Vale F, Scherzberg J, Cavaleiro J, Sanz D, Caramelo F, Malo L . 3D virtual planning in orthognathic surgery and CAD/CAM surgical splints generation in one patient with craniofacial microsomia: a case report. Dental Press J Orthod. 2016; 21(1):89-100. PMC: 4816591. DOI: 10.1590/2177-6709.21.1.089-100.oar. View

13.

Zhang N, Liu S, Hu Z, Hu J, Zhu S, Li Y . Accuracy of virtual surgical planning in two-jaw orthognathic surgery: comparison of planned and actual results. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016; 122(2):143-51. DOI: 10.1016/j.oooo.2016.03.004. View

14.

Shaheen E, Sun Y, Jacobs R, Politis C . Three-dimensional printed final occlusal splint for orthognathic surgery: design and validation. Int J Oral Maxillofac Surg. 2016; 46(1):67-71. DOI: 10.1016/j.ijom.2016.10.002. View

15.

da Silva N, Barriviera M, Junqueira J, Panzarella F, Raitz R . Intraobserver and interobserver reproducibility in linear measurements on axial images obtained by cone-beam computed tomography. Imaging Sci Dent. 2017; 47(1):11-15. PMC: 5370249. DOI: 10.5624/isd.2017.47.1.11. View

16.

Heufelder M, Wilde F, Pietzka S, Mascha F, Winter K, Schramm A . Clinical accuracy of waferless maxillary positioning using customized surgical guides and patient specific osteosynthesis in bimaxillary orthognathic surgery. J Craniomaxillofac Surg. 2017; 45(9):1578-1585. DOI: 10.1016/j.jcms.2017.06.027. View

17.

Ritto F, Schmitt A, Pimentel T, Canellas J, Medeiros P . Comparison of the accuracy of maxillary position between conventional model surgery and virtual surgical planning. Int J Oral Maxillofac Surg. 2017; 47(2):160-166. DOI: 10.1016/j.ijom.2017.08.012. View

18.

Cousley R, Bainbridge M, Rossouw P . The accuracy of maxillary positioning using digital model planning and 3D printed wafers in bimaxillary orthognathic surgery. J Orthod. 2017; 44(4):256-267. DOI: 10.1080/14653125.2017.1383708. View

19.

Chin S, Wilde F, Neuhaus M, Schramm A, Gellrich N, Rana M . Accuracy of virtual surgical planning of orthognathic surgery with aid of CAD/CAM fabricated surgical splint-A novel 3D analyzing algorithm. J Craniomaxillofac Surg. 2017; 45(12):1962-1970. DOI: 10.1016/j.jcms.2017.07.016. View

20.

Dawson P . A classification system for occlusions that relates maximal intercuspation to the position and condition of the temporomandibular joints. J Prosthet Dent. 1996; 75(1):60-6. DOI: 10.1016/s0022-3913(96)90419-9. View