Clinical Accuracy of 3D-Planned Maxillary Positioning Using CAD/CAM-Generated Splints in Combination With Temporary Mandibular Fixation in Bimaxillary Orthognathic Surgery

Overview

Journal Craniomaxillofac Trauma Reconstr

Publisher Sage Publications

Date 2021 Jan 18

PMID 33456700

Citations 4

Authors

S Pietzka

F Mascha

K Winter

P W Kammerer

A Sakkas

A Schramm

F Wilde

Affiliations

Soon will be listed here.

Abstract

Study Design: The aim of this study was to evaluate the accuracy of 3-dimensional (3D)-planned maxillary positioning by using computer-assisted design (CAD)/computer-assisted manufacturing (CAM) splints combined with temporary mandibular fixation in bimaxillary orthognathic surgery. In orthognathic surgery, customized splints work sufficiently well to transfer preoperative planning into the operation site for transverse und sagittal positioning of the maxilla. The vertical positioning is more difficult due to the non-fixed mandibular reference. Therefore, the combined use of CAD/CAM splints and temporary mandibular fixation to the zygomatic region was applied for transferring the 3D-planned maxillary position into the operation site from 2012 until 2015 in our hospital.

Objective: In addition to the general accuracy, the precision should therefore be checked especially in the vertical plane compared to axial and sagittal plane.

Methods: In this retrospective study, we calculated the deviation of 5 occlusal landmarks of the maxilla in 35 consecutive patients by fusing preoperative 3D planning images and postoperative computed tomography scans after bimaxillary surgery.

Results: The overall median deviation of maxillary positioning between plan and surgical result was 0.99 mm. The accuracy of left-right positioning was median 0.96 mm. Anterior-posterior positioning of the maxilla showed a median accuracy of 0.94 mm. Just slightly higher values were determined for the upward-downward positioning (median 1.06 mm).

Conclusions: This demonstrates the predictability of maxillary positioning by using CAD/CAM splints in combination with temporary mandibular fixation in all 3 axes.

Citing Articles

Accuracy Analysis of Computer-Assisted and Guided Dental Implantology by Comparing 3D Planning Data and Actual Implant Placement in a Mandibular Training Model: A Monocentric Comparison between Dental Students and Trained Implantologists.

Ebeling M, Sakkas A, Schramm A, Wilde F, Scheurer M, Winter K J Pers Med. 2023; 13(7).

PMID: 37511650 PMC: 10381824. DOI: 10.3390/jpm13071037.

Accuracy of maxillary repositioning surgery in teaching hospitals using conventional model surgery.

Yari A, Hasheminasab M, Badri A, Tanbakuchi B, Fasih P Oral Maxillofac Surg. 2023; 28(2):935-943.

PMID: 37486423 DOI: 10.1007/s10006-023-01174-2.

Dental Root Injuries Caused by Osteosynthesis Screws in Orthognathic Surgery-Comparison of Conventional Osteosynthesis and Osteosynthesis by CAD/CAM Drill Guides and Patient-Specific Implants.

Pietzka S, Fink J, Winter K, Wilde F, Schramm A, Ebeling M J Pers Med. 2023; 13(5).

PMID: 37240877 PMC: 10221129. DOI: 10.3390/jpm13050706.

Steam-sterilized and degradable fused filament fabrication-printed polylactide/polyhydroxyalkanoate surgical guides for dental implants: Are they accurate enough for static navigation?.

Gielisch M, Heimes D, Thiem D, Boesing C, Krumpholtz M, Al-Nawas B Int J Bioprint. 2023; 9(2):655.

PMID: 37065653 PMC: 10090533. DOI: 10.18063/ijb.v9i2.655.

References

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

Ellis 3rd E . Accuracy of model surgery: evaluation of an old technique and introduction of a new one. J Oral Maxillofac Surg. 1990; 48(11):1161-7. DOI: 10.1016/0278-2391(90)90532-7. View

Hatamleh M, Turner C, Bhamrah G, Mack G, Osher J . Improved Virtual Planning for Bimaxillary Orthognathic Surgery. J Craniofac Surg. 2016; 27(6):e568-73. DOI: 10.1097/SCS.0000000000002877. 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

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

Lin H, Lo L . Three-dimensional computer-assisted surgical simulation and intraoperative navigation in orthognathic surgery: a literature review. J Formos Med Assoc. 2015; 114(4):300-7. DOI: 10.1016/j.jfma.2015.01.017. 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

Schouman T, Rouch P, Imholz B, Fasel J, Courvoisier D, Scolozzi P . Accuracy evaluation of CAD/CAM generated splints in orthognathic surgery: a cadaveric study. Head Face Med. 2015; 11:24. PMC: 4514936. DOI: 10.1186/s13005-015-0082-9. 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

10.

Cevidanes L, Tucker S, Styner M, Kim H, Chapuis J, Reyes M . Three-dimensional surgical simulation. Am J Orthod Dentofacial Orthop. 2010; 138(3):361-71. PMC: 2994415. DOI: 10.1016/j.ajodo.2009.08.026. View

11.

Badiali G, Ferrari V, Cutolo F, Freschi C, Caramella D, Bianchi A . Augmented reality as an aid in maxillofacial surgery: validation of a wearable system allowing maxillary repositioning. J Craniomaxillofac Surg. 2014; 42(8):1970-6. DOI: 10.1016/j.jcms.2014.09.001. View

12.

Swennen G, Mollemans W, Schutyser F . Three-dimensional treatment planning of orthognathic surgery in the era of virtual imaging. J Oral Maxillofac Surg. 2009; 67(10):2080-92. DOI: 10.1016/j.joms.2009.06.007. View

13.

Stokbro K, Aagaard E, Torkov P, Bell R, Thygesen T . Virtual planning in orthognathic surgery. Int J Oral Maxillofac Surg. 2014; 43(8):957-65. DOI: 10.1016/j.ijom.2014.03.011. View

14.

Metzger M, Hohlweg-Majert B, Schwarz U, Teschner M, Hammer B, Schmelzeisen R . Manufacturing splints for orthognathic surgery using a three-dimensional printer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 105(2):e1-7. DOI: 10.1016/j.tripleo.2007.07.040. View

15.

Gander T, Bredell M, Eliades T, Rucker M, Essig H . Splintless orthognathic surgery: a novel technique using patient-specific implants (PSI). J Craniomaxillofac Surg. 2015; 43(3):319-22. DOI: 10.1016/j.jcms.2014.12.003. View

16.

Jaisinghani S, Adams N, Mann R, Polley J, Girotto J . Virtual Surgical Planning in Orthognathic Surgery. Eplasty. 2017; 17:ic1. PMC: 5238634. View

17.

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

18.

Xia J, Gateno J, Teichgraeber J, Christensen A, Lasky R, Lemoine J . Accuracy of the computer-aided surgical simulation (CASS) system in the treatment of patients with complex craniomaxillofacial deformity: A pilot study. J Oral Maxillofac Surg. 2007; 65(2):248-54. DOI: 10.1016/j.joms.2006.10.005. View

19.

Zinser M, Sailer H, Ritter L, Braumann B, Maegele M, Zoller J . A paradigm shift in orthognathic surgery? A comparison of navigation, computer-aided designed/computer-aided manufactured splints, and "classic" intermaxillary splints to surgical transfer of virtual orthognathic planning. J Oral Maxillofac Surg. 2013; 71(12):2151.e1-21. DOI: 10.1016/j.joms.2013.07.007. View

20.

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