Objective: To validate the accuracy of a cone-beam computed tomography (CBCT)-guided surgical stent for orthodontic mini-implant (OMI) placement by quantitatively evaluating the difference between CBCT-prescribed and actual position of mini-implants in preoperative and postoperative CBCT images. Materials and Methods: A surgical stent was fabricated using Teflon-Perfluoroalkoxy, which has appropriate biological x-ray attenuation properties. Polyvinylsiloxane impression material was used to secure the custom-made surgical stent onto swine mandibles. CBCT scanning was done with the stent in place to virtually plan mini-implants using a three-dimensional (3D) software program. An appropriate insertion point was determined using 3D reconstruction data, and the vertical and horizontal angulations were determined using four prescribed angles. A custom-designed surveyor was used to drill a guide hole within the surgical stent as prescribed on the CBCT images for insertion of 32 OMIs. The mandibles with a surgical stent in place were rescanned with CBCT to measure the deviations between the virtual planning data and surgical results. Results: The difference between the prescribed and actual vertical angle was 1.01 6 7.25, and the horizontal difference was 1.16 6 6.08. The correlation coefficient confirms that there was no intrarater variability in either the horizontal (R 5 .97) or vertical (R 5 .74) vectors. Conclusions: The surgical stent in this study guides mini-implants to the prescribed position as planned in CBCT. Since the statistical difference was not significant, the surgical stent can be considered to be an accurate guide tool for mini-implant placement in clinical use. (Angle Orthod. 2012;82:275-283.)
In scissors bite cases, a good diagnosis will help the clinician to decide whether treatment should involve orthognathic surgery. The authors have shown a case that was corrected with surgery and a case that was corrected using TSAD anchors. Treatment planning must include evaluation of the basal arch width of maxilla and mandible in class I occlusion, any skeletal asymmetry concomitant with a mandibular shift, the inclinations or atypical eruption degree of the posterior teeth, and the number of teeth involved in the scissors bite.
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