2020. The preoperative virtual surgical plan and postoperative cone beam computed tomographic scan were registered in 3-Matic software (Materialise, Leuven, Belgium) using cranial base landmarks. The conformity of the postoperative skull model to the virtual surgical plan was quantified using linear and angular measurements at various 3D bony landmarks. The average mean difference (AMD) in the x-, y-, and z-axes was calculated. Paired T-tests were used to compare postoperative measurements with those from the preoperative STL. Multivariate linear regression was performed to analyze and modifying effects of age, gender, number of segments (2 vs. 3), and malocclusion class.Results: Twenty-nine patients were included (mean age 24.5 years; 72.4% female). Three-dimensional analysis showed significant AMD between the virtual plan and postop CBCT for the following landmarks: U1 Midpoint (y, AMD: 1.65mm, P = .03), B point (y, AMD: 1.63mm, P = .005), pogonion (y, AMD: 2.38mm, P = .0005), menton (y, AMD: 2.22mm, P = .0003). There were no differences between the virtual plans and postop CBCT at any other points. Transversely, the overall AMD was 1.15mm, with under-expansion occurring in 79.3% (2.18mm) and over-expansion in 20.7% of patients (1.65mm). Angular measurements revealed statistical significance for SNB (AMD: 1.38, P = .02), but not for SNA and ANB values. Multivariate regression showed no association between age, gender, segmentation (2 vs. 3), or class of malocclusion and the extent of conformity for any measurements.Conclusion: There is a high degree of conformity between the VSP and postoperative results following triple jaw orthognathic surgery with segmental maxillary osteotomies. The greatest nonconformity was found in the sagittal plane and was mostly limited to the mandible. Segmentation did not affect surgical accuracy of the maxillary movements.
Freeze-dried cortical bone can be used as a biological plate, either alone or in combination with other internal fixation devices, to stabilize fractures. In addition to it conferring mechanical stability, freeze-dried cortical bone may enhance fracture-healing and increase the bone stock. This study examined the effect of a freeze-dried allograft cortical bone plate (FACBP) on the biomechanical properties of an implant site in a canine bone defect model. Twelve adult mongrel dogs (around 4.8 kg) were used. A segmental critical-size defect (5 mm in length) at ulna diaphysis was created using an oscillating saw. The experimental animals were divided into two groups: eight dogs treated with an absorbable bone plate (FACBP) fixed by metal bone screws (Group A) and four dogs treated with a commercial stainless steel bone plate and metal bone screws (Group B). Bone healing was assessed by radiography, Dual-energy x-ray absorptiometry and a three-point bending test. The FACBP incorporated in the host bone produced complete remodeling of the cortical bone. There was no significant difference in the bone mineral density and biomechanical tests between the FACBP application site and normal ulna or a stainless steel bone plate of the ulna. These results suggest that FACBP facilitates recovery from a bone fracture by assisting in the induction of new bone formation in a defected fracture.
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