A Complete Digital Workflow for Planning, Simulation, and Evaluation in Orthognathic Surgery

Abstract

The purpose of this study was to develop a complete digital workflow for planning, simulation, and evaluation for orthognathic surgery based on 3D digital natural head position reproduction, a cloud-based collaboration platform, and 3D landmark-based evaluation. We included 24 patients who underwent bimaxillary orthognathic surgery. Surgeons and engineers could share the massive image data immediately and conveniently and collaborate closely in surgical planning and simulation using a cloud-based platform. The digital surgical splint could be optimized for a specific patient before or after the physical fabrication of 3D printing splints through close collaboration. The surgical accuracy was evaluated comprehensively via the translational (linear) and rotational (angular) discrepancies between identical 3D landmarks on the simulation and postoperative computed tomography (CT) models. The means of the absolute linear discrepancy at eight tooth landmarks were 0.61 ± 0.55, 0.86 ± 0.68, and 1.00 ± 0.79 mm in left–right, advance–setback, and impaction–elongation directions, respectively, and 1.67 mm in the root mean square direction. The linear discrepancy in the left–right direction was significantly different from the other two directions as shown by analysis of variance (ANOVA, p < 0.05). The means of the absolute angular discrepancies were 1.43 ± 1.06°, 0.50 ± 0.31°, and 0.58 ± 0.41° in the pitch, roll, and yaw orientations, respectively. The angular discrepancy in the pitch orientation was significantly different from the other two orientations (ANOVA, p < 0.05). The complete digital workflow that we developed for orthognathic patients provides efficient and streamlined procedures for orthognathic surgery and shows high surgical accuracy with efficient image data sharing and close collaboration.

Effect of occlusal coverage depths on the precision of 3D-printed orthognathic surgical splints

“…In recent years, computer-aided design and computer-aided manufacturing (CAD/CAM) splints have been widely applied in surgical-orthodontic treatment. The splints are often produced in professional software by a Boolean operation which subtracts the digital dentition from the blank splints [ 3 , 8 , 31 ]. Theoretically, splints generated by the Boolean operation have exact indentations of the digital models and thus can be fully fitted on the model.…”

Differentiable Simulation for Outcome‐Driven Orthognathic Surgery Planning

“…Orthognathic surgery is planned by an interdisciplinary team of surgeons, orthodontists and technicians. In its first stage, landmarks are identified on the soft‐tissue and bony surface [RMV*20, LYW*21, Rey10]. The inter‐landmark distances are compared to optimal reference values, which allows the treatment goal to be defined [PP70,Ste60,And15].…”

“…Many software products have been built to facilitate VSP [LL15]. There are ongoing efforts to create a unified environment for performing all the necessary tasks of VSP, including medical image registration, 3D surface extraction, cephalometric analysis, virtual osteotomy, interactive bone movement, and post‐operative soft‐tissue prediction [LYW*21, YML*17]. Despite the value provided by outcome predictions, clinical software seldom supports the generation of simuation‐based predictions.…”

“…Planning orthognathic surgery is labour intensive, and necessitates the collaboration of an interdisciplinary medical and technical team [CMF*21, LYW*21]. This team determines the goals of the treatment, i.e.…”