A new approach of splint-less orthognathic surgery using a personalized orthognathic surgical guide system: A preliminary study

Abstract

The purpose of this study was to evaluate a personalized orthognathic surgical guide (POSG) system for bimaxillary surgery without the use of surgical splint. Ten patients with dentofacial deformities were enrolled. Surgeries were planned with the computer-aided surgical simulation method. The POSG system was designed for both maxillary and mandibular surgery. Each consisted of cutting guides and three-dimensionally (3D) printed custom titanium plates to guide the osteotomy and repositioning the bony segments without the use of the surgical splints. Finally, the outcome evaluation was completed by comparing planned outcomes with postoperative outcomes. All operations were successfully completed using the POSG system. The largest root-mean-square deviations were 0.74 mm and 1.93° for the maxillary dental arch, 1.10 mm and 2.82° for the mandibular arch, 0.83 mm and 2.59° for the mandibular body, and 0.98 mm and 2.45° for the proximal segments. The results of the study indicated that our POSG system is capable of accurately and effectively transferring the surgical plan without the use of surgical splint. A significant advantage is that the repositioning of the bony segments is independent to the mandibular autorotation, thus eliminates the potential problems associated with the surgical splint.

Accuracy of 3D virtual surgical planning for maxillary positioning and orientation in orthognathic surgery

“…The examinations were obtained at two intervals as part of the surgical protocol: 1‐month preoperatively to assist diagnostics and 3D VSP, and 1‐month postoperatively, to ascertain early surgery outcomes . The patients were instructed to adopt a natural head position (NHP) by looking at their own eyes in a mirror on the opposite wall, with their tongues and lips at rest, breathing lightly and avoiding swallowing during image acquisition .…”

A precisão da cirurgia ortognática com placas de titânio personalizadas: revisão sistemática

“…Okumura e colaboradores foram os primeiros a apresentar o uso da tomografia computadorizada e modelos escaneados no auxílio ao planejamento e reposicionamento cirúrgico (OKUMURA et al, 1999). Esta ciência foi aprimorada com os estudos de Jaime Gateno e James Xia (GATENO et al, 2003XIA, 2003;XIA et al, 2007;XIA;TEICHGRAEBER, 2005), e Gwen Swennen (SWENNEN et al, 2007 (HEUFELDER et al, 2017;KIM et al, 2019;LI et al, 2017;MAZZONI et al, 2015;STOKBRO et al, 2019).…”

“…Algumas desvantagens são o maior custo operacional, maior tempo de planejamento e produção dos guias e placas (HEUFELDER et al, 2017;LI et al, 2017). As placas customizadas representam uma das tecnologias mais recentes em cirurgia ortognática, que necessita de uma série de estudos para comprovar sua eficácia clínica.…”

“…As placas customizadas representam uma das tecnologias mais recentes em cirurgia ortognática, que necessita de uma série de estudos para comprovar sua eficácia clínica. Alguns autores defendem seu uso e apresentam resultados positivos em relação à precisão cirúrgica promovida por elas (BRUNSO et al, 2016(BRUNSO et al, , 2017HEUFELDER et al, 2017;KIM et al, 2019;LI et al, 2017;MAZZONI et al, 2015). Entretanto, não existem revisões sistemáticas ou estudos clínicos randomizados que respondem se a precisão promovida pelas placas customizadas é igual ou superior aos tratamentos já bem estabelecidos.…”

“…Several techniques are used to increase surgical precision in relation to virtual planning, including surgical guided navigation (Mazzoni et al, 2010), CAD-CAM repositioning guides (Zinser et al, 2012), and more recently, customized titanium plates (Philippe, 2013a(Philippe, , 2013bGander et al, 2015;Mazzoni et al, 2015;Brunso et al, 2016Brunso et al, , 2017Heufelder et al, 2017;Li et al, 2017;Kim et al, 2019). Customized titanium plates are based on surgical guide-oriented osteotomies, capable of repositioning bone segments without an occlusal splint (Mazzoni et al, 2015;Brunso et al, 2016;Heufelder et al, 2017;Li et al, 2017). Treatment with these plates has some advantages, such as shorter surgical time, greater vertical control and the absence of an occlusal splint or intermaxillary block during surgery (Brunso et al, 2016).…”