Accuracy of Intentional Change of Frontal Ramal Inclination From Virtual to Actual Orthognathic Surgery Using Computer-Aided Design and Computer-Aided Manufacturing-Made Customized Metal Plates

Woo, M.H.; Youn, Sungbin; Woo, Jae-Man; Baek, Seung‐Hak; Choi, Jin-Young

doi:10.1097/scs.0000000000008174

Cited by 2 publications

(4 citation statements)

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“…In addition, through this process, maxillomandibular complex can be adjusted to be symmetrical to the patient's true sagittal plane. 27,28 These are possible because the true sagittal plane and the horizontal plane can be used as a reference by reorienting the patient's skull image to suit the patient's NHP. 29 Furthermore, intentional changes of FRI can be possible to correct facial asymmetry by VSP software.…”

Section: Discussionmentioning

confidence: 99%

“…Considering these aspects, it can be seen that all limitations of the conventional orthognathic method can be overcome by applying VSP and CAD/CAM technologies to the treatment of patients with facial asymmetry. [27][28][29] To obtain these excellent results, it can be said that the most important process is to set the patient's NHP well and reorient the skull image accordingly. If the NHP setting is incorrect, reorientation will be inaccurate, and if the patient's midline cannot be coordinated in the true sagittal plane due to incorrect reorientation, the left-right symmetry achieved through VSP will not be symmetric in the actual patient's face.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, all patients recognized that facial asymmetry was highly improved and was satisfied with the results of the surgery. Considering these aspects, it can be seen that all limitations of the conventional orthognathic method can be overcome by applying VSP and CAD/CAM technologies to the treatment of patients with facial asymmetry 27–29 . To obtain these excellent results, it can be said that the most important process is to set the patient’s NHP well and reorient the skull image accordingly.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, existing cant and yaw can be corrected perfectly by additional revision after positioning the maxillomandibular complex as a surgical plan. In addition, through this process, maxillomandibular complex can be adjusted to be symmetrical to the patient’s true sagittal plane 27,28 . These are possible because the true sagittal plane and the horizontal plane can be used as a reference by reorienting the patient’s skull image to suit the patient’s NHP 29 …”

Section: Discussionmentioning

confidence: 99%

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The Accuracy and Stability of Intentional Change of Frontal-Ramal Inclination in Orthognathic Surgery for Facial Asymmetry Patients

Meny

Jeong³

et al. 2023

Journal of Craniofacial Surgery

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Facial asymmetry can be defined as differences in the left and right sides of the face, and most of the patients with facial asymmetry have different left and right frontal-ramal inclinations (FRIs). Restoring the symmetry of both FRIs is important in the surgery of facial asymmetry patients, but it is very difficult to achieve perfect symmetry through conventional orthognathic surgery. However, by using 3-dimensional (3D) virtual planning and CAD/CAM technolo gies, intentional change of FRIs can be possible so the symmetry can be improved. The purpose of this study is to evaluate the surgical accuracy and long-term stability of intentional change of FRIs by 3D virtual surgery, CAD/CAM-assisted orthognathic surgery for patients with facial asymmetry. The study included 20 patients who had undergone orthognathic surgery for skeletal class III malocclusion from January 2019 to December 2021. To evaluate the accuracy of surgery, 3D facial cone beam computed tomography (CBCT) taken immediately after surgery (T1) and virtual surgery data (Tv) were measured and the difference values were calculated. The evaluation of the long-term stability of intentional change of FRI was performed by measuring T1 and T2 (3D facial cone beam computed tomography images taken 6 mo after surgery) and the difference values were calculated. The difference values of FRIs in the left and right proximal segments of each patient were calculated. And then, for comparison depending on the direction of rotation, increased FRI groups (n=20, medial rotation) and decreased FRI groups (n=20, lateral rotation) were analyzed separately. As a result, all difference values at both (ΔT1−Tv) and (ΔT2−T1) were <1 degree. As a result of analyzing the entire FRI by dividing it into decreasing and increasing groups, the mean value of (ΔT1−Tv) was 0.225 degrees for the decreasing group and 0.275 degrees for the increasing group. It means that the proximal segment moved less than the movement implemented by the virtual surgery through actual surgery but it shows a very small error, which means that the overall operation almost accurately implements the virtual surgical planning. Compared with (ΔT1−Tv), the mean value of (ΔT2−T1) showed a much smaller error value, and no specific tendency was observed. This indicates that the stability after surgery is very good. Based on this study, using 3D virtual surgery planning and CAD/CAM technologies for treating patients with facial asymmetry was very useful, and surgery could be performed accurately and predictably. In particular, left-right symmetry was almost perfectly achieved through virtual simulation and could be implemented through actual surgery. Therefore, it can be said that the use of these 3D technologies is recommended for the surgical approach of facial asymmetry.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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