Accuracy of splint vs splintless technique for virtually planned orthognathic surgery: A voxel-based three-dimensional analysis

Karanxha, Lorena; Rossi, Diego; Hamanaka, Ryo; Giannì, Aldo Bruno; Baj, A.; Moon, Won; Fabbro, Massimo Del; Romano, M.

doi:10.1016/j.jcms.2020.11.008

Cited by 29 publications

(23 citation statements)

References 52 publications

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“…A total of 566 patients from 21 articles were included for this systematic review. Eleven articles had a prospective study design [ 13 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ], of which five were randomized [ 31 , 34 , 36 , 37 , 38 ], four were clinical trials [ 31 , 34 , 36 , 38 ] and two were multi-center [ 34 , 38 ]. The study characteristics are presented in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Sixteen records evaluated the accuracy of PSI for the maxilla [ 13 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ], out of which eight exclusively focused on non-segmental Le Fort I procedures [ 31 , 32 , 34 , 36 , 38 , 43 , 45 , 46 ] and two on non-segmental Le Fort I procedures in conjunction with the accuracy of PSI for mandibular osteotomies [ 13 , 39 ]. Six studies included mixed single and segmental Le Fort I osteotomies [ 33 , 37 , 40 , 41 , 42 ]. One of the included studies investigated exclusively segmental Le Fort I osteotomies [ 44 ].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Three-Dimensional Accuracy and Stability of Personalized Implants in Orthognathic Surgery: A Systematic Review and a Meta-Analysis

Diaconu¹,

Holte

Berg‐Beckhoff

et al. 2023

JPM

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This systematic review aimed to determine the accuracy/stability of patient-specific osteosynthesis (PSI) in orthognathic surgery according to three-dimensional (3D) outcome analysis and in comparison to conventional osteosynthesis and computer-aided designed and manufactured (CAD/CAM) splints or wafers. The PRISMA guidelines were followed and six academic databases and Google Scholar were searched. Records reporting 3D accuracy/stability measurements of bony segments fixated with PSI were included. Of 485 initial records, 21 met the eligibility (566 subjects), nine of which also qualified for a meta-analysis (164 subjects). Six studies had a high risk of bias (29%), and the rest were of low or moderate risk. Procedures comprised either single-piece or segmental Le Fort I and/or mandibular osteotomy and/or genioplasty. A stratified meta-analysis including 115 subjects with single-piece Le Fort I PSI showed that the largest absolute mean deviations were 0.5 mm antero-posteriorly and 0.65° in pitch. PSIs were up to 0.85 mm and 2.35° more accurate than conventional osteosynthesis with CAD/CAM splint or wafer (p < 0.0001). However, the clinical relevance of the improved accuracy has not been shown. The literature on PSI for multi-piece Le Fort I, mandibular osteotomies and genioplasty procedure is characterized by high methodological heterogeneity and a lack of randomized controlled trials. The literature is lacking on the 3D stability of bony segments fixated with PSI.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Three-Dimensional Accuracy and Stability of Personalized Implants in Orthognathic Surgery: A Systematic Review and a Meta-Analysis

Diaconu¹,

Holte

Berg‐Beckhoff

et al. 2023

JPM

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show abstract

“…[8][9][10] To encounter these shortcomings of the 3D analysis, superimposition techniques have been introduced for 3D analysis of the postoperative outcome of corrective jaw surgery, orthognathic surgery. [11][12][13] These techniques facilitate registration of two consecutive uni-or multimodal scans based on a reference structure. Using mutual image information (voxel-based registration (VBR)), surface similarity (surface-based registration (SBR)), or landmark similarity (landmark-based registration (LBR)), two scans or 3D objects can be superimposed.…”

Section: Introductionmentioning

confidence: 99%

“…19,21,22 For the analysis of the surgical outcome of orthognathic surgery the anterior cranial base, including the zygomatic arches and forehead, structures unaffected by surgery, have shown to be reliable references for superimposition, 18 and are therefore often used. 22 Although superimposition has shown to be efficient and reliable for skeletal assessment of orthognathic surgery, [11][12][13] this technique has only been sparsely adopted for UA analysis. [23][24][25][26][27][28][29][30][31][32] The majority of these studies used CBCT as the imaging technique, dividing the UA into three segments using cutting planes and measuring the UA volume and CSA.…”

Section: Introductionmentioning

confidence: 99%

A semi-automatic approach for longitudinal 3D upper airway analysis using voxel-based registration

Diaconu

Holte

Cattaneo

et al. 2022

Dentomaxillofacial Radiology

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Objectives: To propose and validate a reliable semi-automatic approach for three-dimensional (3D) analysis of the upper airway (UA) based on voxel-based registration (VBR). Methods: Post-operative cone beam computed tomography (CBCT) scans of ten orthognathic surgery patients were superimposed to the pre-operative CBCT scans by VBR using the anterior cranial base as reference. Anatomic landmarks were used to automatically cut the UA and calculate volumes and cross-sectional areas (CSA). The 3D analysis was performed by two observers twice, at an interval of two weeks. Intraclass correlations and Bland-Altman plots were used to quantify the measurement error and reliability of the method. The relative Dahlberg error was calculated and compared with a similar method based on landmark re-identification and manual measurements. Results: Intraclass correlation coefficient (ICC) showed excellent intra- and inter observer reliability (ICC ≥0.995). Bland-Altman plots showed good observer agreement, low bias and no systematic errors. The relative Dahlberg error ranged between 0.51–4.30% for volume and 0.24–2.90% for CSA. This was lower when compared with a similar, manual method. Voxel-based registration introduced 0.05–1.44% method error. Conclusions: The proposed method is shown to have excellent reliability and high observer agreement. The method is feasible for longitudinal clinical trials on large cohorts due to being semi-automatic.

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“…Although this is new technology, several authors have already reported improved final surgical accuracy when using VSP and patient-specific custom plates compared to VSP and stereolithographic splints. 10,11,12 The purpose of this paper is to report the senior author's experience over the past 3 years using VSP and custom patient-specific implants in orthognathic surgery cases and compare these cases to a prior cohort of orthognathic surgical patients who underwent VSP without custom plates. Most importantly, we seek to specifically describe the learning curve and technical adaptations that we have implemented both in the planning and execution phases to improve intraoperative efficiency with this new technology.…”

mentioning

confidence: 99%

Custom Plates in Orthognathic Surgery: A Single Surgeon’s Experience and Learning Curve

Fleury

Sayyed

Baker

2022

Journal of Craniofacial Surgery

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Background: Virtual surgical planning (VSP) now allows for the fabrication of custom plates in orthognathic surgery. The senior author was an early adopter, using VSP and stereolithographic splints for over a decade, before transitioning to custom plates in 2019. The authors present our experience and learning curve with this new technology and compare results to a prior cohort of orthognathic patients. Methods: A retrospective chart review identified patients undergoing orthognathic surgery with the senior author between 2016 and 2021. All underwent VSP and stereolithographic splint formation, and then either traditional or custom-plate fixation. Demographics, perioperative variables, and postoperative outcomes were analyzed. Traditional fixation consisted of craniomaxillofacial plates, bent intraoperatively by the surgeon to adapt to the facial skeleton. Custom plates were prefabricated and prebent to fit drill holes outlined by customized cutting guides. Results: Forty-three patients underwent surgery in the study period, 25 (58.1%) with traditional fixation hardware and 18 (41.9%) with custom plates. The surgical technique evolved throughout the custom-plate cohort, with the most recent technique involving custom maxillary plate fixation and traditional mandibular plate fixation. When comparing this group of patients to the prior cohort of traditional fixation patients, operative time significantly decreased (mean 233 minutes versus 283 minutes, P = 0.044), without significant difference in complications. Conclusions: Patient-specific cutting guides and custom plates allow for precise spatial positioning of the osteotomized jaw in the orthognathic surgery. Unsurprisingly, obstacles must be overcome in adopting this new technology; here, we outline our experience and technical modifications that have resulted in increased surgical efficiency with comparable outcomes.

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Accuracy of splint vs splintless technique for virtually planned orthognathic surgery: A voxel-based three-dimensional analysis

Cited by 29 publications

References 52 publications

Three-Dimensional Accuracy and Stability of Personalized Implants in Orthognathic Surgery: A Systematic Review and a Meta-Analysis

Three-Dimensional Accuracy and Stability of Personalized Implants in Orthognathic Surgery: A Systematic Review and a Meta-Analysis

A semi-automatic approach for longitudinal 3D upper airway analysis using voxel-based registration

Custom Plates in Orthognathic Surgery: A Single Surgeon’s Experience and Learning Curve

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