Can electromagnetic-navigated maxillary positioning replace occlusional splints in orthognathic surgery? A clinical pilot study

Berger, Moritz; Nova, Igor; Kallus, Sebastian; Ristow, Oliver; Freudlsperger, Christian; Eisenmann, Urs; Dickhaus, Hartmut; Engel, Michael; Hoffmann, Jürgen; Seeberger, Robin

doi:10.1016/j.jcms.2017.08.005

Cited by 19 publications

(18 citation statements)

References 24 publications

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“…For navigation using the electromagnetic (EM) tracking, Berger, et al [32] reported that the mean absolute deviation ascertained by EM tracking was 0.9 mm after maxillary repositioning using EM navigation in phantom skulls. In a clinical pilot study using EM tracking by the same study group, the mean absolute deviations of the maxilla were 1.0 mm on the x-axis, 0.9 mm on the y-axis, and 1.2 mm on the z-axis in the intraoperative navigation, and the RMSD was 2.1 mm [26]. Unlike navigation-assisted orthognathic surgery, where a number of surgical accuracy assessments have been reported, there are few studies on surgical accuracy for robot and navigation assisted surgery.…”

Section: Discussionmentioning

confidence: 97%

“…Lee, et al [23] developed an image-guided orthognathic surgical system for repositioning the maxillomandibular complex. However, stabilization and fixation of the movable bone segment while holding the bone segment in the target position is challenging in navigation assisted orthognathic surgery [7,26,27]. Although various temporary support of the mobilized maxillary segment can be used, drilling on an unstable maxillary segment and the unsuitability of the plate bending may influence the repositioning accuracy.…”

Section: Discussionmentioning

confidence: 99%

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A Robot Arm and Image-Guided Navigation Assisted Surgical System for Maxillary Repositioning in Orthognathic Surgery: A Phantom Skull-Based Trial

Han

Woo

et al. 2020

Applied Sciences

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This study aimed to present a simplified and safe method to reposition the bone segment with easy identification and removing bone interference using a robot arm and image-guided navigation and to assess the accuracy for maxillary orthognathic surgery on phantom skulls. A surgical system consists of a robot arm with specialized end-effector, and image-guided navigation including the optical tracking system. The end-effector was designed to reflect the surgical procedures including identification and removal of bone interference and repositioning of the bone segment. To evaluate the handling and accuracy of this system, 10 phantom-based experiments were conducted according to four surgical plans. Mean absolute deviations at the upper central incisor were 0.10 ± 0.15 mm medio-laterally, 0.05 ± 0.07 mm antero-posteriorly, and 0.12 ± 0.15 mm supero-inferiorly. There was no significant difference in deviations between anterior and posterior regions of the maxilla. The mean root mean square deviation was 0.18 ± 0.16 mm, and ranged from 0.05 mm to 0.54 mm. The robot arm and image-guided navigation assisted surgical system would be helpful to manage bone interferences and reposition bone segments with improved accuracy. Though further technological advances are necessary, this study may provide a basis for developing clinically applicable robot assisted system for orthognathic surgery.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

A Robot Arm and Image-Guided Navigation Assisted Surgical System for Maxillary Repositioning in Orthognathic Surgery: A Phantom Skull-Based Trial

Han

Woo

et al. 2020

Applied Sciences

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“…For the commercial optical surgical navigation system, the acceptable error values of the entry and end points are approximating 1.50 mm and the maximum angular deviation error is about 3°. Unfortunately, the surgeons must position patients and trackers for direct line of sight to the overhead cameras in them and overcome the challenges of a strong possibility of being contaminated by patients' blood and disruption to the line of sight 10‐12 …”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, the surgeons must position patients and trackers for direct line of sight to the overhead cameras in them and overcome the challenges of a strong possibility of being contaminated by patients' blood and disruption to the line of sight. [10][11][12] Compared with the optical-tracking systems, EM SNSs exhibit great advantages in the absence of line-of-sight hindrance, outstanding flexibility and consumption reduction due to the property of magnetic fields to penetrate human tissue and reusable small-size sensors. Several companies (Medtronic; KARL STORZ) have introduced their commercial EM navigation systems Fusion™ ENT for otorhinolaryngology surgeries and NAV1 ® electromagnetic for endoscopic surgeries.…”

Section: Introductionmentioning

confidence: 99%

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An electromagnetic tracking implantation navigation system in dentistry with virtual calibration

Gao

Qin

Tao

et al. 2021

Robotics Computer Surgery

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Background Dental implant placement navigation systems based on optical tracking have been widely used in clinics. However, electromagnetic (EM) navigation method that does not suffer from problems of hidden line‐of‐light has not yet been described. Methods This work proposes an EM‐guided navigation method named TianShu‐ESNS with virtual calibration. Model (12 implants) and animal experiments (pig head: six implants) were conducted to evaluate its performance and stability. Result The mean virtual calibration error was 0.83 ± 0.20 mm. The mean deviations at the entry point, end point and angle in the phantom experiment of TianShu‐ESNS were 1.23 ± 0.17 mm, 1.59 ± 0.20 mm and 1.83 ± 0.27°, respectively. In the animal experiment, the same deviations were 1.25 ± 0.07 mm, 1.57 ± 0.35 mm and 1.90 ± 0.60°, respectively. Conclusions The experimental results show that TianShu‐ESNS with the virtual calibration method could serve as a promising tool to eliminate the line‐of‐light hidden problem and simplify operation procedure in dental implant placement.

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A hybrid registration method using the mandibular bone surface for electromagnetic navigation in mandibular surgery

et al. 2022

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Purpose To utilize navigated mandibular (reconstructive) surgery, accurate registration of the preoperative CT scan with the actual patient in the operating room (OR) is required. In this phantom study, the feasibility of a noninvasive hybrid registration method is assessed. This method consists of a point registration with anatomic landmarks for initialization and a surface registration using the bare mandibular bone surface for optimization. Methods Three mandible phantoms with reference notches on two osteotomy planes were 3D printed. An electromagnetic tracking system in combination with 3D Slicer software was used for navigation. Different configurations, i.e., different surface point areas and number and configuration of surface points, were tested with a dentate phantom (A) in a metalfree environment. To simulate the intraoperative environment and different anatomies, the registration procedure was also performed with an OR bed using the dentate phantom and two (partially) edentulous phantoms with atypical anatomy (B and C). The accuracy of the registration was calculated using the notches on the osteotomy planes and was expressed as the target registration error (TRE). TRE values of less than 2.0 mm were considered as clinically acceptable. Results In all experiments, the mean TRE was less than 2.0 mm. No differences were found using different surface point areas or number or configurations of surface points. Registration accuracy in the simulated intraoperative setting was-mean (SD)-0.96 (0.22), 0.93 (0.26), and 1.50 (0.28) mm for phantom A, phantom B, and phantom C. Conclusion Hybrid registration is a noninvasive method that requires only a small area of the bare mandibular bone surface to obtain high accuracy in phantom setting. Future studies should test this method in clinical setting during actual surgery.

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Can electromagnetic-navigated maxillary positioning replace occlusional splints in orthognathic surgery? A clinical pilot study

Cited by 19 publications

References 24 publications

A Robot Arm and Image-Guided Navigation Assisted Surgical System for Maxillary Repositioning in Orthognathic Surgery: A Phantom Skull-Based Trial

A Robot Arm and Image-Guided Navigation Assisted Surgical System for Maxillary Repositioning in Orthognathic Surgery: A Phantom Skull-Based Trial

An electromagnetic tracking implantation navigation system in dentistry with virtual calibration

A hybrid registration method using the mandibular bone surface for electromagnetic navigation in mandibular surgery

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