Many Moving Pieces: Virtual Preoperative Surgical Planning for Traumatic Occlusal Splints

Abstract

Introduction:Achieving anatomic reduction and re-establishing premorbid occlusion in patients with complex maxillomandibular fractures is challenging even for seasoned surgeons. Historically, surgeons have utilized occlusal splints to help establish occlusal relationships before fracture reduction and fixation. These acrylic splints are fabricated from dental impressions and require manual repositioning of tooth bearing segments along the fracture line to reapproximate premorbid occlusion. The process is laborious, requires a dental lab, and is less efficacious in edentulous patients or those with significantly comminuted fractures; as such it has largely fallen out of practice. Recently, with advances in virtual 3D modeling and printing, we demonstrate that occlusal splints can be designed from computed tomography scans, manipulated virtually, and printed without obtaining impressions from the patient.Methods/Results:In our series of 3 patients with complex maxillomandibular fractures, occlusal splints were created by 1) obtaining maxillofacial computed tomography scans, 2) reducing the fractures virtually, and 3) using orthognathic virtual surgery software to create the splint. The time between planning and delivery of the splint was 4 to 7 days. These splints were successfully utilized to help establish premorbid occlusion in conjunction with maxillomandibular fixation and aided in expeditious intraoperative fracture reduction and fixation.Conclusions:In the treatment of complex facial fractures, occlusal splints can be a useful adjunct in the operative reduction and fixation of fractures. With the advent of virtual preoperative surgical planning via 3D modeling and 3D printing, these occlusal splints can be created of a sufficient fidelity to avoid the strict need for dental impressions.

Control of Mandibular Width With 3D Printed Occlusal Splint in Children With Multiple Mandibular Fractures

“…The 3D printed occlusal splint can be used as an intraoperative reference to verify whether the mandibular reduction is in place 24 . It controls the adduction of the mandible through the placement of the teeth.…”

“…[20][21][22][23] The 3D printed occlusal splint can be used as an intraoperative reference to verify whether the mandibular reduction is in place. 24 It controls the adduction of the mandible through the placement of the teeth. However, it needs to design a mandibular restored model and simulate occlusion before operation.…”

Automatic segmentation of inconstant fractured fragments for tibia/fibula from CT images using deep learning

“…3. Normally, most surgeons identify fractured fragments using only 2D/3D CT images during diagnosis or preoperative surgical planning [40][41][42][43][44][45][46] . Moreover, although there are several dedicated software and 3D modeling tools, few orthopaedic surgeons perform manual segmentation with a long working time (approximately 2-3 h) before trauma surgery, except for research purposes or the fabrication of patientspecific devices [40][41][42][43] .…”

“…The core point of clinical support ability in the results section is the recognition of fractured fragments within a short time under actual clinical conditions [41][42][43][44][45][46] . Recognition of fractured fragments is defined as the ability to classify the object class, such as the number of fragments, and it is a lower-level concept than identification, which is the ability to describe the object in detail, such as the size of the fragment and its location and shape.…”

“…Orthopedic trauma includes several fractures with various patterns and conditions. In particular, a highly complex comminuted fracture makes it difficult for surgeons to perform reduction and the operation is timeconsuming [41][42][43][44][45][46] . Therefore, surgeons typically want to correctly identify bone fragments before surgery using 2D/3D CT images 41,43 .…”