The accuracy and stability of the maxillary position after orthognathic surgery using a novel computer-aided surgical simulation system

Abstract

BackgroundMany reports have been published on orthognathic surgery (OGS) using computer-aided surgical simulation (CASS). The purpose of this study was to evaluate the accuracy of the maxillary repositioning and the stability of the maxilla in patients who underwent OGS using a newly developed CASS program, a customized osteotomy guide, and a customized miniplate.MethodsThirteen patients who underwent OGS from 2015 to 2017 were included. All patients underwent a bimaxillary operation. First, a skull-dentition hybrid 3D image was rendered by merging the cone beam computed tomography (CBCT) images with the dentition scan file. After virtual surgery (VS) using the FaceGide® program, patient-customized osteotomy guides and miniplates were then fabricated and used in the actual operation. To compare the VS with the actual surgery and postoperative skeletal changes, each reference point marked on the image was compared before the operation (T0) and three days (T1), four months (T2), and a year (T3) after the operation, and with the VS (Tv). The differences between ΔTv (Tv-T0) and ΔT1 (T1-T0) were statistically compared using tooth-based reference points. The superimposed images of Tv and T1 were also investigated at eight bone-based reference points. The differences between the reference points of the bone surface were examined to evaluate the stability of the miniplate on the maxilla over time.ResultsNone of the patients experienced complications. There were no significant differences between the reference points based on the cusp tip between ΔTv and ΔT1 (p > 0.01). Additionally, there were no significant differences between the Tv and T1 values of the bone surface (p > 0.01). The mean difference in the bone surface between Tv and T1 was 1.01 ± 0.3 mm. Regarding the stability of the miniplate, there were no significant differences between the groups. The difference in the bone surface between T1 and T3 was − 0.37 ± 0.29 mm.ConclusionsVS was performed using the FaceGide® program, and customized materials produced based on the VS were applied in actual OGS. The maxilla was repositioned in almost the same manner as in the VSP plan, and the maxillary position remained stable for a year.

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

“…All seven studies are clinical case series, five prospective (Mazzoni et al, 2015;Brunso et al, 2016Brunso et al, , 2017Heufelder et al, 2017;Li et al, 2017) and two retrospectives Kim et al, 2019). The studies were published between 2015 and 2019 and were performed in upper-middle-and high-income countries: Italy (Mazzoni et al, 2015), The Netherlands , Spain (Brunso et al, 2016, Germany (Heufelder et al, 2017), China (Li et al, 2017) and South Korea (Kim et al, 2019). The total sample included 74 patients who underwent orthognathic surgery with customized bone plates for fixation.…”

“…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).…”

“…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.…”

“…State of the art planning and performing of orthognathic surgery is closely linked to computer assistance. 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). There are studies that have tested customized plates by assessing the precision of the surgical outcome compared to the virtual planning (Mazzoni et al, 2015;Brunso et al, 2016Brunso et al, , 2017Heufelder et al, 2017;Li et al, 2017;Kim et al, 2019); however, there are no systematic reviews on the subject.…”