Abstract
The purpose of this study was to develop a complete digital workflow for planning, simulation, and evaluation for orthognathic surgery based on 3D digital natural head position reproduction, a cloud-based collaboration platform, and 3D landmark-based evaluation. We included 24 patients who underwent bimaxillary orthognathic surgery. Surgeons and engineers could share the massive image data immediately and conveniently and collaborate closely in surgical planning and simulation using a cloud-based platform. The digital surgical splint could be optimized for a specific patient before or after the physical fabrication of 3D printing splints through close collaboration. The surgical accuracy was evaluated comprehensively via the translational (linear) and rotational (angular) discrepancies between identical 3D landmarks on the simulation and postoperative computed tomography (CT) models. The means of the absolute linear discrepancy at eight tooth landmarks were 0.61 ± 0.55, 0.86 ± 0.68, and 1.00 ± 0.79 mm in left–right, advance–setback, and impaction–elongation directions, respectively, and 1.67 mm in the root mean square direction. The linear discrepancy in the left–right direction was significantly different from the other two directions as shown by analysis of variance (ANOVA, p < 0.05). The means of the absolute angular discrepancies were 1.43 ± 1.06°, 0.50 ± 0.31°, and 0.58 ± 0.41° in the pitch, roll, and yaw orientations, respectively. The angular discrepancy in the pitch orientation was significantly different from the other two orientations (ANOVA, p < 0.05). The complete digital workflow that we developed for orthognathic patients provides efficient and streamlined procedures for orthognathic surgery and shows high surgical accuracy with efficient image data sharing and close collaboration.
Highlights
Orthognathic surgery is used in the correction of facial asymmetry, dentofacial deformity, and skeletal malocclusion, as well as adjunctive procedures, to improve masticatory function and esthetics
We developed a complete digital workflow for planning, simulation, and evaluation for orthognathic surgery based on 3D digital natural head position (NHP) reproduction, a cloud-based collaboration platform for planning and simulation, and 3D landmark-based evaluation, and evaluated the accuracy of orthognathic surgery performed using the digital workflow
We comprehensively evaluated the translational and rotational accuracies at the identical 3D landmarks on the simulation and postoperative computed tomography (CT) models by fusing the high-resolution and artifact-free dentition with preoperative and postoperative CT models, respectively, using automatic registration, which minimized the human error of manual landmark selection; the accuracy of the automatic registration method used in this study may influence the overall accuracy of the orthognathic surgery outcome
Summary
Orthognathic surgery is used in the correction of facial asymmetry, dentofacial deformity, and skeletal malocclusion, as well as adjunctive procedures, to improve masticatory function and esthetics. Many methods have taken advantage of 3D digital models to improve overall procedures in orthognathic surgery and provide more efficient, affordable, predictable, and convenient planning and simulation [4,5,6,7,8,9,10,11,12]. Surgical planning and 3D printing methods based on 3D digital models have higher accuracy in osteotomy and repositioning and are less time-consuming in comparison with conventional methods [13,14]. Surgical outcomes after the use of a 3D printing splint show similar accuracies to those by wafers produced from conventional model surgery [14,15], and accurate, predictable, and efficient treatment outcomes can be achieved using 3D virtual planning [16]
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