Abstract
Abstract Objective To evaluate the accuracy of maxilla and mandibular repositioning during two-jaw orthognathic surgery using computerassisted surgical simulation (CASS) Materials and methods Fifteen patients who underwent two-jaw orthognathic surgery using CASS (VSP,® Orthognathics by 3D Systems) were evaluated to assess the accuracy of the simulation. Translational and rotational discrepancies of the centroids of the maxilla and mandible and the translational discrepancy of the dental midline between the planned and actual outcomes were reported using the root mean square error (RMSE). The number of cases that exceeded limits set for clinical significance, the direction of the error in relation to the direction of planned movement and the differences between segmental and non-segmental procedures were evaluated as secondary outcomes Results The largest translational RMSE was 1.53 mm along the y-axis in the maxilla and 1.34 mm along the y-axis in the mandible. The largest rotational RMSE was 1.9° about the x-axis in the maxilla and 1.16° about the x- and y-axes in the mandible. The largest RMSE for the dental midline was 1.6 mm along the y-axis in the maxilla and 1.34 mm along the y-axis in the mandible. A tendency for insufficient advancement of the maxilla was noted Conclusions CASS is an efficient and accurate way to develop the surgical plan and transfer the plan to the patient intraoperatively. While CASS is accurate on a population level, there remains the potential for clinically significant errors to occur on an individual basis Conclusion The present case indicated that the timely extraction of palatally-placed maxillary lateral incisors facilitated functional appliance therapy in the management of a skeletal Class II problem. The crowding of the lower anterior teeth was relieved and alignment of the upper arch was achieved with full fixed appliance therapy, resulting in improved aesthetics and a stable occlusion at one year review
Highlights
Orthognathic surgery to reposition the jaws or dentoalveolar segments is required to treat individuals with severe orthodontic problems not amenable to correction by growth modification or camouflage or for which camouflage options will be detrimental to facial aesthetics.[1]
For the dental midline position, the largest root mean squared error (RMSE) was 1.6 mm along the y-axis in the maxilla and 1.34 mm along the y-axis in the mandible, which exceeded the threshold set for clinical significance
The mean overall discrepancy and 95% confidence intervals (CI) from the Bland-Altman plots are presented in Table IV and Figure 4
Summary
Orthognathic surgery to reposition the jaws or dentoalveolar segments is required to treat individuals with severe orthodontic problems not amenable to correction by growth modification or camouflage or for which camouflage options will be detrimental to facial aesthetics.[1]. Further research is required to validate the accuracy of CASS, as there are many variations in the CASS protocol, and as the experience of the individual surgical/orthodontic team and the difficulty and complexity of the surgery may affect the accuracy of the procedure. 2,10,11
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