Computer guided maxillary positioning using osteotomy/plates locating surgical guides in management of maxillary deficiency

Abstract

Maxillary segment repositioning is essential for esthetic and functional outcomes. Increased success and experience achieved with computer guided Le Fort I osteotomy turned the attention to develop surgical techniques to cope with deficient maxilla solving the problem of the time-consuming manual steps of intermediate wafer fabrication in addition to its inability to adjust the correct vertical position of the maxilla in relation to the skull base. This study aimed to evaluate CAD/CAM generated osteotomy/ plates locating surgical guides in three-dimensional maxillary segment repositioning. Ten patients with maxillary hypoplasia were subjected to virtual model surgery forming corrected 3D skull models for titanium plates pre-bending. Screw holes were marked to the corrected 3D skull models for construction of osteotomy / plates locating surgical guides. Pre-bent plates were installed intra-operatively into the predetermined screw holes. Placement of the plates adjust the depressed maxilla three dimensionally. All patients were clinically and radiographically evaluated pre and post-operatively. Degree of three-dimensional corrective movement were measured and statistically evaluated. CAD/CAM generated osteotomy plates locating surgical guides were proved to be more reliable for three-dimensional maxillary segment repositioning.