Operator Performance of the Digital Setup Fabrication for Orthodontic-Orthognathic Treatment: An Explorative Study.

Olivier De Waard,Hendrikus A J Reukers,Robin Bruggink,Anne Marie Kuijpers-Jagtman,Frank Baan,Edwin M Ongkosuwito,Ewald M Bronkhorst

doi:10.3390/jcm11010145

Abstract

The purpose of this study was to explore the operator performance of the fabrication of digital orthodontic setups integrated into cone beam computed tomography (CBCT) scans. Fifteen patients who underwent a combined orthodontic–orthognathic surgical treatment were included. The pre-treatment digital dental models and CBCT scans were fused, and four operators made virtual setups twice for all patients. Differences between the virtual setups were calculated by recording tooth crown movement from the pre-treatment model to the virtual setup. To examine performance, Pearson’s correlation coefficients, duplicate measurement errors, and inter-operator differences were calculated. For intra-operator performance, correlation values varied among tooth types, with mean correlation values from 0.66 to 0.83 for the maxilla and 0.70 to 0.83 for the mandible. For inter-operator performance, mean correlation values varied from 0.40 to 0.87 for the maxilla and from 0.44 to 0.80 for the mandible. Rotational mean differences exceeded the range of clinical acceptance (>2 degrees) at 18% for the maxilla and 20.8% for the mandible, and translational mean differences exceeded the range of clinical acceptance (0.6 mm) at 9.7% and 26% for the maxilla and mandible, respectively. The intra- and inter-operator performance of digital orthodontic setup construction for virtual three-dimensional orthognathic planning shows significant errors.

Highlights

Patients with severe skeletal deformities cannot be treated with orthodontics alone to create a harmonious face and stable occlusion
With the use of cone beam computed tomography (CBCT) and computer-aided design/computer-aided manufacturing technology, it is possible to add a third dimension to surgical treatment planning, allowing for greater accuracy [2]
Fifteen skeletally mature non-syndromic patients who underwent orthodontic treatskeletally mature non-syndromic patients who Treatment underwentwas orthodontic mentFifteen combined with orthognathic surgery were included

Summary

Introduction

Patients with severe skeletal deformities cannot be treated with orthodontics alone to create a harmonious face and stable occlusion. These patients instead undergo a treatment comprising an orthodontic preparation phase followed by orthognathic surgery [1]. Conventional orthognathic treatment planning comprises model plaster surgery and the use of cephalograms to display the relation among dentition, the facial profile, and the facial skeleton [2]. The aim of the orthodontic preparation is to deliver optimal decompensated dental arches with correct incisor inclination in relation to the jaws to finish in a stable occlusion in a harmonious profile after the surgery [3]. In contrast to the surgical treatment phase, orthodontic preparation is currently not simulated digitally before the start of treatment

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