Osteotomy guides and customised osteosynthesis plaques made with CAD–CAM and rapid prototyping technology in the skeletal surgical treatment of severe OSA

Abstract

Introduction Skeletal corrective surgery for severe OSA requires a large advancement of the maxillary and an exhaustive planning. We present the results of a improvement in surgical technique and planning in which digital 3D technology has been used as well as CAD–CAM and rapid prototyping for greater precision and safety. Materials and methods We present 5 cases of skeletal correction of severe OSA, in which a custom osteosynthesis system designed with CAD–CAM technology was used. After digital 3D surgical planning, we have obtained the STL files that have allowed the design of an osteosynthesis system adapted to the patient’s skeletal surface. The use of biocompatible cutting guides allowed planning reproducibility. Results In the 5 cases planned objectives were achieved. Costumised plates allowed a good fit of the facial buttresses, without altering the characteristics of the titanium and offering maximum stability, precision and safety compared to conventional osteosynthesis systems. The biggest drawbacks were planning times, manufacturing and cost, as well as the limitations of the 3D planning programs. A comprehensive study and an accurate reproduction of the expected movements by the surgeon are required, especially in oclusal plane change. In all the cases it was possible to reduce the Apnea-Hypoapnea Index below 10, improve sleep architecture and reduce daytime sleepiness. Conclusion A significant proportion of patients with severe OSA probably have skeletal anomalies, especially young people. In severe OSA skeletal surgery may be an alternative to conservative medical treatment in selected cases. Customized systems can offer a very high level of accuracy, stability and safety. Acknowledgements Dr. Jose Amilibia, Dr. Valentin Cabriada, Dr. Jose Antonio Municio, Dr. Joseba Santamaria.