Presentation and Evaluation of a Modified Wax-Bite Dental Splint for Surgical Navigation in Craniomaxillofacial Surgery

Abstract

The purpose of the present study was to introduce and evaluate the use of a modified "wax-bite dental splint" for surgical navigation in craniomaxillofacial surgery. A 2-layer wax bite dental splint was fabricated with an anterior extension, and 8 gutta percha markers were incorporated in each splint for marker-based pair-point registration. To evaluate the accuracy, the occlusal registration of the wax bite dental splint was performed on 10 artificial skulls. Consecutively, all the skulls were scanned using a standardized cone-beam computed tomography scanning protocol with the 2-layer wax bite dental splint in place. Automatic rigid marker-based pair-point registration was performed using the iPlan CMF software, version 3.0 (Brainlab AG, Feldkirchen, Germany) using 8 gutta percha markers incorporated into the wax bite dental splint. Additionally, the registration accuracy of 6 anatomic skeletal landmarks was measured on each skull. The mean registration error for each wax bite dental splint ranged from 0.78 to 1.01 mm. The overall mean registration error for the wax-bite dental splint-based registration was 0.89 ± 0.08 mm. The mean registration error for the 6 anatomic landmarks ranged from 1.23 to 2.3 mm. The overall mean registration error was 1.68 ± 0.28 mm. The results of the present study show the potential for a wax-bite dental splint as an alternative rigid registration method for surgical navigation in craniomaxillofacial surgery. Moreover, from a clinical viewpoint, the method is accurate, user-friendly, inexpensive, and not time-consuming.