Abstract
Traditional planning method for orthognathic surgery has limitations of cephalometric analysis, especially for patients with asymmetry. The aim of this study was to assess surgical plan modification after 3-demensional (3D) simulation. The procedures were to perform traditional surgical planning, construction of 3D model for the initial surgical plan (P1), 3D model of altered surgical plan after simulation (P2), comparison between P1 and P2 models, surgical execution, and postoperative validation using superimposition and root-mean-square difference (RMSD) between postoperative 3D image and P2 simulation model. Surgical plan was modified after 3D simulation in 93% of the cases. Absolute linear changes of landmarks in mediolateral direction (x-axis) were significant and between 1.11 to 1.62 mm. The pitch, yaw, and roll rotation as well as ramus inclination correction also showed significant changes after the 3D planning. Yaw rotation of the maxillomandibular complex (1.88 ± 0.32°) and change of ramus inclination (3.37 ± 3.21°) were most frequently performed for correction of the facial asymmetry. Errors between the postsurgical image and 3D simulation were acceptable, with RMSD 0.63 ± 0.25 mm for the maxilla and 0.85 ± 0.41 mm for the mandible. The information from this study could be used to augment the clinical planning and surgical execution when a conventional approach is applied.
Highlights
For correction of facial deformities[25,26,27,28]
The 3D virtual surgery combined with navigation was proposed and suggested that simulation-guided navigation makes accurate postoperative outcomes possible for maxillary repositioning in orthognathic surgery[40,41,42,43,44,45]
This study evaluated how conventional 2D surgical plans were modified after 3D computer-assisted surgical simulation for patients with class III malocclusion and facial asymmetry
Summary
Developed 3D computer-assisted orthognathic surgery systems incorporate advanced 3D imaging, computer simulation software, CAD/CAM techniques, and image-guidance technologies and offer the high level of precision essential for optimal treatment planning and intraoperative execution[29,30,31]. Bell et al combined computer planning and intraoperative navigation[35,36], and Lucia et al presented a computer-aided surgery system that provides surgical planning and simulation and intraoperative guidance[37]. Lin et al proposed a protocol for assessing the surgical simulation, guide positioning, intraoperative navigation, and outcome validation provided by computer-assisted surgery systems[38,39]. This study evaluated how conventional 2D surgical plans were modified after 3D computer-assisted surgical simulation for patients with class III malocclusion and facial asymmetry
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