Surgical Planning In Orthognathic Surgery Research Articles

Does the Implementation of Virtual Planning has a Significant Impact on Reducing the Revision Rate in Orthognathic Surgery?

Conventional orthognathic surgical planning has limitations in accurately transferring the relationship between soft tissue and bone. Virtual planning offers enhanced accuracy and visualization through computer simulation. This study aimed to compare the need for reoperation between patients who underwent conventional and virtual surgical planning for orthognathic surgery. The study included 352 patients who underwent orthognathic surgery. Reoperation rates and reasons for reoperation were evaluated in patients with conventional model surgery planning (143 patients) and virtual planning (209 patients). The reoperation rate was 7.69% for conventional surgery patients and 3.82% for virtual planning patients. Malocclusion was the most common reason for reoperation in both groups. Bilateral sagittal split ramus osteotomies (BSSO) and genioplasty were the most frequently performed revision procedures. Virtual planning in orthognathic surgery may lead to a reduced reoperation rate compared with conventional planning methods. The accuracy, visualization, and interdisciplinary collaboration offered by virtual planning can improve surgical outcomes.

Three-Dimensional Evaluation of Changes in Condylar Position After Orthognathic Surgery With Different Types of Jaw Deformities

BackgroundAssessing condyle position post orthognathic surgery is pivotal for optimizing surgical accuracy, sustaining postoperative stability, and ensuring predictable treatment outcomes. PurposeThe aim of this study was to analyze the changes of condyle position after orthognathic surgery with different types of jaw deformity and to analyze whether the changes of condyle position are different. Study design, setting, sampleA retrospective cohort study was designed and conducted, involving adults who underwent orthognathic surgery for jaw deformities at the affiliated Stomatological Hospital of Nanchang University between 2019 and 2022. Patients with incomplete CT data were excluded. Predictor/exposure/independent variableThe primary predictor variable was time (pre-operative and post-operative) and types of jaw deformities (skeletal Class III, skeletal Class II, and mandibular deviation). Main outcome variable(s)The main outcome variables were the 3D linear and rotational positional changes of the condyle. CovariatesEvaluated covariates included sex and age. AnalysesMIMICS 20.0 software measured all data, and SPSS 22.0 software facilitated statistical analyses. Intra- and inter-group correlation analyses employed paired t-tests and independent t-tests, with statistical significance set at P < 0.05. ResultsThe study sample was composed of 32 subjects with a mean age of 22.43±1.6 and 9 were male. The analysis of changes of condylar position from virtual surgical planning to immediate postoperative period showed that the maximum condylar displacement was 1.74 mm and the maximum angular change was 3.92°. The analysis of changes in condylar position from the immediate postoperative period to 1-year postoperatively showed no statistically significant changes for the same type of jaw deformity. But patients with Class II malocclusion exhibited distinct condylar displacement and rotation patterns compared to those with Class III malocclusion and mandibular deformity. Conclusions and RelevanceThe application of virtual surgical planning in orthognathic surgery ensures a high degree of consistency in achieving the desired condylar position. Moreover, no significant change in condylar position was observed after orthognathic surgery for the same type of jaw deformity. However, patients with Class II deformities exhibited a higher susceptibility to rotational displacement of the condyles compared to those with other types of jaw deformities.

Virtual Surgical Planning in Orthognathic Surgery

Virtual Surgical Planning in Orthognathic Surgery

Customization and Virtual Surgical Planning in Orthognathic Surgery – A Paradigm Shift

Customization and Virtual Surgical Planning in Orthognathic Surgery – A Paradigm Shift

Virtual surgical planning in orthognathic surgery: a dental hospital's 10-year experience.

The primary objective of this study was to evaluate how the utilization of virtual surgical planning (VSP) and the epidemiological profile of patients undergoing orthognathic surgery (OGS) have changed in the past decade. The records of patients who had undergone orthognathic surgery at a national dental hospital were reviewed. Trends in VSP, epidemiological data, presentation of dentofacial deformity, and management details were recorded. A total of 1184 patients were included in this study. The majority of the patients seeking treatment in this dental hospital were young Chinese adults with dentofacial deformities requiring bimaxillary surgeries. Most patients presented with a skeletal Class III pattern (79.0%), and asymmetry was diagnosed in 80.8% of all cases. There was an initial slow pick-up rate for VSP, but this rapidly increased to a high adoption rate of 98.7-100% between 2019 and 2021. Together with an increasing body of evidence suggesting greater accuracy in VSP, utilization in this technology can be enhanced with greater familiarity with the technology and improvements in the VSP services.

Surgical accuracy of CAD/CAM splints using virtual surgical planning in orthognathic surgery: policy implications for healthcare in Australia.

This study examines post-surgical outcomes of maxillary position using virtual surgical planning (VSP) with computer designed and manufactured surgical splints, without the use of costly patient specific implants (PSI), in the treatment of routine nonsyndromic orthognathic patients. The cost of these personalized medical devices and their impact in the setting of cranio-maxillofacial surgery is currently under review by The Department of Health and Aged Care in Australia. This is a single-centre retrospective analysis of 49 patients who underwent bimaxillary orthognathic surgery by a single surgeon at Epworth Richmond Hospital (Victoria, Australia) over a period spanning 2016 to 2020. Patients were included in the study provided their surgery was facilitated using VSP with manufacture of computer designed occlusal splints. Use of computer designed and manufactured splints were highly reliable in reproducing the virtual surgical plan, when using palatal plane, upper incisor angulation, and anterior upper facial height. Use of computer designed and manufactured splints provide a method of leveraging the accuracy of VSP methods, without the additional costs associated with PSI. These findings may assist in appropriate resource allocation and case stratification in patients undergoing orthognathic surgery.

P-67650479-350 - Do new surgeons and experienced surgeons perform virtual surgical planning in orthognathic surgery the same way?

P-67650479-350 - Do new surgeons and experienced surgeons perform virtual surgical planning in orthognathic surgery the same way?

An Automatic Voxel-Based Method for Optimal Symmetry Plane Generation for the Maxillofacial Region in Severe Asymmetry Cases.

Symmetry is representative of aesthetics and health in all kinds of vertebrates, especially the human face. Therefore, to automatically locate the appropriate symmetry plane is crucial. The aim of this study was to develop an automatic and reliable method to determine the symmetry plane of the maxillofacial region. We compared the proposed method of determining the symmetry plane by assessing landmark-based and surface-based methods by way of quantitative symmetry assessments. Statistical analysis was applied to evaluate whether significant difference existed among these three kinds of symmetry planes. Twenty cases who had a diagnosis of severe facial asymmetry were evaluated retrospectively. The results showed that searching for the symmetry plane using a voxel-based method, named the optimal symmetry plane (OSP), achieved the most representative symmetry according to the outcomes of the trials. The OSP was significantly more symmetrical than the other two planes, as determined by other methods. The paired-voxel computation method proposed in this research is a robust and reliable method for identifying the unique symmetry plane for patients with severe facial asymmetry. Symmetry is of crucial significance for all kinds of vertebrates, including its clinical implications for surgical planning in orthognathic surgery.

Virtual Surgical Planning in Orthognathic Surgery: Two Software Platforms Compared

Over 70% of patients suffering from dentofacial deformities mention esthetics as the biggest issue pushing them to look for orthodontic and orthognathic treatment. At present, several pieces of software for computer-aided surgery have been released on the market. This surgical planning software allows surgeons to manipulate digital representations of hard and soft tissue profile tracings and subsequently morph the pretreatment image to produce a treatment simulation. The aims of this study were to investigate and find the difference between two of the most used pieces of digital software in pre-surgical planning for patients affected by dentofacial deformities by using the following parameters: usability, validity, timing, accessibility, efficacy, and predictability of the pre-surgical planning. Analyzing the results obtained from our study, it is correct to define both software tools useful and valid in digital surgical planning for the treatment of patients with dentofacial deformities. Each software has negligible differences in performance that do not in any way affect the success of surgical planning. The IPS software represents a valid alternative to the most popular and tested Dolphin Imaging software, and we are even inclined to evaluate it as better in terms of accuracy, effectiveness, and reliability.

Wafer as an adjunct to plating patient-specific implants for the multi-segment maxilla: a useful tool

Virtual surgical planning for orthognathic surgery using patient-specific implants (PSI) is usually waferless nowadays. However, without an occlusal wafer, difficulties arise in controlling the accuracy of multi-segment maxillary osteotomies, especially for expansion and rotational movements of each segment. It is technically challenging intraoperatively to manipulate multiple segments to fit into the PSI, as the relatively small bone segments need to be secured into the PSI while simultaneously achieving individual segment movements in all planes and with potential bony interferences with each other. Therefore, the use of a maxillary tooth-supported surgical guide is proposed and described. When the guide is inserted before the PSI, it overcomes difficulties in handling multiple maxillary segments and facilitates achieving maximal positional precision of each individual bone segment. The guide enables multiple smaller segments to behave as one unit with the designated occlusion whilst visualizing bony interferences before PSI plating is commenced. Adding a tooth-borne surgical guide in the form of a wafer and a customized arch bar is a cost-effective method to enhance accuracy in virtually planned multi-segment maxillary surgery. Further investigations are required to validate the accuracy and advantages of using wafers and PSI in multi-segment maxillary and mandibular orthognathic surgeries.

Comparison of time and cost between conventional surgical planning and virtual surgical planning in orthognathic surgery in Korea

BackgroundThe purpose of this study was to measure the time of the conventional surgical planning (CSP) and virtual surgical planning (VSP) in orthognathic surgery and to compare them in terms of cost.Material and methodThis is a retrospective study of the patients who underwent orthognathic surgery at the OOOOO University Dental Hospital from December 2017 to August 2018. All the patients were analyzed through both CSP and VSP, and all the surgical stents were fabricated through manual and 3-dimensional (3D) printing. The predictor variables were the planning method (CSP vs. VSP) and the surgery type (group I: Le Fort I osteotomy+bilateral sagittal split osteotomy [LFI+BSSO] or group II: only bilateral sagittal split osteotomy [BSSO]), and the outcomes were the time and cost. The results were analyzed using paired t test.ResultsThirty patients (12 females, 18 males) met the inclusion criteria, and 17 patients were excluded from the study due to missing or incomplete data. There were 20 group I patients (LFI+BSSO regardless of genioplasty) and 10 group II patients (BSSO regardless of genioplasty). The average time of CSP for group I was 385±7.8 min, and that for group II was 195±8.33 min. The time reduction rate of VSP compared with CSP was 62.8% in group I and 41.5% in group II. On the other hand, there was no statistically significant cost reduction.ConclusionsThe time investment in VSP in this study was significantly smaller than that in CSP, and the difference was greater in group I than in group II.

Cone beam computed tomography as a first line investigation in the pediatric dental patient

Cone beam computed tomography overcomes many of the limitations of traditional radiographic techniques and has become commonplace in dental practice. Pediatric patients are more likely to move during acquisition of the images and are susceptible to the harmful effects of ionising radiation. Therefore, justification for each individual and clinical scenario must occur before prescription of cone beam computed tomographs. There are clinical situations in which three-dimensional imaging is indicated as a first line investigation such as impacted canines and neighbouring root resorption, internal and external cervical resorption defects, virtual surgical planning for orthognathic surgery, autotransplantation analogues and assessment of TMJ anomalies. In these clinical situations, care should be taken to optimise the lowest radiation dose achievable for the pediatric patient whilst being indication-orientated and patient-specific.

Predictability and Accuracy between 3D Virtual Surgical Planning and Actual Outcomes in Orthognathic Surgery

Introduction: We are living a paradigm shift in orthognathic surgery. Several tools and technological advances are being implemented to help improve surgical experience and to offer better functional and aesthetical results. Virtual surgical planning is a revolutionary tool which helps us design the surgical plan preoperatively and establish a surgical protocol specifically designed for that patient. In this study, our goal is to validate the predictability of virtual surgical planning in orthognathic surgery, comparing the final results with the virtual plan. Material and methods: We performed an ICP based super imposition of 3D models of the virtual planning preoperatively designed and the 3D model of the postoperative CBCT using free software (Slicer) in patients who underwent bimaxillary orthognathic surgery. The results of the super imposition were saved on the postoperative model and presented as a color-coded map. This was generated as a .vtk file that was exported to another free software that displayed the difference in mm in relevant cephalometric points (point A, point B, pogonion, left and right gonion and first upper molars) in the three axis (x, y and z) between the postoperative result and the virtual plan. Then, we registered these results for all patients and analysed these data. Results: A total of 41 patients were included. The median of the differences in mm between virtual planning and postoperative results were less than 1mm for all cephalometric points, except for both gonion, where greater than 1mm differences were found in the mediolateral (horizontal) direction. For the rest of landmarks, the highest differences were found at A point and pogonion in the anteroposterior direction (0,83mm and 0,78mm, respectively). Conclusions: We found overall small and tolerable differences (&lt;1mm) between the planned movements and the postoperative results. The highest were found at the gonion in the mediolateral direction and mandibular rami, which could be explained by the torque of the proximal segment. The differences in A point and pogonion in the anteroposterior direction were the highest among the rest, which may be related to inaccuracy of the splint in this direction.

Segmentation and Three Dimensional Visualization of Mandible Using Active Contour and Visualization Toolkit in Craniofacial Computed Tomography Images

Three-dimensional representation of facial bone surface is needed in the virtual surgical planning for orthognathic surgery. Segmentation of facial bone surface from computed tomography images is first step in developing the 3D model. This paper focuses on segmentation of mandible bone using active contour segmentation of Insight Segmentation and Registration Toolkit library. The results are given as 3D stereo lithographic image. The result is compared with the ground truth image segmented by an expert radiologist. Various evaluation metrics are used for finding the segmentation accuracy and the result has given segmentation accuracy of 97.50%. Therefore, this method can be used as an initial step in automatic cephalometric land marking, an important task in virtual surgical planning for orthognathic surgery.

Comparison of time and cost between conventional surgical planning and virtual surgical planning in orthognathic surgery in Korea

BackgroundThe purpose of this study was to measure the time of the conventional surgical planning (CSP) and virtual surgical planning (VSP) in orthognathic surgery and to compare them in terms of cost.Material and methodThis is a retrospective study of the patients who underwent orthognathic surgery at the Pusan National University Dental Hospital from December 2017 to August 2018. All the patients were analyzed through both CSP and VSP, and all the surgical stents were fabricated through manual and three-dimensional (3D) printing. The predictor variables were the planning method (CSP vs. VSP) and the surgery type (group I: Le Fort I osteotomy + bilateral sagittal split osteotomy [LFI+BSSO] or group II: only bilateral sagittal split osteotomy [BSSO]), and the outcomes were the time and cost. The results were analyzed using the paired t test.ResultsThirty patients (12 females, 18 males) met the inclusion criteria, and 17 patients were excluded from the study due to missing or incomplete data. There were 20 group I patients (LFI+BSSO regardless of genioplasty) and 10 group II patients (BSSO regardless of genioplasty). The average time of CSP for group I was 385 ± 7.8 min, and that for group II was 195 ± 8.33 min. The time reduction rate of VSP compared with CSP was 62.8% in group I and 41.5% in group II. On the other hand, there was no statistically significant cost reduction.ConclusionsThe time investment in VSP in this study was significantly smaller than that in CSP, and the difference was greater in group I than in group II.

The Use of Virtual Surgical Planning in Orthognathic Surgery in Oral and Maxillofacial Surgery Training Programs

The purpose of this study is to evaluate the current utilization of virtual surgical planning (VSP) for orthognathic surgery in academic oral and maxillofacial surgery training programs in the United States.

The Role of Virtual Surgical Planning in Increasing the Predictability in Orthognathic Surgery

Purpose: To evaluate our surgical outcomes by comparing our surgical plan to the outcome of the surgery and evaluate our efficacy using Virtual Surgical Planning and Medical Modeling software. Our aim is to determine the quality and validity of Virtual Surgical Planning when comparing pre-surgical plans with post-surgical outcomes. Patients and Methods: A cohort study was conducted for patients who underwent orthognathic surgery at a single institution. Utilizing virtual plans and models, select points for the virtual plans were compared and superimposed with that of the actual surgical movements. The primary predictor variable were the pre-surgical virtual plans of movements; the outcome variable consisted of the actual post-surgical movements. Statistical analysis was computed via IBM SPSS Version 25 software utilizing a paired t-test assuming equal variance with alpha (p&lt;0.05). The sample of patients included those who had pre-operative and post-operative cone beam computed tomography scans, a virtual surgical plan, CAD/CAM splints, and LeFort I osteotomy and bilateral sagittal split osteotomy.Results: The study consisted of ten patients between the ages of 18-51 years old. Pre and post surgical plans were superimposed and four points of measurement were compared along 3 dimensional planes. There were no statistical significant associations between the virtually planned and post surgical planned values.Conclusion: Our results suggest that the use of virtual surgical planning in orthognathic surgery yields favorable and accurate surgical outcomes regarding rotational movements with minor degrees of discrepancies.

Is Virtual Surgical Planning in Orthognathic Surgery Faster Than Conventional Planning? A Time and Workflow Analysis of an Office-Based Workflow for Single- and Double-Jaw Surgery

The purpose of this study was to measure and compare the working time for virtual surgical planning (VSP) in orthognathic surgery in a largely office-based workflow in comparison with conventional surgical planning (CSP) regarding the type of surgery, staff involved, and working location. This prospective cohort study included patients treated with orthognathic surgery from May to December 2016. For each patient, both CSP with manual splint fabrication and VSP with fabrication of computer-aided design-computer-aided manufacturing splints were performed. The predictor variables were planning method (CSP or VSP) and type of surgery (single or double jaw), and the outcome was time. Descriptive and analytic statistics, including analysis of variance for repeated measures, were computed. The sample was composed of 40 patients (25 female and 15 male patients; mean age, 24.6years) treated with single-jaw surgery (n=18) or double-jaw surgery (n=22). The mean times for planning single-jaw surgery were 145.5±11.5minutes for CSP and 109.3±10.8minutes for VSP, and those for planning double-jaw surgery were 224.1±11.2minutes and 149.6±15.3minutes, respectively. Besides the expected result that the working time was shorter for single-versus double-jaw surgery (P<.001), it was shown that VSP shortened the working time significantly versus CSP (P<.001). The reduction of time through VSP was relatively stronger for double-jaw surgery (P<.001 for interaction). All differences between CSP and VSP regarding profession (except for the surgeon's time investment) and location were statistically significant (P<.01). The surgeon's time to plan single-jaw surgery was 37.0minutes for CSP and 41.2minutes for VSP; for double-jaw surgery, it was 53.8minutes and 53.6minutes, respectively. Office-based VSP for orthognathic surgery was significantly faster for single- and double-jaw surgery. The time investment of the surgeon was equal for both methods, and all other steps of the workflow differed significantly compared with CSP.

Virtual planning of a composite model of bone and teeth to facilitate the adjustment of a hybrid distractor for the transport of alveolar bone

In recent years 3-dimensional computer planning in maxillofacial surgery has been widely used. 1 Hammoudeh J.A. Howell L.K. Boutros S. et al. Current status of surgical planning for orthognathic surgery: traditional methods versus 3D surgical planning. Plast Reconstr Surg Glob Open. 2015; 3: e307 Crossref PubMed Scopus (70) Google Scholar Hammoudeh et al described stereolithographic modelling for the orientation of vectors when using a bone-to-bone distractor, 2 Varol A. Basa S. The role of computer-aided 3D surgery and stereolithographic modelling for vector orientation in premaxillary and trans-sinusoidal maxillary distraction osteogenesis. Int J Med Robot. 2009; 5: 198-206 Crossref PubMed Scopus (14) Google Scholar but the method is not accurate enough for use with a hybrid distractor.

Virtual surgical planning in orthognathic surgery.

Computer-aided surgical simulation has greatly enhanced the efficiency and accuracy of orthognathic surgery for correction of dentofacial deformities. Virtual surgical planning (VSP) improves the efficiency of the presurgical work-up and provides an opportunity to illustrate the multidimensional correction at the dental and skeletal level. VSP provides preoperative insight into the surgical intervention and the fabrication of cutting jigs/guides and templates can help decrease intraoperative surgical inaccuracies. VSP is rapidly becoming the standard of care for surgical treatment planning of dentofacial deformities.