Evaluation of the Predictability and Accuracy of Orthognathic Surgery in the Era of Virtual Surgical Planning (original) (raw)
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The Role of Virtual Surgical Planning in Increasing the Predictability in Orthognathic Surgery
Journal of Dental and Maxillofacial 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<0.05). The sample of patients included those who had pre-operative and post-operative cone beam computed...
Accuracy of virtual planning in orthognathic surgery: a systematic review
Alkhayer et al. Head & Face Medicine, (2020) 16:34, 2020
Background: The elaboration of a precise pre-surgical plan is essential during surgical treatment of dentofacial deformities. The aim of this study was to evaluate the accuracy of computer-aided simulation compared with the actual surgical outcome, following orthognathic surgery reported in clinical trials. Methods: Our search was performed in PubMed, EMBASE, Cochrane Library and SciELO for articles published in the last decade. A total of 392 articles identified were assessed independently and in a blinded manner using eligibility criteria, out of which only twelve articles were selected for inclusion in our research. Data were presented using intra-class correlation coefficient, and linear and angular differences in three planes. Results: The comparison of the accuracy analyses of the examined method has shown an average translation (< 2 mm) in the maxilla and also in the mandible (in three planes). The accuracy values for pitch, yaw, and roll (°) were (< 2.75, < 1.7 and < 1.1) for the maxilla, respectively, and (< 2.75, < 1.8, < 1.1) for the mandible. Cone-beam computed tomography (CBCT) with intra-oral scans of the dental casts is the most used imaging protocols for virtual orthognathic planning. Furthermore, calculation of the linear and angular differences between the virtual plan and postoperative outcomes was the most frequented method used for accuracy assessment (10 out of 12 studies) and a difference less than 2 mm/°was considered acceptable and accurate. When comparing this technique with the classical planning, virtual planning appears to be more accurate, especially in terms of frontal symmetry. Conclusion: Virtual planning seems to be an accurate and reproducible method for orthognathic treatment planning. However, more clinical trials are needed to clearly determine the accuracy and validation of the virtual planning in orthognathic surgery.
Journal of Oral and Maxillofacial Surgery, 2017
The aim of this study was to systematically review methods used for assessing the accuracy of 3-dimensional virtually planned orthognathic surgery in an attempt to reach an objective assessment protocol that could be universally used. Materials and Methods: A systematic review of the currently available literature, published until September 12, 2016, was conducted using PubMed as the primary search engine. We performed secondary searches using the Cochrane Database, clinical trial registries, Google Scholar, and Embase, as well as a bibliography search. Included articles were required to have stated clearly that 3-dimensional virtual planning was used and accuracy assessment performed, along with validation of the planning and/or assessment method. Descriptive statistics and quality assessment of included articles were performed. Results: The initial search yielded 1,461 studies. Only 7 studies were included in our review. An important variability was found regarding methods used for 1) accuracy assessment of virtually planned orthognathic surgery or 2) validation of the tools used. Included studies were of moderate quality; reviewers' agreement regarding quality was calculated to be 0.5 using the Cohen k test. Conclusions: On the basis of the findings of this review, it is evident that the literature lacks consensus regarding accuracy assessment. Hence, a protocol is suggested for accuracy assessment of virtually planned orthognathic surgery with the lowest margin of error.
2013
Purpose: The purpose of this prospective multicenter study was to assess the accuracy of a computeraided surgical simulation (CASS) protocol for orthognathic surgery. Materials and Methods: The accuracy of the CASS protocol was assessed by comparing planned outcomes with postoperative outcomes of 65 consecutive patients enrolled from 3 centers. Computergenerated surgical splints were used for all patients. For the genioplasty, 1 center used computergenerated chin templates to reposition the chin segment only for patients with asymmetry. Standard intraoperative measurements were used without the chin templates for the remaining patients. The primary outcome measurements were the linear and angular differences for the maxilla, mandible, and chin when the planned and postoperative models were registered at the cranium. The secondary outcome measurements were the maxillary dental midline difference between the planned and postoperative positions and the linear and angular differences of the chin segment between the groups with and without the use of the template. The latter were measured when the planned and postoperative models Received from the Methodist
Virtually Planned Surgical Guides to Optimize Orthognathic Surgery
2017
Citation: Bicallho LS, Cardador CM, Zille DR, Longo JPF, Avelar RP (2017) Virtually Planned Surgical Guides to Optimize Orthognathic Surgery. Res Rep Oral Maxillofac Surg 1:002. Received: June 19, 2017; Accepted: August 28, 2017; Published: August 31, 2017 Copyright: © 2017 Bicallho LS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. ISSN: 2643-3907
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 2017
The main objective of the present study was to assess the accuracy of two- and three-dimensional prediction techniques in orthognathic surgery. It was also a test of the very planning sequence. The scientific question was how well does the software support the surgeon in his way to find the perfect correction of the facial appearance while normalizing the occlusion? Thirty patients with a class III occlusion were included in this prospective study. Surgical planning with both techniques were undertaken for all patients. Surgery was performed according to the two-dimensional technique. The cephalometric measurements from two-dimensional and three dimensional predictions were compared with the postoperative results at the 12 months follow-up respectively. Together with an analysis of tracing error, placements of 2020 markers, 1860 measurements and 1280 comparisons was performed. The analysis showed an equally high accuracy for the studied techniques. The highest accuracy was found in ...
British Journal of Oral and Maxillofacial Surgery, 2019
The aim of this randomised controlled trial was to compare the costs and benefits of computer-based 2-dimensional and 3-dimensional predictions in orthognathic surgery. Subjects aged 18-30 years with severe class III malocclusion had their treatment planned with both 2-and 3-dimensional techniques. They were randomised in a 1:1 ratio for one or other planning technique. Costs (financial, time, and dose of radiation) were compared with benefits (accuracy and health-related quality of life (HRQoL)). In total, 57 subjects (27 women and 30 men, mean (range) age 21 (18-28) years) completed the study. Comparisons showed no significant difference in total time spent, but a large advantage for the 2-dimensional technique in financial costs (p < 0.001); it also required a significantly lower dose of radiation (p < 0.001). The cost-effectiveness analysis showed a reduction in time of 0.53 minutes/HRQoL-point gained, and an increased economic cost of US$15/HRQoL point gained for the 3-dimensional technique. It also showed that the two techniques consumed an equal amount of time, but that the 2-dimensional technique had lower financial costs, and the 3-dimensional technique a larger dose of radiation.
Three-Dimensional Treatment Planning of Orthognathic Surgery in the Era of Virtual Imaging
Journal of Oral and Maxillofacial Surgery, 2009
Purpose: The aim of this report was to present an integrated 3-dimensional (3D) virtual approach toward cone-beam computed tomography-based treatment planning of orthognathic surgery in the clinical routine. Materials and Methods: We have described the different stages of the workflow process for routine 3D virtual treatment planning of orthognathic surgery: 1) image acquisition for 3D virtual orthognathic surgery; 2) processing of acquired image data toward a 3D virtual augmented model of the patient's head; 3) 3D virtual diagnosis of the patient; 4) 3D virtual treatment planning of orthognathic surgery; 5) 3D virtual treatment planning communication; 6) 3D splint manufacturing; 7) 3D virtual treatment planning transfer to the operating room; and 8) 3D virtual treatment outcome evaluation. Conclusions: The potential benefits and actual limits of an integrated 3D virtual approach for the treatment of the patient with a maxillofacial deformity are discussed comprehensively from our experience using 3D virtual treatment planning clinically.
A Complete Digital Workflow for Planning, Simulation, and Evaluation in Orthognathic Surgery
Journal of Clinical Medicine
The purpose of this study was to develop a complete digital workflow for planning, simulation, and evaluation for orthognathic surgery based on 3D digital natural head position reproduction, a cloud-based collaboration platform, and 3D landmark-based evaluation. We included 24 patients who underwent bimaxillary orthognathic surgery. Surgeons and engineers could share the massive image data immediately and conveniently and collaborate closely in surgical planning and simulation using a cloud-based platform. The digital surgical splint could be optimized for a specific patient before or after the physical fabrication of 3D printing splints through close collaboration. The surgical accuracy was evaluated comprehensively via the translational (linear) and rotational (angular) discrepancies between identical 3D landmarks on the simulation and postoperative computed tomography (CT) models. The means of the absolute linear discrepancy at eight tooth landmarks were 0.61 ± 0.55, 0.86 ± 0.68,...
International Journal of Morphology
Recent technical and technological advancements in orthognathic surgery concepts, intricate in the diagnosis and treatment planning for corrections of dento-facial deformities, have achieved stable oro-dental functional occlusion and facial esthetic harmony. Undeniably, this can be attributed to the integration of modern, innovative and advanced facial analysis and computer-aided imaging exams into well-orchestrated and executed orthodontic and surgical methods. Three-Dimensional (3-D) virtual planning is a fine example. Today, the acquisition of 3-D images of a patient's craniofacial complex via cone-beam computed tomography (CBCT), supported by software tools allowing the construction of 3-D dynamic and interactive visual models, eliminates the uncertainty experienced with two-dimensional images. Thereby allowing for a more accurate or predictable treatment plan and efficient surgery, especially for patients with complex dento-facial deformities. This review article aims to describe the current benefits as well as shortcomings of 3-D virtual planning via discussing examples and illustrations from orthognathic procedures, attained from the reported English and Spanish literature during the last 10 years. It is designed to deliver updated and practical guidelines for dental practitioners and specialists (particularly, oral and maxillofacial), as well as researchers involved in 3-D virtual approaches as an alternative to conventional/traditional surgical planning; thereby validating its superiority or benefits in terms of outcome prediction for soft and hard tissues, operational timeand cost-effectiveness; for its integration in day-today practise.