Comparison of Actual Surgical Outcomes and 3-Dimensional Surgical Simulations (original) (raw)
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Computer simulation in the daily practice of orthognathic surgery
International Journal of Oral and Maxillofacial Surgery, 2015
The availability of computers and advances in imaging, especially over the last 10 years, have allowed the adoption of three-dimensional (3D) imaging in the office setting. The affordability and ease of use of this modality has led to its widespread implementation in diagnosis and treatment planning, teaching, and follow-up care. 3D imaging is particularly useful when the deformities are complex and involve both function and aesthetics, such as those in the dentofacial area, and for orthognathic surgery. Computer imaging involves combining images obtained from different modalities to create a virtual record of an individual. In this article, the system is described and its use in the office demonstrated. Computer imaging with simulation, and more specifically patient-specific anatomic records (PSAR), permit a more accurate analysis of the deformity as an aid to diagnosis and treatment planning. 3D imaging and computer simulation can be used effectively for the planning of office-based procedures. The technique can be used to perform virtual surgery and establish a definitive and objective treatment plan for correction of the facial deformity. In addition, patient education and follow-up can be facilitated. The end result is improved patient care and decreased expense.
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
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.
Three-dimensional surgical simulation
American Journal of Orthodontics and Dentofacial Orthopedics, 2010
This paper discusses the development of methods for computer-aided jaw surgery. Computeraided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semiautomatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases.
Accuracy of orthognathic surgery using 3D computer-assisted surgical simulation
Australasian Orthodontic Journal
To evaluate the accuracy of maxilla and mandibular repositioning during two-jaw orthognathic surgery using computerassisted surgical simulation (CASS). Materials and methods: Fifteen patients who underwent two-jaw orthognathic surgery using CASS (VSP ® Orthognathics by 3D Systems) were evaluated to assess the accuracy of the simulation. Translational and rotational discrepancies of the centroids of the maxilla and mandible and the translational discrepancy of the dental midline between the planned and actual outcomes were reported using the root mean square error (RMSE). The number of cases that exceeded limits set for clinical significance, the direction of the error in relation to the direction of planned movement and the differences between segmental and non-segmental procedures were evaluated as secondary outcomes. Results: The largest translational RMSE was 1.53 mm along the y-axis in the maxilla and 1.34 mm along the y-axis in the mandible. The largest rotational RMSE was 1.9° about the x-axis in the maxilla and 1.16° about the x-and y-axes in the mandible. The largest RMSE for the dental midline was 1.6 mm along the y-axis in the maxilla and 1.34 mm along the y-axis in the mandible. A tendency for insufficient advancement of the maxilla was noted. Conclusions: CASS is an efficient and accurate way to develop the surgical plan and transfer the plan to the patient intraoperatively. While CASS is accurate on a population level, there remains the potential for clinically significant errors to occur on an individual basis.
International Journal of Morphology, 2018
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.
Pesquisa Brasileira em Odontopediatria e Clínica Integrada, 2021
Objective: To evaluate the accuracy of Virtual Surgical Planning (VSP) comparing VSPs and postoperative CBCT scans in patients undergoing bimaxillary orthognathic surgery of severe Skeletal Class III malocclusion. Material and Methods: Twenty-three patients (9 males and 14 females, mean age 24.1 ± 7.0 years) were selected and submitted to bimaxillary orthognathic surgery. Pre-operative VSPs and postoperative CBCTs were compared using both linear (taking into account four skeletal and six dental landmarks, each one described by the respective coordinates) and angular measures (seven planes in total). The threshold discrepancies for post-operative clinical acceptable results were set at ≤2 mm for liner and ≤4° for angular discrepancies. The mean difference values and its 95% confidence interval were identified, comparing which planned and which obtained in absolute value. Results: There were significant statistical differences for all absolute linear measures investigated, although only two overcome the linear threshold value of 2mm in both X and Y-linear dimensions. Linear deviations in Z-linear dimension do not reach statistical significance. All 12 angular measures reach the statistical significance, although none overcome the threshold angular value of 4°. Angular deviation for roll register the higher accuracy in contrast to pitch and yaw. Conclusion: Virtual surgical planning is a reliable planning method to be used in orthognathic surgery field; as a matter of fact, although some discrepancies between the planned on the obtained are evident, most of them meet the tolerability range.
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.
Journal of Craniofacial Surgery, 2009
The aim of this study was to present a new approach to acquire a three-dimensional virtual skull model appropriate for orthognathic surgery planning without the use of plaster dental models and without deformation of the facial soft-tissue mask. A Btriple[ cone-beam computed tomography (CBCT) scan procedure with triple voxel-based rigid registration was evaluated and validated on 10 orthognathic patients. First, the patient was scanned vertically with a wax bite wafer in place (CBCT scan N-1). Second, a limited dose scan of the patient with a Triple Tray AlgiNot impression in place was carried out (CBCT scan N-2). Finally, a high-resolution scan of the Triple Tray AlgiNot impression was done (CBCT scan N-3). Sequential and semiautomatic triple voxel-based rigid registration (RN-1YRN-3) was performed to augment the patient's skull model with accurate occlusal and intercuspidation data (Maxilim, version 2.1.1., Medicim NV, Mechelen, Belgium). All registrations were based on the Maximisation of Mutual Information registration algorithm. Because the accuracy and stability of the voxel-based registration (RN-1) between the Triple Tray AlgiNot impression scan and the limited low-dose patient scan were not known, this particular registration step needed to be validated. The accuracy of registration was measured on a synthetic skull and showed to be highly accurate. A volume overlap of 98.1% was found for registered impression scan N-1. The mean distance between registered impression scan N-1 and registered impression scan N-2 was 0.08 T 0.03 mm (range, 0.04Y0.11 mm). As far as the stability of registration was concerned, successful registration with a stable optimal position was obtained with a maximum variability of less than 0.1 mm. The results of this study showed that semiautomatic sequential triple voxel-based rigid registration of the triple CBCT scans augmented the 3-D virtual skull model with detailed occlusal and intercuspidation data in a highly accurate and robust way. The method is therefore appropriate and valid for 3-D virtual orthognathic surgery planning in the clinical routine.