Accuracy Assessment of Virtual Surgical Planning Comparing 3D Virtual Surgical Planning and Post-Operative CBCTs in Surgical Skeletal Class III Cases: A Retrospective Study (original) (raw)
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Orthodontics & Craniofacial Research, 2020
Objective: This retrospective and observational study evaluated the accuracy of a 3D VSP for the maxillary positioning and orientation in patients undergoing bimaxillary orthognathic surgery, comparing the planned and postoperative outcomes. Setting and Sample Population: Seventy consecutive patients of both sexes, who were submitted to bimaxillary orthognathic surgery between 2015 and 2019 were included in our study. Material and Methods: The patients were evaluated by fusing preoperative planning and postoperative outcome using CBCT scan evaluation. 3D VSP and postoperative outcome were compared by using three linear and three angular measurements. The main outcome interest was the difference between the VSP movement, and the surgical movement obtained. The success criterion adopted was a mean linear difference of <2 mm and a mean angular difference of <4°. Results: Results were analyzed using a linear mixed model with fixed and random effects, at α=0.05. No significant statistical differences were found for linear and angular measurements between the planned and postsurgical outcomes (p>0.05). All overlapping points presented values within the range considered clinically irrelevant (<2 mm; <1°). Conclusions: 3D VSP was executed with a high degree of accuracy. When comparing the planned and postsurgical outcomes, all overlapping points presented values within the range considered clinically irrelevant.
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.
New developments in: three-dimensional planning for orthognathic surgery
Journal of Orthodontics, 2010
The limitations of plain film radiographs are well documented and the recent introduction of cone beam computed tomography (CBCT) imaging has been a breakthrough in enabling three-dimensional (3D) visualization of the bony skeleton and dentition. There are many reported applications for CBCT in the field of orthodontics and maxillofacial surgery, including the localization of impacted teeth and implant site assessment. More recently, by augmenting CBCT volumes of the maxilla, mandible and dentition, a virtual 3D patient can be created, which can allow planning of orthognathic surgery entirely in 3D. A commercially available software package for 3D orthognathic planning (MaxilimH, Medicim NV, Belgium) is independently reviewed, familiarizing the reader with the technique for creating a virtual 3D patient, outlining the advantages and disadvantages of the software and concluding on the feasibility of its routine use in clinical practice.
Progress in Orthodontics
Objectives The aim of this study is to introduce a novel 3D cephalometric analysis (3DCA) and to validate its use in evaluating the reproducibility of virtual orthodontic-surgical planning (VOSP) in surgery-first approach (SF) comparing VOSP and post-operative outcome (PostOp). Methods The cohort of nineteen patients underwent bimaxillary orthognathic surgery following the VOSP designed in SimPlant O&O software by processing cone-beam computed tomography (CBCT) scans and intraoral digital scanning of the dental arches. Said records were re-acquired once the post-operative orthodontic treatment was completed. The 3DCA was performed by three expert operators on VOSP and PostOp 3D models. Descriptive statistics of 3DCA measures were evaluated, and outcomes were compared via Wilcoxon test. Results In the comparison between cephalometric outcomes against planned ones, the following values showed significant differences: Wits Index, which suggests a tendency towards skeletal class III in ...
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.
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.
Medicina Oral Patología Oral y Cirugia Bucal, 2019
Background: To evaluate the accuracy between actual outcomes and virtual surgical planning (VSP) in orthognathic surgery regarding the use of three-dimensional (3D) surface models for registration using iterative closest point (ICP) algorithm and generated color maps. Material and Methods: Construction of planning and postoperative 3D models in STL files format (M0 and M1, respectively) from CBCT of 25 subjects who had been submitted to bimaxillary orthognathic surgery was performed. M0 and M1 were sent to Geomagic software in semi-automatic alignment surface mesh order of M0 and M1 for registration using ICP algorithm to calculate mean deviation (MD, MD+, MD-, SD) and root mean square (RMS-3D Error). Color maps were generated to assess qualitative congruence between M0 and M1. From deviation analysis, 3D Error was defined as accuracy measurement. To assess the reproducibility, the workflow was performed by two evaluators multiple times. t-tests were used to assess whether all means of MD, MD+, MD-, SD and 3D Error values would be ≤-2 mm and ≥ 2 mm. Results: High intra and inter evaluators correlation were found, supporting the reproducibility of the workflow. t-tests proved that all MDs and 3D Error values were >-2 mm and < 2 mm.
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.