A New Software Suite in Orthognathic Surgery : Patient Specific Modeling, Simulation and Navigation (original) (raw)
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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,...
Use of Three-Dimensional Medical Modeling Methods for Precise Planning of Orthognathic Surgery
Journal of Craniofacial Surgery, 2007
Stereolithographic (medical rapid prototyping) biomodeling allows three-dimensional computed tomography to be used to generate solid plastic replicas of anatomic structures. Reports in the literature suggest that such biomodels may have a use in maxillofacial surgery, craniofacial surgery, orthopedics, neurosurgery, otology, vascular, and nasal research. A prospective trial to assess the usefulness of biomodeling in orthognathic surgery has been performed. In 12 patients with mandibular prognathism and/or maxillary retrusion, in addition to routine preoperative cephalometric analysis, preoperative high-resolution (cutting slice thickness of 1 mm) three-dimensional computed tomography scan of the patients was obtained. Raw data obtained from computed tomography scanning was processed with a Mimics 9.22 Software (Materialise's Interactive Medical Image Control System, Belgium). Fabrication of three-dimensional medical models was obtained through a process called powder depositional modeling by use of a Spectrum Z 510 3D Color Printer (Z Corporation, Burlington, MA). Alveolar arches of the maxilla and mandibula of the models were replaced with orthodontic dental cast models. Temporomandibular joints of the models were fixed with Kirschner wire. Maxillary and mandibular bony segments were mobilized according to preoperative orthodontic planning done by analysis of cephalometric plain radiographs. The relation between proximal and distal mandibular segments after bilateral sagittal split osteotomies were eval-uated on models preoperatively. The same surgeon had a role in both model cutting preoperatively and as an instructor preoperatively. The same bony relation was observed both in preoperative models and in the perioperative surgical field in all patients. Condylar malpositioning was not observed in any of the patients. Studying preoperative planned movements of osteotomized bone segments and observing relations of osteotomized segments of mandibula and maxilla in orthognathic surgery increased the intraoperative accuracy. Limitations of this technology were manufacturing time and cost.
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.
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.
Three-Dimensional Computerized Orthognathic Surgical Treatment Planning
Clinics in Plastic Surgery, 2007
Orthognathic surgery involves anatomically defining the deformity, establishing an appropriate orthodontic-surgical treatment plan, and then executing the recommended treatment. The surgical-orthodontic team must then not only predict the various possible outcomes based on the options available, but once agreed, must execute that plan as precisely as possible. Historically, the surgical-orthodontic planning has relied on two-dimensional (2D) analysis of radiographic images, the lateral cephalometric film. Currently available cephalometric software planning uses standard osteotomies (the LeFort I, bilateral sagittal split osteotomy [BSSO], and genioplasty) and soft tissue prediction based on 2D analysis to develop a virtual treatment plan. For the surgeon, however, a 2D blueprint using only the sagittal plane as a guide for executing a three-dimensional (3D) surgical procedure in multiple planes is less than ideal. Moreover, standard osteotomies in such software packages cannot simulate asymmetric osteotomies, or the osteotomies that are more appropriately tailored to correct the specific deformities, such as a modified LeFort I, in which to varying degrees the zygoma are included. Therefore, each of the elements of the craniofacial structure may require a complex osteotomy pattern and individual 3D manipulation to achieve an optimal outcome.
Computer aided planning for orthognatic surgery
Eprint Arxiv Physics 0610213, 2006
A computer aided maxillofacial sequence is presented, applied to orthognatic surgery. It consists of 5 main stages: data acquisition and integration, surgical planning, surgical simulation, and per operative assistance. The planning and simulation steps are then addressed in a way that is clinically relevant. First concepts toward a 3D cephalometry are presented for a morphological analysis, surgical planning, and bone and soft tissue simulation. The aesthetic surgical outcomes of bone repositioning are studied with a biomechanical Finite Element soft tissue model.
Applied Sciences
Orthognathic surgery allows broad-spectrum deformity correction involving both aesthetic and functional aspects on the TMJ (temporo-mandibular joint) and on the facial skull district. The combination of Reverse Engineering (RE), Virtual Surgery Planning (VSP), Computer Aided Design (CAD), Additive Manufacturing (AM), and 3D visualization allows surgeons to plan, virtually, manipulations and the translation of the human parts in the operating room. This work’s aim was to define a methodology, in the form of a workflow, for surgery planning and for designing and manufacturing templates for orthognathic surgery. Along the workflow, the error chain was checked and the maximum error in virtual planning was evaluated. The three-dimensional reconstruction of the mandibular shape and bone fragment movements after segmentation allow complete planning of the surgery and, following the proposed method, the introduction of both the innovative evaluation of the transversal intercondylar distance...
Computer Assisted Planning in Cranio-Maxillofacial Surgery
Journal of Computing and Information Technology, 2006
In cranio-maxillofacial surgery physicians are often faced with the reconstruction of massively destroyed or radically resected tissue structures caused by trauma or tumours. Also corrections of dislocated bone fragments up to the complete modeling of facial regions in cases of complex congenital malformations are common tasks of plastic and reconstructive surgeons. With regard to the individual anatomy and physiology, such procedures have to be planned and executed thoroughly in order to achieve the best functional as well as an optimal aesthetic rehabilitation. On this account a computer-assisted modeling, planning and simulation approach is presented that allows for preoperative assessment of different therapeutic strategies on the basis of three-dimensional patient models. Bone structures can be mobilized and relocated under consideration of anatomical and functional constraints. The resulting facial appearance is simulated via finite-element methods on the basis of a biomechanical tissue model, and visualized using high quality rendering techniques. Such an approach is not only important for preoperative mental preparation, but also for vivid patient information, documentation, quality assurance as well as for surgical education and training.
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.