Accuracy of splint vs splintless technique for virtually planned orthognathic surgery: A voxel-based three-dimensional analysis |
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| Authors: | Lorena Karanxha Diego Rossi Ryo Hamanaka Aldo Bruno Giannì Alessandro Baj Won Moon Massimo Del Fabbro Michele Romano |
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| Affiliation: | 1. Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi di Milano, Milan, Italy;2. Maxillo-Facial and Dental Unit, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, Milan, Italy;3. Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Biomedical Sciences, Nagasaki University, Japan;4. Section of Orthodontics, School of Dentistry, University of California, Los Angeles, USA;5. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy;1. Department of Oral and Maxillofacial Surgery (Chair: Juergen Hoffmann MD, DDS, PhD), University Hospital Heidelberg, Germany;2. Department of Medical Biometry and Informatics (Chair: Meinhard Kieser MSc, PhD), University Hospital Heidelberg, Germany;1. University of Sassari Hospital, Maxillofacial Surgery Operative Unit, Viale San Pietro 43B, 07100, Sassari, Italy;2. University of Sassari Hospital, Dental School, Viale San Pietro 43B, 07100, Sassari, Italy;3. University of Naples “Federico II” Hospital, Maxillofacial Surgery Operative Unit, Via Pansini 5, 80131, Napoli, Italy;1. Oral and Maxillofacial Surgery, Hospital Das Clínicas, University of São Paulo (USP), Rua Dr Eneas de Carvalho, 255, 05403-010, São Paulo, São Paulo, Brazil;2. Oral and Maxillofacial Surgery, State University of Maringá (UEM), Avenida Mandacaru, 1550, 87080-000, Maringá, Paraná, Brazil;3. Oral Radiology and Stomatology, Department of Dentistry, State University of Maringá (UEM), Avenida Mandacaru, 1550, 87080-000, Maringá, Paraná, Brazil;4. Department of Dentistry, School of Health Sciences, University of Brasilia (UNB), Campus Universitário Darcy Ribeiro, Brasília, 70910-900, Distrito Federal, Brazil;5. Department of Dentistry, São Leopoldo Mandic, Rua Dr José Rocha Junqueira, 13, 13045-755, Campinas, São Paulo, Brazil;1. European Face Centre (Chair: Prof. Maurice Y. Mommaerts), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium;2. Department of Mechanical Engineering, Biomechanics Section, KU Leuven, Leuven, Belgium;3. R&D Officer, CADskills BVBA, Gent, Belgium;1. Department of Plastic and Reconstructive Surgery, and Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan;2. Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan;3. College of Medicine, Chang Gung University, Taoyuan, Taiwan |
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| Abstract: | PurposeThis study compared two transferring methods for virtually planned orthognathic surgery — the CAD/CAM intermediate splint and the customized surgical guide with fixation plates.MethodsThis was a prospective clinical study in which participants were consecutively recruited and underwent bimaxillary orthognathic surgery. They were divided into two groups based on the transferring method used. The pre- and postoperative CBCTs were aligned using voxel-based landmark-free registration, and the discrepancies for selected points were compared with the planned displacement of the virtually planned surgery. The maxilla and mandible were analyzed separately, and translation and rotation movements were considered.ResultsA total of 16 patients, divided into two groups of eight patients each, were included in this study. The splintless group was significantly more accurate for the translation movement along the x-axes for points A (p = 0.008; mean absolute error 0.527 ± 0.387 for the splint group and 0.137 ± 0.067 for the splintless group) and Ans (p = 0.045; mean absolute error 0.535 ± 0.446 for the splint group and 0.156 ± 0.002 for the splintless group). For the mandible there was a significant difference in accuracy along the x-axes for points B (p = 0.049; mean absolute errors 1.728 ± 1.181 and 0.697 ± 0.519 for the splint and splintless groups, respectively), LL3 (p = 0.049; mean absolute error 1.629 ± 0.912 and 0.851 ± 0.797 for the splint and splintless groups, respectively), LR3 (p = 0.049; mean absolute error 1.711 ± 0.906 and 0.844 ± 0.780 for the splint and splintless groups, respectively), with the splintless group being more accurate. For the rotation the splintless group was significantly more accurate along the y-axes (p = 0.04; mean absolute error 1.62 ± 0.78 and 0.49 ± 0.31 for the splint and splintless groups, respectively) and z-axes (p = 0.04; mean absolute error 0.63 ± 0.45 and 0.17 ± 0.05 for the splint and splintless groups, respectively) for the maxilla, while no significant difference was found for the mandible.ConclusionsOverall, the customized fixation plate system is more accurate than the intermediate CAD/CAM splint for transferring the virtual plan into the operation room. |
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| Keywords: | Virtual planning Orthognathic surgery Accuracy Voxel-based landmark-free registration Three-dimensional evaluation |
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