An in vitro study of the accuracy of a new protocol for planning distraction osteogenesis of the mandible.
OBJECTIVE
The purpose of this study was to determine the in vitro accuracy of a new protocol for distraction osteogenesis of the mandible that involves a planning process and a surgical technique.


METHODS
An experimental design was developed to simulate distraction osteogenesis on stereolithographic models of patients with craniofacial deformities. All patients had previously undergone 3-dimensional computerized scans of the craniofacial skeleton. The data from these scans were used to generate stereolithographic models. Before the fabrication of the models, the computed tomography (CT) data were manipulated to add a series of rulers and markers to the models. The 3-dimensional computerized scans were also used as the basis of the planning process. They were imported into an animation software (3D-Studio Max; Discreet, Montreal, Canada), and a virtual distractor was built and installed on the model, and the osteotomies and distraction processes were simulated. Finally, a recipe for sequencing the linear and angular changes of the distractor were calculated. A surgical technique was developed to facilitate the precise installation of the distractor as indicated in the presurgical plan. The transfer of information regarding pin position and orientation from the computer model to the patient was accomplished by creating a surgical template. This template was designed in the computer and fabricated by use of stereolithography. Mock surgery was performed on the stereolithographic models, and the results were compared with those predicted by the computer. The difference between the actual position and the predicted position was recorded.


RESULTS
On the X-axis, the difference between the predicted position for the condylar marker and the actual position of the marker on the stereolithographic models was 0.6 +/- 1.1 mm. On the Y-axis, the difference between the predicted position for the condylar marker and the actual position of the marker on the stereolithographic models was -0.9 +/- 2.6. On the Z-axis, the difference between the predicted position for the condylar marker and the actual position of the marker on the stereolithographic models was 0.04 +/- 0.8 mm. There was excellent correlation between the predicted and the actual measurements for the X, Y, and Z axes: 0.98, 0.93, and 0.98, respectively.


CONCLUSIONS
The results indicate that the combination of this planning process and surgical technique was very accurate. This in vitro study is the first step in determining the clinical usefulness of this protocol. If the results of this study are validated in clinical practice, this protocol will allow clinicians to improve the clinical outcomes of patients treated with distraction osteogenesis.
Gateno
J
J
Department of Oral & Maxillofacial Surgery, University of Texas Health Science Center, Houston 77030, USA. jgateno@mail.db.uth.tmc.edu
Allen
M E
ME
Teichgraeber
J F
JF
Messersmith
M L
ML
D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D019465:Craniofacial Abnormalities / Q000601:surgery*; D003394:Craniofacial Dysostosis / Q000601:surgery; D005146:Facial Asymmetry / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D019186:Mandibular Advancement / Q000379:methods*; D008342:Mandibulofacial Dysostosis / Q000601:surgery; D008953:Models, Anatomic; D003765:Models, Dental; D019857:Osteogenesis, Distraction / Q000379:methods*; D010347:Patient Care Planning; D010780:Photogrammetry; D010781:Photography / Q000379:methods; D018709:Statistics, Nonparametric; D013813:Therapy, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome