Computer-assisted orthognathic surgery: feasibility study using multiple CAD/CAM surgical splints.
OBJECTIVE
We present a virtual planning protocol incorporating a patented 3-surgical splint technique for orthognathic surgery. The purpose of this investigation was to demonstrate the feasibility and validity of the method in vivo.


METHODS
The protocol consisted of (1) computed tomography (CT) or cone-beam computed tomography (CBCT) maxillofacial imaging, optical scan of articulated dental study models, segmentation, and fusion; (2) diagnosis and virtual treatment planning; (3) computed-assisted design and manufacture (CAD/CAM) of the surgical splints; and (4) intraoperative surgical transfer. Validation of the accuracy of the technique was investigated by applying the protocol to 8 adult class III patients treated with bimaxillary osteotomies. The virtual plan was compared with the postoperative surgical result using image fusion of CT/CBCT dataset by analysis of measurements between hard and soft tissue landmarks relative to reference planes.


RESULTS
The virtual planning approach showed clinically acceptable precision for the position of the maxilla (<0.23 mm) and condyle (<0.19 mm), marginal precision for the mandible (<0.33 mm), and low precision for the soft tissue (<2.52 mm).


CONCLUSIONS
Virtual diagnosis, planning, and use of a patented CAD/CAM surgical splint technique provides a reliable method that may offer an alternate approach to the use of arbitrary splints and 2-dimensional planning.
Department of Cranio-Maxillo-Facial Surgery, University of Cologne, Germany. drmaxzinser@yahoo.de
Max J
MJ
Zinser
Robert A
RA
Mischkowski
Hermann F
HF
Sailer
Joachim E
JE
Zöller
D000328:Adult; D002508:Cephalometry; D017076:Computer-Aided Design; D054893:Cone-Beam Computed Tomography; D005145:Face / Q000033:anatomy & histology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional / Q000379:methods; D007568:Jaw / Q000000981:diagnostic imaging; D008297:Male; D008313:Malocclusion, Angle Class III / Q000601:surgery*; D008953:Models, Anatomic; D003765:Models, Dental; D017090:Occlusal Splints; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D010347:Patient Care Planning; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface; D055815:Young Adult