title: Evaluation of two dental registration-splint techniques for surgical navigation in cranio-maxillofacial surgery.
abstract: BACKGROUND
  Surgical navigation requires precise registration of the pre-operative image dataset to the patient in the operation theatre. Different marker-based and marker-free registration techniques are available, each of them with advantages and disadvantages regarding precision and clinical handling. In this model study, the precision of two dental splint techniques for marker-based registration is analyzed.
  
  
  METHODS
  A synthetic full-size human skull was registered with its cone beam computed tomography dataset using (a) a dentally-mounted "rapid" occlusal splint with five titanium screws directly attached to the splint, (b) an "extender", a dentally-mounted occlusal splint with similar fiducials fixed to an extension of the splint. The target registration error was measured for 170 landmarks distributed over the viscero- and neurocranium in 10 repeats per splint type using the Vector Vision2 (BrainLAB AG, Heimstetten, Germany) navigation system. Statistical and graphical evaluations were performed per anatomical region.
  
  
  RESULTS
  In the periorbital region, the rapid splint, with an average deviation of 1.50 mm (SD = 0.439) showed greater accuracy than the extender with 1.76 mm (SD = 0.525). The viscerocranial results for both splints were similar (extender 1.84 mm, SD = 0.559, rapid occlusal splint 1.86 mm, SD = 0.686). In the cranial vault region, registration with the extender (2.33 mm, SD = 0.685) proved to be more precise than with the rapid splint (2.86 mm, SD = 0.929).
  
  
  CONCLUSIONS
  Due to the more compact dimension of the rapid occlusal splint, errors close to the splint were smaller compared to the extender technique. The advantage of greater distances between the registration fiducials on the extender is particularly important in areas such as the orbital roof, the cranial vault, and the lateral skull base.
authors.affiliation: Clinic for Cranio-Maxillofacial Surgery (Head: K.W. Grätz), University Hospital Zurich, Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Venosta
authors.affiliation: Oral and Maxillofacial Surgery (Head: C. Politis), St. John's Hospital, Schiepse bos 6, 3600 Genk, Belgium; Faculty of Medicine, Hasselt University, Diepenbeek, Belgium.
authors.forename: Yi
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Surgical Planning Laboratory (Head: R. Kikinis), Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 USA.
authors.forename: Felix
authors.initials: F
authors.lastname: Matthews
authors.affiliation: Clinic for Cranio-Maxillofacial Surgery (Head: K.W. Grätz), University Hospital Zurich, Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland.
authors.forename: Astrid L
authors.initials: AL
authors.lastname: Kruse
authors.affiliation: Clinic for Cranio-Maxillofacial Surgery (Head: K.W. Grätz), University Hospital Zurich, Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Lanzer
authors.affiliation: Clinic for Cranio-Maxillofacial Surgery (Head: K.W. Grätz), University Hospital Zurich, Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gander
authors.affiliation: Clinic for Cranio-Maxillofacial Surgery (Head: K.W. Grätz), University Hospital Zurich, Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland.
authors.forename: Klaus W
authors.initials: KW
authors.lastname: Grätz
authors.affiliation: Clinic for Cranio-Maxillofacial Surgery (Head: K.W. Grätz), University Hospital Zurich, Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland; Surgical Planning Laboratory (Head: R. Kikinis), Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 USA. Electronic address: t.luebbers@gmail.com.
authors.forename: Heinz-Theo
authors.initials: HT
authors.lastname: Lübbers
mesh_terms: D059925:Anatomic Landmarks / Q000000981:diagnostic imaging; D001672:Biocompatible Materials / Q000737:chemistry; D001863:Bone Screws; D002508:Cephalometry / Q000379:methods; D054893:Cone-Beam Computed Tomography / Q000379:methods; D005147:Facial Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D057918:Fiducial Markers; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007574:Jaw Relation Record / Q000295:instrumentation*; D008953:Models, Anatomic; D017090:Occlusal Splints; D009915:Orbit / Q000000981:diagnostic imaging; D012886:Skull / Q000000981:diagnostic imaging / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D014025:Titanium / Q000737:chemistry
chemical_list: D001672:Biocompatible Materials; D014025:Titanium
keywords: Computer-assisted; Cranial; Extender; Maxillofacial; Navigation; Occlusal; Orbital; Rapid; Registration; Splint; Surgery; Surgical planning