title: Computer-aided design and computer-aided manufacturing cutting guides and customized titanium plates are useful in upper maxilla waferless repositioning.
abstract: OBJECTIVE
  The purpose of the present study was to develop a computer-aided design (CAD) and computer-aided manufacturing (CAM) technique that enabled fabrication of surgical cutting guides and titanium fixation plates that would allow the upper maxilla to be repositioned correctly without a surgical splint in orthognathic patients.
  
  
  METHODS
  Ten patients were recruited. A complete CAD-CAM workflow for orthognathic surgery has 3 steps: 1) virtual planning of the surgical treatment, 2) CAD-CAM and 3-dimensional printing of customized surgical devices (surgical cutting guide and titanium fixation plates), and 3) computer-aided surgery. Upper maxilla repositioning was performed in a waferless manner using a CAD-CAM device: the surgical cutting guide was used during surgery to pilot the osteotomy line that had been planned preoperatively at the computer and the custom-made fixation titanium plates allowed desired repositioning of the maxilla.
  
  
  RESULTS
  To evaluate the reproducibility of this CAD-CAM orthognathic surgical method, the virtually planned and actually achieved positions of the upper maxilla were compared. Overlap errors using a threshold value smaller than 2 mm were evaluated, and the frequency of such errors was used as a measurement of accuracy. By this definition, the accuracy was 100% in 7 patients (range in all patients, 62 to 100%; median, 92.7%).
  
  
  CONCLUSIONS
  These results tend to confirm that the use of CAD-CAM cutting guides and customized titanium plates for upper maxilla repositioning represents a promising method for the accurate reproduction of preoperative virtual planning without the use of surgical splints.
authors.affiliation: Assistant, Department of Maxillofacial Surgery, S Orsola Malpighi Hospital, University of Bologna, Bologna, Italy. Electronic address: simonamazzoni@libero.it.
authors.forename: Simona
authors.initials: S
authors.lastname: Mazzoni
authors.affiliation: Assistant, Department of Maxillofacial Surgery, S Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bianchi
authors.affiliation: Student, Medical School, University of Bologna, Bologna, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Schiariti
authors.affiliation: PhD Student, Department of Maxillofacial Surgery, S Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Badiali
authors.affiliation: Department Head and Professor, Department of Maxillofacial Surgery, S Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Marchetti
mesh_terms: D000497:Alloys / Q000737:chemistry; D001672:Biocompatible Materials / Q000737:chemistry*; D001860:Bone Plates; D017076:Computer-Aided Design; D004867:Equipment Design; D005146:Facial Asymmetry / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008313:Malocclusion, Angle Class III / Q000601:surgery; D008437:Maxilla / Q000601:surgery; D063166:Maxillary Osteotomy / Q000295:instrumentation* / Q000379:methods; D056948:Orthognathic Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D066330:Printing, Three-Dimensional; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D014025:Titanium / Q000737:chemistry*; D014584:User-Computer Interface
chemical_list: D000497:Alloys; D001672:Biocompatible Materials; C031462:titanium alloy (TiAl6V4); D014025:Titanium