title: Presentation and Evaluation of a Modified Wax-Bite Dental Splint for Surgical Navigation in Craniomaxillofacial Surgery.
abstract: OBJECTIVE
  The purpose of the present study was to introduce and evaluate the use of a modified "wax-bite dental splint" for surgical navigation in craniomaxillofacial surgery.
  
  
  METHODS
  A 2-layer wax bite dental splint was fabricated with an anterior extension, and 8 gutta percha markers were incorporated in each splint for marker-based pair-point registration. To evaluate the accuracy, the occlusal registration of the wax bite dental splint was performed on 10 artificial skulls. Consecutively, all the skulls were scanned using a standardized cone-beam computed tomography scanning protocol with the 2-layer wax bite dental splint in place. Automatic rigid marker-based pair-point registration was performed using the iPlan CMF software, version 3.0 (Brainlab AG, Feldkirchen, Germany) using 8 gutta percha markers incorporated into the wax bite dental splint. Additionally, the registration accuracy of 6 anatomic skeletal landmarks was measured on each skull.
  
  
  RESULTS
  The mean registration error for each wax bite dental splint ranged from 0.78 to 1.01 mm. The overall mean registration error for the wax-bite dental splint-based registration was 0.89 ± 0.08 mm. The mean registration error for the 6 anatomic landmarks ranged from 1.23 to 2.3 mm. The overall mean registration error was 1.68 ± 0.28 mm.
  
  
  CONCLUSIONS
  The results of the present study show the potential for a wax-bite dental splint as an alternative rigid registration method for surgical navigation in craniomaxillofacial surgery. Moreover, from a clinical viewpoint, the method is accurate, user-friendly, inexpensive, and not time-consuming.
authors.affiliation: Resident, Division of Maxillo-Facial Surgery, Department of Surgery, General Hospital St-Jan Bruges/3-D Facial Imaging Research Group, Bruges, Belgium. Electronic address: philippe.boeckx@gmail.com.
authors.forename: Philippe
authors.initials: P
authors.lastname: Boeckx
authors.affiliation: Staff Member, Division of Cranio-Maxillo-Facial and Oral Surgery, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Harald
authors.initials: H
authors.lastname: Essig
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Medical University Hannover, Hannover, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Kokemuller
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Medical University Hannover, Hannover, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Tavassol
authors.affiliation: Professor and Department Head, Department of Oral and Maxillofacial Surgery, Medical University Hannover, Hannover, Germany.
authors.forename: Nils Claudius
authors.initials: NC
authors.lastname: Gellrich
authors.affiliation: Professor, Division of Maxillo-Facial Surgery, Department of Surgery, General Hospital St-Jan Bruges/3-D Facial Imaging Research Group, Bruges, Belgium; Department of Oral and Maxillofacial Surgery, Medical University Hannover, Hannover, Germany.
authors.forename: Gwen R J
authors.initials: GR
authors.lastname: Swennen
mesh_terms: D006801:Humans; D012886:Skull / Q000601:surgery*; D013165:Splints; D013515:Surgery, Oral / Q000295:instrumentation*; D014885:Waxes
chemical_list: D014885:Waxes