title: The use of patient-specific implants in orthognathic surgery: A series of 30 mandible sagittal split osteotomy patients.
abstract: OBJECTIVE
  Virtual surgery combined with patient-specific saw and drill guides and osteosynthesis materials are rapidly spreading from reconstructive surgery to orthognathic surgery. Most commercial partners are already providing computer-aided design and computer-aided manufacture (CAD/CAM) wafers and patient-specific saw guides. Clear benefits have been demonstrated for custom-made drill guides combined with individually designed three-dimensional (3D) printed patient-specific implants (PSI) as a reposition and fixation system in Le Fort I osteotomy.
  
  
  METHODS
  We treated 30 patients who underwent bilateral sagittal split osteotomy (BSSO) due to class II dento-skeletal deformities with the additional use of drill guides combined with PSI as a fixation and positioning system.
  
  
  RESULTS
  The PSIs fitted bilaterally with total precision in 11 of the 30 patients. In 17 patients, the PSIs were used with some modifications. In 2 of 30 patients, the PSIs could not be used as a fixation due to misfit.
  
  
  CONCLUSIONS
  Due to unpredictable fitting, the use of PSIs with drill guides alone in BSSO without wafers cannot be recommended. Further studies are needed to evaluate the interfering parts, which seem to be related to condylar positioning and bony interferences at the osteotomy sites.
authors.affiliation: Departments of Oral and Maxillo-Facial Diseases (Head: Risto Kontio, MD, DDS, PhD), University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4E, 00029 HUS, Helsinki, Finland. Electronic address: juho.suojanen@helsinki.fi.
authors.forename: Juho
authors.initials: J
authors.lastname: Suojanen
authors.affiliation: Cleft Lip and Palate and Craniofacial Centre (Head: Hannu Kuokkanen, MD, PhD), Helsinki University Hospital, Sibeliuksenkatu 10, 00029 HUS, Finland.
authors.forename: Junnu
authors.initials: J
authors.lastname: Leikola
authors.affiliation: Departments of Oral and Maxillo-Facial Diseases (Head: Risto Kontio, MD, DDS, PhD), University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4E, 00029 HUS, Helsinki, Finland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Stoor
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008312:Malocclusion, Angle Class II / Q000000981:diagnostic imaging / Q000601:surgery*; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D059229:Osteotomy, Sagittal Split Ramus / Q000295:instrumentation*; D019736:Prostheses and Implants; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: BSSO; CAD/CAM; Orthognatic surgery; Patient specific implants; Sagittal ramus osteotomy; Sagittal split osteotomy