Skip to main content

Advertisement

SpringerLink
Log in

Customized virtual surgical planning in bimaxillary orthognathic surgery: a prospective randomized trial

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

The aim of the present study was to compare conventional (CSP) versus customized virtual surgical planning (VSP) in bimaxillary orthognathic surgery. The primary goal was to compare the accuracy of defined angles. The secondary purpose was to analyze the accuracy of the splints, the time required for surgery, and the costs of both methods.

Materials and methods

A total of 21 patients (nCSP = 12; nVSP = 9) treated by two-jaw orthognathic surgery were analyzed prospectively between the years 2014 and 2016. Customized VSP consisted of virtual planning as well as CAD/CAM printing of splints and pre-bent osteosynthesis plates. The evaluated parameters were the difference between planned and postoperative situation (SNA/SNB/ANB), accuracy of splints, time required for surgery (min), and total costs of planning (€).

Results

When compared to CSP, VSP appears to be a more accurate method for orthognathic treatment planning with significant differences in the angle outcome (SNA p < 0.001; SNB p = 0.002; ANB p < 0.001). There were significant differences in splint accuracy in favor of CAD/CAM splints (p = 0.007). VSP significantly reduced the duration of operation (p = 0.041). Nevertheless, VSP increased the total costs (481.80 € vs. 884.00 €).

Conclusions

When using virtual 3D technology in combination with printed acrylic splints, 3D models of the jaws and pre-bent osteosynthesis, there is a noticeable reduction in the duration of the operation in conjunction with an improvement in accuracy.

Clinical relevance

Virtual model surgery and the prefabrication of splints and plates may replace traditional orthognathic surgery as it becomes cost-effective.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hammoudeh JA, Howell LK, Boutros S, Scott MA, Urata MM (2015) Current status of surgical planning for orthognathic surgery: traditional methods versus 3D surgical planning. Plast Reconstr Surg Glob Open 3:e307. https://doi.org/10.1097/GOX.0000000000000184

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lu CH, Ko EW, Huang CS (2003) The accuracy of video imaging prediction in soft tissue outcome after bimaxillary orthognathic surgery. J Oral Maxillofac Surg 61:333–342. https://doi.org/10.1053/joms.2003.50058

    Article  PubMed  Google Scholar 

  3. Caloss R, Atkins K, Stella JP (2007) Three-dimensional imaging for virtual assessment and treatment simulation in orthognathic surgery. Oral Maxillofac Surg Clin North Am 19:287–309, v. https://doi.org/10.1016/j.coms.2007.04.006

    Article  PubMed  Google Scholar 

  4. Kaipatur NR, Flores-Mir C (2009) Accuracy of computer programs in predicting orthognathic surgery soft tissue response. J Oral Maxillofac Surg 67:751–759. https://doi.org/10.1016/j.joms.2008.11.006

    Article  PubMed  Google Scholar 

  5. Cevidanes LH, Tucker S, Styner M, Kim H, Chapuis J, Reyes M, Proffit W, Turvey T, Jaskolka M (2010) Three-dimensional surgical simulation. Am J Orthod Dentofac Orthop 138:361–371. https://doi.org/10.1016/j.ajodo.2009.08.026

    Article  Google Scholar 

  6. Adolphs N, Liu W, Keeve E, Hoffmeister B (2014) RapidSplint: virtual splint generation for orthognathic surgery - results of a pilot series. Comput Aided Surg 19:20–28. https://doi.org/10.3109/10929088.2014.887778

    Article  PubMed  PubMed Central  Google Scholar 

  7. Grauer D, Cevidanes LS, Proffit WR (2009) Working with DICOM craniofacial images. Am J Orthod Dentofac Orthop 136:460–470. https://doi.org/10.1016/j.ajodo.2009.04.016

    Article  Google Scholar 

  8. Gateno J, Xia JJ, Teichgraeber JF (2011) New 3-dimensional cephalometric analysis for orthognathic surgery. J Oral Maxillofac Surg 69:606–622. https://doi.org/10.1016/j.joms.2010.09.010

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gateno J, Xia J, Teichgraeber JF, Rosen A, Hultgren B, Vadnais T (2003) The precision of computer-generated surgical splints. J Oral Maxillofac Surg 61:814–817

    Article  Google Scholar 

  10. Metzger MC, Hohlweg-Majert B, Schwarz U, Teschner M, Hammer B, Schmelzeisen R (2008) Manufacturing splints for orthognathic surgery using a three-dimensional printer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:e1–e7. https://doi.org/10.1016/j.tripleo.2007.07.040

    Article  PubMed  Google Scholar 

  11. Zhang N, Liu S, Hu Z, Hu J, Zhu S, Li Y (2016) Accuracy of virtual surgical planning in two-jaw orthognathic surgery: comparison of planned and actual results. Oral Surg Oral Med Oral Pathol Oral Radiol 122:143–151. https://doi.org/10.1016/j.oooo.2016.03.004

    Article  PubMed  Google Scholar 

  12. Schneider D, Kammerer PW, Schon G, Bschorer R (2015) A three-dimensional comparison of the pharyngeal airway after mandibular distraction osteogenesis and bilateral sagittal split osteotomy. J Craniomaxillofac Surg 43:1632–1637. https://doi.org/10.1016/j.jcms.2015.07.014

    Article  PubMed  Google Scholar 

  13. Xia JJ, Gateno J, Teichgraeber JF (2009) New clinical protocol to evaluate craniomaxillofacial deformity and plan surgical correction. J Oral Maxillofac Surg 67:2093–2106. https://doi.org/10.1016/j.joms.2009.04.057

    Article  PubMed  PubMed Central  Google Scholar 

  14. Quevedo LA, Ruiz JV, Quevedo CA (2011) Using a clinical protocol for orthognathic surgery and assessing a 3-dimensional virtual approach: current therapy. J Oral Maxillofac Surg 69:623–637. https://doi.org/10.1016/j.joms.2010.11.009

    Article  PubMed  Google Scholar 

  15. Zinser MJ, Mischkowski RA, Sailer HF, Zoller JE (2012) Computer-assisted orthognathic surgery: feasibility study using multiple CAD/CAM surgical splints. Oral Surg Oral Med Oral Pathol Oral Radiol 113:673–687. https://doi.org/10.1016/j.oooo.2011.11.009

    Article  PubMed  Google Scholar 

  16. Lin HH, Lo LJ (2015) Three-dimensional computer-assisted surgical simulation and intraoperative navigation in orthognathic surgery: a literature review. J Formos Med Assoc 114:300–307. https://doi.org/10.1016/j.jfma.2015.01.017

    Article  PubMed  Google Scholar 

  17. Ruhland A (1969) Latitude of variation of teleroentgen drawings. Fortschr Kieferorthop 30:67–71

    Article  Google Scholar 

  18. Ellis E 3rd (1990) Accuracy of model surgery: evaluation of an old technique and introduction of a new one. J Oral Maxillofac Surg 48:1161–1167

    Article  Google Scholar 

  19. Schneider M, Tzscharnke O, Pilling E, Lauer G, Eckelt U (2005) Comparison of the predicted surgical results following virtual planning with those actually achieved following bimaxillary operation of dysgnathia. J Craniomaxillofac Surg 33:8–12. https://doi.org/10.1016/j.jcms.2004.05.010

    Article  PubMed  Google Scholar 

  20. Kolokitha OE, Topouzelis N (2011) Cephalometric methods of prediction in orthognathic surgery. J Maxillofac Oral Surg 10:236–245. https://doi.org/10.1007/s12663-011-0228-7

    Article  PubMed  PubMed Central  Google Scholar 

  21. Xia JJ, Gateno J, Teichgraeber JF, Christensen AM, Lasky RE, Lemoine JJ, Liebschner MA (2007) Accuracy of the computer-aided surgical simulation (CASS) system in the treatment of patients with complex craniomaxillofacial deformity: a pilot study. J Oral Maxillofac Surg 65:248–254. https://doi.org/10.1016/j.joms.2006.10.005

    Article  PubMed  Google Scholar 

  22. Hoang D, Perrault D, Stevanovic M, Ghiassi A (2016) Surgical applications of three-dimensional printing: a review of the current literature & how to get started. Ann Transl Med 4:456. https://doi.org/10.21037/atm.2016.12.18

    Article  PubMed  PubMed Central  Google Scholar 

  23. Choi JY, Song KG, Baek SH (2009) Virtual model surgery and wafer fabrication for orthognathic surgery. Int J Oral Maxillofac Surg 38:1306–1310. https://doi.org/10.1016/j.ijom.2009.06.009

    Article  PubMed  Google Scholar 

  24. Hatamleh M, Turner C, Bhamrah G, Mack G, Osher J (2016) Improved virtual planning for bimaxillary orthognathic surgery. J Craniofac Surg 27:e568–e573. https://doi.org/10.1097/SCS.0000000000002877

    Article  PubMed  Google Scholar 

  25. Jaisinghani S, Adams NS, Mann RJ, Polley JW, Girotto JA (2017) Virtual surgical planning in orthognathic surgery. Eplasty 17:ic1

    PubMed  PubMed Central  Google Scholar 

  26. Wrzosek MK, Peacock ZS, Laviv A, Goldwaser BR, Ortiz R, Resnick CM, Troulis MJ, Kaban LB (2016) Comparison of time required for traditional versus virtual orthognathic surgery treatment planning. Int J Oral Maxillofac Surg 45:1065–1069. https://doi.org/10.1016/j.ijom.2016.03.012

    Article  PubMed  Google Scholar 

  27. Xia JJ, Phillips CV, Gateno J, Teichgraeber JF, Christensen AM, Gliddon MJ, Lemoine JJ, Liebschner MA (2006) Cost-effectiveness analysis for computer-aided surgical simulation in complex cranio-maxillofacial surgery. J Oral Maxillofac Surg 64:1780–1784. https://doi.org/10.1016/j.joms.2005.12.072

    Article  PubMed  Google Scholar 

  28. Resnick CM, Inverso G, Wrzosek M, Padwa BL, Kaban LB, Peacock ZS (2016) Is there a difference in cost between standard and virtual surgical planning for orthognathic surgery? J Oral Maxillofac Surg 74:1827–1833. https://doi.org/10.1016/j.joms.2016.03.035

    Article  PubMed  Google Scholar 

  29. Xia JJ, Gateno J, Teichgraeber JF (2005) Three-dimensional computer-aided surgical simulation for maxillofacial surgery. Atlas Oral Maxillofac Surg Clin North Am 13:25–39. https://doi.org/10.1016/j.cxom.2004.10.004

    Article  PubMed  Google Scholar 

  30. Tucker S, Cevidanes LH, Styner M, Kim H, Reyes M, Proffit W, Turvey T (2010) Comparison of actual surgical outcomes and 3-dimensional surgical simulations. J Oral Maxillofac Surg 68:2412–2421. https://doi.org/10.1016/j.joms.2009.09.058

    Article  PubMed  PubMed Central  Google Scholar 

  31. Gateno J, Xia JJ, Teichgraeber JF (2011) New methods to evaluate craniofacial deformity and to plan surgical correction. Semin Orthod 17:225–234. https://doi.org/10.1053/j.sodo.2011.02.006

    Article  PubMed  PubMed Central  Google Scholar 

  32. Xia JJ, Shevchenko L, Gateno J, Teichgraeber JF, Taylor TD, Lasky RE, English JD, Kau CH, McGrory KR (2011) Outcome study of computer-aided surgical simulation in the treatment of patients with craniomaxillofacial deformities. J Oral Maxillofac Surg 69:2014–2024. https://doi.org/10.1016/j.joms.2011.02.018

    Article  PubMed  PubMed Central  Google Scholar 

  33. Orentlicher G, Goldsmith D, Horowitz A (2010) Applications of 3-dimensional virtual computerized tomography technology in oral and maxillofacial surgery: current therapy. J Oral Maxillofac Surg 68:1933–1959. https://doi.org/10.1016/j.joms.2010.03.013

    Article  PubMed  Google Scholar 

  34. Aboul-Hosn Centenero S, Hernandez-Alfaro F (2012) 3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results - our experience in 16 cases. J Craniomaxillofac Surg 40:162–168. https://doi.org/10.1016/j.jcms.2011.03.014

    Article  PubMed  Google Scholar 

  35. Li B, Zhang L, Sun H, Yuan J, Shen SG, Wang X (2013) A novel method of computer aided orthognathic surgery using individual CAD/CAM templates: a combination of osteotomy and repositioning guides. Br J Oral Maxillofac Surg 51:e239–e244. https://doi.org/10.1016/j.bjoms.2013.03.007

    Article  PubMed  Google Scholar 

  36. Gander T, Bredell M, Eliades T, Rucker M, Essig H (2015) Splintless orthognathic surgery: a novel technique using patient-specific implants (PSI). J Craniomaxillofac Surg 43:319–322. https://doi.org/10.1016/j.jcms.2014.12.003

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Helios Kliniken Schwerin, Wismarsche Straße 393-397, 19049, Schwerin, Germany

    Daniel Schneider, Matthias Hennig & Reinhard Bschorer

  2. Department of Oral, Maxillofacial and Plastic Surgery, University Medical Center of Johannes Gutenberg, Mainz, Germany

    Peer W. Kämmerer & Daniel G. E. Thiem

  3. Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

    Gerhard Schön

Authors
  1. Daniel Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peer W. Kämmerer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthias Hennig
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gerhard Schön
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel G. E. Thiem
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Reinhard Bschorer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel Schneider.

Ethics declarations

Conflict interest

The authors declare that they have no conflicts of interest.

Ethical approval

Ethical approval was obtained from the regional ethical committee of the University Medical Centre Rostock, Germany.

Informed consent

All included patients signed an informed consent form before participating.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schneider, D., Kämmerer, P.W., Hennig, M. et al. Customized virtual surgical planning in bimaxillary orthognathic surgery: a prospective randomized trial. Clin Oral Invest 23, 3115–3122 (2019). https://doi.org/10.1007/s00784-018-2732-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-018-2732-3

Keywords

Search

Navigation