Guide surgery osteotomy system (GSOS) a new device for treatment in orthognathic surgery

Abstract

Introduction

This article proposes an innovative and revolutionary diagnostic and therapeutic protocol for performing dentoalveolar osteotomies in office under local anaesthesia with piezoelectric surgery using a surgical acrylic guide produced through software-based planning.

Methods

The method was applied in the correction of crossbites, changing in the curve of Spee, incisal decompensations and dental ankylosis. Performing a preoperative CT with a special splint, optical scanning of the models and the subsequent planning with software has enabled us to produce a model with rapid prototyping with the design of the osteotomy on which the surgical guide was shaped, the use of the guide associated with piezoelectric surgery, allowed to perform surgery under local anaesthesia, with minimal invasiveness and high accuracy.

Results

Dentoalveolar immediate movements, with preservation of the roots of teeth involved, allow for rapid treatment of malocclusions which would be long and often difficult if not impossible to treat with orthodontics only. Dentoalveolar osteotomies associated to osteodistraction concepts, allow the orthodontist to achieve with accuracy the objectives required by the treatment plan.

Conclusions

GSOS is a new method, which, utilizing 3D optical scanning images of models, software and piezoelectric surgery, allows to perform dentoalveolar movements which may be dangerous to the roots or for the periodontal support, with orthodontics only. It dramatically reduces total surgical-orthodontic treatment time, with obvious great patient satisfaction.

Introduction

Changes in the curve of Spee and significant incisal decompensation are often required in the correction of adult Class III as well as Class II deep bite malocclusions (Reyneke, 2002; Chung et al., 2008; Boye et al., 2012).

Given the poor periodontal and dentoalveolar support, and the peculiarly thin anatomy of the symphysis in these patients, these movements, may lead to gingival recession, root resorption and relapse and require long orthodontic treatment times (Foushee et al., 1985; Graber et al., 2005). For these reasons the true partial crossbites, which have a prevalence of between 8% and 23% (Kutin and Hawes, 1969) and which often cannot be treated in the adult, with orthodontic movements only (including surgical-orthodontic expansion), require segmental surgery. Performing dentoalveolar osteotomies, associated with orthodontic anchorage, allows for more rapid and effective dentoskeletal movements (Melsen et al., 1989; Liou et al., 2000). In particular, in Class II Division I cases, they allow non-extraction treatment.

The risk of apical resorption and loss of tooth vitality in the execution of dentoalveolar osteotomies is operator dependent and has a wide range in the literature (Kole, 1959a, Kole, 1959b; Pepersack, 1973; Kramer et al., 2004). The use of rotary instruments can be potentially damaging to the teeth and to the periodontium (Rullo et al., 2013; Morgan and Fridrich, 2001; Schultes et al., 1998) and reduces the compliance of patients under local anaesthesia. Piezoelectric surgery facilitates dentoalveolar osteotomy under local anaesthesia, as it is has a more conservative approach on the soft tissues and is less taxing for patients (Robiony et al., 2004).

The methods commonly used in guided implant surgery have been applied to the managing of post-traumatic deformities (Herlin et al., 2011) and in the planning and execution of dentoalveolar osteotomies to allow these minimally invasive, more accurate and more conservative outpatients procedures.