Zinser Max J, Sailer Hermann F, Ritter Lutz, Braumann Bert, Maegele Marc, Zöller Joachim E
Associate Professor, Department of Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany.
J Oral Maxillofac Surg. 2013 Dec;71(12):2151.e1-21. doi: 10.1016/j.joms.2013.07.007.
Advances in computers and imaging have permitted the adoption of 3-dimensional (3D) virtual planning protocols in orthognathic surgery, which may allow a paradigm shift when the virtual planning can be transferred properly. The purpose of this investigation was to compare the versatility and precision of innovative computer-aided designed and computer-aided manufactured (CAD/CAM) surgical splints, intraoperative navigation, and "classic" intermaxillary occlusal splints for surgical transfer of virtual orthognathic planning.
The protocols consisted of maxillofacial imaging, diagnosis, virtual orthognathic planning, and surgical planning transfer using newly designed CAD/CAM splints (approach A), navigation (approach B), and intermaxillary occlusal splints (approach C). In this prospective observational study, all patients underwent bimaxillary osteotomy. Eight patients were treated using approach A, 10 using approach B, and 12 using approach C. These techniques were evaluated by applying 13 hard and 7 soft tissue parameters to compare the virtual orthognathic planning (T0) with the postoperative result (T1) using 3D cephalometry and image fusion (ΔT1 vs T0).
The highest precision (ΔT1 vs T0) for the maxillary planning transfer was observed with CAD/CAM splints (<0.23 mm; P > .05) followed by surgical "waferless" navigation (<0.61 mm, P < .05) and classic intermaxillary occlusal splints (<1.1 mm; P < .05). Only the innovative CAD/CAM splints kept the condyles in their central position in the temporomandibular joint. However, no technique enables a precise prediction of the mandible and soft tissue.
CAD/CAM splints and surgical navigation provide a reliable, innovative, and precise approach for the transfer of virtual orthognathic planning. These computer-assisted techniques may offer an alternate approach to the use of classic intermaxillary occlusal splints.
计算机和成像技术的进步使得三维（3D）虚拟规划方案在正颌外科手术中得以应用，当虚拟规划能够正确转换时，这可能会带来一种模式转变。本研究的目的是比较创新的计算机辅助设计和计算机辅助制造（CAD/CAM）手术夹板、术中导航以及“传统”颌间咬合夹板在虚拟正颌规划手术转换中的通用性和精确性。
方案包括颌面成像、诊断、虚拟正颌规划以及使用新设计的CAD/CAM夹板（方法A）、导航（方法B）和颌间咬合夹板（方法C）进行手术规划转换。在这项前瞻性观察研究中，所有患者均接受双颌截骨术。8例患者采用方法A治疗，10例采用方法B治疗，12例采用方法C治疗。通过应用13项硬组织和7项软组织参数，使用三维头影测量和图像融合（ΔT1与T0对比）来评估这些技术，以比较虚拟正颌规划（T0）与术后结果（T1）。
在上颌规划转换中，CAD/CAM夹板观察到最高精度（ΔT1与T0对比）（<0.23毫米；P>.05），其次是手术“无薄片”导航（<0.61毫米，P<.05）和传统颌间咬合夹板（<1.1毫米；P<.05）。只有创新的CAD/CAM夹板能使髁突保持在颞下颌关节的中心位置。然而，没有一种技术能够精确预测下颌骨和软组织。
CAD/CAM夹板和手术导航为虚拟正颌规划的转换提供了一种可靠、创新且精确的方法。这些计算机辅助技术可能为使用传统颌间咬合夹板提供一种替代方法。
