Department of Craniomaxillofacial Surgery, Hannover Medical School, Germany.
Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Military Hospital Ulm and Academic Hospital University, Ulm, Germany.
J Craniomaxillofac Surg. 2017 Dec;45(12):1962-1970. doi: 10.1016/j.jcms.2017.07.016. Epub 2017 Jul 29.
The benefit of computer-assisted planning in orthognathic surgery has been extensively documented over the last decade. This study aims to evaluate the accuracy of a virtual orthognathic surgical plan by a novel three dimensional (3D) analysis method. Ten patients who required orthognathic surgery were included in this study. A virtual surgical plan was achieved by the combination of a 3D skull model acquired from computed tomography (CT) and surface scanning of the upper and lower dental arch respectively and final occlusal position. Osteotomies and movement of maxilla and mandible were simulated by Dolphin Imaging 11.8 Premium (Dolphin Imaging and Management Solutions, Chatsworth, CA). The surgical plan was transferred to surgical splints fabricated by means of Computer Aided Design/Computer Aided Manufacturing (CAD/CAM). Differences of three dimensional measurements between the virtual surgical plan and postoperative results were evaluated. The results from all parameters showed that the virtual surgical plans were successfully transferred by the assistance of CAD/CAM fabricated surgical splint. Wilcoxon's signed rank test showed that no statistically significant deviation between surgical plan and post-operational result could be detected. However, deviation of angle U1 axis-HP and distance of A-CP could not fulfill the clinical success criteria. Virtual surgical planning and CAD/CAM fabricated surgical splint are proven to facilitate treatment planning and offer an accurate surgical result in orthognathic surgery.
在过去的十年中，计算机辅助规划在正颌外科中的益处得到了广泛的证实。本研究旨在通过一种新的三维（3D）分析方法评估虚拟正颌手术计划的准确性。本研究纳入了 10 名需要正颌手术的患者。通过将 CT 获得的三维颅骨模型与上下牙弓的表面扫描分别结合，并结合最终的咬合位置，实现了虚拟手术计划。通过 Dolphin Imaging 11.8 Premium（Dolphin Imaging and Management Solutions，Chatsworth，CA）模拟了截骨术和上颌骨及下颌骨的移动。手术计划通过计算机辅助设计/计算机辅助制造（CAD/CAM）转移到手术夹板上。通过三维测量评估虚拟手术计划与术后结果之间的差异。所有参数的结果均表明，通过 CAD/CAM 制造的手术夹板的辅助，虚拟手术计划得以成功转移。Wilcoxon 符号秩检验显示，手术计划和术后结果之间没有统计学上显著的偏差。然而，U1 轴-HP 角度和 A-CP 距离的偏差无法满足临床成功标准。虚拟手术规划和 CAD/CAM 制造的手术夹板被证明可以促进治疗计划，并在正颌手术中提供准确的手术结果。
