University of Heidelberg, Department of Oral and Maxillofacial Surgery, (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
University of Heidelberg, Department of Oral and Maxillofacial Surgery, (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
J Craniomaxillofac Surg. 2019 Jun;47(6):847-853. doi: 10.1016/j.jcms.2019.02.011. Epub 2019 Mar 2.
Because of the many limitations of conventional surgery planning for the treatment of orthognathic deformities, as well as advancements in computer-assisted planning, there is an urgent need for technical devices that transfer the surgical plan into the operating theatre. In this regard, additive-manufactured, patient-specific implants (PSI) and additive-manufactured interocclusal splints represent promising approaches. The aim of this retrospective study was to compare the accuracy of these two devices, with regard to preoperative virtual treatment planning for maxillary Le-Fort I advancement surgery using IPS CaseDesigner, and based on a new analysis method without the use of landmarks.
A retrospective evaluation of 18 class III patients (n(PSI) = 9; n(splint) = 9), who had undergone virtually planned orthognathic surgery (including maxillary Le Fort I advancement), was performed. The preoperative treatment plan and the postoperative outcome were combined to calculate the translational and rotational discrepancies between the 3D planning and the actual surgical outcome.
For the PSI and splint groups the accuracy of left/right positioning was 0.51 mm ± 0.48 and 1.11 mm ± 1.32 respectively. The accuracy of anterior/posterior positioning was 0.39 mm ± 0.26 and 1.42 mm ± 0.87, and that of up/down-positioning was 0.44 mm ± 0.31 and 0.62 mm ± 0.47. The rotational discrepancies were less than 2° in both groups.
The findings demonstrate that both PSI and splint approaches can accurately transfer the virtual planning into the operating theatre. However, PSIs show an overall higher accuracy, especially for anterior/posterior translational movement (p < 0.002).
由于传统手术规划在治疗正颌畸形方面存在诸多局限性，以及计算机辅助规划的进步，因此迫切需要将手术计划转移到手术室的技术设备。在这方面，增材制造的、患者特异性的植入物（PSI）和增材制造的咬合夹板代表了很有前途的方法。本回顾性研究的目的是比较这两种设备的准确性，方法是使用 IPS CaseDesigner 对上颌 Le-Fort I 推进手术进行术前虚拟治疗规划，并基于不使用地标进行的新分析方法。
对 18 名 III 类患者（PSI 组 n=9；夹板组 n=9）进行了回顾性评估，这些患者均接受了虚拟计划的正颌手术（包括上颌 Le Fort I 推进）。将术前治疗计划和术后结果相结合，计算 3D 规划与实际手术结果之间的平移和旋转差异。
PSI 组和夹板组左右定位的准确性分别为 0.51 ± 0.48mm 和 1.11 ± 1.32mm。前/后定位的准确性分别为 0.39 ± 0.26mm 和 1.42 ± 0.87mm，上/下定位的准确性分别为 0.44 ± 0.31mm 和 0.62 ± 0.47mm。两组的旋转差异均小于 2°。
研究结果表明，PSI 和夹板方法都可以准确地将虚拟规划转移到手术室。然而，PSI 总体上具有更高的准确性，特别是在前/后平移运动方面（p < 0.002）。
