Department of Orthodontics, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX, USA; Orthodontics of Dental Corps, The United States Air Force, USA.
Department of Oral and Maxillofacial Surgery, Houston Methodist, Houston, TX, USA.
Int J Oral Maxillofac Surg. 2022 Aug;51(8):1043-1049. doi: 10.1016/j.ijom.2022.02.001. Epub 2022 Feb 17.
Digital dental articulation for three-piece maxillary orthognathic surgery is challenging. The purpose of this proof-of-concept study was to evaluate the clinical feasibility of a newly developed mathematical algorithm to digitally establish the final occlusion for three-piece maxillary surgery. Five patients with jaw deformities who had undergone a three-piece double-jaw surgery that was planned virtually were randomly selected for this study. The final occlusion had been hand-articulated using stone casts, scanned into the computer and used in the surgery. These hand-articulated occlusions served as the control group. To form the experimental group, the three-piece maxillary dental arch was articulated again automatically from the patient's original occlusion using the mathematical algorithm. The hand- and algorithm-articulated occlusions were then evaluated qualitatively by two experienced orthodontists. A quantitative evaluation was also performed. The results of the qualitative evaluation showed that all of the three-piece occlusions, hand- and algorithm-articulated, were clinically acceptable based on the American Board of Orthodontics grading system. When compared, two of the algorithm-articulated occlusions were clearly better (40%), one was the same (20%), and two were slightly worse (40%) than the hand-articulated occlusions. All of the quantitative measurements were comparable between the two articulation methods. In conclusion, the results of this study demonstrate that it is clinically feasible to digitally articulate the three-piece maxillary arch to the intact mandibular dental arch.
数字化的三段式上颌骨正颌手术咬合关系建立具有挑战性。本研究旨在评估一种新开发的数学算法在三段式上颌骨手术数字化最终咬合关系建立中的临床可行性。本研究随机选择了 5 例接受过虚拟规划三段式双颌手术的颌骨畸形患者。最终咬合关系通过手工咬合记录，然后扫描到计算机中，并应用于手术中。这些手工咬合记录作为对照组。为了形成实验组，使用数学算法从患者原始咬合关系自动重新建立三段式上颌牙弓的咬合关系。然后，两位经验丰富的正畸医生对手工和算法咬合关系进行定性评估。同时进行了定量评估。定性评估结果显示，根据美国正畸委员会分级系统，所有三种咬合关系（手工和算法）都是临床可接受的。相比之下，有两个算法咬合关系明显更好（40%），一个相同（20%），两个稍微差一些（40%）于手工咬合关系。两种咬合关系的所有定量测量结果均相似。总之，本研究结果表明，数字化建立三段式上颌牙弓与完整下颌牙弓的咬合关系在临床上是可行的。
