From the Departments of Plastic and Reconstructive Surgery, Radiology, and Convergence Medicine, University of Ulsan College of Medicine, and Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center; Eastman Orthodontic Center; and Smile Again Orthodontic Center.
Plast Reconstr Surg. 2022 Mar 1;149(3):496e-499e. doi: 10.1097/PRS.0000000000008818.
The surgery-first orthognathic approach has been applied at our institution since 2007. However, its indications remain debated. The aim of this study was to investigate the reliability of the surgery-first approach to correct facial asymmetry compared to the traditional orthodontics-first approach using a novel artificial intelligence-based cephalometric analysis.
Intervention outcomes of surgery-first (n = 33) and orthodontics-first (n = 26) approaches to correct facial asymmetry were examined. Patients with facial asymmetry who had undergone orthognathic surgery from January of 2006 to January of 2019 were included in the study. In the surgery-first approach, the novel preoperative simulation process on the dental model was performed to determine the final occlusion without presurgical orthodontic treatment. Changes in cephalometric landmarks were compared using the supervised deep learning process developed at our institution.
The surgery-first approach without presurgical orthodontic treatment corrected facial asymmetry and yielded results similar to those of the traditional orthognathic approach. The statistical analysis revealed that changes in skeletal cephalometric landmarks were similar in the two groups.
The surgery-first orthognathic approach without presurgical orthodontic treatment treated facial asymmetry, possibly suggesting a possible paradigm shift in treatment. In addition, artificial intelligence-based cephalometric analysis was an effective tool.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
自 2007 年以来，我们机构一直在采用外科优先正颌方法。然而，其适应证仍存在争议。本研究旨在通过基于新型人工智能的头影测量分析，探讨外科优先方法与传统正畸优先方法矫正面部不对称的可靠性。
检查了外科优先（n=33）和正畸优先（n=26）两种方法矫正面部不对称的干预效果。研究纳入了 2006 年 1 月至 2019 年 1 月期间因正颌手术而患有面部不对称的患者。在外科优先方法中，在术前对牙模进行了新的术前模拟过程，以确定最终的咬合关系，而无需进行术前正畸治疗。使用我们机构开发的监督深度学习过程比较了头影测量标志点的变化。
无需术前正畸治疗的外科优先方法矫正了面部不对称，结果与传统正颌方法相似。统计分析显示，两组的骨骼头影测量标志点的变化相似。
无需术前正畸治疗的外科优先正颌方法治疗了面部不对称，这可能提示治疗方法的范式转变。此外，基于人工智能的头影测量分析是一种有效的工具。
临床问题/证据水平：治疗，III。
