Ebker Tobias, Korn Paula, Heiland Max, Bumann Axel
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
Private Orthodontic Clinic, Georgenstraße 25, 10117 Berlin, Germany.
Br J Oral Maxillofac Surg. 2022 Oct;60(8):1092-1096. doi: 10.1016/j.bjoms.2022.04.008. Epub 2022 Apr 29.
The surgery-first concept is becoming increasingly popular in orthognathic surgery since it offers major advantages such as a reduction of treatment duration and an increase in patient satisfaction by eliminating phases of presurgical orthodontic decompensation. Here, we present a novel interdisciplinary pathway of a fully virtual orthodontic-surgical planning concept in a surgery-first setting using a 3D-printed cutting guide and a customised maxillary implant for the Le Fort I osteotomy as well as a CAD/CAM-based stereolithographic final splint. Patient data from cone-beam computed tomography of the skull and a full arch dental scan were processed using the OnyxCeph software (Image Instruments). A mutual computer-aided surgical simulation was conducted by the orthodontist and the oral and maxillofacial surgeon to determine the three-dimensional maxillary and mandibular movements. In a separate virtual planning session, the surgeon designed a customised maxillary guide and implant for precise intraoperative transfer (Geomagic Freeform Plus software, 3DSystems). A 3D-printed CAD/CAM-based final splint was fabricated by the orthodontist and used for accurate mandibular repositioning. We established a comprehensive virtual interdisciplinary orthognathic workflow and successfully applied this concept with a high level of accuracy in a series of surgery-first patients with different types of dentofacial anomalies. This novel fully computer-based pathway offers a high potential to improve the outcomes of orthognathic surgery and reduce total treatment time in the management of the orthognathic patient.
手术优先理念在正颌外科中越来越受欢迎，因为它具有诸多主要优势，比如通过消除术前正畸去代偿阶段来缩短治疗时间并提高患者满意度。在此，我们展示了一种全新的跨学科路径，即在手术优先模式下采用全虚拟正畸-手术规划理念，使用3D打印切割导板和定制的上颌植入物用于Le Fort I截骨术，以及基于CAD/CAM的立体光刻最终夹板。来自头颅锥形束计算机断层扫描和全牙弓牙科扫描的患者数据使用OnyxCeph软件（影像仪器公司）进行处理。正畸医生和口腔颌面外科医生进行了相互的计算机辅助手术模拟，以确定上颌和下颌的三维移动。在一个单独的虚拟规划环节中，外科医生设计了定制的上颌导板和植入物以便精确的术中转移（Geomagic Freeform Plus软件，3D Systems公司）。正畸医生制作了基于CAD/CAM的3D打印最终夹板，并用于精确的下颌重新定位。我们建立了一个全面的虚拟跨学科正颌工作流程，并在一系列不同类型牙颌面畸形的手术优先患者中成功且高精度地应用了这一理念。这种全新的完全基于计算机的路径在改善正颌外科手术效果和减少正颌患者治疗总时间方面具有很大潜力。
