Graduate School of Clinical Dentistry, Ewha Womans University, Seoul, South Korea.
Department of Oral and Maxillofacial Surgery, School of Medicine, Ewha Womans University, Anyangcheon-Ro 1071, Yangcheon-Gu, Seoul, 158-710, Korea.
BMC Oral Health. 2023 May 3;23(1):255. doi: 10.1186/s12903-023-03000-3.
Computer-aided design/manufacturing (CAD/CAM) technology was developed to improve surgical accuracy and minimize errors in surgical planning and orthognathic surgery. However, its accurate implementation during surgery remains a challenge. Hence, we compared the accuracy and stability of conventional orthognathic surgery and the novel modalities, such as virtual simulation and three-dimensional (3D) titanium-printed customized surgical osteotomy guides and plates.
This prospective study included 12 patients who were willing to undergo orthognathic surgery. The study group consisted of patients who underwent orthognathic two-jaw surgery using 3D-printed patient-specific plates processed by selective laser melting and an osteotomy guide; orthognathic surgery was also performed by the surgeon directly bending the ready-made plate in the control group. Based on the preoperative computed tomography images and intraoral 3D scan data, a 3D virtual surgery plan was implemented in the virtual simulation module, and the surgical guide and bone fixation plate were fabricated. The accuracy and stability were evaluated by comparing the results of the preoperative virtual simulation (T0) to those at 7 days (T1) and 6 months (T2) post-surgery.
The accuracy (ΔT1‒T0) and stability (ΔT2‒T1) measurements, using 11 anatomical references, both demonstrated more accurate results in the study group. The mean difference of accuracy for the study group (0.485 ± 0.280 mm) was significantly lower than in the control group (1.213 ± 0.716 mm) (P < 0.01). The mean operation time (6.83 ± 0.72 h) in the control group was longer than in the study group (5.76 ± 0.43 h) (P < 0.05).
This prospective clinical study demonstrated the accuracy, stability, and effectiveness of using virtual preoperative simulation and patient-customized osteotomy guides and plates for orthognathic surgery.
计算机辅助设计/制造（CAD/CAM）技术的发展旨在提高手术准确性，减少手术计划和正颌手术中的误差。然而，其在手术中的准确实施仍然是一个挑战。因此，我们比较了传统正颌手术和新方法（如虚拟模拟和三维（3D）钛打印定制手术截骨导板和板）的准确性和稳定性。
这项前瞻性研究纳入了 12 名愿意接受正颌手术的患者。研究组由接受 3D 打印患者特定板的正颌双颌手术患者组成，这些板由选择性激光熔化和截骨导板处理；对照组的外科医生直接弯曲预制板也进行了正颌手术。基于术前 CT 图像和口腔内 3D 扫描数据，在虚拟模拟模块中实施了 3D 虚拟手术计划，并制造了手术导板和骨固定板。通过比较术前虚拟模拟（T0）与术后 7 天（T1）和 6 个月（T2）的结果，评估了准确性和稳定性。
使用 11 个解剖参考物进行的准确性（ΔT1‒T0）和稳定性（ΔT2‒T1）测量，研究组的结果更准确。研究组的准确性平均差值（0.485 ± 0.280 毫米）明显低于对照组（1.213 ± 0.716 毫米）（P < 0.01）。对照组的平均手术时间（6.83 ± 0.72 小时）长于研究组（5.76 ± 0.43 小时）（P < 0.05）。
这项前瞻性临床研究表明，使用虚拟术前模拟和患者定制截骨导板和板进行正颌手术具有准确性、稳定性和有效性。
