Waard Olivier de, Baan Frank, Bruggink Robin, Bronkhorst Ewald M, Kuijpers-Jagtman Anne Marie, Ongkosuwito Edwin M
Department of Dentistry-Orthodontics and Craniofacial Biology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands.
Radboudumc 3DLab, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands.
J Clin Med. 2025 Jul 25;14(15):5270. doi: 10.3390/jcm14155270.
Inadequate presurgical planning is a key contributor to suboptimal outcomes in orthognathic surgery. This study aims to assess the accuracy of a digital surgical planning workflow conducted prior to any orthodontic intervention. Digital planning was performed for 26 patients before orthodontic treatment (T0) and compared to the actual preoperative planning (T1). Digitized plaster casts were merged with CBCT data and converted to orthodontic setups to create a 3D virtual head model. After voxel-based registration of T0 and T1, dental arches were virtually osteotomized and repositioned according to planned outcomes. These T0 segments were then aligned with T1 planning using bony landmarks of the maxilla. Anatomical landmarks were used to construct virtual triangles on maxillary and mandibular segments, enabling assessment of positional and orientational differences. Transformations between T0 and T1 were translated into clinically meaningful metrics. Significant differences were found between T0 and T1 at the dental level. T1 exhibited a greater clockwise rotation of the dental maxilla (mean: 2.85°) and a leftward translation of the mandibular dental arch (mean: 1.19 mm). In SARME cases, the bony mandible showed larger anti-clockwise roll differences. Pitch variations were also more pronounced in maxillary extraction cases, with both the dental maxilla and bony mandible demonstrating increased clockwise rotations. The proposed orthognathic surgical planning workflow shows potential for simulating mandibular outcomes but lacks dental-level accuracy, especially in maxillary anterior torque. While mandibular bony outcome predictions align reasonably with pretreatment planning, notable discrepancies exceed clinically acceptable thresholds. Current accuracy limits routine use; further refinement and validation in larger, homogeneous patient groups are needed to enhance clinical reliability and applicability.
术前规划不足是正颌外科手术效果欠佳的关键因素。本研究旨在评估在任何正畸干预之前进行的数字手术规划流程的准确性。对26例患者在正畸治疗前（T0）进行数字规划，并与实际术前规划（T1）进行比较。将数字化石膏模型与CBCT数据合并，并转换为正畸模型以创建三维虚拟头部模型。在对T0和T1进行基于体素的配准后，根据规划结果对上颌牙弓进行虚拟截骨和重新定位。然后使用上颌骨的骨性标志将这些T0节段与T1规划对齐。利用解剖标志在上颌和下颌节段构建虚拟三角形，以评估位置和方向差异。将T0和T1之间的变换转化为具有临床意义的指标。在牙齿水平上，T0和T1之间存在显著差异。T1显示上颌牙齿有更大的顺时针旋转（平均值：2.85°），下颌牙弓向左平移（平均值：1.19 mm）。在骨膜牵张成骨术（SARME）病例中，下颌骨显示出更大的逆时针滚动差异。在上颌拔牙病例中，俯仰变化也更明显，上颌牙齿和下颌骨均显示顺时针旋转增加。所提出的正颌外科手术规划流程显示出模拟下颌手术效果的潜力，但缺乏牙齿水平的准确性，尤其是在上颌前牙转矩方面。虽然下颌骨手术效果预测与术前规划合理一致，但明显差异超过临床可接受阈值。目前的准确性限制了其常规应用；需要在更大的同质患者群体中进一步完善和验证，以提高临床可靠性和适用性。
