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Observational Study
. 2021 Jul 13;17(1):27.
doi: 10.1186/s13005-021-00279-x.

Predictability of maxillary positioning: a 3D comparison of virtual and conventional orthognathic surgery planning

Anja Quast  1 , Petra Santander  2 , Timon Kahlmeier  2 , Norman Moser  3 , Henning Schliephake  3 , Philipp Meyer-Marcotty  2
Affiliations
Observational Study

Predictability of maxillary positioning: a 3D comparison of virtual and conventional orthognathic surgery planning

Anja Quast et al. Head Face Med. .

Abstract

Background: Virtual surgery planning (VSP) is believed to reduce inaccuracies in maxillary positioning compared to conventional surgery planning (CSP) due to the elimination of face-bow transfer and laboratory steps. However, there is still a lack of comparative studies for the accuracy of splint-based maxillary positioning in CSP versus VSP. Therefore, the objective of this retrospective, observational study was to compare if splints produced by VSP and CSP reach postoperative outcomes within clinically acceptable limits.

Methods: The planned and actual postoperative results of 52 patients (VSP: n = 26; CSP: n = 26) with a mean age of 24.4 ± 6.2 years were investigated by three-dimensional (3D) alignment with planning software. The conventional treatment plan was digitized, so that the evaluation of both methods was performed in the same manner using the same coordinate system. Inaccuracies were measured by sagittal, vertical and transversal deviations of the upper central incisors and the inclination of the maxillary occlusal plane between the planned and achieved maxillary positions.

Results: Both methods demonstrated significant differences between the planned and actual outcome. The highest inaccuracies were observed in vertical impaction and midline correction. No significant differences between CSP and VSP were observed in any dimension. Errors in vertical and sagittal dimension intensified each other.

Conclusions: In conclusion, splint-based surgeries reached similar results regardless of the applied planning method and splint production.

Keywords: Accuracy; BSSO; Le Fort I; Maxillary positioning; Orthodontic-surgical treatment; Orthognathic surgery; Osteotomy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Digital reconstruction of the conventional surgery planning: Left side: Alignment of the preoperative CBCT scan and the dental casts with the upper and lower jaw in the preoperative, centric position. Right side: Reconstruction of the planned postoperative maxillary position by alignment of the preoperative mandible and the osteotomized maxilla as bony structures and the upper jaw in the postoperative and lower jaw in the preoperative position as dental casts. The mandible served as fixed reference while the maxilla moved in the planned postoperative position
Fig. 2
Fig. 2
Comparison of the preoperative, the planned and the postoperatively achieved maxillary position: a Preoperative CBCT scan with the maxilla in the preoperative position. b Preoperative CBCT scan with the maxilla in the planned position. c Preoperative CBCT scan with the maxilla in the postoperatively achieved position. d The superimposition of the planned (yellow) and the achieved (green) maxillary position demonstrates the commonly observed underimpaction of the maxilla in vertical direction and a mild deviation of the midline in transversal direction
Fig. 3
Fig. 3
Scatterplots indicated correlations between the mean discrepancies in different translational and rotational movements
Fig. 4
Fig. 4
Scatterplots indicated no correlation between the planned surgical movement and the inaccuracy of the result
See this image and copyright information in PMC

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