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. 2022 Mar 23;12(1):5013.
doi: 10.1038/s41598-022-08991-7.

Comparison of soft tissue simulations between two planning software programs for orthognathic surgery

Ali Modabber  1 , Tanja Baron  1 , Florian Peters  1 , Kristian Kniha  1 , Golamreza Danesh  2 , Frank Hölzle  1 , Nassim Ayoub  1 , Stephan Christian Möhlhenrich  3
Affiliations

Comparison of soft tissue simulations between two planning software programs for orthognathic surgery

Ali Modabber et al. Sci Rep. .

Abstract

The aim of this study was to compare the soft tissue predicative abilities of two established programs depending on the surgical technique and amount of displacement. On the basis of 50 computed tomography images, 11 orthognathic operations with differences in displacement distances and technique (maxillary advancement, MxA; maxillary impaction, MxI; mandibular setback, MnS; mandibular advancement, MnA bimaxillary displacement, MxA/MnS) as well as corresponding soft tissue predictions were simulated using the programs Dolphin (D) and ProPlan (PP). For all the soft tissue predictions by the two programs, eight linear and two angular measurements were performed and compared. The simulation of maxillary impaction showed a similar soft tissue behaviour between the two programs. However, differences or divergent behaviours were observed for other procedures. In the middle third of the face these significant differences concerned in particular the nasolabial angle (Ns-Sn-Ls)(5 mm-MA, D: 119.9 ± 8.6° vs. PP: 129.5 ± 8.4°; 7 mm-MnS: D: 128.5 ± 8.2° vs. PP: 129.6 ± 8.1°; 10 mm-MnA D: 126.0 ± 8.0° vs. PP: 124.9 ± 8.4°; 5 mm-MxA/4 mm-MnS, D: 120.2 ± 8.7° vs. PP: 129.9 ± 8.3°; all p < 0.001) and in the lower third the mentolabial angle (Pog´-B´-Li) (5 mm-MA, D: 133.2 ± 11.4° vs. PP: 126.8 ± 11.6°; 7 mm-MnS: D: 133.1 ± 11.3° vs. PP: 124.6 ± 11.9°; 10 mm-MnA D: 133.3 ± 11.5° vs. PP: 146.3 ± 11.1°; bignathic 5 mm-MxA/4 mm-MnS, D: 133.1 ± 11.4° vs. PP: 122.7 ± 11.9°; all p < 0.001) and the distance of the inferior lip to the aesthetic Line (E-Line-Li) (5 mm-MA, D: 3.7 ± 2.3 mm vs. PP: 2.8 ± 2.5 mm; 7 mm-MnS: D: 5.1 ± 3.0 mm vs. PP: 3.3 ± 2.3 mm; 10 mm-MnA D: 2.5 ± 1.6 mm vs. PP: 3.9 ± 2.8 mm; bignathic 5 mm-MxA/4 mm-MnS, D: 4.8 ± 3.0 mm vs. PP: 2.9 ± 2.0 mm; all p < 0.001). The soft tissue predictions by the tested programs differed in simulation outcome, which led to the different, even divergent, results. However, the significant differences are often below a clinically relevant level. Consequently, soft tissue prediction must be viewed critically, and its actual benefit must be clarified.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Segmented models of the facial soft tissue and the cranial and facial skeleton including the maxilla and the mandible.
Figure 2
Figure 2
Osteotomy lines (red) for LeFort I from a submentovertex (A) and frontal view (B), and for mandibular sagittal split from a lingual (C) and buccal view (D) using Dolphin imaging.
Figure 3
Figure 3
Profile view of the soft tissue simulation for the 7 mm mandibular setback using ProPlan CMF (A) and Dolphin imaging (B).
Figure 4
Figure 4
Angular and linear measurements of the middle (green) and lower (grey) third of the face in the profile view.
Figure 5
Figure 5
Line charts for the changes in the respective programs (ProPlan CMF vs. Dolphin imaging) in middle third of the face depending on surgical technique and displacement distance.
Figure 6
Figure 6
Line charts for the changes in the respective programs (ProPlan CMF vs. Dolphin imaging) in lower third of the face depending on surgical technique and displacement distance.
See this image and copyright information in PMC

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