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. 2024 Jun 29;11(7):668.
doi: 10.3390/bioengineering11070668.

A New Method to Design and Manufacture a Low-Cost Custom-Made Template for Mandible Cut and Repositioning Using Standard Plates in BSSO Surgery

Liliana Di Brigida  1   2 , Antonio Cortese  3 , Emilio Cataldo  1   4 , Alessandro Naddeo  1
Affiliations

A New Method to Design and Manufacture a Low-Cost Custom-Made Template for Mandible Cut and Repositioning Using Standard Plates in BSSO Surgery

Liliana Di Brigida et al. Bioengineering (Basel). .

Abstract

In this study, a new methodology for designing and creating a custom-made template for maxillofacial surgery has been developed. The custom-made template can be used both for cutting and repositioning of the mandible arches for executing a BSSO (bilateral sagittal split osteotomy) treatment. The idea was developed in order to give the possibility of using a custom-made template with standard plates, thus reducing long times, high costs and low availability of custom-made plates; this represents the proof of novelty of the proposed template, based on a well-established methodology. The methodology was completely developed in the CAD virtual environment and, after the surgeons' assessment, an in-vitro experiment by a maxillofacial surgeon was performed in order to check the usability and the versatility of the system, thanks to the use of additive manufacturing technologies. When computer-aided technologies are used for orthognathic surgery, there are significant time and cost savings that can be realised, as well as improved performance. The cost of the whole operation is lower than the standard one, thanks to the use of standard plates. To carry out the procedures, the proposed methodology allows for inexpensive physical mock-ups that enable the BSSO procedure to be performed.

Keywords: computer-aided surgery; low-cost procedure; orthognathic; standard plate; surgical template.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
The standard Carcitek plate set by Tekka.
Figure 2
Figure 2
Segmentation operation.
Figure 3
Figure 3
Configuration of the jaw before correction.
Figure 4
Figure 4
Three-dimensional model of the mandible and cutting planes to simulate osteotomies.
Figure 5
Figure 5
Osteotomized mandible.
Figure 6
Figure 6
Mandible and cutting plane for the representation of the first osteotomy section.
Figure 7
Figure 7
Jaw in the final, desired position.
Figure 8
Figure 8
Jaw in the desired final position with the screws and the standard plate (in blue).
Figure 9
Figure 9
Osteotomised mandible with screws without heads (cylinders).
Figure 10
Figure 10
Details of the screws’ housing and grooves.
Figure 11
Figure 11
Cutting and repositioning guide (in green).
Figure 12
Figure 12
Placing the template and making the osteotomies.
Figure 13
Figure 13
Replacement of the screws (in red the replaced one).
Figure 14
Figure 14
Perspective view of the plate.
Figure 15
Figure 15
Perspective view of the screw.
Figure 16
Figure 16
Z Suite’s work session.
Figure 17
Figure 17
Zortrax M200 plus printer.
Figure 18
Figure 18
Custom-made printed template.
Figure 19
Figure 19
Printed plate.
Figure 20
Figure 20
Creality CR-M4 printer.
Figure 21
Figure 21
FIloalfa® filaments.
Figure 22
Figure 22
Creality’s work session.
Figure 23
Figure 23
A 3D model of the jaw.
Figure 24
Figure 24
Positioning of the template and screws.
Figure 25
Figure 25
Final position of the jaw with the plate and screws.
Figure 26
Figure 26
Dimensional verification of mandibular advancement.
Figure 27
Figure 27
Flowchart of the new procedure for designing and manufacturing the proposed low-cost custom-made template for BSSO with standard plates.
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