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Accuracy of Segmented Le Fort I Osteotomy with Virtual Planning in Orthognathic Surgery Using Patient-Specific Implants: A Case Series

Background: When maxillary transversal expansion is needed, two protocols of treatment can be used: a maxillary orthodontic expansion followed by a classical bimaxillary osteotomy or a bimaxillary osteotomy with maxillary segmentation. The aim of this study was to assess the accuracy of segmented Le...

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Autores principales: Rios, Olina, Lerhe, Barbara, Chamorey, Emmanuel, Savoldelli, Charles
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9572233/
https://www.ncbi.nlm.nih.gov/pubmed/36233363
http://dx.doi.org/10.3390/jcm11195495
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author Rios, Olina
Lerhe, Barbara
Chamorey, Emmanuel
Savoldelli, Charles
author_facet Rios, Olina
Lerhe, Barbara
Chamorey, Emmanuel
Savoldelli, Charles
author_sort Rios, Olina
collection PubMed
description Background: When maxillary transversal expansion is needed, two protocols of treatment can be used: a maxillary orthodontic expansion followed by a classical bimaxillary osteotomy or a bimaxillary osteotomy with maxillary segmentation. The aim of this study was to assess the accuracy of segmented Le Fort I osteotomy using computer-aided orthognathic surgery and patient-specific titanium plates in patients who underwent a bimaxillary osteotomy for occlusal trouble with maxillary transversal insufficiencies. Methods: A virtual simulation of a Le Fort I osteotomy with maxillary segmentation, a sagittal split ramus osteotomy, and genioplasty (if needed) was conducted on a preoperative three-dimensional (3D) model of each patient’s skull using ProPlan CMF 3.0 software (Materialise, Leuven, Belgium). Computer-assisted osteotomy saw-and-drill guides and patient-specific implants (PSIs, titanium plates) were produced and used during the surgery. We chose to focus on the maxillary repositioning accuracy by comparing the preoperative virtual surgical planning and the postoperative 3D outcome skulls using surface superimpositions and 13 standard dental and bone landmarks. Errors between these preoperative and postoperative landmarks were calculated and compared to discover if segmental maxillary repositioning using PSIs was accurate enough to be safely used to treat transversal insufficiencies. Results: A total of 22 consecutive patients—15 females and 7 males, with a mean age of 27.4 years—who underwent bimaxillary computer-assisted orthognathic surgery with maxillary segmentation were enrolled in the study. All patients presented with occlusion trouble, 13 with Class III malocclusions (59%) and 9 (41%) with Class II malocclusions. A quantitative analysis revealed that, overall, the mean absolute discrepancies for the x-axis (transversal dimension), y-axis (anterior–posterior dimensions), and z-axis (vertical dimension) were 0.59 mm, 0.74 mm, and 0.56 mm, respectively. The total error rate of maxillary repositioning was 0.62 mm between the postoperative cone-beam computed tomography (CBCT) and the preoperatively planned 3D skull. According to the literature, precision in maxilla repositioning is defined by an error rate (clinically relevant) at each landmark of <2 mm and a total error of <2 mm for each patient. Conclusions: A high degree of accuracy between the virtual plan and the postoperative result was observed.
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spelling pubmed-95722332022-10-17 Accuracy of Segmented Le Fort I Osteotomy with Virtual Planning in Orthognathic Surgery Using Patient-Specific Implants: A Case Series Rios, Olina Lerhe, Barbara Chamorey, Emmanuel Savoldelli, Charles J Clin Med Article Background: When maxillary transversal expansion is needed, two protocols of treatment can be used: a maxillary orthodontic expansion followed by a classical bimaxillary osteotomy or a bimaxillary osteotomy with maxillary segmentation. The aim of this study was to assess the accuracy of segmented Le Fort I osteotomy using computer-aided orthognathic surgery and patient-specific titanium plates in patients who underwent a bimaxillary osteotomy for occlusal trouble with maxillary transversal insufficiencies. Methods: A virtual simulation of a Le Fort I osteotomy with maxillary segmentation, a sagittal split ramus osteotomy, and genioplasty (if needed) was conducted on a preoperative three-dimensional (3D) model of each patient’s skull using ProPlan CMF 3.0 software (Materialise, Leuven, Belgium). Computer-assisted osteotomy saw-and-drill guides and patient-specific implants (PSIs, titanium plates) were produced and used during the surgery. We chose to focus on the maxillary repositioning accuracy by comparing the preoperative virtual surgical planning and the postoperative 3D outcome skulls using surface superimpositions and 13 standard dental and bone landmarks. Errors between these preoperative and postoperative landmarks were calculated and compared to discover if segmental maxillary repositioning using PSIs was accurate enough to be safely used to treat transversal insufficiencies. Results: A total of 22 consecutive patients—15 females and 7 males, with a mean age of 27.4 years—who underwent bimaxillary computer-assisted orthognathic surgery with maxillary segmentation were enrolled in the study. All patients presented with occlusion trouble, 13 with Class III malocclusions (59%) and 9 (41%) with Class II malocclusions. A quantitative analysis revealed that, overall, the mean absolute discrepancies for the x-axis (transversal dimension), y-axis (anterior–posterior dimensions), and z-axis (vertical dimension) were 0.59 mm, 0.74 mm, and 0.56 mm, respectively. The total error rate of maxillary repositioning was 0.62 mm between the postoperative cone-beam computed tomography (CBCT) and the preoperatively planned 3D skull. According to the literature, precision in maxilla repositioning is defined by an error rate (clinically relevant) at each landmark of <2 mm and a total error of <2 mm for each patient. Conclusions: A high degree of accuracy between the virtual plan and the postoperative result was observed. MDPI 2022-09-20 /pmc/articles/PMC9572233/ /pubmed/36233363 http://dx.doi.org/10.3390/jcm11195495 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Rios, Olina
Lerhe, Barbara
Chamorey, Emmanuel
Savoldelli, Charles
Accuracy of Segmented Le Fort I Osteotomy with Virtual Planning in Orthognathic Surgery Using Patient-Specific Implants: A Case Series
title Accuracy of Segmented Le Fort I Osteotomy with Virtual Planning in Orthognathic Surgery Using Patient-Specific Implants: A Case Series
title_full Accuracy of Segmented Le Fort I Osteotomy with Virtual Planning in Orthognathic Surgery Using Patient-Specific Implants: A Case Series
title_fullStr Accuracy of Segmented Le Fort I Osteotomy with Virtual Planning in Orthognathic Surgery Using Patient-Specific Implants: A Case Series
title_full_unstemmed Accuracy of Segmented Le Fort I Osteotomy with Virtual Planning in Orthognathic Surgery Using Patient-Specific Implants: A Case Series
title_short Accuracy of Segmented Le Fort I Osteotomy with Virtual Planning in Orthognathic Surgery Using Patient-Specific Implants: A Case Series
title_sort accuracy of segmented le fort i osteotomy with virtual planning in orthognathic surgery using patient-specific implants: a case series
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9572233/
https://www.ncbi.nlm.nih.gov/pubmed/36233363
http://dx.doi.org/10.3390/jcm11195495
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