Advertisement
Oral and maxillofacial surgery Online only article| Volume 115, ISSUE 2, e16-e25, February 2013

A novel design of a computer-generated splint for vertical repositioning of the maxilla after Le Fort I osteotomy

      Objective

      The objective of this study was to evaluate the efficacy of a novel tooth/bony-supported virtual splint design to control the maxillary vertical, rotational, and anteroposterior intraoperative movements.

      Study Design

      A tooth/bone-borne splint was designed to position the osteotomized maxilla intraoperatively. Lateral cephalometric radiographs were obtained 1 week before the operation and 1 week after to compare the planned and actual movements of the maxilla.

      Results

      The paired t test showed no significant difference between the planned and actual movements in both the vertical and horizontal measurements (P ≤ .05). The difference between the planned and actual horizontal movements in 4 (66.7%) of the 6 patients was 1 mm or less. For the vertical movements, 5 (83.3%) of the 6 patients showed a difference equal to or less than 1 mm.

      Conclusions

      The 2-piece surgical stent showed accurate control on the osteotomized maxilla and succeeded its repositioning to the preplanned positions.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Yoshioka I.
        • Khanal A.
        • Kodama M.
        • Furuta N.
        • Tominaga K.
        Postoperative skeletal stability and accuracy of a new combined Le Fort I and horseshoe osteotomy for superior repositioning of the maxilla.
        Int J Oral Maxillofac Surg. 2009; 38: 1250-1255
        • Mogavero F.J.
        • Buschang P.H.
        • Wolford L.M.
        Orthognathic surgery effects on maxillary growth in patients with vertical maxillary excess.
        Am J Orthod Dentofacial Orthop. 1997; 111: 288-296
        • Arpornmaeklong P.
        • Shand J.M.
        • Heggie A.A.
        Skeletal stability following maxillary impaction and mandibular advancement.
        Int J Oral Maxillofac Surg. 2004; 33: 656-663
        • Kim S.G.
        • Park S.S.
        Incidence of complications and problems related to orthognathic surgery.
        J Oral Maxillofac Surg. 2007; 65: 2438-2444
        • Ko E.W.
        • Huang C.S.
        • Chen Y.R.
        Characteristics and corrective outcome of face asymmetry by orthognathic surgery.
        J Oral Maxillofac Surg. 2009; 67: 2201-2209
        • Wolford L.M.
        • Cassano D.S.
        • Cottrell D.A.
        • El Deeb M.
        • Karras S.C.
        • Goncalves J.R.
        Orthognathic surgery in the young cleft patient: preliminary study on subsequent facial growth.
        J Oral Maxillofac Surg. 2008; 66: 2524-2536
        • Anwar M.
        • Harris M.
        Model surgery for orthognathic planning.
        Br J Oral Maxillofac Surg. 1990; 28: 393-397
        • Bamber M.A.
        • Harris M.
        The role of the occlusal wafer in orthognathic surgery; a comparison of thick and thin intermediate osteotomy wafers.
        J Craniomaxillofac Surg. 1995; 23: 396-400
        • Bryan D.C.
        • Hunt N.P.
        Surgical accuracy in orthognathic surgery.
        Br J Oral Maxillofac Surg. 1993; 31 (Discussion 9-50): 343-349
        • Cope M.R.
        Measuring changes in maxillary height during osteotomy surgery.
        Br J Oral Maxillofac Surg. 1994; 32: 257-259
        • Donatsky O.
        • Bjorn-Jorgensen J.
        • Holmqvist-Larsen M.
        • Hillerup S.
        Computerized cephalometric evaluation of orthognathic surgical precision and stability in relation to maxillary superior repositioning combined with mandibular advancement or setback.
        J Oral Maxillofac Surg. 1997; 55 (Discussion 9-80): 1071-1079
        • Ferguson J.W.
        • Luyk N.H.
        Control of vertical dimension during maxillary orthognathic surgery.
        J Craniomaxillofac Surg. 1992; 20: 333-336
        • Hillerup S.
        • Bjørn-Jørgensen J.
        • Donatsky O.
        • Jacobsen P.U.
        Precision of orthognathic surgery.
        Int J Oral Maxillofac Surg. 1994; 23: 255-261
        • Kahnberg K.E.
        • Sunzel B.
        • Astrand P.
        Planning and control of vertical dimension in Le Fort I osteotomies.
        J Craniomaxillofac Surg. 1990; 18: 267-270
        • McCance A.M.
        • Moss J.P.
        • James D.R.
        Le Fort I maxillary osteotomy: is it possible to accurately produce planned pre-operative movements?.
        Br J Oral Maxillofac Surg. 1992; 30: 369-376
        • Nattestad A.
        • Vedtofte P.
        Mandibular autorotation in orthognathic surgery: a new method of locating the centre of mandibular rotation and determining its consequence in orthognathic surgery.
        J Craniomaxillofac Surg. 1992; 20: 163-170
        • Nattestad A.
        • Vedtofte P.
        • Mosekilde E.
        The significance of an erroneous recording of the centre of mandibular rotation in orthognathic surgery.
        J Craniomaxillofac Surg. 1991; 19: 254-259
        • Perkins S.J.
        • Newhouse R.F.
        • Bach D.E.
        A modified Boley gauge for accurate measurement during maxillary osteotomies.
        J Oral Maxillofac Surg. 1992; 50: 1018-1019
        • Polido W.D.
        • Ellis 3rd, E.
        • Sinn D.P.
        An assessment of the predictability of maxillary repositioning.
        Int J Oral Maxillofac Surg. 1991; 20: 349-352
        • Schwestka R.
        • Engelke D.
        • Kubein-Meesenburg D.
        • Luhr H.G.
        Control of vertical position of the maxilla in orthognathic surgery: clinical application of the sandwich splint.
        Int J Adult Orthodon Orthognath Surg. 1990; 5: 133-136
        • Sharifi A.
        • Jones R.
        • Ayoub A.
        • Moos K.
        • Walker F.
        • Khambay B.
        • McHugh S.
        How accurate is model planning for orthognathic surgery?.
        Int J Oral Maxillofac Surg. 2008; 37: 1089-1093
        • Carls F.R.
        • Schuknecht B.
        • Sailer H.F.
        Value of three-dimensional computed tomography in craniomaxillofacial surgery.
        J Craniofac Surg. 1994; 5: 282-288
        • Fuhrmann R.A.
        • Frohberg U.
        • Diedrich P.R.
        Treatment prediction with three-dimensional computer tomographic skull models.
        Am J Orthod Dentofacial Orthop. 1994; 106: 156-160
        • Sarver D.M.
        • Johnston M.W.
        Orthognathic surgery and aesthetics: planning treatment to achieve functional and aesthetic goals.
        Br J Orthod. 1993; 20: 93-100
        • Southard T.E.
        • Morris J.H.
        • Southard K.A.
        • Zeitler D.L.
        A three-dimensional system for planning orthognathic surgery.
        J Am Dent Assoc. 1994; 125: 452-460
        • Watzinger F.
        • Wanschitz F.
        • Rasse M.
        • Millesi W.
        • Schopper C.
        • Kremser J.
        • et al.
        Computer-aided surgery in distraction osteogenesis of the maxilla and mandible.
        Int J Oral Maxillofac Surg. 1999; 28: 171-175
        • Xia J.
        • Ip H.H.
        • Samman N.
        • Wang D.
        • Kot C.S.
        • Yeung R.W.
        • Tideman H.
        Computer-assisted three-dimensional surgical planning and simulation: 3D virtual osteotomy.
        Int J Oral Maxillofac Surg. 2000; 29: 11-17
        • Swennen G.R.
        • Mollemans W.
        • Schutyser F.
        Three-dimensional treatment planning of orthognathic surgery in the era of virtual imaging.
        J Oral Maxillofac Surg. 2009; 67: 2080-2092
        • Gateno J.
        • Xia J.
        • Teichgraeber J.F.
        • Rosen A.
        • Hultgren B.
        • Vadnais T.
        The precision of computer-generated surgical splints.
        J Oral Maxillofac Surg. 2003; 61: 814-817
        • Metzger M.C.
        • Hohlweg-Majert B.
        • Schwarz U.
        • Teschner M.
        • Hammer B.
        • Schmelzeisen R.
        Manufacturing splints for orthognathic surgery using a three-dimensional printer.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 105: e1-e7
        • Choi J.Y.
        • Song K.G.
        • Baek S.H.
        Virtual model surgery and wafer fabrication for orthognathic surgery.
        Int J Oral Maxillofac Surg. 2009; 38: 1306-1310
        • Hallermann W.
        • Olsen S.
        • Bardyn T.
        • Taghizadeh F.
        • Banic A.
        • Iizuka T.
        A new method for computer-aided operation planning for extensive mandibular reconstruction.
        Plast Reconstr Surg. 2006; 117: 2431-2437
        • Bell W.H.
        • Proffit W.R.
        • White Jr, R.P.
        Surgical correction of dentofacial deformities.
        W. B. Saunders, Philadelphia1980
        • Kärcher H.
        Three-dimensional craniofacial surgery: transfer from a three-dimensional model (endoplan) to clinical surgery: a new technique (Graz).
        J Craniomaxillofac Surg. 1992; 20: 125-131
        • Santler G.
        3-D COSMOS: a new 3-D model based computerised operation simulation and navigation system.
        J Craniomaxillofac Surg. 2000; 28: 287-293
        • Santler G.
        Computerised three-dimensional surgical simulator.
        Mund Kiefer Gesichtschir. 2000; 4 (German): 39-44
        • Terai H.
        • Shimahara M.
        • Sakinaka Y.
        • Tajima S.
        Accuracy of integration of dental casts in three-dimensional models.
        J Oral Maxillofac Surg. 1999; 57 (Discussion 6): 662-665
        • Yeong W.Y.
        • Chua C.K.
        • Leong K.F.
        • Chandrasekaran M.
        Rapid prototyping in tissue engineering: challenges and potential.
        Trends Biotechnol. 2004; 22: 643-652
        • Gil J.N.
        • Claus J.D.
        • Manfro R.
        • Lima Jr, S.M.
        Predictability of maxillary repositioning during bimaxillary surgery: accuracy of a new technique.
        Int J Oral Maxillofac Surg. 2007; 36: 296-300
        • Emshoff R.
        • Scheiderbauer A.
        • Gerhard S.
        • Norer B.
        Stability after rigid fixation of simultaneous maxillary impaction and mandibular advancement osteotomies.
        Int J Oral Maxillofac Surg. 2003; 32: 137-142
        • Swennen G.R.
        • Barth E.L.
        • Eulzer C.
        • Schutyser F.
        The use of a new 3D splint and double CT scan procedure to obtain an accurate anatomic virtual augmented model of the skull.
        Int J Oral Maxillofac Surg. 2007; 36: 146-152
        • Swennen G.R.
        • Mommaerts M.Y.
        • Abeloos J.
        • De Clercq C.
        • Lamoral P.
        • Neyt N.
        • et al.
        A cone-beam CT based technique to augment the 3D virtual skull model with a detailed dental surface.
        Int J Oral Maxillofac Surg. 2009; 38: 48-57
        • Van Sickels J.E.
        • Larsen A.J.
        • Triplett R.G.
        Predictability of maxillary surgery: a comparison of internal and external reference marks.
        Oral Surg Oral Med Oral Pathol. 1986; 61: 542-545
        • Kwon T.G.
        • Mori Y.
        • Minami K.
        • Lee S.H.
        Reproducibility of maxillary positioning in Le Fort I osteotomy: a 3-dimensional evaluation.
        J Oral Maxillofac Surg. 2002; 60: 287-293
        • Gateno J.
        • Xia J.
        • Teichgraeber J.F.
        • Rosen A.
        A new technique for the creation of a computerized composite skull model.
        J Oral Maxillofac Surg. 2003; 61: 222-227
        • Uechi J.
        • Okayama M.
        • Shibata T.
        • Muguruma T.
        • Hayashi K.
        • Endo K.
        • Mizoguchi I.
        A novel method for the 3-dimensional simulation of orthognathic surgery by using a multimodal image-fusion technique.
        Am J Orthod Dentofacial Orthop. 2006; 130: 786-798
        • Xia J.J.
        • Gateno J.
        • Teichgraeber J.F.
        Three-dimensional computer-aided surgical simulation for maxillofacial surgery.
        Atlas Oral Maxillofac Surg Clin North Am. 2005; 13: 25-39