1. PSI-Guided Mandible-First Orthognathic Surgery: Maxillo-Mandibular Position Accuracy and Vertical Dimension Adjustability
- Author
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Ottavia Lunari, Alberto Bianchi, Federico Bolognesi, Federica Ruggiero, Giovanni Badiali, Elisa Lovero, Liliana Grazia Francesca Feraboli, Claudio Marchetti, Mirko Bevini, and Badiali G, Bevini M, Lunari O, Lovero E, Ruggiero F, Bolognesi F, Feraboli L, Bianchi A, Marchetti C.
- Subjects
Orthodontics ,Cephalometric analysis ,Cone beam computed tomography ,patient-specific implants ,Osteosynthesis ,Computer science ,medicine.medical_treatment ,orthognathic surgery ,virtual surgical plan ,patient-specific implant ,Mandible ,Orthognathic surgery ,Medicine (miscellaneous) ,Surgical planning ,Article ,CAD/CAM ,Maxilla ,medicine ,Medicine ,mandible-first ,Displacement (orthopedic surgery) - Abstract
In orthognathic surgery, patient-specific osteosynthesis implants (PSIs) represent a novel approach for the reproduction of the virtual surgical planning on the patient. The aim of this study is to analyse the quality of maxillo-mandibular positioning using a hybrid mandible-first mandibular-PSI guided procedure on twenty-two patients while the upper maxilla was fixed using manually-bent stock titanium miniplates. The virtual surgical plan was used to guide the design of PSIs and positioning guides, which were then 3D printed using biocompatible materials. A CBCT scan was performed one month after surgery and postoperative facial skeletal models were segmented for comparison against the surgical plan. A three-dimensional cephalometric analysis was carried out on both planned and obtained anatomies. A Spearman correlation matrix was computed on the calculated discrepancies, in order to achieve a more comprehensive description of maxillo-mandibular displacement. Intraoperatively, all PSIs were successfully applied. The procedure was found to be accurate in planned maxillo-mandibular positioning reproduction, while maintaining a degree of flexibility to allow for aesthetics-based verticality correction in a pitch range between-5.31 and +1.79 mm. Such correction did not significantly affect the achievement of planned frontal symmetry.
- Published
- 2021