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Comprehensive virtual orthognathic planning concept in surgery-first patients

  • EBKER Tobias
    Correspondence
    Corresponding author at: Department of Oral and Maxillofacial Surgery, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
    Affiliations
    Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
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  • KORN Paula
    Affiliations
    Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
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  • HEILAND Max
    Affiliations
    Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
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  • BUMANN Axel
    Affiliations
    Private Orthodontic Clinic, Georgenstraße 25, 10117 Berlin, Germany
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      Abstract

      Objective

      The surgery-first concept is becoming increasingly popular in orthognathic surgery since it offers major advantages like a reduction of treatment duration and an increase in patient satisfaction by eliminating phases of presurgical orthodontic decompensation. Here, we present a novel interdisciplinary pathway of a fully virtual orthodontic-surgical planning concept in a surgery-first setting using a 3D-printed cutting guide and a customised maxillary implant for the Le-Fort-I osteotomy as well as a CAD/CAM-based stereolithographic final splint.

      Methods

      Patient data from a cone beam computed tomography of the skull and a full arch dental scan were processed using the Onyx Ceph software (Image Instruments, Chemnitz, Germany). A mutual computer-aided surgical simulation was conducted by the orthodontist and the oral and maxillofacial surgeon to determine the three-dimensional maxillary and mandibular movements. In a separate virtual planning session, the surgeon designed a customised maxillary guide and implant for precise intraoperative transfer (Geomagic Freeform Plus software, 3DSystems, Darmstadt, Germany). A 3D-printed CAD/CAM-based final splint was fabricated by the orthodontist and used for accurate mandibular repositioning.

      Results

      We established a comprehensive virtual interdisciplinary orthognathic workflow and successfully applied this concept with a high level of accuracy in a series of surgery-first patients with different types of dentofacial anomalies.

      Conclusion

      This novel fully computer-based pathway offers a high potential to improve the outcomes of orthognathic surgery and reduce total treatment time in the management of the orthognathic patient.

      Keywords

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