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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Article Info
Publication History
Accepted:
April 20,
2022
Received in revised form:
April 7,
2022
Received:
January 9,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2022 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons.
