Accuracy Evaluation Of Virtual Surgical Planning (VSP) in Orthognathic Surgery: Comparison between CAD/CAM Fabricated Surgical Splint and CAD/CAM Cutting Guides with PSI
2Dipartimento di Scienze Odontostomatologiche e Chirurgia Maxillo-Facciale, U.O.D. Chirurgia Oncologica Ricostruttiva Maxillo-Facciale - Policlinico Umberto I di Roma
Objectives: Several surgical strategies exist to improve accuracy in orthognathic surgery. CT Cone Beam (CBCT), computer-assisted surgical planning and simulation software and 3D printing devices improved prediction of surgical outcomes in orthognathic surgery. The purpose of present report was to analyze our surgical results in two groups of patients treated with CAD/CAM surgical splints and custom-made cutting guides with PSI.
Methods: This retrospective cohort study included patients treated with orthognathic surgery in our Department from 2016 to 2018. Inclusion criteria were: adult patients who were classified as skeletal Class II or III treated by bi-maxillary orthognsthic surgery; CBCT pre and post-operative and 3D VSP simulated by Dolphin Imaging 11.9 premium software. We included in Group 1 patients treated with the CAD/CAM fabricated surgical splint and patients treated with the CAD/CAM cutting guides and PSI in Group 2. After surgery second CBCT was carried out. The comparison was performed by overlapping the STL files of the VSP and the CBCT and we evaluated the differences of three-dimensional movement.
Results: 20 patients were enrolled in the study, 10 in each group. In Group 1 our results show an avarage difference of 1.1 mm between the pre and post-operative position evaluating the linear values, and 0.46° regard the angular displacements. In Group 2 Cephalometric linear landmarks show an avarage difference of 0,14 mm and an angular avarege displacement of 0,09°.
Conclusion: This study investigate the benefits that can be achieved using 3D Virtual Surgical Planning in orthognathic surgery. The critical issues associated with the use of the splint is related to the the mandible position that raise the error and reduce the accuracy. The splintless surgical treatment with PSI appears to be the better system and have allowed to overcome the limits of splint tequinche: the repositioning of the maxilla is completely released from the jaw.
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