Evaluation of Postoperative Patient Specific Implants Clinical Position Accuracy and Clinical Outcome in Maxillofacial Surgery, Compared to Preoperative Virtual Surgical Planning (VSP), Using Cad-Cam Technologies

Objectives: VSP in the maxillofacial surgery field has grown gradually in the last decade. Despite the computerization era, varied cases have failed to introduce better accuracy compared to conventional methods. The development of advanced software and 3 Dimensional (3D) printers had assisted to generate accurate 3D models for study and evaluation, customized surgical guides and patient specific implants (PSI). The aim of this study was to present our experience in the Galilee Medical Center in VSP, its accuracy and contribution in enhancing clinical outcome.

Methods: Patients suffering from dento-facial deformities, tumors in the maxillofacial area or maxillofacial trauma were evaluated clinically and CT or CBCT scans of the area of interest were obtained. Preoperative DICOM of the patients` radiographs were obtained and the cases went through a workflow of: segmentation of areas of interest by software, 3D models In-House printing, VSP by software, Printing surgical guides, PSIs manufacturing and Pre-bending plates. All the products were tested on printed personalized 3D model. After Surgery, postoperative CT and DICOM were obtained; segmented and the position of PSIs and plate`s accuracy, and the clinical outcome were evaluated and compared to the preoperative planning using fixed and variable points on the 3D bone meshes.

Results: Cases were divided into 2 categories: First Trauma and Oncology cases and second Orthognathic surgery. Each category analyzed by specific parameters. Preliminary results demonstrate high accuracy and predictability in both categories. Furthermore, patients underwent surgery after VSP exhibit less complications and fewer hospitalization days and even shorter procedure`s time.

Conclusion: The new approach of combining VSP and 3D printing preoperatively in maxillofacial surgery seems to be of high liability in predicting final clinical outcome, even in complex malformation or trauma cases. It allows us to increase our precision to give the patient the most ideal outcome.