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      Validation of a patient-specific system for mandible-first bimaxillary surgery: ramus and implant positioning precision assessment and guide design comparison

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          Abstract

          In orthognathic surgery, the use of patient-specific osteosynthesis devices is a novel approach used to transfer the virtual surgical plan to the patient. The aim of this study is to analyse the quality of mandibular anatomy reproduction using a mandible-first mandibular-PSI guided procedure on 22 patients. Three different positioning guide designs were compared in terms of osteosynthesis plate positioning and mandibular anatomical outcome. PSIs and positioning guides were designed according to virtual surgical plan and 3D printed using biocompatible materials. A CBCT scan was performed 1 month after surgery and postoperative mandibular models were segmented for comparison against the surgical plan. A precision comparison was carried out among the three groups. Correlations between obtained rami and plates discrepancies and between planned rami displacements and obtained rami discrepancies were calculated. Intraoperatively, all PSIs were successfully applied. The procedure was found to be accurate in planned mandibular anatomy reproduction. Different guide designs did not differ in mandibular outcome precision. Plate positional discrepancies influenced the corresponding ramus position, mainly in roll angle and vertical translation. Ramus planned displacement was found to be a further potential source of inaccuracy, possibly due to osteosynthesis surface interference.

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          Computer-aided design and computer-aided manufacturing cutting guides and customized titanium plates are useful in upper maxilla waferless repositioning.

          The purpose of the present study was to develop a computer-aided design (CAD) and computer-aided manufacturing (CAM) technique that enabled fabrication of surgical cutting guides and titanium fixation plates that would allow the upper maxilla to be repositioned correctly without a surgical splint in orthognathic patients.
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            The use of patient-specific implants in orthognathic surgery: A series of 32 maxillary osteotomy patients.

            The use of virtual surgery, patient-specific saw and drill guides, and custom-made osteosynthesis plates is rapidly spreading from deformity surgery to orthognathic surgery. Most of the commercially available systems are using computer-aided design/computer-aided manufacture (CAD/CAM) wafers to produce patient-specific saw guides. However, most plate systems provided are still the conventional "in stock" mini plates that can be individually designed by pre-bending according to the stereolithographic model of the patient. Custom made three-dimensional (3D) printed implants have earlier been demonstrated to be an ideal solution in deformity surgery and in reconstruction of complex posttraumatic cases. In this study, we report the novel use of patient-specific saw and drill guides combined with patient-specific 3D titanium alloy implants as a fixation system in maxillary movement after Le Fort I and bimaxillary osteotomies (n = 32). The implants were individually designed for each patient to follow anatomical structures and to provide exact positioning and stability of the repositioned maxilla.
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              A new approach of splint-less orthognathic surgery using a personalized orthognathic surgical guide system: A preliminary study

              The purpose of this study was to evaluate a personalized orthognathic surgical guide (POSG) system for bimaxillary surgery without the use of surgical splint. Ten patients with dentofacial deformities were enrolled. Surgeries were planned with the computer-aided surgical simulation method. The POSG system was designed for both maxillary and mandibular surgery. Each consisted of cutting guides and three-dimensionally (3D) printed custom titanium plates to guide the osteotomy and repositioning the bony segments without the use of the surgical splints. Finally, the outcome evaluation was completed by comparing planned outcomes with postoperative outcomes. All operations were successfully completed using the POSG system. The largest root-mean-square deviations were 0.74 mm and 1.93° for the maxillary dental arch, 1.10 mm and 2.82° for the mandibular arch, 0.83 mm and 2.59° for the mandibular body, and 0.98 mm and 2.45° for the proximal segments. The results of the study indicated that our POSG system is capable of accurately and effectively transferring the surgical plan without the use of surgical splint. A significant advantage is that the repositioning of the bony segments is independent to the mandibular autorotation, thus eliminates the potential problems associated with the surgical splint.
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                Author and article information

                Contributors
                giovanni.badiali@unibo.it
                mirko.bevini@studio.unibo.it
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                7 August 2020
                7 August 2020
                2020
                : 10
                : 13317
                Affiliations
                [1 ]GRID grid.412311.4, Azienda Ospedaliero-Universitaria di Bologna, ; Via Massarenti 9, Bologna, Italy
                [2 ]GRID grid.6292.f, ISNI 0000 0004 1757 1758, Department of Biomedical and Neuromotor Sciences, , University of Bologna, ; Bologna, Italy
                [3 ]GRID grid.8158.4, ISNI 0000 0004 1757 1969, Department of General Surgery and Medical-Surgical Specialties, , University of Catania, ; Catania, Italy
                Article
                70107
                10.1038/s41598-020-70107-w
                7415134
                32770002
                5c15470d-8fc6-42ba-8414-ac6d17037147
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 6 February 2020
                : 25 June 2020
                Categories
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                Custom metadata
                © The Author(s) 2020

                Uncategorized
                maxillofacial surgery,oral surgery,malocclusion,three-dimensional imaging,bone imaging,fracture repair,biomedical engineering

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