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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (1): 74-80. doi: 10.19723/j.issn.1671-167X.2024.01.012

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Comparison of the virtual surgical planning position of maxilla and condyle with the postoperative real position in patients with mandibular protrusion

Andong CAI1,2,Xiaoxia WANG1,*(),Wenjuan ZHOU3,Zhonghao LIU2,3,*()   

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Characteristic Laboratories of Colleges and Universities in Shandong Province for Digital Stomatology, School of Stomatology, Binzhou Medical University, Yantai 264003, Shandong, China
    3. Yantai Engineering Research Center for Digital Technology of Stomatology, The affiliated Yantai Stomatological Hospital, Binzhou Medical University, Yantai 264000, Shandong, China
  • Received:2023-09-18 Online:2024-02-18 Published:2024-02-06
  • Contact: Xiaoxia WANG,Zhonghao LIU E-mail:doctorwang66@sina.com;dentlzh@163.com
  • Supported by:
    the Program for New Clinical Techniques and Therapies of Peking University School and Hospital of Stomatology(PKUSSNCT23AO2)

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Abstract:

Objective: To compare the difference between virtual surgical planning (VSP) position and postoperative real position of maxilla and condyle, and to explore the degree of intraoperative realization of VSP after orthognathic surgery. Methods: In this study, 36 patients with mandibular protrusion deformity from January 2022 to December 2022 were included. All the patients had been done bilateral sagittal split ramus osteotomy (SSRO) combined with Le Fort Ⅰ osteotomy under guidance of VSP. The VSP data (T0) and 1-week postoperative CT (T1) were collected, the 3D model of postoperative CT was established and segmented into upper and lower jaws in CCMF Plan software. At the same time, accor-ding to the morphology of palatal folds, the virtual design was registered with the postoperative model, and the unclear maxillary dentition in the postoperative model was replaced. Then the postoperative model was matched with VSP model by registration of upper skull anatomy that was not affected by the operation. The three-dimensional reference plane and coordinate system were established. Selecting anatomical landmarks and their connections of condyle and maxilla for the measurement, we compared the coordinate changes of marker points in three directions, and the angle changes between the line connecting the marker points and the reference plane to analyze the positional deviation and the angle deviation of the postoperative condyle and maxilla compared to VSP. Results: The postoperative real position of the maxilla deviates from the VSP by nearly 1 mm in the horizontal and vertical directions, and the anteroposterior deviation was about 1.5 mm. In addition, most patients had a certain degree of counterclockwise rotation of the maxilla after surgery. Most of the bilateral condyle moved forward, outward and downward (the average distance deviation was 0.15 mm, 1.54 mm, 2.19 mm, respectively), and rotated forward, outward and upward (the average degree deviation was 4.32°, 1.02°, 0.86°, respectively) compared with the VSP. Conclusion: VSP can be mostly achieved by assistance of 3D printed occlusal plates, but there are certain deviations in the postoperative real position of maxilla and condyle compared with VSP, which may be related to the rotation axis of the mandible in the VSP. It is necessary to use patient personalized condylar rotation axis for VSP, and apply condylar positioning device to further improve surgical accuracy.

Key words: Digital technology, Orthognathic surgical procedures, Angle class Ⅲ malocclusion

CLC Number: 

  • R782.2

Figure 1

Registration of virtual surgical planning and postoperative head model, and establishment of 3D reference planes T0, the virtual surgical planning data; T1, 1-week postoperative CT."

Table 1

Definitions of anatomic landmarks for 3D measurement"

Measurement landmarks T0 T1 Definition
Mesio-proximal point of maxillary central incisor U1 U1’ Mesial contact point of maxillary central incisor
Mesial buccal tip of left maxillary first molar U6L U6L’ Mesial buccal tip of left maxillary first molar
Mesial buccal tip of right maxillary first molar U6R U6R’ Mesial buccal tip of right maxillary first molar
Lateral pole of condyle A A’ Lateral most prominent point of condyle
Medial pole of condyle B B’ Medial most prominent point of condyle
Condylar center point D D’ The midpoint of the line between the inner and outer poles of the condyle
Sigmoid notch point C C’ The lowest point of sigmoid notch
Condylar neck point E E’ The concave point of the neck of the condyle
Apex of condyle S S’ The superior pole of condyle

Figure 2

Measurement method for maxillary distance deviation a, measurement of anterior-posterior deviation of maxillary; b, measurement of horizontal deviation of maxillary; c, measurement of vertical deviation of maxillary. The notes for the letters in the figure are shown in Table 1."

Figure 3

Measurement method for condylar distance and angular deviation a, measurement of anterior-posterior deviation of condylar; b, measurement of inward and outward deviation of condylar; c, measurement of vertical deviation of condylar. The notes for the letters in the figure are shown in Table 1. α, the anteroposterior angular deviation of the condyle; β, the angular deviation of the condyle from inside to outside; θ, the vertical deviation of the condyle."

Table 2

Measurement difference between virtual surgical planning and postoperative real position of maxilla"

Items X Y Z
Left side deviation Right side deviation Upward deviation Downward deviation Anterior deviation Posterior deviation
U1/mm 1.18±1.24
(0.75, 1.61)		 -1.24±1.15
(-1.74, -0.75)		 1.27±1.10
(0.75, 1.80)		 -1.08±0.88
(-1.50, -0.66)		 1.75±1.39
(1.08, 2.42)		 -1.56±1.12
(-2.12, -1.00)
U6R/mm 1.16±1.32
(0.40, 1.93)		 -0.99±0.97
(-1.38, -0.59)		 0.94±0.81
(0.51, 1.37)		 -1.05±0.94
(-1.48, -0.63)		 1.15±1.06
(0.68, 1.62)		 -1.37±1.24
(-2.03, -0.71)
U6L/mm 1.06±0.88
(0.49, 1.62)		 -1.41±1.96
(-2.22, -0.60)		 0.53±0.51
(0.19, 0.87)		 -0.66±0.63
(-0.92, -0.39)		 1.55±1.08
(1.10, 2.01)		 -1.97±1.58
(-2.88, -1.06)
Overall deviation/mm 1.19±1.34
(0.94, 1.44)		 0.96±0.92
(0.69, 1.23)		 -0.93±0.82
(-1.14, -0.72)		 1.53±1.23
(1.31, 1.76)

Table 3

Measurement difference between virtual surgical planning and postoperative real position of condyle"

Items ΔD/mm ΔB/mm ΔS/mm α/(°) β/(°) θ/(°)
Left condyle 0.08±1.33
(-0.37, 0.54)		 2.16±1.49
(1.65, 2.67)		 -1.29±1.56
(-1.82, -0.75)		 4.35±2.80
(3.39, 5.32)		 1.29±2.15
(0.56, 2.03)		 -1.09±3.12
(-2.17, -0.20)
Right condyle 0.21±0.91
(-0.09, 0.52)		 -2.16±1.49
(-2.65, -1.67)		 -1.80±1.44
(-2.29, -1.32)		 4.29±2.32
(3.51, 5.08)		 0.85±2.23
(0.09, 1.62)		 -0.62±3.57
(-1.83, 0.59)
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